Avoiding the “wall of silence” in the lecture hall: keep your first question simple

By Anthony Llewellyn (@hetimeddir)

I was recently asked by another faculty member to help out by taking a lecture for some medical students.

The audience was a group who I had not yet met and the topic (Introduction to Psychiatry) was one of many delivered in an introductory week of lectures for a course on Medicine and Surgery (for which the psychiatric aspects of medicine and surgery was just one of about about 24 learning outcomes).

This presented somewhat of a challenge for me as my normal approach to delivering lectures is to turn them into a seminar where I try to outline areas of important knowledge and skill first by questioning students about what they already know and then by endeavouring to fill in the gaps.

I was a bit worried that this approach might fall a bit flat as a) there had been little recent engagement by the students in the topic and b) I had not had a chance to develop a rapport with them previously.

As an adjunct to this I currently supervise a number of trainees who assist me with teaching and I had been reflecting with one of them about how best to include audience questions as part of a teaching session. What I had been noticing in trainees and myself is that sometimes we not asking the best questions of students in order to stimulate a response.

Sometimes the initial questions were too difficult for e.g. “what is a nihilistic delusion?” Or sometimes to complex, for e.g. “can you tell me the difference between insight and judgement?”

If our aim of questioning our audience is to improve their confidence in a subject then the easier our first questions are the better (even if these may sound so simple that the students may think there is some sort of trick going on). It is better to build more complexity on top of previous questions than to start out too complex. The former is commonly referred to as using the “Socratic Method” and the latter “Pimping” although there are many other factors (particularly psychologically safety) involved in the Socratic Method (Stoddard, O’Dell, 2016).

So, using the first example above, when asking a class of medical students about nihilistic delusions one might start off by asking them to build the headings of the Mental State Exam, then asking them about disorders of thought content, then what a delusion is, then what types of delusions they might know of etc…

And, using the second example one might start by asking students to give an example of poor insight and then an example of poor judgement and then asking them to reflect on what they think the differences between the two may be.

I should also add that in the process of answering questions students may often give a partially satisfactory response. Its important to praise this effort rather than to correct it yourself. If required ask another question to build on the response, such as “great and does anyone else know anything more about nihilistic delusions?”

In reflecting on this process I was reminded of the excellent Ted Talk by Derek Sivers on “How to Start a Movement”.

In his talk Sivers shows how it is often not the first person (leader) that starts a movement. It is the job of the first leader to show others how simple their movement is. But it is the first follower who is most crucial in convincing others to join in.

When your task is shifting your audience from passively engaging with you to actively engaging with you, the first few engagements are critical as audience members may be reluctant to be one of the first to move to the “new norm”. By kicking off with simple questions you make it easier for audience members to feel ok about diverging from the group.

Just like in Derek Sivers video, I’ve noticed in my audiences there is often one person who looks like they know the answer and needs your encouragement but if you also look more closely there are usually one or two others who look like they might want to help out and encourage the first person. If you target these people next the whole group should quickly start to engage with you.



Stoddard HA, O’Dell DV. Would Socrates Have Actually Used the “Socratic Method” for Clinical Teaching? J Gen Intern Med. 2016 Sep;31(9):1092-6.

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