Why don’t clinicians come to Grand Round anymore?

799px-The_Anatomy_LessonI’m sat listening to Martin Rutter chairing a session entitled ‘Knowledge is Power’. The topic is diabetes with contributions from diabetes, radiology and surgical colleagues. I could not agree more with Martin, as clinicians it’s vital that we keep learning, keep questioning and keep sharing our knowledge.

Knowledge is power.

In a trust like CMFT we have some amazing clinicians with regional, national and international reputations but the nature of our work in such specialised units means that we don’t have as many opportunities to share learning as we might hope.

An exception to this is the medical grand round that takes place every Wednesday in the postgrad centre (though confusingly it was in undergrad today). It’s an opportunity for a range of clinicians from all specialities and all grades to come together and learn. This week we have a multifaceted presentation from the diabetes team encompassing medical, surgical and radiological presentations. Last week we heard an equally excellent presentation on the use and complications of new drugs of abuse such as PMA. Both these are excellent, interesting and relevant to a range of clinicians across the trust, but like most weeks I am surprised and in all honesty a bit disappointed at the turn out. I think there’s probably about 50 people here from a workforce of hundreds if not thousands of junior doctors, consultants and nursing clinicians.

So why the low turn out and what can we do to increase attendance?

  • Remind colleagues that they can attend. You don’t need to be a physician to come along. The meeting is open to medical students, nurses, doctors in all specialities and at all grades.
  • Encourage your juniors to attend. Grand round is all about teaching and learning, if you are a clinical supervisor then please encourage your juniors to attend and even better, let them bring you along too.
  • Come along to something new. An observation I’ve made is that attendance is often boosted by members of the presenters team coming along. Clearly such support from colleagues is great, but it does not expand your learning horizons. I love the ED sessions (obviously) but those are probably the ones from which I learn the least, rather it is presentations from other teams that alert me to new and interesting knowledge and skills. So, come along to grand round when others are presenting and not just your own team.
  • Use your attendance as evidence of CPD for appraisal and ARCPs. Simply put all educational activities can contribute to your portfolio. It’s an opportunity for an externally validated activity, it’s free and you might learn something.Network. As a big hospital we don’t bump into people in the way that we once did. Teams can get isolated from each other and lose touch. Grand Round is a great way to informally meet and talk about clinical or management issues, and from a trainee perspective it can be an opportunity to discuss careers and training opportunities.
  • Other commitments. We are all busy people and it can feel difficult to justify time off the wards to attend. I do understand that for some of the time, but as DME I believe that it’s vital that we protect and support education across the trust. Whilst it may be difficult to attend every week try and make the effort.
  • Suggest something different. Perhaps Grand Rounds have had their day. In a world of just in time technology, smart phones, blogs, apps and other digital media is there a better way of getting diverse clinicians together to learn and share experiences. If you think there is then we’d love to hear from you.

This week started with Martin Rutter telling us that ‘Knowledge is Power’. He’s right of course, and the knowledge gained at Grand Round is free, open access, up to date and relevant. It’s not getting accessed though…..so what can we do?

Will we see you next week, or are you going to suggest something different to resuscitate and recover this venerable teaching institution?

vb

S

8 thoughts on “Why don’t clinicians come to Grand Round anymore?

  1. I agree with your comments and considerations. I would very much like to be able to attend more often but Wednesday is essentially devoted to preparing for and attending the NE sector Gynaecology MDT. Hence, I am vitually unable to attend meetings held on wednesdays. Could the day be rotated?

  2. Hi Simon

    I occassionally attend a Grand Round because it the theme might help me keep up with what is happening in the wards and the clinics, but so many of the titles are so vague that I have no idea whether it’ll be time well-spent. I have very little time to spend, so unless there’s a clear indiacion of relevance, I spend it elsewhere.

  3. Simon,
    We need to do ‘grand rounds’ like they used to be done and like they still are done in many of the big American Institutes. It should be about presenting unusual or even usual cases which bring together contributions from a range of specialities who had input into the management of the patient. This means clinicians at the front door (A&E/MAU, on call consultants), through to speciality input, including radiology, pathology……..
    So that we can learn from them.
    This clearly takes some effort and organization amongst the presenters.

  4. Dear Simon,
    >
    > Your email caught my attention. Are anaesthetists invited because I don’t think it’s on our radar? Or is it “physician” only meeting?
    >
    > I never attend because I work in an operating theatre all day every Wednesday. I think some of the topics are of great interest to those that work in perioperative medicine. If you rotated the day I and others who work on Wednesdays would have fairer access to this educational opportunity.
    >
    > As much as I need to keep abreast of developments in “general medicine” I never catch sight of anything directly related to perioperative medicine. There are 80 consultants and 50(ish) trainees delivering care in anaesthesia, critical care and pain management across MRI (not including RMCH). As it stands we do not seem to feature in your program. Granted critical care get a slot every so often.
    >
    > Think about it. I may be wrong but I think your are missing a trick here and disenfranchising a large proportion of consultants at CMFT. It is estimated that we are involved in the care of 2/3 of the inpatient population in the NHS and yet no one seems to know what we do! Wonder why.
    >
    > Yours sincerely,
    > Adam
    >
    >
    > Dr AC Pichel
    > Manchester Royal Infirmary
    > Central Manchester University Hospitals
    > Oxford Road
    > Manchester
    > M13 9WL
    >
    > Tel: 0161 276 4551/2

    Paging and Bottom Toolbar

  5. Dear Simon

    I agree with your comments and hope the Grand Round can return to its once prized place.

    However, as is clear from the comments here, it can be difficult to manage competing priorities and arrange attendance. One idea to solve this problem and to share the knowledge is to record the session as a webinar and post on cmftpostgrad.com.

    I also agree with Dr Pichel’s comments (as an anaesthetist myself) relating to the paucity of perioperative education on the program.

    Yours Sincerely

    Dr Clare Elizabeth Conlon

  6. I think it’s currently very hard for FY doctors to leave the wards for more than half an hour but if it was constantly in our faces then I think more of us would probably remember!

    At medical school there used to be posters on all staircases and in lifts as we use them probably more than we go onto these specific websites! If I had access to a poster with enough time and had permission to put these up around the trust I would be more than happy to do so!

    I also think grand rounds involving multiple teams would be much more interactive and useful to observe from the juniors’ POV – often it’s only us who has contact with all the different specialities when looking after one patient.

    Avni
    FY1 MRI (Gastro)

    • Hi Anvi

      You are right about the posters on the staircases in the Medical School. Many of them are for Manchester Medical Society meetings, but they too have dwindling attendances. We pay for speakers from around the country to come and lecture, so it can be embarrassing to have an audience of fewer than 20 people – and despite the posters, very few of the attendees are medical students. Personally, I really like to learn about new developments outside my own field by listening to experts, but that puts me in a minority.

      The medical Royal Colleges don’t help: mine makes it clear that any such learning should be relevant for my professional life if I’m to claim it for CPD points, but it doesn’t define what is “relevant”. I claim almost anything because it can be “relevant” for my role in undergraduate education, but I know a lot of histopathologists only claim stuff of immediate relevance to their sub-specialty. Perhaps we need to change this inward-looking culture. Any Ideas?

      Emyr
      Senior Lecturer in Pathology

  7. Hi Anvi

    You are right about the posters on the staircases in the Medical School. Many of them are for Manchester Medical Society meetings, but they too have dwindling attendances. We pay for speakers from around the country to come and lecture, so it can be embarrassing to have an audience of fewer than 20 people – and despite the posters, very few of the attendees are medical students. Personally, I really like to learn about new developments outside my own field by listening to experts, but that puts me in a minority.

    The medical Royal Colleges don’t help: mine makes it clear that any such learning should be relevant for my professional life if I’m to claim it for CPD points, but it doesn’t define what is “relevant”. I claim almost anything because it can be “relevant” for my role in undergraduate education, but I know a lot of histopathologists only claim stuff of immediate relevance to their sub-specialty. Perhaps we need to change this inward-looking culture. Any Ideas?

    Emyr
    Senior Lecturer in Pathology

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