November 3, 2010

Application of the Socratic Method in Health Professionals Education

by Stacy Elder, Pharm.D., PGY1 Pharmacy Practice Resident, Johns Hopkins Hospital

The Socratic Method is a widely used term for teaching via question and answer dialogue between a teacher and a student. However, the Socratic Method has undergone many changes since its first documentation by Plato, a student of Socrates.  Health professional instructors frequently employ various forms of this style of teaching in order to explore the critical thinking of their students and trainees. Analysis of the Socratic Method in the healthcare setting is a prime example of the evolution and contemporary utility of this mode of teaching.

The classic Socratic Method involves dismantling prior ideas in order to free the mind to think about a topic without the constraints of preconceived notions. By definition, this method deconstructs all prior thoughts on a topic and leaves the learner without a satisfactory answer to the primary question. Socrates taught that the only person who cannot learn, is the person who thinks he already knows the answer, so it is logical to remove prior beliefs in order to make way for the creation of new ideas. An example of the classic Socratic Method is observed in Meno, where Socrates asks Meno to define virtue. They discovered that they could not define virtue and, furthermore, virtue could not be taught. Meno learned that even this common term, when broken down to its fundamental parts, was actually not definable. As you might imagine, it was an Earth-shattering revelation for Meno to realize that it was impossible to trust even the most basic beliefs. The abolishment of prior beliefs on a subject is the deconstructive phase of the Socratic Method.

Once the student’s mind is freed from the constraints of prior beliefs, the teacher is free to bring forth new ideas during the constructive phase.  Notably, the teacher’s role in this scenario is to help the student clear away previous ideas in the deconstructive phase so that he may build new ideas in the constructive phase. Socrates stressed the importance of humility on the part of the teacher, due to the need to create a safe environment for the student to have these revelations. He believed that the teacher served to help the student do his own learning and asking questions was his method to facilitate that goal.
The classic definition of the Socratic Method is not always practical for teaching health professionals.  After the abolishment of the definition of virtue during Meno’s lesson with Socrates, Meno suggested a paradox that no one could ever question anything if definitions are impossible. Science, in general, does not accept the impossibility of defined answers, making the classic Socratic Method incompatible with the field of science. Also, healthcare does not generally involve discussion of abstract ideas. Established definitions of terms used to describe conditions and disease states are a critical part of healthcare learning. Standard, well-accepted “truths” in medicine make it possible to advance patient care by using the outcomes from research in a specific subset of patients in order to apply the highest level of decision making to patient care. However, the Socratic Method is still utilized in healthcare teaching, in a modified form.

The modern Socratic Method differs from the classic method by establishing that knowledge is recollection. Another of Socrates’ theories was that a student can only learn that which he already knows. Therefore, the teacher’s role is to facilitate the production of a constant progression of defined knowledge from the students pre-existing stores. In general, the teacher asks direct questions that have a predefined range of answers, allowing the student to answer correctly before moving on to the next step in the construction of an idea. If the student is unable to answer the question at hand, the teacher is responsible for guiding the student to a point where he/she can conquer the question.  This is accomplished by helping in the student/trainee recollection prior knowledge required to answer the question.  The modern Socratic Method is compatible with the training of health professionals, and it remains within the scope of Socrates’ belief that a student can only learn things that he already knows.

Using the Socratic Method is more than asking a lot of questions. In contrast to “pimping,” the Socratic Method requires the teacher to create a nurturing environment and ask helpful questions to achieve the desired lessons for the student.  Teachers must recognize that these probing questions can expose ignorance … and this can invoke fear in the student.  But Socrates described the role of the teacher as similar to a midwife, in that they facilitate by clearing the way for the student to bring forth new knowledge without intimidation. In any setting, finding the balance between using progressive questions to provoke deep thought while maintaining a comfortable environment for learning is the key to using the Socratic Method of teaching.

2    Fritts, HW. Are We Socratic Teachers? Trans Am Clin Climatol Assoc 1979;90:109–115.
3    Gordon, LA. Is the Socratic Method Illegal? Am Surg 2003;69:181-182.

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