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Intraoperative questioning to advance higher-order thinking

  • Christopher P. Magas
    Affiliations
    Department of Surgery, University of Michigan Health System, 2207 Taubman Center, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5346, USA
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  • Larry D. Gruppen
    Affiliations
    Department of Learning Health Sciences, University of Michigan Medical School, 219 Victor Vaughn House, 1111 E. Catherine Street, Ann Arbor, MI, 48109-2054, USA
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  • Meredith Barrett
    Affiliations
    Department of Surgery, University of Michigan Health System, 2207 Taubman Center, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5346, USA
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  • Priya H. Dedhia
    Affiliations
    Department of Surgery, University of Michigan Health System, 2207 Taubman Center, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5346, USA
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  • Gurjit Sandhu
    Correspondence
    Corresponding author. Depts of Surgery & Learning Health Sciences, University of Michigan, 2207 Taubman Center, 1500 E. Medical Center Dr., SPC 5346, Ann Arbor, MI, 48109-5346, USA.
    Affiliations
    Department of Surgery, University of Michigan Health System, 2207 Taubman Center, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5346, USA

    Department of Learning Health Sciences, University of Michigan Medical School, 219 Victor Vaughn House, 1111 E. Catherine Street, Ann Arbor, MI, 48109-2054, USA
    Search for articles by this author
Published:October 07, 2016DOI:https://doi.org/10.1016/j.amjsurg.2016.08.027

      Abstract

      Background

      The type of question asked elicits a particular response. The purpose of this study was to determine what types and levels of questions were asked in the operating room. These insights are important for understanding how questions are used to advance learners.

      Methods

      12 laparoscopic cholecystectomy operations were observed and recorded at a single institution. Intraoperative questions asked by faculty were transcribed for all cases. Using revised Bloom's taxonomy, questions were classified into one of 5 levels: (1) remembering, (2) understanding, (3) applying, (4) analyzing, (5) evaluating.

      Results

      141 questions were asked by faculty and ranged from 0 to 34 questions per case. Classification of questions showed there were 43 remembering, 29 understanding, 47 applying, 13 analyzing, and 8 evaluating questions asked.

      Conclusions

      Questioning was predominately classified at lower-order and mid-level thinking skills (120/141). Integrating intraoperative questions at higher-order levels has the potential to guide trainees into progressively complex thinking and decision making.

      Keywords

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      References

        • Kolb D.A.
        Experiential Learning : Experience as the Source of Learning and Development.
        Prentice-Hall, Englewood Cliffs, N.J1984 (xiii, 256 pp. p)
        • Thompson A.R.
        • O'Loughlin V.D.
        The Blooming Anatomy Tool (BAT): a discipline-specific rubric for utilizing Bloom's taxonomy in the design and evaluation of assessments in the anatomical sciences.
        Anat Sci Educ. 2015 Nov-Dec; 8 (PubMed PMID: 25516150): 493-501
        • Sandhu G.
        • Teman N.R.
        • Minter R.M.
        Training autonomous surgeons: more time or faculty development?.
        Ann Surg. 2015 May; 261 (PubMed PMID: 25575257): 843-845
        • Vollmer Jr., C.M.
        • Newman L.R.
        • Huang G.
        • et al.
        Perspectives on intraoperative teaching: divergence and convergence between learner and teacher.
        J Surg Educ. 2011 Nov-Dec; 68 (PubMed PMID: 22000535): 485-494
        • Reznick R.K.
        Teaching and testing technical skills.
        Am J Surg. 1993 Mar; 165 (PubMed PMID: 8447543): 358-361
        • Sandhu G.
        • Rich J.V.
        • Magas C.
        • Walker G.R.
        A diverging view of role modeling in medical education.
        Can J Scholarsh Tea. 2015; (PubMed PMID: WOS:000360040300007. English): 6
        • Roberts N.K.
        • Williams R.G.
        • Kim M.J.
        • Dunnington G.L.
        The briefing, intraoperative teaching, debriefing model for teaching in the operating room.
        J Am Coll Surg. 2009 Feb; 208 (PubMed PMID: 19228544): 299-303
        • Tofade T.
        • Elsner J.
        • Haines S.T.
        Best practice strategies for effective use of questions as a teaching tool.
        Am J Pharm Educ. 2013 Sep 12; 77 (PubMed PMID: 24052658. Pubmed Central PMCID: 3776909): 155
        • Oh R.C.
        The Socratic Method in medicine–the labor of delivering medical truths.
        Fam Med. 2005 Sep; 37 (PubMed PMID: 16145625): 537-539
        • Rohrich R.J.
        • Johns D.F.
        The Socratic method in plastic surgery education: a lost art revisited.
        Plastic Reconstr Surg. 2000 Apr; 105 (PubMed PMID: 10809114): 1803-1805
        • Reilly B.M.
        Inconvenient truths about effective clinical teaching.
        Lancet. 2007 Aug 25; 370 (PubMed PMID: 17720022): 705-711
        • Oyler D.R.
        • Romanelli F.
        The fact of ignorance: revisiting the Socratic method as a tool for teaching critical thinking.
        Am J Pharm Educ. 2014 Sep 15; 78 (PubMed PMID: 25258449. Pubmed Central PMCID: 4174386): 144
        • Pohlmann T.
        • Thomas N.M.
        Relearning the Art of Asking Questions.
        Harvard Business Review, 2015 ([cited 2016 March 22]; Available from:)
        • Ross J.
        How to Ask Better Questions.
        Harvard Business Review, 2009 ([cited 2016 March 22]; Available from:)
        • Bloom B.S.
        Taxonomy of Educational Objectives; the Classification of Educational Goals.
        D. McKay Co., Inc., New York1974: 2 (1 pp.)
        • Krathwohl D.R.
        A revision of Bloom's taxonomy: an overview.
        Theor Pract. 2002; 41 (212-+. PubMed PMID: WOS:000179371600002. English)
        • Adams N.E.
        Bloom's taxonomy of cognitive learning objectives. Journal of the Medical Library Association.
        JMLA. 2015 Jul; 103 (PubMed PMID: 26213509. Pubmed Central PMCID: 4511057): 152-153
        • Baldoni J.
        Learn to Ask Better Questions.
        Harvard Business Review, 2010 ([cited 2016 March 22]; Available from:)
        • Lillydahl D.
        Questioning questioning: essential questions in english classrooms.
        Engl J. 2015; 104 (Jul 2015, 2015-07-06) (PubMed PMID: 1693822378. Epub High school edition. English): 36-39
        • Cope A.C.
        • Bezemer J.
        • Kneebone R.
        • Lingard L.
        'You see?' Teaching and learning how to interpret visual cues during surgery.
        Med Educ. 2015 Nov; 49 (PubMed PMID: 26494063): 1103-1116
        • ACGME
        Resident Duty Hours in the Learning and Working Environment: Comparison of 2003 and 2011 Standards.
        2011
        • Halpern S.D.
        • Detsky A.S.
        Graded autonomy in medical education — managing things that go bump in the night.
        N. Engl J Med. 2014; 370 (PubMed PMID: 24645941): 1086-1089
        • Fronza J.S.
        • Prystowsky J.P.
        • DaRosa D.
        • Fryer J.P.
        Surgical residents' perception of competence and relevance of the clinical curriculum to future practice.
        J Surg Educ. 2012 Nov-Dec; 69 (PubMed PMID: 23111048): 792-797
        • Mattar S.G.
        • Alseidi A.A.
        • Jones D.B.
        • et al.
        General surgery residency inadequately prepares trainees for fellowship: results of a survey of fellowship program directors.
        Ann Surg. 2013 Sep; 258 (PubMed PMID: 24022436): 440-449
        • Magas C.
        • Dedhia P.
        • Barrett M.
        • et al.
        Strategic questioning in surgical education.
        Clin Teach. 2016 Apr 19; (PubMed PMID: 27091023, Epub ahead of print)
        • Beckman T.J.
        • Lee M.C.
        Proposal for a collaborative approach to clinical teaching.
        Mayo Clin Proc. 2009 Apr; 84 (PubMed PMID: 19339652. Pubmed Central PMCID: 2665979): 339-344