Moving from Basic to More Advanced: Is there an Increase Over Time in the Complexity of Teacher Questions and Student Responses in Case Based Clinical Seminars?

Introduction: Case-based group discussions (CBGD) are a specific, interaction-focused form of case based medical education dedicated to foster medical students’ skills of applying basic biomedical knowledge to patient cases. In such seminars, teacher question-student response patters are a crucial aspect. We empirically investigate to which degree clinical teachers progress from more basic, knowledge-oriented towards more advanced, elaboration-oriented questions in CBGD-seminars.Methods: We video recorded 32 case-based seminars in the areas of surgery and internal medicine. 21 different clinical teachers had taught and 398 medical students had attended these seminars. We coded closed-reproductive and open-elaborative teacher questions as well as reproductive and elaborative student responses to these questions. Interrater reliability was satisfactory. For determining trends regarding the teacher questions / student responses, we compared eight equally long time-segments per seminar.Results: Overall, clinical teachers posed more closed-reproductive than open-elaborative questions to students and the latter gave more reproductive than elaborative responses. Regarding the frequencies of these forms of teacher questions / student responses, we found no significant differences over time.Discussion: We found that clinical teachers did not deliberately modify the types of questions they posed over time to push their students towards more elaborative responses. Generally, this raises the critical question to which degree promising didactic concepts are actually put into clinical teaching practice. In our sample, we observed substantial heterogeneity regarding the variables in focus of our study. We conclude that medical education researchers should more thoroughly take different starting conditions and teaching approaches of different teachers into account.