Inquiry Teaching Guide

USING QUESTIONS TO F A C I L I T A T E L E A R N I NG PROMOTING INQUIRY, NOT ANSWERS

Prepared by Karen C. Spear Ellinwood, PhD, JD, EdS Director, Instructional Development The University of Arizona College of Medicine - Tucson kse@medadmin.arizona.edu FID.medicine.arizona.edu

USING QUESTIONS TO FACILITATE LEARNING: PROMOTING INQUIRY, NOT ANSWERS Outline and summaries prepared by Karen C. Spear Ellinwood, PhD, JD, EdS, Director, Instructional Development

Table of Contents How do questions facilitate learning? ........................................................................................................... 1 What is an "Effective" question? ..................................................................................................................... 1 A Taxonomy of Questions .................................................................................................................................. 1 Activity: Formulate questions in “Knowledge Domains” ...................................................................... 3 What else should we consider in asking questions of students? ........................................................ 4 Comment on Socratic Method .......................................................................................................................... 5 References ............................................................................................................................................................... 6

Outline & Summary of Inquiry Learning Strategies

How do questions facilitate l earning?

Effective questions… 

Engage the audience

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Direct attention to Specific topics/aspects, what's important about it

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Make new connections - asking question that helps students synthesize info from different sources or make connections to other sources

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Make students think and discover their answers

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Emphasize process, and learning through articulation.

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Enhance memory.

What is an "Effective" question?

Sometimes it helps to define something by articulating what it isn't. So, let's ask: – What makes a question ineffective?

- How do ineffective questions harm or discourage learning process?

Ineffective questions …  Confuse the issue, misdirect attention 

Require less depth of inquiry or reflection

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Promote assumptions (without inquiry or investigation)

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Affect confidence - decrease or overly increase confidence on the part of the learner.

Effective questions… do not!

A Taxonomy of Questions 

Convergent v. divergent o Convergent Questions - Closed questions that look for specific answers from a finite list of possible answers. These tend not to encourage deep thinking or reflection. Convergent Questions are also Known Answer Questions (KAQs).

o Divergent Questions- Open-ended questions that require dialogue and deeper thinking or problem-solving; generally, there is not one answer, or no

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Outline & Summary of Inquiry Learning Strategies

easy answer. Divergent questions encourage multiple perspectives, divergent thinking. Divergent Questions > Discussion. [Preferred method of questioning] Patrick & Urhievwejire (2012). 

Target Cognitive Level o Questions should aim for a particular “cognitive” level of engagement, that is, lower order or higher order thinking. o Higher order level questions require students to think about HOW knowledge applies to particular circumstances or to synthesize knowledge acquired at over time or in different contexts. o It can be helpful to combine lower and higher order thinking questions:

Think Bloom's Taxonomy!

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Lower order – What field of knowledge does this case involve?

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Higher order – How does that knowledge apply to these facts under these circumstances?

o Instructors ought to identify the cognitive level at which the question is or should be directed. Consider using Bloom’s taxonomy as a guide to select the verb appropriately gauged to the level of challenge you want to create.

o Anderson & Krathwohl (2000) generated a model of learning objectives based upon their revision of Bloom’s taxonomy identifying synthesis as the highest level of engagement in learning.

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Unfortunately, most questions in lectures are aimed at simple recall and basic comprehension levels.

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Such questions may serve as threshold questions, to monitor for understanding or to determine the range of knowledge in the classroom, but instructors should strive to engage students at the higher level of analysis, evaluation, or synthesis.

Target "Knowledge Dimensions" o Questions may be designed to target various dimensions of knowledge. We should choose strategically the dimensions of knowledge we want to trigger. 

Factual questions ask (WHAT)

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Conceptual questions ask about (knowledge of classifications, taxonomies, theory)

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Procedural questions ask (HOW)

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Outline & Summary of Inquiry Learning Strategies



Metacognitive questions ask about (process) and promote (reflection)

o My note: On metacognition and domains of knowledge, see also, Schraw & Dennison (2004). 

Question Circles o Question circles pose compound questions aimed at multiple domains. o While compound questions might seem as though they have the potential to confuse, when articulated well, they promote deeper reflection on issues of ethics, professionalism and decision-making.

o Questions Circles are defined by their inclusion of two or three of the following fields: 

Subject matter (topic, field)

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Personal reality (meta reality, self in process, relationship to subject matter)

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External reality (circumstances, conditions or factors)

o When questions target the interrelation of these domains they engage students at the deepest, most reflective level. The following are examples of such compound questions: 

Under what circumstances would it be appropriate to ask patients about medication behavior?

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If there were disagreement on the team about the patient’s plan of care, how would you resolve these differences?

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Under what circumstances would it be appropriate for you to act against a team decision when the patient not taking medication as prescribed?

Activity: Formulate questions in “ Knowledge Domains” 

Ask students to formulate questions based on a case scenario presented.

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Questions should be of various types, e.g., Conceptual; Procedural; and Metacognitive. 

Procedural - How would you ask the patient about whether he is taking the medication as prescribed? [method]

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Conceptual: What does the CDC say about the role of prescribing antibiotics for nonproductive cough? [involves theory, rule of thumb, law or principles]

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Metacognitive: How would you address the physician if you thought she informed the patient incorrectly? [Involves reflection on self, issue and process; such

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Outline & Summary of Inquiry Learning Strategies

questions are stated as hypothetical, e.g., asking someone to imagine what if or how someone else would respond under particular circumstances, requiring anticipation or prediction.]

IF ACTIVITY LEADS TO MORE INQUIRY... Don't worry! You're promoting learning!

INQUIRY STRATEGIES CAN IMPROVE THE QUALITY OF OUR TEACHING.

What else should we consider when we ask questions? 

Psychological safety – Students are reluctant to participate for fear of looking foolish or being wrong. How can we create an environment of psychological safety to encourage students to participate and do so more often? The audience suggested the following: 

We could allow students to use a “Lifeline”, that is, to ask to consult with students nearby if they are not sure of the answer.

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Use the Think-Pair-Share method or ask for teams or small groups to consult and then respond. Use an audience response system that allows for anonymity.

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Encourage students to parse facts from opinions.

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When correcting students, model reflective thinking - Instead of saying, hey, you’re wrong!, ask them to evaluate what they have asserted and/or or provide a framework for their evaluation process.

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Phrasing [Framing] – How you frame (set up) or phrase (language use) the question makes a difference in whether it invites a thoughtful response or a quick yes/no answer. Frame and phrase your questions strategically.

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Get comfortable with silence - If silence ensues, reframe the question, but resist answering it!

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Wait time - Deliberately offer sufficient time to respond. Time it. One minute etc. If silence, resist answering the question – reframe your question to invite a response.

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Sequencing - Build on prior knowledge; big picture, then little picture

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Balance (of type) – Ask a variety of types of questions. For example, don’t only ask factual (recall) questions. Ask procedural, conceptual questions, or divergent and convergent questions.

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Rapid-reward – Offer rewards to students for responding to questions, and ask follow up questions to continue the momentum.

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Participation. Risk takers may dominate; the issue is to identify how we can encourage others to participate. One approach is to create participation rules, e.g., everyone

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Outline & Summary of Inquiry Learning Strategies

participates twice per session; take turns leading discussion, prepare in advance so you feel confident in participating.

Comment on Socratic Method The Socratic Method aims to strategically reveal the underlying assumptions and beliefs of the learners by posing questions to promote their examination of their reasoning and its applicability or suitability in the given context or application of knowledge.

The correctness of reasoning, then, and not the perfect answer is at issue.

In true Socratic Method, students should also be encouraged to question authority - that is, to examine and "interrogate" the reasoning of the sources they find, the instructor,or colleagues.

The goal of true Socratic teaching, then, is to urge learners to LISTEN to one another's ideas and build upon them to arrive at co-constructed meaning of concepts, new ideas and to pose more questions.

Note This outline was inspired by the presentation by STUART HAINES [11/2/2012] at the University of Arizona College of Pharmacy, and draw on the work of others in active learning, metacognition and reflective engagement.

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Outline & Summary of Inquiry Learning Strategies

References Huynh, D., Haines, S.T., Plaza, C.M. Sturpe, D.A., Williams, W., Rodriguez de Bittner, M.A. & Roffman, D.S. (2009). The Impact of Advanced harmacy Practice Experiences on Students’ Readiness for Self-directed Learning. American Journal of Pharmaceutical Education 73 (4) Article 65.

Patrick, A.O. & Urhievwejire, E.O. (2012). Is Soliciting Important in Science? An Investigation of Science Teacher-Student Questioning Interactions. International Education Studies Vol. 5, No. 1; February 2012, pp. 191-199, access at http://www.ccsenet.org/journal/index.php/ies/article/view/11024/9867.

Paul W. Jungnickel, P.W., Kelley, K.W., Hammer, D.P., Haines, S.T., and Marlowe, K.F. (2009).

Addressing Competencies for the Future in the Professional Curriculum. American Journal of Pharmaceutical Education, 73 (8) Article 156.

Stewart, D.W., Brown, S.D., Clavier, C.W. & Wyatt, J. (2011). Active-Learning Processes Used in US Pharmacy Education. American Journal of Pharmaceutical Education; 75 (4) Article 68.

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Appendix Guides for Developing & Using Inquiry Strategies in Medical Education

Source: Karen Spear Ellinwood, PhD, JD, EdS, Director, Instructional Development Inspired by: Tofade T, Elsner J & Haines S T. Best Practice Strategies for Effective Use of Questions as a Teaching Tool. Am. J. Pharm.

Educ. 77(7):155; 2013. Shraw G & Sperling Dennison R. Assessing Metacognitive Awareness. Contemporary Educational Psychology 19:460-475; 1994; Moll L C. L.S. Vygotsky & Education. Routledge:NY; 2013.

Determine Target Knowledge Dimension

Identify Purpose Frame the question for the student: 

Situate the question in the relevant context. For example, indicate the setting, situation, or other relevant facts.

Educator Frame:

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 Lay foundation. The purpose  is to establish student’s:   Knowledge base - What  can student do without assistance? 

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The Target Knowledge Dimension refers to the kind of thinking in which you want the student to engage. Once you know that, you can choose how to phrase your questions. Ask yourself, do you want the student to demonstrate:

Appropriate level of challenge - What student can do with strategic guidance?

Deep-dive. The purpose is to  ask student to engage in higher-order thinking (e.g., in-depth analysis.) 

Select Question Type 

Convergent – Asks student to choose from among finite possibilities, such as single correct/best answer, yes/no.

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Divergent (Open-ended) – Narrative response; requires application of knowledge, analysis or other higher order thinking.

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Complex\Compound [Question Circles] – Answer depends upon critical analysis of multiple factors and relationship among these

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Conceptual – Questions that ask students to explain concepts or articulate reasoning (Analysis, Synthesis, Evaluation)

Knowledge/Recall

Comprehension Application of Knowledge Conceptual Knowledge

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Metacognition or reflection

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Procedural – Questions that ask students to explain how something functions, or to describe causal connections.

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Analysis

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Synthesis

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Evaluation

Conditional – Ask the student to predict what might happen under various conditions or circumstances (What if questions).

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Reflective\Metacognitive – questions that promote reflection past, present or future action, process or self

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Question Posing – Ask students to formulate questions or to lead the inquiry

Conditional Knowledge (knowledge that depends on circumstances)

Creative\Innovative thinking

Source: Karen Spear Ellinwood, PhD, JD, Office of Medical Student Education

Reflective Teaching Practice

Reflect BEFORE the Encounter

B-D-A Framework = Structures the learning experience by engaging the student Before, During and After a patient encounter or other clinical experience. = Communicates that you are mindful that the student is there to learn, not just to “tag along”, and that you have given some thought to how learning can occur.

BEFORE

DURING

Reflect AFTER the Encounter

Reflect DURING the Encounter

= Identify learning demands = Establish student’s relevant knowledge & skills =

Set/Clarify learning objectives = Identify relevant & appropriate resources = Monitor for expected performance = Ask student to be mindful of questions or

issues that you can address together after the encounter or experience = Ask student to self-assess performance, identify questions = Discuss relevant

AFTER

resources to address questions = Provide constructive feedback = Establish goals for future learning

Karen Spear Ellinwood, PhD, JD, Director, Faculty Instructional Development Office of Medical Student Education, University of Arizona College of Medicine.

A Structured Approach to Medical Problem-solving

1 Frame the Problem

(1) What problems or questions do I need to address for/with this patient?

2

5 Reflect

(2) Given these problems or questions, what are the possible conditions that could be causing the patient’s symptoms? Why would I include these or not?

Revisit & Revise as needed

(3) What do I need to know and how should I go about finding out? Are there other things about the patient's situation I should consider?

(4) Given what I know now, how does this new knowledge help me differentiate from among the possible diagnoses? What can I rule in or rule out? Why or why not? What else do I need to know?

Formulate Hypotheses with Rationales

4 Narrow Diagnoses with Rationales

(5) Now that I have concluded this encounter or clinical situation, what did I do well and why? What could I have done better? How? What should I do next time to improve my approach to this process or clinical encounters in general?

3 Strategize for Assessment

The purpose of this structured approach is to help you:  

Systematically apply reasoning to clinical problems Re-evaluate evidence, inferences and assumptions

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Identify and acknowledge cognitive errors Develop strategies for avoiding error in future cases.

FID.medicine.arizona.edu Karen Spear Ellinwood, PhD, JD, Director, Faculty Instructional Development Office of Medical Student Education, University of Arizona College of Medicine.

Inquiry Strategies for a Reflective Approach to Medical Problem-solving Question the Process      

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How do I know that?

What else do I need to know?

How could/should I find out?

How will it help me to differentiate from among the possible diagnoses?

Is there another approach I/we can take?

Are these problems due to a single cause? Multiple causes?

Multiple related causes?

How can I/we narrow POSSIBLE causes to highly PLAUSIBLE or PROBABLE causes?

Question the Case

  

Question Perspectives      

Have I/we framed the inquiry in a way that helps or hinders us from reaching a conclusion supported by evidence?

How could I/we (re)frame the problem?

How could I/we reframe the question?

Am I/are we biased in some way?

What assumptions am I/are we making?

What kind of questions should I/we be asking?

Are these problems due to a single cause? Multiple causes?

Multiple related causes?

Which facts support my conclusions?

Which facts do not support my conclusions? Should this cause me to continue investigating? Why? Why not?

Question How to Approach Future Cases

    

What have I learned from my approach in past cases?

How can problem-solving in past cases help me take an effective approach to the current case?

Have I/we made any cognitive errors? What are they?

How/why did I/we make those errors?

How/why could I/we avoid these in future cases?

Karen Spear Ellinwood, PhD, JD, Director, Faculty Instructional Development Office of Medical Student Education, University of Arizona College of Medicine [FID.medicine.arizona.edu]