When should lectures be compulsory?

"Lectures were once useful; but now, when all can read and books are so numerous, lectures are unnecessary" Samuel Johnson, c. 1780
“Lectures were once useful; but now, when all can read and books are so numerous, lectures are unnecessary” Samuel Johnson, c. 1780

We’re revisiting the debate about compulsory lectures in our medical school.  Attendance was poor at a series of lectures on important themes that mostly aren’t formally taught elsewhere in the curriculum.

Our University regulations don’t make lectures compulsory, but in the Medical School we say that attendance is compulsory at tutorials, PBL, practicals, and clinically-based experiences.  The reason for compulsion is usually stated as something to do with these being essential experiential events, or specifically about group working skills, and the learning from these can’t be got in any other way.  Group activities may also include an element of assessment around contribution.

"No discipline is ever requisite to force attendance upon lectures which are really worth the attending."  Adam Smith, 1776
“No discipline is ever requisite to force attendance upon lectures which are really worth the attending.” Adam Smith, 1776

Local feelings vary widely.  Some lecturers are outraged when attendance at their lecture is poor, others just disappointed, yet others thrilled to have a smaller, more engaged audience.  Some clinical modules state that attendance is compulsory; some even document it.  But in the medical curriculum’s early years, as across the university in general, attendance at lectures is not compulsory.

Some ask that if the learning objectives can be achieved in other ways, why should lectures be compulsory?  We’re dealing with adult learners who are learning to prioritise.  Others argue that ability to show up to scheduled events is an important professional attribute.

As we get more creative and interactive in our ‘large group teaching’, some of these events may be harder to replace with books. Does using particular teaching approaches blur the issue?

What do you think justifies making attendance at a teaching event compulsory? What else might we do to make lectures ‘unmissable’ to students without compulsion?  Suggestions below please – click on comments just below this, or use the box at the foot of the comments.

10 Comments

  1. R.knight@ed.ac.uk

    Lectures are not the only educational resource. If they are good, people attend. If not, then they won’t. These are adults in medical education and should decide themselves. If they can pass all their assessments despite nonattendance, then either lectures are not essential or the assessments are defective or the candidates can manage without. If attendance compulsory- how is it measured efficiently if the audience is 200+ and maybe they attend and leave after 5 minutes or attend and sleep.

  2. Jamie Davies

    I have no strong feelings for the majority of students, but I do think we should be consistent rather than ambush students with complaints about professionalism when they were not told that attendance was compulsory. If we do make lectures compulsory, it should be for a good educational reason (not the lecturer’s wish to see a full room) and anyone with a genuine learning profile that says that other methods of learning would be better should be exempt. I have always felt that the best way to ensure a full room was to put a lot of effort into giving good lectures. Jamie.

  3. Allan Cumming

    We need a more evolved syntax for “lectures”. Has relevance for the attendance issue and also for some of the disability adjustments. “Knowledge transfer session” might be the default for a traditional lecture, with “interactive case-based learning”, “flipped learning session”, “situational judgement session” and so on used for other things. You could argue for getting rid of “KTS” altogether, but in the meantime others should be defined as compulsory, at least to the extent that attendance records are kept, which is probably enough.

    • Neil Turner

      Calling them non-compulsory knowledge transfer sessions might indeed kill lectures … but importantly, you’re suggesting that some of these more interactive elements should be compulsory. How would we decide which?

  4. Jeni Harden

    This is a question I have been thinking about for many years, but most recently in relation to Health, Ethics and Society in year 1. The students have many learning events to attend, and ‘lectures’ in the format of whole class teaching is only one. So the first question is ‘on what grounds do we differentiate between these learning events, in relation to attendance, and why?’ I thnk that inevitably leads onto a much bigger question, ‘what is the purpose of a lecture?’ As a student, I was selective in lecture attendance – if I could get the information from a textbook, ie the lecturer was simply reproducing readily accessible information, then I chose not to attend. For lectures that went beyond that, even those still maintaining a fairly didactic format, I would attend, as they had a learning value for me. In HES, I have told the students that the lectures are there to save them time – we do not use a textbook and there is no single source that they can access to cover the material addressed in the lecture. The lecture is therefore a sythesis of key ideas and evidence across a particular topics, that they can use as a stand alone starting point for the topis. To acquire this knowledge themsevles would be very time consuming. However I have questioned whether this could be presented to them in other ways – online or in lecture note format – and so ‘what added value does being there in the lecture present?’. Speaking to the students, they did not seem keen on the idea of dropping lectures in favour of other formats, and this may relate to their stage of learning. In year 1 they have many challenges, adjusting to the demands of learning in HE and lectures are a more familiar context for them to be in. I’ll stop the ramble there!
    Key questions – what’s different about lectures; what should lectures be? How significant is the stage of learning?

  5. Students come to university not just to worship what is known but to challenge it. And if that includes a certain sense of irreverence for their teachers all the better. Certainly, we should expect a certain sense of symmetry between staff and students: if students are to be censured for a certain behaviour, then it is up to staff to produce robust evidence to support why this behaviour is wrong. (Otherwise the staff should get PPD concerns raised too!). For instance, a paper last year in Med Ed tried to incriminate lack of attendance at lectures with an inability to turn up for work— but without any empirical evidence. I find this a little sinister. Professionalism has to be subservient to evidence, not vice versa.
    I never went to lectures beyond year 2 at medical school (year 5 was lecture free anyway, whereas for years 3 and 4 lectures were four afternoons a week). I had struggled in the first two years, and during my first clinical attachment in year 3, a paediatrician, Nigel Speight, picking up on my sense of failure, and suggested to me that I might be better using the library instead. I did, and I owe him a great debt of gratitude. Of course, lots like attending lectures. That is fine too, but compulsion seems misplaced.

    Richard and Jamie I think get it right. The argument has to be based on evidence and faith in our assessment methods, and whether we can produce evidence about the efficacy of our lectures. The problem, however, is that I do not think lectures are a natural kind. Most of us have been spellbound by lecturers like AJP Taylor (no notes, talk to the camera), Jacob Bronowski, Richard Feynman or, in more recent times, Michael Sandel (iTunes University if you want to watch). But most of our lectures, and lecturers, are not like that. Think of year four, prior to the SSC and senses module, where around 30 or more lectures are delivered within 5 days. We know from our own research that students do not consolidate the material and for these sort of events, I think Carl Wieman — the Nobel Laureate in physics who has been trying to improve US STEM higher education— has got it right: most lectures perform badly in terms of promoting learning.
    Many believe that the key feature in determining learning is intellectual challenge as you focus on the material. This seems intuitively attractive. Remember Herb Simon’s mantra: “Learning results from what the student does and thinks and only from what the student does and thinks. The teacher can advance learning only by influencing what the student does to learn.”
    In a paper in Science 2 years back, Carl Wieman showed how you could achieve this, even with less well trained staff, for a large audience. The issue is of course, to what extent this model is transferable to medicine. Asking whether lectures ‘work’ is a bit like asking whether ‘drugs work’. Yes, if you give the right dose for the right indication following an accurate diagnosis etc. To develop this type of lecture, we would, I think, have to drastically reduce the numbers of lectures. Such a transition needs to proceed slowly, and with proper measures of learning (and not just ‘feedback / course evaluation’ please).

    But Neil, the debate is more than timely, and thanks for posting. Even without the MOOC hyperbole, any forward looking institution has to ask what value it is providing to students — student debt is, as we are reminded, larger than credit card debt in the US. And once you say that a core component is sitting in conventional lectures, why would students pay for that, when you can increasingly obtain the same online for free. If you lecture to 300, why not 30,000 with a commensurate drop in unit cost. Why does each medical school need to provide the same basic lectures? Why not see which are best, and buy those in? Institutions are likely to oppose unbundling and disintermediation, but then that is what the Web allows.

    Value for the student now will have to come from something else. In clinical medicine we have always been able to dodge this issue by saying it is about bedside teaching. But we all know there are real constraints there too (not least in England as units that have previously taught students have now been outsourced to Circle or ISTCs (so the clinical material has moved, but the students haven’t). Perhaps somebody can correct me, but in England medical school fees are going to cost over 50K over the lifetime for a consultant (the additional 9% tax over 30K etc and knowing that you are paying for the 50% of the graduates who will not pay back their loan). Interesting times.

    I have also posted this over at http://www.reestheskin.me with links to citations.

  6. Valerie Luyckx

    interesting discussion…personally i don’t understand why one form of teaching is universally ‘better’ than another. the argument is always people have their own learning styles, but then make everything optional…what happens in practice is lectures of well known good lecturers are well attended, less good are not well attended…and unknown lecturers maybe in between…as a lecturer, one takes time to prepare, i think the students should also learn that respect is important…and there is always a chance of learning something in a lecture…which is why they are there???

  7. Alice Gerth

    I thought that it would be helpful to provide a student perspective to this discussion. I have now spent 5 years studying at university and during that time have attended 100s of hours of lectures, I also have had the opportunity to lecture myself and so have an understanding (all be it small) of the time and effort that goes into preparing a lecture.

    Lectures can be seen in one of two ways. Firstly as a forum for passing on knowledge and understanding alongside textbooks, papers, youtube videos, MCQ books etc. if this is all that they are then I do not believe that they should be compulsory, some students do not learn well in this environment. From personal experience regardless of the level of sleep I have had the night before I really struggle to focus for a full 50 minute lecture. I learn better in an interactive setting or from textbooks where I am in control of my learning environment. If students choose not to attend this should be seen as no different from students choosing to read one text book over another – it is not a personal snub to the lecturer but a reflection of their individual learning style. I acknowledge that not all students skip lectures for such a well thought through reason but ultimately if they are attaining the knowledge to pass exams does this matter?

    I acknowledge that ultimately we cannot know if a lecture is useful unless we attend. Many of our opinions on lectures come from the years above and so to increase attendance the reputation of certain lectures will need to be rebuilt, the old saying of ‘it takes 20 years to build a reputation and five minutes to ruin it. If you think about that, you’ll do things differently’ comes to mind. I also appreciate that it is frustrating to have spent hours preparing a lecture to only have a proportion of the year attend but I believe that our motivation for lecturing should be to teach not just to be heard by the masses and so if those who attend learn, our lecture has been a success.

    Interestingly throughout the years there are some lectures that are always well attended – one that comes to mind are Dr Stewart’s immunology lectures in year 1. All that he used was an over head projector, fine liners and hand outs requiring annotation. This goes to show that lectures do not need to be full of clever tricks to be well attended and useful but instead provide something that the students desire – in this case a clear explanation of immunology, a topic that daunts most 1st years and is often poorly explained in the textbooks.

    The other view that can be taken of lectures is that they provide more than facts found in a textbook or online. If this is the case then there is grounds for them being compulsory. For instance if an external speaker is brought in to talk about a personal experience this direct, physical interaction cannot be obtained by reading an account of it in a textbook; or if an interactive session with an ethics based discussion is set up, the ability to respectively listen and convey ones own opinion cannot be learned in a textbook. Many of these situations are better suited to a smaller tutorial session; however, given resource limitations an obligatory lecture may need to be the compromise. The other area where one could justify lectures being compulsory is if what is being conveyed is difficult to assess in an exam format and so attendance is required to show that you have explored these concepts, for instance a session on patient safety – vitally important for our future as doctors but difficult to assess.

    In summary, most medical students are very conscientious and have worked hard to get into medical school. There needs to be an element of trust that we are acquiring the necessary knowledge to be doctors and exams provide a way for the medical school and GMC to assess if we are doing this effectively. There are components of being a ‘good doctor’ that cannot be assessed through MCQs these should picked up in OSCEs, on the wards and in tutor assessments. There is a final area where assessment is particularly difficult and these justify ensuring that all students have at least been present when the teaching has occurred. Students want to be ‘good doctors’ and if lectures help us to be that we will, in general, attend; if we do not find them helpful then we are likely to hit the books instead. If we want lectures to be the primary form of learning used by medical students they need to go beyond the information given in textbooks or available online.

  8. David Swann

    Those guys in the powdered wigs understood a lot.

    I’d broadly agree with the view that lectures are inefficient ways of learning. I don’t mind if students would prefer to read (or send) texts.

    However, there may be some added value to coming to a lecture. Lectures can help students understand the clinical relevance of knowledge. Using case scenarios is an easy way of doing so. I also like the idea of providing the lecture on-line, then using the session for problem-solving and answering questions. Would students and lecturers be prepared to spend more time doing this? Is it really easy, or effective to ‘interact’ with 200 students?

    Lectures should not be made compulsory. We must respect the choices young adults make, relieved when many turn up, and pleased with any applause the students give us.

    If too few attend, it’s because the students have made an informed choice (not only Marvin heard it through the grapevine). It’s then up to the lecturer to improve his, or her, behaviour.

    Attendance at clinical teaching sessions should be the norm – that’s more of a professional matter.

  9. Neil Turner

    Here are some criteria from the University of Arizona’s Preclinical years (Prof Paul Standley):
    1. guest lecture from out of town
    2. patient involvement
    3. team-based activities such as case based instruction, team learning, etc.
    4. ethics sessions
    I’m not sure what ‘ethics sessions’ are that distinguishes them but must presume they aren’t straight delivery-of-content sessions (that you could just as well read, perhaps).

    “We typically achieve 40-80% attendance at non-mandatory lectures across the first year, with some loss in second year. Attendance appears highest when our best educators present the session. Attendance lowest around examination dates and holidays as one might expect.
    Our philosophy is similar to what others have mentioned: students are adult learners and may choose how they acquire the knowledge base for non-mandatory sessions. Additionally, if we really want them to attend, build a better session. They will come if they find value.”

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