off record
Shaukat Ali Jawaid

Teaching effectively
does not mean asking

difficult questions

Medical Education has now emerged as a new important discipline and new developments in information technology has almost revolutionized the way it used to be practiced in the past. The recent Covid19 Pandemic forced the medical educationists and medical institutions to accelerate adopting the newer teaching modalities and we saw tremendous progress in e Learning, Online teaching which though cannot replace the Face to Face learning which remains the Gold Standard, but in circumstances of long lockdowns, it proved to be an extremely useful alternative.

Despite all this, the traditional practices of teaching have not completely died down. In the past Ward Rounds and Bedside Teaching was given too much importance and it was accepted as the most important teaching modality when the teachers would discuss in detail the case scenario with medical students and residents in training. However, some of the teachers would ask students and residents in training questions in a way which would depict them as much more learned intellectually dominating. This not only leads to lot of stress among trainees but also induces shame and humiliation. The teachers must realize that teaching effectively does not mean asking difficult questions. It is perhaps due to these reasons that the need was felt to formally train the teachers in teaching and training skills. Now Certificate in Medical Teaching has become almost mandatory for all the faculty members and numerous medical universities, medical colleges have started training their faculty. Over half a dozen medical universities in Pakistan have now also started Masters in Health Professional Education (MHPE) which it is hoped will have a positive impact on medical education and how the students and trainees are taught and trained in medical institutions.

Grilling the students, residents, teaching by intimidation, and toxic quizzing should be avoided. It is important that teaching should stimulate critical thinking among the students and trainees. On the other hand, asking difficult questions proves to be vindictive, demoralizing for the students. It also provokes anxiety and defeats the very purpose of teaching and training. Studies have reported that faced with such a situation, some learners regret their decision to adopt medicine as a choice for their careers.1

Late Lt. Gen. Mahmudul Hassan an eminent surgeon of Pakistan Army used to say that a teacher must have some interest in poetry as well and during the lecture they should supplement it with couplets from related poetry to convey the message effectively. It makes teaching and learning enjoyable both for the students and the teachers. In a friendly environment, the students can concentrate on what is being taught. The knowledge gaps identified during the teaching should be used to emphasize that these are opportunities for learning which the student should not hide. Remember, to accept one’s ignorance is the first step towards learning. While discussing management of the patients, the teachers should encourage the students and trainees to explain what is happening and how they think the patient can be managed better. Incorrect answers to the questions asked will provide an opportunity to stimulate critical thinking. Everyone must realize that there is no harm to say “I do not Know” if one does not know the correct answer. In fact such practices should be encouraged when they are found true. Benjamin Kinnear and colleagues had discussed all these and other related issues in detail which is worth reading and offer answer to numerous such questions.2


  1. Barrett J. Scott KM. Acknowledging medical students reports of intimidation and humiliation by their teachers in hospitals. J Paed Child Health; 2018;54(1):69-73
  2. Kinnear B, DeCoursey B, Caya T, Baez J, Warm EJ. Things We Do For No Reason: Toxic quizzing in medical education. J Hosp Med 2022:1-4. DOI: 10.1002/jhm.12846
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