2014, 36: 789–793

What happens when teachers do not give students handouts? APINUT WONGKIETKACHORN, JETBODIN PRAKOONSUKSAPAN & DANAI WANGSATURAKA Chulalongkorn University, Thailand

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Abstract Background: Handouts have been a primary tool to help students learn and understand class content in lectures better. Some lecturers, however, do not provide handouts to students. Currently, little research has studied the disadvantages of lectures without handouts. We, therefore, aim to survey medical student opinions and behaviors in lectures with handouts comparing to lectures without. Methods: A cross-sectional study using questionnaires was conducted on first to fifth year medical students at the Faculty of Medicine, Chulalongkorn University. Results: Study response rate was 89.5%. Less concentration in lectures without handouts was reported at 83.6%. Note-taking decreased 38.3% from 89.7% to 51.4% (p50.001) with a statistically significant increase of class-skipping behavior. Absence of handouts also resulted in a rise in photocopying peer lecture notes but had no significance increase in either self-directed or peer learning. There was no association between student grade point average and handout attitudes. Conclusions: Handouts are essential in lectures for medical students. Taking them away could immensely reduce student capability to concentrate and understand dynamic lectures. Providing handouts does not spoon-feed students with information. Rather, handouts help offer qualitative improvements to lectures.

Introduction Lectures are one form of teaching methods using oral presentation. It is also the oldest (Thompson & Sheckley 1997) and the most common method of teaching (Brown & Manogue 2001). It is an effective and cost worthy way of delivering information to a large group of students at the same time (Brown & Manogue 2001; Wood 2003). In pre-clinical years, students attended lectures more often than seeing patients. By the end of the medical degree program, medical students would have attended over a thousand lectures (Brown & Tomlinson 1979; Brown & Manogue 2001). Since the main characteristics of lecture are: intention, transmission, receipt, and output, students might not gain benefits from lecture in some ways (Baddeley 1996). Some of the major obstacles that students may face in a lecture are: lecturers speaking too quickly, poor use of audiovisual aids, and insufficient period of time to copy diagrams (Brown & Bakhtar 1987). Furthermore, messages received by students are easily forgotten after 30 seconds if students do not take note or cannot put concepts in long-term memory (Brown & Tomlinson 1979; Brown & Manogue 2001). One way to overcome these common obstacles is with the use of handouts. According to MacLean (1991), handouts are any learning materials given to students as an advanced organizer to provide technical terminology and basic information that students should read either at or prior to the beginning of

Practice points   



The absence of handouts in lecture has negative impacts on student learning. Clinical students are slightly less handout-dependent than pre-clinical students. Most students will not employ more self-directed learning when handouts are not provided. They will search for photocopies of complete peer lecture notes. There is no statistically significant correlation between student GPA and their attitudes towards handouts.

the lecture. It can also be used as a study guide. Having access to handouts during lectures is associated with a number of benefits. Handout enhances a lecture and ensures that all students have access to the same information (De Young 1990). It allows for less note-taking (Marsh & Sink 2010). Students, therefore, have more time to listen and think during a lecture (Amato & Quirt 1990; Wood 2003). There are a few disadvantages of handout though. According to some literature, teachers are required to submit handouts a long time before the lecture. This puts more burdens on teachers and lecturers to prepare such material in advance. In addition, printing is costly which creates pressure on both teachers and administration (Amato & Quirt 1990). However, there are different points of view between lecturers and students (Marsh & Sink 2010). Some lecturers

Correspondence: Danai Wangsaturaka, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Patumwan, Bangkok, Thailand. Tel/Fax:+662-256-4477; E-mail: [email protected] ISSN 0142-159X print/ISSN 1466-187X online/14/90789–5 ß 2014 Informa UK Ltd. DOI: 10.3109/0142159X.2014.909921

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do not see the importance of giving handouts before class; therefore, hand them out after class (Marsh & Sink 2010). While other lecturers want students to always take notes to prevent a lack of concentration and encourage students to use standard textbooks by not providing any handouts. Unsurprisingly, students have adverse views of the issue. Students are more concerned about having handouts prior to class (McDougall et al. 1972; Collingwood & Hughes 1978; Marsh & Sink 2010). Some claimed to have better concentration during lectures with handouts (McDougall et al. 1972; Hartley & Marshall 1974). Earlier literature has made great contributions to the understanding of the advantages of lectures with handouts. However, there are very few studies focusing on the disadvantages of lectures without handouts. This current study aims to identify student attitudes and lecture behavior without handouts compared to lectures with handouts while evaluating the association between Grade Point Average (GPA) and handout attitudes.

Study design and methods A cross-sectional study using questionnaire was conducted at the Faculty of Medicine, Chulalongkorn University.

Questionnaire development Direct observation Target study population was comprised of third-year medical students. This was due to the fact that third years are required to attend more lectures than any other years. Two researchers observed student behavior in three periods: during lectures, immediately after lectures, and prior to examinations. Study observation took place in lecture halls, libraries, and dormitory study rooms.

Short interviews Information regarding student attitudes and behaviors that could not be directly observed was also gathered by way of short interview. Fifty students from first to fifth year were purposively selected and interviewed until a redundancy of answers was found. Four open-ended questions were used: (1) What is your opinion towards a lecture without handouts? (2) What do you do in a lecture without handouts? (3) What do you do after the lecture without handouts? (4) How do you prepare for an examination when content was not provided in a handout? Questionnaire design was based on results obtained from direct observation and short interviews. It was piloted on 30 students.

The questionnaire was distributed on the last examination date of each year to reduce recall bias.

Data analysis Data were analyzed using SPSS software (version 16.0 for Windows; copyright 2007. SPSS Inc., Chicago, IL). In addition analysis data obtained from the entire study population, Year 3 and Year 5 students were chosen as representative batch samples for pre-clinical and clinical students. The comparison between these two sub-groups aims to study different student opinions and behavior in these two phases. McNemar’s test and Spearman’s correlation were used for statistical analysis. A p value less than 0.05 was considered statistically significant.

Results A total of 89.5% (1146/1280) of all students completed and returned the questionnaires. First-year students accounted for 95.7%, second year 67.8%, third year 97.5%, fourth year 97.8%, and fifth year 92.9%. There were more female participants (53.8%) than male (46.2%). Approximately, 50% of respondent GPA were between 3.25 and 3.74.

Student opinions on lectures without handouts A majority of students (65.3%) claimed that less attention would be paid in lectures when handouts were not provided. A total of 18.1% of the students would feel completely lost with an inability to focus on lectures without handouts. Table 1 shows that lectures without handouts would have a negative effect on 83.4% of respondents and was statistically significantly different (p50.001) among Year 3 and the Year 5 students.

Student behavior when handouts were provided compared to when they were not During lectures When handouts were not provided, student note-taking behavior changed statistically significantly (p50.001). Active note-taking behavior decreased while there was an increase in audio-recording, photo-taking and, class-skipping behavior (Table 2). There was a statistically significant change in notetaking behavior in both Year 3 and Year 5.

Table 1. Student opinions about lectures without handouts.

Study population Students in Thailand spend six years in their undergraduate medical curriculum. The first three years (Phase I) are mostly classroom-based. Fourth and fifth years (Phase II) are clinical clerkship with some classroom experience while the sixth-year students rarely have lectures. All 1280 students from Year 1 to Year 5 were included in this study. 790

Student opinions lectures without handouts 1. 2. 3. 4.

Complete loss of attention Paying less attention Same as having handouts Paying more attention

Total population (%)

Year 3 (%)

Year 5 (%)

18.1 65.3 11.1 5.5

23.4 66.8 6.2 3.6

6.0 69.4 18.0 6.6

What happens when teachers do not give handouts?

Table 2. Student behavior during lectures when handouts were provided compared to when they were not.

Total population (%)

Student behavior during lectures 1. Note-taking (1) active note-taking (2) taking notes from slides without listening* (3) Only listening (4) Sleeping (5) Other (e.g. playing games, talking to friends) 2. Audio recording 3. Photo-taking of every slide 4. Skipping lectures

Year 3 (%)

Handout Handout provided not provided

p

Handout Handout provided not provided

50.001 89.7 – 8.7 0.8 0.8 18.1 4.1 0.5

51.4 15.7 19.8 4.7 8.4 22.7 11.2 2.5

50.001 50.001 50.001

Year 5 (%) Handout Handout provided not provided

p

0.009

50.001 92.4 – 5.4 1.4 0.7 31.4 4.1 0.7

47.4 11.3 23.0 4.7 13.5 40.7 17.5 2.2

50.001 50.001 0.022

p

90.2 – 8.7 1.1 0.0 2.3 0.0 0.0

62.1 18.7 12.6 3.8 2.7 2.3 0.6 2.8

0.344 –** –**

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*This choice was not available in ‘‘lectures with handouts’’. **p Value cannot be computed.

Table 3. Student behavior after lectures when handouts were provided compared to when they were not.

Total population (%)

Year 3 (%)

Year 5 (%)

Handout Handout Handout Handout Handout Handout provided not provided provided not provided provided not provided

Student behavior after lecture Reading own notes Completing own notes by checking with peer notes Peer learning Reading from textbooks or online sources Abandoning the topic Photocopying peer notes Reading handouts given after lecture or photograph taken during lectures Listening to sound clips taken from lectures Studying from e-lecture Reviewing old examinations of topic

23.2 22.0 14.5 4.7 16.8 6.7 2.6 2.6 5.7 1.2

14.5 12.7 7.5 5.3 15.7 21.6 9.6 3.5 7.9 1.8

25.2 20.8 12.6 8.1 18.4 11.4 1.8 0.2 0.6 1.0

18.5 16.1 6.6 7.5 17.7 25.8 5.3 0.1 1.1 1.4

21.1 29.4 15.8 2.3 14.4 8.7 1.7 4.6 0.8 1.2

12.9 12.3 6.2 2.2 14.3 30.5 9.7 7.6 2.5 1.9

Table 4. Student behavior before examination when handouts were provided compared to when they were not.

Total population (%) Student behavior before examination Reading own notes Peer learning Reading from textbooks or online sources Photocopying peer notes Listening to sound clips taken from lectures Studying from e-lecture Abandoning the topic

Year 3 (%)

Year 5 (%)

Handout provided

Handout not provided

Handout provided

Handout not provided

Handout provided

Handout not provided

44.4 14.2 9.7 17.9 3.2 8.5 2.1

28.7 10.9 9.8 31.5 4.2 10.15 4.7

47.3 14.9 8.3 21.0 5.1 1.8 1.7

26.7 11.2 7.4 38.7 7.2 2.6 6.3

43.9 13.3 11.6 26.3 0.2 2.4 2.2

33.5 10.8 11.1 37.5 0.9 2.0 4.1

After lecture

Before examination

Table 3 shows that, without handouts, desired learning activities (e.g. reading own notes, completing own notes with peer notes and peer learning) were decreased. However, students that further studied with textbooks slightly increased. The most significant increase in behavior was the use of photocopying to reproduce completed lecture-notes. These particular patterns of behavioral changes were similar in both Year 3 and Year 5.

As shown in Table 4, student behavior before examination was concordant with behavior after ‘‘lecture without handouts’’. There was a decrease of student revisions of own notes, and of peer learning. Student use of textbooks was unchanged. Similarly, student photocopying peer notes seemed be the act that increased the most. Abandonment of the topic and use of sound clips and e-lectures were slightly increased.

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Table 5. Association between GPA and handout attitudes.

Year

Correlation

p Value

1st 2nd 3rd 4th 5th

0.053 0.108 0.117 0.143 0.096

0.367 0.141 0.055 0.060 0.203

Association between GPA and handout attitudes

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There was no association between student GPA and attitudes towards handouts (Table 5).

Discussion Study limitations include the use of self-report questionnaires as respondents may not have completed the questionnaire honestly or accurately. However, heavy emphasis of the importance of the study during questionnaire distribution and collection was stressed to the entire study population. Research in medical schools in other cultures might yield different results. A large number of students were reported to have less attention during lectures where handouts were not provided. This result confirmed our understanding of the benefits of handouts in improving student concentration during lectures in previous studies (McDougall et al. 1972; Hartley & Marshall 1974). In terms of pre-clinical and clinical students, Year 5 students tended to maintain concentration levels more than that of Year 3 students when handouts were not given. This may be due to difference of their learning environment and increased maturity and focus of senior students. Year 5 students, similar to residents and practicing physicians, were found to pay more attention to the application of knowledge obtained from lectures (Kroenke 1991). However, the aim of most Year 3 students was to maximize examination scores which might require more complete memorization of lectures. Since a lecturer is always in control of the content in each and every assessment, students are more aware of the importance of class information that is discussed during any given lecture to ensure the best outcome. Note-taking is one critical skill in medical education. It is expected to help students learn (Russell et al. 1983; Isaacs 1989). Some teachers might wish to promote this skill by not giving handouts at all. Our study, on the contrary, showed a reduction in note-taking behavior when handouts were not provided. This may suggest that student note-taking skills require more attention and improvement. However, this result may not be surprising as Isaacs (1989) found that the percentage of information taken from the lectures ranged from 11% in first-year psychology students (Hartley & Marshall 1974) to 50% in third-year geography students (Maddox & Hoole 1975). The introduction and practice of Cornell’s notetaking system (Pauk 2001) may possibly be an effective solution. 792

Nevertheless, some students might take notes inaccurately or incompletely (MacLean 1991). Our findings show that students have other options besides taking notes. With the advent of and increased access to technology nowadays, students could photocopy note from the best note-taker in class (Tables 3 and 4). Sadly, these ‘‘perfect’’ notes are usually just another copy of lecture slide material (Marsh & Sink 2010). Therefore, it might be more convenient and more efficient if teachers provide handouts prior to class. Some medical teachers may consider that giving handouts tend to ‘‘spoil’’ medical students but the evidence from this research and McLeod & Tenehouse (1988) suggests that the absence of handouts does not necessarily encourage learning from textbooks. Further, there are a variety of types of handouts which can be used such as a full transcript, outlines, key information, interactive, and tasks and problems handouts. Each of these may have differential influences on learning from lectures (Brown & Manogue 2001). Further using lectures as the only or primary teaching method might actually be fostering passive, dependent learning. As this research shows, the inclusion of handouts prior to a lecture will probably encourage students to more actively engage with the topic by ‘‘allowing students more time to listen and think.’’ (Cantillon 2003).

Conclusion A survey was conducted to study student behavior in two lecture settings: with handouts and the other without. Results showed that handouts are key elements in promoting and optimizing student learning in lectures. It is strongly recommended that every lecturer consider providing handouts prior to or at the time of lectures.

Notes on contributors APINUT WONGKIETKACHORN was a third-year medical student when he initiated this research in 2010. He designed, conducted data collection and analysis in this study. He was a major contributor and writer of this manuscript. JETBODIN PRAKOONSUKSAPAN was a third-year medical student at the time of research initiation. He helped design, conduct, and write a portion of this research and manuscript. DANAI WANGSATURAKA, MD, PhD, is a Medical Educationalist. He supervised the study design and data analysis process in addition to reviewing and revising this manuscript.

Acknowledgements We gratefully thank Mr. Thanapoom Rattananupong for his statistical advice. This study was presented at the Association for Medical Education in Europe (AMEE) 2011 conference in Vienna, Austria and won the Patil Award in Teaching and Learning Category. Declaration of interest: The authors report no conflict of interest. The authors alone are responsible for the content and writing of the article.

What happens when teachers do not give handouts?

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What happens when teachers do not give students handouts?

Handouts have been a primary tool to help students learn and understand class content in lectures better. Some lecturers, however, do not provide hand...
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