The Art of Asking Questions

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 [email protected]. If you've enjoyed this podcast, please subscribe until our next rounds together. We encourage you to continue to connect lab medicine and the clinical practice through educational conversations.