January 1998

For the Office-based Teacher of Family Medicine

Paul M. Paulman, MD
Feature Editor

Editor's Note: In this month’s column, Dan Benzie, MD, of the University of Minnesota-Duluth, explores different levels and types of questions and their use in teaching students. In next month’s column, Dr Benzie will explore teaching styles. Dr Benzie is a rural practitioner in Minnesota, with extensive experience in administering the University of Minnesota’s multispecialty community medical student rotations. I welcome your comments about this feature, and I encourage all predoctoral directors to make copies of this feature in its entirety and distribute it to their preceptors. Send your submissions to Paul Paulman, MD, University of Nebraska, Department of Family Medicine, 600 South 42nd Street, Box 983075, Omaha, NE 68198-3075. 402-559-6818. Fax: 402-559-6501. E-mail: ppaulman@mail.unmc.edu.

Types of Questions
Factual Questions
Factual questions are helpful in quickly assessing the student’s specific knowledge on the current patient or problem. Factual questions may involve basic science or clinical questions.

Broadening Questions
Ask the student to describe the differential for the current problem, or ask about a general approach to the current problem. This helps identify the breadth of the student’s understanding.

Justifying Questions
Use justifying questions to determine the depth of the student’s understanding. You might ask about specific treatment plans, specific outcomes expected, or side effects of a medicine.

Hypothetical Questions
Hypothetical questions will allow you to assess other areas of student knowledge while still benefiting from a single clinical encounter. If you are seeing a patient with hypertension, you might ask, “What would your treatment be if this patient were 20 years older, were diabetic, or had angina?”

Alternative Questions
Alternative questions help remind students to think about many correct ways of doing things and are helpful in developing their understanding of the natural history of disease. You might ask about the patient prognosis if that person did not undergo surgery, if he/she did not take this particular medicine, or if the physician ordered an alternative treatment option.

Teaching With Optimal Stress
    While asking questions about content, the teacher is gathering data and assessing students’ knowledge of factual information. To ensure that students are learning clinically appropriate information, we need to discuss common problems and correlate them with basic science information. The teacher needs to keep the level of questions asked at an optimal stress level for the students. The model in Figure 1, modified from Whitman,1 represents teaching with the optimal level of stress. It is important to offer enough challenges to force students to think and learn (without being overly anxious) and yet avoid frustrations by providing support when their knowledge is not yet at that level. We also know that knowledge alone is not what our students need to learn. As Patrick White said, “I forget what I was taught. I only remember what I’ve learned.”2 Just as important as knowledge are the attitudes that we teach the students and residents by our own interactions with patients, colleagues, and students. These attitudes are some of the more important aspects learned by students on community family medicine preceptorships. Along with the specific questions that are being asked, the method or style that we use to ask these questions is critical in assessing knowledge and presenting a positive attitude. This is a big part of what determines how much students will retain or truly learn from their experiences.

References
1. Whitman N, Schwenk TL. The physician as teacher, second edition. Salt Lake City: Whitman Associates, 1997.
2. Charlton J, ed. A little learning is a dangerous thing. New York: St Martin’s Press, 1994.

Correspondence: Address correspondence to Dr Benzie, University of Minnesota-Duluth, Department of Family Medicine, 139 Med, 10 University Drive, Duluth, MN 55812. 218-726-7574. Fax: 218-726-6235. E-mail: dbenzie@d.umn.edu.