Reflecting on the Grand Rounds

So I gave a Grand Rounds presentation on pseudobulbar affect which Dr. Robert G. Robinson, MD, PhD, my co-presenter, colleague, and former chair of our psychiatry department says is a misnomer and prefers the term “pathologic emotionality.” He should know–he’s an internationally recognized expert on post-brain injury neuropsychiatric syndromes. I used most of the slides from a recent Clinical Problems in Consultation Psychiatry (CPCP) presentation led by a couple of very talented and hard-working residents, Drs Emily Morse and Andrew Segraves, shown below in the usual dignified attitudes involving Nigella, our treasured psychiatry consult service mascot.

Dr. Emily Morse and Nigella

Dr. Emily Morse and Nigella

Dr. Andrew Segraves and Nigella

Dr. Andrew Segraves and Nigella

She reminds us not to take ourselves too seriously. Which reminds me, though she looks fine in the pictures here, in the last few days it’s clear she’s overdue for a trip to the gift shop for her usual shot of gas. She’s been looking a bit deflated.

Anyway, the Grand Rounds presentation is organized differently lately than it has been in years past. Our Grand Rounds was recently revamped. We used to have a separate Research Rounds and Grand Rounds, which lends the impression that we divided them based on whether we were in the research or clinical tracks–which we did.

Now the rules have changed and the two presentations have been restructured into one. This Grand Rounds includes presentations by representatives from both tracks. Sometimes they don’t work because they’re not in the same fields, but the opportunity is there to bring together clinicians who mainly conduct research and those who mainly do clinical patient care.

I always reflect on the conference before I deliver a presentation. I admit I’m a bit ambivalent about its role in academic medical departments these days. A recently published paper whose authors say the goals of the Grand Rounds are to “disseminate knowledge, change physician behavior, and improve patient outcomes” seeks to restore the Grand Rounds to its former grandeur [1].

That sounds like a tall order and I wonder if that’s part of the reason the Grand Rounds is said by many to be on the decline, including Sandal et al, the authors of the aforementioned paper. Another author simply says that its time for a requeim for the Grand Rounds [2].

The patient interview is still an integral part of the conference here, although it’s not always practical or even desirable in some circumstances, especially in psychiatry. However, this part of the presentation can be the most interactive and compelling feature.

Engaging the audience can be challenging, especially in the age of death by powerpoint. But it’s possible to wake some people up with a break from the data dense slides. I have to tell you, I really didn’t add much to the CPCP by Emily and Andrew because it was so well done. I did add an interesting advertisement video for a relatively new treatment for pseudobulbar affect–Nuedexta, which Emily brought to my attention.

 

I added a couple of slides. In order to see the picture galleries of photos or powerpoint slides, click on one of the slides, which will open up the presentation to fill the screen. Use the arrow buttons to scroll left and right through the slides or up and down to view any annotations.

 

And I made a little video of the PBA Top Ten–which I deferred presenting because some members of the audience might have found it unbefitting the dignity of the conference.

 

 

There’s a place for dignity. I just can’t remember where.

References:

1. Sandal, S., et al. (2013). “Can we make grand rounds “grand” again?” J Grad Med Educ 5(4): 560-563.
2. Stanyon, M. and S. A. Khan (2015). “Requiem for the grand round.” Clin Med 15(1): 10-11.
The time-honoured tradition of Grand Round is firmly rooted in medical education, but has little evidence for its effectiveness or its impact on patient management. A mode of didactic teaching, Grand Round has lost its appeal in modern medical education with dwindling attendance at Grand Rounds worldwide. Once a platform for eminence-based medicine and a cross fertilisation of medical ideas, emphasis on sub-specialisation and clinical governance, combined with rota, trainee engagement and attendance failures has made Grand Round obsolete. To survive, Grand Round must have evidence for its effectiveness in medical education. It must be able to compete with other forms of teaching and adapt by using technology to reach trainees. Engaging the audience and encouraging participation needs to be woven into the fabric of the modern Grand Round, alongside learning clinical skills and developing clinical reasoning. Understanding the needs of today’s trainees and their involvement in formulating the Grand Round programme is vital. Attendance at Grand Round is a recognised measure of its success and will be used in its evaluation. Questions still remain regarding the future of Grand Round. Its survival will depend upon its ability to change with time and reclaim its place as a credible tool to promote learning.

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