Van Hoof Thomas J, Monson Robert J, Majdalany Gibran T, Giannotti Tierney E, Meehan Thomas P
University of Connecticut School of Nursing, Storrs, Connecticut 06269-2026, USA.
Acad Med. 2009 Aug;84(8):1144-51. doi: 10.1097/ACM.0b013e3181ad1c0e.
Grand rounds are a time-honored continuing medical education activity that is intended to keep doctors current and competent. In addition, health care leaders and medical educators often rely on grand rounds to change physician behavior and improve patient outcomes. However, the extent to which grand rounds programs are consistent with evidence-based educational practices is unknown.
The authors used an instrumental case study approach in 2007 to determine whether one grand rounds program, such as medical grand rounds held at a U.S. academic medical center, adhered to well-accepted educational practices. Qualitative data collected from program planners, presenters, and participants via structured observations, key informant interviews, and a focus-group session allowed an assessment of consistency with five evidence-based practices. The authors used an intensive, inductive approach to analyze data to determine the extent to which the medical grand rounds program incorporated the five practices.
Studied during 2007, this traditional medical grand rounds program only minimally reflected the five evidence-based educational practices of needs assessment, multifaceted intervention strategy, sequencing, interaction, and commitment to change. Authors found grand rounds sessions to be slide-driven, passive presentations reflecting a broad range of subspecialty topics. Opportunities for questions were limited, and audience attendance was inconsistent and varied, particularly for nonfaculty participants.
This study has identified important opportunities for improving a specific grand rounds program and for researching similar examples of this common, traditional educational forum for physicians.
大查房是一项历史悠久的继续医学教育活动，旨在使医生紧跟医学前沿并保持专业能力。此外，医疗保健领导者和医学教育工作者常常依靠大查房来改变医生的行为并改善患者治疗效果。然而，大查房项目与循证教育实践的契合程度尚不清楚。
作者于2007年采用工具性案例研究方法，以确定一个大查房项目，比如在美国一所学术医疗中心举办的医学大查房，是否遵循了广为接受的教育实践。通过结构化观察、关键信息人访谈和焦点小组会议从项目规划者、演讲者和参与者那里收集的定性数据，使得对与五种循证实践的一致性进行评估成为可能。作者采用深入的归纳方法来分析数据，以确定医学大查房项目纳入这五种实践的程度。
在2007年进行研究时，这个传统的医学大查房项目仅最低限度地体现了需求评估、多方面干预策略、顺序安排、互动以及对变革的承诺这五种循证教育实践。作者发现大查房环节是由幻灯片驱动的、被动的展示，反映了广泛的亚专业主题。提问机会有限，听众出席情况不稳定且各不相同，尤其是非教员参与者。
本研究确定了改进特定大查房项目以及研究这个面向医生的常见传统教育论坛类似案例的重要机会。
