November 26th, 2017

Should Medical Students Bring Laptops to Lectures?

You can file this under, “Old man yells at cloud,” but here goes.

Twice a year now for over a decade, I’ve been lecturing the senior medical students in a therapeutics and pharmacology course. It’s an elective, but it’s very popular — most of the class takes it.

Not surprisingly, my topic is Treatment of HIV (duh) and my goal is to convey the “big picture” themes of HIV treatment and prevention — who gets treated and when, what we choose and why, the basics of pre- and post-exposure prophylaxis, the remaining challenges.

Since most of the students will never become ID or HIV specialists, I don’t go into much minutiae — no molecular diagrams of mechanisms of action, or complex resistance patterns, or immunology flow charts, or phylogenetic trees.

As a result, I  stopped using Powerpoint years ago in this talk, instead making it as interactive as possible. I put a few key principles up on a white board as take-home points, and use cases to illustrate each one.

There’s only one problem — a few of the students never look up from their laptops, and hence don’t join in the process.

And nearly all of them now have laptops; the laptop-to-student ratio is very close to 1. It’s much greater than 1 if you count the other screens periodically appearing in the room (phones, tablets, etc).

It might be my teaching style that’s boring these laptop lovers, of course, or the topic (you could imagine that treatment of HIV isn’t high on the list of must-know items for future orthopedists), or some combination.

But there is evidence that laptops in classes and lecture halls impair learning. In this piece just published in the New York Times, the author cites several such studies:

A growing body of evidence shows that over all, college students learn less when they use computers or tablets during lectures. They also tend to earn worse grades. The research is unequivocal: Laptops distract from learning, both for users and for those around them.

It’s not just that some are checking emails, messaging friends, or engaging in whatever social media is currently vogue among their demographic. Their laptop activity is also making it harder for others in the class to concentrate, according to some studies.

Finally, the note-taking process itself is less effective at storing new material when it’s typed rather than written.

So “No laptops” is a “No brainer”, right?

Wait — it’s not quite so simple.

I’m one of those terrible-handwriting sorts for whom learning to type opened up a whole new way of communicating. I type much faster than I write, and my handwritten notes are often illegible. During our weekly case-conference, I type the details of the case into my laptop because I could never write fast enough longhand to get the details down.

I’m also the first to admit that the internet is the most extraordinary resource. If I mention the START study (which I inevitably do), the students can find the original reference instantaneously.

Plus, there’s the paternalism issue cited in the Times piece, which even more strongly applies to medical students:

Most college students are legal adults who can serve in the armed forces, vote and own property. Why shouldn’t they decide themselves whether to use a laptop?

Bottom line is that I think there are pros and cons to using laptops in the classroom — which means it’s perfect fodder for a poll.

Should medical students bring laptops to lectures?

View Results

Register Now for more NEJM Journal Watch Content

20 Responses to “Should Medical Students Bring Laptops to Lectures?”

  1. Robert Güerri-Fernández says:

    Anything you can write down during the class could be find in a book, internet… however paying attention to clinical examples, the clinical reasoning…even non verbal communication from the lecturer is extremely important. And for these ones, computers does not help!

  2. Meg Newman says:

    Hi Paul,

    I still always enjoy your columns.
    As a woman who has reached her mid 7th decade in the trump era, I find that I too, have started yelling at clouds. At least it is not a terminal illness and more or less limited. And Twitter is a great therapeutic option. Be well

  3. Denis Hart says:

    As noted, the students are adults, so I don’t think laptops should be banned.

    I do think, however, that the information regarding the adverse consequences of the intense engagement with the computers at the expense of the engagement with the instructor(s) and the rest of the class should be made known to the students so their decisions to use or not use are based on the currently best available information.

  4. Charlie Williams says:

    When I was a medical student I took far fewer notes when the speaker provided access to their power point presentation. When no presentations were provided I was always worried about missing important points.

    Maybe do a deal with the students – provide them with an outline of your talk and the key references (so they know when you said START and when you said SMART) and in return use your speaker’s prerogative to ban laptops from your talks?

    How about asking this poll question to your students too?

    • Mickey says:

      As a lecturer in medical research, I found good slides to be valuable as a speaker and to bring my points across with minimal effort to the audience. My slides got better the older I got. I embrace new technology. However, the cell phone goes off during any presentation or at dinner with anyone.

  5. Combine the two. Designate 2 or 3 students as laptop assistants. Have them be able to attach laptop to projector screen that is seen by all behind the professor. Their preassigned job is to show pertinent internet info they search during lecture like abstract of key studies mentioned or other related internet info deemed important or of interest. Also type on screen pertinent comments or questions that come into their heads for including in discussion. All other students are available for direct interaction with eye contact and immediate questions and answers. Notes and references (webpages) are copied and distributed by group email to students and teacher after the “lecture” for comment, correction and filing on individual laptops for future reference.
    This major learning process for med students and trainees that is totally omitted from curricula now and can be summarized as follows:
    Problem identified (CC from patient, question from yourself or patient or colleague, etc)
    Student must find all the pertinent information to answer question from internet and person asking question or personal communication with other experts if needed.
    Then the student must synthesize, organize and use the information to make the right decision about the best answer to the question or patient management and type the summary and conclusion onto computer in coherent and usual manner.
    And do it in the shortest amount of time possible while being without error and without influence of any special interest. Because time performing this process is money (trillions of $) and the determinant of how much value to quality and quantity of life for our patients and society that we as individuals can provide.
    This is how education should work in the information age. It isn’t so complicated. Just totally different than lectures, closed book tests (like the medical boards in med school and specialty exams) which are a totally worthless process in our current world.
    BTW in my last three years in practice this is how I ran my patient visits for a nephrology/transplant practice with very complicated patients with my role as “student” (getting the info from internet in real time and synthesizing it and entering info, conclusions and recommendations in EMR real time, on screen for patient to see. Then, as “teacher” to the patient, educate them on what I did and recommend with written copy and/or file of EMR to patient and all involved in the care of the patient at end of visit.

  6. Howard says:

    Should they bring their laptop to the exam room? To the consultation office? Bringing the laptop to the patient bedside might be the most appropriate for a ménages à trois. The best we can do is discuss the effect and teach the pros and the cons of having the laptop be part of the relationship between student/teacher and student/patient, text the NYT article to them and hope for the best.
    Tip: If you have TA’s in the course never ever let them sit in front. They are always doing non-class related work and all the students behind them see that.

  7. Loretta S says:

    I voted “yes” only because I don’t want to ban laptops. But on the first day of class (a pathophysiology and pharmacology class for undergrad nursing students), I do discuss the evidence that NOT using a laptop is likely to help them remember more and put the big picture together better. My students do get PowerPoint slides and I do my darnedest to make it clear what info is important for them to know. Interestingly, most of my traditional BSN undergrads (getting their first bachelor’s degree) still opt to use their laptops. But my second-degree BSN students — who, overall, are not very much older than my traditional students — are more evenly divided among laptop users and handwritten note writers. Perhaps my second-degree students have learned the hard way that using a laptop can impede learning and retention? BTW, one of my colleagues who also teaches science does ban laptops.

    This is a great topic, and judging by the number of responses to the poll already, lots of people agree with me.

    • Sandra Hrometz says:

      I totally agree with Loretta S. Banning laptops isn’t the answer. I believe that providing pros and cons of typed versus written notes puts the ball back in the student’s court. I prefer to use a handout that is an outline and gives them space to write-in additional information rather than the power point slides. However, I provide both to them online so that they can choose what they prefer. I teach in a College of Pharmacy where the students are given (they paid for) a laptop and so they feel obligated to use it for everything, including notes during lecture. It has been difficult convincing students to figure out what works best for them; however, when a student is failing the class I do talk to them about how they are taking notes and their level of distraction during lecture.

  8. Bryan Burke says:

    I vote no. First, the data is unequivocal – student education is being harmed by having laptops in the classroom. Laptops not only harm the education of the students who use them they distract the students around them and harm their education too. What if instead of laptops we substituted guns? Gun harm is physical, not mental, but now we’re just talking degrees of harm. If we believe better educated students will take better care of their future patients – and we may as well shut down our medical schools if we do not – then less educated students are going to take poorer care of their future patients, thus bringing physical harm, albeit indirectly, into the argument, making the gun analogy more apt if less graphic. To me this line of argument trumps the “the student has a right to use a laptop if he/she wants to” argument.
    A second philosophical argument, one which I believe, contends that responsibilities should always supercede rights. If a student does have a right to use a laptop, the responsibility which they have to their fellow students who will distracted by it, the responsibility they have to pay attention to their teacher, and the responsibility they have to their future patients should come before their right to a laptop, phone, or other electronic device.
    Third, we as teachers, too, have responsibilities, one of which is to ensure that our students have the best possible education. Since laptops harm their education, and some students either don’t believe the data or do not have the ability to forego the use of their laptop, we should help them by preventing their use in the classroom. Of course students are adults. I think we can learn from certain Asian cultures, though, who revere the wisdom of those older than themselves. In this case we, the older professors, know better.
    Fourth, students need to be taught, and we older adults need to be reminded and re-taught, to respect authority. Many examples show that we live in a world and in a culture than has little respect for authority. However, we as academicians have been put in places of authority over them. Though they are just as intelligent as we are – and many are more intelligent than I am 🙂 – we have an advantage over them because not only have we been students but we have observed students, we have studied students and learning as the laptop data shows, and we have far more life experience, both in the medical arena and other areas of life, so we should be able to make decisions that will be for their benefit.
    I realize nobody died and made me right. I may be a fascist at heart and not consciously realize it. I may have seen too many robot movies and feel that all electronic devices are trying to become SkyNet. 🙂 If you will, though, as a final argument, think about the issue from the standpoint of immunizations. Doctors need to take a stand on universal immunization because we have proven immunization’s benefits. (After food, clothing, and shelter, I cannot think of anything better for one’s health than to be completely immunized.) California’s recent immunization law proves that at least one large state agrees with this stand. Teachers need to take a stand on laptops for similar reasons. Just as we have proven that immunizations improve public and personal health, so we have proven that laptops harm education. If we cannot eliminate classroom laptop use because of personal rights them we cannot support California’s law, either, because it takes away a person’s right to be unimmunized. Individual rights cannot be unlimited. I support California’s law and I support laptop elimination in the classroom.

  9. Sanford Kimmel says:

    I think that students do have the right to bring a laptop to class. Let’s be realistic, in this day of EMRs, I too find myself using a laptop in the room with patients, and yes they can be distracting. When I was in academic medicine, I used to ask medical students questions based on clinical cases that I had placed in my Power Point slides. So as not to discriminate, I typically went through each row, student by student (obviously this was usually a group of 30 or so students). The purpose of this was to generate interaction with the students and occasionally wake up the one that was drowsing off.

    By the way, I spoke on immunizations and helped author the “Shots” program that is available for IPhone and Android users (sorry for the plug).

  10. MIchael Rowe says:

    I agree completely that it’s an impediment though probably hopeless to try an intevention. While medical students are bright and earnest, they’re also contemporary screen zombies like everyone else.

    Look up the various videos on the topic of “What will Steve Kerr do while reporters Tweet” to see one strategy. (He’s coach of the Golden State Warriors basketball team for those not lucky enough to be living in the Bay Area-from a former Boston dweller).

  11. Susan Larrabee says:

    A conversation I had with a patient last week:

    Social Worker – “So, how did it go with your new HIV MD?” (fellow)
    Patient – “I don’t know. I didn’t really see him. He was busy on the computer”.
    Social Worker – “Wow”

    Well, I guess he learned it in the classroom.

  12. Yehuda says:

    True, you can type faster than you can write. But, while you type, you can not pay attention to what is being taught during that time. So better just pay attention and tape very sparse hand-written notes w/ nothing but bullet points.
    Yes, med students are adults etc. But young adults nowadays are faced with extremely challenging choices which are seemingly innocuous but have long-term repercussions, choices that most of you did not have as med students. While perhaps outright banning laptops (and other digital connectors to the outside world) should not necessarily be banned from the classroom, there should be a strong and active campaign within each school to bring awareness of these issues to the med students, this way they are engaged, knowledgeable, and can make the right decisions on their own volition.

  13. Rogerio Luz Coelho says:

    If you are into lectures you are dead as a modern professor.

    A lot more studies show that lectures do not teach … Interactive learning is the future. Maybe it’s time for teachers to learn how people learn, so then they can make a serious attempt to show these people what they want them to learn.

    PBL you next lecture, give them a chance to SHOW how they can learn by themselves with the technology. You will be amazed.0


  14. Nick says:

    The transition to taking notes on laptops is driven more by changes in content delivery with Powerpoint, and subsequent disorganized information overload, than anything else.

    I 100% agree that handwritten note-taking, unlike typing, requires a little bit of intellectual distillation before thought hits paper. But, the same logic applies to creating a lecture when you’re limited by what you can write on the board versus a near infinite capacity to copy-paste tables and figures into a Powerpoint-driven lecture. In a pre-Powerpoint era, lecturers were limited by chalk and overhead to identify a couple figures that highlighted a key concept for a given lecture. Unlike today where the average lecture (at my school) is delivered by 40-60 Powerpoint slides, about half of which figures.

    How is a student who may not have an established pathophysiologic paradigm and certainly does not have a clinical understanding of what their seeing deal with 25 different graphical representations of key concepts in an hour? Which are crucial and which expository? You use the means to capture as much of it as possible and try to make sense out of it later. This is why most students use laptops and particularly applications like Notablility and OneNote – resources where you import a powerpoint file and annotate. Relatively few were using Word or text-based software, again, at least at my school.

    The technology available has made it so easy to include more information that critical concepts and facts are being diluted or presented in so many ways that a preparadigmatic student is confused. If you don’t believe me that technology can drive this kind of behavior, I bet we can all point to medical documentation where the ratio of autopopulated nonsense to clinical thinking is 9:1 or worse.

  15. Mickey says:

    When I was at Berkeley in 1974, taking quantitative analysis, I was the only student without a calculator. I did the math in my mind. I was at a disadvantage. I too learned a lot from my Professors. I hate note taking but a few notes on a computer lets me remember topics emphasized.
    Writing notes takes more time, is less efficient. As a lefty, my handwriting is not so good.
    I have 4 collage degrees, note taking was not key to my grades or understanding.
    Finally, it is the students decision. Science is more rigorous that liberal arts. More study is required, textbooks are critical. To this day I look for documentation, on the internet. It is very efficient.

  16. Shishir Gokhale says:

    I teach medical graduate students. We do not have yes/ no policy about laptops/ smart phones. At the beginning of every class we request students to keep their phones off/silent mode as not to disturb other students.We do not permit use of social media etc for purposes other than the topic under discussion. We consider such activity disruptive for the benefit of all students. We handover all power point presentations along with bibliography/references as further study material.
    The laptops can be brought to the classrooms as long as it serves to enhance the discussion/interaction/explanation of the topic under consideration.

  17. Robert H Bowden Jr MD says:

    Is there much diffrence between a computer screen and the”turn off the lights,first slide” of my day? Also the teacher has to be willing to engage students and share knowledge,not to impress students with their knowledge. Dr. Sax seems to be trying to do this,but”you can lead a horse to water,but you can’t make him drink”.

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

Biography | Disclosures | Summaries

Learn more about HIV and ID Observations.