by Naaseha Rizvi, Pharm.D., PGY1 Pharmacy Resident, Johns Hopkins Bayview Medical Center
Starting my second week of my internal medicine rotation, my preceptor told me that I would be responsible for leading the pre-round group discussion sessions from now on. Our “group” included not only the preceptor and myself, but also two advance pharmacy practice experience (APPE) students. I had watched my preceptor lead these sessions effortlessly the first week, so I thought “this can’t be that hard, right?” Wrong! After the first few sessions, I realized the questions that I asked were random and unsystematic. The students were not benefitting from our discussion at all! I remembered back to my days as an APPE student. Some of my best preceptors were able to stimulate critical analysis by asking the right questions in the right order. They got me to think about my thinking – metacognition. I wanted to be able to do this for my students! I decided to do some research.
There are many ways to teach critical thinking skills to students. A particularly tried and true method was developed by the ancient philosopher, Socrates. Consequently, the teaching method is called the Socratic Method or Socratic Questioning. After a logical series of specific, systemic questions, Socrates observed that students were able to develop self-generated knowledge and regulate their thoughts.1 The key to this method is to ask the right questions in the right sequence. Poorly thought-out questions can intimidate and confuse students. Bad questions can even limit a student’s ability to think critically.2 Questions generate an inquisitive mind, a mind that keeps forming new questions to find more answers, which may lead to more questions and so on and so forth.3
Why is it necessary to teach critical thinking skills? In order to provide the best care to patients, practitioners utilize the knowledge that comes from previous patients with similar diseases as well as current medical knowledge. The ability to make a logical and defendable connection between these two sources of knowledge to the current situation is critical thinking.1 Three principles are important to keep in mind when teaching or stimulating critical thinking: 1) it is a skill that takes time to develop; 2) learners must use certain metacognitive strategies; and, 3) critical thinking relies on domain knowledge that the learner already possesses. It is challenging to validate methods for teaching critical thinking and the ability to yield consistently positive results to show improvement.1 Different methods of instruction to develop critical thinking include group learning, case-based learning, concept mapping, and experiential education. The evidence regarding the effectiveness of the teaching strategies in promoting critical thinking is lacking.1
How is the Socratic Method applied? How does it work? The Socratic Method requires the student to look at the deep structure of the question. To do so, they must have basic domain knowledge in the content area. The underlying goal of the Socratic Method is to prove opinions with facts. Therefore the student must have a frame of reference before the Socratic Method may be used. The authors of a recent article in the American Journal of Pharmaceutical Education outline the elements of the Socratic Method (See Table 1). The mnemonic PAPER CLIP (figure 1) can be used to construct a sequence of questions which stimulate deeper thinking.1 Three types of questions are often used: exploratory, spontaneous and focused.2 Exploratory questions show how much the student knows and may be used to introduce a new topic or review past discussions that may relate to the current topic. Spontaneous questions can be used to probe the student in exploring their beliefs and assumptions; they allow the student to reflect on the issue at hand. Focused questions narrow the discussion on what the preceptor would like the student to think about, stimulating them intellectually.2
Table 1. Effective Socratic Questioning1
By using this method of questioning, the student (hopefully) becomes inquisitive and motivated to learn. This method is quite different from another form of questioning called “pimping,” which may do more harm than good in terms of teaching critical thinking.1 Although the effectiveness of the Socratic Method has not been studied, a few articles describe its benefits in health professional education. In one study conducted at the Robert Wood Johnson Medical School, third and fourth year medical students participated in a series of 90-minute conferences. The instructors used a traditional didactic method as well as the interactive Socratic Method interchangeably. Each method was used approximately the same amount of time. After the conference, students were given a survey to determine their preference. The majority of students preferred the Socratic Method over the didactic method (93.3 vs 6.7%, p < 0.001).4
After constructing the Socratic questions, it is important to use them in an effective manner.2 Avoid compound questions that require multiple answers as it can cause confusion. Provide a safe environment where students can express their thoughts openly. Questions should be balanced in their cognitive level. Lastly, it is important to provide enough “wait time” after asking a question. For higher-order questions that stimulate critical thinking, as much as 1-2 minutes should be given for best responses.2
The Socratic Method is very well suited for students on experiential rotations. The learner needs adequate domain knowledge in order for the Socratic Method to be most effective. Therefore, it may not work as well in a first year course where foundational knowledge needs to be acquired. In the pharmacy curriculum, the experiential rotations provide an opportunity for one-on-one interaction. This is an ideal opportunity for the preceptor to use the Socratic Method. Students on experiential rotations typically have the foundational knowledge needed. They just need to learn how to apply it towards patient care by learning how to think critically. By developing this vital skill, students will be well equipped to practice pharmacy.
- Oyler DR, Romanelli F. The fact of ignorance: Revisiting the Socratic Method as a tool for teaching critical thinking. Am J Pharm Educ. 2014;78: Article 144.
- Tofade T, Elsner J, Haines ST. Best practice strategies for effective use of questions as a teaching tool. Am J Pharm Educ. 2013;77: Article 155.
- The Critical Thinking Community. The Role of Socratic Questioning in Thinking, Teaching, and Learning. 2013. Accessed October 25, 2014.
- Zou L, King A, Soman S, et al. Medical students' preferences in radiology education a comparison between the Socratic and didactic methods utilizing powerpoint features in radiology education. Acad Radiol. 2011;18:253-6.