When I recounted this vignette to a colleague, he recalled a classmate who was renowned for being stoned during most of his preclinical training. Years later, despite this state of altered consciousness (or maybe because of it?), he was able to solve some thorny problems in medicine for which he was awarded a Nobel Prize. Is there a moral to these stories? Hopefully not.
Fast forward a few more decades, and I am the guy standing at the front of the lecture hall gazing out at a sea of mostly empty seats. Where have all the second-year medical students gone? Clearly not to class. I estimate that the room is less than half filled, meaning there are only 80 students in attendance. Some appear to be focused on my lecture slides demonstrating the histopathology of leukocytoclastic vasculitis, while others are busy, no doubt checking their Facebook pages or tapping out text messages. A few of them don’t seem to mind using their hard plastic desktops as pillows and are using the time to catch up on their sleep. At least I don’t see any entwined bodies out there.
The Lecture Hall Is Dead
What has happened to the medical school lecture hall? For those of you who have been absent from class, some fairly dramatic changes are taking shape. First, let’s review a bit of history. In the 1970s and 1980s, as student enrollments mushroomed and physical facilities that were mostly built in the postwar era became cramped and antiquated, universities went on a tear, building numerous state-of-the-art facilities. Lecture halls started resembling movie theaters, full of plush seats, quality acoustics, and state-of-the-art imaging technology. They served their purpose extremely well, until the start of this century. It was around this time that our world became even more interconnected, first through wires, then via wireless systems that grew exponentially with the proliferation of mobile devices such as smart phones and tablet computing. Who needed to lecture students using a 35-mm carousel slide projector when PowerPoint presentations could be easily assembled and electronically transmitted to virtually anyone anywhere? What about those massive lantern slide projectors that were needed to crisply project the intricate detail of histology slides? Bill Gates killed that industry, too!
How Disruptive Technologies Changed the Way We Teach
The transformation to digital devices in medical education was fairly dramatic. For example, in September 2011, only three Year II Harvard Medical School students owned iPads. A mere two months later, as we started our rheumatology teaching block, nearly 95% of the class had purchased one.1 What triggered this whirlwind shopping spree? My informal survey of students confirmed their view of the iPad as the ideal multitasking device. Unlike its computing ancestors, it could simultaneously serve as a web browser, book reader, word processor, movie screen, camera, video recorder, and messaging device—all with amazing speed. In the race for computing speed, if the desktop computer is the turtle and the laptop is the hare, the iPad is the gazelle. As M. Eric Johnson, dean of the Owen Graduate School of Management at Vanderbilt University in Nashville, Tenn., observed when commenting about the changing face of business schools, “Technology used to be all about installing expensive equipment that we’d show off to you if you visited us. Now everyone brings [their] own iPad. It’s all very personal now. It requires students to take ownership of their education in ways they haven’t in the past.”2
