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A ‘Grand’ Tradition

A ‘Grand’ TraditionIn a recent New York Times article looking back at developments in the medical field, Tufts graduate Lawrence K. Altman explores the evolution of grand rounds.

Boston [01.02.07] Grand rounds, Lawrence K. Altman recalls from his days as a student at Tufts School of Medicine, were once an opportunity for doctors to gather together, discuss a patient’s case and glean wisdom from the best-of-the-best in the medical field. In the past 50 years, however, the exercise that once took the form of a “master class in the art and science of medicine” has evolved into a lecture-based meeting, Altman wrote in a recent article in The New York Times. While today’s grand rounds are efficient, he explained, it may be useful to revive some of the traditions of the past.

“In recent years, grand rounds have become didactic lectures focusing on technical aspects of the newest biomedical research,” Altman, a 1962 graduate of Tufts School of Medicine, wrote in the Times article, the fourth in a series of columns looking back at developments in the field of medicine. Missing from today’s grand rounds, he pointed out, are live patients who present treatment challenges and thoughtful debate about their care.

“The Socratic dialogue has given way to PowerPoint,” wrote Altman, who remembers when grand rounds were more engaging. At Tufts in the late 1950s, he attended grand rounds featuring Dr. Louis Weinstein -- the first Chief of Infectious Diseases at Tufts-New England Medical Center -- who shared his expertise on the subject.

“Usually, the patient’s pertinent information was on a blackboard. Dr. Weinstein would study the fever chart, seeking clues in the pattern to help identify a particular infection,” Altman wrote. “Then he would regale the crowd with anecdotes from his vast experience in caring for patients with typhoid fever, diphtheria, polio and many other infectious diseases.”

According to Altman, grand rounds were an opportunity for more experienced physicians to share what they had learned over time and for younger doctors to ask questions and offer fresh perspectives.

“The emphasis was on diagnosis, treatment and the management of a patient, not on research,” Altman wrote. “Sometimes doctors in the audience asked questions of the patient and professor… Even the smartest experts had to be on their toes, because younger doctors often selected a case intended to tax their brains.”

Today’s grand rounds, Altman explained in the Times, barely resemble their predecessors.

“Patients have disappeared,” he wrote. “If a case history is presented, it is usually as a brief synopsis and the discussant rarely makes even a passing reference to it.”

While Altman noted in the Times article that these new grand rounds “are often useful,” he added that they are “certainly not grand.”

The “chief aim” of today’s lecture-based grand rounds “is to emphasize a core body of knowledge that all physicians need to share and to keep abreast of,” he wrote in the Times. He added that with advances in medicine, greater time pressures on doctors and growing staff numbers at hospitals, there is a value to the new lecture format.

But still, Altman wrote in the newspaper, “experiences with single cases can be important because doctors have to mold treatments for the many patients who do not match the criteria used in studies.”

With attendance rates at grand rounds dropping, Altman said it might be worth examining what made these regular gatherings so popular years ago.

“As medical educators seek ways to increase the appeal of grand rounds, they might look at being more imaginative and restoring a sense of humor,” he wrote in the Times.

 

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