Questions that Work: The Key to Cultivating Student Success in the Clinic
Purpose
Clinical reasoning and interpersonal skills are core to professional development. While educators provide the foundation for these skills in the classroom, it is not until students get into the clinical setting that these skills are refined. Teaching in the clinic environment requires clinicians to implement multiple strategies and modify them at a moment’s notice. Common teaching strategies include having students observe skilled practitioners, practice hands-on skills, and receive feedback on their performance. Underpinning each of these strategies is the use of effective questions. Using questions helps the clinical instructor differentiate what the student knows and does not know. However, questions should not be limited to a fact-finding mission of content knowledge. Skilled use of questions can provide students with opportunities to reflect, self-assess, gain confidence, hone professional behaviors, foster interpersonal communication, and develop clinical reasoning skills. However, unskilled use of questions can create an unsafe learning environment in which students feel anxious or perceive they are in continuous “testing” mode. The purpose of this educational workshop is to provide participants with tools to formulate and apply effective questions that target specific teaching purposes in the clinic environment.
Methods and/or Description of Project
Student learning outcomes in the clinic environment center on professional behaviors and higher order clinical reasoning that result in entry-level performance. This session will include a brief overview of questioning frameworks and focus on how best to design effective questions to achieve expected outcome. Participants will explore frameworks and develop effective questions through discussion, small group work, and role-plays. The use of case vignettes will facilitate immediate application of concepts presented and enable participants to develop targeted questions to enhance student learning and performance in the clinic.
Results/Outcomes
After the session, the participant will have readily available question frameworks that can be adapted to specific learning objectives in the clinic environment. Participants will be prepared to design questions targeting all performance levels and facilitate clinical reasoning and interpersonal skills in physical therapy students and residents at all levels and abilities.
Conclusions/Relevance to the conference theme: Through the Looking Glass: Transforming Physical Therapy Education
Intentional use of questions in the clinic environment supports a positive learning environment and develops clinical reasoning and overall professional growth as a future physical therapist or physical therapist assistant. It challenges students to reflect and make positive changes in their ability to articulate rationale for actions in a professional manner. Questions can also provide opportunities for students to develop professional communication skills through reflection on their actions as well as plans for future performance.
References
Adams M. Change your questions, change your life. San Francisco, CA: Berrett-Koehler; 2004.
Atkinson H, L., Nixon-Cave K. A tool for clinical reasoning and reflection using the international classification of functioning, disability and health (ICF) framework and patient management model. Phys Ther. 2011;91(3):416-430.
Brookfield SD. Developing critical thinkers: Challenging adults to explore alternative ways of thinking and acting. San Francisco: Jossey-Bass, Inc.; 1987.
Carraccio CL, Benson BJ, Nixon J, Derstine PL. From the educational bench to the clinical bedside: Translating the Dreyfus Developmental Model to the learning of clinical skills. Academic Medicine. 2008;83: 761-767.
Fook J, Askeland G. Challenges of Critical Reflection: 'Nothing Ventured, Nothing Gained'. Social Work Education [serial online]. August 2007;26(5):520-533. Available from: Academic Search Complete, Ipswich, MA. Accessed December 14, 2016.
Kassirer JP. (2010). Teaching clinical reasoning: case-based and coached. Academic Medicine. 85(7): 1118-1124.
Lavoie P, Pepin J, Boyer L. Reflective debriefing to promote novice nurses' clinical judgment after high-fidelity clinical simulation: A pilot test. Dynamics. 2013;24(4):36-41.
Long M, Blankenburg R, Butani L. Questioning as a teaching tool. Pediatrics. 2015;155(3):406-406-408.
Marquardt M. Leading with questions: How leaders find the right solutions by knowing what to ask. San Francisco, CA: Jossey-Bass; 2005.
Mezirow J, Associates. Fostering Critical Reflection in Adulthood: A Guide to Transformative and Emancipatory Learning. San Francisco, CA: Jossey-Bass Publishers; 1990.
Nguyen Q, Dinh, Fernandez N, Karsenti T, Charlin B. What is reflection? A conceptual analysis of major definitions and a proposal of a five-component model. Med Educ. 2014;48(12):1176-1189
Plack MM, Driscoll M. Reflection and Questions: Developing Self-Awareness and Critical Thinking for Continuous Improvement in Practice. In: Plack M, Driscoll M (Eds). Critical Teaching and Learning in Physical Therapy from Classroom to Clinic. 2nd Ed. Thorofare, NJ: SLACK Incorporated; 2017.
Ruckert E, Plack M. Going Beyond the Basics to Facilitate Higher-Order and Critical Thinking. In: Plack M, Driscoll M (Eds). Critical Teaching and Learning in Physical Therapy from Classroom to Clinic. 2nd Ed. Thorofare, NJ: SLACK Incorporated; 2017.
Tofade, T., Elsner, J., & Haines, S. T. (2013). Best practice strategies for effective use of questions as a teaching tool. American Journal of Pharmaceutical Education, 77(7), 1-9.
Schon DA. The Reflective Practitioner: How Professionals Think in Action. USA: Basic Books, Inc; 1983.
Schon DA. Educating the Reflective Practitioner. San Francisco, CA: Jossey-Bass Publishers; 1987.
Course Objectives
Identify frameworks to facilitate effective question development specific to the learner’s needs
Discuss effective strategies of when, what, and how to use questions in clinical teaching
Formulate questions based on student case studies/vignettes
Utilize developed questions in role play with participants
Critique developed questions from role play for effectiveness and achievement of expected outcome
Instructional Methods
Lecture
Discussion
Case scenarios
Small group work
Role play
Tentative Outline/Schedule
5 min: Introduction and review of session
20 min: Present three frameworks for effective questions
5 min: Video case discussion on effective use of question frameworks to support clinical reasoning development
15 min: Present/discuss effective strategies for question delivery in the clinic environment
30 min: Video case scenarios, worksheet activity on question development, role-play with participant with feedback on how questions were delivered
10 min: Debrief as a group with examples of effective/ineffective questions and achievement of expected outcome of the scenario
5 min: summary and wrap up of session