July 19, 2021

Questioning students

Bruce Peyser, MD, FACP
Director of Education and Teaching, Duke Primary and Urgent Care
Physician, Duke Primary Care Pickett Road

Professor of Medicine, Duke University School of Medicine

Recently, one of our experienced clinician-educators, Dr. Divya Jaiprakash of Duke Primary Care North Hills, reached out to me with a query about resources she might utilize to help teach her students.

She wrote, “I am currently using MKSAP for enhancing student learning on certain topics. I understand that some of this may be a little advanced for them. Are there any other resources that I can use for our second-year medical students that are congruent with their level of learning?”

I was excited to reflect upon this request for multiple reasons. It can be challenging to figure out training-level appropriate questions in order to emphasize and teach content. Questions that are too easy can negatively influence a teaching session, and questions that are too hard or esoteric can frustrate and stymy the educational process.

Many of us have tended to shy away from asking too many questions of our learners. Some of our more senior educators (myself included) were trained at a time when professors utilized a more traditional Socratic method of teaching, which often involved aggressive questioning.

It turns out that medical students like to be questioned, though they understandably prefer that this be done in a respectful and supportive manner. A recent study was published in Academic Medicine on this very topic, and many attendings also prefer to ask lots of questions.

I also liked Divya’s question because it gave me a chance to go through texts I have used recently to review content and teach concepts to students. Here are my four favorite texts. You might consider ordering one from Amazon and seeing if it helps you become a more effective teacher.

  1. Step Up to Medicine by Agabegi and Agabegi (very direct and succinct, lots of practical information and charts; most recent version published 2019)
  2. MKSAP (Medical Knowledge Self Assessment Program) for Students 5 (published by American College of Physicians; latest edition is from 2011)
  3. Internal Medicine Essentials for Students (also published by American College of Physicians; there is a text with content, and there is a book of questions, but this was last updated in 2014 )
  4. Symptom to Diagnosis (covers more of differential diagnoses and pathways for evaluation and diagnosis of common problems)

I find that giving reading assignments to students at the end of a clinic session is a helpful way to strengthen their clinical knowledge. We know that linking the readings to what they have seen clinically enhances their learning, and they can recall content better when it’s linked to a clinical interaction. It’s important to be focused, though. We can’t just say, “Read about diverticulitis.” It’s better to pick one aspect of a problem so one might guide a student and say, “Why don’t you read about the common causes of left lower abdominal pain?” I also like to ask the student to come back the following week and teach me what they have learned.

My final reason for welcoming Divya’s question relates to a project we have been working on lately to create an online repository for the review articles that we have been sending out twice a month. (If you are not signed up to receive these articles please let me know so we can add you to the list.) Many of us served as chief residents in the past, and we often had to refer back to important articles in the literature about a particular topic. I am hoping that this website will replace the file cabinets we previously used to store these important teaching papers.

Our goal is to have this site up and running by the middle of March. It will be embedded in a system called Canvas, and if you have any interest in accessing this site early, please let me know and we will share the link with you.