How improving grand rounds lowered silos in our faculty
By Dr. Henri Bi, FRCPC
The COVID-19 pandemic, which shuttered lecture halls, forced all medical departments to rethink their delivery of continuing medical education, including in the Department of Anesthesiology at the University of Saskatchewan, where I am director of continuing professional development (CPD).
I’d like to share a story of how we improved the quality of our grand rounds to encourage a multidisciplinary culture in our faculty and break down communication barriers between departments. (Please see the Maintenance of Certification (MOC) guidance note from the Royal College below for details on how we were all able to claim MOC credits for this group improvement project.)
In spring of 2020, many medical specialties were shutting down their in-person academic rounds to allow for social distancing. In contrast, our department, with guidance from our provincial department head, Mateen Raazi, MD, FRCPC, identified tremendous value in continuing our rounds virtually.
At that time, people wanted more information on non-traditional topics, such as access to personal protective equipment, treatment options and vaccines for SARS-CoV-2 and mental health support. We responded by holding weekly province-wide rounds on WebEx. We invited speakers from Infectious Disease as well as leading vaccine researchers, lead investigators on convalescent plasma, mental health experts, the Canadian Medical Protective Agency and even the president of the Canadian Medical Association.
Our rounds were and continue to be well attended, peaking at over 250 participants. The feedback from colleagues has been very positive and encouraging. Most importantly, local departments are now actively engaged in discussing issues with us, and our relationships with them have become much stronger.
If you’d like to make your own grand rounds more interdisciplinary, here are four steps that I recommend you consider:
- Pick topics that are relevant to all specialties, not just one. To bring in fresh perspectives, we became better at identifying controversial clinical issues and topics that were interesting to the other departments and not just our own. Then we invited other disciplines to come for the discussion.
- Dedicate time to pre-planning. Before our multidisciplinary rounds with Orthopedic Surgery and General Internal Medicine, the three CPD heads meet twice to plan out topics of discussion, review literature and coordinate speakers. Although time consuming, it has led to more of a focus on how we can work together as a team. We are fortunate to have tremendous support from our provincial CPD chair, James Barton, MD, FRCPC, as well as every CPD director in the departments we have collaborated with.
- Invite local speakers from other disciplines to present best-practice guidelines for their specialty. For an anesthesiologist, an up-to-date understanding of physiology and pharmacology is instrumental. There are no better teachers than local experts within our medical community. Popular speakers are routinely invited back, along with their whole department in attendance. This fosters a better relationship between all members of different specialties.
- Include non-traditional social aspects of medicine in your content calendar. For our academic rounds, we brought in speakers on topics such as physician wellness and racism in medicine. In the spirit of continuity, we are inviting some speakers back to do a workshop using case studies. Gender inequality in medicine and in particular medical leadership, is another topic we plan to tackle in the coming academic year. I am now actively receiving requests from other departments to do joint rounds, whereas a few years ago, I had to beg people in the hallway!
The direction of health care is trending towards team-based problem solving. The beauty of grand rounds is that as a tool, it has endless potential. You can make it assume any shape or style that works for you. I am hoping that the next evolution of our academic rounds will be on the delivery of medical education — empowering staff physicians to become better teachers and coaches. I am hoping grand rounds will play a big role in achieving this goal.
Henry Bi, MD, FRCPC, is an anesthesiologist practising in Saskatoon, Sask. He is an assistant professor with the College of Medicine at the University of Saskatchewan and the director of CPD in the Department of Anesthesiology.
We think Dr. Bi’s story is an excellent example of practice improvement work! In a CPD context, this means simply leveraging your own practice data to uncover your needs, then making changes in an identified area of your practice supported by data, feedback and targeted CPD activities, and finally reporting on the resulting outcomes.
This project also demonstrates that data for improvement needn’t always be quantitative and that extensive research and big datasets are not always required. The data in this project was more qualitative and gathered from attendees.
- For this group improvement project, Dr. Bi and his team who worked on the rounds with him can claim MOC credits under Section 3: Practice Assessment.
- Grand round speakers can claim credits under Section 2: PLP and choose “Preparation for formal teaching activities” for the time they spent on new learning in preparation for speaking at the grand rounds.
- Attendees can claim Section 1: Accredited rounds, provided the rounds are accredited, and Section 2: PLP for additional learning. Attendees can also explore Section 3 if they wish to engage in their own practice assessment/improvement stimulated by the rounds.
The Royal College will soon be offering practical and supportive tools to support Fellows who wish to incorporate more improvement work into their MOC Program reporting. Please stay tuned for more information coming soon!