Is Digital Attendance Enough?

Many medical schools have responded to student requests and begun to record and stream didactic lectures.  Students report watching these lectures can be more convenient and allow them to personalize the time, location, and speed to their specific needs. Meanwhile, faculty are freed up from giving the same Powerpoint lecture every semester and schools can highlight their “digital presence.” It seems to be a win on all sides, except when you look at the outcomes.

The pitfalls of streaming lectures:

1. Streaming is not experiencing.
2. Getting content at 2x speed can affect retention. [1,2]
3. Placing boring content online doesn’t make it more interesting.

The Evidence

There is conflicting data about whether students actually benefit from streaming lectures. A recent survey of medical students found that regular in-class attendance was associated with a significantly higher likelihood of getting A’s during pre-clinical years [3]. Additionally, students who primarily streamed lectures reported spending less time on studying and were more likely to earn C’s [3]. A study looking at the utilization of online lectures at the Loyola University Stritch School of Medicine concluded that students who viewed online lectures more frequently had lower grades [2]. This suggests what we’ve always known: education is experiential and requires showing up and engaging. The study from Stritch also concluded that students who were struggling with the material were more likely to repeatedly view lectures online as part of their study strategy, but remained toward the bottom of the class. The overall grade distribution for students was identical to the prior year when video lectures had not been available.

Assessment of student preferences for streaming lectures may be measuring the wrong thing. The most common metric of online lectures in medical schools is self-assessment of learner satisfaction, knowledge acquisition, or confidence [4]. Students and faculty are bored by “slideuments,” which often entail the lecturer reading long blocks of information for a large lecture hall with a goal of covering as much material as possible in a given time frame. Is it possible that improved self-assessment scores are due to the ability to cover the material faster rather than an actual improvement in knowledge translation? 88.5% of students reported watching lectures at an accelerated speed, yet it is unclear how this influences processing time and retention [5].

The Opportunity

The AAMC and other education groups have encouraged digital education that utilizes multimedia design principles and creation of new quality content. The quality of online resources is rarely mentioned in assessments of online lectures [4,6]. 

So, what can you do to optimize your lectures for online streaming?

1. Optimally use video, animation, interactive websites, and pre-existing resources to take advantage of a digital learning environment and supplement your lecture. These may be valuable platforms, especially for teaching physical examination or procedural skills. Check out ALiEM’s AIR Series for curated digital resources organized by subject matter.
2. Focus on how you’ll retain engagement and clarity as your students watch you at 2x speed while doing other things. This can include asynchronous discussion boards, recorded responses to an end of class question, or in-person problem based learning exercises.
3. Assess measurable, relevant outcomes and adapt material accordingly to maximize impact.

Emphasis on flipped classrooms, design thinking, and problem-based learning are great innovations to improve medical education, but we must do more than simply put lectures online [7,8].

Blog post edited and curated by:

Mark Ramzy, DO
Faculty Incubator Multimedia and Communications Editor

References:

1. Song K, et al. Does the Podcast Video Playback Speed Affect Comprehension for Novel Curriculum Delivery? A Randomized Trial. West J Emerg Med. 2018; PMID: 29383063
2. McNulty JA, et al. An analysis of lecture video utilization in undergraduate medical education: associations with performance in the courses. BMC Med Educ. 2009; PMID: 19173725
3. Liles J, et al. Study Habits of Medical Students: An Analysis of which Study Habits Most Contribute to Success in the Preclinical Years. MedEdPublish. 2018.
4. Tang B, et al. Online Lectures in Undergraduate Medical Education: Scoping Review. JMIR Med Educ. 2018; PMID: 29636322
5. Cardall S, et al. Live lecture versus video-recorded lecture: are students voting with their feet? Acad Med. 2008; PMID: 19202495
6. Candler C, et al. Effective use of educational technology in medical education: AAMC Institute for Improving Medical Education. 2007. PMID: 23488758
7. Gottlieb M, et al. Applying Design Thinking Principles to Curricular Development in Medical Education. AEM Educ Train. 2017 PMID: 30051004 
8. King AM, et al. Flipping the Classroom in Graduate Medical Education: A Systematic Review. J Grad Med Educ. 2019 PMID: 30805092

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