Applying the Question Formulation Technique to Enhance Active Learning in Health Professions Education (Part 2)

In the first blog post in this two-part series, we explored the reliance on lectures and memorization-based assessment within medical and health professions education, where learners are typically required to answer questions as a means of demonstrating their knowledge. We argued that alternative methods exist to ensure knowledge acquisition while simultaneously fostering important life skills. Specifically, we highlighted the Question Formulation Technique (QFT) as a particularly promising approach to enhance the critical and creative thinking skills and dispositions required for complex problem-solving. As educators, our goal is to create learning experiences that prepare trainees for the intricate decision-making required in their future work. Active learning is a powerful way to achieve this goal. Encouraging learners to formulate their own questions about course content in didactic settings is an engaging and meaningful strategy to facilitate active learning and move beyond mere memorization.

To illustrate the multi-step QFT method, we will use the example of Eastern Virginia Medical School’s Advanced Medical Neuroscience preclinical neurology course. Instead of delivering a traditional lecture on a specific disease, the teacher provides students with a real-life clinical case that exemplifies the disease process. This case becomes the Question Focus, guiding students in their exploration and inquiry.

Step 1: Generate Questions

After reviewing the case, learners are given time to think independently and write down as many questions as possible about both the case and the disease. This phase involves divergent thinking, requiring creativity as learners generate new ideas and potentially identify aspects of the case not explicitly stated. Although learners may initially find the question generation process challenging, educators often see improvements in divergent and creative thinking skills with repeated practice using the QFT method.

Examples of questions learners might generate during this step include "What is the most likely diagnosis?" "How do we know this is the correct diagnosis?" "What cellular and molecular signaling pathways are responsible for the main features of this disease’s pathophysiology?” and "What other pathologies might contribute as we develop a differential diagnosis?" At this stage, students write down their questions exactly as they conceive them, without attempting to answer, judge, or revise them. Once each learner has had time to compile their lists individually, they form small groups of four to five students, sharing and recording on chart paper for everyone to see. If time is limited, this step can be compressed into one single brainstorming session rather than allocating time for individual brainstorming first.

Step 2: Assess The Questions

After questions are shared and recorded for everyone to see, group members collaborate to review and categorize each question as either closed or open-ended. They then spend a few minutes converting some open-ended questions to closed-ended ones, and vice versa. This step is crucial in the QFT process as it encourages learners to think flexibly and consider different perspectives on their questions. It also enhances awareness and analysis of their questions, illustrating how the way questions are phrased can influence the quality of information and thinking that they generate. While both closed and open-ended questions have value, each possesses unique advantages and disadvantages. This step helps learners recognize how different types of questions serve specific purposes in research and learning.

Step 3: Prioritize The Questions

The next step is to prioritize the questions based on criteria that the instructor finds suitable for achieving the session’s learning goals. This convergent thinking process requires learners to refine their thoughts by evaluating the quality and relevance of their questions, thereby improving their critical thinking skills. Once questions are prioritized, there are numerous directions for learning. Learning can be personalized from this point of curiosity and the questions that are identified can be used for further inquiry as individuals, small groups, or as a large group. For instance, learners might be empowered to research the questions most compelling to them and report back to the group. Alternatively, small groups can divide questions among members, who then share their findings. The instructor might also use the prioritized questions as the basis for subsequent instruction in the coming days or for the remainder of the class session.

A range of next steps can deepen understanding of the clinical diagnosis or pathology of the disease, tailored to match learner comprehension and the session objectives. Regardless of how prioritized questions are used, there is great value in the divergent and convergent thinking involved in formulating, discussing, evaluating, and reflecting on the questions.

Step 4: Reflect

The final step involves reflecting on the case-based QFT process and what learners have gained from it. This reflection encourages metacognition, helping solidify learners’ understanding of the subject matter while further developing their skills and dispositions as critical and creative thinkers. Thinking about their thinking helps learners appreciate their own capacity to ask the types of questions needed to solve the complex problems they will face in class and in their professional and personal lives.

In the coming months, our group will assess the impact of this QFT application across multiple different medical education efforts at three institutions in different countries. Once the study is complete, we hope to report back with our findings as well as provide further tips for implementing this process effectively in your own settings.

 

Nancy Van Erp, PhD, MA, MA (Educators ‘24) is an assistant professor and director of Curriculum at Mayo Clinic College of Medicine and Science. HMI has made an impact on Nancy’s career by connecting her with inspiring leaders and activators in medical education. Nancy’s areas of professional interest include active learning, critical thinking, and human flourishing. Nancy can be followed on LinkedIn or contacted via email. 

 

 

Joseph Carton, BS is a medical student at Eastern Virginia Medical School. Joseph’s areas of professional interests include mentoring, clinical skills teaching, and interdisciplinary education. Joseph can be contacted via email.  

 

 

Alberto E. Musto, MD, PhD, FAES (Educators ’19) is an Associate Professor in Biomedical and Translational Sciences and Neurology at the Macon and Joan Brock Virginia Health Science Center Eastern Virginia Medical School at Old Dominion University. HMI has made an impact on Alberto’s career by applying educational leadership and building community with HMI colleagues and students. Alberto’s areas of interest are neuroscience translational research, mentorship, and critical thinking. Alberto can be followed on LinkedIn or contacted via email.