Diagnostic reasoning is one of the most complex, analytical, and intuitive processes to develop in the medical profession. Even seasoned physicians spend a lot of time fine tuning this skill. Although charged with teaching others, some excellent diagnosticians find it difficult to explain in detail how they arrived at a diagnosis or a differential diagnosis. Some might even find themselves in a position in which they have to assess someone else’s diagnostic reasoning. This task is even more daunting since we are not all taught much about this process, even less how to teach it to others.
“I desire no other epitaph…than the statement that I taught medical students in the wards, as I regard this as by far the most useful and important work I have been called upon to do.” — Sir William Osler (1)
One method used to assess diagnostic reasoning in medical students and junior physicians is by using the Socratic method, or in what’s known under medical slang “pimping.” Here are four links from the site Life In The Fast Lane where Dr. Chris Nickson (@precordialthump) does an excellent review of the topic of “pimping.”
What is the Socratic method?
It is a learning tool used via dialogue in the form of questions and answers in various fields to impart knowledge. Its purpose is for the questioner (the person with more seniority) leads the more junior person to arrive at the answer through his/her own analytical thinking (the aha! moment).
It takes someone with the right set of skills to carry this out effectively, even more so in the clinical arena. As Dr. Nickson points out, this process can be a positive or negative experience for all parties involved. Unfortunately those who do not have this skill mistakenly assess diagnostic reasoning by asking students and junior residents by regurgitating information. Regurgitating information has a place in Medicine and it’s definitely the base on which we build upon, but it’s not diagnostic reasoning. Admittedly assessing someone’s diagnostic reasoning is time consuming and a complex process, but it can be done even in a busy emergency department.
The Socratic method, if used appropriately, expands the learner’s base knowledge to the point where not only the learner knows WHAT piece of information he/she lacks but also improves on his/her THOUGHT PROCESS.
Pearls when using the socratic method
Dr. Robert Oh (2) states 3 important points:
- Challenge the learner’s preconceived notions of Medicine by asking questions in a logical and stepwise fashion to hone critical thinking skills in the context of the patient.
- Diagnose the learner’s level of understanding to assess his/her learning needs through questioning
- Engage the learners- encourage focused self-directed learning strategies or teach clinical pearls.
He also addressed some pitfalls when using the Socratic method:
- Avoid ambiguous questions (“Guess what I’m thinking”)
- Do not use the Socratic method to evaluate a learner’s performance, rather focus on the process.
- Do not use this method to humiliate the learner as this is not compatible with adult learning.
Being a great clinician does not necessarily equate to being a great teacher, and being a great teacher does not necessarily equate to being a great clinician.
Learning to become an effective teacher in Medicine requires dedication to the craft. People get PhD’s in education. It’s not simple or quick to be a great teacher. To presume so is to set up all of those involved for failure (including patients).
Your challenge is to first be aware of how complex this process is and dig deep into evidence-based education.
I hope this post helps you gain more understanding on the Socratic method and how it may affect the learning process. If it did add value to your understanding or you have more suggestions on the topic, add your comment below and let us know how to learn and teach more effectively.
- Osler Society of New York http://www.oslersociety.org/index.php/by-osler; accessed January 17, 2013.
- Oh RC. The Socratic Method in Medicine–the labor of delivering medical truths Fam Med. 2005 Sep;37(8):537-9.
Image 1 source