POINT/COUNTERPOINT:  STUDENT DIRECTED CLINICAL AND RESEARCH DEBATE 

R. M. Walsh*, K. Cobb, and S. Preztak,  Departments of General Surgery and Family Practice, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, 44195 U.S.A.

Purpose: Some of the goals of a new combined Medical/Surgical rotation include acknowledging divergent surgical and medical approaches to common clinical problems, advance the concept that various approaches are supported by competing data, and that both clinical and basic science research can be utilized in clinical decision analysis. 

Methods: Clinical scenarios are presented depicting common clinical problems with confounding variables.  These scenarios include a young woman with genetic breast cancer; a young man with reflux symptoms, Barrett’s esophagus and no insurance for medications; and a patient needing perioperative anticoagulation.  Students are assigned to support one of two predetermined clinical algorithms:  Prophylactic bilateral mastectomy vs. medical surveillance; laparoscopic Nissen fundoplication vs. medical therapy and endoscopic surveillance; and low molecular weight heparin vs. hospitalization and full anticoagulation.  Four students are divided into two teams:  each student formulates their own argument, one based on clinical data, the other with basic science literature.  The debate is presented in front their peers, and a faculty facilitator encourages feedback on quality of data and argument formed.  Each presenter also provides one principle article in advance to their colleagues for review.  Outcome was assessed by anonymous feedback.

Results: Student preparation and review of literature has been of high quality.  Student feedback suggests that case scenarios have clinical relevance and competing arguments for patient management were justified and compelling.

Conclusion: The combination of traditionally separated disciplines allows for discussion of diverse approaches to common clinical problems.  Students seem to thrive in the debate format.