1. Creation of an Active Learning Environment in the Lecture Setting
Bonnie Desselle, MD
Program Director
LSUHSC Pediatric Residency Program
Introduction: ACGME mandates didactic lectures and this is traditionally accomplished in a large group lecture where the expert faculty member is the main active member: doing all of the talking and providing factual information the audience that is passive and not engaged and not challenged. The disadvantages of this are numerous.
Due to research in medical education, most medical schools have significantly reduced the number of hours of lectures for medical students. There is more small group teaching with an emphasis on problem solving, clinical reasoning skills and for our students to be critical thinker. I would like to incorporate some of these active learning strategies into our core resident lecture series. We will review the advantages of this and then strategies to create an active learning environment. I will demonstrate an example of a shock lecture that has been converted from a traditional 50 slide power point to an interactive case based session. Then we will have you think about your own upcoming lecture and see if it is possible to implement any of these strategies.
Desselle BC, English R, Hescock G, Hauser A, Roy M, Yan T, Chauvin SW. Evaluation of a Faculty Development Program Aimed at Increasing Residents’ Active Learning in Lectures. J Grad Med Educ. 2012;4(4):

2. Disadvantages of Traditional Lectures
Desselle BC, English R, Hescock G, Hauser A, Roy M, Yan T, Chauvin SW. Evaluation of a Faculty Development Program Aimed at Increasing Residents’ Active Learning in Lectures. J Grad Med Educ. 2012;4(4):
Disadvantages of Traditional Lectures
Disadvantages of traditional lectures are numerous with the main one being the low retention rate. Learners will only recall 5% of what we say 24 hours after a lecture. Active learning promotes long-term learning.
It seems like we spend a lot of time preparing for these sessions and are not getting the optimal result. In addition, the lecturer doesn’t know what the audience is learning or understanding.

3. Why promote Active Learning in lectures?
Increase learning with active participation
Improve attention span and motivation
Increased memory
Increased faculty and resident satisfaction
Sternert Y and Snell LS. Interactive Lecturing: strategies for increasing participation in large group settings. Med Teacher 21:37-42, 1999
ASK THE AUDIENCE FIRST, THEN LIST ANSWERS
Medicine involves complex issues and therefore a good critical thinker is essential in the medical field.
“Studies have shown that students who are active participants will learn more than passive recipients of knowledge.” After 20 minutes there is marked decline in attention…less likely to occur if session has short activities
for problem solving or clinical reasoning..a change in activity renews attention…increased attention does increase memory
Desselle BC, English R, Hescock G, Hauser A, Roy M, Yan T, Chauvin SW. Evaluation of a Faculty Development Program Aimed at Increasing Residents’ Active Learning in Lectures. J Grad Med Educ. 2012;4(4):

4. Passive vs. Active Learning
Desselle BC, English R, Hescock G, Hauser A, Roy M, Yan T, Chauvin SW. Evaluation of a Faculty Development Program Aimed at Increasing Residents’ Active Learning in Lectures. J Grad Med Educ. 2012;4(4):
Passive vs. Active Learning
Is the purpose of conducting lectures for the faculty to teach or is it for the learners to learn?
Shift the focus to the learner
Don’t view your lecture just as a delivery of information
Bi-directional flow of information
What is most important at the end of the lecture is what the residents LEARNED and not what was taught!
Is the purpose of the lecture for you to teach or is the purpose of the lecture for the residents to learn? Who is doing all of the talking during the lecture? Learner must address their gaps in knowledge, misunderstandings..we need them to make the mental connections. You will definitely learn what they know and don’t understand with this type of lecturing. What is most important at the end of the lecture is what the residents LEARNED and not what was taught!!

5. Barriers to Interactive Lectures Sternert Y and Snell LS
Barriers to Interactive Lectures Sternert Y and Snell LS. Interactive Lecturing: strategies for increasing participation in large group settings. Med Teacher 21:37-42, 1999
Losing control of audience
Not being able to cover all content information
Not knowing the answer to the questions posed by residents
Time it will take to alter present lectures or create new ones
There are some challenges to this type of lecture, but most are minimal and can be overcome.
The most common concern from clinician educators is that “I will not have enough time to present all of the necessary material” with this type of session. Studies have shown that learners have better recall and understand presentations that are based on essential principles and less detail than those with much detail. Therefore less content is most likely better. And remember, these learners have a lot of other opportunities to fill in any gaps that are not covered in your session: their clinical rotations, encounters, bedside rounds, small group discussions, etc. Do not feel that you need to cover EVERYTHING about your topic in this one hour session. Truly focus on the essential information.
Desselle BC, English R, Hescock G, Hauser A, Roy M, Yan T, Chauvin SW. Evaluation of a Faculty Development Program Aimed at Increasing Residents’ Active Learning in Lectures. J Grad Med Educ. 2012;4(4):

6. How do we promote active learning in didactic lectures?
Desselle BC, English R, Hescock G, Hauser A, Roy M, Yan T, Chauvin SW. Evaluation of a Faculty Development Program Aimed at Increasing Residents’ Active Learning in Lectures. J Grad Med Educ. 2012;4(4):

7. Attributes of the Effective Medical Lecture
Desselle BC, English R, Hescock G, Hauser A, Roy M, Yan T, Chauvin SW. Evaluation of a Faculty Development Program Aimed at Increasing Residents’ Active Learning in Lectures. J Grad Med Educ. 2012;4(4):
Attributes of the Effective Medical Lecture
Case-based format
Better retention of material
‘Stories’ are easier to retrieve than conceptual memory
Problem solving
Interactive
Higher order questioning
Successful Lecturing: A prospective study to validate attributes of the effective medical lecture. J Gen Intern Med 2000;15:
AMEE Medical Education guide no. 22: refreshing lecturing: a guide for lectures. Medical Teacher 2001;23:
There are three essential elements of a good medical lecture for graduate medical education purposes: case based, interactive and use of higher order questions. Audience can relate to real life situations. We want to engage them and we want to challenge them. A study was conducted over 3 large symposia on intensive review of IM and looked at the predictors of the evaluation of lectures and found that lectures should encourage engagement of audience, provide clear and organized session, utilize authentic situations.

8. Interactive Techniques
Questioning the audience
Wait time ( > 5 secs), ask the whole audience
Breaking into small groups or pairs
Think-pair-share
Completing worksheets
Using audience response systems
Simulation or role play
Videotapes
ASK AUDIENCE FIRST:”WHAT STRATEGIES HAVE YOU USED?” Techniques to ask questions
Many methods to create interactive lecturing. The most widely used one is questioning the audience. Other methods…
Wait time of > 5 seconds will increase response time 3 – 7 fold, not putting one person on the spot will keep everyone on task
Simulation or role play is useful for topics such as delivering bad news.
Videotapes of patients demonstrating physical exam findings are an excellent ways of instructing on certain features as well as it can break up the mundane use of words.
worksheets: use all senses-thinking and writing
Desselle BC, English R, Hescock G, Hauser A, Roy M, Yan T, Chauvin SW. Evaluation of a Faculty Development Program Aimed at Increasing Residents’ Active Learning in Lectures. J Grad Med Educ. 2012;4(4):

9. Lower vs Higher Order Thinking
Lower level objectives
Verbs
Knowledge
Define, list, state, name
Comprehension
Identify, explain, recognize, discuss
Higher level objectives
Verbs
Application
Apply, demonstrate, illustrate, interpret
Analysis
Analyze, categorize, compare, differentiate
Synthesis
Design, formulate, plan, manage
Evaluation
Choose, critique, rate, appraise
Based on bloom’s toxonomy
There is a spectrum of thinking that we want our residents to exhibit from lower order to a higher order of thinking.
Desselle BC, English R, Hescock G, Hauser A, Roy M, Yan T, Chauvin SW. Evaluation of a Faculty Development Program Aimed at Increasing Residents’ Active Learning in Lectures. J Grad Med Educ. 2012;4(4):

10. Higher Order Questioning How, what if, when, why..?
Identify the patient problem?
What do you think is the main problem?
Data acquisition
What historical info will you obtain?
What will you be looking for on physical exam?
Create a differential
What do you think could be the cause (s)?
Anything else could be causing this?
Can you compare and contrast these diseases?
What if…?
Upon reading literature in clinical reasoning it is suggested that the first step is for novices to define the patients’ problem. In one statement, state the patient’s main issue. You may not realize that you do this. Experts do this unconsciously. Experts know but usually do not articulate the main problem in one summary sentence. Ask the residents to state in one sentence a summary of the problem = problem definition. If you jump right to what would you do for this patient you will miss some important opportunities to teach.
Ask them their hypothesis. This may not be natural to you, but you need to ask them what seems obvious to you.
Don’t ask What is…ask how, why, and what if…ask… do not tell, ask them
Desselle BC, English R, Hescock G, Hauser A, Roy M, Yan T, Chauvin SW. Evaluation of a Faculty Development Program Aimed at Increasing Residents’ Active Learning in Lectures. J Grad Med Educ. 2012;4(4):

11. Higher Order Questioning
Justify their answers
Why do you think ____?
Physical exam or lab tests or radiographs
How do you interpret this?
How does it fit with your diagnosis?
Can you expand your answer or explain further?
How would you approach this patient?
Many times residents know the answer but can not explain why…they are just modeling behaviors that they have seen their upper level or attendings do and they do not have a true understanding.
Desselle BC, English R, Hescock G, Hauser A, Roy M, Yan T, Chauvin SW. Evaluation of a Faculty Development Program Aimed at Increasing Residents’ Active Learning in Lectures. J Grad Med Educ. 2012;4(4):

12. Review an Interactive Lecture
Review the structure of an interactive lecture on Shock. Show the worksheet on the Shock lecture. Start the session by stating the objectives to the lecture first and explain to the audience the structure of the session. For each question or a group of questions, let the learners complete the answers by writing them on the worksheet. Then, let them share with those around them to create peer to peer teaching and then asked for volunteers to state their answers.
Desselle BC, English R, Hescock G, Hauser A, Roy M, Yan T, Chauvin SW. Evaluation of a Faculty Development Program Aimed at Increasing Residents’ Active Learning in Lectures. J Grad Med Educ. 2012;4(4):

13. Getting Started: How to Create an Interactive Lecture
Identify a few key essential points
Create one or more cases
Determine how to reveal case
Create a worksheet
Formulate questions/structure
Develop a few slides
pictures, summary points, diagrams
State key elements in beginning or end
Refer to worksheet
Desselle BC, English R, Hescock G, Hauser A, Roy M, Yan T, Chauvin SW. Evaluation of a Faculty Development Program Aimed at Increasing Residents’ Active Learning in Lectures. J Grad Med Educ. 2012;4(4):

14. State the organization of the lecture Ask clear questions
Other tips…
State the organization of the lecture
Ask clear questions
Pause after each question >5sec
Ask them to recall similar cases
Make them justify their answers
Incorporate basic science principles
You can state objectives at end if you are doing a puzzler type situation.
We want them to recall similar cases to build on their memory…this will help with recall .
Desselle BC, English R, Hescock G, Hauser A, Roy M, Yan T, Chauvin SW. Evaluation of a Faculty Development Program Aimed at Increasing Residents’ Active Learning in Lectures. J Grad Med Educ. 2012;4(4):