Impatience

I am generally a very patient guy, but when I am the attending physician on the infectious diseases consultation service, I sometimes struggle in my role as an educator. This is especially true on the first day of service when all of the patients are new (to me). Then when an additional four consultations come in mid-afternoon I get stingy with my teaching time.  In the pressure to get through the afternoon, I “teach” on the fly, asking questions, only to jump in with the answer before the learners can even think about a response. Guilty as charged.

Balancing Your Roles

As healthcare providers in an academic setting, I suspect that you too sometimes struggle with this same dilemma…the balance between efficient and timely patient care and teaching the learners who are dependent on our ability to strike the right balance between serving patients and serving learners. We don’t want to sacrifice efficiency for effectiveness on either side of that equation. A similar issue will surface in the outpatient clinic when the combination of phone calls, an electronic record monster to feed, an extra new patient you didn’t expect in the session, and the needs of your learners all come together to make for a time-crunched afternoon. For those of you who do most of your teaching in a classroom, the perceived need to “cover” your material can crowd out the time you might like to take in asking good questions, and having the patience to wait for an answer. In all these situations, though, I will offer that the learner will win if you resist the urge to jump in after asking a question.

Think-Time

Well, the good news is that we are not the first ones to struggle with this, so let’s look at the evidence around just how long we typically wait for an answer after asking a question and how waiting just a few seconds more is an investment that will drive significant benefits to both you and your learner. Don’t consider it wait time…, consider it THINK-TIME, or the time needed for learners to process the questions you pose.

So just what is happening during this 3 seconds of think-time after you ask a question? The student/resident is listening, processing what you asked, translating the question to link it to information in their heads, and building the courage to put their hand up and answer. That’s a lot to do in just 3 seconds, but it does result in benefits that are valuable to both of you. If you jump in after the typical 1.5 seconds, your learners will learn something. They learn that if they just stay quiet they can avoid the potential embarrassment of a possible wrong answer, or, they don’t have to bother thinking about a response because you will go ahead and answer your own question. As a result, you think you are teaching, but in reality, they didn’t have time to process the question and work through to answer it and learn for themselves.

While we are at it, I am going to ask for another investment of time. In addition to the think-time after you ask a question, you should also wait 3-5 seconds after the learner answers (Yaqubi & Pourhaji Rokni, 2013). Oh, come on you might say. Enough is enough. I don’t have time to wait an additional few seconds at this point in the process…I have patients to see, or I have to finish covering my slides, etc.  Well, if you are willing to give just a few more seconds at this point in the learning exchange, this second think-time pause will invite other learners on the team or in the classroom to comment on the answer and join in on the learning. Resist the urge to speak too quickly. Again, the learners will win if you don’t jump in.

Putting Think-Time into Practice 

What steps could we take to build-in think-time into our clinical and classroom teaching? The first one is simple to suggest, yet difficult for many of us to put into practice. Wait. I would encourage you to think about this the next time you ask a question of your learners. Ask a question and mentally count to three or five seconds before you follow-up in any way. Some of the best educators I know can quietly wait 5, 10, 20 seconds before saying anything. At some point, the learners get uncomfortable with the silence, and someone speaks up. This initial answer will allow you to determine a baseline of learner knowledge on the topic and you may just get another learner to agree or disagree with that point, should you wait long enough (Rowe, 1987; Stahl, 1994).

I would also caution you from asking a different question right away. So many times we ask a question of the learners and we may get blank looks which can encourage the faculty to ask a different question. The next question may or may not be related to the first one. Our learners have to stop thinking about the first question and switch gears to understand the next one. The think-time would need to be expanded for the additional question. The best plan is to rephrase the initial question you already asked and not change it too dramatically (Yaqubi & Pourhaji Rokni, 2013).

Waiting provides a number of benefits to you and the learner, they include:

• You will get longer & more accurate answers
• More learners will participate
• More learners will volunteer answers
• Achievement will increase for learners

 Just imagine the potential if we all added a few seconds to each learner encounter this week., We will have a big impact on learner engagement, better answers, and more learning. Every patient encounter and every class session is a precious teaching opportunity for our learners. Since we have so little face-to-face time with them, let’s make the most of each encounter by investing those precious few seconds to enhance their learning. Resist the urge to jump in and answer your own questions.

Did we convince you to give wait time a try? Let us know how it goes, and what your experience is with adding a few more seconds after asking a question. Email your experience to HSCFacDv@louisville.edu with the phrase “wait time” in the subject line. We look forward to hearing from you.

References

Rowe, M. B. (1987). Wait time: Slowing down may be a way of speeding up. American Educator, 11, 38-43.

Stahl, R. J. (1994). Using "Think-Time" and "Wait-Time" Skillfully in the Classroom. ERIC Digest.

Yaqubi, B., & Pourhaji Rokni, M. (2013). Teachers’ limited wait-time practice and learners’ participation opportunities in EFL classroom interaction. Journal of English Language Teaching and Learning, 4(10).