by Whitney Chaney, Pharm.D., PGY2 Critical Care Pharmacy Resident, University of Maryland Medical Center
If you are like most pharmacy students or residents completing clinical rotations, you have probably come into contact with a preceptor whose main teaching strategy is to fire questions, one after another. This can be a good learning experience or a very bad one. Imagine going on patient care rounds with a preceptor. As you discuss various diagnoses and treatments, you are asked a series of very pointed questions to which the preceptor is looking for very specific answers. You may know a few answers. Some questions you are unsure what the preceptor is asking. And sometimes you have no idea what the correct answers are. As this goes on you get more and more nervous, blurting out a few too many "I don’t knows," and the scenario ends with the preceptor giving you a long lecture about the disease state … very little of which you remember because you have become so flustered, frazzled, and distracted by your thoughts. The strategy of teaching through questions is often called the “Socratic teaching” method. The Socratic method can be very useful and effective, but all too often it is misused and abused.
Defining the Socratic teaching method is challenging – there is a lack of consensus on the exact definition. Much of the information describing Socrates' teaching comes from the writings of his students. They describe conversations with deep inquiry and intense debates on philosophical topics. Generally speaking, the Socratic method involves asking a series of questions in a logical manner until a common “truth” is reached. The goal of this type of inquiry is to stimulate critical thinking and lead to discussion in which the learner must use their baseline knowledge and analytical skills to reach a well supported conclusion. This method is also meant to point out unsubstantiated, preconceived notions and gaps in knowledge. In this process of inquiry, less emphasis was placed on the final answer, and more was placed on the thought process. While Socrates generally used his method to explore and answer moral concepts, this strategy of questioning can be and often is applied to clinical teaching.
As pharmacy students and residents complete their pharmacy practice experiences, this method of questioning and discussion can be a very effective learning tool. One key way in which it applies to healthcare is that good clinical practice (so called "truths") must be critically evaluated and supported by good evidence. Teaching with Socratic questioning forces the learner to not only know the "answers," but also to understand the background and reasoning to support them. Thus, the learner must be able to defend her/his recommendations and conclusions. Furthermore, as the Socratic method helps build critical thinking skills, it prepares the learner to become an independent practitioner in an environment where the standard of care continues to change as new information becomes available. Lastly, this method is very useful in experiential clinical settings because questioning and discussion can occur as situations arise in practice.
In order to effectively use the Socratic method, it is important to make sure that teachers and preceptors are asking the right questions – ones that stimulate discussion. Questions should be asked in a thoughtful and logical manner in order to guide the learner to appropriate conclusions. Using a variety of question types is more likely to achieve the learning objective. Questions can be exploratory ... these types of questions probe for basic knowledge. Challenge questions are intended to scrutinize conclusions and assumptions. Diagnostic questions probe for causes, connections, or cause-and-effect relationships. Extension questions are meant to expand on the discussion. It is often useful for the instructor to use priority questions to help identify the most important points and, at the conclusion of the discussion, ask summary questions. Questioning can also be categorized by the type of cognitive level following Bloom’s hierarchy of cognitive skills: knowledge, comprehension, application, analysis, synthesis, and evaluation. In addition to the type of question, another strategy is to think about the order of the questions. Specifically, are the questions going from general to specific, simple to complex, or convergent to divergent? Finally, as the teacher probes the learner, the teacher’s response to the answers also impacts the learning process. It is important for the teacher to listen to the entire answer and use non-verbal cues that signals that he/she is interested in the learner’s thoughts. Correct or well-reasoned answers should be appropriately praised, while partially correct answers should be accepted and the learner should guided down the correct path with additional inquiry. Incorrect answers should be tactfully corrected in a non-judgmental manner.
The Socratic method of questioning and discussion can be a valuable teaching tool, especially in the setting of clinical pharmacy training. The secret to using this teaching tool is the appropriate use of questioning strategies and responding to the learner’s answers. The Socratic method should be used to facilitate an open dialog and the instructor must take care to create a non-threatening learning environment, where learners are free from fear and anxiety. Its important to keep an open mind, accept feedback, and be prepared to adjust the questioning strategy to ensure that every student and resident gets the best learning experience.
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