Thursday, 18 Oct 2018

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Leading With Questions

The hour-long talk is winding down, and you have five minutes left. Time to spend those last five minutes engaging your audience with questions and answers.

If you’re the U.S. President, you have a gaggle of people whose job is to ask you the tough questions. All hands are up and the session always ends abruptly, and too soon, when the man says “that’s it”.

However, if you’re a rheumatologist lecturing on new psoriatic arthritis therapies, there may not be as much interest - in you, the topic, or your last 47 PowerPoint slides.

I find it interesting that: a) when the Q&A part of the lecture begins, everyone acts as if they just got on the elevator. Who is willing to go out on a limb and ask the first question?; b) after one or two questions, the audience often relaxes and the inquisition bar lowers just enough for several more to come through; and c) when the lecture is over, 18 people rush the stage to pepper the speaker with issues or items that can only be discussed after the lecture.

Seth Godin says the “ready” questioner has a new thought that he/she believes is unique. Lurking behind are many would-be questioners who are afraid their question is too mundane, too private or too silly to ask in the open forum.

The astronomer and astrophysicist, Carl Sagan said: "There are naive questions, tedious questions, ill-phrased questions, questions put after inadequate self-criticism. But every question is a cry to understand the world. There is no such thing as a dumb question".

I attended a lecture by the college basketball coach Bobby Knight. I hoped he would end with a Q&A session – and he did. When the Q&A started my hand shot right up and stood out. He pointed my way, but first questioned me, asking if I had “ever been a basketball referee”? (I said no.) “Maybe in College?” (no) “What about High school basketball?” (again, no). He then declared I must be a blind-as-a-bat referee because he was actually pointing to the guy behind me. A good laugh ensued and I let went along with the weak comedic moment. And then I asked, what does Coach Bobby Knight do, when another super-coach (such as Bill Parcells) calls asking for advice on how to follow a championship season. It was a good question, I know, because he struggled for the right words, but stated “what an honor that is, when it happens”. More importantly, it ignited the conversation between the audience and a Hall of Fame coach.

I’ve often wondered about how to improve the Q&A session, so I’ve asked some well-known leaders for their comments and advice on audience questions. Below you’ll find some advice on Q&A sessions and how you may approach these differently in the future.

RheumNow Advice On Q&A

  • If you’re the moderator/host – ask the first question to “break the ice” - It doesn’t have to a mind bender.
  • If you ask your question privately (afterwards) – then only you learn. If you ask your question in the open forum, everyone learns and you’re the one who got to “poke the fire”!
  • If you think your question is too simple, embarrassingly easy, or too common – you should definitely ask it! Why? First the speaker has already heard this question hundreds of time and will undoubtedly have an accurate, well-rehearsed and clear response that will help you. If he/she doesn’t know the answer, then the audience will and the educational fireworks will fly. Second, there are at least four other wimpy-cats in the audience who have the same question – do you really want to be one of them or the one who stands out amongst peers?
  • Ask questions about what you don’t agree or what you have a different point of view. These will come up during the lecture session, you should write the issue down, ruminate and formulate a straight forward question.
  • Don’t ask questions about patients unless it’s a brief two-line vignette followed by a specific question. Examples: RIGHT: “If a woman with lupus were to become pregnant, what meds would you stop and/or continue?” WRONG: “I have this lady with lupus, seizures, diabetes who is on Medicaid and wants to self-medicate. But then she becomes pregnant and has seizures and the OBGYN is suggesting termination and I have to guide her on what to do – What do I tell her?”
  • Lastly, when you ask me a question, I learn if my lecture was: focused rightly or wrongly; too brief or overloaded; was clear or confusing. If you don’t ask questions, I’m likely to go on and give that same (good or bad) lecture over and over again, without edit. Don’t be afraid to point out my errors – then I learn from you!

Advice from Rheumatology Educators

  • Stephen Paget, MD (Hospital for Special Surgery, NYC): I believe that at the beginning of the lecture, the lecturer should state with strength and clarity that s(he) wants/needs questions throughout the lecture to enhance the delivery and get a sense of how the lecture is actually going. Just as I give all of my patients my email address and at times cell phone number to text, I give it to members of the audience so they can feel comfortable "asking" questions whenever they wish, during, after or way after the lecture to allow people to ask their questions in a way that befits their personality. The lecture is only the beginning of the dialogue that can continue at any time.
  • Roy Fleischmann, MD (UT Southwestern, Dallas): I always invite audience questions during my talk and like to ask them questions as I go along, which usually gets the discussion going. If it is a formal talk, and there are no questions, I start by saying: ”Do I have to get down form this stage and ask myself the first question?” Which usually works – if not, then I do ask the questions that I would have asked of myself. But, if there really are no questions, then I question myself as to how I could have created a better lecture that wasn’t so boring that no one wanted to ask a question.
  • Eric Matteson, MD (Mayo Clinic, Rochester): Here are few things I try to do as the Q or the A: Don’t ask compound questions. Give the speaker, and other audience members a chance. If the speaker knows the answer will be very long, offer to discuss it with the questioner offline. Also, it’s definitely OK to challenge the speaker, but with facts, not personal opinions. In a professional setting, where there are others who are not personally acquainted with the speaker, it is bad form to address the speaker by his/her first name, indicating some special connection that can alienate others in the audience. The speaker should keep the question/questioner on topic. If it is not on topic, then offer to discuss the issue after the session.
  • Artie Kavanaugh, MD (Univ. California at San Diego): One thing for the speaker - try not to say "that is a good question..." when someone asks a question. Even if it is true, it implies other questions may be less important.
  • Chris Ritchlin, MD (Univ. of Rochester, NY): the moderator may invite written questions before the session begins. Questions should be brief, specific and to the point and limit to one (give others a chance). Don’t engage in a long discussion with the speaker. Don’t be afraid to challenge the speaker or provide a different perspective and always do so in a collegial and calm manner.

I began this article describing the 55 minute lecture with five minutes of Q&A. Education research has shown us over and over again that long didactic lectures are arcane and have little educational impact. The best educational sessions are driven by shorter lectures, with distinctive and clear messaging, followed by substantial discussion between the audience and leader/lecturer.

Thus, the ideal lecture should be 15-20 minutes, followed by 20-30 minutes of discussion. If such changes are in your future, then YOU will have to be a more engaged, active learner who will help all by helping yourself with not one, but several questions. When you learn, everyone learns.

Voice your thoughts. Be a force.

“The scientist is not a person who gives the right answers, he's one who asks the right questions.” ― Claude Lévi-Strauss

Now, who has any questions or comments for me? 

The author has no conflicts of interest to disclose related to this subject
Dr. Cush is the Director of Clinical Rheumatology at the Baylor Research Institute and a Professor of Medicine and Rheumatology at Baylor University Medical Center in Dallas, TX. He is the Executive Editor of and Co-Editor of the online textbook Dr. Cush's research and interests include novel drug development, rheumatoid arthritis, spondyloarthritis, drug safety, pregnancy and Still's disease/autoinflammatory syndromes. He has published over 140 articles and 2 books in rheumatology.
He can be followed on twitter: @RheumNow.

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