A retrospective analysis of grand rounds in continuing medical education

Combining Physician Expertise and Women's Lived Experience to Educate Health Professionals about Preventing Fetal Alcohol Spectrum Disorders

INTRODUCTION

Physician Champions from the American College of Obstetricians and Gynecologists (ACOG) and trained women Speakers from FASD United, who have given birth to a child with a fetal alcohol spectrum disorder (FASD), co-present to healthcare providers (HCPs) in medical residency programs as part of an educational intervention. They present FASDs as a biological and social problem surrounded by stigma that prevent pregnant women from talking openly to their HCPs about their alcohol use or alcohol use disorder (AUD) and getting the medical help they need.

METHODS

Semi-structured interviews were conducted with 10 ACOG Champions and nine FASD United Speakers and a thematic analysis assessed how the co-presentations can enhance HCPs' understanding about FASDs and address stigma associated with alcohol use during pregnancy.

RESULTS

Interview findings indicated that both Champions and Speakers emphasized the need for HCPs to be nonjudgmental and create a safe space for open dialogue. They reported that residents were moved by mothers' personal stories, wanted to understand AUD better, and asked about the type of help HCPs can offer women.

DISCUSSION

Combining physicians' expertise with mothers' personal stories of lived experiences of FASDs directed at residents, who are more reflective and open at this phase of their careers, moved them from a fact-based to an empathy-based approach to learning that is critical to address the stigma surrounding women who may be using alcohol or struggling with an AUD during pregnancy. Collaboration between national organizations allowed this intervention to be widely implemented across the country.

Twelve tips for adapting grand rounds for contemporary demands

Grand rounds have evolved since inception in the early 1900s and subsequently, there has been a continual debate surrounding the best purpose for the time-honoured event. However, the purpose of grand rounds can be broadened to meet the needs of the medical community today, especially at a time where there is great distribution of medical practitioners and learners geographically and events such as COVID-19, which prevent the community from physically gathering. Using the evidence and lessons available from the literature we developed a grand rounds series with goals and objectives suited to our context. In this guide we provide twelve tips covering goal planning, logistics, presentation preparation and presentation delivery in order to illustrate how one could organize an informed grand rounds which is successful contextually.

Rebooting medical education with virtual grand rounds during the COVID-19 pandemic

Social distancing during the coronavirus disease 2019 (COVID-19) pandemic has necessitated drastic changes in the practice of hospital medicine, including the cancellation of many educational activities. At the same time, the emergence of a new disease with a rapidly evolving knowledge base has mandated timely educational updates. To resolve this conflict in our hospital, we substituted 'traditional' grand rounds with 'virtual' grand rounds delivered over Zoom, consisting of a local situation report and operational update, followed by a specialty-specific clinical presentation on management of COVID-19. Attendance was greatly increased (mean 384 attendees) compared to traditional grand rounds (mean 44 attendees) and included a diverse audience of medical professionals. Feedback was overwhelmingly positive, with >80% of responders stating that the sessions would or might inform their clinical practice. COVID-19 has therefore provided an opportunity to modernise grand rounds, and develop a new model matching the needs of medical education beyond the pandemic.

Principles for Patient and Family Partnership in Care: An American College of Physicians Position Paper

In this position paper, the American College of Physicians (ACP) examines the rationale for patient and family partnership in care and reviews outcomes associated with this concept, including greater adherence to care plans, improved satisfaction, and lower costs. The paper also explores and acknowledges challenges associated with implementing patient- and family-centered models of care. On the basis of a comprehensive literature review and a multistakeholder vetting process, the ACP's Patient Partnership in Healthcare Committee developed a set of principles that form the foundation for authentic patient and family partnership in care. The principles position patients in their rightful place at the center of care while acknowledging the importance of partnership between the care team and patient in improving health care and reducing harm. The principles state that patients and families should be treated with dignity and respect, be active partners in all aspects of their care, contribute to the development and improvement of health care systems, and be partners in the education of health care professionals. This paper also recommends ways to implement these principles in daily practice.

Stakeholders' qualitative perspectives of effective telepractice pedagogy in speech-language pathology

BACKGROUND

Academic programmes in speech-language pathology are increasingly providing telehealth/telepractice clinical education to students. Despite this growth, there is little information describing effective ways to teach it.

AIMS

The current exploratory study analyzed the perceptions of speech-language pathology/therapy (SLP/SLT) faculty, student and SLP/SLT clinicians to ascertain effective pedagogical approaches for telepractice service delivery, rank the relative importance of telepractice skills and knowledge competencies, and define any pedagogical challenges to teaching them.

METHODS & PROCEDURES

Qualitative data were collected from two sources: three open-ended questions within an online survey (SLP/SLT faculty n = 31, graduate students n = 16, telehealth ('telepractice') clinicians n = 16); and follow-up telephone interviews (n = 22). Data were analyzed with a grounded theory approach followed by a summative rank-order analysis of themes.

OUTCOMES & RESULTS

All three groups agreed the most effective telepractice instructional approach was telepractice demonstrations (such as students role playing or watching a supervisor). Professional development approaches such as workshops or training manuals were less effective and didactic approaches such as lecture-only were ineffective. Skills and knowledge competencies students needed before entering the workforce were, in order of implied importance: telepractice clinical skills, telepractice technology skills, legal knowledge pertinent to telepractice and knowledge of telepractice literature. The most important telepractice clinical skills students needed to acquire were appropriate selection of telepractice materials and engaging the client over the internet. Many participants said teaching and learning telepractice was more challenging than in-person service delivery because of the difficulties in selecting appropriate telepractice clinical materials, managing technology problems and engaging with clients over the internet.

CONCLUSIONS & IMPLICATIONS

Despite substantial limitations to this investigation, findings imply that telepractice instruction, like other methods of SLP/SLT clinical education, may be most effective when students engage in critical thinking and problem-solving issues through intense practice. Because the skills and competencies associated with telepractice appear to vary in their perceived value, academic programmes may wish to consider prioritizing how they are taught, giving students additional instruction in the selection of telepractice clinical materials and development of online interpersonal communication skills. For some clinical educators, the challenges associated with telepractice may necessitate additional educator training.

Multicultural Grand Rounds: Competency-Based Training Model for Clinical Psychology Graduate Students

Preparing students to enter the field of psychology as competent professionals requires that multicultural practices be infused into all areas of training. This article describes how the Grand Rounds model was adapted to a graduate clinical psychology training program to foster applied learning in multicultural competence. This extension of Grand Rounds as A? student-driven program to enhance multiculturalism may help others in doctoral psychology training programs develop experiential learning opportunities to further enhance professional competence.

The Interprofessional Radiation Oncology Rounds (IROR) as a New Model of Continuing Education-Program Evaluation

The Interprofessional Radiation Oncology Rounds (IROR) were developed to meet the continuing education objectives of an interprofessional audience at the Sunnybrook Odette Cancer Centre in 2003. The IROR audience consists of representatives from: oncology nursing, radiation therapy, radiation oncology and medical physics. To achieve a multiprofessional program, it was determined that each discipline would organize two IROR sessions to present their perspectives on topics of interest. The purpose was to evaluate the IROR program with respect to presentation topics, speakers and session evaluations. A retrospective review of the IROR evaluation forms between October 2005 and November 2008 was conducted. The IROR program was evaluated using descriptive statistics. This review describes the topics presented, the comments from the audience and the suggestions for future improvement. A total of 908 evaluation forms were submitted. The evaluation scores for the sessions were consistently high on all four items of assessment: relevance, interest, instructional merit and overall satisfaction. Overall, presentations were considered relevant and interesting to their practices and high mean scores indicated a strong consensus that these rounds were valuable to an interprofessional audience. However, decreased attendance of physicians was observed over the years. By incorporating the suggestions provided by a needs assessment, we hope that the rounds could be further improved to fulfill the participants' learning needs and to advocate a truly interprofessional learning environment. Further studies could determine if the rounds have any effect on team dynamics or interprofessional collaboration.

Beyond grand rounds: a comprehensive and sequential intervention to improve identification of delirium

PURPOSE OF THE STUDY

Delirium is a widespread concern for hospitalized seniors, yet is often unrecognized. A comprehensive and sequential intervention (CSI) aiming to effect change in clinician behavior by improving knowledge about delirium was tested.

DESIGN AND METHODS

A 2-day CSI program that consisted of progressive 4-part didactic series, including evidence-based reviews of delirium recognition, prevention, and management, interspersed with interactive small group sessions and practical case conferences was conceptualized in consultation with a leading expert on delirium. Pretest and posttest instruments were designed to test the attendees on their knowledge and confidence around delirium identification.

RESULTS

An average of 71 people attended each didactic session. Among all responses, 50 pretests and posttests were matched based on numeric coding (6 MD/DOs, 34 RNs, and 10 others). Mean pretest and posttest scores were 7.9 and 10.8 points, respectively (maximum: 17), showing a positive change in knowledge scores after the intervention (2.9 points, p < .001). Improvement in knowledge scores was higher in the cohort attending 2 or more lectures (3.8 points, p < .001) compared with those attending only 1 lecture (1.3 points, p < .12). Confidence in identifying patients with delirium increased by 28% (p < .001), and self-assessed capacity to correctly administer the Confusion Assessment Method increased by 36% (p < .001).

IMPLICATIONS

A novel CSI increased clinician knowledge about delirium identification and management and improved confidence and self-assessed capacity to identify delirium in the hospitalized elderly patients. This strategy, which incorporates multiple reinforcing modes of education, may ultimately be more effective in influencing clinician behavior when compared with traditional grand rounds.

Diagnostic grand rounds: a new teaching concept to train diagnostic reasoning

INTRODUCTION

Diagnostic reasoning is a core skill in teaching and learning in undergraduate curricula. Diagnostic grand rounds (DGRs) as a subform of grand rounds are intended to train the students' skills in the selection of appropriate tests and in the interpretation of test results. The aim of this study was to test DGRs for their ability to improve diagnostic reasoning by using a pre-post-test design.

METHODS

During one winter term, all 398 fifth-year students (36.1% male, 63.9% female) solved 23 clinical cases presented in 8 DGRs. In an online questionnaire, a Diagnostic Thinking Inventory (DTI) with 41 items was evaluated for flexibility in thinking and structure of knowledge in memory. Results were correlated with those from a summative multiple-choice knowledge test and of the learning objectives in a logbook.

RESULTS

The students' DTI scores in the post-test were significantly higher than those reported in the pre-test. DTI scores at either testing time did not correlate with medical knowledge as assessed by a multiple-choice knowledge test. Abilities acquired during clinical clerkships as documented in a logbook could only account for a small proportion of the increase in the flexibility subscale score. This effect still remained significant after accounting for potential confounders.

CONCLUSION

Establishing DGRs proofed to be an effective way of successfully improving both students' diagnostic reasoning and the ability to select the appropriate test method in routine clinical practice.

Skin of color education in dermatology residency programs: does residency training reflect the changing demographics of the United States?

BACKGROUND

It is projected that by the year 2050, close to 50% of the US population will comprise people with skin of color.

OBJECTIVE

We sought to assess whether future dermatologists will be prepared to treat patients with skin of color.

METHODS

An e-mail with a link to a brief 9-question survey was sent to 109 program directors and chief residents.

RESULTS

A total of 41 (37.6%) program directors and 63 (50.0%) chief residents completed the online survey. In all, 14.3% (P<.001) of chief residents and 14.6% (P<.001) of program directors recognized an expert at their institutions who conducted a skin of color clinic. In all, 25.4% (P<.001) of chief residents and 19.5% (P<.001) of program directors reported having lectures on skin of color from an acknowledged expert. In all, 30.2% (P<.001) of chief residents and 12.2% (P<.001) of program directors reported a specific rotation in which residents gained specific experience in treating patients with skin of color. In all, 52.4% (P=.70) of chief residents and 65.9% (P<.02) of program directors reported to have either lectures or didactic sessions focusing on diseases in skin of color incorporated into their curriculums. In all, 84.1% (P<.001) of chief residents and 90.2% (P<.001) of program directors reported having training programs in which residents gained experience treating patients with central centrifugal cicatricial alopecia. In all, 100% (P<.001) of both chief residents and program directors reported having training programs in which residents gained experience treating patients with keloids and melasma.

LIMITATIONS

The limitations of this study included recall bias, an incomplete response rate, unsure respondents, and questions that may not have applied to certain programs.

CONCLUSION

The results indicate a need for increased exposure, educational sessions, and overall training in diseases pertaining to skin of color in US dermatology residencies.

Current status of medical grand rounds in departments of medicine at US medical schools

OBJECTIVE

To assess the status of medical grand rounds (MGR) as an educational endeavor.

METHODS

A survey of 133 departments of medicine at US medical schools was performed from September 2003 to March 2004; the results were compared with those of a previous (1988) survey.

RESULTS

Ninety-nine departments (74%) responded to the survey; all 99 conducted MGR. Providing updates in diagnosis, treatment, and medical research, educating house staff and faculty, and promoting collegiality were the most important objectives of MGR. Regarding objectives, responses to the current survey differed significantly from the responses to the 1988 survey for providing updates in medical research (P=.047), providing continuing medical education credit (P<.001), educating house staff (P=.048), and educating faculty (P<.001); the differences were primarily due to higher proportions of current survey respondents rating these objectives as "quite" or "very" important. The most common format was the didactic lecture. Case presentations were uncommonly used, and patients were rarely present. Only 44% of departments used educational needs assessments, and only 13% assessed knowledge gained by attendees. Feedback was irregularly provided to presenters. Most departments (64%) relied on industry to pay for MGR. Lack of presenter-attendee interaction and conflicting meetings were cited as Important challenges. Nevertheless, most (62%) of the current survey respondents thought the quality of MGR had increased.

CONCLUSIONS

Departments of medicine regard MGR as an important educational and social endeavor. However, most departments use suboptimal teaching, planning, and evaluation methods, and many rely on industry to pay for MGR. Addressing these concerns and other challenges may enhance the value of MGR.

Hospital grand rounds in Australia

OBJECTIVE

To determine whether grand rounds are becoming less common in Australian hospitals.

DESIGN AND PARTICIPANTS

Between November 2003 and April 2004, we surveyed 88 clinicians with educational responsibilities in Australian hospitals. A written questionnaire evaluated whether grand rounds were held and how frequently; the structure and percentage of attendees; and the perceived value of grand rounds with regard to education, professional development and general characteristics.

RESULTS

Clinicians in 73/88 hospitals completed the survey (83% response rate). Of the 73 respondents, 63 reported that their hospitals continued to hold grand rounds, and most considered them to be valuable in the areas surveyed. Grand rounds were more common in larger hospitals, public hospitals, and those having junior medical officers. The proportion of clinical staff regularly attending grand rounds was estimated to be 10%-50% by most respondents.

CONCLUSION

Grand rounds continue in the majority of hospitals and are considered valuable for educational and professional reasons. There may be scope for improving attendance at grand rounds by greater emphasis on the specific needs of attendees.

Strategies for improving attendance at medical grand rounds at an academic medical center

OBJECTIVE

To evaluate, in this before-and-after study, the results of 5 strategies for improving attendance at medical grand rounds at a tertiary care academic medical center.

METHODS

The strategies included (1) using electronic card readers to improve understanding of attendance patterns, (2) conducting yearly needs assessment surveys, (3) developing sessions of topical interest, (4) increasing formal participation by residents and faculty researchers, and (5) enhancing publicity. Attendance at medical grand rounds by Mayo Clinic faculty, fellows, residents, and others was measured by card readers between 1998 and 2001.

RESULTS

After implementation of the 5 strategies, the mean +/- SD attendance (as measured by card readers) at medical grand rounds increased 39% from 99.0 +/- 24.6 persons in 1998 to 137.4 +/- 25.2 persons in 2001 (P < .001).

CONCLUSION

An organized effort can improve attendance at medical grand rounds at an academic medical center.

Multidisciplinary radiation oncology palliative care rounds as a continuing educational activity implementing the rapid response radiotherapy program at the toronto sunnybrook regional cancer centre

BACKGROUND

This paper describes the development of the Rapid Response Radiotherapy Program and evaluates the continuing medical education (CME) series, in the form of multidisciplinary monthly Radiation Oncology Palliative Care Rounds at the Toronto Sunnybrook Regional Cancer Centre.

METHODS

Palliative care rounds were initiated by the multidisciplinary committee in September, 1998. From January, 2000, to June, 2002, attendees used a standard 5- point Likert rating scale to conduct formal evaluations.

RESULTS

A total of 203 evaluation forms examining 20 rounds have been collected. Findings indicated that 86.8, 96.0, 87.1, and 90.8% of participants thought the material of the presentation was relevant to their practice, interesting, and instructional. Overall 90.1% of the respondents highly rated the grand rounds (rating of 4 or 5).

CONCLUSION

The grand rounds are an effective CME activity at our hospital.

Evaluating medical grand rounds

INTRODUCTION

Since January 2000, standard presenter evaluation forms have been made available to grand rounds organizers in the Department of Medicine, University of Toronto. During the 2000-2001 academic year, effort was directed at the accumulation of evidence for the validity of the results generated.

METHODS

Two issues were addressed: the integrity or coherence of the form itself and the number of forms or evaluations required to achieve a stable estimate of the construct "presenter effectiveness" for an individual presenter.

RESULTS

Positive evidence relating to the integrity of the form is presented and the number of evaluations or ratings required to provide a stable estimate of presenter effectiveness is suggested.

DISCUSSION

Most presenters' ratings were distributed in a narrow range. Ranking of individual presentations would require exceptionally high precision. Separation into groups requires less precision. This type of classification appears sufficient to enable planning decisions.