When I was a medical student, some enterprising classmate started a note taking service so we wouldn’t have to take notes on our own. He set up a tape recorder and transcribed the notes for distribution the next day. One day, our professor showed up with a tape recorder, set it up on the table in front of the lecture hall, and turned it on. The result was an electronic pas de deux of tandem tape decks whispering to each other as the lecture hall emptied.

The model has not changed much since then.

Research shows that active learning gets more results than passive learning. One medical school finally got the memo and has eliminated those dreaded lectures, that, until now, every medical student has experienced.

“Give up power to empower.”

This is the teacher’s mantra for teaching. For too long, students have been conditioned not to have power in their education. As PBL helps to empower students, the teacher must be willing to give up the power to them. Don’t be a helicopter. Be present, but also give space for them to take ownership and problem solve.

Medical school education is badly in need of reform and should follow these principles:

• Whatever we recommend should be aligned with the vision and mission of the institution.
• Teaching hospitals are but a part of a community of care and their roles are being redefined not just in the areas of clinical care, but research and education as well.
• The goal is to create graduates who can serve the needs of the community by improving population health, reducing per capita costs, and improving the patient and provider experience.
• Education and research are stepchildren to clinical care. Just follow the money.
• Education is different than training.
• Management is different from leadership, entrepreneurship, and innovation.
• Terms like innovation, value, and disruption are used often, with great passion, misinterpretation, and misunderstanding.
• Those that don’t walk the talk can only come back to the well so many times.
• Teaching is not easy or free, only considered by those who pay the bills to be so.
• What, who, when, and how we teach and measure outcomes is insufficient, costly, and badly in need of innovation.
• Education needs to be responsive to the forces driving the Fourth Industrial Revolution.
• Students should be selected based on their Steampathie (thanks, Thomas Friedman).

Based on survey data, here are some things medical schools should improve:

• Offer career services
• Do a better job with customer service
• Cut the costs
• Offer digital health and data science courses
• Rethink how to test competencies, not recall
• Change how applicants are screened and selected
• Use technologies to teach
• Assign every student a mentor
• Create associate degrees in medicine
• Offer bioentrepreneurship education and training

Education should be active, not passive.

I’ve been a student and teacher for many years and have participated in online, hybrid, and face-to-face formats, proctored case-based learning groups, serve as an iCorps teacher, and have been a surgical attending for my entire career. Here’s what I’ve learned:

• Active learning takes passive teaching.
• Medical educators are not taught to teach, regardless of whether it is active or passive.
• Using a flipped classroom and facilitating active learning takes more planning and is harder than giving a 50-slide PPT presentation.
• Some students thrive in an active learning environment. Others sit and say nothing.
• In most group learning situations, 20 percent of the participants will do 80 percent of the work.
• Since all medical students are required to pass several multiple-choice tests to practice, the end result is they learn to the test.
• If you choose the students in the top 0.5 percent of academic achievement and tell them they will have to pass a test in two years, they will find a way to pass it regardless of how you occupy their time in the interim.
• In many instances, particularly when students are tested on recall rather than problem solving or interpretation, the teacher is a placebo and their teaching ability is not correlated with student outcomes.
• Everyone thinks teaching is easy, anyone can do it, and medical schools shouldn’t have to pay for it.
• Education is probably the least important part of entrepreneurial education. What really counts are resources, mentors, networks, experience, and peer support.

You can be PowerPointless by using:

• Guest speakers and fireside chats
• Office hours
• Flipped classroom
• Case-based learning
• Project team learning
• Problem-based learning
• Student-designed goals and learning objectives
• Open education resources
• Student engagement techniques
• Simulations

Pulling the plug on lectures sounds like a good idea. Without consistent and proper alignment with premed and postgraduate residency training, however, it might just be another lesson learned. You can pick up your notes at the usual place tomorrow at 7 a.m.

Arlen Meyers is a physician executive.