Cutting class

As medical education evolves, Deola Adesanya wonders if traditional teaching styles are obsolete

A freshman once asked me if it was really necessary to attend lectures at medical school. He did not mince words: "Can lectures be totally chopped (slashed)?" My reply was a straight, almost thoughtless, no. But when he asked further if I could estimate what percentage of my cumulative academic knowledge could be ascribed to the lectures I attended, the reply didn't come as fast. I discovered to my chagrin that I was merely part of an old, wayfaring generation.

Traditionally, the medical school programme is strictly structured to allow little chance for truancy. But recently it is becoming clear that attending classes is no longer a priority. It isn't that my junior colleague is averse to learning; it's the teaching part he has problems with. He's bought the recommended textbooks; now he'd like to copy a classmate or senior's notes as somebody is always willing to go to class to write them. I soon found out that his opinion and attitude were representative of a generation of risk takers that have always existed but are fast becoming a majority.

Patience is no longer a virtue

Anyone can see the reasoning. The teaching of basic preclinical courses in Nigeria is not dynamic, and my junior colleagues know that. The old set would call them lazy, but they are simply being smart. These students have eschewed the archaic system of teaching and are impatient. Patience is no longer a virtue. They have zero tolerance for snail paced change, and the internet plays a far more exciting part for them than any old man with bushy white whiskers in fraying braces will ever do.

The information technology age has a bigger influence on these colleagues as new facts can easily be obtained faster with just a click of the mouse. The entire course of human anatomy^{w1 w2 w3} could be studied with plastic models, three dimensional visualisations, and simulations,^w4 or even downloaded on to CDs or pen drives, without once stepping into the dissecting room, thereby eliminating the discomfort of learning environments without air conditioning and the risk of diseases. For example, neuroanatomy,^{w5 w6} which is abstract enough by itself, is studied without the distraction of other body parts. Is it any wonder that they see going to classes as time wasting at best and uninspiring and foolish at worst?

In Europe some students get along by attending only the problem based learning sessions and still manage to get through to year 4. Research is supposed to be a part of the learning process in universities, and it is done faster these days. There is little need to go through stacks of dusty old books, theses, journals, and so on in libraries. New discoveries in medicine are made daily, and the newer they are the faster they are downloaded into their hot little hands or on to their hard drive. Information is obtained even faster than their lecturers can get their hands on it to revise their notes.

The virtual world is real enough,^w2 and the benefits are limitless. Since students have to do much of their research by themselves, they bypass lectures altogether, thereby eliminating the supposed middleman. And of course, they can have some fun chatting with friends while working. They have taken their learning into their own hands-it is not all about laziness.

Choosing how to learn

You might say that students are missing out on the time acquired experience of their professors, but this may be a small sacrifice. You may even argue that what students know is virtual, too slick, or a finished product, but because learning secondhand from Web 2.0 can be combined with time spent doing other things, this itself is considered an advantage.

How do they get away with it? How are practical sessions managed? Two and a half years ago I was in their shoes in those classes, and attendance was a matter of importance to the small groups we were divided into. Then, no matter how bad the dissecting rooms were, how nauseous the cadavers preserved with formaldehyde smelt, and how generally uninspiring the conditions seemed, we maintained an admirable quorum on our stipulated days. This record can't be boasted of again.

Harried lecturers come to class, usually late, to read out notes from old yellowing papers-perhaps from their own undergraduate days-for students to copy down verbatim. No mind play, no explanations, and scarcely enough time for questions in the hurried one or two hour period allocated. Perhaps the university system can be faulted here for recruiting lecturers who automatically qualify to teach just by having the fellowship of a specialty college, which was originally meant for clinical work.

So my junior colleagues have gone one step ahead by steadfastly refusing to sit in overpopulated classrooms under overworked fans on drowsy afternoons. Rather than wasting time and energy on protests and boycotts like the rest of the school, clamouring for change in these uninspiring conditions that would take aeons; they swot up in the relative comfort of their own rooms.

Maybe it is just about knowing one's options: enjoying alternatives to information acquisition and the choice to select the form most suitable and convenient for one's apprenticeship, thereby opting out of drudgery. Learning becomes self styled, individualised, and, most of all, fun.

In hospital, at clinics, and during presentations and rounds, there seem to be no differences between class attendees and note copiers, or between the old school and the new breed. And things that don't really need doing or that are normally done in leisure hours-surfing the net, playing on a PlayStation 2, and coordinating manicures with wardrobes-are now included as primary pursuits. Boring old routines are unrepentantly swept aside. Results are often excellent, too. Therefore the norm becomes a myth-you do not have to go to class to pass.

What lies ahead?

Naturally, experiences differ. In other medical institutions the approach to managing programmes varies. Even here in my school the academic staff differ in their teaching methods. But generally they all have lecturing as the backbone of tutelage. These days the face of medicine has changed, gradually mutating from old trial and error methods to evidence based medicine proved by skilled research and highly specialised equipment. What has become evident is that the art of studying, no matter the discipline or course, has subtly, infinitesimally, evolved another step.

This trend has not gone far enough to be seen in my medical school's graduating class, and therefore I cannot predict the future of solely self styled learning as yet. But one thing is sure: I can safely speculate that bedside manners, if nothing else, might improve because outside experiences invariably play a part in social interactions. The more expansive a doctor's range of interests outside medicine, the more likely he or she is to form better doctor-patient relationships. Empathy would become easier, even to fake.

In all, my advice to read books and go for classes with minimal extracurricular pursuits may not be so relevant to the new generation of medical students. Is this trend being seen anywhere else? I confess to feeling a twinge of regret for things that will pass, as we who were instructed the old way will go. But what will follow in our stead?

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

1. Robert D Acland. Acland’s Video Atlas of Human Anatomy: The Upper Extremity: Tape 1[Video]. Lippincott Williams & Wilkins. Available at http://www.lww.com and http://www.amazon.com/gp/gss/media/books.html. Accessed June 21, 2007.
2. The International Virtual Medical School (IVIMEDS). Available at: http://www.ivimeds.org/index.html. Accessed February 2, 2007.
3. Anatomy: A select bibliography of Medical Library Multimedia/Audiovisual titles. Available at: http://www.lib.nus.edu.sg/mlb/index.html. Accessed July 4, 2007.
4. The Visible Human Project ATLAS of Functional Human Anatomy, version 1.0 The Head and Neck. Available at: http://www.nlm.nih.gov/research/visible/products.html. Accessed July 7, 2007.
5. Harvard Whole Brain Atlas. Available at: http://www.med.harvard.edu/AANLIB/home.html. Accessed July 7, 2007.
6. The Midbrain and Hindbrain: The Anatomy Project Series. CD-ROM #3. Parthenon Publishing Group; 1997. Available at: http://www.anatomy-interactive.org/info/info01.htm. Accessed June

       

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