Wednesday during the academic year always gives me the opportunity to consider grand rounds- the history, the why, the how could we be doing this better (since we all know that’s one of my favorite questions about almost everything). Today and last Wednesday served as no exception; the prior Wednesday was a break from my incessant questioning, mostly because I was away at Surgery Education Week.
Historically, grand rounds were Socratic in nature, and focused around patient presentations (usually by a junior team member) to more senior faculty. Often the patient was present, and the presentations were oriented around problem-solving of the cases. Attendance at grand rounds was expected as part of one’s civic duty in academia and the interactive nature fostered engagement through active learning.
Fast forward to the present- and I’ll open with a confession that I can be complicit in any/ all of these on a given day. Grand Rounds is typically a Power Point (or Prezi, for the more hip) based lecture, hopefully with a few minutes left for questions at the end. Minimal interaction occurs, and the audience engagement often reflects the paucity of direct interaction. Email gets answered, EMR charting gets caught up. Even those who are engaged and attentive are likely to retain no more than 5% of the information provided. The modern model allows people to share from a place of expertise, and for those in the audience it’s typically a fine exhibition of passive learning.
A side effect of the failure of engagement in modern grand rounds is a lack of attendance; if people’s learning needs aren’t being met, they simply vote with their feet and stop coming. Multiple sources have bemoaned decreased attendance at grand rounds in particular, and educational conferences in general, by faculty members. Sometimes those absences are unavoidable and are driven acutely by patient needs. Often they are simply a reflection of perceived relevance of the day’s topic, with citizenship “obligations” being inadequate to overcome the pull to take care of the myriad other things on the to-do list during that sheltered hour.
Grand Rounds in some form is likely a tradition worth maintaining, both for the citizenship/ networking benefits, as well as for educational benefits when it’s done well. The question becomes how do we resuscitate grand rounds before it’s too late? Better coffee? Bigger controversies? More interaction?
I’m not sure I have a single perfect answer, though I hope to open a dialogue on how we can best identify and meet the needs of our learners. My suspicion is that it won’t involve a long-term relationship with the lecture format, and it might even entail a return to old traditions with entirely interactive, case-based sessions. Or it might be something entirely different and entirely unexpected- something revolutionary, perhaps?
If you were designing an effective grand rounds for your Department of Surgery, what would it look like?