From Inquiry to Insight: Unlocking the Potential of Students' Questions in Medical Education in Singapore

Background: Question-asking serves as a fundamental tool for active learning, allowing students to articulate uncertainties, link concepts, and refine their understanding. Despite its recognized value, the potential of student-generated questions in medical education remains underexplored, particularly in Asian academic settings where sociocultural norms may discourage students from speaking up in classroom discussions. Research on students' questions has overlooked their application as a resource for understanding cognitive engagement and identifying problem areas in student learning. This study, conducted at the National University of Singapore, addresses this gap by exploring student-generated questions as a lens into cognitive engagement with course content. Methods: A content analysis approach was used to classify questions submitted anonymously by first-year medical students via a shared question-and-answer document embedded in the self-directed learning segment of a cardiovascular physiology course. Questions were categorized by cognitive levels using the revised Bloom's taxonomy, which provides a structured framework for assessing cognitive complexity. A chapter-based analysis examined question distribution across content areas to identify patterns in topic-specific inquiry. Two independent raters performed the classification, reaching an inter-rater agreement of 83.2%. Results: Two-hundred ninety-eight (298) questions were analyzed, with most categorized at the 'Understand' (56%) and 'Apply' (29%) levels. This distribution closely aligns with the educational objectives of the self-directed learning segment and foundational medical curriculum, which prioritize comprehension and practical application. Slight variations across cognitive levels, particularly in higher-order categories, suggest that the nature of certain topics or instructional activities may promote deeper engagement. Question frequency was not uniformly distributed across topics, with electrocardiogram and clinical examination topics eliciting the most questions, likely due to the foundational relevance and integration with subsequent teaching activities. Discussion: Incorporating opportunities for question-asking within the curriculum is a promising strategy for examining students' cognitive engagement in medical education. The prevalence of 'Understand' and 'Apply' questions highlights a strong engagement pattern aligned with early-stage medical education, while chapter-based trends suggest topic complexity or instructional activities may influence question-asking patterns. By systematically analyzing student-generated questions, this study provides a structured means of assessing how students engage with course content at different cognitive levels. These insights can be used to inform instructional strategies that better support student engagement, allowing educators to refine teaching approaches according to learners' needs.