Background: In medical education, there has been a push to implement innovative teaching techniques that encourage critical thinking rather than just knowledge dissemination. Debate promotes critical thinking by challenging individuals to consider alternate viewpoints, which could make it an ideal format to review the evidence relevant to common clinical dilemmas in infectious diseases (ID). We describe a pilot of one such debate format in our ID fellowship program.
Methods: We reviewed literature regarding the effectiveness of ceftriaxone for outpatient antibiotic therapy (OPAT) in methicillin-susceptible Staphylococcus aureus (MSSA) osteoarticular infections. The evidence was presented as a structured debate in place of our weekly case conference. Pre- and post-session surveys containing multiple choice questions and Likert items were administered to assess the impact of the debate on attendees knowledge, attitudes, and practices on this topic along with their attitudes toward the debate format. Differences between pre- and post-session surveys were analyzed using paired t-tests and McNemars test.
Results: At the first debate 33 residents, fellows, and faculty members were present, and 24 (73%) completed both the pre- and post-session surveys. Attendees demonstrated significant improvement between the pre- and post-session knowledge questions, which covered the following topics: study design of articles supporting ceftriaxone use (31% vs 62%, p=0.008), appropriate method to assess ceftriaxone susceptibility (64% vs 100%, p=0.004), and whether the inoculum effect applies to ceftriaxone (35% vs 77%, p=0.003). After the debate, attendees were more willing to use ceftriaxone (p=0.001) and felt more familiar with the literature (p<0.001). The post-session survey showed that individuals both enjoyed the format and found it effective (Figure 1). Most individuals stated that they were either extremely likely (85%) or likely (8%) to attend if this format was used again. Written comments included strongly recommend continuing this format and much better than regular case conference with more discussion and critical thinking.
Conclusion: Debate appears to be an effective and enjoyable format to teach clinical controversies in ID.
J. O. Spicer,