CHAPTER 6

Socratic Pedagogy: Teaching Students to Think Like Nurses

Christine Sorrell Dinkins

Through the years since nursing education has moved from hospitals into colleges and universities, what nurses need to learn and know has changed dramatically. What has not changed substantially is the way students are taught to learn and know. One of the major recommendations from the study sponsored by the Carnegie Foundation for the Advancement of Teaching, Educating Nurses: A Call for Radical Transformation, was the need to “Expand the focus on critical thinking to an emphasis on clinical reasoning and multiple ways of thinking” (Benner, Sutphen, Leonard, & Day, 2010, p. 89). Thus, this chapter introduces a new approach to teaching thinking, Socratic pedagogy. Clinical nurse educators can use Socratic pedagogy to bridge the knowledge–action gap that students and new graduate nurses often experience by helping each of them learn to think like a nurse.

One question to ask about this chapter might be, “What is a philosophy professor doing writing a chapter in a book for nurse educators?” Philosophy has a strong and proud connection with nursing and nursing education, thanks to Patricia Benner, Nancy Diekelmann, Jean Watson, and others who brought to nursing an attention to phenomenology, hermeneutics, and other philosophical ways of thinking and knowing. In addition, philosophy happens to be the home discipline for many of the oldest and best explorations of education—from Parmenides in 6th century BCE to John Dewey in the 20th century. In between those two, of course, in the 5th century BCE, was perhaps the most famous teacher of all, Socrates.

We know a little about the historical Socrates—he was a teacher before all else in his life, he was devoted to his students and to his beloved city of Athens, and he was tried, convicted, and executed for corrupting the youth. Since Socrates never wrote anything, we know him best through the writings of his greatest student, Plato. Nearly all of Plato’s works are constructed dialogues featuring Socrates as the main character. How close is this character to the historical Socrates? That is a matter of debate. But regardless of historical authenticity, the character of Socrates in Plato’s works is a model teacher. Looking into his comportment and the methods he used to lead his students in inquiry, readers today can gain great insights into new (but very old!) ways of teaching.

“Socratic pedagogy” is not a consistently defined term, and in fact it is a term often misused (Kost & Chen, 2015). In this chapter, this term refers to a philosophy of teaching based on the model of Socrates in Plato’s dialogues. It is a type of teaching that requires active learning and engagement from students and teacher alike, and thus is particularly valuable for teaching in the clinical area. Throughout the chapter, illustrations from Plato’s works serve as explanations of Socrates’s teaching philosophy and as models for clinical nurse educators to follow.

WHY SOCRATIC PEDAGOGY?

New Teaching Methods Are Needed

Nursing education is a complex challenge for even the most experienced nurse educators. Nursing students and newly hired nurses must learn a tremendous volume of knowledge, skills, critical thinking, and ethical reasoning, and must know how to put all these resources together in their care for patients. In this era when new information, theories, and facts are being produced at a rapid pace, “nurse educators are faced with the need to do more than help students recall facts … they are challenged to assist students to learn how to learn for a lifetime” (Rogge, 2001, p. 69). Students need to know how to apply and synthesize what they have learned in the classroom, but they also need to know how to continue learning, processing, and synthesizing new information throughout their careers.

In addition to teaching in such a challenging era, educators may have trouble developing new pedagogies and active teaching strategies because of “lack of time, student and faculty resistance, structural barriers, and the academy’s devaluing of the scholarship of teaching” (Tedesco-Schneck, 2013, p. 59). Thus, the Carnegie Foundation study on nursing education (Benner et al., 2010) was a much-needed call to action, a call to give nurse educators the resources and support they need to develop the unique teaching skills required for educating within a practice. The report found that students receive little education on setting priorities, even though this skill is critical for providing safe patient care. The report also found that students are often asked to learn from lectures and linear PowerPoint presentations, but students find they tune out or lose focus when learning using these formats. In addition, the report identified a need for teaching everyday ethics, as opposed to artificial dilemmas taught in ethical theory classes, and a need to teach skills for reflective practice. As Marlow et al. (2015) state, “the concern is on moving away from a content-driven didactic teaching to a learning environment that is dialogic, open, allows for multiple perspectives, and creates space to challenge assumptions and to develop a sense of ethical knowing” (p. 26).

A call for teaching thinking in nursing education is not new, and in fact Benner is concerned that “critical thinking” has become more of a catch-all phrase for how teachers want students to think, rather than a focus on teaching specific ways of learning and knowing that nurses need for competent practice (Benner et al., 2010). Benner, Hughes, and Sutphen (2008) emphasize that while “critical reflective skills are essential for clinicians,” nurses’ thinking must include much more: “reflection, induction, deduction, analysis, challenging assumptions, and evaluation of data and information to guide decision-making.” To educate nurses for these diverse skills, Benner et al. (2010) recommend a movement away from a simple emphasis on critical thinking to an emphasis on multiple ways of thinking, including “the ability to reason as a clinical situation changes, taking into account the context and concerns of the patient and family … as well as critical, creative and scientific reasoning” (p. 85).

Socratic Pedagogy Helps Students Develop Critical Thinking and Other Key Skills

Nurse educators are faced with the stress of covering more and more information in their teaching as new evidence for best practices in caring for patients evolves from research. Yet, considering that “covering” something also means to obscure it, one realizes that even if it were possible to give students all the essential information needed in their practice, it would be counter-productive to try to do so. Thus, nurse educators need teaching approaches to help students develop thinking skills that will encourage continued learning.

Socratic dialogue—a question-driven, student-centered, discussion-based shared inquiry between teachers and students—builds confidence and reliability in students by helping them think through why they do what they do: why they make certain decisions, why they look at certain situations in a particular way. In Plato’s dialogues, Socrates explains that beliefs and opinions need to be “tied down” so that they do not run away or lead us to error. The more we can justify our beliefs by pondering our reasons for holding them and also the connections between the beliefs, the more reliable and high-quality our decisions will be (Plato, 97d, trans. 1981d). Socratic pedagogy is not about asking questions with specific answers in mind; it is an active engagement in dialogue, asking students to think and be creative in their answers, while the instructor remains open to what the students might respond or ask. And it is not just about giving feedback on a particular situation or recently completed task, it is about helping students learn to think and to apply the learning from the current moment to situations in the future. Engaging students in dialogue helps them connect the dots between what they learned in pathophysiology or pharmacology class and what is happening here, now with their patients.

In Plato’s dialogue Meno (trans. 1981d), Socrates offers an image to help explain why beliefs and opinions need to be examined and justified in order to become reliable knowledge. He evokes the statues of Daedalus, which were reportedly so lifelike they would run away if not tied down. Like these statues, Socrates explains, even true and accurate beliefs “run away and escape if one does not tie them down” (97d). In a similar explanation in the Republic (Plato, trans. 1992c), Socrates asks, “do you think that those who express a true opinion without knowledge or understanding are any different from blind people who happen to travel the right road?” (506c). For Socrates, if we make decisions based on untested opinions or on facts we have not considered and contextualized, we are operating in the darkness; these opinions and facts may help us find the right path, but we cannot reliably stick to that path, partly because we do not know why it is the right path.

Throughout Plato’s dialogues, the distinction Socrates and his dialogue partners (usually referred to as his interlocutors) consistently make is that true beliefs and genuine knowledge will point to the same direction, but true belief cannot be trusted to stay with a person. A nursing student who has learned the course content or a particular skill may do well when situations are typical, relaxed, or straightforward, but the student will be more likely to make an error if the situation is more complicated or he or she is under time pressure. Once that student has examined and “tied down” his or her course content and skills, that is, once the student has knowledge and understanding, he or she will more reliably know, and be able to follow through on, the right decision in a complicated situation.

The beauty of teaching through dialogue and employing Socratic pedagogy is that it gives educators the opportunity to address skills called for in recent reports and articles on the future of nursing education: ethical thinking, creative thinking, learning to learn, and adapting to rapidly changing situations. Moreover, since Socratic pedagogy is student-centered, it tends to keep students engaged more than lecture alone, allowing them to be active participants in their own learning. Socratic pedagogy allows the instructor to respond to the needs of the moment and of the student, so that students learn what they need to know when they need to know it, leading to better retention and comprehension. Imagine a clinical post conference that was originally intended to stick to the objective for the day, “end-of-life care,” but a student raises an ethical question, or makes a statement that the instructor believes points to an ethical problem, such as assisted suicide. The instructor can then follow on that change of the conversation, taking that student and his or her peers down a path of inquiry that responds to the moment and the situation.

Benner et al. (2008) argue that “critical reflection requires that the thinker examine the underlying assumptions and radically question or doubt the validity of arguments, assertions, and even facts of the case.” Socratic questioning does just that—it seeks out and exposes false assumptions and gaps in knowledge. By comparing beliefs and assumptions of one student or several, the questioning “focuses on one’s desire not to contradict oneself and thus allows the teacher to compel the student to examine her or his internal incoherences” (Bloch-Schulman, 2012, p. 20).

Some educators may be concerned that Socratic teaching is less efficient than lecture, since discussion will always take more time than would the teacher simply speaking to the students, formally or informally. However, Garlikov (n.d.) notes that Socratic dialogue is “a very efficient teaching method, because the first time through tends to cover the topic very thoroughly, in terms of their understanding it.” Even though a teacher can always lecture in less time, this method “gives constant feedback and thus allows monitoring of the students’ understanding as you go. So you know what problems and misunderstandings or lack of understandings you need to address as you are presenting the material” (Garlikov, n.d.). In a clinical setting, this means instructors can structure a pre-conference to review the patients who are assigned to the students that day, and by asking questions and engaging in dialogue with the students, guide them to think about what to notice in their patients, what they can expect will happen, and catch any problems, misunderstandings, or false assumptions sooner and more efficiently than without dialogue.

Since the dialogue will almost always happen in a group, not only does this method help individual students analyze their own decisions and learn from any mistakes or misunderstandings, but peers will also learn from hearing these conversations or from joining them. As Boghossian (2003) points out, “Socratic pedagogy impacts the entire learning community because even those students who are hesitant to speak up … can benefit from seeing a genuine discourse modeled” (p. 20). Just as the historical Socrates taught and learned with his students gathered together, dialogue in today’s teaching settings nearly always has an audience or a group to join in, and that larger group benefits from the experience nearly as much as those engaged directly in the conversation.

Socratic pedagogy asks the teacher to be a member of a community of learning with his or her students. The pedagogy is student-centered in that student needs and responses drive the inquiry, but the teacher remains an important guide at all times. Such a pedagogy helps create “a community of scholars because it requires the teacher to take seriously what students think and say and it encourages teacher and students to rely on each other for learning” (Rogge, 2001, p. 68). In a Socratic exchange in a simulation lab or a classroom, “assumptions and beliefs are challenged, questioned, and discussed communally in the moment. It is through this communal process of being actively engaged with one another and the subject matter at hand that new understandings arise” (Marlow et al., 2015, p. 26). As a group, students participating in Socratic pedagogy have many opportunities for ethical thinking and creative thinking as they discuss with their teacher and each other their thoughts and concerns about what they have learned or things they have done in patient care that day. And in that process of discussion, they are always learning to learn, developing a habit of questioning, analyzing, reflecting, and comparing ideas with their peers and supervisors. Such a habit serves them well as they head into a career where they must often adapt to rapidly changing situations.

Socratic Pedagogy Can Be Used in Many Educational Settings

Socratic pedagogy is as much a matter of comportment and student-centered focus as it is questioning and dialogue. Therefore, Socratic pedagogy can result in long, complex, sweeping discussions or small, quiet moments of exchange. Socratic questioning works very well during clinical conference or in a brief conversation in a hallway after seeing a patient. It can happen one-on-one between teacher and student, or as a discussion among a group, or with a group listening to a one-on-one conversation. A Socratic discussion in a clinical conference might go something like this:

(The conversation would then continue, with the teacher helping to guide the students in inquiry about this patient or other patients they saw on the unit that day.)

Socratic pedagogy serves well whenever an instructor wants to help students make connections between things—vital signs, the patient’s current behavior, the baseline, a patient’s previous behavior. The Socratic method is designed to connect beliefs and break ideas and questions down into component parts, ideal for teaching in a practice setting such as nursing. If a student in a simulation lab suggests, “I think we should try X” the teacher can ask, “Well, what would X do?” The student may respond that it would accomplish Y result. The teacher might then ask, “What might be higher priority than Y?” or “What might be more effective than X?” The teacher could then open the discussion up to other students: “Do you agree? Why or why not?” Or, if a student is feeling overwhelmed with data or options, a teacher can help him or her focus. “What data do you have? What have you observed? What do you think you need to focus on within all that data? Why?” If the student indicates focusing on A or B, the teacher can ask, “And how do those connect to C? Is C important here?”

THE SOCRATIC APPROACH: TEACHING AS AN ACT OF CARING

Common Misconceptions About Socratic Pedagogy

Socratic questioning and Socratic pedagogy in general should always grow out of respect and care for students. Too often in portrayals in popular media—or in practice in some education—Socratic questioning involves embarrassing students and calling them out, trying to catch them in a mistake or expose gaps in their knowledge. The fact is that Socratic questioning is excellent for catching students’ gaps and mistakes, but it can be done in a respectful and caring way that allows all present to benefit from dialogue, especially the student being questioned (Kost & Chen, 2015). The questioning should not be antagonistic—a little uncomfortable or slightly anxiety-producing, perhaps, but always with the understanding that the dialogue is expressly for the benefit of the students.

The malignant style of questioning prevalent in medical schools features “techniques designed to humiliate the learner, such as ‘guess what I’m thinking?’ questions or testing knowledge so obscure that only the questioner would know the answer” (Kost & Chen, 2015, p. 20). Such malignant questioning, even when the questioning itself is not as painful, often brings about humiliation and shame because it is done in a very public setting. Students also can be hurt or ashamed if one student is singled out for a long period of time, or if a student’s ideas are dismissed or ignored as the professor moves on to a new student to seek the desired answer (Kost & Chen, 2015).

In contrast, the Socrates of Plato’s dialogues cares deeply about his interlocutors and is never looking for facts or one right answer. He does not engage in a fishing expedition of “guess what I’m thinking?” but focuses on the individual being questioned, trying to determine: What are this person’s assumptions? What is he overlooking? Why did he give the answer or make the decision he just did? Indeed, Socrates often insists he does not know the answer to the questions at hand and wants to learn through dialogue with his interlocutor. Thus, true Socratic pedagogy is not merely about teaching and probing; it is also about a teacher and students learning together. The teacher is not expected or desired to have all the answers but to guide the questions and thinking to help all learn together.

Socratic Comportment

Today, we recognize that components essential to successful adult learning include “mutual respect; a safe and supportive educational environment; and challenging learners in a nonthreatening way” (Kost & Chen, 2015, p. 21). And 2,400 years ago, Socrates seemed to understand these same essential components for learning. Moreover, his calling and his greatest joy were teaching and learning with his students. He spent the majority of his time with Athens’ youth. In Plato’s dialogue Charmides (trans. 1992a), one of Socrates’s first priorities when returning to Athens after a long absence is to inquire whether there are any promising youth ready to learn.

Certainly, Socrates was thought of as an annoying pest at times, especially by those in power whom Socrates encouraged the youth to question. But there is no doubt that Socrates’s questioning came from a position of caring—for his students, for the city, for their citizenship in that city, a context not so different from nurse educators and their students today. Socrates’s friends and students were devoted to him. At Socrates’s execution, Phaedo and other friends gathered “all felt as if we had lost a father and would be orphaned for the rest of our lives” (Plato, 116a, trans. 1981e). It is clear that Socrates was a beloved teacher. His students as portrayed in Plato’s dialogues note that he noted their reactions to a discussion and cared that they were learning and were not in too much distress (trans. 1981e).

When interlocutors do become frustrated, Socrates always emphasizes that he, too, is frustrated because he does not have the answers. He encourages his interlocutors to continue the dialogue so they can inquire together. Socrates believes he has a moral obligation to press his students to help them recognize their own mistaken beliefs or false assumptions. As he explains in Plato’s Theaetetus (trans. 1990), “People have often before now got into such a state with me as to be literally ready to bite when I take some nonsense or other from them. They never believe that I am doing this in all good will; … I don’t do this kind of thing out of malice, but because it is not permitted to me to accept a lie and put away truth” (151d).

Socrates as Stingray, Gadfly, and Midwife

Throughout Plato’s works, he writes of different people making various analogies to describe Socrates and what it is like to have a conversation with him. Over 2,000 years later, these analogies can serve today’s educators as models for how-to-be as teachers. Each of us can be a bit of the stingray, the gadfly, and the midwife.

Socrates’ friend Meno, in the dialogue of the same name (Plato, trans. 1981d), finds himself in a frustrating conversation with Socrates about the nature of virtue and whether it can be taught like other subjects can. Meno offers an analogy to try to help Socrates understand how he feels when Socrates refuses to let Meno’s answers be and continues pressing with more questions. He declares Socrates to be like a “torpedo fish,” what we might call a stingray today. Meno seems to be partly joking, adding that Socrates even looks like a torpedo fish. But he is serious enough when he explains that like Socrates, the stingray “makes anyone who comes close and touches it feel numb” (80a–b). Socrates somewhat accepts this analogy, taking it in stride, but he argues it fits only in a limited way: “If the torpedo fish is itself numb and so makes others numb, then I resemble it, but not otherwise, for … I am more perplexed than anyone when I cause perplexity in others” (80c). Socrates is as likely to get “stung” himself as his students are, and Socrates believes that is just as it should be.

The most famous analogy for Socrates and his trademark questioning is the one devised by Socrates himself at his trial, as featured in Plato’s Apology (trans. 1981a). He tells the gathered jurors that he was “attached to this city by the god … as upon a great and noble horse which was somewhat sluggish because of its size and needed to be stirred up by a kind of gadfly” (30e). Continuing with this analogy he adds, “I never cease to rouse each and every one of you, to persuade and reproach you all day long and everywhere I find myself in your company” (30e–31a). Socrates is here referring to the fact that he has used questioning every day to exhort his fellow Athenians to do good, to be good citizens. This unrelenting questioning, he believed, was his duty to Athens to keep it on a good path; his oft-irritating questioning was employed in service to others and to the greater good.

A nurse educator today has the same responsibility as Socrates to be a stingray and a gadfly, if not more so. In addition to Socrates’ goal of helping his students grow into good citizens, nurse educators must also help students navigate a complex landscape of science, technology, ethics, and social interaction. A teacher who calls out a new nurse—respectfully, from a place of care—on a questionable decision, may sometimes seem like a stingray or a gadfly, but the teacher is nurturing that student and doing a service to the larger context of nursing practice and patient care.

Another analogy for Socrates is also one he offers up himself: He sees himself as a midwife. In Plato’s Theaetetus (trans. 1990), Socrates explains that he is the son of a midwife, and while he does not help in pregnancy and delivery of children, he helps in the same sort of process in learning and the birthing of ideas. He explains that like the midwives of ancient Athens, he himself is barren, seeking to help those who are pregnant with ideas, such as students or others who are struggling with a concept or are on the verge of an important discovery. Socrates explains that he can help bring on delivery or relieve labor pains; he can help students know when they need to question or think through some of their ideas, and he can help them when they are lost or struggling. Also like midwives of his day, Socrates says he knows which couplings of ideas are likely to produce fertile offspring; he can help his students make connections between ideas and experiences to further their learning and understanding. Socrates says that his art is in one key way different from the traditional midwives’ because he must also distinguish between “phantoms” and “realities,” between errors and “fertile truth” once he has delivered another’s ideas (149b–150c).

This image of Socrates as a midwife is extremely important because it allows us to see the other side of the stingray and the gadfly. Once he has stung (if necessary) a lazy horse or momentarily stunned a confused student, he continues to help that person through the painful process of moving from rejected assumptions or gaps in knowledge toward new ideas, connections, or pathways of thought. A nurse educator today is always a midwife as much as a gadfly. Out of caring for the students and patients, a teacher is obligated to press students with questions and poke around a bit for learning gaps. But just as importantly a teacher must help students think about what they already know and how it connects to their practice. The teacher can help them think through their own ideas and actions (correct or incorrect) to move them toward better knowledge, more confidence, and an increased ability to analyze their own ideas in the future.

Socrates as Teacher–Learner, Co-Inquirer

The consistent theme in all of these analogies for Socrates is that he does not know better than anyone else; he can get stung by his own stingray methods, and he can help others “deliver” ideas because he himself is barren, just like the midwives of his day. Consistently throughout Plato’s dialogues, we see that Socrates is humble about his knowledge and wisdom. Plato tells his friend Theaetetus, “I am always asking questions of other people but never express my own views about anything, because there is no wisdom in me; and that is true enough … I am not in any sense a wise man; I cannot claim as the child of my own soul any discovery worth the name of wisdom” (150c, trans. 1990). And it is nearly always true that, as Socrates claims, he does not offer his own opinions on things. This holding back of his own ideas seems to be a key part of his pedagogy. In contemporary scholarship on teaching and learning, this holding back is sometimes referred to as a Socratic veil. Socrates does not want to give his students the answers—indeed he says he often does not have the answer—but instead wants to help them find the answers themselves.

Socrates’ most elegant statement on his educational philosophy comes as a metaphor—Plato’s famed Cave Allegory in the Republic (trans. 1992c). In the allegory, prisoners are shackled in a cave and have been there from birth. They see only shadows cast by a fire in the cave, and they believe these shadows to be reality. The journey out of the cave is difficult and painful, as the prisoners’ eyes adjust to the light of the sun and they realize that now they are seeing truth, and everything they thought they knew before was misguided. In an incredibly poignant part of the story, Plato, writing this piece two decades after his beloved teacher’s execution and choosing the words Socrates will say, has Socrates worry that if someone tries to go into the cave and bring the prisoners into the light, they may fight or even kill that person. Thus, Plato honors the sacrifice of his teacher who was only trying to help Athenians to learn to help themselves (514a–518b).

After Socrates finishes telling the story of the cave, he explains to his friends what the story tells us about education. Education is not a matter of putting knowledge into a soul ready to receive it. Rather, it is a matter of helping each person to realize he has knowledge within him, “that the power to learn is present in everyone’s soul and that the instrument with which each learns is like an eye that cannot be turned around from darkness to light without turning the whole body” (518c). A teacher’s job is to put students on the path leading out of the cave, and to catch them when they stumble, guide them when they cannot find their way, and comfort them when the journey becomes too difficult.

Socrates consistently emphasizes that he expects to learn as much from his students as they from him. At the end of the dialogue Euthyphro (Plato, trans. 1981c), he is disappointed that his dialogue partner on the subject of piety has suddenly remembered somewhere he has to be (a common escape plan for Socrates’s interlocutors!) and says, “by going you have cast me down from a great hope I had, that I would learn from you the nature of the pious and the impious … and that I would be better for the rest of my life” (15e–16a). Similarly, in the Theaetetus (Plato, trans. 1990), Socrates tells his companions that the search for wisdom is a search inside each of themselves. He explains that when students discuss matters with him, they do not learn anything directly from him, but rather “they discover within themselves a multitude of beautiful things, which they bring forth into the light” (150d).

As educators today, we can learn from our students as we teach them. In nursing education, of course, the teacher has far more knowledge and experience on most subjects than the students are likely to have. And yet, students’ inferior knowledge and skills do not prevent them from giving new insights on material being studied or on a situation with a patient. Sometimes students’ novice outlook and lack of knowledge may free them to notice things an experienced instructor may have overlooked or forgotten. And like Socrates, nurse educators can hold back on giving answers or opinions, maintain a Socratic veil. Sometimes, of course, giving an answer will be the best thing for the student or patient. But more often, asking questions and letting the student find the answer him- or herself will be the better lesson. Socrates was a lifelong learner on a quest for knowledge and wisdom just as much as he was a teacher, and his best lesson to today’s educators may well be that only through a constant desire to learn can one become a great teacher or a true lover of wisdom. And what a rewarding teaching experience it is to help students “discover within themselves a multitude of beautiful things, which they bring forth into the light” (Plato, 150d, trans. 1990).

SOCRATIC QUESTIONING

How and When to Start the Discussion

Socrates’s trademark question-and-answer approach is often referred to as his elenchus, and it is important to understand that the elenchus is only part of the overall Socratic method we see modeled and described in Plato’s works. Socratic questioning is certainly the most prominent aspect of the method, though, so we will start by examining this style of questioning before moving on to the rest of the method.

Socrates usually begins his questioning in response to some statement or action that makes Socrates wonder if the person has knowledge about a relevant issue. For instance, when he learns that the priest Euthyphro is about to prosecute his own father for murder (an act many Athenians would consider impious), Socrates wants to discuss piety with Euthyphro, to help Euthyphro determine what he does and does not know about piety and therefore pious actions. In a modern context, Socratic questioning often works well with a similar impetus. A teacher might say, “You did (or said) something that surprised me. Tell me your reasoning.” Or, “You chose X instead of Y” or “You chose X when others might have been unsure what to do. Why did you do that?” By starting from a point of the student’s statement or action, the student is already invested and engaged in the conversation, ready to explore and learn about the subject at hand.

Socrates’s inquiries often move forward through a comparison of beliefs. He guides one person to compare his own various beliefs (Plato, Euthyphro, Crito, Meno) or guides a group to compare beliefs among themselves (Plato, Phaedo, Republic). Part of Socrates’s goal in this comparison of beliefs is to look for inconsistencies or conflicting beliefs, because these often point the way to mistaken assumptions or gaps in knowledge. Socrates describes this comparison of beliefs to Theaetetus: “Our first aim will be to look at our thoughts themselves in relation to themselves, and see what they are—whether, in our opinion, they agree with one another or are entirely at variance” (Plato, 154e, trans. 1990). When Socrates finds conflicts between beliefs, he usually asks his interlocutors how they want to deal with the inconsistency. Do they want to abandon one of the things they have said in favor of another? Do they want to abandon an assumption Socrates has helped them realize they held?

In nursing, educators can check not only connectedness between beliefs but among all the other data and observations nurses must pay attention to. “Why did you do X?” “Because of Y.” “But the patient also has a P situation. How does that connect? Is there a conflict there?” Students or new graduate nurses are often focused on tasks and specific skills and may not see the connections between bits of information. Engaging them in dialogues such as these examples can help students to be aware of what to notice when working with their patient and to make connections to see the whole picture of the patient’s care needs.

Very consistently in Plato’s works, Socrates insists that his dialogue partners must say what they truly believe. This is sometimes referred to as the “Say What You Believe” requirement (Vlastos, 1991, p. 113). Two typical statements of this requirement occur in the Crito and the Charmides. Socrates asks Crito to “try to answer what I ask you in the way you think best” (Plato, 49a, trans. 1981b), and he asks Charmides, “I suppose you could express this impression of yours in just the way it strikes you?” (159a, trans. 1992a; see also Euthyphro 14e and Laches 193c). Even more pointedly, Socrates tells his friend Theaetetus: “if you answer ‘Yes,’ [just to avoid contradicting yourself] … the tongue will be safe from refutation but the mind will not” (154d, trans. 1990). This last quotation from Socrates lets us see the reason for the requirement. If students do not say what they actually believe, but instead say something to please the teacher or to avoid contradicting themselves, then the teacher is less able to help the student ferret out conflicts and inconsistencies in beliefs. In a classroom or clinical setting today, teachers should make clear to students that they want them to say what they really think or believe, not what they read in a book (but do not believe) or what they think the teacher wants to hear. The students must say what they believe because that is what needs to be tested. If a teacher thinks students are doing otherwise, the teacher should call them out on it!

Another consistent principle Socrates follows in his questioning is the Priority of Definition (Beversluis, 1987; Lesher, 1987; Nehamas, 1975). Socrates believes that he and his interlocutors have to start by looking for a definition of the thing in question before looking into aspects of that thing. When Meno wishes to know whether or not virtue is teachable (i.e., when he wants to know something about virtue), Socrates resists, saying, “I am so far from knowing whether virtue can be taught or not that I do not even have knowledge of what virtue itself is” (Plato, 71a, trans. 1981d). In the Laches (Plato, trans. 1992b), Socrates asks about courage, “If we are not absolutely certain what it is, how are we going to advise anyone as to the best method of obtaining it?” (190b–c). Socrates seems to believe that a definition or some other foundational point is necessary to anchor the conversation, to have not only a starting point but a point to return to later in the conversation. Definitions and foundational concepts also tend to be things that interlocutors can debate, shape, and explore together.

When teaching in today’s classrooms and clinical settings, starting by asking for a definition may sometimes be appropriate. More likely, some other foundational principle will be a good starting point. “Shonda, what are the hematocrit levels we would expect to see with this patient?” Or “Lorie, in class you learned about the principles of NSAIDs (nonsteroidal anti-inflammatory drugs). Are there specific principles that you want to keep in mind when you give this medication to Mr. Rosen today?” Or, quite differently, “I see that you are frustrated and concerned, George. What would represent good care for you in this situation with this patient? Let’s start from there.” And then, after George responds, the teacher could follow up with more questions, helping George think through the priorities for providing good care for his patient. The teacher might then open up the question for the group of students: “What do you think represents good care in this situation?”

Using Analogies and Examples

Socrates often uses analogies to help his interlocutors clarify their thoughts. By putting questions into an easier, more recognizable context via an analogy, Socrates helps his co-inquirers more easily think through their own beliefs and assumptions. Not surprisingly, they find it far easier to think and talk about horse breeding or blacksmithing than to answer difficult questions about the nature of courage. By thinking about these analogous questions and situations, they are then more able to think carefully and directly about the question at hand.

Analogies can be used to pose a challenge as well. If an interlocutor seems too sure or comfortable of his statement or action, Socrates uses an analogy to get him to rethink his position. In the Apology (Plato, trans. 1981a), when Socrates’s accuser at his trial, Meletus, boldly claims that all Athenians “make the young into fine good men” except for Socrates, Socrates demands, “Does this also apply to horses do you think? That all men improve them and one individual corrupts them? Or is quite the contrary true?” (25a–b).

Analogies can be very useful in clinical teaching, as they can help to make abstract concepts more concrete and help students understand what changes may be needed in specific situations. If a student is having trouble clarifying his or her thoughts on starting an IV, the instructor might ask, “Well, what if you were doing this with an elderly and frail patient? What if your patient is dehydrated? How would you adapt your IV insertion technique to meet the needs of this patient?” If the student does not understand what changes he or she should consider, the instructor might suggest, “Think of a sponge that has been sitting on the counter for a day and is all stiff. If you wanted to use it for cleaning, what would you do first?” Helping the student to think in concrete terms with an analogy such as the sponge may stimulate him or her to think of the potential for hydrating his or her patient to facilitate the IV start.

Likewise, if a student is having trouble seeing why his or her reasoning may be faulty or a decision in the simulation lab may be a problem, the instructor can introduce an analogy to help the student see the problem. Sometimes humorous analogies can be effective. For example, if a student is caring for a patient in the simulation lab who has a history of bed rest for several days and is complaining of abdominal pain with no obvious cause, the instructor may probe to see if the student considers the possibility of constipation. The instructor might ask: “What happens if you don’t take the garbage out regularly?” (Beitz, 2013). The resulting humor is likely to help both the student and his or her peers remember to consider this possibility in the future. Thus, analogies can act as an anchoring concept, helping to create a type of “cognitive scaffolding” or framework upon which students can “hook” new information to previous understandings (Beitz, 2013).

Similar to his use of analogies, Socrates often gives examples to test his interlocutors’ assumptions and reasoning. He gives examples that should fit what the interlocutor has said, but that do not really fit. For instance, if someone were to say to Socrates that “Love is an undying passion,” Socrates might point to an obvious case in literature or life that most people would agree was love, but that perished or faded. In a nursing context, if a student says I did X because of Y, the teacher can ask, “Well, situation Z would also be Y—would you do that there?” For example, a student may say that it is important to get patients out of bed because it enhances blood circulation. The teacher might say: “Well, this patient has a suspected head injury. Would your rationale for getting patients out of bed hold for this patient?” If the answer to that question is “No,” then the student would need to look for reasons for exceptions to the “get them out of bed” principle, such as identifying the need for bed rest in a patient with head injury to decrease further brain swelling.

Lack of Resolution: Aporia and Circling Back

Many of Socrates’s conversations end without resolution. The Greek word for this lack of resolution is aporia—an impasse or puzzlement. Plato often dramatically brings attention to the situation of aporia: Socrates’s companion suddenly has an appointment to keep or youths are run off by their guardians; in the Symposium (Plato, trans. 1989), the conversation is cut short by drunken revelers! Aporia is a key part of the Socratic process. Without a clear resolution, Socrates’s dialogue partners are left to ponder the questions further on their own, or with each other, and may even feel driven to do so. In this way, the dialogue acts as a springboard for further dialogue and reflection.

Aporia will of course not be appropriate in conversations where a resolution is immediately necessary, such as urgent decisions for a patient’s care. But in less pressing settings, nurse educators should resist the temptation to lead students to right answers or definite conclusions, because it is the thinking that is the goal; it is the journey that is valuable. The frustration or desire for further reflection and inquiry that result from aporia will show students the way to become lifelong learners and careful analysts of their situations going forward. Allowing a lack of resolution is an act of caring, like a parent running along holding onto the back of a young child’s bike, then letting go so that the child can ride on his or her own. As Kost and Chen (2015) put it, “The ultimate aim of elenchus followed by aporia [is] to create a common ground—a state of curiosity—among everyone in the group. From there the group could begin a collective search for truth through further discussion” (p. 22).

The final Socratic questioning technique we should examine is his tendency to take the conversation in a circle or back to where it started. In the Charmides (Plato, trans. 1992a), Socrates insists, “Then start over again, Charmides” (160d); in the Republic (Plato, trans. 1992c), after many, many pages have gone by, Socrates suggests, “Let’s return to the first things we said, since they are what led us here” (588b). This circling-back to the beginning or to an earlier point allows the current conversation to inform a previous one, and vice versa. And by moving with his dialogue partners back and forth, beginning from a similar point multiple times but following new paths, Socrates and his interlocutors are better able to catch their false assumptions and clarify their thoughts. This circling back technique is much like painting a wall, where with each stroke one overlaps the previous one while also covering new territory. And because the dialogue is a circle of sorts, it does not matter where one starts—in a complex clinical situation, many things are connected. Starting with one will lead to others, and then students can be invited to circle back to the beginning and re-examine their thoughts and tentative findings, making more connections as they go.

Socratic Dialogue in Today’s Nurse Education Settings

Socrates’s techniques—starting from where the student’s thoughts and actions are, comparing beliefs, the “say what you believe” rule, priority of definition, analogies, examples, aporia, and circling back—are excellent strategies for clinical nurse educators to use in leading their students in Socratic discussion. It may also be helpful to look more closely at what such a discussion looks like in today’s nursing setting. First and foremost, it is important for the teacher to explain the approach to students: Why questioning? What is the goal? Teachers should make very clear that the questions are directed toward the benefit of student learning and are intended in a respectful way. Teachers should further emphasize that during discussion, peers should show the same respect for the teacher and their peers.

It might be helpful to think of questions fitting into specific categories: exploratory, spontaneous, and focused (Tofade, Elsner, & Haines, 2013). Beginning with exploratory questions (“Can someone describe the situation to me?”) puts students on a common ground and gives the teacher a good idea of what students know and understand. Spontaneous questions can then be asked to follow up on student responses. These questions cannot be planned ahead of time but should be drawn exclusively from the students’ comments, challenging the students and asking them to clarify, think deeper, or consider implications. Then, if there is a topic of particular importance or interest, the teacher can ask more focused questions on that topic, inviting students to look at that part of the discussion in more detail.

Questions can be learner-centered or knowledge-centered (Kost & Chen, 2015). Knowledge-centered questions (“What did your physiology class tell you to expect with a patient like this?”) can be interwoven occasionally into a discussion and can be a good way to test basic knowledge. The majority of questions, however, should be learner-centered, pressing students to reflect on their own beliefs, assumptions, and actions. Learner-centered questions can be “a series of progressively harder questions to encourage metacognition by helping a learner identify the contours of his or her knowledge base, including areas that need improvement” (Kost & Chen, 2015, p. 22).

In choosing questions, a teacher should aim for a good mix of comfortable questions (questions expected to fall within students’ easy grasp) and harder questions. A Socratic discussion session should generally push students to a point past their comfort, confidence, and/or knowledge. Guiding them gently to that point of discomfort is what allows the students to discover gaps, recognize false assumptions, and question their own answers and decisions in a healthy, constructive way.

It may help the reader to look at some sample questions to illustrate these categories. “What were the relevant assessment findings?” would be a fairly comfortable, knowledge-centered, exploratory question. “What would you do based on these findings?” will prompt the student to move into slightly less comfortable territory. When the student responds, a question such as “Why was that your priority?” or “Why did you do X rather than Y?” will move the question into learner-centered, more difficult territory. This spontaneous question is a direct response to the answer the student gave. The student is now being asked to reflect on his or her own thinking and choices. If relevant or in line with learning goals, the teacher might then choose to focus on the student’s response to this line of questions, inviting other students to provide their own thoughts on the matter.

In a Socratic discussion, exploratory questions can be planned ahead of time, but the majority of the teacher’s questions must largely be determined by what the students say—a responsive, genuine inquiry in reaction to student actions and statements. And even starting or exploratory questions should not be overplanned; as Socrates often chose his discussion based on actions or decisions he witnessed, it is highly appropriate for a nurse educator to wait and choose the starting point of the discussion based on the happenings of the day in the classroom or simulation lab or on the hospital unit. The main goal is for the students to think, reflect, and learn. Going into a Socratic discussion session with too many specific content or skill goals in mind will hamper students’ opportunities for genuine inquiry.

All of these techniques and guidelines are well and good for a teacher already comfortable leading discussions with a group of students. But many educators are used to imparting vast amounts of facts in order to cover all the content. These educators are most comfortable with lecture and other more planned teaching approaches. The transition to Socratic discussion can be a bit scary for these teachers. Researchers in a study that incorporated this approach with clinical instructors who were teaching new graduate nurses in a hospital setting found that after the instructors changed their teaching approach to Socratic discussion, they were initially quite uncomfortable, as they were used to providing answers, not having the students provide the answers (Sorrell, 2013). After several weeks of practice with the new approach, however, the instructors gradually became very enthusiastic about using it, as their students were actively engaged in learning. One clinical nurse educator who moved from a lecture approach to a teaching strategy of questioning with her students shared the following:

Stay updated, free articles. Join our Telegram channel

Join