Council on Medical Student Education in Pediatrics


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Why do we question?

Socrates was not a pimp: Changing the paradigm of questioning in medical education.
Kost A et al. Academic Medicine (epub ahead of print) 5 Aug 2014.

What is this article about?
This article discusses the pedagogical practice of questioning learners in the clinical setting. It highlights that the slang term “pimping” has negative connotations, and should be used to describe situations where questioning is harmful and unprofessional, and is done with the intent to shame or humiliate the learner in order to maintain a power hierarchy. This is in contrast to the use of questioning as a teaching method.

The authors propose three recommendations to change practices so that questioning is purposeful and effective. First, teachers should examine each question they pose to the learners and establish its purpose; to what degree is the question is knowledge centered, learner centered, assessment centered or community centered? Second, clinical teachers should employ questioning that promotes critical thinking skills. This can be done by having learners work collaboratively, exploring interpretive questions that activate prior knowledge, and by providing the opportunity to reflect on discussion. Lastly, clinical teachers should look to adult learning theory to guide changes to questioning methods. This involves creating a learning environment in which questioning has an understood and valued role, developing relationships with learners with clear expectations and based on mutual respect, and by discussing the important role of reflection, action and refinement as a means of learning.

What are the implications?
The potential benefits of a learner-centered approach to questioning are numerous. Improved questioning methods may not only allow learners to acquire knowledge and skills, but may also provide valuable assessment opportunities for clinical teachers. Faculty development and support for initiatives to change questioning practices will be required to create a culture change needed to reframe the purpose and value of questioning in the clinical setting, and to provide clinical teachers with the tools to deliberately improve their questioning methods.


Editor’s note: Questions are a central part of the practice, and teaching, of medicine. Through questioning, we diagnose patients, reflect upon our own practice, assess learners, and teach. An upcoming article in our Monthly Feature in Pediatrics (by Michelle Long, Rebecca Blankenburg, and Lavjay Butani) provides an approach to questioning for the purposes of student assessment and teaching by considering the Dreyfus and Bloom frameworks. The authors offer practical ways to use questions to diagnose students’ understanding, to teach, and to model life-long learning (SB).


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