To Be There or Not To Be There: Is Attendance Really the Question?

Kanter, Steven L. MD

doi: 10.1097/ACM.0b013e31825a5a2a
From the Editor

One morning, as I was walking from the parking garage to my office, I saw the usual group of a dozen or so medical school applicants, dressed in standard dark suits, on a tour given by one of my school’s second-year medical students. I was delighted that the medical student sounded bright, cheery, and happy to be at our medical school.

As I started down an escalator and they started up the adjacent one, I heard the medical student guide say, “Well, it’s really great here. There is even a notorious course that, like, only 25 students [about one-sixth of the class] attend, and the school still records and podcasts it. So, I mean, it’s not like you have to go to lecture.”

I could tell that the applicants were very favorably impressed and considered this a “plus” for selecting this medical school. The medical student was communicating to the applicants that the curriculum leaders at our medical school do not withhold podcasting in order to boost attendance. Clearly, both the medical student and the applicants saw the situation in a positive light.

Of course, faculty members discuss exactly the same situation, but often in a negative light. In fact, talk to any faculty member who gives a lecture in a course for first- or second-year medical students, and somewhere in the conversation, he or she will tell you that student attendance is a problem. The faculty member may blame it on (1) generational issues (“The current generation just can’t sit still for an hour,” one person told me), (2) technological issues like podcasting (many students don’t see the need to attend a lecture if they can listen to a podcast at their convenience), (3) values (“The students do not appreciate the time and effort it takes to write a lecture and make the slides, and I even spend time practicing it the night before,” another faculty member said), or (4) etiquette (a course director told me, “It was so embarrassing—I had a prominent guest lecturer and hardly anyone was there to hear him”).

As long as we continue to frame the problem as “attendance,” it limits the range of potential solutions.

If we reframe the problem in terms of the learner–teacher relationship (LTR), it begins to reveal how we might glean a better understanding of the issues. And it makes it possible to broaden the discussion to learners at all levels and to all forms of LTRs, including advising and mentoring sessions.

In the context of the LTR, we can ask questions like

* How do rational adults enrolled in an advanced degree program make decisions about whether or not to engage in LTRs?

* What do learners give and receive when they so engage?

* What do teachers give and receive when they participate in such encounters?

* How does a technological intervention, like podcasting, change what learners and teachers give and receive?

As I listen to colleagues’ concerns about the dwindling attendance of medical students because of the availability of lecture podcasts, I hear them express the underlying feeling that they do not get as much out of teaching as they would if the students were present. They get less energy, less reward, a lesser sense that they are doing good by educating the next generation of physicians. In other words, engaging in the LTR is less satisfying for the teachers when learner attendance is low.

It is important to know that this may be occurring. The internal reward that faculty members receive from teaching medical students is critical to the quality of teaching and to the overall success of an educational program.

But is it effective simply to improve—even force—learner attendance? When the problem shifts from improving attendance to improving the LTR, the challenge shifts from simply devising ways of getting students to be present, to the challenge of ensuring that both learners and teachers are able to contribute to and benefit from the LTR, even in the face of podcasting or some other intervention.

Since students seem to enjoy learning from podcasts—and many like them better because they can listen to lectures at two or three times normal playback speed and can replay selected parts of the lecture that require special attention—perhaps it is an invitation to explore new and better ways to use the time that learners and teachers spend together.

I think we will discover that, for many students, certain kinds of learning are more efficient when a learner is alone with his or her podcasting device, and that other kinds of learning are more effective in the context of an LTR. And so, I believe it will become clear that podcasting has its place but will replace neither classroom learning nor the need for high-quality time in the context of an LTR. If we do it right, ultimately, both learner and teacher will derive new and richer benefits from an improved learner–teacher relationship.

© 2012 Association of American Medical Colleges