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Improving Medical Education by Refining “Guess What I’m Thinking” Questions

May 3, 2022

Editor’s Note: The article that is the subject of this blog discusses a strategy often used in medical education. I felt that it would be important to have a trainee perspective. Krista Roncone, MD is a first-year resident physician in pediatrics at the University of Virginia. She is interested in medical education and health disparities research, and is considering integrating these components into a career in pediatric hospital medicine or critical care.

-Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics

“I’m sorry, that was a ‘Guess What I’m Thinking’ question.” This is a phrase nearly every trainee in medicine, often with nervous hands clasped inside their short or long white coat, has heard. In a Feature being early released this week in Pediatrics, Drs. Katherine Jordan, Nicholas Potisek, and Eric Zwemer, from the University of North Carolina and Wake Forest School of Medicine, have detailed the precarious nature of “Guess What I’m Thinking” (GWIT) questions, and how this style of questioning can be avoided while still championing the Socratic method (10.1542/peds.2022-057450).

A GWIT question is defined as “an open-ended question to which there are multiple right answers, but the educator is only interested in ”.

Perhaps the most insightful take away from this article is that, while GWIT questions can undermine the confidence of learners, they also undermine our confidence as educators. At times, our medical education skills may not match the level of our medical knowledge. This cognitive dissonance may in turn cause us to question our competence. It is often said that true intelligence is the ability to make those around you feel smarter. With this in mind, it is no surprise that when our team members who rely on us perceive that they are falling short in their performance, the end result is that we may feel ineffective or inadequate as an educator.

The authors provide specific strategies on how GWIT questions can be avoided:

  • Careful Question Structuring: Thoughtful wording is something pediatricians are uniquely skilled in, as we focus on using conscientious phrasing in our interactions with patients each day. This same careful framing can be applied to the way in which educational questions are posed. Even without changing the content of a question, reframing a simple query from, “What is the most likely diagnosis?” to “What do you believe is the most likely diagnosis and why?” can subtly acknowledge the inherent gray areas of medicine and the potential for multiple correct answers while fostering a gentle learning environment.
  • Building on Existing Knowledge: Educators should not focus so intently on obtaining a specific answer that they pass up the opportunity to reinforce other correct answers. It is important to acknowledge other answers as valid statements, and use them to build upon this existing knowledge to re-route to the desired teaching point.
  • Scaffolding: Experienced clinicians draw connections between concepts that learners are still trying to tie together. Daniel Kahneman, in his 2011 book, “Thinking Fast and Slow”, discusses the difference between Type 1 (fast, intuitive) and Type 2 (more effortful, slow, and logic-based) thinking, and I think that these two types of thinking are evident in clinical training. As we grow as clinicians, we begin to use more Type 1 processing: understanding clinical scenarios rapidly by using intuition molded from experience. This article uniquely acknowledges that this type of processing may affect the way we deliver questions to learners who are still largely working in the realm of Type 2 processing. With this in mind, we must objectively relay our clinical reasoning and thought processes to give learners a structure to lean on.

There is much more in this article, including examples for how to use these strategies with trainees. After reading this article, I have already begun to incorporate these simple tips into my own teaching style. I’ve learned that, as a resident, there is no better feeling than watching those one short step behind you in their professional journey gain confidence and succeed because of how I framed my teaching questions to them.



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