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Teaching with questions.

In medical education, questions are constant. Questions are asked of fellows, residents, and students. Questions are asked at conferences, rounds, and morbidity and mortality meetings. Questions drive medical education. However, not all questions promote learning. Some questions actually hinder learning. Knowing the difference, and asking questions that promote learning, are key aspects to being an effective teacher. So what kinds of questions promote learning, and what kinds of questions do not? A good place to begin is to understand the difference between pimping and Socratic questioning.

PIMPING

Definitions of pimping typically include the following:

1. Someone higher on the ladder questions someone lower on the ladder in a way that reinforces the hierarchical order. In other words, intimidation is present.

2. The questions have specific, factual answers, so there is a right answer and many wrong answers.

3. The questions have an evaluative purpose: Who knows the answer? Who doesn't?

4. Failure to give the right answer to the question leaves the learner feeling embarrassed, humiliated, and feeling like a failure (1).

By simply defining pimping we have revealed it to be a poor approach to teaching. Intimidation, embarrassment, and humiliation do not foster adult learning (2). Therefore, to be a good teacher, we should avoid pimping. The better alternative is Socratic questioning.

SOCRATIC QUESTIONING

To define Socratic questioning, reflect on the difference between these two related questions:

1. What are the 14 causes of diastolic murmur?

2. What factors can you think of that would cause a diastolic murmur to develop?

The first is a pimping question, as it wants 14 right answers all at once. No thinking is required here, just a regurgitation of facts. And with 14 right answers required, there is a very good chance of failure, causing the learner to feel humiliated and embarrassed (3).

The second question, on the other hand, is a Socratic question because it asks the learner to think, thereby promoting critical thinking. With each right answer there can be praise. With each wrong answer there can be follow-up questions that reveal to the learner his or her need for additional self-directed learning. When done carefully, this kind of questioning avoids humiliation.

Socratic questions can take many forms, as the Figure illustrates. The figure also illustrates how Socratic questions promote critical thinking, a must for practicing medicine.

To ask questions that promote learning, here are some pointers:

1. Diagnose the learners and teach to their level. New knowledge is best built on prior knowledge in small increments.

2. Avoid asking questions for questions' sake. Do students really need to know the year the stethoscope was invented?

3. Tell learners your goal in asking questions. Your goal is to teach, not to embarrass.

4. Emphasize important learning points. What are the need-to-know items?

5. Do not attempt to intentionally embarrass or humiliate learners. When you do humiliate a learner, reflect on how you can avoid doing the same thing going forward (1).

Finally, to be a good teacher, keep the words of Cicero before you: "Often, the authority of the teacher gets in the way of those who wish to learn" (3).

[FIGURE OMITTED]

Lonnie Gentry, MTh

From the Department of Surgery, Baylor University Medical Center at Dallas, and the Texas A&M Health Science Center College of Medicine.

Corresponding author: Lonnie Gentry, MTh, Department of Surgery, Baylor University Medical Center at Dallas, 3500 Gaston Avenue, Dallas, TX 75246 (e-mail: Lonnie.Gentry@BaylorHealth.edu).

(1.) Oh RC, Reamy BV. The Socratic method and pimping: optimizing the use of stress and fear in instruction. Virtual Mentor 2014; 16(3):182-186.

(2.) Oh RC. The Socratic Method in medicine-the labor of delivering medical truths. Fam Med 2005; 37(8):537-539.

(3.) Fritts HW Jr. Are we Socratic teachers? Trans Am Clin Climatol Assoc 1979; 90:109-115.

(4.) Paul R, Elder L. The Art of Socratic Questioning. Tomales, CA: Foundation for Critical Thinking Press, 2006.
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Title Annotation:medical education
Author:Gentry, Lonnie
Publication:Baylor University Medical Center Proceedings
Article Type:Report
Geographic Code:1U7TX
Date:Dec 27, 2014
Words:650
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