1/12 Giving a talk to our UCLA IM Residents in the Med Ed Pathway @uclaimchiefs @PamelaTsing inspired me to make a thread on how to construct questions to maximize learning! Thanks @rktsevat and your group for the inspiration behind this example!

#MedEd #FOAMEd #MedTwitter

2/12 The highest yield question for medical training is centered around VIGNETTES, since this is direct application of knowledge to patient care. Each question that you construct should lead to a key teaching point.

3/12 First you must think about who is in the audience. You must construct a case that includes your most junior learner and still engages your most senior learner (good luck!).

4/12 Let's say you are giving a noon conference talk on heart failure and your key learning point to is to teach your learner the K and Cr cutoffs for initiation of spironolactone (note that this is an answer that is not known by many senior residents).

5/12 Let's analyze the following sample case.

6/12 How can we improve it and include more junior learners? We can:
- Remind them of some of the classic symptoms of heart failure
- Have them practice reading a chem panel as a fishbone

7/12 We can highlight what the correct answer is (this is not consistently done by a lot of folks).

8/12 We can take it a step further and explain why the correct answer is correct (this is where you should embed your main learning point).

9/12 We can then explain why the wrong answers are not the best choice (this is particularly helpful when there are two seemingly equivocal answers).

10/12 This then gives me an opportunity to discuss how systemic racism was integrated into medicine and how we must now unlearn our practice patterns to provide better care.

11/12 By deliberate case creation, we went from one teaching point and added:
- Accessibility to more junior learners
- Practice reading fishbones
- Explanations for why the wrong answers were not the best choice
- Highlighted systemic racism and its impact on patient care

12/12 To do this carefully takes a tremendous amount of effort and time, but can be so useful for your learners whether they realize it or not. Would love to hear thoughts/comments from others!