Chapter 8 Lectures are the oldest and most ubiquitous method of learning in medicine and allied subjects. They are economical and at least as effective as other methods of teaching at conveying knowledge (Bligh 2001). Given the usefulness and universal usage of lectures it is important that all medical teachers develop and refresh their expertise in lecturing. This chapter provides a brief guide to improving student learning from lectures. It considers briefly the strengths and limitations of lectures, the processes of learning from lectures, the core skills and structures of lectures and some ways in which the efficacy of lectures may be evaluated. The main purposes of lectures are coverage of a topic or theme, understanding of processes and phenomena and motivating students to learn. Of these broad purposes, coverage is the most common, and the most common weakness (Brown & Manogue 2001). Understanding, the creation of new connections in the minds of the learners, and motivating students to learn are twin priorities. Beneath these priorities is a hidden purpose of developing one’s own understanding of a subject and of the way students learn. Docemur docemus: we learn as we teach. For lectures, like all methods of teaching, have limitations. These actions can be summarized as a series of processes which are expressed in the following apparently simple explanatory model of lecturing derived from social and cognitive psychology (Brown & Manogue 2001) (see Fig. 8.1). Amongst the many hints that can be adduced from the model are: Articulate your intentions. If you use intended learning outcomes, use only a few. A brief statement of the structure and content of the lecture may be more meaningful to students than a list of learning outcomes. Ascertain what the students know, including their experiences and interests. Match your content and structure to your intentions. Prepare the lecture and prepare particularly the opening phase of the lecture so it gains the attention of students. Ask yourself (and answer!) how can you make the lecture clear and interesting. Bear in mind that transmission includes verbal messages, extra-verbal messages (emphatics, expressiveness, hesitations, stumbles) and nonverbal messages (eye contact, gestures, movement). These can convey your interest in the topic and favourable attitudes to students. Alternatively, they can convey boredom, disinterest, arrogance and hostility. In the lecture, use examples, give students time to copy diagrams, vary activities, speak clearly and use eye contact and gestures. Use educational media effectively. Lectures can be enriched by educational media, such as PowerPoint, whiteboards, interactive whiteboards, slides, overhead transparencies, videos, sound recordings, models and simulations. ‘Blackboard’ or similar tools such as ‘LEARN’ can be useful. Electronic voting systems (EVS) can increase interaction in lectures and provide feedback to both the lecturer and the students. All of these can improve the quality of lectures, but they can also distract, confuse or produce mental dazzle. To be effective, educational media need to be designed for their purpose and the students. Monitor the students’ reactions and change accordingly. These reactions are the basis of lecturer responsiveness, and it is these features which account for student preferences for live rather than recorded lectures (Bligh 2001). Looking at students in different parts of the lecture theatre enables the lecturer to gauge the reactions of interest, puzzlement or boredom of the students. Students who sit near the front tend to be the more interested; students who sit near the back tend to be the less interested or troublemakers (Brown & Atkins 1988). Monitoring can reduce the probability of disruption as well as help anticipate other reactions. Bear in mind the limited capacity of the sensory and working memory, so do not talk too quickly and do chunk the information provided into meaningful and relatively brief sentences. Presentations that are too fast or too distracting cannot be processed by the working memory. Remember that attention in lectures usually declines after about 20 minutes, so vary activities or switch the focus of the lecture. The use of analogies, metaphors and similes will create new connections rapidly with existing schemata (networks of knowledge in the long-term memory). The use of frequent summaries, guiding statements and cognitive maps can help students to change their schemata which can then be elaborated upon by the students after the lecture. Personal narratives interwoven with concepts and findings can trigger the episodic memory (memories of events and experiences) and the semantic memory (memories of knowledge, ideas, skills) and so aid storage and retrieval. For example, explaining aspects of disease in relation to a patient or recounting one’s initial attempts at performing a colonoscopy can assist students or trainees to learn, remember and understand. The processes of lecturing are effected through the skills shown in Table 8.1. Of these skills, the preparation of lectures, explaining and the use of educational media are the most important. A more detailed description of the skills and subskills involved in lecturing may be found in Brown and Atkins (1988), Brown and Manogue (2001) and Hargie (2006). Table 8.1 The skills of lecturing. What are your strongest and weakest skills?
Lectures
The ubiquity of lectures
Purposes, strengths and limitations of lectures
Processes of lecturing and learning from lectures
The skills of lecturing
Skill
Comments
Preparation
Takes account of knowledge of learners. Specifies purposes or outcomes and provides structure and sequence. Undue specificity and very loose structures not recommended.
Opening
Gains attention, establishes rapport and provides framework of lecture.
Explaining
The key skill. Creates understanding in the learners. Clarity and generating interest are its key components. Embraces many of the skills of lecturing such as preparation, openings, use of audio-visual aids/IT, summarizing.
Presenting information
An important but lower level skill than explaining. It is concerned with coverage of the essential facts or theories. Danger of providing too much detail and inducing boredom.
Narrating
Telling a story of a patient, case or experience that captures the imagination of the students and deepens their understanding. A powerful but neglected skill.
Comparing and contrasting
Easy to do badly. Requires a clear outline of what is to be compared and contrasted and careful framing of the comparisons. 2 × 2 matrices are useful for paired comparisons.
Design and use of educational media
Important in medicine and health but sometimes produces mental dazzle or sleep rather than intellectual enlightenment.
Responsiveness to audience
A neglected skill. Includes monitoring audience, reading reactions of audience and responding accordingly.
Varying student activity
Necessary to keep them awake! Can improve learning and heighten interest. Ensure, if possible, that the changes in activity are relevant.
Summarizing
Should be used during a lecture as well as at the end of a lecture. Should emphasize the key points, show the links within the lecture topic and between the topic and cognate topics. 
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Merely reading this chapter is not sufficient to improve one’s lectures: just as reading a text on clinical diagnosis may not be sufficient to make one a better clinician
‘A superfluity of lectures can lead to ischial bursitis (pain in the buttock).’
‘The decrying of wholesale lecturing is certainly justified. The wholesale decrying of lectures is just as certainly not justified.’
