Skipping class is the new normal. What does it mean for med school today?

As a second-year medical student, Brittney Kolb skips class sometimes—and her school is OK with that.

Kolb, who attends Pacific Northwest University of Health Sciences College of Osteopathic Medicine (PNWU-COM), is part of a growing demographic of medical students who choose to watch recorded classroom lectures remotely, at their own pace, instead of attending class in-person.

Nearly a quarter (23.5 percent) of second-year medical students reported in 2017 that they “almost never” attended class, an increase of 5 percentage points from 2015. And only about 13 percent of students reported attending lectures often.

As today’s first- and second-year students juggle preclinical coursework with preparing for their national licensing exams, they are turning to technology, such as videos and high-yield notes via online test-prep resources, to help them multitask and maximize their precious time. Educators, in turn, are adapting to meet the growing demand for on-demand learning.

Since a change in attendance policy last year, PNWU-COM has seen a 44 percent increase in student viewing of online lectures over the previous year. The school’s new policy mandates attendance at labs, including clinical simulation, and any activity that has a quiz component, but lectures can be attended in person or watched online.

“I really tried during my first semester to attend lecture and found I had a hard time putting it all together in that hour,” Kolb says. “I much prefer to watch and pause when I don’t understand something rather than attending and then coming home to figure it out on my own. It saves that hour for me.”

The self-guided student

At A.T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA), the modern, self-guided student is not an anomaly but the norm. The school has a unique educational approach—after an accelerated first year on campus, students begin clinical rotations second year at community health centers across the country.

“We are moving increasingly away from lecture-based in year one, toward more active teaching and learning classroom environments, more engaged environments,” says ATSU-SOMA Dean Jeffrey Morgan, DO, MA.

At the college, lectures are supplemented with small group discussions and activities, says Dr. Morgan. The teaching facility was designed with this interactive learning environment in mind—smaller satellite rooms are positioned around a circular lecture hall.

“If you make the content engaging and create an active learning environment as a carrot, students want to come to class, without forcing it or mandating it,” says Dr. Morgan.

At ATSU-SOMA, after the first year, coursework becomes more self-guided for students, with lectures delivered via video podcasts, or vodcasts. This is supplemented with in-person, small group instruction one to two days a week led by a physician embedded in the CHC.

To attend or not attend

Whether to attend a lecture in person or watch it recorded depends on an individual’s learning style, says Kimia Etemadi, OMS III at ATSU-SOMA, who is also pursuing an MPH.

Recorded lectures really help people who are auditory learners like herself, Etemadi says. “Listening to lectures isn’t something that’s going to work for everybody,” she says. “I know some friends that really like going to lecture and can take notes and ask questions then and there.”

Because she’s pursuing two degrees, time-saving is crucial for Etemadi, who says she attended lectures in-person about 30 percent of the time her first year. She also found recorded lectures particularly useful as review aids on the day of an exam in some of her tougher classes.

“I personally love having my own schedule and organizing my day to suit it,” Etemadi says. “If I have a day where I’m too tired to focus on a lecture, I can listen to it at my pace, when I’m more alert.”

Kolb agrees.

“There are certainly not enough hours in the day of a med student,” she says. “You find what works for you and you find the way you’re most efficient, and for me it was the luxury of pre-recorded lectures.”

Merit-based policy

William Carey University College of Osteopathic Medicine (WCUCOM) is currently trying out a merit-based attendance policy that allows students meeting a grade threshold to opt out of attending lectures in person. Those that don’t meet the threshold must attend at least 80 percent of the time.

“It’s really about empowering each other and looking at techniques for engagement,” says WCUCOM Dean Italo Subbarao, DO, MBA. Millennials who were raised with technology need to be offered a strong online component and other means of engagement such as gaming-style approaches, he says.

“A sage on a stage is a dying dinosaur. The millennials really want to engage and you have to give them mechanisms to engage,” Dr. Subbarao says.

Despite this, there also must be some level of hands-on learning, especially for instruction in osteopathic principles, he says.

“When you start to get into clinical discussions and OPP, it’s very difficult to manage that via technology,” Dr. Subbarao says. “There is a richness that can only be derived in that hands-on environment, and it’s not something that can be put into a video.”

Does attendance matter?

Whether class attendance has an effect on student learning is something that educators have been questioning since the shift toward self-guided studies began.

Uzoma Ikonne, PhD, a pharmacology assistant professor at ATSU-SOMA, set out to examine first-year med student preferences for content delivery and whether there was a relationship between class attendance and grades. The results of a study he led showed that a significant decrease in student attendance during the school year did not lead to any significant drop in aggregate mean course grades.

“Students regarded lecture capture recordings as a practical alternative to attending class; however, podcasts were the preferred modality for receiving didactic content,” concluded the study, which was published last year in The Journal of the American Osteopathic Association.

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