The Art of Asking Questions
ACPE Academy
April 20, 2016
Martin G. Montonye
VA NY Harbor HealthCare System
New York, NY
[email protected]
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“You may ask yourself…
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)
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Questions We May Answer
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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?
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Questions We’ll Never Solve
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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?
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Purpose
The competencies of ACPE-CPE include not only cognitive &
behavioral outcomes but also outcomes related to personalsocial 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.
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ACPE Outcomes
 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
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Overview
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
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Overview
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.
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Musings for Artists
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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?
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Affective Learning
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.
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Designing Effective Questions
 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…
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Example: Verbatim 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…
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ACPE-CPE Educator Unspoken
Musings
 “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?”
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What Informs the Questions We
Ask Our Students?
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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
 ???
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Methodology
Moore, M. E. (1998). Teaching from the heart: Theology
and Educational Method. A&C Black.
Methods: Case Study, Phenomenological, Gestalt,
Narrative, and Conscientization
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Educational Methods and ACPECPE Areas of Learning
Educational Methods
ACPE-CPE Focus of Learning
Examples (pre-2005)
Phenomenological
Self-Awareness
Narrative
Interpersonal Awareness
Conscientization
Conceptual Awareness
Case Study
Pastoral Functioning
Gestalt
Ministry Dev. & Manage
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Case Study
Method
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?
 To see more in the particular
 Reaching into the particular
and drawing out multiple
insights
 Connects theory and practice
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Gestalt
Method
Questions
 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
 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
Questions
 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
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 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
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experience?
Narrative
Method
Questions
 Connects people with
experiences of others through
their stories
 Connections across boundaries
of space and time
 Nonlinear, indirect, emphasis
on use of imagination
 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
Questions
 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
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 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
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strategies of action?
Instructional Design
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.
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Bloom’s Cognitive Domain Taxonomy
 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)
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What is Socratic Questioning?
 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),
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Elements of Socratic Method
 Systematic questioning
 Inductive reasoning
 Universal definitions
 Disavowal 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.
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Classic & Modern Socratic
Methods
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.
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Changing Minds or Guiding
Discovery?
 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.
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Padesky, C. A. (1993, September). Socratic questioning: Changing minds or guiding discovery. In A keynote
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address delivered at the European Congress of Behavioural
and Cognitive Therapies, London (Vol. 24).
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Socratic Questioning & Discovery
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)
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Modern Socratic & Scientific
Questioning
Blooms (New) Taxonomy
1.
2.
3.
4.
5.
6.
Socratic Questioning
Knowledge (Remembering)
Comprehension (Understanding)
Application (Applying)
Analysis (Analyzing)
Synthesis (Evaluating)
Evaluation (Creating)
1.
2.
3.
4.
5.
6.
Clarification
Probe assumptions
Probe reasons & evidence
Viewpoint & perspectives
Implications & consequences
Questions about the question
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.
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Clarification Questions
 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).
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Questions to Probe Assumptions
 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?
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Questions to Probe Reasons
 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?
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Questions on Differing Perspectives
 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?
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Questions on Consequences
 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?
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Examples: Cognitive Interview Questions for
Prospective Students asked:
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)
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Examples: Cognitive Interview Questions of
Prospective Students
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)
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Cognitive Discovery Questions
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?
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A Conceptual Model for Affective
Development
1. Emotional Development
2. Moral Development
3. Social Development
4. Spiritual Development
5. Aesthetic Development
6. 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.
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Affective Development
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.
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Affective Development
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.
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Affective Development
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.
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Emotional Developmental Affective
Questions
 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)
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Emotional Developmental Affective
Questions
 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)
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Moral Developmental Affective
Questions
 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)
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Moral Developmental Affective
Questions
 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)
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Social Developmental Affective
Questions
 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)
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Social Developmental Affective
Questions
 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)
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Spiritual Developmental Affective
Questions
 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)
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Spiritual Developmental Affective
Questions
 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)
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Aesthetic Developmental Affective
Questions
 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)
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Aesthetic Developmental Affective
Questions
 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)
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Motivational Affective Developmental
Questions
 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)
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Motivational Affective Developmental
Questions
 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)
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Krathwohl’s Affective Domain for
Developmental Assessment
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.
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Assessment Questions in the mind of the
of ACPE-CPE Educator
 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)
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Affective Assessment
 Receiving
 Responding
 Exploring self
 Emoting
 Exploring surroundings
 Addressing life’s
 Experiencing
challenges
 Leveraging life’s
 Emotions
successes
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Affective Assessment
 Organizing
 Valuing
 Regulating self
 Valuing self
 Managing performance
 Valuing nature, diversity
 Managing emotions
 Refining personal values
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Affective Assessment
 Internalizing
 Competency Levels
 Synergizing feelings
5. Transformative Use
 Facilitating personal
4. Self-Reflective Use
development
3. Consistent Performance
 Challenging self
2. Conscious Use
 Committing beyond self
1. Non-Conscious Use
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Examples: Affective Assessment
Questions
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)
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Examples: Affective Assessment
Questions
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)
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Examples: Affective Assessment
Questions
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)
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Example of Designing a Class: Affective
Developmental Process
 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
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Example of Designing a Class: Affective
Development Process
 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.
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Dimensions of Development
1. Emotional Development
2. Moral Development
3. Social Development
4. Spiritual Development
5. Aesthetic Development
6. Motivational Development
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Developmental Learning & Educational
Methods
Developmental Learning
Educational Methods
Emotional & Spiritual
Phenomenological
Social
Narrative
Aesthetic
Conscientization
Moral
Case Study
Motivational
Gestalt
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Developmental Assessment
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)
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Takeaways
 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.
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Resources
ACPE Standards & Manuals (2016). http://www.manula.com/manuals/acpe/acpemanuals/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.
70
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Resources
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.
71
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Resources
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.
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Psychotherapy: Theory, Research, Practice, Training, 30(1), 67.
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