Asking Questions in the Clinical Learning Environment
Part 1: General Rules
By Geoff Stetson, MD
I often ask others how they approach teaching in the clinical setting. Many respond saying they use the “Socratic Method.” I then probe deeper, “what do you mean by ‘the Socratic Method’?” A common refrain is, “I like to use questions to teach.” To which I will say, “Great! How do you use questions?” This is typically where the answers become vague and confusing. That is because the idea of the Socratic Method, through the ~2,500 years since it was first employed (so they say), has come to become a non-specific concept of teaching through questions.1
If this is a person’s entire pedagogical approach, this can prove problematic. Not all questions are made equal. We’ve all experienced poorly asked questions. They can be too specific, too vague, too esoteric, too long, too short, too public, requiring too much background knowledge, etc. Asking better questions is a skill. Fortunately, there are some general rules that apply to asking questions, and then there are specific approaches, backed up by adult learning theory. In this post, I will briefly touch on the general rules to asking effective questions. In subsequent pieces, we’ll cover some of my favorite evidenced-based approaches to asking questions, including an on-the-fly needs assessment, solidifying learning through recall, and enhancing thought-processes through deliberate predictions.
In medical education, questioning learners in the clinical setting has an infamous past. To use inquiry as a teaching tool it is important to always do a few things:
- Set the expectation – As with all parts of clinical teaching, everything goes a lot smoother when the curriculum is less hidden, and expectations are clear. Let learners know that questions are a tool you use to teach, and that they should be ready to participate.
- Do not use their answers as part of their evaluation – This is key to creating a safe learning environment. When you are setting the expectations around questions (Rule # 1), tell everyone that you will assess participation and effort, not correctness. Questions, when used correctly, help teachers find gaps in knowledge, and promote knowledge retention, critical thinking, and denser conceptual connections. They should not be used as a tool for evaluation. Make this point clear to your learners so they see answering questions as learning opportunities, and not potential pitfalls.
- “I don’t know” is an acceptable (desired?) answer – Your learners need to know that revealing the gaps in their knowledge is a good thing. It is important to realize the bounds of current understanding such that building upon that foundation can take place. However, when a learner says they don’t know, try to probe a little to find out what they do know, so you can connect your learning point to their current level of knowledge.2
- Know why you are asking the question – As has been stated previously, too often are people using “asking questions” as an entire teaching philosophy. Each time you use inquiry as an educator, you need to be able to clearly state the information you are trying to garner from your learner, or the point of the mental exercise in which you are inviting them to participate. Even better, tell your learners why you are asking the question. If you aren’t able to do that, then it is likely that another modality is better for getting your point across.
- Do not interrupt – Remember we are creating a safe learning environment. People need to feel respected and heard. And this is just one of those, “everything I need to know I learned in kindergarten” things.
- Wait — Give your learners time to answer. Being put on the spot is hard for everyone, especially when there are traditional hierarchies in place. If your questions require thought (which they should), give your learners time to think!3 Five seconds at a minimum, but more is always better. Unless, of course, you are getting quizzical looks back. In which case…
- Admit when you ask a “bad question” – Revealing your mistakes to your learners is always a strong move. It shows your fallibility and humility, making you that much more approachable as an instructor. Showing your compassion for the predicament of learners in the clinical learning environment goes a long way. Once you have owned up to the “bad question”, just explain the concept you were trying to coax from your learners, so you don’t miss the teaching opportunity.
- Correct Incorrect Answers – The key word in “safe learning environment” is learning. You don’t want your efforts to make your learners comfortable to reinforce any misconceptions. If an answer is incorrect, praise the effort, but point out the error in a straightforward and concise way. Then explain the correct answer. If you have done all of the previous steps well, this should have no effect on the team culture.
By following the above rules, you are off to a great start. The rest of this series will focus on rule number four and give you reasons to ask questions. But before we do that, we need to discuss what makes a “bad question”.
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