The Resident Educator: Asking Effective Questions

One of my favorite parts about being a resident is the chance to interact with medical students. Teaching is such a fantastic way to learn, and it can be a lot of fun, but even the best teachers can be less helpful than they think they are. Sometimes I just get too enthusiastic about the topic at hand. I’ve found myself dominating conversations, even as I’m thinking in my head, “Stop talking!” 

residency education

One method that helps me teach in a more evidence-based way is incorporating elaborative interrogation and self-explanation into conversations. Both strategies prompt learners to understand the reasoning behind concepts, and in doing so help to make the concepts more memorable. 

Elaborative interrogation is primarily focused on “why” questions. 

“Why is this true?”

“Why does this make sense?”

Self-explanation prompts are more variable. 

“How does this work?”

“How does this relate to what I already know?”

“What thought process leads me to the correct answer?”

“Why is this answer correct and the others wrong?”

While it may seem forced, incorporating these questions into teaching can enhance your students’ learning. Studies have demonstrated that learners may not engage in sufficient elaboration on their own, even when instructed to learn “for understanding.” (1, 2) Getting into the habit of using these questions has helped us make interactive teaching our default.

Here’s the interesting part: Even though these two strategies sound quite similar, elaborative interrogation tends to be more helpful for students with more prior knowledge (eg, M4s), (3) while self-explanation may disproportionately benefits students with less prior knowledge (eg, preclinical students). (4, 5) It’s thought that early learners lack well-defined illness scripts and may benefit from how self-explanation forces them to clarify their thinking. After sufficient knowledge has been acquired, learners may benefit more from the global “why’s” used in elaborative interrogation, since they can use their knowledge base to accurately understand why a new fact might be true. Both strategies can certainly be used one-to-one no matter the learner’s prior knowledge, as the teacher can guide the learner in answering the questions accurately. However, recognize that longer-term memory benefits for each strategy may depend on how much the learner already knows.

What are your go-to teaching moves? What do your favorite teachers do right?

1. Woloshyn, V. E. & Stockley, D. B. Helping students acquire belief-inconsistent and belief-consistent science facts: Comparisons between individual and dyad study using elaborative interrogation, self-selected study and repetitious-reading. Appl. Cogn. Psychol. 9, 75–89 (1995).

2. Endres, T., Carpenter, S., Martin, A. & Renkl, A. Enhancing learning by retrieval: Enriching free recall with elaborative prompting. Learn. Instr. 49, 13–20 (2017).

3. Woloshyn, V. E., Wood, E. & Willoughby, T. Considering prior knowledge when using elaborative interrogation. Appl. Cogn. Psychol. 8, 25–36 (1994).

4. Chamberland, M. et al. Students’ self-explanations while solving unfamiliar cases: the role of biomedical knowledge. Med. Educ. 47, 1109–1116 (2013).

5. Heitzmann, N., Fischer, F., Kühne-Eversmann, L. & Fischer, M. R. Enhancing diagnostic competence with self-explanation prompts and adaptable feedback. Med. Educ. 49, 993–1003 (2015).