Grand rounds are considered a useful vehicle for education, exchange of ideas, promotion of collegiality, and continuing medical education (CME). Educational goals of grand rounds are best achieved by selecting meaningful and relevant topics, pitching the material to an appropriate level, establishing clear educational objectives, promoting active involvement of the participants, and developing means of obtaining their feedback (1–4). Further, grand rounds are widely advertised in and outside the institutions and serve to showcase departmental reputation so that potential recruits for residency and faculty alike, are often invited to participate. Thus the audience for grand rounds often comprises participants with different backgrounds, expertise, and educational needs, making it potentially difficult to achieve some of these goals (5–7).
This article will report the findings of a study of the educational value and relevance of weekly psychiatric grand rounds for medical students, as compared to the general audience, and discuss if the findings warrant programmatic modification.
The study was conducted in the psychiatry department of an urban medical school. The grand rounds program consists of weekly lectures during the academic year. The selection of speakers is made by a standing departmental CME committee that has members representing the faculty in psychiatry and psychology and residents. Topics are usually suggested by the invited speaker, who submits a list of goals and objectives for the lecture. The topic is then approved by the university CME committee for Category I credit. The program is supported entirely by departmental funds and occasional unrestricted education grants.
The weekly grand rounds are attended by approximately 50–75 faculty, psychiatric residents, psychology interns, social workers, nursing staff, and medical students. Residency applicants are invited to attend during their interviewing visits and potential faculty recruits are invited to present their work. The presentations are typically 45 minutes long, with an additional 15 minutes set aside for discussion. The attendees are asked to submit an anonymous feedback questionnaire consisting of 16 items that include relevance of the content to practice, conduciveness of the setting, overall educational quality of the session, conformance of the presentation to standards of experimental design, data collection and analysis, degree to which the learning objectives were met, disclosure of commercial support and conflict of interest, degree of balance and freedom from commercial bias, degree to which the content was considered up-to-date, degree to which the discussion facilitated the sharing of experiences and solutions, adequacy of time allotted for the topic, potential of content of this activity to alter physician practice, potential value of materials as reference tools in the future, degree to which material facilitated learning, quality of audiovisuals and quality of the facility. Medical students are asked to check off their status on the anonymous questionnaire. The questionnaire is collected at the end of the presentation.
Each item is rated on a five-point Likert scale. For the purpose of simplifying the statistical analysis for this study, a rating of 4 or 5 on the scale was considered a positive response with high level of agreement. A rating of 3 or below was considered neutral or negative with low level of agreement. Student and nonstudent responses to four relevant items on the 16-item questionnaire were compared to identify differences in the perceptions of the two groups regarding relevance of the topic, future value of content, educational quality, and the degree to which objectives were met. The data were subjected to statistical analysis. The means, medians, standard deviations, skew, and standard errors of skew for the percentile positive responses to each of these items for the 19 grand rounds presentations were calculated. The first two items had relatively low skew values and were more normally distributed, requiring t tests. The latter two were more skewed and less normal in their distribution, so a nonparametric test (Wilcoxon) was done. The distribution of the differences, which is more directly relevant, was checked.
A total of 83–85 medical students and 206–274 general audience members (comparison subjects) responded to the four items for all 19 grand rounds presentations in the academic year 2006–2007. Two hundred one out of 271 comparison subjects ranked the presentations to be of current relevance, but only 53 out of 83 medical students ranked them to be so. One hundred fifty-two out of 206 comparison subjects thought that the presentations may be of future value to their practices, but only 38 out of 83 students thought so. However, 239 out of 273 comparison subjects rated the educational quality of the presentations positively, and 69 out of 83 students agreed. Also, 227 out of 274 comparison subjects believed that the speakers achievedthe stated objectives of their presentations and 68 out of 85 students responded likewise. Thus both groups had comparable responses to the educational quality of the presentations and to the degree to which the speakers achieved their stated objectives. However, the two groups differed on the relevance of the topics to their needs and the potential value of the content for future use and this difference was statistically significant (Figure 1
As one might intuitively expect, medical students found the content of the topics to be of less potential value to them in the future and be less relevant for their needs than the psychiatric audience; only 5% of medical students are likely to be eventually involved in psychiatric practice. However, this did not affect their recognition of the quality of the sessions and the speakers. Thus, one can surmise that there is no significant necessity for program change. Although this limited study was not designed to address the issue, it might well be argued that the positive impression created by the grand rounds program may have an overall beneficial effect on the recruitment of these students into psychiatry, or, at least, on their view of the usefulness of psychiatry regardless of their specialty choice.
The institution of grand rounds is increasingly under siege (4, 8–10). As overworked physicians are dispersed in far flung clinical practice sites, attendance at grand rounds is flagging. The lack of financial resources to support programs in many departments is also a contributing factor. In fact, many grand rounds programs are now supported by pharmaceutical companies that provide both refreshments and CME credits. Grand rounds are in danger of being regarded as mere social gatherings (8) where presentations must satisfy the minimum needs of every constituency of the audience. In such “one size fits all” presentations, superficial glitter (provided by marquee speakers who are well-spoken but use packaged presentation material) replaces substantive content.
The results of this study, however, offers hope that this need not be so. The disparate components of a grand rounds audience appear to agree in their opinions about the inherent quality of grand rounds presentations even though they differ in their perceptions about the relevance of the topics to their current needs and the potential value of the content for future use. Thus, grand rounds programs do not necessarily have to seek the lowest common denominator to satisfy their varied audience.
The author would like to gratefully acknowledge the assistance of Edward J. Gracely, Ph.D. in the statistical analysis of the data.
At the time of submission, the author disclosed no competing interests.