title: Intraoperative questioning to advance higher-order thinking.
abstract: BACKGROUND
  The type of question asked elicits a particular response. The purpose of this study was to determine what types and levels of questions were asked in the operating room. These insights are important for understanding how questions are used to advance learners.
  
  
  METHODS
  12 laparoscopic cholecystectomy operations were observed and recorded at a single institution. Intraoperative questions asked by faculty were transcribed for all cases. Using revised Bloom's taxonomy, questions were classified into one of 5 levels: (1) remembering, (2) understanding, (3) applying, (4) analyzing, (5) evaluating.
  
  
  RESULTS
  141 questions were asked by faculty and ranged from 0 to 34 questions per case. Classification of questions showed there were 43 remembering, 29 understanding, 47 applying, 13 analyzing, and 8 evaluating questions asked.
  
  
  CONCLUSIONS
  Questioning was predominately classified at lower-order and mid-level thinking skills (120/141). Integrating intraoperative questions at higher-order levels has the potential to guide trainees into progressively complex thinking and decision making.
authors.affiliation: Department of Surgery, University of Michigan Health System, 2207 Taubman Center, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5346, USA. Electronic address: cmagas@med.umich.edu.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Magas
authors.affiliation: Department of Learning Health Sciences, University of Michigan Medical School, 219 Victor Vaughn House, 1111 E. Catherine Street, Ann Arbor, MI, 48109-2054, USA. Electronic address: lgruppen@med.umich.edu.
authors.forename: Larry D
authors.initials: LD
authors.lastname: Gruppen
authors.affiliation: Department of Surgery, University of Michigan Health System, 2207 Taubman Center, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5346, USA. Electronic address: mebarret@med.umich.edu.
authors.forename: Meredith
authors.initials: M
authors.lastname: Barrett
authors.affiliation: Department of Surgery, University of Michigan Health System, 2207 Taubman Center, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5346, USA. Electronic address: pdedhia@med.umich.edu.
authors.forename: Priya H
authors.initials: PH
authors.lastname: Dedhia
authors.affiliation: Department of Surgery, University of Michigan Health System, 2207 Taubman Center, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109-5346, USA; Department of Learning Health Sciences, University of Michigan Medical School, 219 Victor Vaughn House, 1111 E. Catherine Street, Ann Arbor, MI, 48109-2054, USA. Electronic address: gurjit@med.umich.edu.
authors.forename: Gurjit
authors.initials: G
authors.lastname: Sandhu
mesh_terms: D017081:Cholecystectomy, Laparoscopic; D000066491:Clinical Decision-Making; D005180:Faculty, Medical; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D007432:Intraoperative Period; D008824:Michigan; D011340:Problem Solving; D013850:Thinking
keywords: Bloom's taxonomy; Intraoperative teaching; Questioning