Asking Questions to the CPC Year 3 and 4 Student
"In collaborative clinical education, asking questions is the very foundation of nearly everything else." (Westberg and Jason, 1993)
Westberg and Jason stated that question asking should be central to teaching because questions tend to place significant responsibility on the trainee and stimulate further reflection, exploration, and self-directed learning. having learned how to ask clinically appropriate questions, the trainee may be more equipped to ask clinically relevant and probing questions when interacting with patients. Instead of asking questions that result in nothing more than the "recall of facts", Westberg and Jason suggest asking questions that will probe for thinking in the cognitive and affective domains. Therefore, asking your CPC Year 3 and 4 student questions that trigger critical thinking and problem-solving skills is a key teaching tool.
Douglas, Hosokawa, and Lawler (1988) propose that the most commonly asked questions could be classified as "lower level" and "higher level." Specifically, "lower level questions require knowledge, comprehension or application," while "higher level questions require analysis, synthesis or evaluation." It is also important to ask open-ended questions. Also noted by Douglas, Hosokawa, and Lawler, open-ended questions can help to stimulate discussion. These types of questions, according to Westberg and Jason are expansive and encourage reflection, speculation, synthesis of ideas and experiences, and problem-solving. Overall, the use of questions can add considerably to the learning experience and stimulate self-directed learning on the part of the trainee.
Consider using the 5 Microskills Model of Clinical Teaching developed by physician educators at the University of Washington (Neher, et.al. 1992). This model, in part, focuses on asking questions to the student following his/her examination (history and focused physical) of a patient. The 5 microskills are:
1) Get a commitment. - "What do you think is going on with Mr. Jones?"
2) Probe for supporting evidence. - "What were the major findings that led you to your conclusion?"
3) Tell what the student did right. - "You didn't jump into solving her presenting problem but kept open until the patient revealed her real agenda for coming in today."
4) Teach a general rule. - Patients with cystitis usually experience pain with urination, increased frequency and urgency of urination, and you may see blood in their urine." - In this example it might be more effective to ask a question that forces the student to generate the rule him/her self. This could be done by asking, "With regard to pain, frequency and urine content, what is a general rule we can state about patients with cystitis?"
5) Correct mistakes. - "You may be right that the child's symptoms are due to a viral upper respiratory infection, but you can't be sure it is not otitis media until you have examined the ears." - In this example it might be more effective for the teacher to turn this into a questioning situation by saying, "You may be right that the child's symptoms are due to a viral upper respiratory infection, but what would you need to do. that you have not done, before coming to that conclusion?"
In addition to asking questions that focus on clinical information, also include questions that stimulate students to think about the basic sciences, psychosocial issues, and osteopathic principles. Details and suggestions on how to do this will be the focus of a future bulletin.
Douglas, K., Hosokawa, M., and Lawler, F. A Practical Guide to Clinical
Teaching in Medicine. 1988.
Westberg, J. and Jason, H. Collaborative Clinical Education. 1993.
Neher, J.O., Gordon, K.C., Meyer, B., and Stevens, N. A Five-step Microskills Model of Clinical Teaching. Journal of the American Board of Family Practice. 5:419-424, 1992.
Next month's OUCOM/CORE Curriculum Bulletin will focus on multicultural sensitivity in the clinical setting.