January 31, 2011
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Medical Grand Rounds: A Venerable Teaching Tool Finds New Life

By Kate Darby Rauch

One hundred years ago, medical grand rounds often involved wheeling a patient into an auditorium where seasoned doctors led trainees on an exploration of the case at hand.

Today’s grand rounds at UCSF Medical Center provide a good example of just how much this venerable teaching tradition has evolved over time. Instead of specific illnesses or conditions, grand rounds topics now range from health care policy and hot new technologies to ethics and epidemiology. And instead of presenting patients, grand rounds have gone digital with videos, slideshows, PowerPoint presentations and other electronic means of communication.

Take, for example, a recent UCSF Department of Medicine grand rounds session with Chancellor Susan Desmond-Hellmann, MD, MPH. She presided over the packed auditorium with a PowerPoint presentation, not a patient, and her subject wasn’t a disease, but the “health” of UCSF.

Maybe it was the fact that it was UCSF’s chancellor leading grand rounds, offering the opportunity for anyone in the audience of roughly 100 trainees, faculty and staff to ask Desmond-Hellmann a question. Maybe the free burritos had something to do with it. But this medical grand rounds session was well attended and lively. Attendees listened carefully as the chancellor detailed UCSF’s accomplishments and explored its challenges.

This was exactly the aim of Bob Wachter, MD, chief of the Division of Hospital Medicine and associate chair of the Department of Medicine. Wachter is the medical grand rounds organizational guru. He and the chief medical residents select the speakers, and he facilitates the sessions.

Eighteen months ago, after observing steadily declining attendance at grand rounds, Wachter revamped the tradition, determined to resuscitate what he considers a valuable collegial learning opportunity. “We need grand rounds and other venues that nurture our communities and expose us to content and concerns outside our sweet spots,” he said.

Desmond-Hellmann agrees: “I am a big fan of grand rounds,” she said. “First, broad knowledge of medicine has always helped me do a better job, as it allows me to better put into context what I am personally working toward. Second, one of my favourite things about UCSF is being a part of a wonderful community of colleagues, and the chance to say hello in person, learn together, and benefit from the questions and dialogue is priceless.”

The chancellor’s session roughly coincided with the first anniversary of the grand rounds makeover. So far, so good, Wachter said. “The results have been impressive. Average attendance has tripled to 100 to 150. We’ve created some real buzz.”

Making Grand Rounds Relevant

An optional weekly lecture series that targets trainees, grand rounds is open to all members of the UCSF community. Continuing education credits can be earned for health professionals in attendance.

After seeing attendance dip to what he calls an “embarrassing” low of 25 to 30, Wachter halted grand rounds at the start of summer in 2009, and assembled a group of key faculty and chief residents to think about its fate. The grand rounds committee considered, among other things, whether the sessions should be buried as an educational fossil whose time had come and gone.

The threat of their demise invigorated Wachter to see whether, and how, grand rounds could be made more relevant in the lives of busy medical professionals who have instant access to personalized learning via any number of computerized devices.

The committee surveyed a dozen major medical departments about their grand rounds, examining everything from the timing and length of sessions to topic choice and edible offerings. One thing they quickly discovered, Wachter said, was that grand rounds were losing popularity everywhere, not just at UCSF.

The group agreed on several changes. They included expanding the variety of the speakers, limiting the lectures to 35 minutes to leave time for audience discussion, asking each speaker to start with something personally meaningful, and boosting the food budget.

Topics scheduled for this year include “Shrinking the Malaria Map” with Richard Feachem, DSc(Med), PhD, executive director of UCSF Global Health Sciences, and “Opiate Addiction: Can It Be Treated in Primary Care?” with Elinore McCance-Katz, MD, PhD, adjunct professor of psychiatry and state medical director of the California Department of Alcohol and Drug Programs.

Now, a year into the new and improved grand rounds, Wachter says that attendance remains strong, there are more requests to speak than there are spots and the energy in the room is palpable.

Branding UCSF

In Desmond-Hellmann’s turn at the grand rounds helm, she clipped through the five priorities she had set when she became chancellor (patient care, discovery, education, people and business), using a variety of metrics to call out progress and note room to grow.

Desmond-Hellmann spoke with pride of UCSF’s place among the top hospitals and schools of medicine, dentistry, nursing and pharmacy in US News & World Report’s annual rankings. She cited UCSF as a consistent national leader in attracting funding from the National Institutes of Health (NIH).

She listed new facilities, including UCSF Medical Center at Mission Bay and the stem cell building, an architectural marvel chiseled into the side of Mount Sutro. Desmond-Hellmann also spoke of major recent awards received by UCSF faculty and noted significant new hires, as well as game-changing philanthropic donations, particularly the $100 million naming gift from Marc and Lynne Benioff for the new children’s hospital at Mission Bay, which is expected to be completed in 2014.

Desmond-Hellmann was, however, careful not to come across as too rosy. “Even as an eternal optimist, there are challenges, and I want to make sure you know that my eternal optimism doesn’t blind me to seeing these.”

She defined the main challenges facing UCSF as the increased regulation of health care, continuing state budget strains, the escalating costs of retirement, a potential decline in NIH funding, and the ability to recruit and retain star faculty in the face of increasing competition from other institutions.

Her future goals include updating UCSF’s overall strategic plan; strengthening programs in global health and human biology; continuing to invest in not only new facilities, but also renovation and seismic upgrades; recruiting and retaining top faculty; and pursuing additional revenue streams such as increased philanthropy.

The question-and-answer session that followed Desmond-Hellmann’s talk started with a true confession of sorts.

When asked what she wished she’d been taught when she was a resident at UCSF, Desmond-Hellmann – who entered clinical practice after her residency, then went into the biotech industry – didn’t miss a beat. “The one thing I wish that I’d recognized is that a career path doesn’t need to lead to being a faculty member,” she said. “When I left UCSF, I definitely felt like a failure.” More exposure to meaningful career paths outside of academia would have been valuable, she said.

Other questions focused on comparisons between running the halls – or labs – of academia and running a private business, a theme woven through Desmond-Hellmann’s talk. To captivated listeners, she spoke of the challenge of measuring success at a medical center as opposed to a business, where selling products and levitating the stock price are the unifying goals.

She implored the audience to ponder the one mission or goal shared by all at UCSF, searching out loud herself. And then she said: “It’s the UCSF brand. I actually think we underestimate the power of the UCSF brand and how each of our individual actions contributes to it.”

And so Desmond-Hellmann added a new goal to her list. “In my second year, I’d love to articulate that more effectively to the campus and ask people to participate in keeping the brand strong. I think that touches everyone on campus.”