improving medical education - education methods (27)

There are -I believe- endless list of ways to learn.

The success of teaching / learning is a difficult thing to measure, but something that can be influenced by many things, such as the planning, its implementation, its relevance to the social and community contexts, proficiency of lecturer, student engagement etc.

in this post, I attempt to highlight the age-old lecture method of education, and its strength and weaknesses.

strength and weaknesses of lecture-based education

Strengths

• it is expected - most, if not all students are familiar with lectures. It is not a difficult skill to be able to listen, and learn. Hence it is probably an education tool that can be utilized with the least amount of resistance both from students or lecturers.
• it can provide for the largest volume of students per time - possibly with the exception of e-learning modes of education, lecture-based education has a very large amount of cost-and-time effectiveness, if effectiveness can be measured by just delivery of study material
• the content is less likely affected by environment factors - most lecture theater as a roof, walls, and doors. It is less likely cancelled due to heavy rain, or blackouts (lecturers can still present in darkness)
• easily carried out - most medical schools have lecture halls. therefore it needs no additional cost, or additional staffing. furthermore, no additional equipments need to be purchased in order for lecture to be carried out. Other learning methods, for e.g. small group learning, needs a new set of facilities, like group discussion rooms and table / chairs. 

Weaknesses

• limited by time - lecturers can only present a set amount of content in the stipulated time frame. Hence the volume of content is limited by the time with which the lecturer is available to conduct the lecture
• It usually only transcend the lowest of the Miller's pyramid of competency, skill and knowledge. - it is difficult to communicate skills and competency through a lecture without demonstrations or role-plays. Usually, lectures only impart knowledge. 
• largely Lecturer-dependent - some good lecturers manage to engage students, even inspire them to learning more on their own. however, the worst of the lecturers are (for the lack of bette word) a waste of time. 
• probably the least engaging of the many modes of education - most students have spent years just listening to lectures. While they are most familiar with this, students will never be as engaged as PBLs, group discussions, or game-based education. Students frequently sleep during lectures, which reduces the learning efficacy to near zero. It won't be as easy to sleep during small group discussions. 

methods for student assessment and tutor evaluation

it is important to assess student learning achievements and tutor efficiency. 

in a way, assessment for students is an assessment of tutor efficiency since unless the curriculum is largely dependent upon student self-regulation and peer motivation, the role of tutor is paramount to successful learning. 

methods of student assessment is varied and extensively researched. it includes;

• Traditional MCQ style questions - in which they could be used in a traditional way, but evaluated more extensively in finding out which portion of knowledge may be deficient, where the curriculum needs to put in more effort etc. (Item analysis).  a slightly better alternative is the EMQ (Extended Matching Questions) where there are more choice options, and less space for guessing. 
• MEQ (Modified Essay Questions) which is a deciphering exercise of patient case scenario and a test on clinical diagnosis and decision making. this can be conducted to test the second level of the Miller's pyramid, the "Knows how.
• OSCE (Objective Structured Clinical Examination) consisting of a clinical scenarios and SP (Standardized Patients) to emulate an authentic clinical setting. Students can be assessed on the "shows how" component of the Miller's pyramid of skills and competencies. 
• Mini-CEX (Clinical Evaluation Exercise) which is a supervised learning Event which involves direct observation of a doctor-patient encounter by a trained tutor for formative assessment purposes. this examines the "shows how" and partially, "Does" portion of the Miller's pyramid. 
• Portfolio assessment  which can be outlined by Collection, Reflection, Evaluation (by assessors) Defence (of evidence by the student) and assessment and feedback. the "Evidence" collected should be the evidence of the students' clinical encounters and the thought processes, and decisions made by the students. the Reflection portion of the Portfolio included, it can be used to assess whether the student possesses the qualities to become a reflective practitioner that can continuously reflect on their own actions. This assessment method is thought to test the topmost "Does" component of the Miller's pyramid. 

the tutor assessment is a difficult one to discuss, as these aren't as throughly discussed as student assessments. however some attempts can be made by;

• student assessments - as mentioned above, the student performance indirectly reflected by the tutor excellence. 
• student satisfaction survey - although it may be biased, and students may not recognize a good tutor, a satisfaction survey and objective questions like "is the lecture well understood?", "does the lecturer try to engage students?", "does s/he make use of multimedia learning tools?" can be used to assess tutor strengths and weaknesses. 
• peer evaluation - in the form of commentary. It may be useful for tutors to assess each other, giving frank opinions in order to improve each other
• self-assessment and evaluation - tutors are expected to be reflective practitioner themselves. However sessions for reflection may help facilitate this process of self assessment, reflection, and improvement.