For more information about the modules, contact: Amy Guenther, PhD at email@example.com
For more information about the modules, contact: Amy Guenther, PhD at firstname.lastname@example.org
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Asking questions is common practice medical education that has its roots in the use by philosopher Socrates. Questioning is a powerful strategy for educators to scaffold learning and encourage development of critical thinking skills (Costa, 1985; Garside, 1996; Ritchhart, 2011; Smith, 1977)
Why ask questions?
The Shared Discovery Curriculum is designed to provide fellows and other clinician educators questions to ask medical students. Many of these questions are really great high-level questions because the purpose of the SDC curriculum is to develop students/clinicians who not only understand the basic science content; but also think critically about why it matters, consider social determinants, and apply it all to patient cases and care.
What kind of questions should be asked?
Effective coaches, teachers, facilitators, and curriculum writers working with undergraduate medical education (UME) students, residents or graduate level medical education (GME) students ask questions, but what kind should be asked? Not all questions prompt learners to the same level of thinking and response. In an effort to push learners beyond basic facts, questioning frameworks such as Bloom’s Taxonomy (1956) were developed. Connecting Bloom’s Taxonomy with medical education, Barrett et al (2017) researched questioning in GME surgical contexts according to Bloom’s Taxonomy. Table 1 is an adapted version of their findings.
Which levels of questions should clinician educators ask? All levels of questions need to be asked at various times. However, as the learner becomes more knowledgeable and proficient, the questions should move toward higher-order thinking questions.
Asking questions to elicit student thinking
Traditional question and answer patterns between teacher and student follow an I-R-E pattern (Almasi, 1996): Initiate (teacher), Respond (student), Evaluate (teacher). For example:
Teacher: Thomas, what is hypertension?
Student: Abnormally high blood pressure.
Teacher: Good, that’s right.
Notice the questions and responses are simply asking for and responding with recall of information. In order to encourage students to think critically and respond at higher-order levels, teachers need to use the third-turn response to prompt and probe further with another question instead of evaluation (Ford-Connors & Robertson, 2017). There are three ways to do this described below.
Questions to consider when deciding questions to ask:
Probing vs. Pimping
Caution must be used when asking students challenging questions that ask for higher-order thinking. The learner will feel dissonance as they move from wondering to considering to knowing. Medical students who are probed with questions often feel they are being “pimped” instead of challenged. How do clinician educators challenge students with questions without creating an unsafe environment for learning? See this handout on Proving vs. Pimping.
Using student responses to questions
Asking great questions is only the beginning. Paying attention to student responses is imperative – otherwise why ask the question? Effective educators pay attention to student responses noting:
Giving wait time for learners to think
Yes, we want learners to eventually be able to think and respond quickly on their feet, but when concepts are new, learners need think time. When asking challenging questions, especially when concepts are new, it is important to give wait time before demanding a response (Rowe, 1986). During this time learners are given time to think through their answers and work out justification for their answers. Educators are often surprised at how little time they leave learners to think after answering a question, tempted to fill the silence with hints, their own answers, or a response from a quicker responding student. Challenge yourself to provide longer wait time after asking questions. The silence may feel awkward, but it won’t kill you!
Active Learning is an approach with various methods/strategies for implementation. Listed below are active learning strategies that could work in medical education. For more description and examples from the SDC Curriculum, click the name of the strategy.
Case-based learning requires students to apply their knowledge to reach a conclusion about an open-ended, real-world situation. Provide students with a case, asking them to decide what they know that is relevant to the case, what other information they may need, and what impact their decisions may have, considering the broader implications of their decisions. Give small groups of 3-4 students time to consider responses, circulating to ask questions and provide help as needed. Provide opportunities for groups to share responses. Case-based learning example
When a question or case is posed, students discuss in groups of 3-4 for 5+ minutes. It is important that the question or case is difficult enough that group members need to spend considering what they know (from readings, experience, or data) and multiple options could be considered before coming to a conclusion. If there is not enough to discuss, and students are able to come to a conclusion quickly, the discussion will become flat quickly. Group discussion example
Find 2-3 concepts, or questions around a single topic. Put students in groups of 3-4 to work on their assigned concept/question. After groups have some time to work on it, they spend time teaching/explaining their ideas to the other group(s). Group Teaching (Jigsaw) example
When solving a problem, (e.g., logic or critical thinking) have students work out the problems themselves, by asking them to go to the whiteboard in small groups to solve problems. If there is insufficient whiteboard space, students can still work out problems as a group, using chart paper and markers. Work at the whiteboard example
After students have read or heard about an important principle, generalization, theory, or procedure, hand out an index card and ask students to write down at least one possible, real-world application for what they have just learned. (Why does this matter?)
Ask students to paraphrase part of a lesson for a specific audience and purpose, using their own words. (e.g. explaining a diagnosis to a patient) Direct paraphrasing example
A variation of the minute paper, asking for feedback about where students are still confused. Ask a question such as “What questions remain uppermost in your mind as we conclude this class session?” Muddiest point example
At the end of the discussion, have students summarize the overall concepts in a one-sentence format: What, how, why?
In order to promote active listening, after one student has volunteered an answer to your question, ask another student to summarize the first student's response. Given the possibility of being asked to repeat a classmates' comments, most students will listen more attentively to each other and promotes the idea that learning is a shared enterprise.
Students are asked to "act out" a part. In doing so, they get a better idea of the concepts and theories being discussed. Role-playing exercises can range from the simple (e.g., "How would you introduce yourself to a patient?”) to the complex (after a student details a clinical experience that appears to have some ethical issues for how to treat patients, you ask partners to role play how they would address the situation. Role playing example
Ask students a question that requires higher order thinking (e.g., application, analysis, or evaluation levels within Bloom’s taxonomy). Ask students to think or write about an answer for one minute, then turn to a peer to discuss their responses for two minutes. Ask groups to share responses and follow up with instructor explanation if needed. Think-pair-share example
Present students with a grid made up of several important categories and a list of scrambled terms, images, equations, or other items. Ask students to quickly sort the terms into the correct categories in the grid. Ask volunteers to share their grids and answer questions that arise. Categorizing grids example
Concept maps are visual representations of the relationships between concepts. Concepts are placed in nodes (often, circles), and the relationships between indicated by labeled arrows connecting the concepts. To have students create a concept map, identify the key concepts to be mapped in small groups or as a whole class. Ask students to determine the general relationship between the concepts and to arrange them two at a time, drawing arrows between related concepts and labeling with a short phrase to describe the relationship. Concept map example
This activity requires students to categorize concepts according to the presence (+) or absence (-) of important defining features. Defining features matrix example
Ask students to predict the result of a demonstration, briefly discussing with a neighbor. After demonstration, ask them to discuss the observed result and how it may have differed from their prediction; follow up with instructor explanation. Demonstrations example
This is a two-dimensional diagram, a rectangle divided into rows and columns used to organize information and illustrate relationships. In a memory matrix, the row and column headings are given, but the cells are left empty for students to fill out during class as they learn. Memory matrix example
Ask students to jot down quick lists of pros and cons related to a topic. Pro and con grid example
Give students the steps in a process on strips of paper that are jumbled; ask them to work together to reconstruct the proper sequence. Strip sequence example
Mini-maps are like concept maps, but students are given a relatively short list of terms (usually 10 or fewer) to incorporate into their map. To use this approach, provide students a list of major concepts or specific terms and ask them to work in groups of two or three to arrange the terms in a logical structure, showing relationships with arrows and words. Ask groups to volunteer to share their mini-maps and clarify any confusing points. Visual modeling (Mini-maps) example
HOW SHOULD YOU START?
Start small, start early, and start with activities that pose low risk for both instructors and students. The minute papers, turn-and-talk, think-pair-share, and one sentence summaries technique provide easy entry points to incorporating active learning approaches, requiring the instructor to change very little while providing students an opportunity to organize and clarify their thinking. As you begin to incorporate these practices, it’s a good idea to explain to your students why you’re doing so; talking to your students about their learning not only helps build a supportive classroom environment, but can also help them develop their metacognitive skills (and thus their ability to become independent learners).