Ágoston Kecskés

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January 17, 2012

Blog Entry #11: Grand rounds

            Since the beginning of this selective in medical education, I have frequently reflected on my learning experiences in medical school. It has helped me realize what has worked for me and perhaps why. More than anything, however, this selective has given me a framework within which to think about my medical education experiences. I've given some thought to one particular application of medical education: grand rounds.[1] Ensconced in the pomp of tradition, grand rounds represent an opportunity for physicians in a broadly defined group to assemble and learn something together. But what is the value of grand rounds? Earning credits towards continuing education seems to be a key part of this exercise, but is there more? In particular, what is the value of grand rounds for lower levels of trainees? I have been attending grand rounds for three years now, and I still lose my bearings approximately 15 minutes into the presentation. Sadly, grand rounds presentations typically violate many of the "rules" of good presentations. For licensed physicians and certainly for more senior attending physicians, the value of grand rounds seems to be high. Grand rounds are often the only time that members of some specialties have an opportunity to interact with and learn from each other. There is a disturbing tendency of presenting very esoteric cases at grand rounds, the value of which is highly suspect. The most important parts of these presentations to the audience (e.g. when to suspect a particular disease or condition, when to refer a patient, how to order a test) are often lost in the myriad details or glossed over superficially. The value of conciseness in these cases also cannot be overemphasized. Senior physicians regularly instruct (and in some cases berate) their clerks to try to consolidate information, only to turn around and provide excruciatingly detailed accounts of esoteric diseases. It is as if the audience members are so proficient at managing every disease they see in clinic that they are bored and can only learn from esoteric cases.

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[1] R. M. Lewkonia and F. R. Murray, “Grand rounds: a paradox in medical education,” Canadian Medical Association Journal, http://www.cmaj.ca/content/152/3/371; accessed 16 January 2012.