An Alternative to Lecturing
in a Large Group Classroom Teaching:
An Example


Reynaldo O. Joson, MD, MHA, MHPEd

Abstract || Text || Appendix 1 || Appendix 2

Appendix 1: Case Study: The Operation, Its Preop Preparation and Postop Care
Appendix 2: Learning Objectives: The Operation, Its Preop Preparation and Postop Care


Lecturing is a common teaching method in a large group in Philippine medical schools. Although widely used, it is being frowned upon primarily because of its passive student learning character. Many medical educators are recommending the use of other more active learning strategies. This paper describes an example of a strategy other than lecturing in a large group classroom undergraduate surgery instruction. The description serves to illustrate its feasibility and benefits and it hopes to instil awareness among Filipino medical educators.



Lecturing as a teaching method occurs when the teacher does a monoloque to students usually lasting 30 minutes or more. It is the most common teaching method in the classrooms of medical schools in the Philippines (1).

Why lecturing is very common as a teaching method in Philippine medical schools, the author offers the following observations and possible explanations:

1. The size of the medical class is usually large, some reaching 200 students and lecturing is the most economical and easiest teaching method.

2. Most Filipino medical teachers do not have extensive training in andragogy and may not be aware of and adept with other methods of large group instruction.

Athough widely used in the Philippines, even globally, lecturing has been frowned upon for a variety of reasons, foremost of which is the passive learning on the part of the students.

Many medical educators have suggested the use of more active learning strategies in large group classroom instruction. Gibbs et al (2) have suggested a number of ways of improving lectures as learning devices. Joorabchi (3) has described a problem-based programmed lecture. Barrows et al (4) have even shown how problem-based learning can be applied to a large group. Schwartz (5) has used active small group learning with a large group of medical students in biochemistry in a lecture theatre.

This paper describes an example of an alternative to lecturing in a large group classroom teaching in undergraduate surgery. The author hopes that this paper will create an awareness among medical teachers in the Philippines on the feasibility as well as advantages of a more active learning strategy other than lecturing in a large group.

Background to the Alternative Method

In the College of Medicine of the University of the Philippines Manila, there is a surgery course in Year Level IV (equivalent to the conventional second year medicine proper), entitled Theories and Fundamental Principles in Surgery (Surgery 201). The course runs for one semester with about 160 students.

The days and time alloted are Tuesdays (1-5 pm) and Thursdays (10-12 nn). The Thursday schedule is alloted for classroom teaching. One half of the four hours in the Tuesday schedule is alloted for clinical teaching while the other half, for classroom teaching.

In the classroom, the usual teaching method is the lecture.

The scenario is: A faculty is assigned a topic to teach the 160 students in one hour. What the faculty usually does is to give a lecture wherein he talks for about 50-60 minutes in a monoloque fashion on the assigned topic, often accompanied by visual aids. At the end of his talk, the faculty entertains questions from the students.

From 1985 up to 1992, the author used lecture just like the rest of the surgical faculty staff as the teaching method in the one-hour large group classroom instruction. In 1993, the author, after undergoing some training in andragogy, decided to utilize another kind of teaching method, which is the alternative method to lecturing described below. The author has been using this alternative method up to the present.

Instructional Design of the Alternative Method

The Scenario:

Before Class Preparations:

1. Author's write-up on the assigned topic to be given as hand-out in class

2. Author's write-up of two surgical cases with complete description of management to be used for case study in class (See Appendix 1).

During the Class:

1. Distribution of hand-out and cases to the students.

2. Declaration of the learning objectives on the topic (See Appendix 2).

3. Description of the teaching-learning activities to be undertaken and time allotment.

3.1 Given the 2 cases, with the help of the hand-out, each student identifies the following (20 minutes):

1. Preop, operative, and postop phase

2. Elements in the preop phase

3. Elements in the operative phase

4. Elements in the postop phase

3.2 Dyad groups formed to discuss each student's output (10 minutes).

3.3 At random, 2 dyad groups asked to present their output to the whole class (10 minutes).

3.4 Questions and feedback.

3.5 Synthesis

Faculty Evaluation:

During Class:

Observation of students' activities - individual work, dyad discussion, group presentation, and open discussion.

After Class:

1. Students' written output during the individual work.

2. Result of a written examination 2 weeks after the class.

Evaluation of the Alternative Method:

For 4 years, from 1993 to 1996, using the abovementioned instructional design for 4 times, the author has consistently observed the following:

1. All the students were actively learning as evidenced by the individual learning (reading hand-out, doing case study, and discussing with classmates).

2. The students could easily grasp the concept of operation, its preop preparation and postop care as evidenced by the group presentation, written output on the case study, and results of the written examination.

3. No students slept during the one-hour teaching-learning activity.

4. The author could clearly see that the students were all learning during the one-hour class.

The problems that were observed with the abovementioned instructional design were basically related to time management. Official time allotment wasone hour. On three of the four occasions, the time consumed was more than one hour, but only five to ten minutes more.

Three major factors that contributed to the difficulty in time management were identified as:

1. Faculty waiting for majority of the students to settle down to start the session. Some students would come in late.

2. Faculty waiting for majority of the students to finish their case study and dyad discussion before proceeding to the group presentation. Some students would ask for extension of alloted time.

3. Students presenting for more than the alloted time.

Comparison Between Lecturing and the Alternative Method

The following table shows a comparison of the alternative and lecturing methods that the author has experienced:



Time allotment

one hour

one hour

Student's effort in learning in class

passive, listening, understanding, absorbing teacher's talk

active, reading hand-outs,doing exercises, discussing with classmates, and teacher,some presenting in class

Student sleeping in class



Faculty's role

giving information, generating understanding, creating interest

facilitating in-depth learning

Level of difficulty of faculty's role



Evaluation of students' learning in class



Time management



Learning resources used in class




The author's experience with the alternative method has been very positive. The faculty's task as a facilitator and time management may be more difficult than in the lecturing method. However, clearly seeing that one's students are learning in class is most gratifying and worth the effort.

In the lecturing method, it is difficult to see clearly on the spot, meaning in class, whether the students are learning or not. However, one can safely conclude that the sleeping students are missing the learning that the teacher wants to impart.

Time management in the lecturing method is evidently easier because it involves practically a single person's activity - that of the teacher. Time management is understandably more difficult in the alternative method because it involves 160 students with varying rates of learning.


An example of a more active learning strategy other than lecturing in a one-hour large group classroom instruction was described. A comparison of the alternative and the lecturing method was made to highlight both the feasibility and advantages of the alternative method. The alternative method described is just one example. It is to be stressed that there are various other ways of promoting active student learning in a large group classroom instruction. Its formulation is dependent on the creativity and innovativeness of the medical teacher.


1. Sana EA et al: The Attitude and Values of Filipino Medical Teachers Toward Teaching. National Teachers Training Center for Health Profession, U.P. Manila, 1996 (unpublished).

2. Gibbs G, Habeshaw S, Habeshaw T: Improving student learning during lectures. Medical Teacher 9:11-20, 1987.

3. Joorabchi B: How to construct and use a problem-based programmed lecture. Medical Teacher 4:6-9, 1982.

4. Barrows HS, Myers A, Williams RG, Moticka EJ: Large group problem-based learning: a possible solution for the "2 sigma problem". Medical Teacher 8:325-331, 1986.

5. Schwartz PT: Active, small group learning with a large group in a lecture theatre: A practical example. Medical Teacher 11(1): 81-86, 1989.

Abstract || Text || Appendix 1 || Appendix 2

Appendix 1

The Operation, Its Preop Preparation and Postop Care

Case Study

Learning Objectives:

At the end of the study, the student should be able to:

1. Identify the preop, operative, and postop phases in the management of a patient with a surgical condition.

2. Identify the elements in the preop management of a patient with a surgical condition.

3. Identify the elements in the operative management of a patient with a surgical condition.

4. Identify the elements in the postop management of a patient with a surgical condition.

Tasks to perform:

Given two cases with a narrative chronological description of the management (the paragraphs are numbered to facilitate your answering task No.1) -

1. For each case, identify the preop, operative, and postop phase. Use the paragraph numbers in the case.

Case 1

Case 2





Preop phase

Operative phase

Postop phase

2. For each case, identify the elements in the preop phase (surgeon's tasks, duties, and responsibilities to the patient).

3. For each case, identify the elements in the operative phase (surgeon's tasks, duties, and responsibilities to the patient).

4. For each case, identify the elements in the postoperative phase (surgeon's tasks, duties, and responsibilities to the patient).

Sample of a Case


A 16-year-old Filipino male consulted a surgeon for a right lower quadrant abdominal pain which started two days ago. There was no associated bowel or urinary disturbance.


On physical examination, there was a definite and persistent direct tenderness and guarding over the right lower quadrant of the abdomen. There was no other significant findings.


Based on the physical examination findings and the other associated data, the surgeon made a clinical diagnosis of "acute appendicitis".


The surgeon discussed the diagnosis with the patient and his guardian. He recommended an operation. The guardian consented to the recommendation of the surgeon.


After the surgeon made a screening for any medical problem that might interfere with the operation and after finding none, he scheduled the operation two hours after. He maintained the patient on nothing by mouth prior to the operation. Since the pain was tolerable, the surgeon did not give any analgesic anymore.


Two hours after, the patient was at the operating room ready for the operation. After the anesthesiologist had administered a spinal anesthesia, the surgeon placed the patient on a supine position. He then cleansed and placed antiseptic solution over the whole abdomen. He then placed sterile drapes over the contemplated operative field. After proper gowning, the surgeon made a transverse right lower quadrant incision to enter the peritoneal cavity. Upon entering the cavity, he saw the appendix to be inflamed and with minimal suppuration. He then removed the appendix. After checking for bleeding and after a correct count of instruments and sponges, the surgeon closed the abdominal incision. A dressing was then placed.


The patient was brought to the recovery room. After two hours, he was transferred to his room.


Analgesics were given to alleviate the postoperative pain. Intravenous fluid started before the operation was discontinued after it was consumed. Diet was started as soon as patient felt like eating.


The day after the operation, the patient was discharged with the following instructions:

1. How to take care of the wound

2. What potential problems to watch out for

3. Home medications

4. When to come for a check-up


One week after, the patient came back for a check-up. On inspection of the wound, there were signs of wound infection. The wound was opened and pus came out. The open wound was then cleansed and a dressing placed. The guardian was instructed on how to take care of the wound at home.


The patient had regular visits with the surgeon for four weeks until the wound was completely free of infection.

Appendix 2

The Operation, Its Preop Preparation and Postop Care

Learning Objectives:

At the end of the study, the student must be able to:

1. Define what an operation is.

2. Indicate the two purposes of an operation.

3. Identify at least six items to discuss with a patient once a decision is made that an operation is needed before a consent is obtained.

4. Enumerate the essential elements of a preoperative preparation.

5. Give at least two examples of diagnostic operative procedures.

6. Give at least four types of therapeutic operative procedures based on objective.

7. Enumerate chronologically the essential steps of an abdominal cavity operation done under general anesthesia.

8. Enumerate chronologically the essential steps of an excision of a sebaceous cyst on the nape done under local anesthesia.

9. Enumerate the essential elements of a postoperative care.

10. Interrelate the operation, its preop preparation, and its postop care in terms of importance.

Abstract || Text || Appendix 1 || Appendix 2

Health Profession Education