Challenging the one-hour university lecture

We do many things in life because we have always done them that way. This applies even when we know that what we do does not work and is unrewarding. An example is the one-hour lecture at universities, which we go on delivering despite all the evidence that it exceeds the attention span of most students, and is usually less effective in delivering information and stimulating learning than almost any other method.

I became an academic in a rather unexpected change of career in 1990. My first teaching experience was on a new masters’ programme in intellectual disability, which was set up by a colleague Dr Beryl Smith. Our students were experienced professionals working in health and social care, and studied part-time. It was difficult for them to get time for studying, and the course was therefore taught for one three-hour session each week. This presented the problem of how on earth we could maintain student learning over such an extended session.

Fortunately, Beryl has great expertise in teaching, and we used her idea of cutting each session into a learning sequence of different elements. This would usually start with an introduction to assess how much the students already knew about the subject, and their experiences of it. This was essential because the students came from different professions, which meant that their knowledge of different subjects was varied and unpredictable. This also gave students an opportunity to reflect on their experience. We would follow this by an introductory lecture of about half and hour, to set out the field of study. Students were then allocated into groups of four or five each, and set a problem to solve. The ‘problem’ might be an analysis of a research paper, discussion of a case study, or the preparation of a draft policy. Each group would then present their response in a plenary session, and this would be followed by a discussion. There could be three or more cycles of this kind in each three-hour session.

On a masters programme, students rightly expect to be taught by topic experts. Beryl and I did not count ourselves experts across the entire field of intellectual disability, and so we invited outside speakers for several sessions. This had the advantage of exposing students to different outlooks, and so stimulated awareness of the difficult policy and ethical dilemmas that frequently arise in working with people with intellectual disabilities.

Looking back on this experience, I realise that we used so many different teaching methods (orienting lecture, reflection, case studies, group problem-solving etc) because Beryl understood that people learn in different ways. Traditional lectures, by contrast, are based on the assumption that there is only one way to learn: by remembering what the teacher says.

A few years later, our masters programme in intellectual disability was converted to distance teaching on the Open University model. By that time, Beryl Smith had retired. Another colleague and I developed distance texts corresponding to each session on the programme. Individual texts still followed the concept of a learning sequence, but self-completion activities replaced group discussions. We ended up with rather more texts than is usual for distance programmes, but students on the programme tell us that they find our texts stimulating and easy to follow.

Moving to distance education had a disadvantage for me. I enjoyed face-to-face teaching, and now I was doing a lot less of it. I eventually moved more into undergraduate medical education. This was a very different world. Teaching was organised into one-hour lectures to 300+ students, plus one-hour tutorials for small groups. As the number of medical students in the University expanded, the ‘small groups’ did too, and eventually we had 22 ‘small groups’, each with about 17 students. Small group tutorials at that time were usually chaired by a staff member and seemed to follow a defined procedure with a clearly-specified set of correct answers which each ‘small group’ was led to discover. However, it has become difficult in some subject areas to find sufficient academic staff to chair all the ‘small groups’, and this has led to greater creativity, with some staff developing self-directed ‘small groups’ in which students are set a problem, and produce a written response which is loaded on WebCT.

For the last three years, I have helped run a module on health services and disability for second-year undergraduate medical students. This comprises ten four-hour sessions, each on a Monday morning. Working with my colleagues Andy Shanks and Dr Qulsom Fazil, we gave each four-hour session a common theme (‘learning disability’, ‘care and carers’, ‘international health’ etc), and divided responsibility for individual sessions between us. Most of these sessions were scheduled to begin with two hours of lectures, followed by two hours of small group teaching. Weighed down by tradition, I initially planned the first two hours as two one-hour lectures. These evoked the usual polite but uninspiring response from students. So I cursed myself for conforming, returned to my experience in masters education, and renewed the idea of teaching using a learning sequence.

I therefore used the first two hours in each session for a sequence of short (half-hour) lectures from a range of presenters, interspersed with short films and question and answer sessions. I have tried to begin these with a film or a personal account which introduces the students to the reality of disability or being a carer, as the case may be. This is followed by a short orienting lecture to clarify terminology and numbers, and present key issues. Further films and short lectures build on this. I have used outside expert speakers to cover more specialist issues. This ‘blended sequence’ approach has been successful, and I will try and improve it further.

I also changed small group teaching on the module, by introducing tutorials led by individual people with an intellectual disability. These were recruited from groups that train and support disabled people in teaching and public presentations. These sessions were much appreciated by students, and helped them develop empathy for living with a disability. However, they were cancelled for this academic year because no budget had been identified to meet the cost of transport and sessional payment. Yet it is surely probable that the University will reinstate this form of teaching, given increasing national concern about the standard of healthcare received by people with an intellectual disability.

I am now quite close to retirement, and so other people will soon become responsible for teaching intellectual disability to medical students in my university. I am encouraged that my colleagues responsible for the medical degree have a firm commitment to innovative and effective education. I hope that in some way I have provided stimulating company for them.