The Analysis of Teaching of Medical Schools (AToMS) survey: an analysis of 47,258 timetabled teaching events in 25 UK medical schools relating to timing, duration, teaching formats, teaching content, and problem-based learning

Abstract

Background: What subjects UK medical schools teach, what ways they teach subjects, and how much they teach those subjects is unclear. Whether teaching differences matter is a separate, important question. This study provides a detailed picture of timetabled undergraduate teaching activity at 25 UK medical schools, particularly in relation to problem-based learning (PBL).

Method: The Analysis of Teaching of Medical Schools (AToMS) survey used detailed timetables provided by 25 schools with standard 5-year courses. Timetabled teaching events were coded in terms of course year, duration, teaching format, and teaching content. Ten schools used PBL. Teaching times from timetables were validated against two other studies that had assessed GP teaching and lecture, seminar, and tutorial times.

Results: A total of 47,258 timetabled teaching events in the academic year 2014/2015 were analysed, including SSCs (student-selected components) and elective studies. A typical UK medical student receives 3960 timetabled hours of teaching during their 5-year course. There was a clear difference between the initial 2 years which mostly contained basic medical science content and the later 3 years which mostly consisted of clinical teaching, although some clinical teaching occurs in the first 2 years. Medical schools differed in duration, format, and content of teaching. Two main factors underlay most of the variation between schools, Traditional vs PBL teaching and Structured vs Unstructured teaching. A curriculum map comparing medical schools was constructed using those factors. PBL schools differed on a number of measures, having more PBL teaching time, fewer lectures, more GP teaching, less surgery, less formal teaching of basic science, and more sessions with unspecified content.

Discussion: UK medical schools differ in both format and content of teaching. PBL and non-PBL schools clearly differ, albeit with substantial variation within groups, and overlap in the middle. The important question of whether differences in teaching matter in terms of outcomes is analysed in a companion study (MedDifs) which examines how teaching differences relate to university infrastructure, entry requirements, student perceptions, and outcomes in Foundation Programme and postgraduate training.

Keywords: Clinical teaching; Lectures; Medical school differences; Problem-based learning; Self-regulated learning; Teaching styles; Timetables; Tutorials.

Fig. 1

Start and end times of teaching events: a start time on logarithmic scale (red) (inset: start time on linear scale (green)), b duration in hours (grey), and c start and end time (blue). In c, note that some events start on 1 day and finish on the next

Fig. 2

Average hours of the different teaching formats for a student at a typical medical school by medical school year. For each teaching format, the 2-year groups with the highest amount of teaching are in blue, with the highest value underlined. Green shading denotes totals of over 200 h. The two groups of teaching formats designate those that are mostly basic medical sciences and mostly clinical, respectively

Fig. 3

Average hours of teaching for the different teaching contents for a student at a typical medical school by medical school year. For each teaching content, the 2-year groups with the highest amount of teaching are in blue, with the highest value underlined. Green shading denotes totals of over 150 h. The two groups of teaching contents designate those that are mostly basic medical sciences and mostly clinical, respectively. Note that SSCs and electives are not included as they are not allocated to particular years

Fig. 4

Total hours of teaching at the 25 UK medical schools. Times are stacked for years 1, 2, 3, 4, and 5, followed by SSCs and electives, all based on the AToMS survey. Schools are sorted by total teaching time in the AToMS study. These are followed by estimates of self-regulated learning; see text for details

Fig. 5

Teaching at individual medical schools. Number of hours of teaching in terms of teaching format (upper) and teaching content (lower). Format and content are ordered in the same way as in Figs. 1 and 2. Medical schools are structured in terms of non-PBL and PBL schools, with schools sorted alphabetically within groups. Within entire rows, colours indicate the highest number of teaching hours (red) and the lowest number of teaching hours (blue). The final column marked CV shows the coefficient of variation; values > 80% are shown in red

Fig. 6

Teaching formats and contents at PBL and non-PBL schools. Average (SD; median) hours of teaching for the different teaching format and content areas for an average student at the ten PBL schools and the fifteen non-PBL schools. Differences significant on the t test (p < .05) are shown in colour, red indicating the group with the greater amount of teaching and green the lesser amount of teaching. t tests take account of differing variances, and significant results are shown in bold

Fig. 7

Curriculum map of formats and contents. a Top: loadings of teaching measures on the first two factors with format measures in red and content measures in green. b Bottom: scores of medical schools on the first two factors: blue—PBL schools, black—non-PBL schools

Fig. 8

Hours of PBL teaching for individual medical schools. Scores of PBL (blue) and non-PBL schools (black) on the first factor (PBL vs traditional) in relation to timetabled hours of PBL teaching (vertical). The fitted line is a Loess curve

Fig. 9

Validation of hours of teaching in the Teaching Survey with hours of teaching in the HEPI Student Academic Experience Survey. Pearson correlations based on 24 medical schools. *p < .05; **p < .001. Correlations greater than an arbitrary level of 0.3 shown in green and correlations less than an arbitrary level of − 0.3 shown in red