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Based on both historical development and functional advantages, such as in emergencies, hierarchical aspects dominate all levels of medicine. Doubtlessly, the high degree of respect for experts and their opinions may impede exchange between different levels of hierarchy. At medical conferences, discussions usually take place between experts, while patients, young doctors and students only listen and rarely actively participate.
For the 11th European Lupus Meeting in Düsseldorf in March 2018, we have tried the fishbowl method to increase participation at all levels. Fishbowl is an interactive and dynamic technique with a group of discussants sitting in an inner circle that contains an additional empty chair and surrounded by the audience in an outer circle.1 The empty chair can be occupied by any member of the outer circle at any time to join the discussion immediately. After the additional discussant of the auditorium has made his/her statement, he or she will leave the chair again to create an opportunity for another member of the audience (figure 1).
Handling editor Josef S Smolen
Contributors JM, MS and MA participated in the conception of the study and data interpretation and drafted the manuscript. H-JA participated in the conception of the study and data interpretation. GC and RF-B conceived the study and interpreted the data. H-ML, AS, CS and REV participated in the conception. All authors participated actively in the discussions and had a prior methodological training. All gave substantial intellectual contributions, and read, revised and approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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