Questioning as a Facilitator, Coach, or Teacher

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?

  • They help students learn by voicing their thinking
  • They allow the educator to hear students explain their thinking – helping the educator assess student understanding

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.

Levels of Questions Asked
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.

  • Open ended questions that help to make student thinking visible (Ritchhart, 2011; Webb, 2009)
    • Example Q’s: What makes you say that? Can you explain how you know this is true? Can you explain why you think it is systolic and not diastolic pressure that causes this?
  • Open ended questions that prompt the student to consider other ideas, theories or reasons (Webb, 2009)
    • Example Q’s: What else might have caused this? Or have you thought about what happens if the pain is radiating? You have done a great job of focusing on the site itself, what else comes to mind if you think about the vitals?
  • Re-voicing and elaboration (Ford-Connors & Robertson, 2017)
    • Listen to the discussion.
    • Pull out a key idea/ point to highlight and could be elaborated on.
    • Re-voice it and ask for elaboration from another student.

Questions to consider when deciding questions to ask:

  • Is the question simply recall? How can I probe students to explain understanding or justify why they think so?
  • Is the question merely engaging? Or will pursuing it lead to the concept’s big ideas? (Wiggins & Wilbur, 2015)
  • Does the question get at what’s odd, counterintuitive, or easily misunderstood? Or is it a predictable question with mundane and relatively superficial answers? (Wiggins & Wilbur, 2015)
  • How can I prompt students to ask questions of each other, instead of me asking?

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:

  • Did the student understand the concept? How do I know?
  • What level of understanding did the student response reveal? Did the student just know the basics, display a surface level understanding, or provide a full understanding of the concept? Should I call on another student to add?
  • Was there a misconception? Should I call on students to question the response?
  • Based on student responses, should I go back (reteach) or forward in my teaching?
  • Was the student able to justify their response (explain why)? Educators need to make sure students didn’t give the right response for the wrong reasons.

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!

References

  1. Almasi, J.F. (1996). A new view of discussion. In Gambrell, L.B. & Almasi, J.F. (Eds.), Lively discussions! Fostering engaged reading (pp.1-24). Newark, DE: International Reading Association.
  2. Barrett, M., Magas, C. P., Gruppen, L. D., Dedhia, P. H., & Sandhu, G. (2017). It's worth the wait: optimizing questioning methods for effective intraoperative teaching. ANZ journal of surgery87(7-8), 541-546.
  3. Bloom, B. S. (1956). Taxonomy of educational objectives. Vol. 1: Cognitive domain.New York: McKay, 20-24.
  4. Costa, A. L. (1985). Developing minds: A resource book for teaching thinking. Association for Supervision and Curriculum Development, 225 N. Washington St., Alexandria, VA 22314.
  5. Ford‐Connors, E., & Robertson, D. A. (2017). What Do I Say Next? Using the Third Turn to Build Productive Instructional Discussions. Journal of Adolescent & Adult Literacy61(2), 131-139.
  6. Garside, C. (1996). Look who's talking: A comparison of lecture and group discussion teaching strategies in developing critical thinking skills.
  7. Ritchhart, R., Church, M., & Morrison, K. (2011). Making thinking routines visible: How to promote engagement, understanding, and independence for all learners. San Fran- cisco, CA: Jossey-Bass.
  8. Rowe MB. Wait time: slowing down may be a way of speeding up!. Journal of teacher education. 1986 Jan;37(1):43-50.
  9. Smith, D. G. (1977). College classroom interactions and critical thinking.Journal of Educational Psychology69(2), 180.
  10. Webb, N. M. (2009). The teacher's role in promoting collaborative dialogue in the classroom. British Journal of Educational Psychology79(1), 1-28.
  11. Wiggins, G., & Wilbur, D. (2015). How to make your questions essential. Educational Leadership73(1), 10-15.