Situation: While checking in the intra/extra oral exam you notice a lesion on the buccal mucosa. The student has not mentioned it to you and you have not looked at the intra/extra oral exam page yet. What question do you ask and why do you ask that question? What follow up questions might you ask? Remember to follow the principles introduced in the readings and discuss how your questions follow those principles.
Response: Before beginning to see patients in clinic, our students here are instructed on normal oral anatomy, common pathologies, and given some basic instructions on how to report and record something out of the ordinary in the patient’s mouth. I expect this information is taught in all pre-clinic courses. In our program we start seeing patients the last half of our junior year, but don’t take the pathology course until our first semester of senior year, where we really get into the nitty gritty of identifying lesions. It was said in HCT Ch. 5 and elsewhere in our coursework that it’s important to know where your student is at in their studies, in order to get a feel for what to expect out of them. I’d first ask the student if there was anything special about the intra/extra oral exam that they’d like to bring to my attention. If the student did indeed find the lesion but just forgot to mention it right away, this would give them the opportunity to tell me and would also remind them to bring up items of note without me having to discover them on my own. Like Ms. Henry said in the lecture, simply asking the student if they saw the lesion would lead to a yes/no response, leaving no opportunity for some better lead-in questions.
If the student did find the lesion, I’d ask them to tell me about it. Hopefully they would cover location, size, and appearance, since those are the very basic steps to take in this situation. If they couldn’t tell me about the lesion, I could remind them of the basic steps and have the student get back into the patient’s mouth so they can examine and describe it themselves. If I just told the student the lesion’s description, then the student wouldn’t get that practice, which they obviously need. This would also have the student go through the first three levels of Bloom’s Taxonomy-knowledge, comprehension, and application.
Next we’d talk about what the lesion could have been caused by. This would involve the next step up Bloom’s Taxonomy, analysis. I’d ask the student if they knew what the lesion was or was caused by. If they do, I’d ask them to explain their reasoning so I could see their thought process, and see if they asked the patient the appropriate follow-up questions. I could then ask them “Why do we want to know how long the lesion has been there?” or “Why do we care how big the lesion is?” to help them connect the facts to the reasoning behind the question. I could also then ask “Does this lesion cause concern?” and if it didn’t, I could then ask “What would raise some red flags?” to help the student think about those things and contrast them to the current situation. Starting with easy questions (describe the lesion) and moving up the chain to more difficult (why do we not need a path consult?) is a method of questioning called scaffolding, or laddering, that is a great method to use in these kinds of situations.
-HH
Great Questions! I agree with the scaffolding method of questioning. It allows for the instructor to truly gage a students understanding and knowledge of the lesion.
I like the scaffolding method as well, having one question lead to another. It allows the student to answer all the questions, without the instructor providing the answer!
`I love the way you presented the loading question. It is a difficult style to master because it is easy to throw in a yes or no question with it.This is a great method for the instructor to have a feel of what the student has been able to learn or knows.
I like how you made your questions increasingly at higher levels of understanding. You move from the more simple- describing- to the more complex- inferring a cause.