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The Art of Asking QuestionsACPE AcademyApril 20, 2016
Martin G. MontonyeVA NY Harbor HealthCare System
New York, [email protected]
1 4/21/2016
Well, how did I get here?
How do I work this?
Where is that large automobile?
What is that beautiful house?
Where does that highway lead to?
Am I right, am I wrong?
My God, what have I done?”
“Once in a Lifetime” Talking Heads (1981)
“You may ask yourself…
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What did I have for breakfast this morning?
Do you think you will have any (more) children?
What is the most horrible thing you have ever eaten?
How much money do you have in your pocket?
What is your most important possession?
Questions We May Answer
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Why is there something rather than nothing?
Is our universe real?
Do we have free will?
Does God exist?
Is there life after death?
Can you really experience anything objectively?
What is the best moral system?
Questions We’ll Never Solve
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The competencies of ACPE-CPE include not only cognitive & behavioral outcomes but also outcomes related to personal-social formation. These “affective” learning areas are often difficult to define and develop. Understanding affective learning related specifically to the aims of ACPE-CPE can help professional educators design, teach and ask questions in these areas of the curriculum more intentionally. Moreover, students may find their personal-social formation less mystifying.
Purpose
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Level I: Articulate, Identify, Initiate, Risk, Recognize, Demonstrate, Use, Formulate
Level II: Articulate, Provide, Demonstrate, Assess, Manage, Establish
SES: Maintains, Demonstrates, Forms, Refines, Ability, Articulates, Assess, Supervises, Defines, Assists, Uses, Facilitates, Enables, Manages, Develops, Uses, Works, Understands, Advocates, Considers, Integrates
ACPE Outcomes
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To examine the methods of Mary Elizabeth Mullino Moore and propose a methodology for ACPE-CPE
To summarize the influence of Socratic questioning in clinical practice and compare it to Bloom’s Cognitive Domain
To review Martin and Reigeluth’s conceptual model for Affective Development as teaching guideline
Overview
9 4/21/2016
To apply Krathwohl’s Affective Domain as a model for ACPE-CPE assessment
To critique CPE verbatim and interview questions
Use a methodology based on Moores’s model to create affective developmental and assessment questions
To provide an example of designing/introducing an ACPE-CPE class using an affective developmental design.
Overview
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What informs your use of questions?
What types of questions do you generally ask?
How do you determine which type of question to ask?
Do you have a personal-social developmental objective in mind when you ask a question?
What questions are you asking yourself as you assess student development?
Musings for Artists
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Affective learning is demonstrated by behaviors indicating attitudes of awareness of feelings and emotions, interest, attention, concern and responsibility, ability to listen and respond in interactions with others, and ability to demonstrate those attitudinal characteristics or values which are appropriate to what the workplace is looking for.
Affective Learning
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Relevant, answerable and practical
Thinking and reflecting are not driven by answers but by questions
Questions delineate issues, define tasks and express problems/opportunities
Our questions need to generate questions in our students
Thinking/reflecting needs to go somewhere… questions we ask influence where thinking/feeling and reflecting goes…
Designing Effective Questions
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Why did you pick this patient?
Could you give a description of her?
What would you like us to help you with?
What were you thinking?
What are you feeling?
Please define anxiety.
Is there a reason why you shifted here?
Tell us about your sister…
Example: Verbatim Questions
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“How can I deepen the dialogue and promote learning?”
“What would happen if I did something unsuspected right now?”
“How much can I challenge him on that point?”
“How might s/he react if I mention her/his clinched fist?”
“How can I use what just happened to an educational advantage?”
“I wonder if this…will work?”
ACPE-CPE Educator Unspoken Musings
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ACPE Objectives and Outcomes
Learning Goals of Students
Individual Supervisor’s Theory of Supervision
ACPE-CPE Activities: Case Study/Verbatim, Didactic/Discussion, IPR, Role Play, IS, Visitation, Care Conferences
???
What Informs the Questions We Ask Our Students?
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Moore, M. E. (1998). Teaching from the heart: Theology and Educational Method. A&C Black.
Methods: Case Study, Phenomenological, Gestalt, Narrative, and Conscientization
Methodology
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Educational Methods and ACPE-CPE Areas of Learning
Educational Methods
Phenomenological
Narrative
Conscientization
Case Study
Gestalt
ACPE-CPE Focus of Learning Examples (pre-2005)
Self-Awareness
Interpersonal Awareness
Conceptual Awareness
Pastoral Functioning
Ministry Dev. & Manage
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Case Study
Method
To see more in the particular
Reaching into the particular and drawing out multiple insights
Connects theory and practice
Questions
What is going on here? What assumptions are you
bringing to this? How did your experience
influence the way you engaged this patient?
What conclusions might you make about this patient’s theology?
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Gestalt
Method
Focus on the way students organize a variety of elements into a whole
Reaching out to many facts and ideas and drawing out their unity
Experiencing many parts of knowledge and seeking unity
Questions
What is the most important aspect of this experience?
Are there any patterns here? Unifying themes?
What insights do not fit with those identified?
What is revealed about God’s actions?
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Phenomenology
Method
Helping students to reach inside themselves and others to observe experience and draw meanings from within
Connections between empirical reality and internal meanings
Study of living human documents
Questions
What experience would you like to talk about? Describe your inner/other’s experience.
How is this experience related to past experiences, interpersonal dynamics, cultural values?
What does this experience mean to you?
What sacred reality is in this experience?
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Narrative
Method
Connects people with experiences of others through their stories
Connections across boundaries of space and time
Nonlinear, indirect, emphasis on use of imagination
Questions
Please share a story…where do you see yourself living in this story?
What does this story say about you as a person? Others?
Can other’s relate to this story? Can you relate to their story?
Pondering this now, what do you want to do next?
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Conscientization
Method
Seeks influence of social structures and the ways by which people become conscious of those structures
Critical reflection on situation and participation in transformation
Co-operative problem-solving
Questions
Can you name the world as you experience it? What aspects are visible and might be invisible?
What does each of the many perspectives reveal about the structure?
How might we sufficiently define this complex problem?
What are the possible strategies of action?23 4/21/2016
1956 Benjamin Bloom led a task force that identified three domains of educational activity:
Cognitive (mental development & skills)
Affective (emotional development, attitude, beliefs & values, feeling awareness, empathy, interpersonal communication & self-awareness)
Psychomotor (physical development & skills, perception, sensory-kinesthetic awareness)
The Classification of Educational Goals: Handbook. Cognitive Domain; by a Committee of College and University Examiners; Edited by Benjamin S. Bloom and Max D. Engelhart...[et Al.]. McKay, 1956.
Instructional Design
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Knowledge (simple recall)
Comprehension (familiar with meaning/can make use)
Application (applying abstraction to a new example)
Analysis (break idea into constituent parts)
Synthesis (creation from existing elements or principles)
Evaluation(formation and substantiation of a judgment)
Bloom’s Cognitive Domain Taxonomy
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Discrepancy concerning various aspects of method
Discord in literature of components
“…the teacher should by patient questioning bring the pupil to recognize some true conclusion, without the teacher’s telling the pupil that the conclusion is true.”
Carey, T. A., & Mullan, R. J. (2004). What is Socratic questioning? Psychotherapy: theory, research, practice, training, 41(3), 217.
What is Socratic Questioning?
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Systematic questioning Inductive reasoningUniversal definitionsDisavowal of knowledge
Question Format: Memory, translation, interpretation, application, analysis, synthesis, and evaluation
Overholser, J. C. (1993). Elements of the Socratic method: I. Systematic questioning. Psychotherapy: Theory, Research, Practice, Training, 30(1), 67.
Elements of Socratic Method
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Classic: To dismantle and discard preexisting ideas
Modern: Known, expected, and verifiable answers
Socratic and Scientific Methods:
1. Ask a question
2. Form a hypothesis
3. Test a hypothesis
4. Accept/reject according to testing
Introduction to the Socratic Method and its Effect on Critical Thinking by Max Maxwell.
Classic & Modern Socratic Methods
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Gathering data
Looking at this data in different ways with the student
Inviting the student to devise his/her own plans for what to do with the information examined, there is discovery going on.
Padesky, C. A. (1993, September). Socratic questioning: Changing minds or guiding discovery. In A keynote address delivered at the European Congress of Behavioural and Cognitive Therapies, London (Vol. 24).
Changing Minds or Guiding Discovery?
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a. The student has the knowledge to answer
b. Draw the student’s attention to information which is relevant to the issue being discussed but which may be outside the student’s current focus
c. Generally move from the concrete the more abstract so that
d. The student can, in the end, apply the new information to either reevaluate a previous conclusion or construct a new idea.
Padesky (1993)
Socratic Questioning & Discovery
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Modern Socratic & Scientific Questioning
Blooms (New) Taxonomy1. Knowledge (Remembering)
2. Comprehension (Understanding)
3. Application (Applying)
4. Analysis (Analyzing)
5. Synthesis (Evaluating)
6. Evaluation (Creating)
Socratic Questioning 1. Clarification
2. Probe assumptions
3. Probe reasons & evidence
4. Viewpoint & perspectives
5. Implications & consequences
6. Questions about the question
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Anderson, L. W., Krathwohl, D. R., & Bloom, B. S. (2001). A taxonomy for learning, teaching, and assessing: A revision of Bloom's taxonomy of educational objectives. Allyn & Bacon.
Tell me about your patient’s condition, problems or needs
What is the most important patient or family problem? Why?
What do you mean when you say ___?
Give me an example of ___.
How does this new information relate to our earlier discussion of the patient’s/family care?
Oermann, M. H. (1997). Evaluating Critical Thinking in Clinical Practice. Nurse Educator (Vol. 22, pp. 25-28).
Clarification Questions
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You seem to be assuming that your patient’s responses are due to ____. Tell me more about your thinking here.
What assumptions have you made about___?
On what data do you base your decisions? Why?
Your decisions about this patient/family are based on your assumptions that ___. Is this always the case? Why or why not?
Questions to Probe Assumptions
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How do you know that___? What are other possible reasons for___?
Tell me why ___?
What would you do if ___? Why?
Is there a reason to question this information? Decision? Approach? Why?
Questions to Probe Reasons
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What are other possibilities? Alternatives?
How might this patient/family view this situation? Does anyone on the team view this differently? Why?
Tell me about the different interventions that might be possible and why each one would be appropriate.
What are other ways of approaching the patient, family, staff?
Questions on Differing Perspectives
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If this occurs, when what would you expect to happen next? Why?
What are the consequences of each of these possible approaches? What would you do in this situation and why?
What would be the effect of ___ on the patient, family, staff, community?
If this is true, then what?
Questions on Consequences
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1. Briefly describe where you have come from, where you are
and where you are headed. (narrative method; knowledge and
clarification)
2. Define ministry. (conscientization method; comprehension
and assumptions)
3. Please share the major growing edges you would like to
work on. (gestalt method; application and reason)
Examples: Cognitive Interview Questions for Prospective Students asked:
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4. Please describe your strengths and weaknesses.
(phenomenological method; application and reason)
5. How do you deal with conflict in this situation? (case study
method; analysis and viewpoint)
6. How do you think the interview went? (gestalt method;
analysis and viewpoint)
Examples: Cognitive Interview Questions of Prospective Students
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What do you mean when you say…?
Has something happened to lead you to this conclusion or have you felt this way for a long time?
So this is a change in your thinking?
How did you think about this in the past?
Why is trying not enough?
Is that what others say of you?
What things would you do differently?
How could you find that out?
Cognitive Discovery Questions
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1. Emotional Development2. Moral Development3. Social Development4. Spiritual Development5. Aesthetic Development6. Motivational Development
Martin, Barbara L. & Reigeluth, Charles M. (1999) Affective Education and the Affective Domain: Implications for Instructional-Design Theories and Models. Instructional –Design Theories and Models: A New Paradigm of Instructional Theory. Charles M. Reigeluth, ed. Pp. 485-509. Mahwah, NJ: Lawrence Erlbaum Associates, Publishers.
A Conceptual Model for Affective Development
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Emotional Development:
Understanding your own and others’ feelings and affective evaluations, learning to manage those feelings, and wanting to do so.
Moral Development:
Building codes of behavior and rationales for following them, including developing prosocial attitudes, often in relation to caring, justice, equality, etc.
Affective Development
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Social Development:
Building skills and attitudes for initiating & establishing interactions and maintaining relationships with others, including peers, family, coworkers, & those different from ourselves.
Spiritual Development:
Cultivating an awareness and appreciation of one’s soul and it’s connection with other’s souls, with God, and with all of Creation.
Affective Development
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Aesthetic Development:
Acquiring an appreciation for beauty and style, including the ability to recognize and create it; commonly linked to art and music, but also includes aesthetics of ideas.
Motivational Development:
Cultivating interests and the desire to cultivate interests, based on the joy or utility they provide, including both vocational and avocational pursuits.
Affective Development
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Please share the various emotions elicited by this case/exchange/relationship(s).
Which elements trigger your response? Can you evaluate their impact on you?
What emotional responses do you imagine others may be having?
Are you having any conflicting emotional responses?
(phenomenological/conscientizing methods)
Emotional Developmental Affective Questions
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How do you sort out these conflicts in light of your beliefs and faith?
What does this experience mean to you?
In which areas is your emotional awareness growing and where does it need more attention?
(phenomenological/conscientizing methods)
Emotional Developmental Affective Questions
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In this story (experience) what moral values do you believe are informing your decisions/actions?
Say more about where you see yourself in this drama and how you understand your personal responsibility.
Please explore some of the effects your actions may have on others.
(narrative/conscientizing methods)
Moral Developmental Affective Questions
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How do you understand the ways your moral values reflect your religious values generally, and do you always act in ways that are consistent with those values?
Say more about your awareness growing in understanding the role of culture, caring, justice and equality and how/where are applying these new insights.
(narrative/conscientizing methods)
Moral Developmental Affective Questions
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What were you thinking/feeling/doing/wishing/imagining during those few minutes as you were telling/listening to that story?
As a result of working together with your peers/staff/patients/supervisor, how are you addressing difficulties directly/feelings as they arise, and how are you creatively working toward solutions?
(narrative methodology)
Social Developmental Affective Questions
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Where are you growing in your awareness of group dynamics, interpersonal communication ?
What meaning(s) are you drawing out of the experience of the last few minutes?
If and how has your story changed/transformed by hearing this story?
Reflecting on all of this now, what do you expect to do next?
(narrative methodology)
Social Developmental Affective Questions
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How is your awareness increasing of God’s presence and actions in your life and in the lives of others?
How do you believe you demonstrate this growing awareness?
What themes or patterns are emerging for you in this experience? Are there any relationships to historical, interpersonal dynamics and cultural values?
(phenomenological method)
Spiritual Developmental Affective Questions
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How is your concept of God, meaning, and life experience changing in light of your patient experiences?
How is getting in touch with your inner life influencing your spiritual life?
(phenomenological method)
Spiritual Developmental Affective Questions
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Where do you see yourself living in this story/experience?
As you grow in awareness of your experience, how are you growing in your understanding of the relationship between your (and others) values and judgments?
What is ministry/chaplaincy/pastoral care?
(narratative/conscientization methods)
Aesthetic Developmental Affective Questions
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How do you know whether or not you are effective?
To whom is what you have learned valuable?
What is the essential knowledge for ministry/chaplaincy/pastoral care?
How is this knowledge constructed? How is it challenged and updated?
(narratative/conscientization methods)
Aesthetic Developmental Affective Questions
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What is your experience? How do you understand what you see?
How/what are you doing? How/what do you feel?
What do you want? How/what do you avoid?
What do you expect?
(gestalt method)
Motivational Affective Developmental Questions
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What is the most important aspect of your learning/small group process/community life?
How are you growing in your understanding of what motivates you ?
What is sustaining you (joy, accomplishment, enthusiasm, etc.)?
(gestalt method)
Motivational Affective Developmental Questions
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1. Receiving
2. Responding
3. Organization
4. Valuing
5. Characterization by a value set/internalizing
Krathwohl, D. R., Bloom, B. S., & Masia, B. B. (1964). II: handbook II: affective domain. David McKay, New York.
Krathwohl’s Affective Domain for
Developmental Assessment
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How open is s/he to this experience? (receiving)
How much is s/he engaged? (responding)
How is s/he managing oneself? (organizing)
What values is s/he cultivating? (valuing)
How is s/he developing oneself? (internalizing)
Assessment Questions in the mind of the of ACPE-CPE Educator
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Affective Assessment
Receiving
Exploring self
Exploring surroundings
Experiencing
Emotions
Responding
Emoting
Addressing life’s
challenges
Leveraging life’s
successes
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Affective Assessment
Organizing
Regulating self
Managing performance
Managing emotions
Valuing
Valuing self
Valuing nature, diversity
Refining personal values
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Affective Assessment
Internalizing
Synergizing feelings
Facilitating personal
development
Challenging self
Committing beyond self
Competency Levels
5. Transformative Use
4. Self-Reflective Use
3. Consistent Performance
2. Conscious Use
1. Non-Conscious Use
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1. Please share the material, ideas, phenomena you are aware of
from this presentation and/or experience. (case study method:
receiving)
2. Can you actively engage the material, ideas, phenomena just
discussed? (phenomenological method; responding)
Examples: Affective Assessment Questions
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3. Please discuss and examine what each of these perspectives
reveal, support, assume about the system or structure and how
might you act? (conscientization method; organizing)
4. Say more about what you perceive and believe this material,
phenomena, illustration or story to be about. What does it say
about you? Others? (narrative method; valuing)
Examples: Affective Assessment Questions
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5. Please take a moment and help us understand how you put all these pieces together. Are there any themes and patterns? If so, please explore how they might play an influence (or be required, or resist change, or may need to be revised, or might help resolve). (gestalt method; internalizing)
Examples: Affective Assessment Questions
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Overview of ACPE Objectives and Outcomes
Individual Theory of Supervision
ACPE-CPE Activities: Case Study/Verbatim, Didactic/Discussion, IPR, Role Play, IS, Visitation, Care Conferences
Individual Learning Goals
Reflective practice
Clinical Assignment
Example of Designing a Class: Affective Developmental Process
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Increasing awareness of self, others, divine
Articulate emotions, reflect on impact, responses
Express feelings, directly address difficulties in self and with others, be creative in finding solutions
Clear understanding of the ways values reflect beliefs and actions; appreciate effects on self and others and take ownership
Appreciate accomplishment and enthusiasm for continuing education and development.
Example of Designing a Class: Affective Development Process
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1. Emotional Development
2. Moral Development
3. Social Development
4. Spiritual Development
5. Aesthetic Development
6. Motivational Development
Dimensions of Development
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Developmental Learning & Educational Methods
Developmental Learning
Emotional & Spiritual
Social
Aesthetic
Moral
Motivational
Educational Methods
Phenomenological
Narrative
Conscientization
Case Study
Gestalt
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How open are you to this experience? (receiving)
How much are you engaged? (responding)
How do you manage yourself? (organizing)
What values are you cultivating? (valuing)
How are you developing yourself? (internalizing)
Developmental Assessment
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Learning environment: Reduced resistance, increased empowerment
Use of methods and sequencing of questions reduces deer-in-the-headlight effect
Increased use of developmental questions
Overall developmental/assessment framework enhances critical reflectivity and practice.
Takeaways
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ACPE Standards & Manuals (2016). http://www.manula.com/manuals/acpe/acpe-manuals/2016/en/topic/cover-page
Anderson, L. W., Krathwohl, D. R., & Bloom, B. S. (2001). A taxonomy for learning, teaching, and assessing: A revision of Bloom's taxonomy of educational objectives. Allyn & Bacon.
Beane, J. A. (1986). The continuing controversy over affective education. Educational Leadership, 43(4), 26-31.
Carey, T. A., & Mullan, R. J. (2004). What is Socratic questioning?. Psychotherapy: theory, research, practice, training, 41(3), 217.
The Classification of Educational Goals: Handbook. Cognitive Domain; by a Committee of College and University Examiners; Edited by Benjamin S. Bloom and Max D. Engelhart...[et Al.]. McKay, 1956.
Resources
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Education, A., & Mean, W. D. I. (2013). Affective education and the affective domain: Implications for instructional-design theories and models. Instructional-design theories and models: A new paradigm of instructional theory, 2(1992), 485.
French, H. W., & Rankin, M. (1999). Zen and the Art of Anything. Univ. of South Carolina Press.
Graham, S. (2003). Instructional design for affective learning in theological education. British Journal of Theological Education, 14(1), 58-77.
Oermann, M. H. (1997). Evaluating critical thinking in clinical practice. Nurse Educator, 22(5), 25-28.
Krathwohl, D. R., Bloom, B. S., & Masia, B. B. (1964). II: handbook II: affective domain. David McKay, New York.
Resources
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Mezirow, J. (1981). A critical theory of adult learning and education. Adult Education Quarterly, 32(1), 3-24.
Moore, M. E. (1998). Teaching from the heart: Theology and Educational Method. A&C Black.
Overholser, J. C. (1993). Elements of the Socratic method: I. Systematic questioning. Psychotherapy: Theory, Research, Practice, Training, 30(1), 67.
Padesky, C. A. (1993, September). Socratic questioning: Changing minds or guiding discovery. In A keynote address delivered at the European Congress of Behavioural and Cognitive Therapies, London (Vol. 24).
Paul, R. W., & Elder, L. (2000). Critical thinking handbook: Basic theory and instructional structures. Retrieved November, 3, 2005.
Resources
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Taylor, L. D. (2014). The Affective Domain in Nursing Education: Educators' Perspectives.
Maxwell, M. (2009). Introduction to the Socratic Method and its effect on critical thinking. http://www.socraticmethod.net
Van Tassell, F. S. (2009). Affective teacher education: Exploring connections among knowledge, skills, and dispositions. P. R. LeBlanc, & N. P. Gallavan (Eds.). R&L Education.
Resources
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