My colleagues and I ask students and residents questions constantly. I talk with students and residents constantly about their educational experiences. The great majority like being asked good questions.
But what is a good question? A good question refers to something that they need to know. The good question frames the importance of the topic. A bad question is pure trivia that will not really help them. (What percent of alcoholic ketoacidosis patients have a negative urine ketone? The answer is approximately 10%) Knowing that some AKA patients have negative ketones and why is useful.
Additionally, to ask questions the questioner should establish the proper learning climate. The learners should understand that the questions are asked to help them learn, not to embarrass them. I use a technique that I call question and rescue. When the learner obviously does not have a clue, I quickly move to the next person.
When several learners do not know the answer I will proclaim something like, “Excellent question, but difficult. We have an opportunity to learn something.” This succeeds when the learners understand that questioning is used to make the education process directed to helping them with things they do not already know.
A good question should include teaching thought process. Students and residents want to learn to think. They (and I) look about data regularly. On rounds I often task one of the learners to quickly look up a fact that evades me, or that I never knew. Yesterday we were talking about the age onset of Crohn's Disease. An acting intern reminded us of the bimodal age distribution. That fact evaded me and the entire team. We all learned something.
Good questions help frame the thought process necessary to help the patient. I could not teach well without using questions.
Is that pimping or grilling or just questioning? JAMA recently had another article about pimping.
What is bad about questioning? Questioning should not be a way to emotionally abuse learners. Some clinician educators use questioning to embarrass their learners. Good questioning enhances learning.
db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.