Interactive lecturing for meaningful learning inlarge groups

MEHMET AL_II GULPINAR1 & BERRAK C. YEGEN2

1Department of Medical Education,Marmara University School of Medicine, Istanbul, Turkey;2Department of Physiology, Marmara University School of Medicine, Istanbul, Turkey

SUMMARY In order to enhance the quality of integration of

physiological basic concepts with clinical sciences and to facilitate

problem solving skills, a ‘structured integrated interactive’ two-hour

block lecture on growth hormone physiology was implemented.

A template showing the central regulation of growth hormone

release and its peripheral effects was developed as an advanced

organizer. Based on this template, new information was presented.

Student feedback demonstrated that the lecture, based on the

expository teaching model and enhanced by different forms of

question and problem solving activities, was successful and

interactive. It was also more motivating and was able to keep

the attention of the students in relatively higher levels throughout

the lecture. Furthermore, students felt that they had made

important gains in transferable problem solving skills and this

opinion was supported by their performance in clinical cases. These

findings reinforced the idea that systematic incorporation of active

learning strategies into lectures may minimize many of the

weaknesses of traditional lectures.

Introduction

Despite the fact that lectures have long been criticized for

their passive nature, they are still the most widely used and

accepted methods of education. Since for the near future

lecturing is likely to remain as the most common, economical

and efficient method of teaching in the early years of under-

graduate medical education, its advantages and limitations

must be well known. Lectures are used in conveying infor-

mation to large audiences with little risk for the students,

while allowing the instructor to have maximum control of the

learning experience, but it fails to provide the instructor with

feedback about the extent of student learning. In classical

didactic lectures, students are frequently seen as passive recip-

ients of information, without any engagement in the learning

process, and therefore their attention wanes quickly after

15–25 minutes. It has been suggested that lectures are not

suited for teaching higher orders of thinking or instructing

skills and for influencing students’ attitudes (Bonwell, 1996;

Keyser, 2000; Kumar, 2003).

Since learning is actually a dynamic process and the

students who are actively involved in the learning activity

will learn more than students who are passive recipients of

knowledge, a well-organized lecture can provoke thought

and enhance clinical thinking if it aims at arousing students’

curiosity, motivating them to learn, and guiding them into

creative thinking (Brown & Manogue, 2001). Thus, instead

of passive listening, a two-ways interaction accomplished

between the presenter and the participants by interactive

lecturing in ‘right hands’ is said to increase the effectiveness

of lecturing in delivering a mass of information (Steinert &

Snell, 1999; Stunkel, 1999).

Many teachers believe that basic sciences cannot be taught

using interactive techniques, while some believe that under-

graduate students, due to their more limited basic knowl-

edge, cannot participate in an interactive lecture. On the

other hand, relevant literature does not support this belief

and the current opinion is that conventional lectures should

be replaced by ‘structured interactive sessions’ (Steinert

& Snell, 1999). Moreover, interactive techniques allow

teachers to receive feedback on students’ needs, on how

information has been assimilated, and on future learning

directions, while students receive feedback on their own

knowledge or performance. In other words, interactive

lecturing is a way to benefit from the strengths of small

group learning in large group format (Steinert & Snell, 1999;

Kumar, 2003).

Although ‘active learning’ was not defined precisely in

educational literature, some general characteristics are

commonly associated with the use of strategies promoting

active learning in the classroom. It was previously suggested

that ‘active learning’ involves students in doing things and

in thinking about what they are doing (Keyser, 2000).

In order to get the students involved, many learning/

teaching models and techniques may be used, including

experiential learning, cooperative learning, problem-solving

exercises, writing tasks, speaking activities, class discussions,

case-study methods, simulations, role-playing, peer teach-

ing, fieldwork, independent study, library assignments,

computer-aided instruction and homework (Keyser, 2000;

Legan, 2001; McLaughlin & Mandin, 2001; Micheal, 2001).

Among many teaching models that have been implicated to

make the lectures interactive, expository model is a model

where meaningful learning is encouraged. In the expository

teaching model, teachers present material in a carefully

organized, sequenced and finished form. In this model, one

of the major components in constructing the lecture is to

provide the students a framework or a ‘big picture’ of the

lecture to enable the students to receive the most usable

material in the most efficient way, organizing knowledge into

hierarchical and integrated patterns, from the general to the

specific and completing the lecture by the reinforcement of

the cognitive schema (Chung & Huang, 1998; Ivie, 1998;

Zarotiadou & Tsaparlis, 2000).

Correspondence: Dr Berrak C. Yegen, Professor of Physiology, Marmara

University School of Medicine, Haydarpas� a, _IIstanbul 34668, Turkey. Tel:

þ90 216 414 47 36; Fax: þ90 216 418 33 27; email: byegen@marmara.edu.tr

Medical Teacher, Vol. 27, No. 7, 2005, pp. 590–594

590 ISSN 0142–159X print/ISSN 1466–187X online/05/070590-5 � 2005 Taylor & FrancisDOI: 10.1080/01421590500136139

Med

Tea

ch D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Lav

al o

n 07

/11/

14Fo

r pe

rson

al u

se o

nly.

Aims of the present study

In the curriculum of the Marmara University School of

Medicine, where lectures are integrated based on subject

committees, physiology is taught by standard didactic

lectures along with related basic and clinical sciences

during the first three years of the Medical School. One of

the subject committees, given by the end of the first year,

titled as ‘Basics of The Nervous and Endocrine Systems

Subject Committee’, aims to demonstrate the dominant

roles of the nervous and endocrine systems in the establish-

ment of homeostasis in all the body systems. In order to

replace some of the conventional lectures by ‘structured

integrated interactive lectures’, to enhance the quality of

integration of physiological basic concepts with clinical

sciences and to facilitate the problem solving skills, a

two-hour block interactive lecture on ‘the functions of

growth hormone and the central control of its release’

was introduced as a pilot study during the academic year of

2002–2003. More specifically, the objectives of the study

include the effects of the prior knowledge and well-structured

advanced organizer on meaningful learning and the students’

evaluation of the interactive learning method. In addition,

we aimed to study the impact of clinical integration on

the comprehension of basic sciences in the early years of

medical education and the practical use of structured

evaluation methods in large groups.

Methods

Designing and implementation of the interactive lecture

Knowing the fact that it is not realistic to expect the students

to remember excess knowledge covered in a lecture, we

aimed to limit the presentation with basic concepts and

principles. Subject committee program was reviewed to

determine the prior knowledge of the students. Information

about the content of the previous related lectures (anatomy,

physiology, histology and biochemistry) was collected. Using

this information, the aims and learning objectives of the

new lecture were determined and a pre-test and the content

of the lecture were constructed (Figure 1––on Medical

Teacher website: www.medicalteacher.org). As an advanced

organizer, we developed a template showing the central

regulation of growth hormone release and its peripheral

effects (Figure 2a––on Medical Teacher website: www.

medicalteacher.org). Based on this template, new informa-

tion was presented in two major parts. In the first part,

information on the central control and mechanisms of action

of the growth hormone was given, while associated pathol-

ogies were discussed in the second part of the lecture. Since

concentration during a lecture declines sharply after approxi-

mately 15 minutes, a task requiring interaction was intro-

duced (open-ended and structured questions) approximately

every 10 or 15 minutes, to capture the students’ attention, to

recall the previous information, to allow repetition of the

material and to integrate the newly presented information

with the previous information, which are known to facilitate

meaningful learning. A variety of techniques (questioning the

audience and using audience response, using clinical cases)

were used to promote active meaningful learning

(McLaughlin & Mandin, 1999; Stunkel, 1999; Brown and

Manogue, 2001; Legan, 2001; McLaughlin & Mandin, 2001;

Micheal, 2001).

By the end of the first part, the simple template given

in the beginning was presented in a more detailed form

(Figure 2b––on Medical Teacher website: www.medical

teacher.org) and the presented information was reinforced

using this template. In the second part of the lecture,

following the presentation on the growth hormone-related

pathologies, two clinical cases were introduced to reinforce

the cognitive schema. The first case was about the effect of

chronic stress on the regulation of growth and development.

The second case was presenting the clinical signs and

symptoms of growth hormone excess. Each case was pro-

jected on the screen for 5 minutes (Figure 3––on Medical

Teacher website: www.medicalteacher.org) and during this

time the students were asked to mark the structured

evaluation charts (Figure 4––on Medical Teacher website:

www.medicalteacher.org) as (þ) or (�). In the last 10 minutes

of the lecture, students were asked to fill in a Lickert type

questionnaire that dealt with students’ preference for the

general opinion on the lecture and the applied expository

teaching model.

Data analysis

The data were analysed using the Statistical Package for the

Social Sciences for Windows. Internal consistencies were

assessed by Cronbach alpha. In order to test the differences

between the performance scores of different cases, paired

t-test was used. The presence of correlation between the

pre-test and post-test scores was tested with Pearson’s

correlation coefficient. In all tests, a p-value smaller than

5% was considered significant.

Results

The response rate averaged 95% with 98 responses from 103

questionnaires distributed to the students attending the

lecture (71% of the total). The internal consistency of

the total items was 0.73.

Students’ evaluation of interactive lecturing

In general, student feedback has been very positive. When

asked about their general opinion on the lecture, most of

the students valued the lecture and stated that the organi-

zation and the application of the new technique were

successful.

Ninety-two percent of the participants rated the lecture

as a whole successful (Figure 5). When the students

were asked to rate how useful each component of the inter-

active lecture (planning, organization, and implementation;

whether the learning environment was interactive; prior knowl-

edge was taken into consideration or the standards of inter-

active lecturing were reached or skills and problem solving skills

were gained ) was for their learning, only z10% of the

student responses were negative. This data is displayed in

Table 1.

Feedback from students clearly indicated that they

welcomed the interactive approach and the more direct

input they had, in class, to the learning process. Most

of the comments mentioning the interactive lecture

Interactive lecturing for meaningful learning in large groups

591

Med

Tea

ch D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Lav

al o

n 07

/11/

14Fo

r pe

rson

al u

se o

nly.

were positive (Table 2––on Medical Teacher website:

www.medicalteacher.org). Clearly, for most of the students

this was an enjoyable and rewarding experience.

When the profile of strengths and weaknesses of the

lecture was evaluated, despite many positive aspects of

the lecture, the students found that the time provided

for the lecture was not suitable to concentrate and analyse

the new knowledge (52%), which was presented in a rather

fast manner (67%). Although z38% of the students stated

that the content of lecture was limited to basic principles

and concepts that are prerequisites to acquire the presented

knowledge, the rest of the students found that the content

was not limited well enough. Since the students found that

the content of the lecture was not adequately limited and

therefore the lecturing was relatively faster, the active

participation of the students decreased. Thus, while 43.9%

of the students found the learning environment inter-

active, 35.7% rated it as partially interactive and 16.3% as

non-interactive.

Performance on problem solving and the effect of

the prior knowledge

Performance on problem solving was evaluated as ‘insuffi-

cient’ (1 to 14 points), ‘acceptable, but needs further support’

(15 to 20 points), ‘sufficient’ (21 to 30 points) and based

on this criteria, about 90% of the students showed an

acceptable performance on problem solving (Figure 4––on

Medical Teacher website: www.medicalteacher.org) in anal-

ysing the case on stress (Figure 6a), while this perfor-

mance was found to be 62% in the case of growth hormone

(Figure 6b).

The mean score of ‘stress case’ was 20.43� 3.95, while

the mean score of ‘growth hormone’ case was 15.95� 4.31

and the difference between the mean scores of these two

cases was statistically significant (paired t-test ¼ 9,46, df ¼ 96

p¼ 0.000). In accordance with these performances, the

students have indicated on the questionnaires that they

could evaluate and analyse the related clinical cases (z 40%

absolutely, z 50% partially). Most of the students (61%)

agreed that prior knowledge was taken into consideration

(Table 1). When a correlation between the success in

answering the pre-test questions and the performance on

the case of stress were evaluated, a borderline significant and

positive correlation was found (r ¼ 0.20; p ¼ 0.05), while

there was no significant correlation between the growth

hormone case and the pre-test results.

Discussion

Positive student feedback and medium-to-high level of

performance in problem solving skills as tested by the two

clinical cases, showed that the interactive lecture designed in

the present study was effective on more meaningful and

interactive learning in a large group session. Student feed-

backs demonstrated that the lecture, based on the expository

teaching model and enhanced by different forms of question

and problem solving activities, was successful and interactive.

It was also more motivating and was able to keep the atten-

tion in relatively higher levels throughout the lecture.

Furthermore, students felt that they have had important

gains in transferable problem solving skills and this opinion

was supported by their performance on clinical cases.

These findings reinforced the idea that systematic incorpo-

ration of active learning strategies into lectures may minimize

many of the weaknesses of traditional lectures (Bonwell,

1996).

Among these weaknesses, the most important one

appears to be the poor development of higher-order thinking.

Higher levels of knowledge that involve problem solving, i.e.

analysis, synthesis and evaluation, require greater participa-

tion and are considered to be poorly attainable in a classical

lecture format (McLaughlin & Mandin, 2001). Didactic

lecturing can mostly reach the lowest two levels of ‘knowl-

edge’ and ‘comprehension’ (Bonwell, 1996; Steinert & Snell,

1999). On the other hand, as reported in a number of studies

Table 1. Students’ perceptions of the implemented interactive lecture.

Student opinions

Agreement Partial agreement Disagreement No comment

Number of students and percentages

In general, planning, organization,

and implementation were successful

76

76.8%

22

22.2%

1

1.0%

–

Learning environment was interactive 52

54.7%

39

41.1%

3

3.2%

1

1.1%

During the presentation, prior knowledge

was taken into consideration

60

61.2%

24

24.5%

13

13.3%

1

1.0%

Standards of interactive lecturing were reached 61

64.9%

32

34.0%

1

1.1%

–

Transferable skills and problem

solving skills were gained

44

44.9%

47

48.7%

7

7.1%

–

13%

47%

32%

6% 2%

excellent

very good

good

fair

poor

Figure 5. Overall score given to the implemented

interactive lecture.

M.A. Gulp|nar & B.C. Yegen

592

Med

Tea

ch D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Lav

al o

n 07

/11/

14Fo

r pe

rson

al u

se o

nly.

and as demonstrated by the results of this study, lectures

can be made more suitable and preferable for the develop-

ment of higher order thinking by implementing some

interactive learning models. Students’ learning process and

outcome could be enhanced by active involvement, either

with material or content, with the teacher or classmates.

Interactions allow higher level of understanding, higher

ability in the analysis and synthesis of material, easier transfer

to other situations and more effective evaluation of the

material presented (Bonwell, 1996; McLaughlin & Mandin,

1999; Steinert & Snell, 1999; Kumar, 2003). Allen (1995)

summarizes the work of several researchers, which show that

active learning affects the cognitive, sensorimotor, and

affective domains. Ridgeway (1989), Sheridan (1990), and

Jacobson & Mark (1995) have also addressed many benefits

to these styles of teaching, including meeting the needs and

learning styles of diverse students, improving student

retention of information presented, increasing student inter-

action with information, and increasing student responsibility

for their own learning in the classroom (Keyser, 2001).

Perhaps more important, in the present study, inter-

action enabled us to observe whether the students truly

comprehended and organized the material being presented.

Similarly, it was previously stated that interactive models

allow teachers to give feedback to the students and receive

feedback on how the learning process is going on (Bonwell,

1996; McLaughlin & Mandin, 1999; Kumar, 2003).

The present study also supported the idea that prior

knowledge is important in meaningful learning and the

new process of learning builds on previously acquired

knowledge. According to Anderson (1997), there are three

conditions that facilitate learning: activation of prior

knowledge, strengthening encoding specificity and elabora-

tion of knowledge (Foster, 1999; McLaughlin & Mandin,

2001). Considering the principles of progressive differentia-

tion and consolidation during the learning process, advance

organizers help in incorporating new concepts hierarchically

into the students’ cognitive structure, discussion of the new

material by the students through the advance organizers

facilitates the revision of the previous knowledge and different

forms of questions, tests or problem solving activities provide

the more elaborated, integrated and strengthened cognitive

schemas and the easier transfer of knowledge in future

problem solving activities (Kirkman & Shaw, 1997; Ivie,

1998; Bastick, 1999). As Ausubel has suggested that

upcoming unfamiliar learning material to what the learner

already knows, using advanced organizers that provide a

framework for the students upon which to hang the lecture

content, making repetitions to reinforce the sequences and

referring to the ‘big picture’ of the lecture facilitates mean-

ingful learning (Pinto & Zeitz, 1997; Chung & Huang, 1998;

Ivie, 1998; McLaughlin & Mandin, 2001).

In the light of these principles of expository teaching

models, we had taken students’ prior knowledge into

consideration in designing and implementing the interactive

lecture, we developed an advanced organizer to demonstrate

the central and peripheral mechanisms of growth and devel-

opment, and we guided the two-hour lecture throughout

the advanced organizer. During the learning process, we

also used some interactive learning tools, such as question-

ing, discussions and problem solving activities using

clinical cases. In both clinical cases, the levels of students’

performances on problem solving skills were acceptable.

These results support the idea that it is possible to achieve

higher order thinking, to some extent, by enhancing

interactivity during the lecture.

According to Ausubel’s view, the most important single

factor influencing learning is what the learner already knows

(Ivie, 1998; Biemans et al., 2001). Analysis of our data,

which demonstrates the presence of a significant correlation

between students’ prior knowledge and the stress-related

case, but the absence of a correlation in the growth hormone-

related one, supports the importance of previous knowledge.

The pre-test that we applied, which was formulated accord-

ing to the contents of the previous lessons in the subject

committee, showed that the previous lectures have supported

the knowledge on stress-related growth and development

comparably more than the growth hormone case. As well as

many other research studies, our study indicates the influence

of prior knowledge on students’ learning processes and

learning outcome. If new learning is not based on prior

knowledge, students may learn new information as ‘isolated’

bodies of knowledge and may therefore face difficulties in

applying and transferring the new knowledge in novel

situations. On the other hand, activation of prior-knowledge

promotes the reconstruction of already existing schemas

and provides students with a more fruitful conceptual

framework for particular contexts (Biemans et al., 2001).

Conclusion

These positive student feedbacks and the achievement

reached in the higher order thinking, encouraged us to

persist in similar efforts to implement interactive teaching

(A) Case on Stress

0

10

20

30

40

50

60

insufficient needs further support sufficient

insufficient needs further support sufficient

Per

cen

tag

e

(B) Case on Growth Hormone

0

10

20

30

40

50

60

Per

cen

tag

e

Figure 6. Student performances in evaluating and

analysing the cases about chronic stress (A) and (B) growth

hormone excess. Insufficient: scores below 15 out of 30 points;

Needs further support: scores between 15–20; Sufficient: Scores

above 20.

Interactive lecturing for meaningful learning in large groups

593

Med

Tea

ch D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Lav

al o

n 07

/11/

14Fo

r pe

rson

al u

se o

nly.

models to a large class format. At least, to reach a higher level

of integration in the multi-disciplinary subject committees,

some of the lectures may be redesigned in interactive,

interdisciplinary formats. In this regard, the format used in

the present study can be applied following some improve-

ments, such as limiting the learning material, increasing the

time up to three to four hours and, most importantly,

designing it with an interdisciplinary approach.

Practice points

Notes on contributors

MEHMET AL_II GULPINAR, MD is a specialist in Physiology and a PhD

student in Curriculum Development and Evaluation program. He is

currently a research assistant in the Medical Education department.

BERRAK, C. YEGEN, MD is a senior lecturer and the head in the Physiology

department. She is a member of the Institutional Undergraduate Medical

Education Research, Planning and Coordination Committee.

References

BASTICK, T. (1999). An Investigation of Ausubel’s assumption

that students use instructional objectives as advance organisers.

http://www.eric.ed.gov/ERICDocs/data/ericdocs2/content_storage_01/

0000000b/80/25/2d/b3.pdf.

BIEMANS, H.J.A., DEEL, O.R. & ROBERT-JAN SIMONS, P. (2001)

Differences between successful and less successful students

while working with the contact-2 strategy, Learning and Instruction,

11, pp. 265–282.

BONWELL, C.C. (1996) New Directions for Teaching and Learning Enhancing

the Lecture: Revitalizing a Traditional Format (San Francisco, CA:

Jossey-Bass Publishers).

BROWN, G. & MANOGUE, M. (2001) AMEE Medical Education Guide

No. 22: Refreshing lecturing: A guide for lecturers, Medical Teacher,

23, pp. 231–244.

CHUNG, J.M. & HUANG, S.C. (1998) The effects of three aural advance

organizers for video viewing in a foreign language classroom, System,

26, pp. 553–565.

FOSTER, P.J. (1999) Teaching engineering at first degree level in the UK,

Teaching in Higher Education, 1, pp. 235–252.

IVIE, S.D. (1998) Ausubel’s learning theory: an approach to teaching

higher order thinking skills, High School Journal, 82, pp. 35–42.

KEYSER, M.W. (2000) Active learning and cooperative learning: under-

standing the difference and using both styles effectively, Research

Strategies, 17, pp. 35–44.

KIRKMAN, G. & SHAW, E.L., Jr. (1997) Effects of oral advanced organiser

on immediate and delayed retention. http://www.eric.ed.gov/

ERICDocs/data/ericdocs2/content_storage_01/0000000b/80/23/f3/96.pdf.

KUMAR, S. (2003) An innovative method to enhance interaction during

lecture sessions. Advances in Physiology Education, 27, pp. 20–25.

LEGAN, S.J. (2001) Multiple-format sessions for teaching endocrine

physiology, Advances in Physiology Education, 25, pp. 228–232.

MCLAUGHLIN, K. & MANDIN, H.A. (2001) Schematics approach

to diagnosing and resolving lecturalgia, Medical Education, 35,

pp. 1135–1142.

MICHEAL, J. (2001) In pursuit of meaningful learning, Advances in

Physiology Education, 25, pp. 145–158.

PINTO, A.J. & ZEITZ, H.J. (1997) Concept mapping: a strategy

for promoting meaningful learning in medical education, Medical

Teacher, 19, pp. 114–121.

STEINERT, Y. & SNELL, L.S. (1999) Interactive lecturing: strategies

for increasing participation in large group presentations, Medical

Teacher, 21, pp. 37–42.

STUNKEL, K.R. (1999) The lecture: a powerful tool for intellectual

liberation, Medical Teacher, 21, pp. 424–425.

ZAROTIADOU, E. & TSAPARLIS, G. (2000) Teaching lower-secondary

chemistry with a Piagetian constructivist and an Ausbelian meaningful-

receptive method: a longitudinal comparison. Research and Practice in

Europe, 1, pp. 37–50.

� A systematic incorporation of active learning strategies

into didactic lectures minimizes many of the weak-

nesses of traditional lectures in a large group session.� Didactic lectures can be made more suitable and

preferable for the development of higher order thinking

by implementing ‘structured integrated interactive’ two

to three hour block lectures, based on the expository

teaching model.� Since prior knowledge has a major influence on

students’ learning processes and learning outcome, it

should be taken into consideration during the design

and implementation of the interactive lecture.

M.A. Gulp|nar & B.C. Yegen

594

Med

Tea

ch D

ownl

oade

d fr

om in

form

ahea

lthca

re.c

om b

y U

nive

rsity

of

Lav

al o

n 07

/11/

14Fo

r pe

rson

al u

se o

nly.