Introduction
The lecture in its many forms is the most
commonly used method for transferring
information in medical education. There are,
however, serious questions regarding the effectiveness
of the traditional lecture approach. Arredondo et al
(1994) point out that, although the lecture method is
used extensively in medical education, academic
physicians often are not trained in giving effective lectures.
There presently are many calls to move away from the
traditional lecture to interactive computer learning
systems that allow students access to information when
and where they need it (Edlich 1993; McIntosh 1996;
Twigg 1994). While this shift to “just in time” information
provided by computer is occurring, there is, and will
continue to be, a need for educators who are prepared
to deliver lectures.
According to Swanson and Torraco (1995), the lecture
was established formally centuries ago as a teaching
process that began with a literal reading of important
passages from the text by the master, followed by the
master’s interpretation of the text. Students were
expected to sit, listen and take notes. In writing about the
lecture method in medical education, Vella (1992) defines
the lecture as the formal presentation of content by the
educator (as subject matter expert) for the subsequent
learning and recall in examinations by students. Ruyle
(1995) describes the lecture simply as an oral pre-sentation
of instructional material.
The purpose of this paper is to:
- examine the characteristics of a lecture,
- offer suggestions for planning and delivering more
effective lectures, and
- recommend ways to evaluate lectures.
Lectures in medical and healthcare education often
have a poor reputation. Edlich (1993) argues that
the lecture format for large classes is outdated and
ineffective. McIntosh (1996) observes that lecturing
is frequently a one-way process unaccompanied by
discussion, questioning or immediate practice, which
makes it a poor teaching method. So why do we
lecture? Most educators learn how to teach based
on their experiences as students. This “teach as I
was taught” approach tends to perpetuate the
lecture as a passive, one-way method of transferring
information. The lack of faculty training in presenting
effective lectures, rather than the method itself, may
be the greatest weakness of the lecture.
Lectures are generally described from the
instructor’s point of view, and the student’s need for
interaction with the instructor is not addressed. In
fact, lack of interaction is considered one of the
major limitations of the traditional lecture (Munson
1992). Furthermore, when students have copies of
the lecture notes or a text, a significant percentage
would prefer reading them rather than attending
classes that offer little or no interaction (Edlich
1993).
In a 1993 study of the clinical teaching skills of
medical student tutors, Price and Mitchell suggest
that, “Clinical teaching and learning must be an
intellectually challenging experience whereby
students, through extensive interactive teaching, are
able to gain thorough conceptual understanding.”
Price and Mitchell also cite evidence that interactive
learning is enhanced through the effective use of key
teaching skills including questioning, demonstrating,
providing positive reinforcement and reviewing.
Similarly, in support of the lecture method in medical
education, Vella (1992) recommends the use of active
learning activities including analysis of case reports,
problem-solving exercises, student presentations and
students working cooperatively in groups. According to
Twigg (1994), recent studies have shown that the
majority of college students are active learners requiring
learning experiences that engage their senses. Cavanagh,
Hogan and Ramgopal (1995), in assessing learning styles
of student nurses, recommend using a variety of
teaching styles with an emphasis on participatory and
experiential learning.
Table 1 compares the effective to the ineffective
lecture. In the effective, active lecture the instructor
involves students through a highly interactive and
participatory approach using a variety of teaching
techniques. Because of the questioning, interaction and
involvement, students are actively engaged and connected
to the educator. By contrast, in an ineffective, passive
lecture, the instructor stands at a lectern and
speaks with minimal student interaction. Not
surprisingly, after a few minutes students find it
difficult to concentrate, as there is little or no
stimulation.
Table 1. Characteristics of the Effective and Ineffective Lecture
|
Characteristics of the Effective Lecture | Characteristics of the Ineffective Lecture | |
Educator-student interaction | 100% educator talk, with limited or no interaction | |
Two-way communication | One-way communication | |
Educator-student questions | Few if any questions (educator or student) | |
Shared responsibility for active learning | Student depends on educator for all information | |
Small group, problem-solving activities | No student activities | |
Variety of supporting media | No supporting media | | Limited note taking required (students have copies of lecture notes) | Extensive note taking required |
|
Efforts to improve the teaching of medical and
other healthcare professionals must focus on
changing the role of the student from passive
observer to active participant. In this approach, the
responsibility for meeting learning objectives is
shared by the instructor and each student. One of
the most important steps in achieving this shared
responsibility is careful planning. First, however, the
instructor must be sure that the lecture is
appropriate for the particular learning situation (Table 2). When properly planned for the
appropriate type of material, the lecture can be a
very effective method of transferring information to
students. Table 2. When to Lecture
| Lecture is appropriate when: | Lecture is not appropriate when: | |
Disseminating information quickly to a large audience
|
Presenting complex, detailed or abstract information
| |
Presenting new information before using other media or
activities (e.g., a brief lecture before playing a videotape)
|
Dealing with information concerning feelings and
attitudes
| |
Providing an overview of a topic
|
Training in psychomotor (hands-on) skills
| |
Arousing interest in a topic
|
Teaching high-level cognitive skills (e.g., synthesis
and evaluation)
|
|
Adapted from: Renner 1993; Ruyle 1995.
Effective lectures do not just happen—they are
planned. The educator must:
- Establish the purpose of the lecture
- Consider the logistics of the lecture
- Plan a variety of approaches (e.g., use of
questioning, media, small group activities)
- Prepare a set of lecture notes
Purpose of the Lecture
The primary purpose of the lecture is to transfer
information from the instructor to the student. Before
developing the content of the lecture, it is a good
idea to clearly state the purpose of the lecture. The
purpose should describe in general terms what the
students will learn during the lecture. It usually is not
written in measurable terms. By contrast, an
objective is a precise and measurable statement
describing what the student will learn by attending the
lecture. Depending on the design of the lecture,
there may be a purpose, objective or both. In some
situations the objective will also describe the criteria
students must meet in order to demonstrate they have learned the content of a lecture. Following is an
example of a lecture topic with both a purpose
statement and an objective.
Lecture Topic: Development of the placenta
Purpose Purpose: The purpose of this lecture is to
acquaint students with the development of the
placenta. Students will identify the placenta, types
of placentation, the embryology of the placenta
and the functions of the placenta.
Objective: After attending this lecture, the
student will be able to locate the placenta, identify
the types of placentation, describe the embryology
of the placenta and match the functions of the
placenta to their correct description.
Lecture Logistics
After determining the purpose and objective of the
lecture, the instructor should next consider its length.
In a study of the use of videotaped lectures in surgical
oncology, Arredondo et al (1994) set the recommended
lecture time at 45 minutes, including approximately 15
minutes devoted to audience interaction. Renner (1993)
recommends that lectures last no longer than 30 minutes. Interactive lectures should last no longer than
60 minutes without giving the students a break, based
on the authors’ experience.
The number of participants attending a lecture has
a significant impact on how the lecture is presented.
Group size determines the use of questions, amount of
interaction, selection and use of media (e.g., overhead
transparencies, slides, computer-based projections,
video, audio) and use of small group activities such as
case studies, role plays and problem-solving exercises.
The most common form of interaction during a
lecture is questioning. Table 3 shows estimates of
how the number of participants can have an impact
on the use of questioning.
Table 3. The Effect of Group Size on Questioning Techniques
|
Number of Participants | Description of Questioning Techniques | |
1–20 | Both educator and students ask many questions. Students discuss lecture content with educator
and among themselves. | | 21–30 | Educator asks questions, which students answer. Students ask some questions. There is some
discussion among students. | | 31–50 | Educator asks questions, which students answer. Students ask some questions. There is limited
discussion among students. | | 51–100 | Educator asks questions, and only a small number of the students answer them. Students ask
some questions. Students are able to discuss content only with other students seated near
them. There is little or no feedback to the educator. | | > 100 | Educator asks questions, and students raise their hands to either agree or disagree. There are
very few comments or questions from the students. Students are able to discuss content only
with other students seated near them. There is little or no feedback to the educator. |
It is important to keep audience size in mind at every
step of designing the lecture. Failure to do so will
undoubtedly have a negative impact on its effectiveness.
The size and shape of the lecture room size and shape of the lecture room also
influence the design and delivery of the lecture.
Consider several common situations.
- A room with tables arranged in a U-shape and
chairs for 20 students is an ideal format for small
group lectures. It allows the presenter to
interact extensively with the students and use a
variety of small group methods and media.
- A large room with 100 chairs arranged theater-style
with an aisle down the middle makes it
possible for the lecturer to move up and down
the aisle to interact with students. The lecturer
can ask students to turn their chairs around to
form small groups for discussion.
- A lecture hall with a sloped floor and 200 seats
firmly anchored in place makes it difficult to
divide students into small groups. In this situation, one of the few alternatives is to ask
students to turn to their neighbor to discuss a
question, react to a slide or solve a problem
being shown on the projection screen.
The final logistical consideration is the media equipment
available. Most lecture halls are designed to accommo-date
the use of slides, overhead transparencies, video
and computer-based projections. In order to develop
an effective lecture, the educator must design and use
a variety of media effectively. An in-depth discussion
of developing and using various forms of media is
beyond the scope of this paper.
Lecture Components
Silberman (1990) suggests five approaches to maxi-mizing
students’ understanding and retention during
lectures. These can be used to help ensure the
effective transfer of knowledge.
- Use an opening summary. At the beginning
of the lecture, present major points and conclu-sions
to help students organize their listening.
- Present key terms. Reduce the major points
in the lecture to key words that act as verbal
subheadings or memory aids.
- Offer examples. When possible, provide
real-life illustrations of the ideas in the lecture.
- Use analogies. If possible, make a comparison
between the content of the lecture and
knowledge the students already have.
- Use visual backups. Use a variety of media
to enable students to see as well as hear what is
being said.
The key to an effective lecture style is to break down
the lecture into its component parts and use a variety
of approaches within each component. This is
especially critical when a group of students will be
attending a series of lectures by the same educator.
The three main parts of a lecture are the introduction, body and summary.
The purpose of the introduction is to capture the
interest and attention of the students. It can also serve to
make students aware of the instructor’s expectations
and encourage a positive learning climate. A good
introduction is critical to the success of a lecture.
Tips for Creating an Effective Introduction
- Review lecture objective(s).
- Ask a rhetorical question.
- Ask for a show of hands in response to a general
question.
- Ask a series of questions related to the lecture topic.
- Use an interesting or famous quotation.
- Relate the topic to previously covered content.
- Use a case study or problem-solving activity.
- Use a videotape or other media.
- Show an appropriate cartoon with the overhead or
slide projector.
- Make a provocative statement to encourage
discussion.
- Give a demonstration.
- Use a game or role play.
- Relate the topic to future work experiences.
- Share a personal experience.
- Relate the topic to a real-life experience.
Source: Sullivan and Wircenski 1996.
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The instructor can then make a smooth transition into
the body of the lecture once the attention of the
students has been captured with an interesting introduction .
The body of the lecture contains the core of the
information to be transferred to the students. Beitz
(1994) recommends that the instructor use brain-storming,
discussions, problem-solving activities, case
studies and games to make the lecture more interactive.
The purpose of the lecture summary is to draw
together the critical information presented and ensure
that students leave the lecture with a clear under-standing
of this information. The summary should be
brief and address only main points. There are several
techniques which can be used to summarize a lecture:
- Ask the students for questions. This gives students
an opportunity to clarify their understanding of
the content.
- Ask questions of the students. Several questions
which focus on the main points of the content may
be used to summarize the content of the lecture.
- Use a transparency, slide or flipchart to review
the summary points.
Lecture Notes
Many lecturers make the mistake of thinking that they
know their content well enough to deliver a lecture
without notes to guide them. This is very difficult for
most instructors and usually results in an unsatisfactory
experience for both the instructor and the student.
Instead, the instructor should prepare lecture notes to
serve as a script or set of cues to follow during the
lecture. Lecture notes are key words, phrases and
other reminders (e.g., audiovisual cues, questions,
examples, notes for activities) organized into an outline
format. If a text rather than an outline format is used,
the lecturer may begin to read the notes and the
students will become bored.
Lecture notes help the instructor:
- Stay on topic and prevent getting lost.
- Cover the main points without forgetting anything.
- Glance at a specific point and quickly return attention
to the students.
- Relax and focus on delivery instead of worrying about
what point to make next.
Source: Sullivan and Wircenski 1996.
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There are seven basic approaches the instructor can
use to outline key points:
- Standard sheets of paper (full-page or two-column)
- Note cards
- Overhead transparencies
- Flipchart pages
- Slides
- Computer-based projections
- Pages from a report, text or manual (with notes
added and key terms highlighted)
An effective lecture can be one of the most exciting
and rewarding aspects of an educator’s responsibilities.
The instructor who is able to maintain participant
interest with an exciting, dynamic delivery using a
variety of instructional methods is more likely to be
successful in helping students reach the learning
objectives. The time and effort invested in planning
pay off as the instructor and students interact, discuss,
question and work together.
Questioning Techniques
One of the most effective techniques an educator can
use during a lecture to help ensure interaction is to
ask and encourage questions. Questions can be used
to introduce lectures, stimulate interaction throughout
the lecture and summarize content. Involving students
through questioning helps to maintain their attention,
which is critical when topics are complex and lectures
are long. Suggestions for using questions include:
- Ask questions of the entire group. Those who
wish to volunteer may do so, although the
educator must guard against some students
dominating the discussion.
- Target a question to a specific student. When the
audience is relatively small, this technique can be
used to involve more of the students.
- Use students’ names when asking and answering
questions—this recognition is a powerful motivator.
- Provide positive reinforcement when students
respond. This praise will help to create a very
positive climate and will encourage more
students to enter into the discussion.
- Repeat students’ questions and answers to
ensure that all students hear the discussion.
- When a student asks a question, the educator
can answer the question directly, respond by
asking the student a different, related question or
offer the question to the other students.
The key in asking and answering questions is to avoid
a pattern. If the educator always asks and answers
questions using the same pattern, this critically
important teaching skill will have limited impact.
Presentation Techniques
The skilled lecturer uses a variety of approaches to
involve students, maintain interest and avoid a repetitive
lecturing style. A number of techniques can be used to
make a lecture more interactive and effective:
- Use the lecture notes prepared during the
planning stage. The notes include reminders
and key points in the lecture introduction, body
and summary.
- Open the lecture with a good introduction
designed to capture the interest and attention
of the students.
- Communicate on a personal level. The educator
should attempt to relate to the students during
the lecture.
- Maintain eye contact with the students. Eye
contact gives the educator feedback on how
well students understand the content and helps
to communicate a caring attitude on the part of
the educator.
- Exhibit enthusiasm about the topic. Smiling,
moving around the room and gesturing with
hands and arms project a feeling of energy and
excitement.
- Project the voice so that those in the back of the
room can hear clearly. For large lecture halls, use
a microphone if necessary, with a long cord that
will permit movement around the room.
- Avoid the use of slang or repetitive words,
phrases or gestures that may become distract-ing
with extended use. Avoid the use of fillers
(e.g., “um,” “er,” “you know”).
- Use a variety of audiovisual media.
- Ask a number of questions and encourage
students to ask questions.
- Provide positive feedback when students ask
questions, answer questions or make comments.
Use students’ names as often as possible.
- Display a positive use of humor (e.g., humorous
transparencies or slides, topic-related stories).
- Make smooth transitions between parts of the
lecture. These transitions should be highlighted
in the lecture notes and might include:
- A brief overview of the next topic
- A review of the agenda between topics
- A change of media
- An interim summary before a new topic
- An activity (case study or problem-solving
activity)
- Close the lecture with a brief but powerful summary.
Tips to Reduce Presentation Anxiety
- Avoid eating a big meal before the lecture. Not only
will a full stomach make you drowsy, but it makes it
more difficult to move around the room with energy.
- Arrive early to make sure that everything is ready
before the first student arrives.
- Make sure all of the media equipment is working.
- Locate and check the lighting and temperature controls.
- Decide where the lecture notes will be placed (e.g., on
a lectern, desk, table) when they are not being held.
- Have a glass of water available during the lecture.
- Go for a short walk just before the lecture.
- Look over your lecture notes one last time.
- Greet students as they enter the room. Shake their
hands, welcome them to the lecture and talk to as
many of them as possible.
- Take a few deep breaths to relax before beginning
the lecture.
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Evaluation questions are easy to ask and often difficult
to answer. The educator would like to know if the
lecture made a difference. How effective was the
educator in transferring knowledge to the students?
Will the information have an impact? Did the students
enjoy the lecture? How can the educator improve
the next lecture?
There are three formal techniques which can be used
to evaluate the quality of a lecture presentation. The first
is feedback from the students and typically
involves asking students to complete an evaluation form.
The second is a self-evaluation that uses a video
recording. The third formal evaluation technique
involves the use of an observer (Sullivan and Wircenski
1996). Student feedback forms are used regularly in
medical and healthcare education and will not be
described in this paper. The use of video or an observer
may be new to some educators and deserves a brief
description.
The most effective technique an educator can use to
improve the quality of presentation skills is to critique
a videotape of her/his lecture critique. When video-taping
is feasible, it is strongly recommended that the
educator periodically record lectures. Analyzing a
video allows the educator to identify positive and
negative behaviors and to set specific goals for
improving the quality of lectures. The educator can
do a self-analysis or may sit with an experienced
presenter who will help to analyze the lecture. In
either case, the educator may refer to a lecture skills
checklist (see Appendix A) to identify presentation
strengths and areas needing improvement.
Another evaluation approach involves the use of an
observer. The observer must be an experienced
presenter who watches the lecture and takes notes
using a lecture skills checklist. The educator and
observer may decide to videotape the lecture also.
Following the lecture, the observer provides feedback
about aspects of the lecture that were effective and
helps the educator identify those lecture skills needing
improvement.
Once the educator has received feedback regarding
one or more lectures, goals can be established for
improving her/his lecture skills. The key to giving
successful lectures is practice. Using this evaluation
process will result in the strengthening of positive
behaviors and the elimination of negative ones.
Follow this three-step process to conduct a self-evaluation:
- Arrange to have the lecture videotaped. Explain
to the students the reason for the recording
equipment.
- At the conclusion of the lecture, distribute a student
satisfaction form (if applicable).
- Using a lecture skills checklist, watch the videotape
(with an experienced presenter if there is one) and
critique the performance.
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With planning and effective presentation techniques,
the lecture can be a highly effective and interactive
method for transferring knowledge to students. If the
lecture is carefully planned, the educator will have a
clear purpose of the lecture and will have considered
the logistics associated with the number of students,
amount of time allocated for the lecture, room size
and available media. Planning will also help ensure that
the educator uses a variety of approaches to introduce,
deliver and summarize the lecture. Lecture notes in
outline form will help the instructor give an effective
presentation.
Other key points to remember in preparing and
delivering a lecture:
- The first few minutes of a lecture are important.
Plan them well!
- Verbal communication skills are critical. These
include appropriate voice projection, avoiding
fillers, using students’ names, making smooth
transitions, using examples and providing praise.
- Nonverbal communication skills also are very
important. These include eye contact, positive
facial expressions, gestures and movement.
- Effective questioning and interaction are critical
to the success of the lecture. Questioning skills
include planning questions in advance, asking a
variety of questions, using students’ names and
providing positive feedback.
- The lecture should be summarized by asking
for questions, asking questions and using media
to review main points.
- An evaluation using a video recording or an
observer can assist the lecturer in assessing the
quality of the presentation and improving
lecture skills.
Arredondo MA et al. 1994. The use of videotaped lectures in surgical oncology. Journal of Cancer Education 9(2): 86–89.
Beitz JM. 1994. Dynamics of effective oral presentations: Strategies for nurse educators. AORN Journal 59(5): 1026–1032.
Cavanagh SJ, K Hogan and T Ramgopal. 1995. The assessment of student nurse learning styles using the Kolb Learning
Styles Inventory. Nurse Education Today 15(3): 177–183.
Edlich RF. 1993. My last lecture. Journal of Emergency Medicine 11(6): 771–774.
McIntosh N. 1996. Why Do We Lecture? JHPIEGO Strategy Paper #2. JHPIEGO Corporation: Baltimore, Maryland.
Munson LS. 1992. How to Conduct Training Seminars: A Complete Reference Guide for Training Managers and
Professionals. McGraw-Hill: New York.
Price DA and CA Mitchell. 1993. A model for clinical teaching and learning. Medical Education 27(1): 62–68.
Renner P. 1993. The Art of Teaching Adults. Training Associates: Vancouver, British Columbia.
Ruyle K. 1995. Group training methods, in The ASTD Technical and Skills Training Handbook.
Kelly L (ed). McGraw-Hill:
New York.
Silberman ML. 1990. Active Training: A Handbook of Techniques, Designs, Case Examples, and Tips . Lexington Books:
New York.
Sullivan RL and JL Wircenski. 1996. Technical Presentation Workbook. ASME Press: New York.
Swanson RA and RJ Torraco. 1995. The history of technical training, in The ASTD Technical and Skills Training Handbook.
Kelly L (ed). McGraw Hill: New York.
Twigg CA. 1994. The need for a national learning infrastructure. Educom Review 29(4–6).
Vella F. 1992. Medical education: Capitalizing on the lecture method. FASEB Journal 6(3): 811–812.
General References
Sullivan RL, L Gaffikin and R Magarick. 1997. Instructional Design for Reproductive Health Professionals . JHPIEGO
Corporation: Baltimore, Maryland. (Forthcoming)
Sullivan RL et al. 1995. Clinical Training Skills for Reproductive Health Professionals. JHPIEGO Corporation: Baltimore,
Maryland.
JHPIEGO Strategy Papers are
designed to summarize JHPIEGO’s experience in reproductive health, with
a focus on education and training. The papers are intended for use by
program staff of JHPIEGO, USAID and its cooperating agencies and other
organizations providing or receiving technical assistance in the area of
reproductive health training.
©Copyright 1996 by JHPIEGO Corporation. All rights
reserved.
Financial support for this publication was provided in
part by the United States Agency for International Development (USAID).
The views expressed in this report are those of the authors/editors and do
not necessarily reflect those of USAID.
JHPIEGO, an affiliate of the Johns Hopkins University,
is a nonprofit organization dedicated to improving the health of women and
families globally.
CREDITS
Editor: Dana Lewison, Ann Blouse
Production Assistance: Holly Simmons
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