My students seem reluctant to answer my questions; any suggestions?
Questioning residents or medical students is a great way to explore knowledge and improve clinical reasoning skills, but there is an art to asking good questions. Occasionally questioning can even be perceived as hostile:
Not so effective questioning;
Levels of Questioning
Bloom categorized questions according to the level of abstraction. His hierarchy of knowledge can be applied to medical questioning:
- Factual recall
- What are the symptoms of a myocardial infarction?
- Understanding causes and effects, interpretation.
- Why is ischemic pain felt in the arm?
- Detecting underlying patterns, finding relevant data, discarding useless information.
- Is this patient having a myocardial infarction?
- Predicting, drawing conclusions
- Should this patient be transferred?
- Reviewing performance
- Would you manage this patient differently next time?
Lower levels test memory and simple comprehension, while higher levels explore students’ ability to link seemingly unrelated facts and draw appropriate conclusions. Higher level questioning encourages the development of clinical reasoning skills.
Examples of higher level questions
- What do these lab values suggest?
- How would you distinguish between diagnosis A and diagnosis B?
- What if this patient was immunocompromised?
- How would you manage this patient if she declined hospital admission?
- What is the likely prognosis?
- What surprised you about that case?
- Any areas you need to review on that disease?
SNAPPS is a great tool to encourage higher-level thinking.
For more on effective questioning visit: Effective use of questions
Bloom B, Taxonomy of educational objectives. Allyn and Bacon, Boston, MA 1984
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