The recitation

The third method of discursive teaching—recitation—resembles the tutorial in that there is an ongoing exchange between teacher and student, but differs in that a question-and-answer method is employed by the teacher in examining the student. Recitation is a frequently neglected form of teaching in clinical disciplines because it may seem to emphasize a paternalistic and hierarchical distinction between the questioning instructor and the responding student that is now out of pedagogical fashion. Although students are accustomed to recitation earlier in their education (as in high school or even in some college classes), they are less accustomed to its challenge after university graduation. We hold that it is most necessary in teaching a discipline such as psychiatry where the linkages between facts, observations, concepts, and opinions must be criticized as well as discursively drawn forth.

In the recitation a group of students are presented with a patient and then are questioned by the teacher one by one about what they observed and what conclusions they can draw on the basis of these observations. This enterprise, carried on as it is in a group and in a question-and-answer form, has great power in demonstrating not only what a student knows (or does not know), but also in challenging received but inaccurate opinions that have shaped the student's perceptions. It is ever an active process. The students must work for their answers. The teacher leading a recitation must sustain a coherent series of questions and develop from the answers (complete or incomplete as they may be) a fuller picture of the issues at hand. The questions that the teacher asks fit into a set of pedagogical purposes. They explore matters of evaluation and explication first, but then usually go on to explore the limits in knowledge about the subject matter.

For a successful recitation the students must bring some knowledge to the session. Efforts at questions and answers attempted with individuals who have no information quickly deteriorate into confusion and embarrassment, an agony for student and teacher alike. The exercise is to evaluate the extent of knowledge and broaden its foundations and contents. Thus the questions asked in successful recitations are seldom trivial ones that can be looked up (e.g. What is the standard dose of an antidepressant?) but rather questions that open the history of psychiatry and point to its future (e.g. What justifies the use of personality diagnoses in categorical terms?). Because all students are questioned and all listen to the answers of their peers, recitations unify a group of students in their understandings and in their conversations. Active participation in the group reassures everyone about what they know and how they know it.

Early in the course of a student's development the recitations must deal with fairly rudimentary issues of facts and theories about clinical issues—often mere restatements of the obvious are needed at the beginning, given the many ways students can be confused by the subject matter. With the gradual development of more sophistication amongst the students, recitations can evolve into discussions and explorations that go into greater depth of information and implication—all still in a question-and-answer form. The critical point about a recitation is that it should never be limited to what the pupils know but quickly move beyond the easy answers to become searching and provocative. Students often find this teaching at once challenging and exciting, particularly if it is possible to move by way of questions and answers into implications about psychiatry that have not been appreciated even though they are fundamental.

Although recitations have a fixed beginning (as with a case presentation), their course must always be improvised because the answers to initial questions determine the direction of subsequent ones and this path cannot be predicted before the first questions are asked. The recitation should conclude with some resolving consensus amongst the group. This resolution emerges as the questions ltimately move the group in a logical fashion towards a defensible proposition. The major goals of recitation are to bring—through questions asked and answers delivered, through making clear what had been vaguely presumed—a greater understanding of the subject matter to the students and a growing enthusiasm for psychiatry as a valuable, engaging, and challenging intellectual enterprise.

Recitations will always elicit many of the presumptions and prejudgements students bring to psychiatry. The very process of composing an answer to a question reveals foundational opinions that students have and often fail to reflect upon. Presumptions and prejudgements are to be expected; prejudices (opinions maintained even after counter-evidence is provided and examined) are what are eliminated in the group encounter with fellow students. The group experience under a knowledgeable critical leader advances learning and reduces prejudices better than any other pedagogic method.

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