When we hear the words debate and medicine, our mind almost automatically turns to healthcare policy. What are the advantages and disadvantages of a single-payer system? Should vaccines be mandated for school registration? Will a fast-food tax lead to a change in eating behaviors?
Understanding healthcare policy is important for aspiring healthcare providers. However, debating the merits of healthcare policy barely scratches the surface of the role that speech and debate skills play in everyday medical practice. Read on to learn how speech and debate classes can help your future physician become an innovative leader in their field from guest writer Dr. Christie Palladino.
Sparked by the release of large-scale data on medical errors, the practice and teaching of evidence-based medicine became a real entity in the 1990s (Djulbegovic, 2017). Organizations began to integrate it into standard practices and medical education programs. One only need look to the three tenets of evidence-based medicine to see the connection to speech and debate (Djulbegovic, 2017):
How do Speech and Debate classes build such skills? The very first step in the Early Scholars Speech and Debate rotational curriculum model is Topic Analysis. Early Scholars Speech and Debate students learn from the beginning that no claim is sufficient without supporting evidence. Without any evidence, there is no case.
Unfortunately, most schools have shied away from focusing on analysis in their science curricula. Because it is an active process, analysis requires resources that schools may not have.
In fact, motivated health students can make it to their first evidenced-based practice class, only to be shocked by its teaching philosophy. Where are the multiple-choice questions that they grew so accustomed to? Why do they have to give a reason for their answer? As a former professor of evidence-based medicine, I have seen this confusion in the flesh.
The second tenet of evidence-based practice states that the totality of evidence should be considered for medical decision-making (Djulbegovic, 2017). This tenet presents its own challenges and questions to students. What do you mean that two studies with similar methods came to different conclusions? How can a certain medication be effective but still have harmful side effects? How can health disparities exist if we all live in the same country?
The most successful health professions students have the skills to weigh the evidence for and against an approach. Medical diagnoses rarely fit the textbook description. It is often hard to tell whether something is related by correlation or by true causation. Answering these types of questions requires patience and the skill of looking across many sources of evidence to make the best scientific case.
Early Scholars Speech and Debate students learn causal analysis as a standard piece of the curriculum. For example, is the South more obese simply due to location? What role might diet play? Economics? Education? A student who has the skill set to weigh multiple sources of evidence will help their patients make smart and informed choices. Not to mention that a student who is comfortable with the uncertainty of medicine may likely become a more open-minded physician. If we do not teach our children these skills at an early age, they will carry their implicit biases and stereotypes into their careers.
In medical education, we have what is called the hidden curriculum. Lessons that are not explicitly taught but are conveyed instead through gestures, hospital culture, observations, or other hidden messaging. One long-held tenet in the hidden curriculum is that you should “never ever admit that you don’t know the answer.” I think the reasoning behind this tenet must be that the patient will have less confidence in you if you say you don’t know. But nothing could be further from the truth.
A patient wants to know what you’re thinking (Bernacki, 2014). What possibilities are you considering? What would be the next step in working through these possibilities? What advantages and disadvantages should they consider before starting this treatment? After all, the third tenet of evidence-based practice is shared decision-making with the patient and caregivers (Djulbegovic, 2017).
Building these types of communication skills takes time. Thankfully, this is another place where a stellar speech and debate skill set can help. Speech and debate students learn several important communication skills:
The last skill is perhaps the most difficult to learn. Patients will have questions. The hidden curriculum physician will shut down the conversation when those questions arise, find a way to run out of the room, change the subject, or worse, just keep talking over the patient. A good debater must carefully listen to questions, place them in the context of the information they have, and give a thoughtful response.
In our current society, information can be found in an instant. However, the volume of information can be overwhelming, especially when your job requires you to locate that information during a patient visit, on your lunch break, or more likely, after hours.
Medicine needs information seekers. Physicians who are motivated by the pursuit of information — good information. The medical community admits that quality evidence is often hard to find (Djulbegovic, 2017). We know that publication bias skews research to show that treatments work (Djulbegovic, 2017), even when there might be evidence to the contrary.
You might think that medical schools are teaching these skills. But recent evidence points to the contrary. Few schools have reported actual courses in information seeking or information literacy. And those schools that have reported such curricula rarely do so in an active way, meaning that most of the instruction occurs in a classroom or online; not in the clinics (Maggio, 2014). Fortunately, debaters do practice active information seeking. It is a standard part of case development and causal analysis in the Early Scholars Speech and Debate curriculum. Students locate information and use it to create and present their claims. Students can also use that information to anticipate weaknesses in their claims.
Training in information literacy and critical thinking skills can be effective (Shao, 2016), but there are many obstacles to acquiring these skills. These include not only tangible but also social and psychological variables (Maggio, 2013; van Dijk, 2010). Even when opportunities to develop critical thinking skills are available, students may not use them. In a recent study of college students, over half did not utilize pre-existing resources (Shao, 2016). Even resident physicians, who already hold a Doctor of Medicine degree, report a lack of critical appraisal skills as a barrier (van Dijk, 2010).
What are we to do? The International Guidelines on Information Literacy highlight the synergistic effect of developing information literacy and lifelong learning skills. Their recommendation is that the sooner students develop these critical skills, the better. As the Guidelines note, these skills are both “self-empowering” and “self-actuating” (Lau, 2006).
So as a physician, researcher, and educator, I can tell you that these skills are important for our young learners. Opportunities to build them may not be readily available in students’ standard educational experiences (Maggio, 2013; van Dijk, 2010; Oberman, 2020). Yet, every patient encounter requires a careful balance of evidence, an intentional decision-making process, and the ability to communicate that process to your patient. Speech and Debate can be an effective way to build such skills in your little nurse, doctor, or therapist! And for those future healthcare providers, their patients will be grateful.
At Early Scholars, we are committed to giving students a challenging and well-rounded education. For more information on enrolling your child in one of our programs, contact us today.
Bernacki RE, Block SD; American College of Physicians High Value Care Task Force. Communication about serious illness care goals: a review and synthesis of best practices. JAMA Intern Med. 2014;174(12):1994-2003. doi:10.1001/jamainternmed.2014.5271
Djulbegovic B, Guyatt GH. Progress in evidence-based medicine: a quarter century on. Lancet. 2017;390(10092):415-423. doi:10.1016/S0140-6736(16)31592-6
Gross, M. and Latham, D. (2012), What's skill got to do with it?: Information literacy skills and self‐views of ability among first‐year college students. J. Am. Soc. Inf. Sci., 63: 574-583. doi:10.1002/asi.21681Lau, J. (2006). Guidelines on Information Literacy for Lifelong Learning. Retrieved July 17, 2020, from https://www.ifla.org/publications/guidelines-on-information-literacy-for-lifelong-learning
Maggio, L. A., & Kung, J. Y. (2014). How are medical students trained to locate biomedical information to practice evidence-based medicine? A review of the 2007-2012 literature. Journal of the Medical Library Association : JMLA, 102(3), 184–191. https://doi.org/10.3163/1536-5050.102.3.008
Maggio LA, Tannery NH, Chen HC, ten Cate O, O'Brien B. Evidence-based medicine training in undergraduate medical education: a review and critique of the literature published 2006-2011. Acad Med. 2013;88(7):1022-1028. doi:10.1097/ACM.0b013e3182951959
Oberman, C. (2020). The Institute for Information Literacy: Formal training is a critical need. College & Research Libraries News, 59(9), 703-706. doi:https://doi.org/10.5860/crln.59.9.703
Shao X, Pupur G. (2016). Effects of Information Literacy Skills on Student Writing and Course Performance. Journal of Acad Librarianship. 2016;42(6):670-678. https://doi.org/10.1016/j.acalib.2016.08.006
van Dijk N, Hooft L, Wieringa-de Waard M. What are the barriers to residents' practicing evidence-based medicine? A systematic review. Acad Med. 2010;85(7):1163-1170. doi:10.1097/ACM.0b013e3181d4152f
Christie Palladino, MD, MSc
Dr. Christie Palladino is an obstetrician-gynecologist by trade and a teacher by heart. She completed her Doctor of Medicine degree at the Medical University of South Carolina and obtained her Master's degree through the Robert Wood Johnson Clinical Scholars Program at the University of Michigan. Dr. Palladino conducted educational research at the University of Michigan and the Medical College of Georgia, where she also co-created and directed a national database of educational assessments. She has published extensively in the peer-reviewed literature.