In a study done by Di Vito-Thomas and published in 2005, it was revealed that the majority of 134 nursing students felt that the most helpful clinical teaching strategy was being questioned by their instructors about their thought process in a way that fostered sound clinical judgment. The success of this process was dependent on the quality of the discussion.
Consider what they are saying and what you want to discover.
In the three tables listed below, you will find a range of suggestions and sample questions you can use to guide and promote clinical questioning with your students.
Table 1: Clinical Questioning: Purpose & Questions
(Adapted from MSU Clinical Questioning)
| Purpose | Questions |
|---|---|
| Clarity | What exactly do you mean by ‘XXX’? Could you elaborate further? |
| Accuracy | How do you know this is true? How could we verify or test that? |
| Precision | Could you give me more details? Could you explain XXX? |
| Relevance | How does that relate to the problem? How does that answer the question? How does that contribute to managing the situation? |
| Depth | What elements make this a difficult situation? What are some of the complexities to consider? What are some of the issues here? |
| Breadth | How can we look at this in another way? What are some other perspectives on this? |
| Logic | Does all of this make sense? What steps did you take to come to this decision? What evidence exists that would support this? |
| Significance | Is this a priority? Why? What is the most important piece of information? What could happen? How possible is this? |
| Fairness | Do I have a vested interest in this? Do I know what assumptions I am making? Am I acting on my assumptions? |
| Evaluation | How well did this go? Why? What are the pros and cons in this situation? How would your patient (family) evaluate this? |
Table 2: Questions based on Bloom’s Taxonomy
(Adapted from MSU Clinical Questioning)
| Domain | Sample Questions |
|---|---|
| Knowledge | What is acute coronary syndrome? How should you assess pain? What diagnostics are used to determine acute renal failure? |
| Comprehension | What patient data tells you that your patient is septic? Why would it be important to take a blood glucose? Can you tell me how this might be done? |
| Application | What are some things that you could do to enhance your patient’s mobility? What does your patient need to know about this medication? What side effects will you monitor this patient for? |
| Analysis | Why do you think the anticoagulant is being held? Why is your patient receiving this medication? How will your patient’s surgery affect his diabetes? |
| Synthesis | How do you think you will teach her how to care for her wound at home? What is your plan of care for your patient today? What impact do you think this decision will have on your patient? |
| Evaluation | How much did your patient learn from the discharge teaching? What is your patient’s priority problem and why? How did your plan of care go today? What worked well and what would you change? |
Table 3: Clinical Interactions & Questioning Strategies
Below are some suggestions for how to enhance specific aspects of clinical interactions.
| Interaction | Questioning Strategy |
|---|---|
| Learning | Asking a combination of open & closed questions along with probing questions can foster critical thought. |
| Relationships | Asking about their opinions in a positive way in order to maintain an open dialogue. |
| Coaching | Asking rhetorical and leading questions can help foster reflection. Eg. “wouldn’t it be great to gain confidence with…” |
| Mutual understanding | Asking probing questions to seek clarification to ensure that there are no false assumptions being made on either end of the interpersonal gap. |
| Diffusing conflict | Using funnel questions can help individuals identify the specifics of their complaint as well as make them feel heard. |
| Getting buy-in | Asking others their opinion about suggestions or plans creates dialogue and allows opportunity for mutual understanding. |