by Tara Bastawrous, PharmD., PGY-1 Pharmacy Practice Resident at Kaiser Permanente of the Mid-Atlantic States.
Personally, I learn the best through questions and answer. I appreciate professors and preceptors who take the time to make study guides and cases where I need to find the answers in the reading materials. I enjoy preceptors asking me questions because — although it may be intimidating or nerve racking when I do not know the answer immediately — searching for the answers makes me remember the concept. In searching for answers, I am able to make connections and relate the information to previously learned material. I learn best through questions and plan to use this excellent teaching and learning tool with students I will precept in the future.
Questions need to be properly constructed in order for students to gain the most out of the learning experience. They should not be asked to confuse or intimidate students, but rather to stimulate critical thinking and apply prior knowledge to the current concept. Students can effectively learn from answering questions, but their answers can also assist the teacher. Teachers are able to assess the student’s prior knowledge and based on student’s responses can guide further instruction, choosing what to focus on and the level of difficulty.1
Not only should questions be planned both in the classroom and at clinical practice experiences, but students should also be taught to ask questions. Students need to feel that they have the freedom to ask scholarly questions to gain better insight or clarity. Questions should provoke higher-level thinking, no matter the academic proficiency of the student, as this will help engage and motivate the student.2
Questions can be constructed based on the 4 knowledge dimensions: factual, conceptual, procedural, and metacognitive. Anderson and Krathwohl first developed these 4 dimensions, ranging from concrete to abstract. Factual questions seek recall information from textbook, guidelines, or studies on the concept being asked. They ask about details from reliable, published data. Students must remember specific, applicable information from various sources. Factual questions are asked to assess understanding and prompt analysis of a disease state, situation, or others work.1 An example of a factual question might be “According to the American Diabetes Association, when should anti-diabetic medications be initiated in a patient?” By reviewing these essential facts, terminology, and details, the learner will be better prepared to solve a problem.3
Conceptual questions ask students to further describe the factual information, to become aware of the “interrelationships between the elements of a larger structure”. Learners are asked “why” — to explain their answer, providing the principles or theories that support their answers. These types of questions also help learners to classify elements into categories, further differentiating information and analyzing correlations to the pertinent subject matter.1,3 An example of conceptual questions would be: “How are the American Diabetes Association and the American Association of Clinical Endocrinologists Guidelines for Diabetes similar and different?” Another conceptual question would be, “Why do the guidelines recommend against using insulin and sulfonylureas concomitantly?”
Procedural questions assess the learners’ ability to choose from well-established methods and select the most appropriate algorithm, technique, or criteria based on the particular situation.1 An example of a procedural question would include: “Based on this patients A1C and fasting blood glucose level, which medications are recommended by the American Diabetes Association for initial therapy?”
Studies have shown only about 20% of questions are procedural, with another 20% being higher level.2 These types of questions help the learner apply their knowledge, skills, and techniques to problems in the pertinent subject matter.3
Metacognitive questions ask learners to reflect on experiences and identify possible areas of improvement. Metacognition is defined as “higher-order thinking that enables understanding, analysis, and control of one’s cognitive processes, especially when engaged in learning.”4 The learners’ answers to metacognitive questions help the teacher assess the learners’ personal motivations and values, which could help shape how the material is taught.1 By “thinking about one’s own thinking” learners are able to approach problems utilizing their strengths and preferences, and examining their weaknesses. An example of a metacognitive question would be: “Thinking back on the patient encounter, how well do you think you did? How do you think you could have improved your patient interviewing and counseling skills for future consults?” These questions also help train learners to use their knowledge strategically and reflectively when solving problems.3
In one study, the questions overwhelmingly (91.2%) asked by clinical teachers were lower level questions, with most being factual type. The authors state this may be because teachers have not been taught how, or the importance of, asking higher order questions.6
Higher-order questions promote higher-order thinking. Higher-order questions “causes cognitive processing and organization of information that’s builds more elaborate mental structures.” 2 Teachers and preceptors should be taught to formulate higher-order questions to stimulate such thinking.
It has been shown that teachers mostly ask lower-level cognitive questions. Lower-level cognitive questions can hamper the learners’ ability to develop higher order critical thinking skills. These skills are important to allow students to practice recalling knowledge they have learned and applying them to new situations. Critical thinking is especially important when problem-solving and determining the best treatment for a patient based on various factors and barriers. By asking students questions in the factual, conceptual, procedural, and metacognitive domains of knowledge, they will be able to learn in a “full circle” and understanding the bigger picture.1,2
- Tofade T, Elsner J, Haines ST. Best Practice Strategies for Effective Use of Questions as a Teaching Tool. Am J Pharm Educ 2013; 77 (7): Article 155. Accessed February 15th, 2016.
- Saphier J, Haley-Speca M, Gower M. Dimensions of Questioning. The Skillful Teacher: Chapter 9: Action, MA. Research for Better Teaching, 2008; 208-214. Accessed February 16th, 2016
- Owen L. Anderson and Krathwohl-Understanding the New Version of Bloom’s Taxonomy. 2013. Accessed February 18th, 2016
- Metacognition defined by dictionary.reference.com
- Gall M, Ward B, Berliner D, et al. Effects of questioning techniques and recitation on student learning. American Educational Research Journal. 1978; 15: 175-199
- Sellapah S, Hussey T, Blackmore A, et al. The use of questioning strategies by clinical teachers. Journal of Advanced Nursing. 1998; 28: 142-148.