Clickers provide an attention-grabbing alternative to traditional lectures

Mary Schuller, MSEd
Northwestern University
Chicago, IL

"Education is not the filling of a pail, but the lighting of a fire."
- William Butler Yeats

“No! Not another boring lecture” is the title of a previous American College of Surgeons Residency Assistance Page article that proposed alternatives to the traditional lecture-style format (Santen and Hemphill, 2009). The title was intended to reflect the experience of learners enduring non-interactive lectures. As the authors noted, “traditional” lectures can be very engaging. We’ve all experienced a very thought-provoking lecture or speech but they are the exception rather than the rule, and for good reason. Research has shown that our attention span is, on average, 20 minutes and that recall of information decreases after 15 to 20 minutes (Burns, 1985). This finding roughly correlates to the maximum amount of time university learners self report that they can withstand uninterrupted lecture (20 to 30 minutes) (Macmanaway, 1970). It is very challenging to maintain learners’ attention for the entire time span of a typical lecture.

Researchers have shown that interaction in lectures improves conceptual learning (Hake, 1998). In this article I would like to briefly describe the use of clickers as a tool for learner engagement. Although no studies have been published on their use in general surgery residency education, using clickers in lectures has been shown to improve retention of lecture concepts among obstetrics and gynecology residents (Pradhan, Sparano, and Ananth, 2005), radiology residents (Rubio, Bassignani, White and Brant, 2008), and plastic surgery residents (Arneja, Narasimhan, Bouwman, & Bridge, 2009). Research in continuing medical education indicates that learners perceive that lectures using clickers are more effective than lectures that do not use clickers. In particular, use of clickers is noted as an instructional approach that promotes clinical reasoning and understanding of medical facts, improves alertness, and identifies learner weaknesses (Copeland, Stoller, Hewson and Longworth, 1998).

What are clickers?

Clickers are sometimes referred to as audience response systems or personal response systems., Instructors display questions to the class using clicker software, and then learners input their answers on a special piece of hardware referred to as a clicker (image on right) or on their own personal electronic device, such as a cell phone.

Answers are instantaneously aggregated and displayed for the instructor and the entire class. In this way, instructors can poll the class on a particular question or issue. The following image is an example of aggregated polling data.

How can clickers be used?

• Grabbing attention: Renowned learning theorist Robert Gagne (1965) identified gaining attention as the first of nine events for effective instruction. One method to focus residents on the lecture is to ask a challenging question at the beginning of the lecture. Examples include having residents respond to a tough ethical question or make a difficult surgical decision. This scenario gives residents an opportunity to disengage from their prior thoughts and to focus on the learning material you are presenting.
  
  
• Assessing residents’ pre-existing knowledge: New knowledge is built upon pre-existing knowledge. One way to assist learners’ construction of new knowledge is to “activate” their previous knowledge. This goal can be facilitated by asking questions about the topic you are going to address. These questions should be based in areas you believe most residents should already be familiar (prior knowledge). An additional benefit of this approach is that you can adjust your teaching to their collective level of understanding based upon the responses from learners. This way, you can ensure your lecture material is neither too basic nor too advanced to effectively engage learners.
  
  
• Establishing resident accountability: If you require your residents to read an article or a book chapter or to review films or videos, such as those that are available on the Surgical Council on Resident Education (SCORE) portal, you can use clickers to have the residents respond to a few questions about the assignment. In addition to holding residents accountable for preparing for a lecture beforehand, it is also a good way for you to gauge their understanding of the material.
  
  
• Providing learning feedback to residents: Requiring residents to respond to practice problem questions and quiz-type questions gives feedback to residents about gaps in their understanding. Some of you may be familiar with Benjamin Bloom’s taxonomy of questions. If you want to engage residents in higher level thinking, pose questions that require them to make predictions, to evaluate a situation, or to create a solution rather than ask factoid-oriented questions such as those that require word definitions and the simple recall of basic facts.
  
  
• Encourage peer-to-peer instruction: The distribution of clickers can vary. Each resident can have his/her own clicker. Alternatively, the residents can be divided up into small groups and each group can be given a clicker. You can instruct the small groups to discuss and arrive at a group consensus on a question you pose. This method encourages peer-to-peer instruction, which has been shown to improve conceptual reasoning and problem solving skills (Crouch and Mazur, 2001).

All of the activities noted above can be performed without clickers. However, it is difficult to devise a non-technical solution that provides learners with the equivalent level of anonymity that clickers provide when they are distributed to individual learners. Clicker systems aggregrate learners’ responses and learners do not need to reveal their individual answers to their instructor or classmates. Thus, anonymity allows learners to answer questions without fear of being wrong in front of their peers and instructor. In comparison to other polling techniques, research has shown that university students respond more honestly to questions posed when they use clickers (Stowell and Nelson, 2007).

Another feature of clickers that is difficult to replicate with “low-tech” solutions is quick data slicing. Data slicing allows you to compare answers to two or more questions. For example, you can ask learners to identify themselves by a question, (for example, “What is your postgraduate year (PGY) level?”) and then view their response to a second question as it relates to the first question. You could then see the percentage of correct answers for question two based on the PGY levels of the residents. This allows you to assess learners’ understanding relative to their years in the residency program.

If used with presentation software such as PowerPoint®, you can configure your presentation to jump to different points in your lecture based upon how students respond to your questions. For example, you can indicate that if more than 50 percent of learners respond to a question incorrectly, then the next series of slides will be an in-depth review of the content; however, if more than 50 percent answer the question correctly, then the in-depth review will be skipped. A more elaborate example would be the creation of a decision tree where a different presentation path is created for each possible answer. This takes time to create, but if there is a surgical case that you use frequently in presentations then it may be worthwhile to create since you only need to do so once.

Considerations

When first learning any new technology, there is a learning curve. The learning curve for clicker systems is not steep; however, allow yourself time to practice using clickers before your initial presentation. Beyond practice time, the most frequently cited reason for not using clickers is the inability to cover the same breadth of material as in a straightforward lecture. Some lecturers hesitate to take time to ask questions because this reduces the amount of time they have to lecture. This criticism of clickers is really a criticism of interaction and learner engagement. There may be times when the breadth of material to be covered is too great for the time allowed.

Conclusion

Incorporating clicker questions into your lectures has many benefits. It is an effective way of soliciting feedback from your learners. It can be used to encourage peer interaction and engagement with the content of your lecture. Additionally, it allows you, the instructor, to adjust your lecture based upon the needs of the learners.

References

1. Arneja J, Narasimhan K, Bouwman D, Bridge P. Qualitative and quantitative outcomes of audience response systems as an educational tool in plastic surgery residency programs. Plastic and Reconstructive Surgery. 2009; 124(6): 2170-2194.
2. Burns R: Information impact and factors affecting recall [paper]. Annual National Conference on Teaching Excellence and Conference of Administrators, Austin, TX: 1985.
3. Copeland H, Stoller J, Hewson MG, Longworth D. Making the continuing medical education lecture effective. Journal of Continuing Education in the Health Professions. 1998; 18(4): 227-234.
4. Crouch C, Mazur E. Peer instruction: Ten years of experience and results. American Journal of Physics. 2001; 69(9): 970–977.
5. Gagne R: The Conditions of Learning. New York: Holt, Rinehart, and Winston, 1965.
6. Hake R. Interactive-engagement versus traditional methods: A six-thousand student survey of mechanics test data for introductory physics courses. American Journal of Physics. 1998; 66(1): 64-74.
7. MacManaway L. Teaching methods in higher education—innovation and research. University Quarterly. 1970; 24(3): 321-329.
8. Rubio EI, Bassignani MJ, White MA, Brant WE. Effect of an audience response system on resident learning and retention of lecture material. American Journal of Roentgenology. 2008; 190:W319–W322.
9. Santen S, Hemphill R: No! Not another boring lecture: Educational theory provides a sound basis for more effective teaching. Residency Assist Page Web site. Internet (http://www.facs.org/education/rap/santen0509.html), retrieved 2009.
10. Stowell J, Nelson J. Benefits of electronic audience response systems on student participation, learning, and emotion. Teaching of Psychology. 2007; 34: 253-258.

 

Online February 8, 2010