I'm of the viewpoint that you shouldn't criticize the actions of others without having a reasonable alternative to offer. I'm not a fan of traditional lecture-based medical education, and just wrote a post against one of the more popular alternatives in Problem-Based Learning (PBL) curriculums, so I should probably provide some sort of third option.
Lectures, PBL, any other approach in education is simply a tool to transmit information. Like any tool, they can be used effectively or ineffectively. Hammers work great on nails, not so much on screws. Lectures are amazing at conveying large amounts of information quickly to large groups of people. However, unless an instructor is particularly capable, lectures are terrible for information retention. PBL is great for information retention, but terrible for information transmission. Used in conjunction, these approaches can maximize efficiency in education. Introductory information is conveyed via lectures in bulk, then emphasized and expanded upon with appropriate problems.
Many schools employ some version of this combined approach, but not necessarily in a well-constructed manner. Sometimes one technique is relied upon too heavily. Sometimes the timing or coordination is problematic, such as providing a PBL task before a lecture, or so far after it that retention from the lecture is minimal. Deliberately using both techniques together, as two parts of a whole, is preferable.
In reality though, the tools themselves are flexible and can be adapted to account for their weakness. Lectures can be interactive and entertaining, maximizing retention. PBL can provide concise supporting resources, or have knowledgeable instructors available to provide context and guidance. Yet achieving these adaptations is easier said than done. Strong lecturers are surprisingly rare. Having adequate numbers of instructors for PBL for an entire curriculum is expensive. As such, combinations of approaches may permit less-than-ideal versions of these tools to be sufficiently effective given basic resource constraints.
If I were designing an educational approach from scratch, my emphasis would be on the basic points of educational psychology that too often get neglected - scaffolding, context, and repetition. Clinical education is so effective because it naturally includes all these elements. Pre-clinical education is often so ineffective because it fails to incorporate them. Repetition in particular is sorely lacking.
My preferred structure for medical education would be based around repetition. If a piece of information isn't conveyed at least three times within the span of a month or so, to me, it's not even worth teaching, at least not at such an early stage as during pre-clerkship years. I would like to see another tool, one which has a good evidence base behind it, used more frequently - formative assessments. Formative assessments are wonderful because they eliminate the pressure for short-term learning seen in summative assessments, while providing an opportunity to identify gaps in knowledge.
So here's my ideal set-up: in the first week, lectures, small group discussions, or readings would be given on a set of associated information. This transmits the information. The second week, a formative assessment is given testing all the transmitted information. This assessment is taken up with students to identify class-wide and personal gaps in knowledge. The third week, an applied, context-heavy session is held. This could be PBL, Team-Based Learning, physical skills instruction, anatomy lab, or really anything that requires some application of the knowledge outside a classroom setting. Ideally, this would adapted to the weak points in class' knowledge based on the formative assessment. Four-to-six weeks later, a summative assessment is given to test the students' knowledge, forming the basis of the students' marks. Even though this is a graded test, the results of the test should be given to the students to identify any remaining deficiencies in knowledge. Evaluations are necessary, but they're also one of the best ways to learn, and I've never understood why schools place such a high priority on keeping test answers secret. Yes, I know they want to keep future classes from just studying the questions on the test, but it's a poor excuse. Either schools are failing to ask a wide enough variety of questions on their tests (question bank is to small for the amount of material provided or they're recycling a limited number of idiosyncratic questions), or all the pertinent information is in those questions they're asking and in that case, who cares how students learn that information - that means they're getting all the necessary data!
The main weakness to my approach is that it's a bit more time-intensive for each fact that gets presented. You can't give nearly the same number of lectures if you're losing a day or two each week to formative assessments or application tasks like PBL. I strongly believe this to be a worthwhile trade-off. While less information is provided to students, more should be retained. More importantly, what information is retained should be more consistent student-to-student. Consistency matters when setting expectations for subsequent steps, such as in clerkship. I found it baffling that I could know nothing about a part medicine that I learned about in pre-clerkship and no one cared - what was the point of those first two years if I could start right back at the beginning without consequence? What I did remember of course came in handy, but what I retained from pre-clerkship and what my colleagues retained from pre-clerkship was at times shockingly different. Clinical instructors have to set the bar very low when there's such variability in learner knowledge.
I'm starting to ramble, so I'll try to wrap this up. In medicine, clinical education will always be the most critical aspect. I've argued before that we should substantially reduce pre-clerkship education, or even scrap it entirely. However, realizing that clinical educational opportunities are limited and that having some base knowledge before seeing patients helps protect both students and patients, I doubt we'll ever eliminate pre-clerkship education. So, if it must exist, I think it could use a revamp, to become more efficient, more effective, and for its results to be more consistent. It doesn't take more money, or more time, or fancy educational innovations. It just requires some variety in instruction techniques and a focus on applying the basics of educational theory thoroughly.
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