October 2023 #MedEdPearls: Creating a Warm Environment for Questioning and Learner Engagement

In health professions education, a history of the questioning style known commonly as “pimping” or “peppering” has been widely documented and discussed. One of the more recent, comprehensive analyses of the use of this questioning style describes it as “questioning with the intent to shame or humiliate the learner” and that it is unprofessional and harmful. I am sure while reading this, you can probably draw to mind an experience you have had with this questioning method! Even if we remove the mal-intent, aggressive pepper-style questioning of learners can do more harm than good, and it de-emphasizes learning in favor of evaluation. It can be challenging to determine when questioning goes from helpful to aggressive, and a reflection on your intent can be useful. One of my fellow #MedEdPearls bloggers, Stacey Pylman and her colleague Amy Ward provided a very helpful tool to guide medical educators in planning effective questioning strategies with a focus on meaningful learning. Avoiding “Guess What I’m Thinking” questions that elicit negative emotions from learners is another way to ensure questions are focused on meaningful learning outcomes.

In addition to developing meaningful questioning strategies to drive learning, it is important to think about how we can make a few minor tweaks to the ways in which we engage learners to create warm learning environments. Adjusting our approach to questioning in small ways can aid in the development of psychological safety in our learning environments. This is key if we want learners to feel comfortable engaging meaningfully in the learning process.

Strategies to try:

Ensure you know and use learner names: Try a question such as “Micaela, could you try to summarize that concept?”

Utilize “warm call” rather than “cold call” to reduce anxiety: Cold calling involves asking a question and randomly calling someone out to respond. Warm calling is an adjustment that involves giving someone a preemptive heads-up that you will be asking them a specific question, which could sound like “Hey Anthony, I am going to ask someone to describe the side effects of this medication later in rounds. Can I call on you for that?”

Practice wait time before eliciting answers to questions: This ensures all learners are able to think before being asked to respond, and allows everyone to reflect on the question before they hear an answer from someone else. Ask a question such as “What is the correct diagnosis?” and then silently count to at least five before taking an answer or calling on someone.)

Consider strategies that allow for collaborative thinking prior to being put on the spot, such as think-pair-share or turn-and-talk: Here, learners are asked a question and then are allowed to collaborate with a partner before someone is asked to share a response out loud.

Switch from asking “Do you have any questions?” to “What questions do you have?” or “Who has a question for me?:” These subtle phrasing adjustments imply that it is normal for learners to have questions and encourage curiosity!

Practice your go-to responses for when learners answer questions incorrectly: Having a few phrases to normalize error creates a safer learning environment and mitigates the embarrassment or fear that can accompany being wrong. An example of what this could sound like is “That was a good try, but not quite right. Could someone add on to what ____ offered?”

What questioning strategies have you employed to enhance inclusion and engagement in the learning environment? Comment below or share your ideas via Twitter at #MedEdPearls!

#MedEdPearls are developed monthly by the Health Professions Educator Developers on Educational Affairs. Previously, #MedEdPearls explored topics including ensuring learner engagement, purposeful questioning, and a primer on learning objectives.

Rachel Moquin, EdD, MA is a medical educator and professional development facilitator. Rachel is currently Assistant Professor and Director of Learning and Development in the Department of Anesthesiology at Washington University School of Medicine. Rachel’s areas of professional interest include clinician educator development, effective feedback practices, and safe learning environments. Rachel can be followed on Twitter or contacted via email.

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