MEDICAL STUDENT CONCENTRATION DURING LECTURES

514

MEDICAL STUDENT CONCENTRATION DURING LECTURES

JOHN STUART Department of Hœmatology, Queen Elizabeth Hospital, Birmingham B15 2TH R. J. D. RUTHERFORD Advisory Service on Teaching Methods, University of Birmingham, Birmingham B15 2TT

used to the buzzer which did not cause undue disturbance. The experiment was conducted in two halves. In the first half, data were collected from 3 lectures given to second-year medical students, each lecture being given by a different lecturer. In the second half of the experiment, data were collected from 9 other lectures given to fifth-year medical students: one lecturer gave 4 of these, two others gave 2 each, and a fourth gave only 1 lecture. Altogether, data from 12 hsematology lectures given by four lecturers were collected: one lecturer gave 5 lectures, a second gave 3, and the other two gave 2 lectures each. One lecturer participated in the second half of the experiment

A

simple procedure, based on a questionnaire, was used for the assessment of student concentration during lectures. Analysis of 1353 questionnaires from 12 lectures showed that student concentration rose sharply to reach a maximum in 10-15 min, and fell steadily thereafter. The data suggest that the optimum length of a lecture may be 30 instead of 60 min. This method by which student feedback is obtained may also be used to improve lecturing perform-

Summary

ance.

INTRODUCTION

place of the conventional lecture in university teaching has been clearly described,1-3 and the well-presented lecture, when interspersed with other teaching methods, remains popular with medical students.4 A considerable amount of learning can take place during the lecture itself,5 and there is fair agreement between what the lecturer perceives as important and the notes taken by students.6

only.

The lecturers were experienced ha:matologists who had contributed to the course on previous occasions. Each gave a 50-min talk illustrated by overhead-projector transparencies and slides of tables, graphs, and clinical photographs. The clinical content of each lecture was deliberately high and the lecturers, who had discussed the overall course content and the presentation of their individual lectures beforehand, introduced the clinical material at regular periods throughout the lecture instead of concentrating it at one point. Student feedback and attendance in previous years had indicated the popularity of the course and we felt that the investigation would reflect student response to lectures of above-average quality.

THE

Nevertheless, criticism of the lecture

as a

method of

and of the frequency of its use continues, and considerable effort has been made to develop other methods of instruction. Although alternatives such as tape-slide programmes promote active student participation, much time and effort are required for their preparation and subsequent revision. Comparisons between the lecture and other forms of instruction have, in general, shown no significant difference in student learning, although self-instruction courses of the Keller-Plan type may be more effective than the traditional lecturebased courses.7 Since many departments still rely on the conventional lecture because they do not have the staff, curriculum time, or resources for comprehensive self-instruction programmes or small-group teaching, it would be important to have better methods of evaluating the lecture as a teaching method and of assessing the effectiveness of individual lecturers. We describe a simple method of monitoring the audience’s concentration during a lecture, which also provides objective data on the optimum duration of lectures and feedback to the lecturer who wishes to improve his performance.

teaching

RESULTS

Analysis of variance of the data at 10 min showed no statistically significant difference in response between second-year and fifth-year students (see table). At 25 and 40 min, however, the difference between the two groups was statistically significant. This difference was attributable to the inclusion of the data for the one lecturer who had lectured to fifth-year students only. In other words, there was no difference between the overall response of second-year and fifth-year medical students to the same lecturers. The response of the fifth-year students at 10, 25, and 40 min to different lectures given by the same lecturer was only significantly different. However, the contribution to the total variability arising from differences between the four lecturers (see table for sum of squares) LEVEL OF CONCENTRATION DURING A LECTURE

At the beginning of the lecture and at regular five-minute intervals (at the signal) please record your level of concentration on the lecture at that particular instant of time, on the table below in the

appropriate box, according 9

7

The purpose of the investigation and the procedure were carefully explained to the students. They were asked to record their level of concentration on a questionnaire (fig 1) at the start of each lecture and at subsequent 5-min intervals, signalled by a buzzer. The scale by which concentration was measured ranged from nine (maximum concentration) to one (not concentrating at all). Examination of the completed forms (average 113 per lecture) and discussion with the students indicated that they had taken the investigation seriously and had tried to be objective. The lecturers and students quickly got

5

on

the lecture

changing

changing average level of concentration

4

3

changing below average level of concentration

2

Fig.

scale:

above average level of concentration 6

1

following

maximum level of concentration 8

METHOD

to the

changing not

concentrating

on

the lecture at all

1-Student questionnaire issued at start of each lecture.

515 ANALYSIS OF VARIANCE OF THE DATA AT

10, 25,

AND

40

MIN

chance

Probability of the observed difference arising by t Not significant was approximately twice as great as the contribution arising from the differences between lectures given by the same lecturer. It seems that much greater differences existed between the lecturers than between lectures given by the same lecturer. The mean level of student concentration at each 5 min interval was then calculated for each of the 12 lectures. The resulting data for individual lecturers showed a similar variation in the mean level of concentration with time; accordingly, the data for each lecturer were combined to give a personal concentration profile (fig. 2). A graph showing the mean level of concentration at each time point for all 12 lectures was drawn for comparison and it suggests that the maximum level of concentration was achieved between 10 and 15 min from the start of the lectures and thereafter fell continuously. *

DISCUSSION

The question of whether student concentration can be maintained throughout a conventional 1-hour lecture has been raised previously. It was suggested8 that student receptivity might rise to an early peak, within 5 min, then decline steadily except for a transient rise at the end of the lecture. This hypothesis received some

71

Fig. 2-Variation

in

mean

level of student concentration with

time from start of lecture (mean for 12 lectures plus profiles for each of the four lecturers).

support from a study9 in which the correctness of students’ answers to multiple-choice questions were found to depend on the time of presentation of the information

during a lecture. Another hypothesis

is that the decrease in student attention does not follow a smooth curve but that the class as a whole loses attention at various times. 10 The authors observed "attention breaks", defined as periods of general lack of concentration during a lecture involving the majority of the class, when the students were settling in, after 10-18 min, and then at progressively more frequent intervals until the end of the lecture. On the other hand, when the percentage of "ideal" notes recorded by students in each 3-min interval during a lecture was determined,11 little evidence was found of a decline in student performance with time. Our study shows that student concentration rose to a maximum at 10-15 min and then fell steadily until the end of the lecture; there was no upturn during the last few minutes. The progressive fall in concentration during the second half of a lecture may reflect saturation of the audience with factual data, partial exhaustion of teacher and students, student boredom, or the lack of variety in the teaching method. The results support the idea that 25-30 min may be a more appropriate length for a lecture than the conventional 50-60 min. Further studies could include the effect of a short break for either discussion, multiple-choice questions, or clinical case presentation when student concentration starts to decline. We found that variations in student concentration with time were fairly uniform for each lecturer and gave rise to a characteristic profile which may reflect lecturing style. Student reaction to a lecturer’s performance will inevitably vary but our data suggest that some lecturers obtain a consistently higher level of student concentration and maintain it for longer than others. The reasons for this are complex and require further study. A concentration profile of this type provides a source of feedback to the lecturer who is trying to improve his lecturing technique and may be used to complement other forms of evaluation such as student questionnaires on teaching effectiveness,12 video-taping of lectures, 13 and the use of an experienced observer in the audience. 14 We are aware of the limitations of our methodology since, as with any study of this type, audience awareness may be artificially raised by the investigation itself. The investigation was, however, readily accepted by the students. Many commented that it was not disruptive and that the transient breaks every 5 min, if anything, aided concentration. Observers in the audience confirmed that ’

516

completion of the questionnaire seemed to become an automatic process quite rapidly. Experimental bias thus favoured an artificially raised level of concentration in highly motivated medical students attending a popular course given by experienced lecturers. Despite this, student concentration declined in the second half of the lecture and further studies of lecturing technique are required to determine how best to arrest this trend. Alternatively, we could adopt the 30-min lecture and gain much useful curriculum time for other teaching methods. We thank the second-year and fifth-year Birmingham medical students and the haematology lecturers who participated in the study,

Hospital

Practice

DARE WE COUNT THE COST OF CANCER

CHEMOTHERAPY?

R. J. BERRY The Middlesex Hospital Medical London W1P 7PN

Department of Oncology, School,

G. BRYAN Pharmaceutical Department, North-East District, Kensington, Chelsea and Westminster Area Health Authority (Teaching), The Middlesex Hospital, London WIN 8AA

During 1972 -1976, when the incidence of cancer rose only slightly in the United Kingdom and the number of cancer patients seen at a large metropolitan teaching hospital and oncological centre remained largely unchanged, the use of cytotoxic drugs rose from 5·1% to 14% of the hospital’s total drug budget. Most of the rise in cost can be ascribed to the increased use and increased unit cost of four effective but expensive drugs. Although the cost of drugs is but a small proportion of the cost of care of the cancer patient, it is argued that cytotoxic chemotherapy cannot offer a "cheap alternative" to surgery and radiotherapy. In a health service with cash spending limits the use of the more expensive cytotoxic drugs should be limited to the treatment of patients in whom "cure" or long-term ablation of disease is being attempted or to protocol studies in which their effectiveness is compared with that of other, possibly less expensive, drugs. Further studies are required of the use of the less expensive cytotoxic drugs in order to maximise their usefulness in the palliative treatment of advanced disease. Summary

INTRODUCTION

THIRTY years after its introduction, the use of cytotoxic chemotherapy for the treatment of human cancer is firmly established, alongside surgery and radiotherapy. Except for the theoretically promising, but clinically unproven, role of immunotherapy in enhancing any pre-existing "host response" to tumour, cytotoxic chemotherapy is the only method available for treating widely disseminated disease. The greatest advance promised by the use of cytotoxic chemotherapy is the prevention of spread of apparently "early" disease controlled locally by surgery and/or irradiation since the

and Dr P. Davies, department of methemancal statistics, for statistical guidance. Requests for reprints should be addressed to J.S. REFERENCES 1.

Report of the Committee Stationery Office, 1964.

on

University Teaching

Methods. London, H.M.

2. 3.

Bligh, D. A. in What’s the use of Lectures? London, 1972. McLeish, J. in The Psychology of Teaching Methods; p. 252. The National Society for the Study of Education, Chicago, 1976. 4. Walton, J. N. Br. med. J. 1977, ii, 1262. 5. Fiel, N. J. J. med. Educ. 1976, 51, 496. 6. Hartley, J., Cameron, A. Educ. Rev. 1967, 20, 30. 7. Stoward, P. J. Med. Educ. 1976, 10, 315. 8. Lloyd, D. H. Visual Educ. Oct. 1968, p. 23. 9. Thomas, E. J. Studies in Adult Education, 1972, 4, 57. 10. Johnstone, A. H., Percival, F. Educ. Chem. 1976, 13, 49. 11. Maddox, H., Hoole, E. Educ. Rev. 1975, 28, 17. 12. Krause, B. L. Med. Educ. 1977, 11, 109. 13. Foley, R., Smilansky, J., Bughman, E., Sajid, A. ibid. 1976, 10, 369. 14. Cantrell, E. G. Br. J. med. Educ. 1971, 5, 309. are potentially effective in controlling micrometastases and small-volume disease undetectable

cytotoxic drugs

by inspection and palpation. In the United Kingdom the treatment of cancer is regarded as a "major need" and the resources made available by the National Health Service (N.H.S.) increased as the number of patients and the complexity of treatment increased. During 1950-1976 the total cost of the N.H.S. rose from under 4% to approximately 6% of the gross U.K. national product.’ Over the past few years, however, more rigorous questioning by the N.H.S. of its immediate goals, and the economic condition of the country, have led to economic pressures to reduce the proportion of the total health budget allocated to the treatment of cancer patients. Non-replacement of radiotherapy treatment machines which have reached the end of their useful life and the diversion of junior medical posts from teaching hospitals to district general hospitals makes it more difficult to retain centres of excellence in surgical oncology and to achieve a "team" approach to which surgeon, radiotherapist, and physician all contribute appropriate skills. In this context, it seemed appropriate to examine the costs of the oncological services in a large metropolitan teaching hospital with special interests in cancer; this paper deals specifically with the cost of cytotoxic chemo-

therapy. THE HOSPITAL

The

has

hospital approximately recognised specialties, and includes

800 beds for most a

large pre-clinical

and clinical medical school. Accommodation has been specifically designated for the care of cancer patients since the 18th century and 60 beds are available for inpatients of the hospital department of radiotherapy and oncology and the medical school department of oncology. The work of these two departments is totally integrated, and the team comprises the professor of oncology, the three consultants in radiotherapy and oncology, one lecturer (senior registrar), two senior registrars, three registrars, and two (pre-registration) house officers. The registrar and senior registrar posts are linked by rotation with the regional radiotherapy centre, and the professor and consultants each have a sessional commitment to provide outpatient oncological services and consultation for in-patients in a large district general hospital remote from the teaching hospital. THE PATIENTS

During 1972-1976 inclusive the total number of new cancer patients did not vary significantly. Because of the