Socratic Method/Creative Failure

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Ihave spent the major portion of my life as a teacher training medical students, residents and fellows in my chosen specialty (Diagnostic Radiology, with special interest in musculoskeletal abnormalities and spine injuries) as well as Boy Scouts, aged 11 to 18-years old. I was fortunate to have encountered many excellent teachers along my journey. These men (considering the era in which I trained) exposed me to the Socratic Method and one of its branches that I call Creative Failure. As a result, having adopted those principles, I am most likely to answer a question from a student with another question.

Socrates of Athens (470 – 399 BCE), an early Greek philosopher/ teacher, engaged in the disciplined practice of thoughtful questioning, allowing his students to examine ideas logically and to determine (challenge) the validity of those ideas. The Socratic Method is a form of cooperative argumentative dialogue between individuals, based on asking and answering questions to stimulate critical thinking and to draw out ideas and underlying presuppositions. The student asks a question, the teacher often replies with a different question, and the process continues until the student arrives at the answer to his/ her original question. Socrates based his method of teaching on the premise that the student already had the answer within himself. The disciplined, thoughtful dialogue was steered by the teacher to elicit the answer from the student.

The classic Socratic Method uses six philosophical “tools” designed to: 1) Clarify concepts, 2) Probe the student’s assumptions, 3) Probe rationale, reasons, and evidence, 4) Question different viewpoints and perspectives, 5) Probe implications and possible consequences, and 6) Question the question itself.

My first encounter with a teacher who used the Socratic Method was in my freshman year at Albany College of Pharmacy. I was having difficulty understanding the principles of calculus (math was never my forte) and gingerly approached the professor, the late Dr. Joseph Lapetina. And, after several hours of personal tutoring, I figured it out. His mantra was, “Get the data, plug it in and turn the crank, and out will come your answer”. (Joe became a life-long friend and we served together on the College’s Board of Trustees until his death at age 95 in 2019.)

My next exposure to the Socratic Method occurred during my first clinical rotation during my junior year of medical school. The late Dr. Casimir

Pietraszek was a pulmonologist assigned to my floor at the E. J. Meyer Memorial Hospital (now Erie County Medical Center) in Buffalo, NY. One day on morning rounds, I asked him if there was any way of balancing admission diagnoses of new patients so we could see a variety of diseases. At the time two-thirds of our patients had COPD. He looked at me and replied, “Are you an expert in managing COPD?” I was not; the lesson was learned. More importantly, the seeds were planted for the method I would use when I became a teacher. Three of my radiology mentors, Drs. William Barry, George Baylin, and Lawrence Davis also used the Socratic Method. All were also philosophers who taught me the ins and outs of academia (and curmudgeonry1).

My mentors added a seventh philosophical “tool”, Creative Failure Creative Failure is the practice of allowing a student to make mistakes (provided those mistakes pose no danger to self or others) in the hope that the learner will realize his/her error(s) and, more importantly, the reasons why they occurred. I used this concept with my medical students and my residents and continue to use it with my Scouts. Two examples follow:

Prior to installing PACS (Picture Archiving and Communication System), I would not allow first-year residents to pre-dictate their reports. Instead, they would review the studies, write their impressions on a pad, and when they were finished with a batch of films, they would review them with me or another attending radiologist. If I approved their interpretations, they would dictate them and then wait for the dictations to be returned, where they signed the reports. I would review the reports, comparing them with the images to insure accuracy, and make any necessary corrections before cosigning. Once we began using PACS, I allowed the first-year residents to predictate. They would often ask, “What if I make a mistake?” I told them I didn’t care if they made mistakes. We would correct them when we reviewed the images because at the review session I had the images, I had the resident, and I had his/her report. If there were any errors in interpretation or in the text of the report, we made the appropriate changes using the voice recognition tool of the PACS after discussing the reasons for the errors. Once we agreed on the revised report, I pushed the “Send” button, and the report “was in the system and available to the clinician(s).

The Scouting program provides many opportunities for the leaders to practice Creative Failure. Several years ago, I participated on a ten-day backpacking trek through Philmont Scout Reservation in New Mexico. Our backpacks typically weighed between fifty and sixty pounds, and I was determined not to have to take any extra steps if possible. The trip had two purposes. The first was to enjoy the beautiful scenery in a wilderness setting and partake in the many activities Philmont provided. The second was to teach the boys the fundamentals of wilderness camping, including navigating by using map and compass (orienteering) and wilderness ecology and etiquette. Our crew of ten consisted of seven youths and three adults. Our daily protocol included forming our “line of march”, which was the single file order of each participant. One boy had the lead (called the “pathfinder”), setting the pace of the trek. We rotated this position each day, as we did with the rest of the duty roster (cook, cleanup, wood gatherer, etc.). Immediately behind the pathfinder was another boy who carried one of the maps of the reservation. I was next, behind the “map man”. A second adult was in the middle of the column and the third adult was the “sweeper” at the end of our column to make sure none of the crew straggled. We also had a rule that at no time would we be spread out so that the “sweeper” could not see the “pathfinder.” Any member of the crew could call a halt at any time and for any reason.

Each of the adults had a map of the reservation on which we had marked our intended hiking route. The “map man” also caried a marked map. Every day the adults would review the map and look for any prominent landmarks or points of interest along our trek. Periodically, when we passed such a site, I would call a halt to our hike to ask the Scouts where they thought we were. The usual answer was that we were on a particular trail. That became a teaching moment when I told him to get the map out, look at the surrounding landscape and see if there was anything they could correlate with the map.

Many of the trails intersected along our route. In most instances, when encountering an intersection, we had only two choices to make to continue our trek. At each intersection, I would ask, “Mr. Pathfinder, which way do we go?” When he answered, I would then ask, “Are you sure?” If he answered affirmatively, and if I knew he was right, I’d say, “Lead on.” If I knew he was wrong, I’d ask, “Are you really sure?” That would prompt him to get out a map and use his compass to determine the correct direction in which we should proceed. This technique proved valuable near the end of our trek when we encountered a convergence of five trails. A trail marker had been placed in a stone cairn indicating each of the five trails. However, boys being boys had rotated the staff on which the markers were attached. By that time, the lesson had been learned and the “pathfinder” immediately used the map and his compass to find the correct trail.

Several years later I was attending a district camporee in Beaver County where the main activity was orienteering. Each patrol was accompanied by an adult from a different troop. Each patrol was given a map as well as a series of compass directions and approximate distances. The adults with each patrol had a marked map to assure that the group would not get lost. At one point, the road we were hiking on ended at a T- shaped intersection. The patrol leader read his compass and directed us to start hiking exactly 180° (we went left instead of right) from the direction we were supposed to take. Since we were only carrying our canteens, and in some cases just a day pack, I didn’t mind taking a few extra steps. After we had traveled about 100 yards, and it was obvious the patrol leader had Continued on Page 10

From Page 9 not recognized his error, I stopped the group and I asked, “Mr. Patrol Leader, where are we?” He proudly pointed to the map and indicated where he thought we were. adjacent lumbar vertebra, explaining her pain. My resident, from Georgia, upon seeing the findings said, in his deep southern drawl, “Fellahs, there’s a lesson here. Crocks daah (die), too.” Unfortunately for the patient, CT scanning and ultrasound exams had not been developed. The important lesson is that for most patients with a diagnosis of psychosomatic illness, the symptoms are real, and in fact a small number of these patients indeed have real abnormalities accounting for their symptoms.

“What’s that blue squiggle on the map?” I asked.

“It’s the creek, sir,” he replied. Then he pointed to the creek, on our left, that ran alongside the road.

“But if we’re where you said we are, the creek should be on our right. How do you explain that?” I asked.

Without hesitation, he replied, “The map is wrong.”

“Is there another explanation?” I asked.

Sigmund Freud’s view of humor was that it was a conscious expression of thoughts that society usually suppressed or was forbidden.2 As long as the humor, in this case name- calling, is meant in a benign fashion, it is considered harmless.

Then it dawned on him that we had gone the wrong way!

And that is how creative failure works. I allowed the patrol leader to make a mistake. The error did not imperil our safety and was easily correctable. And, more importantly, the boys learned to check their directions at each intersection. Interestingly, the result was different for another patrol who had made the same mistake. The adult with them did not realize the error and the patrol ended up several miles inside Ohio. The “Lost Patrol” was returned to camp by two Ohio State Highway Patrol cars after they stopped at a farmhouse to ask directions.

However, in today’s politically divisive atmosphere, it is best to use humor only when you truly know your audience. As a good example, I remember the not so “good old days,” when it was expected that a speaker at a conference or a refresher course would tell jokes. Many of the “old timers” were very colorful characters. Today, fortunately, speakers are business-like and jokes are tacitly forbidden, since they are bound to offend someone. Finally, we should always remember that no matter how unpleasant some of our patients are to us, they are still our fellow human beings.

I have found the Socratic Method and Creative Failure to be useful tools for teaching at multiple levels, whether the learners were adults or youth.

Reference:

Dr. Daffner, associate editor of the ACMS Bulletin, is a retired radiologist who practiced at Allegheny General Hospital for more than 30 years. He is emeritus clinical professor of Radiology at Temple University School of Medicine and is the author of nine textbooks. He can be reached at bulletin@acms.org.

1. Daffner RH. Curmudgeons. ACMS Bulletin, September 2020, pp 271 – 274.

The opinion expressed in this column is that of the writer and does not necessarily reflect the opinion of the Editorial Board, the Bulletin, or the Allegheny County Medical Society.

References

1. Shem S. The House of God. Richard Marek Publishers 1978.

Dr.Daffner is a retired radiologist, who practiced at Allegheny General Hospital for over 30 years. He is Emeritus Clinical Professor of Radiology at Temple University School of Medicine.

2. Freud S, (Strachey J, Trans.). Jokes and their relation to the unconscious New York: W. W. Norton, 1960 (Original work published 1905).