The Art and Science of the Chalk Talk in Clinical Settings
An essential skill for any excellent clinician is the ability to teach effectively. In a variety of fields including the clinical setting, one of the most enduring and practical teaching methods is the chalk talk, a collaborative, simple approach well-suited for engaging medical students, residents, and other trainees.
Despite its popularity, few clinicians receive formal training in delivering a high-quality chalk talk. This blog post explores strategies for using chalk talks effectively in the clinical learning environment.
Key Educational Foundations
The chalk talk is suited to meet the needs of adult learners when delivered deliberately. The chalk talk naturally supports adult learning theory in several ways. Unlike lectures, chalk talks are typically initiated in response to a specific patient case, directly tying the content to the learner's immediate clinical experience. They also focus on collaboration, where the shared, visible canvas encourages the learner to actively participate by asking questions, filling in blanks, and drawing connections. This shifts the dynamic from passive reception to active construction of knowledge. Chalk talks align with how clinicians approach problems and can thus be problem centered, where discussion can start with a chief complaint or a confusing lab value, building the differential diagnosis and management plan organically.
The Science of Visual and Verbal Integration
The effectiveness of chalk talks is rooted in cognitive science, particularly dual coding theory and cognitive load theory. An excellent chalk talk capitalizes on these principles to maximize memory encoding and minimize extraneous cognitive effort. Dual coding theory posits that information is better retained when it is delivered simultaneously through two separate channels. These include a visual channel, such as seeing the writing and/or drawing, and a verbal channel from hearing the explanation. In a chalk talk, the educator utilizes verbal input by speaking the main concepts, while also utilizing visual input by writing or drawing the corresponding key words, flowcharts, or diagrams. This deliberate redundancy allows the learner to encode information through two distinct mental pathways, which can significantly improve recall and comprehension compared to hearing a verbal explanation alone or reading a pre-made slide.
Cognitive load theory states that learners benefit from techniques to decrease extraneous cognitive load and tailor teaching to make it readily applicable and relevant to the learner. Chalk talks are powerful tools for managing extraneous cognitive load because unlike dense PowerPoint slides that can present overwhelming pre-made graphics and text, the chalk talk is built in real-time. This offers three critical advantages. The first is pacing control, where the speed of drawing or writing forces the educator to slow down, matching the pace of content delivery to the learner’s processing speed. Second, the learner's attention is focused on the single, evolving point of creation, rather than scanning a screen for the next bullet point or recalling earlier slides, thus minimizing distractions. Third, by drawing flowcharts or diagrams from scratch, the educator explicitly demonstrates the relationships between concepts, reducing the cognitive effort required for the learner to synthesize the information independently. This also allows flexibility in pivoting the direction of a talk without having to redo the presentation.
The Art of Delivery
Effective chalk talks are short — ideally 10 to 20 minutes — and focused on one core clinical topic or concept. Chalk talks with what the learner already knows, such as the patient case or basic anatomy, and incrementally add complexity. A good structure starts from the chief concern and flows from the mechanism of pathology to the differential, and finally to the management of the underlying condition. When planning your chalk talk, it can be beneficial to begin with the final diagram and then work backward to your starting point.
A strategic visual design is key. Avoid simply listing bullet points. Instead, use the board to create hierarchical structures. Utilize arrows to show cause-and-effect, boxes to group concepts, and different-sized lettering to emphasize high-yield information. If markers of multiple colors are available, utilize distinct colors for specific functions. This quickly provides a visual map for the learner. Drawings should be simple, clear, and quick to execute. The goal is to convey a concept, not to create a medical illustration. Ensure handwriting is large and legible for all learners to see.
The power of the chalk talk is its collaborative, iterative nature. Pose questions that require the learner to apply the information as it is being built. For example, instead of drawing the whole mechanism of heart failure, ask: "If we block the renin-angiotensin system here, what is the expected clinical effect?" Then, allow the learner to fill in the next arrow or box. As such, it is helpful to explicitly create space for learners to make safe mistakes. When a learner offers an incorrect step or differential, write it down, discuss why it is less likely in this context, and then cross it out or erase it. Conclude by having the learner verbally summarize the entire concept using the drawing as their guide, which can serve as a powerful knowledge retrieval practice. Ask for feedback and share any additional resources or learning materials with the learners after the chalk talk.
Conclusion
The chalk talk endures not merely due to tradition or convenience, but because it's core mechanism aligns with established principles of adult learning and cognitive science. By integrating the deliberate use of dual coding theory and managing cognitive load through real-time construction, the modern clinician educator can transform the simple whiteboard into a highly effective, engaging, and durable tool for use in the clinical learning environment.
Jeet Das, M.D., is a PGY3 internal medicine resident at Saint Louis University School
of Medicine and SSM Health. Jeet’s areas of professional interest include peer-led
learning, just-in-time teaching and education technology. Jeet can be followed on
LinkedIn or contacted via email.