Students’ Perspective of Debates as a Pedagogy in a Critical Care Elective
Anthony Hawkins, PharmD,
1,2
BCCCP ;
Michael Fulford,
1
PhD ;
Stephanie V. Phan, PharmD,
1
BCPP
1University
of Georgia College of Pharmacy, Southwest Georgia Clinical Campus, Albany, Georgia
2Medical College of Georgia at Augusta University, Southwest Georgia Clinical Campus, Albany, Georgia
BACKGROUND
RESULTS
ADDITIONAL METHODS AND COURSE DESIGN
• A dilemma with teaching and learning in pharmacy
education is that activities often promote rote learning,
which students may prefer because it requires less mental
fortitude than would a strategy incorporating deeper
learning, such as critical thinking or clinical reasoning.1,2
All students (N=4) participated.
Format
Week prior
• 15 week semester (satellite campus only)
• Weekly – 2 hour class meeting
• Various debate team structure
• Debates are an effective way to introduce clinical reasoning
of complex and controversial issues into teaching and
enable students to take responsibility for their own
learning.3,4
Assign debate
topic and teams
Word cloud derived from focus group transcription
Pre-class
Literature
search
In-Class
Document
sharing
Content debate
Opening statements
Closing statements
P3s vs. P3s
• In pharmacy, debates have been used to teach ethics,
ambulatory care, and perinatal pharmacotherapy.5-7 Use of
debates within courses has been associated with:8,9
– Teamwork
– Enhanced communication
– Critical thinking
– Literature searching
– Application of evidence
P3s vs. P4s
Debate Teams
P3s vs. Facilitator
P3 vs. P3s vs.
Facilitator
Assessment
• This course was developed to impart professional
competencies while ensuring the acquisition of knowledge
and understanding of relevant topics.
• Pass/Fail
• Debate participation
• Position paper
• The course was mapped to the American College of
Pharmacy Education (ACPE) Standards to identify its place in
the curriculum.
Select debate topic titles
Statins as a treatment option in sepsis
METHODS
Choice of fluid for volume resuscitation
Use of dopamine in acute decompensated heart failure
• This is an IRB-approved, observational study.
Targeted temperature management: 33°C vs 36°C
• Inclusion criteria: students enrolled in PHRM 5210 Debating
the Evidence: Focus on Critical Care Controversies
Aggressive caloric intake or permissive underfeeding
• Written informed consent was obtained.
Pepcid or Protonix for stress ulcer prophylaxis
• An outside investigator conducted an off-campus 1-hour
focus group at course completion, which was audio
recorded.
Use of stress dose steroids in septic shock
• Questions and discussion were created to assess student
perceptions on using debates in the course and the impact
on development of necessary skills.
PharmD dedicated to the intensive care unit
• A third party transcribed the audio recorded focus group,
which was used for further analysis.
Olseltamivir dose in the treatment of influenza
Alcohol withdrawal: Symptom triggered or fixed scheduled
Sedative agent in mechanically ventilated patients
Choice of seizure prophylaxis in traumatic brain injury
Thrombolysis in submassive pulmonary embolism
Benzos or booze for alcohol withdrawal syndrome
Acetaminophen to treat fever
Position paper
Focus group questions
• What was appealing to you about this course, if anything?
• Because you were debating, were you more engaged because
you wanted to be or because you felt like you had to?
• Has this class offered you any connections that you could see
making sense outside of critical care? Can you see what you
got out of this class and working in community pharmacy?
The word cloud offers insight into themes that emerged. Further
review of comments shows students felt the course helped them
learn how to review “articles” and identify “different” points of
view. Students continued to say they “probably” spent more
time on this class than others because they had to be prepared.
• When you think about foundational knowledge, how much
preparation time do you think you put into that area of
learning?
Select quotes from focus group transcription
• How much did patient centered care, quality of life, or
cultural or socioeconomic classifications come into play?
“…quality of life was definitely debated quite a lot in most of
our debates…”
• Did you find yourself debating against the standard of care?
“…one side that was like the physician and the other side that is
essentially what will be the pharmacists so that helped with
problem solving and understanding the process that it takes to
kind of get the other side or physician to take your advice…”
• What impact do you think this class had and the format of
debating had on your ability to problem solve?
• How do you feel this class prepared you for answering clinical
question? Discuss your confidence in this area.
ACPE standards
Standard 1: Foundational Knowledge
Standard 2: Essentials for Practice and Care
Standard 3: Approach to Practice and Care
Standard 4: Personal and Professional Development
Standard 10: Curriculum Deign, Delivery, and Oversight
Standard 11: Interprofessional Education
References:
1. Taylor K, Harding G. The pharmacy degree: the student experience of professional training. Pharm Educ
2007;7(1):83-88.
2. Novak JD. The promise of new ideas and new technology for improving teaching and learning. Cell Biol Educ
2003;2(2):122-132.
3. Berdine R. Increasing student involvement in the learning process through debate on controversial topics. J
Manag Educ 1984;9(3):6-8.
4.
Bradshaw MJ, Lowenstein AJ. Debate as a teaching strategy. Innovative Teaching Strategies in Nursing and
Related Health Professions. 5th ed. London: Jones and Barlett Publishers; 2010:163.
5. Elliott J, Koerner P, Heasley J. The Impact of Elective Active-Learning Courses in Pregnancy/Lactation and
Pediatric Pharmacotherapy. Am J Pharm Ed 2012;76(2):26.
6. Vincent AH, Weber ZA. An elective course on current concepts in adult ambulatory care. Am J Pharm Ed
2014;78(10):183.
7.
Hanna L, Barry J, Donnelly R, Hughes F, et al. Using debate to teach pharmacy students about ethical issues.
Am J Pharm Ed 2014;78(3):57.
8. Charrois T, Appleton M. Online debates to enhance critical thinking in pharmacotherapy. Am J Pharm Ed 2013;
77(8);170.
9. Kennedy R. In-class debates: fertile ground for active learning and the cultivation of critical thinking and oral
communication skills. Int J Teach Learn High Educ 2007;19(2):183-190.
“I can’t say, ‘well this is what we found and this is the exact right
answer’ because there are so many things or factors that would
change my answer depending on the patient.”
“…if you didn’t understand what the disease state that was
going on, or things about it, then there really wasn’t a way you
could argue for your side.”
IMPLICATIONS
Students found that debate style learning helped hone
literature search and evaluation skills and critical thinking, but
due to the controversial nature, did not aid in content mastery.
Instead, that many answers are patient specific. They found this
pedagogy required extensive pre-class preparation compared to
other courses.
Disclosures: The authors of this study have nothing to disclose.