This is Lab Medicine Rounds, a
curated podcast for physicians,
laboratory professionals and
students. I'm your host, Justin Kreer,
a transfusion medicine pathologist
and assistant professor of laboratory
medicine and pathology at Mayo Clinic.
Today we're rounding
with Dr. Timothy Long.
Dr. Long is a professor of anesthesiology
and a physician in the Department
of Anesthesiology and perioperative
medicine at Mayo Clinic in Rochester,
Minnesota.
He's also the past program
director for the Anesthesia
residency, and it has been a
long time colleague of mine.
Thanks for joining us today, Dr. Long.
Yeah, my pleasure. Thanks
for having me Justin.
So I wanted to ask you here today to
round on this question of how can we
ask good questions in medicine?
Partially because I know your longtime
history is really a master educator
here at Mayo Clinic,
very well liked by your trainees,
and certainly every time
we have an anesthesiologist
rotate through transfusion
medicine,
we're always blown away about the
high quality learners that you guys
are cultivating.
But I also just recently
saw you at a conference
where as many listeners might
know as junior faculty or
faculty get asked to
moderate at conferences,
usually one of the expectations
is that you've got kind of a
question or two ready to go
to ask presenters. And I,
again,
was really just very blown away
to see how artfully you kind of
pulled a lot more of the marrow
out of a presentation with your
questions. So with that background,
that's what I asked you here today,
and I just wanted our audience
to know why we're talking to you
today.
But maybe for that we can launch
in with why is it important for
healthcare professionals
to develop this skill
of asking questions?
Yeah. Well, first of all,
thanks for those kind comments.
I enjoyed having you in our
conference and we can get into some of
the, I think the asking a question
really,
the type of question you're going to ask
is going to be different based on the
setting you're in. And when
I think about healthcare,
particularly academic healthcare,
we're thrown into so many settings
where you have to be a good
questioner. And it is obviously
important for patient care.
It's obviously important for education.
When you think about learners,
they learn in different ways.
But if you can get them to discover
that knowledge on their own through
questioning that you're asking,
rather than just conveying
information to them,
transferring information to them,
it's going to stick with them
for a much longer period of time.
And I also think it's important
for open-end a dialogue,
having conversation, learning together,
being vulnerable together
in the learning environment.
So I think it's an important topic
and one I haven't given a whole lot of
thought to until you asked
me to come on this podcast.
So it's really, I'm kind of
learning from it as well.
Well, I think it's a hat
tip that you're a natural.
I don't know.
So you're pointing out setting and just,
I love your pointing out that there's
different settings that physicians
and healthcare professionals might find
themselves at the patient's bedside
as an educator. And the last one you
were talking about is conversations,
which am I hearing you is
maybe those conversations
are like if you and I grab
a coffee together and being
that kind of ideal of a continuous
learner or what's the phrase,
master adaptive learner?
Is that what you're talking about?
Yeah, I think so. And when
I'm thinking about it,
I'm thinking about me in the clinical
environment, one-on-one with a trainee,
and I may have a principal
that I want to teach
them, and it's really easy for
me to tell them this principle.
And now I've done my work and it's great,
and I've done intraoperative teaching
and we're all happy and they go home and
then they forget it the next day. Versus
if I've got this principle in mind,
I then can back it up a few
steps, start with questioning,
and now they're discovering
what that answer is.
So that's one setting where I think
questioning is really important, and I
probably have developed that over years.
I'm also, I don't know
if you know this Justin,
but I'm a board examiner for our
board, and that's a different setting.
You're probing for
knowledge in that setting,
but you're also trying to get depth of
answers. So we're much less interested
in what you might do or if this
is the correct drug or if
that's the correct drug,
more interested in why is that the right
answer or why is that the right drug.
So a lot of the questioning that I do
in an educational environment focuses on
the why or how are you or
what is the mechanism of that.
Otherwise,
it's just regurgitation of
facts and that's interpreted as
pimping, and it's probably what it is.
And there may be a
place for that at times.
But I think if you want to really
get depth of knowledge for a trainee,
you really get to the why
and the how and so on.
Let's pick on this a little bit.
I think this is a setting that probably
a lot of our listeners can relate to
whichever side they're on of the
person being asked or the person
asking the questions. Because regardless,
I think probably the skill of asking
is an important one to develop.
What are a few features that
kind of make for maybe a
higher quality question? I mean,
I don't want to go into good or bad,
but what's going to make for
a better question if we back
that.
Up? Yeah, again,
I think it does get to the environment
again, in the setting that you're in,
when I'm thinking about the
learning environment in particular,
I know where I'm going with my
questioning and it's going to be kind of
leading questions initially,
fairly open-ended questions,
and then getting more
specific as we go along.
So my bias in terms of what I
want to teach is within those
questions. And again,
I think it's more than
just factual knowledge,
it's really depth of understanding.
So if you can get to beyond the
pimping of regurgitating this
fact to me and get to the mechanism
or the why of what you're doing,
I think it's a much better question,
different settings. However,
as a past program director,
and even in my current role,
I do a lot of coaching
and advising of trainees.
That's a different kind of
questioning that you're conducting.
You may have your bias and your opinion
of the answer to whatever they're
asking you about, but if you're
really coaching them appropriately,
you're not giving that to them.
You're having them discover
what the answer really is.
So that's open-ended
questions that help them
discover that answer that they
already know what the answer is.
So again, it's a little bit different
questioning. And then if we get to
the large group setting, I think
it's a little bit different.
I've got some opinions
on that setting as well.
But I don't know if I answered
your question. I hope I did.
Yeah, maybe we'll come back to large.
What I'm curious to explore
you're about in these learning settings
about
being open-ended with
the questions and not
factual.
So I'm assuming these are a little bit
more long answer explaining my thought
process to you, that kind of thing.
And you maybe redirecting or pointing
out associations that I'm not seeing.
I imagine that takes a little
bit of time as I talk to
faculty. I mean,
time is one of those things that people
are quite critical of these days or,
and then I've even also heard
it on the learner side of,
geez, Dr. Roiter, you could
have done this a lot quicker,
but again, I asked you to record this
podcast today because I think that
you pull this off in a
way that your learners are
very enthused.
And also you've developed a faculty
that similarly are very good about
taking learners through
these thoughtful questions.
Do you have any advice for listeners
who might kind of say, yeah,
it sounds nice, but geez, it takes time.
Yeah, I don't think it
actually takes a lot of time.
It sounds like it takes a lot of time, but
in our field, in anesthesia,
we're not standing in the operating
room teaching for an hour.
Our surgeons would get very irritated
with us if we were doing that for one
thing. But we also, we want our trainees,
our residents really paying
attention to the patient.
We can't distract ourselves
from the patient for that long.
So the intraoperative teaching that
I'm talking about where you're walking
through a pathway to get to a
learning point, it doesn't take long.
I will tell you though,
it takes quite a bit of
experience and practice in
refining those skills. If you would
ask me to do that 20 years ago,
no way. I don't have
the skillset to do that.
And I'll tell you,
one of the challenges is that it's
less about the time and it's more
about the unpredictability of it.
Because if
you just tell somebody this
thought process or this
theory or whatever, it's very
predictable. You know what?
You want to teach them the
content and you're done.
Versus if you back it up several
steps and you ask a question,
you don't know what they're going to say.
You may have no idea what
they're talking about.
It puts you in a vulnerable
position. They may think, well,
this guy doesn't even
know this content at all.
So you have to be vulnerable.
You have to be willing to not know the
answer to things and to learn together.
So I think that's the challenge
with the questioning approach to
education. It's a lot easier just to
say, here's what you need to know.
Here's the information and walk
away from it. So it takes practice.
And for our listeners, like you
say, the practice you've had,
the experience you've had
over the past 20 years,
what are some things to
highlight for listeners to maybe
in the coming days, weeks that they
might think about being deliberate,
both for educators,
for when they're questioning
their learners or for
colleagues as we're trying to
question each other, learn?
What's your thoughts on tips that people
can be a little bit more deliberate to
develop this skill of being able to have
a vulnerable questioning attitude?
One tip I give our residents often,
and this really comes from my
experience at our board exams
as I tell them to think about everything
that you're doing every day and
ask yourself why with it.
If you can answer the why with
everything that you're doing,
you're going to have depth of knowledge.
You're going to have better
understanding of what you're doing.
You're going to be able to sit for
any board exam and pass it easily.
But you're also going to be able to have
those conversations with colleagues and
peers that may justify
something that you're doing.
You may have a surgeon come to
you with a question about patient
comorbidity.
You have to be able to give them an
answer and then justify that answer.
So I think it's just a matter
of having a questioning
attitude. And if you can ask
those questions of yourself,
then you can ask them
of others as well. And
I also think it's important
questions in general,
because I think it shows somebody
that you care about them and you
care about what they think and
you care that they have some knowledge
and you want to get that knowledge from
them. So this one way
communication, passive learning,
I think we've done it
for many, many years.
I'm guilty of it just like everybody else,
but it's probably not the
best way to approach learning.
It's probably not the best way to
approach a dialogue with a patient.
Well,
I think you've given me a nice transition
maybe to the setting of when we're
focusing on our own learning,
when I'm there at your
conference learning,
how might I approach those
questions where I'm trying to
learn this new information,
I think I want to couch this and recognize
that there are some among us that
really like to learn, hear
about something new, digest,
reflect, think, and then
they can ask questions.
But I'm more focused on in the moment,
maybe while the iron's hot,
if I'm in a conference
learning some new information,
are there some thoughts that
you have on how I can in the
moment take advantage of having the
expert there at the podium and ask some
clarifying questions to help
solidify this new learning?
I can tell you my
approach to it. First off,
I think you have to be a really
careful listener, thoughtful listener.
And that probably gets,
I think you could say that about
the educational environment.
One-on-one with a trainee too. If you're
asking them a series of questions,
you need to think about what they've said.
You need to listen to 'em in
order to ask the next question.
But in a big group setting,
you have to be a listener,
try to identify where those gaps are.
What I do is I think
about the audience that is
there, and I think about, well,
if I'm sitting in the audience and
I know nothing about this topic,
what might somebody be questioning?
Where do they need clarity
on a particular issue?
And I think we've probably all
seen this where somebody gives a
presentation at a national
meeting or something,
and then there's a rush to the
microphone for somebody to ask the most
complex question you can imagine to
demonstrate how smart they are. And
they probably really are that smart.
And I apologize to those
that are super smart,
but I think sometimes that shuts
down the conversation a little bit.
Who wants to follow that
guy with that question?
I don't want to ask my simple question.
What might be that simple question is
on the minds of 90% of our audience.
So I try to keep it pretty simple in that
setting. And again, I'm trying to
open up a dialogue with people.
I'm trying to ask the questions
that may be on other people's minds,
and they may be really simple.
And as we've all heard many times,
there is no dumb question,
but some people are afraid to ask what
appears to be a simple question in front
of a large group like that. So I
don't think it has to be complicated,
and it doesn't have to be. Well,
the question should not be
more complicated than the
answer. How about that?
I really like that.
I think you're hitting the nail on the
head as far as what resonates with my
experience. I think for a long time,
I would often sit on my hands when
I would be listening to something.
I don't have anything smart to ask.
Or like you're saying sometimes,
particularly in national
meetings, you just feel like, wow,
here's these amazing, insightful
questions. Who am I to stand up?
But I think that's like
we're saying, this is the,
and we see this too at
meetings where, okay,
maybe some questions get asked
or maybe no questions get asked,
but still there's a rush to the
speaker once the session is closed to
maybe more privately ask
my simpleton question.
Thinking about your role in coaching,
and now I'm thinking about both learners,
junior faculty,
how do you coach them to
cultivate that a little bit more
self-efficacy of advocating
for their own learning in
these situations?
I think a lot of it is role modeling.
Nobody ever taught me
how to be an educator.
I don't have a master's
in education or anything.
I learned how to be an
anesthesiologist. So
in the way I approached it was I thought
about the great educators that taught
me, and I tried to gain
from them what I could.
I also thought about those who
were not great educators. I'm like,
I don't want to replicate that.
So I think a lot of what we do in
graduate medical education does come down
to role modeling.
Our trainees will pick up on this,
and then when they join our staff,
they're going to hopefully have a
similar approach or somewhat modified
something that works better for them,
but at least they've experienced
that kind of educational model.
I'd love to tell you that I
forget how many faculty we have,
maybe 180 faculty in our department.
I would love to tell you that all of them
are great educators and they're
questioning, but that's not the case.
But you have to have a core of them.
And we've worked on faculty
development through,
we have annual faculty
development opportunities,
mostly for those who have
just joined our staff.
So we try to get to 'em early
and give them some of these
skills.
And I know our current program
director and program leadership,
they work really hard on
developing this growth mindset
within our trainees
and within our faculty.
And I think we've probably all heard
what growth mindset versus a performance
oriented mindset. We want our
trainees asking questions,
being vulnerable. We want our
faculty doing the same thing.
So it takes a long time
to foster that kind of environment.
And I would say we're in the
infancy of that in our department.
I'd love to tell you, we were
all experts at it, but we're not.
It takes a lot of time and effort.
You're being honest and vulnerable,
and we certainly appreciate
that our audience does as well.
I want to transition back really quick
before we close out about the large group
setting.
I know a lot of us certainly
have some work in that area,
and you said you have some
strong thoughts on it. So.
Yeah, most of it is keeping
those questions simple.
I see very often,
and sometimes people come
up to a microphone or a
large group and they're not
asking a question, they're
making a comment. Well,
hopefully that comment is there
for others to gain knowledge,
and it frequently is,
but we've all seen the person that gets
up there just that they want to show how
much knowledge they have.
So I'm very mindful of that
when I'm in front of a group
like that. I'm not speaking
to show people how smart I am.
I'm trying to learn myself.
I'm trying to help others learn by
asking questions that maybe others
are thinking about, but they don't
want to get up to the microphone.
But it's kind what I've,
over the years kind of observed,
and I think I've learned from it. And
yeah, I'm not sure if that
answers that question, but.
Absolutely. And it's
helpful for me to hear too,
because I think about myself
and something that I've
relatively recently in the last couple
of years started getting involved with
our medical school and teaching,
which is in the preclinical
years is large group,
and being mindful of
which questions should be
answered in front of the group
and which questions should be.
That's an interesting question.
Let's follow up after class.
Right, right.
So maybe as a parting question for
this podcast for our listeners,
do you have any kind of parting
advice for medical educators
about asking their learners questions?
Yeah, I think getting comfortable,
being uncomfortable because it is
uncomfortable with that unpredictability
that we already talked about. And
just get in there and be bold.
I think you have to do it.
You have to be willing to admit
when you don't know something,
that vulnerability, I think our
learners appreciate that too.
And you can learn together. There's
many ways to handle that. Well,
that's an interesting response.
I don't know the answer to that.
Let's explore that further.
So there's many ways that you can navigate
that unpredictability,
but I think you just have to get in
there and be bold and practice it a lot.
We've been rounding with Dr. Timothy
Long about the art of asking questions.
Thanks for taking the time
to talk about this with us.
Well, it was my pleasure.
Thanks for having me, Justin.
And to all of our listeners,
thank you for joining us today.
We invite you to share your thoughts
and suggestions via email to MCL
education@mayo.edu. If
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We encourage you to continue to connect
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