Asking to advance: a discourse analytic perspective on how Socratic questioning scaffolds medical house officers’ expertise

BACKGROUND: Housemanship is a transitional phase that prepares medical graduates to become safe, independent practitioners. Learning during this phase occurs through patient-case talk with senior doctors, a hybrid interaction that serves patient care and learning. Effective case-based learning has been linked to fostering participation, dialogue and strategic language use, with Socratic questioning recognised as a key scaffolding approach. However, discursive evidence of how such questioning unfolds in everyday training remains limited. This study examines how house officers and senior doctors formulate questions and responses to facilitate teaching and learning in two training contexts. METHODS: We performed a discourse analysis of naturally occurring patient-case talk between house officers and senior doctors in the Paediatrics Department of a teaching hospital in Kuala Lumpur. Audio-recorded interactions produced 21 units of patient-case talk from five Continuing Medical Education (CME) sessions and 78 units from 13 Ward Rounds (WRs). Drawing on concepts of questioning and responding practices, the analysis identifies how senior doctors design questions to scaffold learning and how house officers orient to these designs in producing responses. RESULTS: Senior doctors use varied questioning practices to scaffold developing expertise and promote self-correction. In CME sessions, they frequently use polar questions and designedly incomplete utterances, with house officers displaying interactional agency through repetitional and transformative responses. During ward rounds, senior doctors rely more on wh-questions, often paired with designedly incomplete utterances, to stimulate reasoning and self-initiated repair. Collectively, these practices foster reflection, critical thinking and discovery-based learning without prematurely providing answers. CONCLUSION: This paper demonstrates how questioning functions as a key discursive resource for scaffolding expertise in Malaysian medical training. It extends understanding of Socratic questioning by showing how distinct question designs support self-correction, reasoning and learner agency across teaching contexts. Strategic questioning allows senior doctors to address knowledge gaps in a manner that aligns with principles of psychological safety. As a result, house officers engage in the interactional display of a clinical voice and demonstrate an orientation toward managing uncertainty as part of learning. These insights provide actionable, evidence-based direction for faculty development and clinical teaching practice.