U.S. medical schools' valuing of curriculum time: self-directed learning versus lectures.

Background: As medical schools implement curriculum changes to address the relevancy of medical education to today's health care needs, examining schools' grading systems and their valuing of curriculum hours has become a priority.

Method: In 1991-92 all 126 U.S. medical schools were surveyed regarding various issues related to the schools' grading systems and valuing of curriculum time, including the ways in which the schools achieved a balance between lectures and self-directed learning activities.

Results: A total of 122 schools responded. Forty-eight schools calculated grade-point averages and used them to compute and publish class ranks; 72 published grade-point averages. Fifty schools reported curriculum revisions that decreased lecture hours, incorporated small-group discussion, or used problem-based learning and/or assessments using standardized patients. These 50 schools fell into four categories: had a system to balance lecture time and self-directed learning (11 schools); were moving toward such a system (27 schools); had tried but failed to balance lecture time and self-directed learning (one school); and had no policy to achieve a balance (11 schools).

Conclusion: The survey results indicate that most schools have not established systems for the valuing of curriculum time that include balancing values for lecture time and values for self-directed learning. If needed curriculum reforms are to be implemented effectively, they must be valued meaningfully.