Summary: In his latest blog Professor Harden discusses whether the death of the lecture has been exaggerated, daring and high-risk research, learning lessons from the past, disruptive innovations and the impact of technology on the roles of a teacher. Description: Has the death of the lecture been greatly exaggerated?
Times Higher Education (19th July 2018) reported on the fiery debate on the role of lectures at a Teaching Excellence Summit held in Glasgow in July. In a keynote address Carl Wieman, A Nobel prizewinning physicist from Stanford University argued that “there is no point in lecturing anymore”. James Conroy, the University of Glasgow’s vice-principal for internationalisation, hit back at claims that lectures almost always delivered worse student outcomes than “active learning”, calling the claims “half-baked nonsense” and “horse manure”. Wieman had argued previously that belief in the value of traditional lecturing was akin to belief in bloodletting in an era of modern, evidence-based medicine. Amanda Fulford and Aine Mahon, however, gave a philosophical defence of the lecture in an article in a previous issue of Times Higher Education (10th May 2018). They suggested that the lecture must not be understood in terms of a unidirectional mode of transmission – a monologic form of communication in which students are merely passive recipients. It should instead be seen as a special form of human encounter. There still is a role for a lecturer as discussed in my newly published book with Pat Lilley as co-author, the Eight Roles of the Medical Teacher. In AMEE Guide 22 Brown and Manogue suggest that there are no bad lectures, only bad lecturers.

Daring, high-risk research
The Wellcome Trust has launched a new £250 million funding scheme to support ambitious projects that have the potential to fundamentally change science or transform health within a 5-10 year span. This £250 million counts for only 5% of Wellcome’s spending over five years. Too often research in medical education is focused on improving what we are already doing rather than fundamentally changing the process of education. The October 2018 Anniversary issue of Medical Teacher presents some interesting and provocative ideas about what the medical school of the future will look like. Perhaps we need funding for research to explore such innovative approaches. As well as a budget specifically allocated to forward-looking innovations we need a larger overall budget for research in education in the health care professions.

Lessons from the past
Those working in education are often not well-versed in early developments in education. Research papers often cite only recent publications in the area. I was interested to read Larry Cuban’s book How Teachers Taught which was part of a Research on Teaching series and looked at consistency and change in American classrooms from 1880-1990. I was particularly interested in the description of what was called the “Activity Programme” introduced in 1934 as a six-year experiment. John Loftus, a former school principal with a reputation for installing innovative programmes, directed the programme and, speaking to teachers, called the Activity Programme a “revolt against verbalism, so-called “textbook mastery” and literal “recitation”.” Teaching was tailored to each child. The “congenial group”, or committee, was typical of activity methods, as was the “integrated curriculum”. All are part of today’s agenda in medical education. 64% of teachers in the selected schools preferred the new programme while in regular schools 93% were content with their current practice and favoured the conventional programme. I wonder what percentage of today’s teachers in medicine are content with their current practice and do not see the need for a great change.

Disruptive innovations
Sustaining innovation and efficiency innovation are more commonplace than disruptive innovation. An article by Flavin and Quintero in Research and Learning Technology (2018)[link to article] examined the published institutional strategies for learning, teaching and assessment in UK higher education. The article analysed the categories of innovation reported as disruptive innovation, sustaining innovation, and efficiency innovation. The authors conclude that higher education institutes learning strategies indicate a willingness to adapt on the part of universities but a disinclination to disrupt. Policies are often ameliorative, more likely to pursue sustaining or efficiency than disruptive innovation. Students and lecturers practice with disruptive technology was largely ignored. In an article E-Learning – Caged Bird or Soaring Eagle? I suggested that e-learning was more frequently being used to make learning more effective or efficient and to do better things that we were already doing rather than to support new approaches to teaching and learning such as adaptive learning.
Harden, R.M. 2008. E-learning-caged bird or soaring eagle? Med Teach. 30(1). 1-4.

Technology and the role of the teacher
I have just read Bertalan Mesko’s book The Guide to the Future of Medicine. The subtitle is Technology AND the Human Touch. He described everyday medical technology which delivers healthcare solutions that were the materials of science fiction just a few years ago. He argues that the trends can be embraced by professionals and patients who value a humanistic approach to medical education. I talked with him this week on a Skype call about his plenary presentation at AMEE 2018 in Basel. He will not only be looking at how technology can make teaching and learning more effective and efficient but also the implications for fundamental changes in teaching and learning and for the role of the teacher and the human touch. Unfortunately, we will not be able to record his presentation for future access on the AMEE website along with the other plenary presentations. Over 3600 participants have already registered for the conference and others with AMEE Live Online. If you are not able to be with us in Basel why not join his and other presentations and symposia sessions at AMEE Live Online. We have reduced the cost to make it even more affordable this year!