What if they had a medical school course

And nobody went?

At University Medical School, the second year is divided into System segments that last between 2 – 4 weeks. At the end of every other segment there are exams on the systems covered, their pharmacology and nutrition. The courses are primarily lecture based, with a few (mandatory or non-mandatory) small groups and pathology laboratories (to view microscopic or gross specimens) scattered here and there.

Attendance is not mandatory except at those classes for which a “unique educational opportunity” is present. This is a big change from previous years when instructors could make lectures mandatory. Now, they can only decree that a lecture is mandatory when there is a real opportunity for embarrassment if the students don’t show up (guest lecturer from afar, patients talking about their diseases, etc.).

Most students vote with their snooze buttons. 830 AM classes are particularly dismally attended, and matters generally improve only slightly until the termination of the proceedings each day at 3 PM. This is a matter of some consternation among the faculty, who do not feel like their time is being well utilized when only ten students are present (out of a class of over one hundred). This attitude is particularly disappointing, although not surprising if one has ever heard the stereotype of an attending physician on rounds or in the lecture hall. Members of this whining subset of lecturers are primarily motivated by egos, whether stroked or bruised.

This attitude may be surprising to educators in other fields. When was the last time that a public high school teacher complained because he had to teach ten students instead of one hundred and ten?

There are also some interesting opportunities for both students and faculty in these situations. First, under-attended lectures can expose bad lecturers and bad powerpoints (full disclosure: I think 99% of all powerpoints are normatively bad, 99.9999% are badly executed, and 100% should have been put through the Guy Kawasaki filter before class). It’s hard to ignore five students falling asleep in a lecture hall when they are the only attendees. They might even force faculty to teach the students what the students need to learn instead of what the faculty want to teach.

The 8th Ammendment does not apply to medical students

Second, under-attended lectures are actually a boon for the students who do go. One student has decided that they are essentially small groups, and feels more free to ask questions. This is particularly true after several under-attended lectures with the same faculty member.

Thirdly, what percentage of the hundred students in a well attended medical school class are actually paying attention? One of our lecturers recently estimated it was ~10%. So, what’s wrong with letting the other 90% maximize their free time while providing a better opportunity for the other 10% to learn.

See, I went through the first half of the year attending class, trying to do reading, and then maybe doing some questions as I studied for tests. Since early February, I’ve flipped that formula completely on its head.

Now I read First Aid FIRST and identify areas that I don’t understand – turn those into flash cards and/or add them to my study list. Then I do questions (all of Kaplan and USMLE World for the system that we’re studying) and make more flashcards, and add more subjects to the study list. Then I go back to the study list and read Robbins or a specific text book. If there’s a class that’s relevant to a topic that I need to learn, then I’ll attend the lecture AFTER doing questions and AFTER doing the reading on my own. Until I’ve done all the questions and all the reading, I won’t go to class (unless it’s mandatory…). I do 1-2 hours a day of flashcards to keep up.

Unfortunately, this rarely happens. And I like going to class – I really do – but going to class isn’t going to get me an “A” or a good score on step 1, any more than surfing the internet will. Only learning the material will do that, and class just isn’t the best way for me to learn.

I wish someone had told me this earlier. I’ve never participated in this kind of self-directed learning, and truth be told, I don’t really like it. But it is what it is.

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