Outline

This chapter is an overview of recent literature aiming to define whether, why, and how the large group oral tradition continues to have a valued place in the medical curriculum. It reviews features of the large group genre that are specific to medicine and presents opposing opinions about the value of the genre. It summarises recent research evidence from the medical domain and tries to find what makes large group teaching most effective.

Having established that charisma and the ability to tell a good story can have a powerful impact on an audience, it suggests that excellent lecturers should continue to lecture despite the growing challenges to this medium. It considers the affordances of new educational technologies and how they can enrich the large group genre. It suggests how to evaluate large group events, and lists useful publications.

There are many assumptions embedded in the terms ‘lecture’ and ‘large group’. This chapter follows Biggs and Tang’s (2007) lead in using the neutral term ‘plenary session’ to mean a many (learners) to one (teacher) event, where the number of learners is great enough (12 or more) to prevent leadership being invested in a ‘small group’ activity of the type described in Chapter 9. The term ‘lecturer’ is used throughout this chapter to mean a facilitator of such a plenary session. Like any good facilitator, an effective lecturer will use techniques ranging from eloquent rhetoric to the appropriate use of silence and is very likely to engage learners into active learning (possibly in small [buzz] groups) for at least part of the allotted time. This chapter is applicable across the undergraduate–postgraduate-continuing education spectrum but has a conscious bias towards undergraduate education because that is where plenary sessions are more often used and abused.

Introduction

Large group teaching has as long a history as medical education itself. Until textbooks came into being, the only way of acquiring a breadth of medical knowledge was to study all the primary sources oneself or attend lectures (Small and Suter, 2002). The oral tradition has survived the advent of the textbook and, more recently, the self-directed learning movement, which spawned policy documents calling for a move away from a ‘transmissive’ style of medical education.

Now that Web technologies (General Medical Council, 1993) offer increasingly sophisticated alternatives to individuals assembling at a single location at a single time to hear a single person speak, a society concerned about greenhouse gas production might reasonably argue that the lecture should at last be consigned to history. But even if technology-mediated alternatives finally win the day, should we not identify what has made large group teaching, and in particular the lecture, such an enduring educational medium, and use that insight to help make best use of the new opportunities afforded us?

The large group genre

Learners in historical paintings are typically depicted clustering around a master, who is holding forth as he conducts a practical demonstration. Changes over time have changed the genre to the one we know today. Rather than gentleman scholars and curious lay people, audiences for plenary sessions are registered learners who are quite narrowly focused on a particular course of study. Despite medical school expansion and the use of audio–visual technology, contemporary learners in plenary sessions still sit in tiered ranks akin to those adopted in Padua and Leiden centuries ago. Freshly executed criminals are no longer available and, even if they were, would not be made welcome in lecture theatres by the custodians of health and safety, so practical demonstrations have generally given way to verbal and pictorial representations of subject matter. The historical ‘theatre in the round’ has given way to an auditorium centred on a lectern and screen. The hanging skeleton and clinical couch may still be there but the couch is used less as doctors become more scrupulous about exposing patients’ peculiarities to several hundred pairs of eyes; audio–visual technology has demoted the skeleton to a passive onlooker.

The one constant feature of the large group genre is the central position of the lecturer, though today lecturers are more likely to be anonymous reproducers of didactic facts than scholars extending the boundaries of their discipline (as depicted in historical medical art). Medicine is a huge, knowledge-rich discipline, which leads staff and learners to regard lectures as a way of defining a curriculum within the curriculum. Even more important, lectures are often taken as an examination syllabus with attention focused not so much on intellectually stimulating aspects of the subject matter as on specifics that might later be tested. Plenary sessions do not need to be that way. Exemplary medical practitioners and non-clinical scholars can communicate excellently and use plenary sessions both to role model what learners aspire to be and to make their otherwise tacit knowledge and professional values explicit. In that way, plenary sessions can expose large numbers of learners to an iconic figure they might not otherwise encounter. Exemplary lecturers typically have both personal charisma and good humour, tell stories about their professional experiences, express compassion, and link relevant theory to practice in an intellectually stimulating way (McKeachie, 2006).

Perspectives on plenary sessions

Laurillard (2002) represented effective university teaching as an ‘iterative dialogue between teacher and learner focused on the topic goal’ and asked why the lecture (‘a very unreliable way of transmitting the lecturer’s knowledge to the learner’s notes’) had not been scrapped. In her words,

Laurillard’s preoccupation was with the need for higher education to cater justly and effectively for geographically dispersed learners from particularly heterogeneous backgrounds. If current admission policies and medical school cultures persist, however, medicine may continue to be an exception to her rule. The uniform and high entry criteria for medicine discussed in Chapter 16 allow lecturers to make reasonably safe assumptions about the capabilities and prior knowledge of their learners, conditions Laurillard regarded as prerequisite to successful lecturing.

Custers and Boshuizen’s (2002) detailed exposition of the psychology of learning took a more positive view. Whilst acknowledging that

the authors drew attention to the lack of experimental evidence that the lecture ‘is an inefficient or ineffective means to present facts or meaningful generalisations’. To the contrary, they quoted evidence that:

The stance of ‘lecture bashing’, they concluded, is driven by social and political rather than educational factors. If we accept their arguments, we should make a well-established genre work to best effect rather than demonise it.

Biggs and Tang (2007), although not writing specifically about medical education, overviewed what is known about lectures. Long periods of unbroken monologue by the lecturer make no greater demand on learners than to jot notes. The snag is that sustained and unchanging low-level activity lowers concentration, whilst the complexity of medicine’s subject matter requires high-level and persistent engagement. Good concentration can typically be sustained for only a quarter of an hour, though it can be restored by brief rest periods or changes in the nature of the activity, such as discussing the subject matter with another learner. Moreover, retention can be enhanced greatly by reviewing the content towards the end or very soon after the lecture. Again, this means getting learners to engage actively with subject matter rather than leaving the learners to absorb it passively. Simple and well known as these pedagogic techniques are, how well embedded are they in practice?

Research in the medical education domain

To access the evidence base behind plenary sessions, we searched four major general medical and five medical education journals for relevant articles published in the years 2007–2008. Many publications were uninformative because they used an unspecified plenary format as the control condition for some novel educational intervention. Twelve articles could be characterised as empirical research. Six examined how to enhance traditional lectures by including active learning techniques or adopting non-standard presentation formats; three showed benefit (Bye et al, 2007; Forgie, 2007; Koklanaris et al, 2008) and three did not (Birgegaard et al, 2008; Duggan et al, 2007; Selby et al, 2007). Three articles claimed benefit for various applications of ICT, including video-linking to a remote subject expert (Kelly et al, 2008), making available podcasts of plenary sessions (Pilarski et al, 2008), and adding aural material to visual material in a Web-delivered lecture (Ridgway et al, 2007). Two articles clarified learners’ reasons for attending plenary sessions and the effect of electronic media on that choice; learners still wanted plenary sessions (Billings-Gagliardi and Mazor, 2007; Mattick et al, 2007). One article found no measurable difference in students’ learning between Web-delivered instruction and attendance at a plenary session (Davis et al, 2008). Based on this review, the current research effort is adding rather limited new knowledge about whether, why, and how the large group oral tradition can continue to have a valued place in the medical curriculum. The next step is to examine whether the knowledge we already have is being applied to best effect.

Techniques

Procedurally, a description of how to conduct a plenary session should consider what the lecturer should do before, during, and after the event – preparation, delivery, and evaluation.

On the day: the importance of personality and craft

Custers and Boshuizen (2002) qualified Flexner’s aphorism that ‘a lecturer is a textbook plus a personality’ with the wry comment that ‘in practice, the personality is often missing’. It could be argued there is not much a lecturer can do about their personality. Perhaps not, but they can put across whatever personality they have to best effect. That means, quite literally, coming across to learners as a person through the use of humour, through understanding learners’ perspectives and difficulties with the subject matter, and through the choice of language. Personality also comes across in a lecturer’s ability to project attitudes onto an audience. It has been asked ‘Which of us can be inspirational day on day?’ (Custers and Boshuizen, 2002) People who struggle to be inspirational should be steered away from lecturing and those who can inspire should be excused the occasional bad day. The best lecturers transmit their enthusiasm, interest in the subject matter, and compassion and pathos. It is not unheard of for subject matter that would otherwise be regarded as boring or irrelevant to be given meaning by an inspirational lecturer. When feedback shows that a lecturer is making inspirational material boring or irrelevant, a curriculum leader should select either a different lecturer or a format more suitable than the plenary one to deliver the subject matter in question.

Closely allied to personality is the rhetorical craft of lecturing. In Laurillard’s words (Laurillard, 2002):

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‘The point of a lecturer’s presence must be to use their oral presentation skills to enable learners to see the subject from their perspective, to see why they are enthusiastic about it.’

To reconcile that argument with the previous one that a lecturer’s personality comes across in their ability to understand learners’ perspectives, the rhetorical skill of an effective plenary session is to show a perspective on subject matter that makes their way of knowing accessible and interesting to learners. Effective lecturers are faithful to their topic and give the critical perspectives of people at the cutting edge; they show the active working of scholarly minds (Biggs and Tang, 2007). When a lecturer has a researcher’s knowledge of a subject matter, they can augment the presentation with personal perspectives on knowledge, including the process of constructing and validating it (Biggs and Tang, 2007), though there is a danger that their enthusiasm for the topic will exceed their ability to see it from an audience’s perspective. Practitioners, likewise, may need to restrain their enthusiasm for the minutiae of the topic and simply help their audience bridge the gap between ‘dry’ theory and a world of practice they aspire to enter. Judicious use of illustrative case examples and anecdotes has a clear role to play.

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Laurillard also emphasised the aesthetic dimension of lecturing; the lecturer should help the learner see what is elegant or pleasing, and how it makes sense of the world. The good lecturer is not just a humane expert but a good story teller. They use a narrative model of delivery and informal language to bring subject matter to life (Box 10.2). Narrative has great power as a medium of communication. The well-delivered plenary session should be, quite literally, both an unfolding story and a thing of beauty.

Box 10.2 Leading a plenary session as ‘craft’

Put across your personality

• Use humour judiciously

• Demonstrate understanding of learners’ perspectives and difficulties with subject matter

• Choose language that forges a personal connection between yourself and your audience

Project attitudes

• Do not be afraid of showing emotion

• Project enthusiasm and interest in the subject matter

Use rhetorical skills

• Show why you are enthusiastic about the subject matter; help others share your enthusiasm but do not get carried away by it

• Use rhetoric to open up interesting and informative perspectives

The critical perspective of the scholar

A practitioner’s perspective, bridging theory and practice

• Be a good raconteur

Make your plenary session aesthetically pleasing

• Show what is elegant and pleasing about your topic and how it makes sense of the world by giving it appropriate:

Relevance

Structure

Story line

Audio–visual aids

Narrative style

Means of learner engagement

Delivery

Procedural rules

Assuming that a presentation has more complex rules than ‘I speak and you listen’, those rules need to be shared with the audience, perhaps coupled with an outline of how the allotted time will be used. When will there be opportunities for questions? Are members of the audience encouraged to stop the flow of the presentation? If they are not able to hear or do not understand something, how will they signal it? Are there breaks in the presentation for learners to ‘buzz’ with the people sitting next to them or in ad hoc groups? How will the audience know that time is up? What report-back will be expected?

Presentation style

The presentation should be a clear and logical exposition of subject matter, making explicit links between theory and practice. Enough words are used to make it very clear and not to depend overmuch on the audience’s ability to fill gaps in the discourse but the presentation is concise and free of verbiage. It is articulated clearly and in an audible voice, using amplification if it is available. Feedback and exaggeration of consonants by speaking too close to a microphone are very distracting but, if those are avoided, the extra audibility afforded by using, for example, a radio microphone can do a lot to gain and sustain an audience’s attention. Because it is essential to speak at a consistent distance from it and in a consistent direction, a lectern microphone can be tricky to use, particularly if the speaker has to turn round and point to slides.

The presentation should not be delivered at such a speed that the audience cannot follow it and should not be so slow as to be boring. The pace varies according to the complexity of the subject matter; it slows to give due emphasis to very important points, while moving quite quickly over prosaic details. The speaker makes a conscious effort to vary the manner and style of the presentation. Likewise, expression is added to a presentation by moving away from the lectern – perhaps moving over to the opposite side of the podium to encourage questions or answers from learners farthest away. Used sparingly, body language and movement add considerably to a speaker’s self-expression. Used excessively, they make the presenter a figure of fun. Judicious variation in style is used to avoid monotony. Also, judicious use of silence punctuates the spoken discourse. Finally, eye contact is a useful tool. It is hard to project personality into thin air so it is helpful to fix different members of the audience with your gaze at different moments of the presentation (always provided you are far enough away not to intimidate them) so you direct your rhetoric towards a single, real person and pay attention to getting your message across to them (Box 10.3).

Box 10.3 Delivering a plenary presentation effectively

Procedural rules

• Explain in advance:

How time will be used

When questions will be invited

How to signal difficulty hearing or understanding

How any active learning will be managed during the event

Presentation

• An exposition of subject matter that is:

Clear

Logical

Comprehensive enough to avoid misunderstanding or doubt

Concise

Well paced

Varied in tone, pace, emphasis, movement, and body language

Punctuated with effective use of silence

Amplification

• Appropriate use of the available room amplification, preferably using a radio-microphone

Make and keep eye contact with the audience

Structure and process

Objectives

Having established clear aims and objectives in advance, it is good practice to communicate them at the beginning and relate subject matter to them on a number of occasions during the presentation. Assuming that slides are being used, the first one(s) after the title slide show the aims and objectives. The same slide can be revisited during the presentation to make the link between subject matter and objectives explicit.

‘Navigation’

A well-prepared plenary presentation should have the sort of explicit and clear navigation you would expect of a good Web site. After the slide of objectives comes a slide setting out the layout of what is to come. The same slide can be used to punctuate the presentation and show the audience where they are in it, perhaps with all the headings except the one for the next section greyed out. Colour or icons on the slides can be used to make the learners’ cognitive navigation even more explicit, though that ploy could also make the presentation unnecessarily fussy. A presenter can help their audience navigate through the nitty-gritty of the presentation by using ‘advance organisers’ and summary statements, such as ‘what I will explain in the next section is …;’ or ‘what I hope I have made clear is that …’.

Managing attention

Continuous periods of exposition of subject matter should not exceed the 15 minutes of the typical learner’s attention span. One technique is to punctuate a presentation every 10–15 minutes with a short period of active learning. For instance, learners can be posed a question to discuss in groups of two or three so as to review what they have learnt in the preceding phase and think about it critically. At the end of the presentation, they can be asked to tell the person sitting next to them what they think the key points of the presentation were. The aim of such interludes is to clear and refresh short-term memory, renew motivation, and actively construct learning rather than transmit it passively. Periods of active learning can usefully be followed by question and answer sessions, the effectiveness of which can be increased by leaving a 2–3 second pause between asking a question and soliciting an answer. A gap between receiving an answer and responding to it is also of value. Setting aside time for note-taking and incorporating it into the pauses and learning activities described above can be beneficial though it is important to make the intention to do so clear at the start of the event. Learners’ ability to concentrate on what is being said is greatly increased by a handout of the slides to be shown or an assurance that the slides will be made available for download afterwards. Handouts should provide enough space to write notes during the presentation.

Finishing

There is an oft-cited aphorism that effective communication entails ‘saying what you are going to say, saying it, then saying what you have said’. Having helped learners construct their understanding of the subject matter, it is important to summarise the same subject matter, emphasising key ‘take-home’ messages in one or two final slides. Once the presentation has finished, it can be deflating to invite a lecture theatre full of learners to ask questions, particularly if all the allocated time has gone and lunch beckons. An alternative is to build in time for them to ‘buzz’ about the lecture. An effective way of getting less articulate members of a group involved in a plenary debrief is to invite them to shout out, one at a time, even single words they were just discussing with their neighbour. The presenter can simply repeat them, add a word or two, comment, or pose questions related to what learners said. A more formal way of setting up a question and answer session would be to invite ‘buzz groups’ to formulate questions then answer them in a plenary discussion (Box 10.4).

Box 10.4 Structuring a plenary session

Opening

• Introduce yourself and your topic

• State the objectives

Navigation

• Explain the layout of the presentation

• Introduce each section, relating it to the structure of the whole

• Revisit the objectives showing how subject matter relates to them

• Preview and summarise the subject matter with advance organisers and summary statements

Managing attention and cognitive load

• Do not present continuously for any longer than 15 minutes

• Punctuate with learning activities alone, with the person sitting next to the learner, or in ‘buzz groups’ of more than two learners such as:

Free conversation

Active review of the subject matter

Framing questions

Stretching legs and taking a comfort break

• Allow pauses between:

Posing a question to the plenary group and inviting an answer

Receiving an answer and responding to it

Handouts and note-taking

• Give learners a handout of the slides, which they can annotate

• Build time for note-taking into pauses in the presentation so learners can concentrate on the narrative

Concluding

• Summarise the presentation, with due emphasis on key points

• Allow time for reflection and questions

Encourage questions by allowing learners first to review the content with one or two other learners and identify what they are clear about and what they do not understand

Content

An analogy between the construction of a building and the construction of knowledge may serve to explore how content works best in a plenary session. The walls of a building are made up of many bricks, which equate to factual knowledge. To erect the building, a structural framework of pillars and beams is needed, which equates to the conceptual framework of the subject matter. Supplying just the factual bricks of a topic results in a formless heap that is overwhelming; moreover, facts are available in any textbook, so the learner has to reconcile this new formless heap with other more or less formed ones given or read before or after. So, a plenary session that concentrates primarily on presenting facts does no more than any readily available textbook and likely overwhelms the learner with formless detail that has to be reconciled with other learning. It is human nature for lecturers to be preoccupied with putting across the factual ‘canon’ of their topic. Having done so, they feel that they have given their subject matter due attention and discharged their responsibility to learners. They can then interpret shortcomings in learners’ subsequent knowledge as a lack of attention or diligence. But that is not good lecturing.

The conceptual structure of a topic is what a lecturer should concentrate on. Provided with a robust structure, learners will assemble the bricks of knowledge with little difficulty. In fact, prior learning will likely have equipped them with large prefabricated sections, waiting for a suitable structure to adhere to. A feature of experts is their possession of highly compiled knowledge structures, which allow them to apply complex subject matter to their practice effectively and without cognitive overload. The term ‘cognitive scaffolding’ describes teachers’ use of such structures to reduce their learners’ cognitive load when acquiring subject matter. An effective teacher can provide quite a simple conceptual structure that makes a whole morass of subject matter more easily assembled into a building with little effort on the part of the learner. So, the question to would-be lecturers is this: ‘Are there simple conceptual frameworks that can open up your field of expertise to needy learners and make otherwise overwhelming detail assemble itself into robust conceptual structures?’ If so, perhaps those can be the two or three things learners should take away from this session’. Knowledge that is orientated towards performance is much more useful than knowledge that is not.

Cognitive insights into large group learning

The construction metaphor might imply that there is a single building whose construct is passed (albeit at the level of explanation rather than fact) from teacher to learner. In fact, cognitive psychology emphasises not just the active construction but also the individual nature of knowledge. The lecturer passes on a framework for learners’ understanding. The goal, then, is to help learners establish, elaborate, link and, ultimately, apply their own conceptual structures.

The preceding text has described how the lecturer can use advance organisers, cognitive scaffolding, summaries of subject matter, social interaction, questioning, and projection of positive attitudes to help learners build knowledge and tell stories. Lecturers can also include precise elaborations and analogies in their teaching. They can ask learners to consider reflectively, rework, and integrate new material into their existing cognitive structures by making notes and reformulating presented material into their own words. They can ask learners to verbalise their learning by explaining it to a neighbour in the lecture theatre. They can generate ‘epistemic curiosity’ by provoking discussion and debate. They can encourage learners to reflect on their learning and refine the descriptions and explanations offered by the lecturer. They can make a question from the floor the business of a whole class, not just a dialogue between a single learner and the lecturer. They can use positive responses to learners’ questions to increase motivation, confidence, and reward. They can use learners’ questions to gain insight into how learners are thinking about a topic and they can use their own enthusiasm and real-world examples to give a topic vicarious relevance that enhance learners’ interest in it.

A drawback of plenary sessions is that learners’ learning may remain contextually bound to the lecture theatre in which it was learnt. That problem may be addressed by linking theory to experience; for example, by appealing to learners’ own prior experience or by using analogy. A thoughtful lecturer asks their learners to draw on their prior experience and share it in a small group or plenary discussion. They may also ask learners to anticipate contexts in which the learning may be applied in the future (Box 10.5).

Box 10.5 The content of a plenary session

Subject matter

• Concentrate on explanations; the simpler and more general the better

• Use facts to illustrate principles but leave the ‘bulk acquisition’ of facts to individual study

• Orientate learning towards practical application

Processes

• Help learners establish, elaborate, and apply their own conceptual structures

• Help learners build knowledge by including in your discourse:

Advance organisers

Cognitive scaffolding

Summaries of subject matter

Precise elaborations and analogies

Projection of your own positive attitudes

• Intersperse the discourse with periods of active learning to promote:

Curiosity

Reflective reworking and integration of new material into learners’ existing cognitive structures

Greater understanding on your part of learners’ level of understanding and difficulty

• Make learning active by encouraging:

Social interaction between learners

Formulation of explanations and questions

Note-taking

Discussion and debate

• Promote retention and transfer by linking:

Prior experience to the current discourse

The current discourse to anticipated future experiences and actions

Evaluation

There are two main categories of evaluation information that can be obtained about plenary sessions: information about process and information about what has been learnt. Information may be gathered in the form of numbers, words, or both. Evaluation forms are nicknamed ‘happy sheets’ because of a tendency to enquire about satisfaction, often with process aspects of an event rather than its educational effectiveness. Numerical ratings are attractive because they allow summative comparison between different components of an event or between different events; however, they can be hard to interpret because of the lack of any benchmark against which to compare them and because inadequate response rates introduce unquantifiable biases. Textual responses may not support summative judgements as conclusively as numerical ones but are of greater formative value. When learners are asked to support their numerical responses with explanatory textual statements, event organisers can make both summative and formative judgements.

It can be argued that the most important information to gather is what participants have learnt from a plenary session. The technique known as a ‘minute paper’ is singled out for description here because it can so easily and effectively be adopted. At the start of the event, every participant is given a sheet of paper with questions (such as those listed in Box 10.7) printed on it, allowing plenty of space for written comment. Although it is optimistically named a ‘minute paper’, typically 5 minutes are scheduled at the end of the event for participants to write something under each heading. In addition to crystallising what they have actually taken away from the event, the minute paper identifies areas for further learning, and encourages learners to make a commitment to pursuing those goals. Finally, it obtains a qualitative evaluation of strengths and weaknesses of the event for formative purposes. From a cognitive perspective, completing the minute paper is not just an act of evaluation but an act of learning because the learner has to verbalise what has been learnt, what is yet to be learnt, and how this event links to future actions and intentions. If time permits, the lecturer can ask members of the audience to share what they have written so that other participants can have the benefit of learning from others’ learning as well as from their own. If learners hand in their papers as they leave, the lecturer can cumulate what has been written on them into a summary evaluation with an extremely high response rate that can be compared with the objectives of the event and used to refine the same presentation on future occasions. The cumulated data from all the minute papers can be returned to learners as a synthesis of the event they took part in to refresh and keep alive their learning and allow them to compare it with what others have learnt.

Training as a lecturer

Chapter 19 discusses faculty development. Suffice it to say here that there is substantial evidence that teaching skills can be learnt and teachers value learning them (Steinert et al, 2006). Not everyone can be funny or inspiring but many can become clearer, more confident lecturers. The art of leading a plenary session can be effectively taught in a workshop, short course, or longitudinal programme. It is consolidated through experience and can be enhanced by feedback from co-teachers, peer observers, and/or students (Steinert et al, 2006).

The future of ‘the lecture’

Chapter 16 defines ‘affordances’ as ‘the things a resource can do or might do’, and divides learning resources into four categories. Type A includes information and knowledge resources, which have quite recently made a variety of media richer and more readily available to medical educators; however, Chapter 16 also reminds us that such resources are relatively passive and/or low in interactivity. Moreover, it states that ‘the use of a learning resource can never be causal’. Simply making learning resources available to learners will not guarantee any kind of result, a caution of which Custers and Boshuizen’s (2002) lecturer without a personality is apparently unaware. Type B includes environments that contain or provide context and can assuredly be both active and interactive. Type C includes the hardware and software ‘tools that act on the world’ and make Type A resources available for instance in lecture theatres. Type D resources support simulation and include ‘wetware’, another name for us members of the human race! In line with Chapter 7, which argues for the importance of learning environments, we suggest that the most interesting affordances of technology lie in the way we put Type C resources to Type B purposes: that is, create context for learning. As for the subject matter, a theme that runs throughout this book is that human Type D ‘wetware’, in all its complexity, is an unrivalled learning resource.

If information and communication technology (ICT) can make Type D resources available in lecture theatres, do we need lecturers at all? Assuredly yes, we submit, if we accept that personality, craft, and interactivity promote learning. And does the lecturer need to be there in person? An excellent lecturer who is present in the flesh may have more impact than an excellent one who is only virtually present, though a streamed excellent lecturer will likely have more impact than a weak or dispassionate one who is present in person. Key concepts here are ‘economies of presence’ and the power of ritual, performance, and direct physical participation in effecting and affecting learning.

There are a number aspects of plenary sessions that are changing as a result of technological support and remediation:

The use of such learning resources in plenary sessions, as well as other settings, is more fully explored in Chapter 16. Economies of scale, reduction in travel, and mitigation of environmental impact come at the cost of technical support, without which the most promising education technologies will fail. Support is necessary but not sufficient because use of new technology for plenary education is a learnable skill, over and above the skill of lecturing without it. Organisations and individuals who want to benefit from the affordances of new technology need to consider implications for faculty development, the subject of Chapter 19.

Beyond the use of technology are the ways that professions, societies, and cultures change over time. Michael Wesch and 200 of his students at Kansas State University produced “a short video summarising some of the most important characteristics of students today – how they learn, what they need to learn, their goals, hopes, dreams, what their lives will be like, and what kinds of changes they will experience in their lifetime” (Wesch, 2009).

Implications for practice

There are many metaphors in and of educational practice. This chapter has argued that the commonly used transmission metaphor – expressed in the language of ‘delivering’, ‘giving’, and ‘presenting’ – tacitly focuses a plenary session on knowledge transfer to the exclusion of performance and experience, features of the participation metaphor (Chapter 2). It has suggested ways plenary session can be improved and enhanced by more critical engagement with the multidimensional nature of the medium. It has tried to show the potential richness and diversity of this technique. Key messages are:

One reason the large group genre is so enduring and seductive to programme leaders is that it can be impersonal, passive, and decontextualised. Yet, current opinion and evidence reviewed in this chapter show that human chemistry at a personal level, active, constructive learning, and contextualisation are as important here as in other learning activities. It has shown how those qualities can be incorporated into the genre. Large group teaching is not a ‘quick fix’ and neither are the new technologies, though they can add value to large group learning. On the other hand, Laurillard’s dismissal of lectures as an outmoded pedagogic medium is also questionable given the nature of the learners and subject matter of medical education (Laurillard, 2002). We predict and rather hope large group learning will endure though there is plenty that lecturers must do to raise our game – and many questions for education researchers to pursue in support of excellent large group medical education.