Faculty Development

Increasing Effectiveness of Grand Rounds

Grand rounds are a time-honored tradition at teaching institutions that have evolved greatly from their inception in the late 19th century. Traditional grand rounds consisted of residents presenting a patient, after which senior physicians would question the patient, exam findings would be demonstrated, and after the patient exited, a discussion of the patient’s problems would ensue. Although modern grand rounds series may incorporate an occasional CPC with some of these features, today’s grand rounds more typically follow a didactic, Powerpointbased format whose primary purpose is to convey new knowledge gained through translational research and to disseminate clinical advances. Some both within and outside medicine have argued that grand rounds are no longer so grand: attendance has declined among faculty and residents, and attendees are often disengaged.

I am not here to advocate a return to the 19th century. I do, however, want to encourage grand rounds chairs/planners to re-consider the straight didactic pedagogic strategy in an effort to improve the educational value of their series.

Effective grand rounds should disseminate knowledge, change behavior of clinicians, and improve patient outcomes. Facilitating this process requires understanding a little about adult learning theory. Adult learners need to feel the need to learn, participate actively in the learning process, and have a sense of progress toward their goals. Here are a few notable points from research on how adults learn:

1. Traditional lectures using a Powerpoint bullet-point approach encourage passive learning at the lowest level of cognitive function and provide for a low rate of knowledge retention.
2. Learners cannot pay attention continuously during a 50-minute talk. Attention alternates between engagement and non-engagement with attention lapses beginning as early as the first minute and recurring in cycles that progressively shorten as the talk progresses.
3. Attention is higher during non-lecture methods/active learning techniques such as demonstrations, clicker questions, and learner discussions, and there is a carryover effect of the benefit of such learner-centered techniques into subsequent lecture segments.
4. Relative to a traditional lecture format, active learning strategies improve knowledge retention, learner attitudes, and likelihood of a change in behavior.

With adult learning theory in mind, here are strategies for increasing relevance and effectiveness of grand rounds:

1. Perform a constituent-wide needs assessment to identify the educational needs of your audience and guide the choice of rounds topics. Don’t leave selection entirely to presenters, who may choose topics that are convenient but not of great interest/value to your audience. Ask subspecialists what common diagnostic or management errors are made by nonspecialists.
2. Develop a curriculum that includes not only subspecialty topics but also such diverse subjects as patient safety, quality improvement, ethics, professionalism, and education. Don’t forget the nonphysicians in attendance.
3. Select presenters based on ability to engage an audience, not solely on level of expertise. Doing great science does not automatically make an individual an effective speaker.
4. Involve residents in case presentation and analysis; provide training to residents in leading casebased presentations.
5. Give presenters tips on maximizing presentation effectiveness.
   1. Vary instructional format within a given session with a mix of interactive and didactic education that stimulates learners. Intersperse short bursts of didactic material with exercises that apply that material (e.g., pose a problem or open-ended question for audience response, use clickers, present a case), short videos, demonstrations, or patient presentations.
   2. Don’t run over time. In fact, stop early, leaving time for discussion at the end.
6. Obtain learner evaluation of grand round content and presenters.

Contact the CME office if you would like additional assistance with planning your series.

Allyson Zazulia, M.D.