Using Riddles as Medical Teaching Tools

In a recent article in The American Journal of Medicine (AMjMED), Stanford Medicine 25’s Abraham Verghese advocates for riddles as a teaching tactic. With co-author Andrew Elder and other colleagues from Stanford and UW School of Medicine, Verghese describes a riddle as an educational “exercise” that “requires thought and deliberate practice, qualities that have their benefits in many aspects of clinical care.” The authors suggest that medical examinations should be presented in the form of riddles to promote “the development of analytical thought,” a skill we know to be beneficial while conducting physical exams at the bedside and determining a diagnosis.

In 2009, Verghese authored Teaching Medicine, One Mystery as a Time which reminds us that “since ancient times, riddles have served as teaching tools [because] the point of the riddle, at least the medical riddle, is to search your brain, then search your books or the library, then connect the dots.” Medical riddles provoke thinking and analysis, inspiring more in-depth research (like ordering better laboratory tests), as well as prompting better questions to help determine a specific diagnosis.

This process, says the AMjMed article, is lost in our “electronic medical record–centered, ’4000 clicks a day’ culture.” Google search can provide a quick answer, but it “circumvents… the practice of analytical thinking” and the development of “higher-level reasoning.” This is why Verghese stresses the value of riddles in teaching and learning: “As the scientific revolution in medicine continues, and as new diseases and therapies appear,” the “canon of riddles” must grow as well.

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