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Teaching large groups

Article in BMJ · March 2003

DOI: 10.1136/bmj.326.7386.437 · Source: PubMed

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 Clinical review

ABC of learning and teaching in medicine

Teaching large groups
Peter Cantillon

Lecturing or large group teaching is one of the oldest forms of

teaching. Whatever their reputation, lectures are an efficient
means of transferring knowledge and concepts to large groups.
They can be used to stimulate interest, explain concepts,
provide core knowledge, and direct student learning.
However, they should not be regarded as an effective way of
teaching skills, changing attitudes, or encouraging higher order
thinking. Large group formats tend to encourage passive
learning. Students receive information but have little
opportunity to process or critically appraise the new knowledge
offered.
How can lectures be used to maximise learning and provide
opportunities for student interaction? This article will supply
some of the answers and should help you to deliver better,
more interactive lectures.

A lecturer holds forth . . .

Getting your bearings
It is important to find out as much as possible about the context
of the lecture—that is, where it fits into the course of which it is
What you need to know before planning a lecture
part.
An understanding of the context will allow you to prepare a x How your lecture fits into the students’ course or curriculum
x The students’ knowledge of your subject—try to get a copy of the
lecture that is both appropriate and designed to move students
lecture and tutorial list for the course
on from where they are. x How the course (and your lecture) will be assessed
x The teaching methods that the students are accustomed to

Helping students to learn in lectures

An important question for any lecturer to consider when
planning a teaching session is, “how can I help my students to
learn during my lecture?” There are several different techniques The successful teacher is no longer on a
you can use to aid student learning in a large group setting. height, pumping knowledge at high
pressure into passive receptacles . . . he is
a senior student anxious to help his
juniors.
Helping your students to learn William Osler (1849-1919)
x Use concrete examples to illustrate abstract principles
x Give handouts of the lecture slides, with space to write notes
x Give handouts with partially completed diagrams and lists for the
students to complete during or after the lecture
x Allow for pauses in the delivery to give students time to write notes
x Check for understanding by asking questions or by running a mini
quiz • Outline purpose of lecture
• Describe main themes that will be
covered

• Outline and explain first key point

Planning your lecture • Illustrate with examples
• Repeat first key point
Optional student activity designed to
It is important to distinguish between the knowledge and reinforce learning first key point
concepts that are essential (need to know) and those which, • Outline and explain second key point
though interesting, are not part of the core message (nice to • Illustrate with examples
• Repeat second key point
know). Optional student activity designed to
The aims of the lecture should be clearly defined (“what do I reinforce learning second key point
• Summarise
hope to achieve with this lecture?”). These will help to define the
• Repeat main themes and conclude
teaching methods and the structure. If, for example, the
purpose of the lecture is to introduce new knowledge and
concepts, then a classic lecture structure might be most Example of a lecture plan with a classic structure
appropriate.
On the other hand, if the purpose is to make the students
aware of different approaches to a particular clinical problem, a

BMJ VOLUME 326 22 FEBRUARY 2003 bmj.com 437

Clinical review

problem oriented design in which alternative approaches are

presented and discussed might be a more appropriate format. Statement of problem

Choosing teaching media Offer solution 1

When you have selected the content of the lecture and placed it Discuss strengths and weaknesses
into a working structure, the next consideration is how to of solution 1
Optional student activity based on
deliver the message. Which teaching media should be used (for solution 1
example, slides, overheads, handouts, quizzes)? The most Offer solution 2
appropriate media will differ depending on the venue, class size,
and topic. Discuss strengths and weaknesses
of solution 2
Optional student activity based on
solution 2
Choosing the medium for delivering the lecture Summary and concluding remarks
x Which teaching media are available at the teaching venue?
x Which teaching media are you familiar with? (It is not always
appropriate to experiment with new media) Example of a lecture plan with a problem oriented structure
x Which medium will best illustrate the concepts and themes that you
want to teach the students?
x Which medium would encourage students to learn through
interaction during your lecture?

Getting started
In the first moments of a lecture it is important that the Handouts
students are given some sense of place and direction. Thus a x Handouts can encourage better learning if they allow students
brief summary of the previous lecture and an indication of the more time to listen and think
major themes and learning objectives for the current session x Handouts should provide a scaffold on which students can build
provide both you and the students with a relatively easy start. If their understanding of a topic
x Handouts should provide a summary of the major themes while
you are working with a new group it may be useful to indicate
avoiding an exhaustive explanation of each
the ground rules for the session—for example, “switch off x Handouts can be used to direct further learning, by including
mobile phones,” or “ask questions at any time.” exercises and questions with suggested reading lists

Encouraging students to interact

Students learn well by “doing.” Yet there is an understandable
tendency for students to regard lectures as an opportunity to sit
back, be entertained, and “soak up” the learning. However, you
can use various methods to encourage students to take a more
Students' recall of facts

active part in the learning process. Better

Lecture without student activity
Students’ attention (and recall) is best at the beginning and Lecture with student activity
end of a lecture. Recall can be improved by changing the
format of your lecture part way through. It is also important
when planning a lecture to think about activities and exercises
that will break up the presentation.

Ask questions
It is useful to ask questions of the group at various stages in the
lecture, to check comprehension and promote discussion. Many
lecturers are intimidated by the silence following a question and Worse
fall into the trap of answering it themselves. Wait for the Start of lecture End of lecture
answers to come. It takes time for students to move from Student
activity Time
listening to thinking mode. A simple tip is to count slowly to 10
in your head—a question is almost certain to arrive.
Graph showing effect of students’ interaction on their ability to recall what
Get students to ask you questions they have heard in a lecture. Adapted from Bligh, 2000 (see “Recommended
An alternative to getting students to answer questions is to ask reading” box)

them to direct questions at you. A good way of overcoming

students’ normal fear of embarrassment is to ask them to
prepare questions in groups of two or three. Questions can then “Tell me, and I forget. Show me, and I remember.
be invited from groups at random. When asked a question, you Involve me, and I understand”
should repeat it out loud to ensure that the whole group is Chinese proverb
aware of what was asked. Seeking answers to the question from
other students, before adding your own views, can increase the
level of interaction further.

438 BMJ VOLUME 326 22 FEBRUARY 2003 bmj.com

 Clinical review

Brainstorming
Brainstorming is a technique for activating the students’
knowledge or current understanding of an issue or theme. The
lecturer invites answers to a question or problem from the
audience and writes them, without comment, on a board or
overhead. After a short period, usually about two or three
minutes, the lecturer reviews the list of “answers” with the class.
The answers can be used to provide material for the next part
of the lecture or to give students an idea of where they are
before they move on. By writing answers in a way that can be
seen by everyone in the audience, you allow the students to
learn from each other.

Buzz groups
Buzz groups also encourage interaction. They consist of groups
of two to five students working for a few minutes on a question,
problem, or exercise set by the lecturer. Buzz group activity is a
useful means of getting students to process and use new
information to solve problems. At the end of the buzz group
session, the teacher can either continue with the lecture or
check the results of the exercise by asking one or two groups to
present their views. Remember that in an amphitheatre lecture
hall, students can sit on their own desks to interact with the
students behind them.
"One-minute" paper worksheet
Mini-assessments
Name:
Mini-assessments and exercises are used in lectures to help
students to recognise gaps in their learning and to encourage Date:
them to use new material in practice. Brief assessments can also
allow the lecturer to measure how well the messages are being Lecture title:

understood. Students could be asked, for example, to complete

Directions: Take a moment to think about the lecture you have just attended,
a brief, multiple choice questionnaire or a “one-minute” paper.
and then answer the following questions.
The timing of quizzes and exercises will depend on what is
required. An assessment of prior learning would be best at the 1. What was the most important thing you learned in today's lecture?
start of a lecture, whereas an estimate of learning from the
current session might be best carried out towards the end of the
lecture.
2. What question remains uppermost in your mind at the end of today's lecture?

How to end your lecture

3. What was the "muddiest point" in today's lecture?
At the end of a lecture it is important to summarise the key
points and direct students toward further learning. You may
present the key points on a slide or overhead. Alternatively, you
may go through the main headings on a handout. Students are
encouraged to learn more about a subject if they are set tasks or Example of a one-minute paper
exercises that will require them to look further than the lecture
notes for answers and ideas. The end of a lecture is also a
common time for questions. Students may find the use of a
one-minute paper a useful tool to help them to identify
concepts and impressions that need clarification.
Please rate the lecture on the following items

Evaluating your lecture Strongly Slightly Slightly Strongly

agree agree disagree disagree
Practice does make perfect, but the process of developing as a Clear
lecturer is greatly helped if some effort is made to evaluate
performance. Evaluation involves answering questions such as Interesting
“how did I do?” or “what did the students learn?”
A lecture can be evaluated in different ways. If the students Easy to take
notes from
are to be used as a source of feedback, the following methods
Well organised
are useful:
x Ask a sample of the students if you can read their lecture
Relevant to
notes—this exercise gives some insight into what students have the course
learned and understood
x Ask for verbal feedback from individual students
x Ask the students to complete a one-minute paper Example of an evaluation form focusing on the lecture. Adapted from
x Ask the students to complete an evaluation questionnaire. Brown et al, 2001 (see “Recommended reading” box)

BMJ VOLUME 326 22 FEBRUARY 2003 bmj.com 439

 Clinical review

If you want to evaluate your teaching style and delivery,

peers can be a useful source of feedback: Please rate the lecturer on the following items
x Ask a colleague to observe part or all of a lecture and provide
feedback afterwards. It is important to inform the observer what
Strongly Slightly Slightly Strongly
aspects of the lecturing process you want evaluated—for agree agree disagree disagree
example, clarity, logical flow, effectiveness of the media used Was
x Videotape the lecture for private viewing, and arrange a joint enthusiastic
viewing with a colleague later. Was clearly
Lectures are still a common teaching method in both audible

undergraduate and postgraduate medical education. Their Seemed

confident
continued popularity is due to the fact that they represent an
effective and efficient means of teaching new concepts and Gave clear
explanations
knowledge. This article has emphasised the importance of good
Encouraged
lecture planning and of the inclusion of student interaction to participation
ensure effective learning.

Example of an evaluation form focusing on the lecturer rather than the

lecture. Adapted from Brown et al, 2001 (see “Recommended reading” box)
Recommended reading
x Newble DI, Cannon R. A handbook for medical teachers. 4th ed.
Dordrecht, Netherlands: Kluwer Academic, 2001.
x Gibbs G, Habeshaw T. Preparing to teach. Bristol: Technical and The ABC of learning and teaching in medicine is edited by Peter
Educational Services, 1989. Cantillon, senior lecturer in medical informatics and medical education,
x Bligh DA. What’s the use of lectures? San Francisco: Jossey-Bass, 2000. National University of Ireland, Galway, Republic of Ireland; Linda
x Brown G, Manogue M. AMEE medical education guide No 22: Hutchinson, director of education and workforce development and
refreshing lecturing: a guide for lecturers. Medical Teacher consultant paediatrician, University Hospital Lewisham; and Diana F
2001;23:231-44. Wood, deputy dean for education and consultant endocrinologist, Barts
and the London, Queen Mary’s School of Medicine and Dentistry,
Queen Mary, University of London. The series will be published as a
BMJ 2003;326:437-40 book in late spring.

Lesson of the week

Epistaxis: an overlooked cause of massive haematemesis
in cirrhosis
Shawinder S Johal, Andrew S Austin, Stephen D Ryder

Epistaxis should The national audit of acute upper gastrointestinal fibrin on a varix) or when varices are the only lesion
be considered haemorrhage reported an overall incidence of acute identified.4 5
as a cause of upper gastrointestinal haemorrhage in the United We describe two patients with alcoholic liver
massive Kingdom of 103 cases per 100 000 adults a year. disease and haematemesis whose bleeding was not
haematemesis Varices have been identified as the source of blood loss controlled by endoscopic treatment. Delayed diagnosis
in patients with in 8% of patients aged less than 60 years, and mortality of severe epistaxis led to prolonged haemodynamic
cirrhosis among these patients is four times the overall mortality instability and further decompensation.
for the age group in patients with haematemesis.1
The most dramatic presentations often occur in
Division of
patients with chronic liver disease. Variceal bleeding is
Case reports
Gastroenterology,
University Hospital, a life threatening complication of cirrhosis, and Case 1
Queen’s Medical
Centre, Nottingham survival is closely related to failure to control haemor- A 45 year old woman with alcohol induced cirrhosis
NG7 2UH rhage or early rebleeding, which occurs in as many as (Child’s-Pugh class C) and idiopathic thrombocyto-
Shawinder S Johal 50% of patients.2 In cases of suspected variceal penic purpura presented with shock after fresh
specialist registrar
bleeding, immediate treatment with agents such as ter- haematemesis. On admission she had a haemoglobin
Andrew S Austin
lipressin or octreotide is recommended, followed concentration of 24 g/l, platelets 10 × 109/l, and
specialist registrar
within 12 hours by upper gastrointestinal endoscopy, prothrombin time 16.0 s (control 10.0 s). She was
Stephen D Ryder
consultant which is essential for accurate diagnosis and allows resuscitated with transfusion of whole blood, fresh fro-
gastroenterologist variceal sclerotherapy or band ligation.3 Endoscopic zen plasma, and platelets. Variceal bleeding was
Correspondence to: diagnosis can be difficult when views are obscured by suspected, and she was given an infusion of octreotide.
S D Ryder blood. Nevertheless, a diagnosis of variceal haemor- Gastroscopy showed a large volume of fresh blood
stephen.ryder@mail.
qmcuh-tr.trent.nhs.uk rhage is acceptable when a venous spurt is seen or restricting the view of the oesophagus and stomach.
there is fresh blood in the lower oesophagus in the No source of bleeding was identified. The patient’s his-
BMJ 2003;326:440–1 presence of varices. In about half of cases there is no tory indicated that variceal bleeding was the most likely
active bleeding; variceal haemorrhage is indicated by cause of blood loss, and a Sengstaken-Blakemore tube
the presence of a “white nipple sign” (a plug of platelet was inserted.

440 BMJ VOLUME 326 22 FEBRUARY 2003 bmj.com

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