We read with great interest the recent article by Chapman et al. reporting the preferences of their residents for a computer-based and anonymous teaching tool over the traditional Socratic method for teaching and assessment. The authors deserve commendation for their commitment to student-centered learning and efforts to modify their teaching practice to address changes to the American Board of Radiology Core Examination. However, we wish to express support for the retention of the Socratic method in contemporary postgraduate radiology teaching.
The Socratic method derives from the work of Socrates , a 4th century BCE Greek philosopher. This method is a pedagogical method that involves the questioning of students with the intention of engaging them in analytical discussion and promoting critical thinking skills. It is a well-established method for the teaching of radiology via case-based “hot-seat” format small group sessions .
In the radiology setting, the Socratic method encourages residents to formulate a hypothesis based on image interpretation under the guidance of a teacher. This technique enables the teacher to elicit misconceptions, to provide real-time feedback, and to challenge the limits of each resident’s interpretative skills. This opportunity is lost with a computer-based answering system where residents’ interpretations are simply dichotomized as either correct or incorrect.
Chapman et al. report an overwhelming desire (94%) among their residents for anonymity in teaching sessions. Although we appreciate that the lack of anonymity for students of the Socratic method is a potential weakness, we contend that this provides a preparation for future practice as a radiologist when anonymity in reporting is not possible.
On their reflection on the learning needs of “Today’s Radiology Student,” Amann et al. identify “communication skills needed to express findings in the appropriate radiologic discourse and lexicon” as a core learning objective for radiology residents. The verbal exchange involved in the Socratic method is inherently well suited for the development of these communication skills, which are of particular relevance to the radiologist’s role in multidisciplinary meetings. These skills are de-emphasized in computer-based teaching tools, which typically involve selecting from a list of options or entering a one-word answer as illustrated in the examples provided by Chapman et al.
A source of negative perception of the Socratic method among radiology residents in general may stem from a prior experience of “pimping,” a practice that has recently provoked divisive debate in medical education communities . Kost and Chen define “pimping” as “questioning with the intent to shame or humiliate the learner to maintain the power hierarchy in medical education.” Pimping is a fundamental digression from Socratic principles, and as educators, we do not advocate its use in the teaching of radiology residents.
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References
1. Chapman T., Reid J.R., O’Conner E.E.: Anonymity and electronics: adapting preparation for radiology resident examination. Acad Radiol 2017;
2. Stoddard H.A., O’Dell D.V.: Would Socrates have actually used the “Socratic method” for clinical teaching?. J Gen Intern Med 2016; 31: pp. 1092-1096. 4 ed
3. Zou L., King A., Soman S., et. al.: Medical students’ preferences in radiology education a comparison between the Socratic and didactic methods utilizing PowerPoint features in radiology education. Acad Radiol 2011; 18: pp. 253-256.
4. Amann J., Kribs S., Hibbert K., et. al.: Today’s radiology student: what every radiology training program director needs to know.Radiology education: the scholarship of teaching and learning.2009.Springer Berlin HeidelbergBerlin, Heidelberg:
5. McCarthy C.P., McEvoy J.W.: Pimping in medical education: lacking evidence and under threat. JAMA 2015; 314: pp. 2347-2348.
6. Kost A., Chen F.M.: Socrates was not a pimp: changing the paradigm of questioning in medical education. Acad Med 2015; 90: pp. 20-24.