“Just thinking about going to an interactive session makes my hands start to sweat,” says one physician, who prefers to remain anonymous. “I have no idea why, but just the thought gets my heart racing. I'd much prefer to sit in a lecture and listen to what the experts have to say.”
He's far from alone. In fact, although adult education research has proven time and again that doctors learn best in interactive programs and that traditional lectures are the least effective format for facilitating behavior change, a survey conducted bymagazine in partnership with CME Inc., a medical education company in Irvine, Calif., found that lectures — as long as they include Q&A — still win docs' hearts, hands down, over case-based sessions, interactive “hands-on” activities, and informal discussion with colleagues. But do lectures motivate physicians to change their practice behavior? Despite all the research to the contrary, the docs say yes. Do they know something we don't?
Talk, Talk, Talk
So, as Rod Abraham, chairman and director of new stuff (that is not a joke — it's his official title) with the Professional Meeting Planners Network, Durham, N.C., asks, “Are the docs still eating the same old dog food and wagging their tails” when it comes to lectures? To find out, we asked what respondents most and least prefer in terms of educational formats, and how effective they believed each of the formats are in motivating them to change their practice behavior. The survey also asked them to rate the extent to which they agreed with various statements about meeting formats, on a Likert scale of 1 to 6, with 1 being “strongly disagree” and 6 being “strongly agree.”
On the one hand, the physician-learners' responses to the survey agree with a commonly held belief among CME providers: The all-too-frequent talking-head lecture, where the docs passively sit at the feet of the masters and absorb information, doesn't motivate most of those surveyed to change their behavior, and they're not too crazy about it, either. Basic lecture without Q&A received the lowest mark — 3.6 on a Likert scale of 1 to 6, with 1 being “not at all effective” and 6 being “extremely effective” in motivating behavior change. Basic lecture also edged out informal discussion with colleagues as the least-preferred educational format, with 33.7 percent of respondents giving it the thumbs-down.
What do they have against straight lectures? “Boring,” said one respondent, in explanation of why noninteractive lectures are at the bottom of the list. They “do not give you a chance to clarify issues” said another. “Also, it tells you what the speaker wants to say, not what you want to address.” Other comments included, “Easily forgotten,” “I fall asleep,” “no scope for brainstorming,” and, “Without questions, you can't integrate or validate knowledge, or challenge it.” The few who did put questionless lectures first, though, said they did so because they provide “more information in less time — time is always limited.” Another respondent was more direct about why he likes his lectures without a Q&A segment: “stupid questions.”
Joseph Green, PhD, associate clinical professor, Duke University School of Medicine, and founder/president of the Professional Resource Network, Durham, N.C., says that the respondents' tendency away from basic lectures “reinforces the theory that people need to be involved in their own learning in order to make a commitment to change.”
Not surprisingly, while only 8 percent of respondents said lecture without Q&A was their most-preferred format, all but one of those were aged 50 or older. “As someone who's over 50, I can make the broad generalization that the older you get, the less comfortable you are with something that's different,” says Abraham. “Physicians are trained in medical schools through lectures, and it's also been the trend for a long time in CME.”
The survey results, in fact, may actually reflect a higher-than-industry-average preference for lectures alone, because of the age of respondents. Though the respondents ranged in age from under 35 to more than 70, and ranged in years in the medical field from fewer than 10 to 50 or more, almost 60 percent were over the age of 50; and 21 percent were 65 or older. So it would seem that the older the dog, the more likely it is that it prefers the bare-bones lecture in its educational doggy dish.
No Question About It
Throw in a little interactivity, however, and lectures shot to the top of the preference list for respondents. “The survey results confirm what we have learned over the past 25 years dealing with thousands of physicians,” says Marsha Meyer, senior vice president of CME Inc. “They prefer data-intensive sessions with Q&A.”
When presented with a 1 to 6 Likert scale on which the participating physicians indicated the extent to which they agreed with statements concerning meeting formats, 64.2 percent strongly agreed that sessions should contain a mix of lecture and Q&A, as opposed to 35.8 percent who preferred less lecture and more case-based examples; 26.1 percent who said sessions should be interactive (i.e., hand-on activities); and 23.9 percent who thought meetings should include formal networking opportunities.
In fact, respondents gave lectures with a Q&A component a mean of 5 on the 1 to 6 scale on a question that asked them how effective different formats were in motivating them to change practice behavior, indicating that they found them to be very effective. This was the most-preferred format for a whopping 67.4 percent of respondents, and only 7.6 percent said it was their least-preferred way to learn; again, the older physicians tended to dislike this format in greater numbers than the younger docs.
Lectures with Q&A, respondents say, “Give attendees the opportunity to receive individualized attention for specific needs,” “allow you to get ‘expert’ opinion on a given topic,” and “cover the most information and provide opportunity to clarify points.”
“There are studies that suggest that physicians come to CME with a series of questions. As they sit in the lectures, some of these questions get answered, and some do not, or new questions are raised,” says Donald Moore, PhD, associate professor of medical education and administration; director, Division of Continuing Medical Education with Vanderbilt University School of Medicine, Nashville, Tenn. Adds Green, “Being able to ask a question that's relevant to their practice will probably help them facilitate a change in their practice. Not having that interaction would have the opposite effect.”
The Case for Case-based Activities
Case-based activities also came in second, albeit a distant one, to lecture with Q&A as the most preferred format. A total of 16.3 percent of respondents made the case for case-based activities, compared with the 67.4 percent who put lecture with Q&A at the top. When asked to rate how effective different formats are in motivating physicians to change their practice behavior, case-based sessions were second only to lecture with Q&A, with a mean of 4.7 on the 1-to-6 scale, with 6 being “extremely effective.”
“We've always found that case-based sessions are favorable for the attendees because it allows them to identify with patients who don't fall into the cookie-cutter mold of treatment, and it allows them to identify with a particular case and helps them work through other treatment options that they may not have thought about,” says Meyer. “So we were a little surprised that it didn't rank up quite so high [as lecture with Q&A], but it's still in the top two out of five.”
Age also appears to be a factor in participants' preferences for case-based activities: While only 13.6 percent of respondents age 50 or older said they preferred less lecture and more case-based examples on the question that asked them to rate their preferences, 39.4 percent of those under 50 gave case-based sessions high ratings. The combined top-two positions on the “strongly agree” end of the scale put 45.5 percent of the under-50s, compared to 30.5 percent of the over-50s, in the “want more case-based examples” camp.
While one respondent criticized case-based activities as an “inefficient use of limited time,” another physician wrote that it was lectures with Q&A that contain “too much irrelevant info,” while another said, “I seem to focus better and learn more when the format is case-based. It allows me to think of a particular client or situation.” Respondents also wrote in that case-based activities are more applicable to practice and they keep participants' attention better. “This format affords the opportunity to learn how others apply skills to real-life situations,” said one respondent.
And cases can spice up the lecture format as well. “Lectures should include more than just case presentations, though,” says Moore. “They should include case discussions.can have them break into small groups, or just talk to their neighbor about what they would do with the case under discussion.”
The Less-Liked Alternatives
The sweaty-hand syndrome was much more in evidence when it came to interactive “hands-on” activities: 17.4 percent marked this as their least-preferred format, and only 2.2 percent said it was their most-preferred format. “I've never seen one that wasn't gimmicky,” said one respondent. Another objection was that there often are too many participants for the format to be effective, and that there really needs to be a 1-to-1 educator-to-participant ratio for this type of activity to be effective.
When it comes to motivating behavior change for the surveyed physicians, interactive, hands-on activities and informal discussion with colleagues tied at a mean of 3.9 on a six-point scale, with 6 being extremely effective and 1 being not at all effective.
Despite common wisdom that more is learned in the hallways and around coffee tables than in the session rooms, the biggest loser, preference-wise, was informal discussion with colleagues, which almost a third said was at the bottom of their list and only 1 percent picked as a top format. “I do not want to discuss with a normal day-to-day practitioner,” said one respondent. “I can do that on my own,” said another. One respondent elaborated on that theme, “I come for education. Informal discussion is not ‘expert’ in the sense of controlled research.” “While socially interesting, it does not allow for a structured educational environment providing maximal information in minimal time,” said another respondent.
One did suggest that informal discussion is most appropriate in large specialty society conferences where networking is generally worked into the formal schedule.
So, Should We Lose the Lectures?
These results leave CME providers in a bit of a quandary: Should they give docs what they want, even if perhaps it isn't the best format for behavior change, waiting for the older crowd to phase out before phasing in the interactivity that appears to be more acceptable to the younger docs?
“I'm not sure we should condemn the lecture,” says Moore. “There's no question that there are too many, and there's no question that there are too many that are badly done, but our job is not to throw lectures out, but to improve how they're delivered.”
For results of a survey on education format preferences by different specialties, see “Different Strokes for Different Docs,” page 23.
For some ideas on how to liven up your lectures and increase behavior change, watch for the next issue of Medical Meetings. If you've had success livening up your lectures, or have successfully used interactivity in your activities, please contact Sue Pelletier at (978) 448-0377; email@example.com.
Set the Record Straight
Misperceptions abound: Here's what adult education research really says about lectures
David Davis, MD, associate dean, continuing education, University of Toronto, who has conducted much of the research that found lectures don't work when it comes to behavior change, would like to clarify something: “If your goal is an uptake of new knowledge, or cementing old knowledge in a doc's head, lectures are a perfectly acceptable way to do that.”
They also can lie somewhere on the continuum of factors that contribute, directly or indirectly, to behavior change. “It isn't good enough for me to sit in a lecture and expect to change my behavior,” he says. “If I'm at a CME event, maybe the first stage is to determine whether I want to, or even can, make that change, given my practice setting. Lectures can help me decide if it's worth the work to actively go after that change through small group discussion, taking away flow charts, and doing other things that will help me apply a new procedure better.”
He adds that while CME providers may hear the word “lecture” and conjure up an hour-long didactic exercise read off a PowerPoint presentation, a physician instead may be thinking of dynamic lectures given by charismatic, passionate faculty who use case-based materials, interesting slides, or even videos. In other words, all lectures are most definitely not created equal.
The Gender Gap
When the results of the survey were cross-tabulated to break out results by gender (41 women, 51 men), women tended to score their CME format preferences lower across the board than did the men. A few interesting results to contemplate:
Strongly agree that sessions should contain a mix of lecture and Q&A: Males, 43.1 percent; females, 29.3 percent. When it comes to motivating practice change, 20.7 percent of the men said lecture with Q&A was extremely effective, compared with 12 percent of the women.
Strongly agree that sessions should contain case-based examples: Males, 17.6 percent; females, 7.3 percent. When it comes to motivating practice change, 27.5 percent of the men said case-based sessions were extremely effective, compared with 19.5 percent of the women.
Strongly agree that sessions should be interactive (top two Likert positions): Males, 31.4 percent; females, 19.5 percent. When it comes to motivating practice change, 15.7 percent of the men said hands-on activities were extremely effective, compared with 4.9 percent of the women.
Strongly agree that sessions should include informal networking opportunities: Males, 15.7 percent; females, 9.8 percent. When it comes to motivating practice change, 11.8 percent of the men said networking was extremely effective, compared with 2.4 percent of the women.
The objectives of this survey were to evaluate meeting formats for CME, and to determine education format preferences for CME meetings. Surveys were distributed in person to attendees of approximately 58 CME educational half-day weekend meetings, provided by CME Inc., and supported by unrestricted educational grants, held nationwide on October 25, 2003. CME Inc.'s event staff received 92 completed surveys. The methodology, data collection, and analysis were performed by Primedia Business Magazines and MediaResearch Department.