Case Based Teaching

Facilitating Case Discussion: Importance of questions and non-question techniques

The goals for the teacher in facilitating case discussion are to: maximize student to student interaction; participate as an equal member of the group; and encourage students to teach each other. Time and time again, we have observed two facts about case discussion—Questions keep the discussion going. Answers interrupt it. The teacher’s role is to facilitate and not lead the discussion.

The minute teachers start answering their own questions, the group is no longer participant focused and the session inadvertently reverts to a didactic session. The facilitator needs to be comfortable with the fact that the participants may leave with more questions than answers. In most of our cases, the “dilemmas” posed have no single best solution. That fact can lead to a very disquieting feeling among the learners and facilitators, especially if they
are used to “traditional” teaching sessions in which solutions are often given.

While each of our cases has suggested “guiding questions” provided for the facilitator, becoming familiar with them and how you anticipate their use is the most important part of preparing for the teaching session. Ask yourself why this question was suggested? Is its purpose to promote: knowledge? comprehension? application? analysis? synthesis? evaluation? Consider the various ways to phrase questions and how you will specifically use them. Reflect on what has and has not worked well for you in the past.

Remember there are limitless ways to pose various types of questions. Open questions promote learner-centered discussion (e.g., What are the major issues involved in this case?). Closed questions promote teacher-centered discussion (e.g., What is the most important diagnostic finding in this case?). Abstract questions allow for a change in
the direction of the discussion (e.g., How does this impact the patient’s life?). Challenge questions will make the discussion more specific (e.g., Why would that information help you?).

Asking well-prepared questions shifts the focus from you as teacher, to the participants as learners. Well-prepared questions will sharpen critical thinking. They can also model development of further questions to be asked and answered by the individual participant on their own time after the conference. Be prepared to let the conversation go in unplanned directions, but balance this with intervening to help the participants return to the main topic and achieve the group’s learning agenda and desired goals.

Discussion is enhanced when you ask single questions and wait for answers. Here are some questions that you might try.

What’s going on? (Diagnosis)
What would you do in this situation? (Action)
How many? What happened? (Information)
How do we know that? (Challenge)
How is that related to the case? (Extension)
What is most important? (Priority)
What will happen next? (Prediction)
Can you think of other situations that may apply? (Generalization)

Boston Children's Hospital © 2013