Lectures remain an important component of medical education in the first year, despite the increases in small-group teaching that have occurred at many schools in the past decade. During the same period of time, the expanded availability and use of technology in teaching have made it possible to provide students with a variety of course materials, and even entire lecture sessions, electronically. Does this access produce unintended side effects, making in-class lecture sessions less attractive to students, decreasing attendance, and consequently diminishing learning, as some faculty worry that it may?
Although effective teaching practices in the lecture setting have been extensively examined,1–3 4–6 7
The purpose of the present qualitative study was to explore whether first-year medical students make deliberate decisions about lecture attendance, and if so, to identify the factors that influence these decisions. Of particular interest was whether the availability of electronic course materials influenced students’ decisions.
Method
This study was conducted at the University of Massachusetts Medical School, where the first-year curriculum is delivered by lectures, conferences, laboratories, small-group discussions, and experiences in physicians’ offices. Lecture attendance is not required, and the number of students present for a particular session usually ranges between 65% and 95% of the class. During the three-year study period (2004–2006), at least 95% of lectures were recorded, and the slides were also provided online for viewing or downloading. Most courses provided additional electronic materials as well, although the amount was variable. The study was carried out in the context of Mind Brain and Behavior 1 (MBB1), a first-year course in which students have access to extensive and varied electronic teaching materials.
Survey and participants
Students are required to complete an online course evaluation at the conclusion of MBB1. The authors added an optional open-ended question to the evaluation that asked students to comment on how they made decisions about lecture attendance. The question instructed students to think about all courses of the first year, and it prompted them to consider electronic course materials specifically. The survey instrument, which is used in all courses, also includes items on how helpful students found each of the types of electronic educational materials provided in the course for their own learning. Students rated these items using a five-point scale.
Students completing MBB1 in 2004, 2005, and 2006 (n = 298) were queried, with IRB approval. Because MBB1 is a spring semester course, students responding to the survey had recently completed their first year of medical school.
Analyses
Initially, one author (S.B.-G.) organized student responses to the open-ended question by topic, treating each year separately, and developed a preliminary coding scheme to capture major themes. Subsequently both authors independently coded a sample of responses from each of the years, on the basis of this preliminary scheme. After discussion of the results, the coding scheme was modified and clarified, and a revised version developed. This process was repeated, with iterative revisions, until both authors concurred that all relevant comments were captured by the coding scheme. Using this final version, all student responses were then read and coded thematically by each author. Any discrepancies were discussed until agreement was reached on item classification. If one student’s response included several themes, each was coded. However, a student was credited with no more than one response for each theme.
To provide an indication of the quality of electronic materials that the respondents had experienced, descriptive statistics were used to summarize students’ ratings of how helpful they found various materials provided in MBB1.
Results
The proportion of students responding, content of comments, and quantitative data from each of the three years that the survey was administered were similar; therefore, the data have been combined for reporting purposes. Of the 292 students completing the MBB1 end-of-course evaluations, 206 responded to the question on lecture attendance (71% response rate), and 197 provided responses that could be coded. Nine responses were not included because they did not address the question that was asked.
Do students make deliberate attendance decisions?
Most respondents (83%) described making decisions about whether to attend or not attend lectures on a case-by-case basis. The remaining 17% indicated that they did not make choices; instead, they routinely attended all lectures.
What factors influence students’ attendance decisions?
About 50% of students (82/163) described their decisions about lecture attendance as a sort of cost–benefit analysis in which the goal was to maximize learning. They identified influential factors, both positive and negative, and explained how they weighed them in making their choices (List 1 ).
List 1 Major Considerations of Students Who Reported Making Decisions to Attend or Not Attend a Particular Lecture
Not surprisingly, of the students who considered how attendance would impact their learning, 82% (134 of 163) cited previous positive or negative experiences with the particular lecturer as a major factor in their decisions. “I decide based on the lecturer’s ability to hold my attention and to add a little something extra. I usually base this on past experience with the lecturer.” As summarized in List 1 , teachers’ approaches that encouraged many students’ attendance included providing clear, understandable explanations, discussing concepts rather than listing facts, and integrating information. “If the lecturer is engaging and you actually learn material during lecture then it’s worthwhile. If someone just presents a list of facts, or doesn’t bring the material alive, then it’s probably better to just learn the material on your own.” A smaller but significant number of students cited active learning experiences as an important, positive factor. “I go to lectures during which there is a chance to interact, ask questions, and really spend the hour engaged in the material.” Anticipation that the teacher would prove confusing, or that the session would provide no additional content or insights to enhance learning, discouraged attendance.
A second, related consideration cited by 40% of students (65 of 163) was the predicted outcome of attending class. Attendance was encouraged by the belief the session would facilitate or enhance students’ subsequent study and learning of the topic, or if students anticipated that they would learn during the session itself. “I come to class based on whether or not I think I will learn anything. If the professor presents information in a way that makes it easier for me to learn, I go. If not, I don’t.”
A number of students cited factors related to personal learning preferences or predictions about whether lecture attendance would help them learn at that moment (List 1 ). These students considered whether a particular teacher or session would meet their needs. “I won’t go if that teacher’s style isn’t for me, and I feel that reading a book would be more beneficial.” They also considered the particular topic being presented, and whether it would be better learned in a lecture or through some other means. Students also referred to their own advance preparation. “I decide to attend class if I have had the opportunity to look at the material ahead of time; otherwise I get lost easily and get little out of lecture.” About 10% of students (21/163) said that factors involving their personal lives as well as their personal learning influenced their decisions. They listed early morning classes and competing commitments as discouraging attendance.
Do electronic course materials impact attendance decisions?
Sixty-two students explicitly described the impact of electronic course materials on their decision making. Of these students, 90% said that electronic materials had no effect, either positive or negative, on their decisions regarding lecture attendance. “Electronic materials have absolutely nothing to do with my decision to attend class. If the lecturer is good I will attend class no matter what materials are available.” The remaining 10% of students stated that electronic course materials encouraged their attendance. “Having electronic course materials helped me understand the lectures better, so I was more likely to come.” No students said that the availability of related electronic course materials discouraged their lecture attendance.
If students did not view electronic materials as helpful or educational, that might provide an explanation for why the availability of these materials did not influence attendance. We therefore examined the student ratings of electronic materials in MBB1 (n = 292; 98% response rate). The percentage of students giving these materials the highest possible rating (“very helpful to my learning”) was 93% for the interactive clinical atlases, 77% for the course Web site, and 60% for online lecture slides.
If students choose to attend all lectures, what reasons do they cite?
As noted above, a minority of respondents (17%) did not make case-by-case decisions about lecture attendance; rather, they attended all lectures. The most frequent reason given by these students for attending consistently was the anticipated benefit to their learning (13 of 26 students who provided explanatory comments). Some noted that repetition and interactions with teachers and peers in the classroom were important for them. “I like to learn by trying to absorb everything that’s offered.” A few students indicated that they always attended class because it helped them to figure out where to focus their studying, or because information might be provided that was not available elsewhere. “I always attend classes. I don’t want to risk missing anything!”
Discussion
About 80% of the medical students in this study reported making deliberate decisions about attendance on a lecture-by-lecture basis, and the rest routinely attended all lectures. In both cases, however, each student’s primary concern seemed to be maximizing his or her own learning. The vast majority of students seemed to be predisposed to attend lectures. The usual comment by those who made lecture-by-lecture decisions was that they would “attend the session unless . …” As one student wrote, “I think many of us would prefer to go to class rather than study on our own, but that is only if we know we are not going to waste our time.” No student reported that they never attended lectures, and no student commented negatively on the large-group lecture as an educational method.
In making attendance decisions, the majority of students predicted what would occur during the scheduled in-class time, and its impact on their own learning. Students felt the availability of electronic course materials had no influence on their attendance choices. However, many described these materials as being their primary learning resource once they had decided not to attend a session: “I see electronic materials as supplements and study tools. But if I don’t think the teacher is good, I will defer to them rather than attend.”
Placing the study question on the MBB1 evaluation ensured that responding students had recently been provided with extensive technology-assisted teaching materials that they rated highly. The argument that electronic materials did not affect attendance decisions simply because these students had never encountered any that they found helpful seems untenable.
This study has limitations. First, it is possible that responding students may have focused on one particular course in formulating their responses, despite the instructions to consider all their courses and lecture experiences. Students referenced many additional courses and teachers in their responses, as intended, but we do not know whether the same pattern of responses would have emerged had students been asked the study question on the evaluation of another course, or at a different time in the academic year. Second, we do not know how generalizable the results are to decision making by students attending other medical schools. Third, the absence of comments in certain areas may occur either because the factor is truly unimportant, or because students are unaware of or unwilling to report its effects. For example, whereas some student comments related decisions about lecture attendance to the content domain of a particular course, none addressed any possible relationship with characteristics of course examinations. Future hypothesis-driven, quantitative investigations into whether and how attendance decisions may be influenced by the overall learning environment, specific course characteristics, or attributes of available technology-based materials, seem warranted.
Increasingly, medical school courses are combining lectures, or other primarily instructor-led educational formats, with the use of sophisticated and varied electronic (technology-supported) materials to create blended learning experiences for their students.8
Our findings have implications for medical educators because they suggest characteristics of lectures to which today’s medical students may attach importance. These students react negatively when lectures become merely a recitation of facts. Instead, they value context and clear explanations. They appreciate guidance in integrating new information with previously learned material and in applying it to understand and solve problems. They are seeking insights and examples that will help them understand the material. They want to “jump-start” their learning in the lecture setting, and many are looking for a framework on which to build and organize their own further learning. Students are motivated to learn, and they are weighing various educational methods to identify those that they anticipate will best support their efforts at the time.
Students seem predisposed to attend lectures, and they will do so regardless of the availability of electronic materials if they feel that the lecture will contribute to their learning. The results of this study should help allay faculty fears that providing electronic teaching materials will negatively impact attendance at lectures. However, they should also challenge faculty to use the lecture setting in ways that most enhance student learning.
Acknowledgments
The authors are grateful to the medical students who participated in the survey and provided their thoughtful comments. The authors also thank Susan V. Barrett in the Division of Research and Evaluation for compiling the MBB1 course evaluation ratings.
References
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