Sustaining Interest During Lectures with the use of Multimedia Erle ...

Lim EC, Ong BK, Wilder-Smith EP, Seet RC. Med Educ Online [serial online] 2006.Sustaining interest during lectures with the use of multimedia.Available from http://www.med-ed-online.orgSustaining Interest During Lectures with the use of MultimediaErle Chuen-Hian Lim, Benjamin KC Ong, Einar PV Wilder-Smith, Raymond CSSeet.Yong Loo Lin School of Medicine, National University of SingaporeKeywords : video, medical education, medical students, survey“A picture paints a thousand words”, goes thecliché. Indeed, pictures, in the form of photographs,charts and diagrams are de rigeur in our daily lives.Newspapers and magazines boast high-resolutioncolored images, as do respected medical journals. 1How much more information, then, can becommunicated by “moving pictures” or videos?A truism is that the written word opens new vistas,which are limited only by the reader’s imagination.Purists boycott movie adaptations of their belovednovels, decrying the crass commercialization andlack of soul that cheapens the beauty and grandeur ofthe written word. Yet, one has only to watch theHarry Potter or Lord of the Rings films to realize thatmovies, in bringing prose to life, really are magic.Some medical journals have appreciated thisphenomenon and have begun to include online orhard-copy videotape reports.To quote 19 th century American theologian TryonEdwards, "to waken interest and kindle enthusiasm isthe sure way to teach easily and successfully". Acolleague, inspired by this, gave a lecture replete withjokes, pictures and animations. He came away,satisfied that it had gone well, judging by how thestudents had participated fully, laughed in all theright bits and applauded him at the end. It was onlywhen he administered a pop quiz the next day that herealized that the students had not absorbed thecontents of the lecture at all!Few would dispute that to be effective, thespeaker has to engage his listener. No one listens to abore who, though brilliant, will likely be ignored byor disenchant his somnolent audience and thusremain uncelebrated. A tongue-in-cheek article byRockwood examined the incidence of physiciansnodding off at scientific sessions, and concluded thatcertain characteristics predisposed one to noddingoff. These include monotonous tone of voice, poorslide quality and a tendency to ramble. 2The Confucian dictum, “Tell me, and I will forget.Show me, and I may remember. Involve me, and Iwill understand”, is said to have influenced theformulation of the experiential learning cycle ofDavid Kolb. 3 The cycle basically refers to the processby which we attend to and understand ourexperiences in order to learn from them. Paired withthe Kolb Learning Style Inventory (LSI), whichmeasures preference for each of four learningorientations, viz abstract conceptualization(thinking), concrete experience (feeling), activeexperimentation (doing) and reflective observation(watching), 4,5 it has been argued that teaching andlearning environments, if matched with the individuallearning styles of students, could greatly enhanceeducational outcomes in medical schools. 6,7 The firsttwo orientations describe modes of acquiring newinformation, whereas the latter two describe thepreferred modes of incorporating new information. 8The LSI defines four discrete learning styles:convergers, assimilators, divergers andaccommodators, based on their combination ofmethods of acquiring and incorporating information.Judicious inclusion of videotaped vignettes (videos),it might be argued, would allow for an experientialelement to the teaching process. For example, insteadof describing choreiform movements in words alone,the inclusion of a videotape assessment of a patientwith chorea, coupled with a text descriptor, wouldprovide a “tie-in” to complete the experience for thestudent. We re-examined how lectures were given atour university, and felt that adding multimediapresentations in the form of videos would help ourstudents understand the material better.The Neuroscience lecture seriesAt our university, the second-year neurosciencemodule consists of a series of didactic lectures givenby anatomists, neurologists and neurosurgeons. Few,if any, incorporated video presentations, but allcontained figures, charts and photographs. Theteaching of neurology is particularly amenable to theuse of videos, as a fair proportion of the neurologicalexamination is visual as well as tactile. Evencomponents such as motor power and tone, whichrequire that the examiner “feel” the response of thepatient, can be discerned by observation as well.Interestingly, some aspects of the clinical1

Lim EC, Ong BK, Wilder-Smith EP, Seet RC. Med Educ Online [serial online] 2006.Sustaining interest during lectures with the use of multimedia.Available from http://www.med-ed-online.orgTable 1A Personal Background Male Female1 Gender (n=216) 124 (57.4%) 92 (42.6%)BDo you think thatinclusion of videos in thelecture help:Male(N=124)Female(N=92)Significance*1Yes No Yes No1 Sustain interest? 100% 0 100% 0 NAn=124n=922 Visualize concepts? 97.6% 2.4% 97.8% 2.2% 0.906n=121 n=3 n=90 n=23 Remember facts better? 76.6% 23.4% 87.0% 13.0% 0.055n=95 n=29 n=80 n=124 Understand better? 95.2% 4.8% 100% 0 *0.032n=118 n=6 n=925 Apply knowledge? 91.9% 7.3% 93.5% 6.5% 0.671n=114 n=9 n=86 n=66 Pass tests/exams? 55.6% 37.1% 65.2% 33.7% 0.147n=69 n=46 n=60 n=31C Would you like to seemore videos in yourlectures?100%n=1240 98.9%n=911.1%n=10.245DA good lecture wouldconsist of components inthe following proportions(total 100%)Male(N=124)Mean (SD)Female(N=92)Mean (SD)Significance*21 Text 37.30 (14.826) 41.09 (14.896) 0.0652 Diagrams/Figures 28.99 (11.348) 26.74 (9.677) 0.1273 Video 33.63 (14.026) 32.17 (14.512) 0.458*1 Pearson chi-square test ; *2 T-test for equality of means for independent samplesexamination (e.g. phenomenology of movementdisorders or the phases of a patient’s gait), are bestassessed “at a distance” i.e. on screen as well as at thebedside.Student feedback after incorporating videosSoon after incorporating videos in our PowerPointlectures, we noticed that students talked less amongstthemselves and appeared to pay better attentionduring the lectures. We were heartened, as well,when students provided positive verbal feedback.Realizing that we should enlist the opinions of our“consumers”, who could provide feedback to help usimprove as lecturers and educationists, we performeda simple survey of 216 medical students after anhour-long lecture on movement disorders. Ourquestionnaire consisted of 11 questions. In it, weasked if they felt that inclusion of videos in lectureshelped sustain interest, visualize concepts, rememberfacts, understand the lecture, apply knowledge andpass tests/exams. Finally, we asked if they would liketo see more videos in lectures and what proportion ofan ideal lecture should consist of text, figures anddiagrams and videos. We were aware of thelimitations of the survey, in that it was limited to oneclass, one field of study and one lecture, but felt thatthe feedback would be useful to our performances aseducators.All of our students (124 males, 92 females)completed the questionnaire. The results aresummarized in Table 1. Students ranged in age from19 to 23. All felt that inclusion of videos helped tosustain interest in the lecture. 97.7% (211/216)agreed that the videos helped them to visualizeconcepts better, whereas only 81% (175/216) felt thatvideos would help them remember facts better.97.2% (210/216) were of the opinion that the videoshelped in their understanding of the lecture, and 93%(200/215) saw benefit in terms of application ofknowledge. Interestingly, only 62.6% (129/216)envisaged that videos in lectures would help thempass tests or examinations better, yet all except onefemale student felt that they would like to see morevideos in their lectures. Approximately a third each2

Lim EC, Ong BK, Wilder-Smith EP, Seet RC. Med Educ Online [serial online] 2006.Sustaining interest during lectures with the use of multimedia.Available from http://www.med-ed-online.orgof text, figures & diagrams and text should,according to the results of our survey, make up theideal lecture. We further analyzed the results bygender using Pearson’s chi-square test. There was nostatistically significant gender difference, except that100% of female students interviewed felt that videoshelped them to understand lectures better, but only95.2% of males (118/124) felt the same way(p=0.032).What is the role for videos in medical education?The use of videotape presentations in medicine isbecoming increasingly popular, although use islargely in distance learning, 9 such as videoconferencingor viewing taped lectures orinformational materials. Time and logisticalconstraints limit the provision of live patients formedical education, yet the honing of the doctors’skills requires live patient contact, or at least thedemonstration of physical signs or examinationtechniques. Simulation-based medical education(using mannequins, actors posing as patients andvideotape presentations) offers a viable alternative to,but not a replacement for, live patient contact. 10Procedurists (endoscopists and angiographers, forexample) have long used real-time videotransmission for mass education. Conn has reportedhow physicians are increasingly using simulators tohone their skills. Interestingly, surgeons who playvideo games are purported to work 27% faster andmake 37% fewer mistakes than their colleagues whodo not. 11 Ernst et al reported the successfulpublication, both on the Internet and in CD-ROMform, of video and digitized images of proceduressuch as angiography and colonoscopy, for a first-yeargross anatomy course. 12 A novel video feedbacktechnique has been found to be effective in enhancingmedical communications skills, 13 and the use ofpatient examination vignettes has been found to beinvaluable for demonstrating signs in various fields inmedicine. 14 This is especially useful for signs whichare rare or ephemeral. Recently, video technology hasbeen harnessed for assessment purposes. Liebermanreported the successful introduction of video clipsinto computer-based testing for a neurology module,in which examinees were asked to interpretvideotaped examination findings. 15 The RoyalCollege of General Practitioners has introduced avideo component in the membership examination, inwhich candidates’ consulting skills are assessed via aseries of videotaped doctor-patient interactions. 16 Therole of multimedia technology in education is beingincreasingly recognized. 17What did we learn from our survey?We sought to assess student perceptions of theutility of videos in lectures. More than 95% of the216 students felt that videos were useful in sustaininginterest, helping them to visualize concepts,understand better and apply knowledge, while fewerfelt that videos would help them remember facts orpass assessments. Almost all, however, indicated apreference for some proportion of videos in theirlectures.In addition to the limitations described above, oursurvey only indicates the attitudes of the students tovideo presentations, not the efficacy of lecturesincorporating videos as an educational tool. To dothis, we would have to perform a study in which 2cohorts of students are exposed to the same lecturecontent, each delivered by the same lecturer, one withand the other without accompanying complementaryvideos. Following this, an assessment can beadministered to both cohorts, testing theirunderstanding and application of the material taught.Obviously, our survey was not a true representationof student attitudes to the incorporation of videotapedmaterial in lectures, as it was carried out after amovement disorders lecture, a field in which thecomplicated phenomenology is greatly aided byvideos. Certainly, large-scale studies on the utility ofvideos in medical education, in different fields, bothpre-clinical and clinical, is indicated.Intriguingly, female students seemed to feel thatvideos helped them understand material better.Gender differences in pedagogy have beendescribed. 18 Intuitively, learning styles might dictatepreference for video inclusion, and it is unfortunatethat we could not administer the Kolb LSI to ourstudents prior to the survey.ConclusionsWe concluded that videos have a place in medicaleducation, and have increasingly incorporated videos,where suitable, in our lectures. We feel that theeffectiveness of video and other multimedia aidswould have to be assessed formally. Our surveyindicates that students find that videos enlivenlectures, and they expect to benefit from videos inlectures. Certainly, however, there is no substitutefor good pedagogic techniques and one must not gooverboard and include multimedia such as animationsand video vignettes purely for their entertainmentvalue. As educators, it behooves us to embracetechnology, especially when it makes us betterteachers and communicators. At the same time, wehave to seek the counsel of our students. To quoteKierkegaard, “Instruction begins when you, the3

Lim EC, Ong BK, Wilder-Smith EP, Seet RC. Med Educ Online [serial online] 2006.Sustaining interest during lectures with the use of multimedia.Available from http://www.med-ed-online.orgteacher, learn from the learner, put yourself in hisplace so that you may understand what he learns andthe way he understands it”.References1. Pritt B, Gibson P, Cooper K, Hardin N.What is a picture worth? Digital imagingapplications in autopsy reports. Arch PatholLab Med 2004;128:1247-50.2. Rockwood K, Hogan DB, Patterson CJ.Incidence of and risk factors for nodding offat scientific sessions. CMAJ 2004;171:1443-5.3. Kolb DA. Experiential learning: Experienceas the source of learning and development.Englewood Cliffs (NJ): Prentice Hall; 1984.4. Kolb DA. Individual learning styles and thelearning process. Cambridge (MA): MITPress; 1971.5. Smits PB, Verbeek JH, Nauta MC, Ten CateTJ, Metz JC, van Dijk FJ. Factors predictiveof successful learning in postgraduatemedical education. Med Educ 2004;38:758-66.6. Curry L. Cognitive and learning styles inmedical education. Acad Med 1999;74:409–13.7. Newble DI, Entwistle NJ. Learning stylesand approaches: Implications for medicaleducation. Med Educ 1986;20:162–75.8. Engleberg NC, Schwenk T, Gruppen LD.Learning styles and perceptions of the valueof various learning modalities before andafter a 2nd-year course in microbiology andinfectious diseases. Teach Learn Med2001;13:253-7.9. Berner ES, Adams B. Added value of videocompared to audio lectures for distancelearning. Int J Med Inform 2004;73:189-93.10. Ziv A, Wolpe PR, Small SD, Glick S.Simulation-based medical education: anethical imperative. Acad Med 2003;78:783-8.11. Conn J. The games doctors play. Physiciansare turning to high-tech simulators topractice their clinical techniques. Evenvideo-game skills prove valuable in the OR.Mod Healthc 2004;34:32-3.12. Ernst RD, Sarai P, Nishino T, Collins T, OtoA, Hernandez A, Walser EM, Chaljub G.Transition from film to electronic media inthe first-year medical school gross anatomylab. J Digit Imaging 2003;16:337-40.13. Roter DL, Larson S, Shinitzky H, ChernoffR, Serwint JR, Adamo G, Wissow L. Use ofan innovative video feedback technique toenhance communication skills training. MedEduc 2004;38:145-57.14. Welsh CJ. OD's and DT's: using movies toteach intoxication and withdrawalsyndromes to medical students. AcadPsychiatry 2003;27:182-6.15. Lieberman SA, Frye AW, Litwins SD,Rasmusson KA, Boulet JR. Introduction ofpatient video clips into computer-basedtesting: effects on item statistics andreliability estimates. Acad Med2003;78(Suppl):S48-51.16. McKinstry B, Walker J, Blaney D, HeaneyD, Begg D. Do patients and expert doctorsagree on the assessment of consultationskills? A comparison of two patientconsultation assessment scales with thevideo component of the MRCGP. Fam Pract2004;21:75-80.17. Liaskos J, Diomidus M. Multimediatechnologies in education. Stud HealthTechnol Inform 2002;65:359-72.18. de Saintonge DM, Dunn DM. Gender andachievement in clinical medical students: apath analysis. Med Educ 2001;35:1024-33.CorrespondenceCorrespondence concerning this article should bedirected to Erle Chuen-Hian Lim, M Med (Int Med),Assistant Professor, Yong Loo Lin School ofMedicine, National University of Singapore, Divisionof Neurology, National University Hospital, 5 LowerKent Ridge Road, Singapore 119074 or via email tomdcelch@nus.edu.sg.4