Since the late 1800s, grand rounds have been a mainstay of medical education. Originally, attendees visited the bedsides of patients with interesting cases and discussed the diseases and treatments with the foremost clinicians of the day in order to disseminate new discoveries, advance new treatments, and promote good communication among physicians. As more people began to attend, it was no longer feasible to conduct grand rounds in the patients' rooms, with the sessions more frequently now conducted in amphitheaters and lecture halls. Grand rounds have changed from patient-oriented or case-based discussions to formal lectures. Modern day grand rounds focus on descriptions of new diseases or new features of diseases, different surgical complications or side effects, unusual or complex cases, and alternative therapies.
Typically, presenters who conduct grand rounds discuss topics that capture their interest. First, they formulate a clinical question based on one or more patient presentations. Next, they review the research that has been published on the subject. Third, they critically assess the existing evidence for its statistical significance and clinical relevance. Finally, they demonstrate how the evidence may be applied to patient cases. In some grand rounds, clinicians from several disciplines may present information from their diverse perspectives.
According to a 2003 survey of 300 United States hospitals, 96 percent of departments conducted grand rounds, with the vast majority of sessions consisting of hour-long lectures with minimal interaction at the end. On average, 83 people attended the sessions, with the largest percentages among the graduate medical trainees and full-time faculty. Most hospital departments, about 72 percent of those surveyed, develop individual educational goals for their programs, with 73 percent annually selecting new topics based on a needs assessment. Only 17 percent of the departments regularly assessed the participants’ retention and application to patient care of the information covered in the sessions.
In addition to teaching, other objectives of grand rounds are stimulation of life-long learning, promotion of a collegial spirit among doctors, and opportunities for continuing medical education (CME) credits. State medical boards, hospitals, and specialty boards require physicians to obtain a number of education hours per year to maintain their licenses, privileges, and certifications. Having a regular meeting among physicians fosters a multidisciplinary approach to clinical problems and provides an easy method to distribute new information to a broad group of people. Pharmaceutical companies frequently sponsor many of the grand rounds, bringing in guest speakers from other regions.
