Grand rounds: a paradox in medical education

Abstract

OBJECTIVES: To assess perceptions of the importance and educational purpose of hospital grand rounds among physicians with administrative responsibilities, and to examine organizational aspects of grand rounds as educational events. DESIGN: Descriptive survey by mailed nonanonymous questionnaire. SETTING: All hospitals of more than 100 beds in Calgary. PARTICIPANTS: A total of 150 residency program directors and directors of departments and divisions in hospitals with differing teaching functions. RESULTS: A total of 120 questionnaires (80%) were returned, and the responses of 107 physicians were analysed. Each year in Calgary formal grand rounds activities occupy auditoriums and seminar rooms for more than 2000 hours. Most respondents considered grand rounds to be the main hospital-based continuing medical education activity in their discipline. Aspects of grand rounds considered to be important were updates in research, diagnosis and management, and only one third of the respondents felt that actual patient problems should always be the focus of discussion. The organization and planning of grand rounds revealed a paradox: despite the perceived educational importance, only 13% of rounds were based on a curricular structure, and 16% were based on needs assessments. The grand rounds topic was most often the choice of the presenter. CONCLUSIONS: The quantity of time devoted to grand rounds suggests importance in the routine workings of hospital departments. Grand rounds are used as a showcase for excellence in medical care or recent medical advances. It is paradoxical, therefore, that little interest appears to be shown in educational structure such as curriculum or evaluation of learning. Professional interaction is an inherent objective of traditional grand rounds. Further evaluation of the purpose and educational efficacy of traditional grand rounds is suggested.