Background/Purpose: A ubiquitous hierarchy pervades all levels of medicine. The high level of recognition and respect for experts and their opinions prevents exchange between the different levels of the hierarchy. Especially at medical conferences, discussions usually take place between experts, while patients, young doctors and students listen, and active participation often does not occur. The fishbowl method is an interactive and dynamic technique with a group of discussants sitting in an inner circle that contains an additional empty chair. Members from the auditorium can, at any time, occupy the empty chair and join the discussion. It was our aim to introduce this method as an alternative to pure expert panels.

Methods: Ten discussion groups with different topics were formed in advance of the European Lupus Meeting 2018. The groups consisted of an SLE expert moderator, a SLE patient representative, a fellow in training and two international SLE experts. Each discussion lasted one hour and was protocolled on flipcharts by another fellow and a fourth SLE expert. The method was evaluated by participants and the auditorium in an online survey distributed via email after the conference among all attendees assessing feelings as active participants and opinions regarding the effectiveness of the method.

Results: A total of 169 attendees completed the online survey. 47 were members of the inner circle (8 moderators, 14 experts, 5 patient representatives, 20 fellows) and 122 were members of the audience. Only 15.5% had heard about the method before and 6.6% had participated in a fishbowl round before. 39 members of the audience participated actively, of whom the majority felt comfortable (28.7%) or even very comfortable (16.6%) with their role on the empty chair. 78.5% of all participants would recommend the method for future conferences. Levels of agreement regarding the effectiveness of the method are shown in Figure 1. Opinions did not differ between the inner circle and the audience.

Conclusion: The fishbowl discussions were overall excellently received and positively evaluated. Fishbowl provides a diverse and apparently effective method for scientific exchange. By reducing hierarchies and challenging traditions, active participation is facilitated and otherwise hesitant listeners can easily contribute to the discussion.

Figure 1