This is the first draft of an article that was eventually published in the Clinical Teacher mobile app.
“The successful teacher is no longer on a height, pumping knowledge at high pressures into passive receptacles. He is a senior student anxious to help his juniors” (William Osler, 1849-1919)
In medical education, the word “lecture” is fast becoming a term of derision. Advances in our understanding of how people learn have demonstrated that passive approaches to teaching and learning is ineffective in developing advanced cognitive skills. However, traditional lectures where students are expected to sit and listen are still one of the most common methods of teaching in health sciences education (Graffam, 2007; Sandhu et al., 2012). When interactive lectures are used instead of didactic lectures, we know that student satisfaction, learning outcomes, and knowledge retention is better. However, rather than suggest that the lecture is dead, as many would have you believe, this article presents a range of methods that clinical teachers can use to enhance lectures by making them more interactive.
What is a lecture?
“…a great lecture is not a rote mechanical reading of notes, but a kind of dance, in which lecturer and listeners watch, respond to, and draw energy and inspiration from each other. One of the greatest pleasures of lecturing occurs when learners pose insightful questions that the lecturer did not — perhaps even could not — foresee..” (Gunderman, 2013)
A good lecture tells a story, as simple as that. It poses problems that are eventually resolved, and it keeps learners in suspense, waiting to see how the problem can be worked out. Great lecturers find ways to share the responsibility for solving these problems with learners, working with them to find a solution. In these kinds of classrooms, students are not merely sitting and listening. Instead, they are challenged and engaged, actively thinking and imagining along with the lecturer as both struggle toward new insights (Gunderman, 2013).
Lectures are often thought of as a mechanism for sharing facts, rather than for sharing personal experiences and insights. When thought of in this way, a lecture can be used to give a human face to a topic, or to paint a bigger picture for a course. They can stimulate interest, explain concepts, provide core knowledge and direct learning (Cantillon, 2003). Outlines of lectures can provide a structure where they can be seen in the context of the whole programme, with concepts shown in relation to each other. In this respect, it is clear that the purpose of a lecture need not be primarily to transmit information, since other techniques like assigning a reading or distributing an electronic copy of the notes, can be equally effective. Lectures should therefore not be used simply as a method of spoon feeding students with predigested facts (Harden & Dent, 2005).
“The real purpose of a lecture is to show the mind and heart of the lecturer at work, and to engage the minds and hearts of learners” (Gunderman, 2013)
It is important to note that lectures in themselves are not bad but that they, like any teaching method, can be used badly. A good lecturer tells a story that inspires and motivates students, so we should use caution when speaking poorly of lectures. When the lecture fails as a teaching medium, it is often the lecturer who is at fault.
Content vs Learning
One of the key challenges faced by lecturers is the tension between covering a range of discipline-specific content and ensuring that deep and meaningful learning happens. This tension is often exacerbated by the limited time in the curriculum allocated to each section of work. The movement of facts from lecturer to the class is pretty much how most people think of learning. However, knowing what to do with facts should rightfully be the centre of the learning process. That doesn’t mean that we shouldn’t stand in front of students and speak, but that our “speech should be to evangelise, to inspire, and to demonstrate”, rather than simply being a mechanism to impart knowledge (Chester, 2013).
“A great lecture is not a rote mechanical reading of notes, but a kind of dance, in which lecturer and listeners watch, respond to, and draw energy and inspiration from each other.” (Gunderman, 2013)
One of the enormous challenges with lectures is the attempt to incorporate students into the process, as part of an interactive exchange. The problem is that one-way lectures are difficult to make interactive because students are generally presented with answers rather than having to find answers for themselves (Dalsgaard & Godsk, 2007). However, a problem-based approach to teaching and learning that is supported by social constructivist principles (Vygotsky, 1978) is not feasible with a lecture. It requires a different approach to learning than what is available in the traditional lecture format, which is why lectures should not be thought of as an effective means of developing skills, higher order thinking, or changing attitudes (Cantillon, 2003). It is therefore worthwhile to consider that multiple teaching approaches have value, and that no single method can be used to cover the range of learning that much happen during clinical education.
“In the world of Google, facts can be accessed quickly and efficiently at any time, from any place, and with any device – so rote mastery of facts is no longer the core of learning” (Chester, 2013)
Types of lecture
Before you begin creating a lecture, it is useful to spend some time thinking about what kind of lecture you’re going to present. Or, to put it another way, what is the overall objective of the lecture? What will it be used for, in the context of the programme? Consider the following different types of lecture (Dent & Harden, 2005):
- Overview – an overview of the module as an introduction to establish the context, before beginning with other teaching and learning methods.
- Core – a series of lectures that presents the major concepts of a module.
- Non-core – using lectures occasionally to elaborate on complex ideas, or to present aspects of the topic that are peripheral to the core curriculum.
- Assessment material – demonstration of worked examples of assessment methods in the module.
- Patient presentations – using a lecture to “walk students through” a case study, which can be more interactive than the one-way transmission of facts
- Shared lectures – when several lecturers provide multiple points of view or perspectives on the same topic e.g. a physician and nurse provide different approaches to the management of the same patient (see also “Team teaching”).
Structuring a lecture
Most lectures are able to follow the simple outline of a beginning, a middle and an end. “Tell them what you are going to tell them, tell them, then tell them what you told them.”
The introduction to the lecture is used to attract the attention of the students and set the mood for the session. One was to “captivate” students from the start is to use an exciting or controversial proposition, question or statement (Sandhu et al., 2012). It can be used to inspire them to concentrate, or to establish pre-existing knowledge. During this early part of the session, make sure you establish context by explaining how this lecture fits into the broader picture. Identify the usefulness of the content, identifying it’s perceived value for the students and thereby giving them a sense of place and direction (Cantillon, 2003). The Introduction should also be used to set the aims and objectives for the lecture. If the lecture is part of a series, it is always useful to use the Introduction to briefly review what was presented during the previous lecture. If this is the first lecture with a new group, this would be a good time to go over the “ground rules” e.g turning off cell phones, late arrivals, questioning periods, etc.
The main part of the lecture can be structured in a variety of ways:
- Sections: Lecture is divided into sections, which is easy to plan and for students to make notes, but can be perceived as boring. This approach may be more useful for topics that are naturally categorised in hierarchies e.g. health or body systems, or classifications of injuries or disease.
- Problems: State a problem and then produce arguments and counterarguments for solutions to the problem. This approach can help students develop critical thinking around clinical problems.
- Sequence: A series of linked statements, each leading logically from one to the other, towards a conclusion. This approach could be used to take students through a patient examination process.
In order to prevent students’ minds from wandering, the Body of the lecture should be broken up into shorter sections, either by alternating the presentation format or by having students engage in relevant activities (Sandhu et al., 2012). After presenting the content, lecturers can have students work individually, in pairs or in small groups. You could even ask them to present short summaries of the key points of the lecture, during the end of the session.
The lecture should finish with a review of the objectives and key points that were covered. The lecturer might highlight ways in which students could extend the lecture by presenting routes for self-study and further independent learning. The Conclusion should avoid the introduction of new ideas.
Keep the time that students are sitting passively to a minimum. Thirty to forty minutes can be considered a maximum period of time without a proper break, since this is about the longest that people can concentrate. This time period can be broken up into ten or twenty minute sections, during which lecturers can have students engage in activities. For example, present them with a new idea or high-level concept (10 minutes), have them engage with the idea by discussing with a neighbour (2-5 minutes), clarify the idea with further examples (10 minutes), before finally moving on to the next idea. After that, give the students a 5-10 minute break before continuing.
The lecturer as a performer
“There are good lectures and bad lectures, just as there are good lecturers and bad lecturers. Rather than disposing entirely of the lecture as a means of learning, we should attempt to understand better the features that distinguish effective, engaging lectures from those that leave learners limp. Good lecturing is an art, and like other arts such as painting, musicianship, and writing, it takes real dedication and many hours of practice to excel at. Some may be more gifted at lecturing than others, but through study and practice, nearly everyone can improve” (Gunderman, 2013).
While it can be useful to think of the lecturer as a performer, they are not entertainers. The lecturer should aim to inspire and captivate students, but not to entertain them. There are a range of verbal and nonverbal skills that can be employed to keep the students captivated and engaged. These include using direct eye contact, changes in body language, gesturing, changing volume and tone for emphasis and exaggeration, projecting a sense of enthusiasm and excitement, and having a sense of humour (Sandhu et al., 2012). Digressions in the form of a personal story or contemporary reference can alter the tone and style of the lecture and can recapture flagging student attention. Students are almost always excited to hear about clinical experiences, especially those that demonstrate that the lecturer is human and fallible.
Maintain eye contact with students, moving your attention around the room. Focus on individuals when making a relevant point, as if you are speaking directly to that person. While this is a good way of maintaining a connection with them, avoid focusing on the same person too often, as this may make them feel targeted. Speak clearly and fluently. You may need to practice enunciating your words if you’re not comfortable speaking to groups. Make sure that you adjust your pace of delivery if you expect students to take notes, and adjust your tone of voice to avoid a monotonous session. Whether you prefer to lecture while seated, standing still or walking around the room, make sure that wherever you are, you are visible and audible to everyone in the room.
The last lecture is a good example of the lecturer as a performer.
It is worth noting that the lecturer may need to change their personal perspective of their role in the classroom, moving from being a “fount of knowledge” towards becoming a more experienced peer, a guide who knows the terrain and who can help students learn how to navigate it independently. If the lecturer sees themselves as the source of the “correct” information, students will also have that perception, which gives them little incentive to actively work through the course (Dalsgaard & Godsk, 2007).
Many lecturers use slideshow presentations as a way of highlighting the major points of the session but many more use presentations in ways that end up distracting students while adding little to the lecture. For example, fancy animated transitions between slides add nothing to what students should learn, and comes across as cheap and gimmicky. In the same way, multimedia integration as part of a slideshow can add significant value to what you want students to learn but can also distract from the main point of lecture. Therefore, avoid adding images and video simply for the sake of it. Try to decide how adding different media will add to the presentation, rather than simply take attention away from the main concepts you’re trying to convey.
When developing a slideshow presentation, lecturers often focus on the bullet points that convey the facts, and pay attention to little else. But slideshow design is important. There’s nothing worse than trying to make sense of too much cramped text forced onto a single slide, or to feel like you’ve been slapped in the face by an ugly presentation. Even if you don’t believe that you can design anything good looking, then a simple black font on a white background is perfectly adequate. Better that than cheap clip art and flashing animated transitions.
For those who are a bit more adventurous and would like to learn more, Presentation Zen is a great site for learning about good design principles for presentations. Here are some example posts from the site that I enjoyed:
If you’re considering (or are already using) slideshows as part of your lectures, you should familiarise yourself with the following tools:
Using images in a slideshow
There’s nothing more boring than reading a long list of bullet points. Consider using pictures embedded in the slide that will help you to make a point more strongly, or that add the kind of detail that is difficult to illustrate with text. Presentation Zen is an amazing resource that has many examples of how images can make or break a presentation.
Always try to find high quality images, preferably from sources that use open licenses (see the section on “Copyright” later). The quality of a digital image is determined chiefly by its resolution. The higher the resolution, the better the quality of the image. However, note that as resolution increases so does the file size, which may be a problem if you need to keep your presentations small. The table below presents examples of an image at different resolutions.
Also, make sure that you maintain the correct aspect ratio when using images in your lecture slides. It’s jarring for the viewer to see images that are stretched or compressed into areas that they were not designed to fill.
Correct aspect ratio
Incorrect aspect ratio
Another common problem is when lecturers take a small image and expand it to take up more screen space. When this happens, the image on display looks pixelated. You can avoid this by using images at their actual size, rather than enlarging them. Note that you can take a large image and make it smaller with no discernable problems. The issue arises when you try to make a small image larger.
Video can be a great way to appeal to students on an emotional level, since it often brings out the human element of a story. However, if you do include a video as part of your lecture, make sure that it’s short, since passively watching a video is no different to passively watching a lecturer. If you do include video, it should go beyond simply telling the students something that you could tell them yourself. If all it does is convey more facts, then it would be better to have them learn those facts in another way. Also, after watching the video, the lecturer should set aside time for the students to engage with the ideas that were presented. If you’d like for students to watch a long video because it’s an essential aspect of the module, rather have them watch it at home, make notes, create questions, and then bring those questions to class for discussion.
It is possible to record lectures in a way that the lecture can be made available for students to watch later. The benefits of this include being able to pause, rewind and re-listen more complex sections of work. In addition, some software programmes allow a slideshow presentation (if one was used) to be synchronised and shown alongside the video of the lecturer. Recorded lectures can be made available on the university intranet along with additional resources, copies of the presentation slides, handouts, etc. for students to access after the lecture. Note however, that watching videos of lectures is not a replacement for attending lectures, especially if the lecturer has created space and time in the lecture for interaction.
A lesson plan is always useful as a guide for students to situate themselves within the context of the lecture, and can be made available to them in print or online. The can be created in advance and given to students either before the lecture to help them prepare, or afterwards as a summary.
The point of a handout is to scaffold students’ independent exploration of a topic, not to provide them with the content of the lecture. Use the handout to identify the aims and objectives of the session, to make connections to other lectures or subjects, summarise the main concepts, provide self-assessment questions for independent study and direct them to additional reading and resources.
More comprehensive handouts avoid the need for students to take extensive notes but this may also encourage them to stop concentrating during the lecture. Notes that provide less detail may encourage students to pay more attention and to engage with the topic independently, since the handouts in themselves do not provide everything that is necessary to know. For this reason, handouts should provide a scaffold for students to build a better understanding of a topic by summarising the major themes of the lecture, while at the same time avoiding exhaustive coverage. They should aim to inform self-directed learning, and should therefore include exercises and questions with reading lists (Cantillon, 2003).
Let students know if they are expected to take notes during the lecture or if the handouts will provide everything they need. Note-taking is a form of engagement during the lecture but can also help students to structure their thoughts during follow up homework. You can teach them how to effectively take notes during class, for example by using the Cornell method (see below for a guide on using this method, from the Cornell Learning Strategies Center).
While most students have had several years of experience attending lectures by the time they reach you, almost all of them view lectures as an opportunity to sit back and soak up the learning, or as one student told me, to “sit back and switch off”. It’s important for students to understand that actively engaging with the lecture will help them to derive maximum benefit from it.
One of the easiest ways to encourage interaction during a lecture is “Think. Pair. Share”. The lecturer presents an idea, then gives the students a short period of time to think about it individually, possibly giving them a question as a stimulus or asking them to write something down. Then, they pair up with the person sitting next to them and discuss the ideas and questions that each of them just came up with. Finally, some of the pairs are asked to share what they discussed with the larger group, with the lecturer providing input at various stages in the form of clarification, reinforcement and challenges.
Another useful option is to get the students to ask the lecturer questions during the session. However, instead of asking them to do it as individuals, try having them work on a question in small groups of two or three. This way they can avoid the perceived embarrassment of asking a “silly” question and will gain confidence to ask questions in public. Then, instead of the lecturer answering the question, give other groups the opportunity to try first. This will not only hold everyones attention but will also give the lecturer a few different ideas to work with during the discussion.
Having students work in small groups is an effective way for them to engage with the content of the lecture. By discussing the concept with others, they not only remain focused during the lecture, but they have an opportunity to reinforce it in their own minds. In this way misunderstanding can be identified early on, with students having the opportunity to ask clarifying questions. In addition, seeing different answers to the same question can demonstrate to students the different ways of understanding something.
Students can also be given short, formative assessments after a significant piece of work has been covered. They can be informed in advance that the assessment will happen at the end of the lecture, thereby prompting them to pay more attention than they would usually. By making it a formative assessment there is less pressure on them to worry about passing, and more attention can be paid to identifying areas of their misunderstanding. The timing of the assessment is important, since doing one at the beginning of the lecture would be more appropriate to determine prior learning, while one at the end would be better for evaluating the work just covered. Having students assess each other’s work using a rubric prepared in advance will not only relieve the lecturer from marking the work but will introduce students to evaluating the work of others. Completing the assessment before the end of the lecture period also allows time for students to ask questions to clarify their misunderstanding.
Questions of copyright
This is a common challenge that lecturers often face. What content you can use and what you can use it for is determined by copyright. How much text can you photocopy and give to students? What pictures can you include in my slides? Are YouTube videos off limits? These are just a few questions that arise when considering the issue of intellectual property and which pieces of content you can include. Note that even if you’re properly referencing the content, it doesn’t matter. This is a problem of how much content you can distribute without paying for it.
It’s always a good idea to try and find content that is licensed with Creative Commons licenses. This is a way of knowing exactly what the content creator will allow you to do. When someone creates a piece of content, even if there is no copyright notice, by default they own all rights to use that content exclusively. This has implications for when lecturers use content they did not create, and share it with students without paying the author. Most university libraries have intellectual property policies and agreements, and specify exactly how much content lecturers can share with students.
It is always useful to get feedback after a lecture as this will allow you to make changes to future lectures based on the students’ experiences. The feedback should not only aim to identify areas that could be improved but should also provide constructive advice on how the lecturer can actually improve. Sources of feedback can include:
- Students, whose opinions are possibly the most valuable
- Colleagues, as part of a more formal peer review
- Personal reflection, as part of developing a teaching portfolio
If mini-assessments are conducted at the end of the lecture they also be kept as part of an informal evaluation of teaching practice, since student performance is a useful indicator of teaching efficacy. In addition, students’ notes can also be reviewed (with their permission) in order for the lecturer to see if the session was clear to them (Cantillon, 2003).
A simple form can be used for either peer or student review of a lecture:
The lecturer was:
Clear and concise
Lecturers will often need to deal with several challenges that may arise during the lecture, including:
- Students arriving late
- Questions that aim to distract
- Cell phones ringing
- Students falling asleep
- Students talking to each other
- Technical failures
While these challenges are outside of the direct control of the lecturer, being well-prepared and engaging the students’ attention will help prevent many of these problems arising. In addition, ensuring that students know the rules of the classroom may also address some of these issues.
Lectures can be an incredible effective, powerful form of communicating important and difficult concepts and ideas to students. Lectures can be used to present core material and to provide an overview of the course. It should be structured, have clearly defined objectives and a lesson plan. Lecturers should pay attention to their own presentation skills and to the preparation of their handouts and other materials. Lectures can be made more effective by capturing and maintaining the attention of students, requiring them to be active participants in the session, leading them in questioning and discussion. In addition, formative assessment with immediate feedback can also be used to enhance traditional lectures.
- Cantillon, P. (2003). ABC of learning and teaching in medicine: Teaching large groups. British Medical Journal, 326: 437-440.
- Chester, T. (2013). The “sage on the stage” and the end of the classroom lecture. Educause blogs.
- Dalsgaard, C., & Godsk, M. (2007). Transforming traditional lectures into problem-based blended learning: challenges and experiences. Open Learning: The Journal of Open and Distance Learning, 22(1), 29–42.
- Dent, J. & Harden, R. (2005). A practical guide for medical teachers. Harcourt Publishers, London.
- Harden, R. M., & Crosby, J. (2000). The good teacher is more than a lecturer: The twelve roles of the teacher. AMEE Medical Education Guide no. 20.
- Graffam, B. (2007). Active learning in medical education: Strategies for beginning implementation. Medical Teacher, 29(1), 38–42.
- Gunderman, R. (2013). Is the lecture dead? The Atlantic.
- O’Donnell, M. (1997). A sceptic’s medical dictionary. BMJ Publishing Group, London
- Ovens, P., Wells, F., Wallis, P. & Hawkins, C. (2012). Developing Inquiry for learning: Reflecting collaborative ways to learn how to learn in higher education. Routledge
- Sandhu, S., Afifi, T. O., & Amara, F. M. (2012). Theories and practical steps for delivering effective lectures. Journal of Community Medicine & Health Education, 02(06).
To the best of my knowledge, all sources used in the creation of this work are freely available and not encumbered by licensing issues. The image in the article header was taken from the Wikipedia page on Meerkats.