Polling can be used to pre-test and post-test participants to assess changes in knowledge, but it also has other uses. Well-designed polls can lead participants to practice clinical decision-making, understand the consequences of those decisions, or help them understand what they still need to learn to be able to adopt the behavior change. Remember to:

• Allow time to discuss the results of a poll, so that participants can understand the reasoning underlying the correct answer.

• Incorporate polling with the familiar case format to engage people more deeply.

• Use a progressive, linked series of polls to help participants see how the clinical picture plays out.

Example Case: Musculoskeletal Medicine

A 45-year-old woman was involved in a low-speed bike accident two days ago. Initially she thinks she has just an abrasion on her right knee, and so she is able to ride another five miles. Then her knee swells markedly and she can no longer bear any weight on that knee, and her range of motion is significantly restricted. She is healthy with no prior knee problems. There is tense effusion. She is holding her knee in 30-degree flexion. On initial exam, her range of motion is limited by pain. Her skin is clear, except for a small, healing abrasion.

 

Poll 1: Would you aspirate her knee?

A. Yes, in a tense effusion, aspiration can be therapeutic.

B. Yes, and if she has a bloody effusion, I will be more likely to order advanced imaging.

C. Yes, and then inject lidocaine to check her range of motion.

D. No, the risk of infection outweighs any potential benefit.

To engage participants after the poll:

The presenter can use discussion between polls to explore participants’ thinking and reasons for choosing a particular option. For example, “Someone who picked A, can you share your thinking?” And then, “Someone who picked B?”

Be sure to explore all the options.

Learning is enhanced through polling only when none of the answers is either right or wrong. Instead each offers some genuine value. As a result, the poll is less about passing a test and more about practicing clinical decision-making.

The case continues. The knee was aspirated, producing 80 cc of bloody fluid with no fat globules. Post-aspiration, the patient has almost full extension, and flexion to 90 degrees, with no apparent laxity. There is some posterior-medial joint line tenderness.

 

Poll 2: What would you do now?

A. Protect her knee in an immobilizer and re-evaluate in a week.

B. Order an MRI to determine whether there is internal derangement.

C. Order a CT scan to look for radiographically occult fracture.

Faculty should again lead the discussion of the reasons for and against choosing each option.

Suppose the group chose Option A—to re-evaluate in one week. The case continues. After one week, there is minimal improvement. The MRI shows a displaced bucket-handle tear, and the patient is scheduled for surgery. Two days before surgery, she calls stating she felt a pop while changing her position in bed, and now she can move and straighten her knee without pain. She’s wondering whether she still needs to go ahead with surgery.

 

Poll 3: What would you tell her?

A. She should still have surgery to attempt repair of the tear or shave back to a stable base.

B. At this point she can take a wait-and-see approach.

Telling the story using linked polls, one result feeding into another, increases participants’ investment in the discussion. Participants want to know what happens to our patient as a result of the decisions we have made! The learning points underlying the case become clearer, more memorable, and more actionable.