496 - When the answer isn't obvious: Using debate in medical education

Publication Number: 496.7090

Aditi Gupta, Baylor College of Medicine, Bellaire, TX, United States; Shelley Kumar, Baylor College of Medicine, Houston, TX, United States; Ana Monterrey, Baylor College of Medicine, Houston, TX, United States

Background: Social determinants of health (SDOH) education is ACGME required for pediatrics. Universal SDOH screening is common but can worsen health inequities if implemented without consideration for ethical principles. Debate can effectively help participants learn communication and critical thinking skills with complex topics requiring understanding multiple points of view (POV). Given the complex nature of SDOH screening, we asked residents to debate the pros and cons of universal screening for SDOH.

Objective: Evaluate debate as a teaching tool for a topic with multiple POVs.

Design/Methods: At the start of their community and advocacy rotation, 2nd year pediatric residents completed a survey asking their agreement with the following (0-100): SDOH screening should be done for all patients. At the end of the rotation, residents virtually debated the ethical considerations of universal SDOH screening and were assigned to the pro or con side alphabetically. After the debate, facilitators lead a group discussion emphasizing important aspects of SDOH screening. Residents completed a post survey with session evaluation questions that again asked their agreement with: SDOH screening should be done for all patients. The post survey also asked how residents’ view on SDOH screening changed and how they would use the information learned in future patient care. Data were analyzed using paired t-test.

Results: Of 113 residents enrolled in the rotation, 48 consented to participate and completed pre and post surveys (July 2023 -September 2024), response rate of 42.5%. Before debating, mean agreement scores were statistically significantly higher (M = 87.4, SD = 13.5) compared to after (M = 80.6, SD = 15.6); p=.017 suggesting that after debating, residents significantly disagreed that social determinants of health screening should be done for all patients. Evaluation data for the debate was positive (Table 1). Free text responses (Table 2) on how the debate changed residents’ views on screening revealed a greater understanding of nuances of SDOH screening and appreciation of the contrary perspective. Responses on how residents would apply concepts learned to patient care focused on awareness of bias in SDOH screening and thoughtfulness on screening implementation including importance of framing.

Conclusion(s): Debating on universal SDOH screening is an interactive and effective way to teach residents how to analyze a complicated issue. As residents transition into practice, it is important they use these skills to critically evaluate new recommendations in patient care.

Debate Session Evaluation Data


Themes and Example Quotes