Asking the Right Question, of the Right Person, at the Right Time

1. Asking the Right Question, of the Right Person, at the Right Time James Honan, Ed.D. Senior Lecturer, Harvard Graduate School of Education Helen M. Shields, M.D. Professor of Medicine, Harvard Medical School Brigham and Women’s Hospital Division of Medical Communications and Division of Gastroenterology, Hepatology and Endoscopy Department of Medicine

2. Making Walk Rounds Fun and High Yield • Prepare ahead • Be organized • Demonstrate terrific communication skills • Be warm and approachable; Smile and shake hands with each patient • Choose a patient who will provide an excellent learning experience • Execute your plan smoothly

3. Learning to Use a Variety of Questions through the Case MethodJames Honan, Ed.D.

4. Different Types of QuestionsDr. James Honan Open Ended Questions: • What’s Going On? What do you (Mr. / Ms. Student) make of this situation? Casting question nets out to see what comes in. Listening for entry and emphasis points. Diagnostic Questions: • How do you interpret and explain ‘A” and “B’s” impact on the situation? • How do you weave these points into some kind of understanding of what else is going on, possibly behind the scenes? Asking for Information: • Where…When…Who…What? Facts and opinions.

5. Different Types of QuestionsDr. James Honan Challenge Questions: • Why do you say that? How would you explain? Where is the evidence for what you say? How can you say a thing like that? Is that all? That’s just the opposite of what Student X said. Can you persuade him/her? Extension Questions: • Exploring the issues. What else? Can you take us further down the path of find new tributaries? Keep going…. therefore? Combination Questions: • How would you relate your points to those mentioned by Student A or to something else you said? Priority Questions: • Which issues do you consider most important? Where do you start? How would you rank these?

6. Different Types of QuestionsDr. James Honan Action Questions: • What would you do in Person X’s shoes? How? And How (again) would you do that? (Keep asking HOW). Prediction Questions: • What do you think would happen if we followed Student Z’s action plan? Give us a forecast of your expectations. How will he/she react to your thinking? Generalizing and Summarizing Questions? • What inference can we make from this discussion and case? What generalizations would you make? How would you summarize the three most critical issues that we have discussed? Can you summarize the high points of the discussion thus far?

7. Five Ways to Make a High Yield Point on Walk Rounds • Vote or Poll Team Members • Ask team to “Buddy Up” to create their own questions about a topic/visual/x-ray/pathology • Quiz using a self-assessment “scratch ticket” • Highlight a question on the outside of a folder with answer inside as schematic/algorithm • Demonstrate a history or physical finding at the bedside with great enthusiasm

8. What are these physical findings associated with? Scleral icterus Spider angiomata Ascites Palmar erythema Gynecomastia Courtesy of Suma Magge, MD

9. What is this? Edythe A. Albano, M.D., and Julie Kanter, M.D. N Engl J Med 2005; 352:1913 Helen M. Shields, MD, FACS

10. What is the CT appearance of a Sister Mary Joseph Nodule? Edythe A. Albano, M.D., and Julie Kanter, M.D. N Engl J Med 2005; 352:1913 Helen M. Shields, MD, FACS

11. Where are readily available clinical pearls for Walk Rounds? Landsberg L. 2015 Wolters Kluwer, Philadelphia. Helen M. Shields, MD, FACS

12. Asking the Right Question, of the Right Person, at the Right Time • Ask questions; keep whole team engaged, including nurses and pharmacists • Use a variety of questions, including prediction, prioritizing, challenge and extension questions • Explain clearly each high-yield point • Demonstrate statesmanship at the bedside: these are the most memorable moments on rounds