Editorial: The Medical Lecture—A Maligned Art Form

PERSPECTIVES IN BIOLOGY AND MEDICINE Volume 36 ¦ Number 4 ¦ Summer 1993 EDITORIAL: THE MEDICAL LECTURE—A MALIGNED ART FORM In the last five decades, the frequency with which young medical educators have discovered that the lecture is the root cause of defects in medical education is a source of amusement to a few old sophists who recall with delight bygone days when the transmission of knowledge to neophytes was a matter of major importance. It is doubtful that any other professionals examine, criticize, and flagellate their colleagues as frequently or as intensively as medical educators. Since finding fault is the ultimate measure of the critic and the medical lecture continues to retain a prominent place in education in spite of the disdain with which it is so commonly regarded, a call for the deemphasis of this art form is not surprising. Never mind that the primary cause of our discontent is the problem of how to accommodate the explosive generation of knowledge in a historically fixed block of time. Unable to mobilize the effort for a sane approach to curricular revision by insisting that the desired amounts of humanities, sociology , psychology, ethics, statistics, basic genetics, and biochemistry be the prime collegiate prerequisites for entry to medical school, we search for impossible solutions by manipulating the few variables over which the faculty has some control. How better to begin than by giving another swift kick to the muchabused medical lecture? The only qualification we bring to the task is the experience of having sat through more lectures, many of which were mediocre or downright bad, than have most of our readers. If most violin soloists performed as poorly as most medical lecturers, we would have an even greater shortage of musical virtuosos, probably with a corresponding increase in saxophonists to plague us. Comparing a violinist to a lecturer leads us to look on the medical lecture as an art form. At first blush it may seem strange to consider the delivery of scientific knowledge an art. Since, however, we concede that most of the poor lectures we have suffered were delivered by individuals possessing a reasonable mastery of their specialty, we conclude that something other than science is involved here. We are dealing with a phenomenon that cannot be defined with precision, let alone measured or quantified; and whatever this something is, we consider it important . A well-executed lecture has a charm that transmits to its recipient delight as well as knowledge. It is for this reason that the medical lecture is an art form. A well-crafted medical lecture is an excellent vehicle for the transmission of knowledge. That does not mean it is the only, or even the most important, Perspectives in Biology andMedicine, 36, 4 ¦ Summer 1993 | 547 component of medical education. It cannot replace the laboratory, the bedside, the textbook, the rounds, the demonstration, the clinic, or the seminar. Still, we regard the lecture as an effective and economical mechanism for the transmission of knowledge. Medical students have, in most instances, relied on this form of learning for at least eight years of their education. While a case can be made that independent forms of self-directed learning are desirable components of the students' maturation, old habits are difficult and painful to change. The vast bulk of information students encounter in medical school can be overwhelming without a guide to lead a path through the morass. The lecture gives particular comfort to students who acquire knowledge more easily by oral transmission than by reading. For all of them it provides a framework to guide them through their encounters with the written word. The lecture highlights the facts, principles , and concepts most desirable to retain. Finally, if the lecture is delivered by a scientist who has made a substantial contribution to an understanding of the subject under consideration, the student has an opportunity to share vicariously in the excitement of discovery. We recall with exaltation lectures delivered by Arthur Rubenstein on the nature of diabetes mellitus, Stephen Fajans on the treatment of diabetic coma, Jerome Conn on the discovery of aldosteronism, Janet Rowley on the chromosomal abnormalities in leukemia, Carl Cori on intermediate carbohydrate metabolism, William Damashek...