Grand Rounds Model in terms of Continuing Medical Education and Lifelong Learning

Yıl 2021, Cilt: 20 Sayı: 62, 16 - 32, 31.12.2021

Güneş Korkmaz , Ayşen Melek Aytuğ Koşan , Çetin Toraman

https://doi.org/10.25282/ted.958176

Öz

Aim: The rapid change in many fields in the global sense and the need for transformation due to this change has also affected the field of medical sciences; therefore, revisions have been required in medical education practices. For this reason, medical education is considered as one of the fields where change occurs fast. This study aims to examine the Grand Rounds model in terms of continuing medical education and lifelong learning through the analysis of its planning, implementation, and evaluation process.
Methods: This traditional literature review, in the context of continuing medical education and lifelong learning, was conducted to examine the planning, implementation and evaluation processes of grand rounds, especially in the United States. In Pubmed, Scopus and Google Scholar search engines, the keywords "Clinical Rounds", "Medical Rounds", "Bedside Teaching Rounds", "Medicine Rounds" and "Ward Rounds", which are called "classical clinical learning cycle", were searched. Then, the studies that included the term “Grand Rounds” model were examined.
Results: The grand rounds are designed to follow up-to-date diagnosis and treatment methods, to encourage knowledge sharing among faculty members, to contribute to the lifelong learning skills of students and faculty members, to create an active learning environment for assistants and students, and to share the faculty’s experiences with other stakeholders. It has been observed that the Grand Rounds, which was created in the context of adult learning theory and lifelong learning, has a more comprehensive process than traditional clinical rounds, is applied both in pre-graduate and postgraduate medical education and with the participation of health professionals from various disciplines. The most important stage of the Grand Rounds is planning. Therefore, there are some key elements that should be considered by the organizing committee that will carry out the planning process. These elements include shaping the content around the themes that will meet the needs of the participants, determining the appropriate learning outcomes, and deciding on the presentations that will contribute to the development of students' skills such as clinical reasoning, problem solving and decision making. During the implementation process, sufficient time should be allowed for the participants to discuss, interact, and share information about the subject. After Grand rounds, both the content in the learning cycles and the presenters should be evaluated with valid and reliable tools.
Conclusions: Integration of Grand rounds into continuous medical education in Turkey is strongly recommended in terms of providing broader lifelong learning opportunities for medical students, resident physicians and medical educators. 

Anahtar Kelimeler

Medical Education, Continuing Medical Education, Lifelong Learning, Grand Rounds

Sürekli Tıp Eğitimi ve Yaşam Boyu Öğrenme Bağlamında Grand Rounds Öğrenme Döngüsü Modeli

Öz

Amaç: Küresel anlamda birçok alanda yaşanan hızlı değişim ve bu değişimin beraberinde getirdiği dönüşüm ihtiyacı tıp bilimini de etkilemekte ve tıp eğitimi uygulamalarında güncellemeler gerektirmektedir. Bu nedenle, tıp eğitimi değişim ve yenilenmenin en hızlı olduğu bilim alanlarından biri olarak kabul edilmektedir. Bu araştırmanın amacı, sürekli tıp eğitimi ve yaşam boyu öğrenme bağlamında Grand Rounds öğrenme döngüsü modelini planlama, uygulama ve değerlendirme açısından incelemektir.
Yöntem: Makale türü geleneksel derlemedir. Sürekli tıp eğitimi ve yaşam boyu öğrenme bağlamında özellikle Amerika Birleşik Devletleri’nde uygulanan grand rounds öğrenme döngüleri ile ilgili planlama, uygulama ve değerlendirme süreçlerini incelemek için kaynak taraması yapılmıştır. Pubmed, Scopus ve Google Scholar arama motorlarında öncelikle “klasik klinik öğrenme döngüsü” olarak adlandırılan “Clinical Rounds”, “Medical Rounds”, “Bedside Teaching Rounds”, “Medicine Rounds” ve “Ward Rounds” anahtar sözcükleri taranmış; sonrasında ise “Grand Rounds” öğrenme döngüsü modelinin yer aldığı çalışmalar incelenmiştir.
Bulgular: Grand rounds öğrenme döngüsünün temel amaçları güncel tanı ve tedavi yöntemlerini takip etmek, öğretim üyeleri arasında paylaşımı teşvik etmek, öğrenci ve öğretim üyelerinin hayat boyu öğrenme becerisine katkı sağlamak, asistanlara ve öğrencilere birlikte aktif bir öğrenme ortamı yaratmak, fakültede edinilen deneyimleri ilgili diğer kişilerle paylaşmaktır. Yetişkin öğrenme kuramı ve yaşam boyu öğrenme bağlamında oluşturulmuş Grand Rounds öğrenme döngüsünün klinik öğrenme döngülerinden daha kapsamlı bir sürece sahip olduğu hem mezuniyet öncesi hem de mezuniyet sonrası tıp eğitiminde uygulandığı, farklı disiplinlerden sağlık profesyonellerinin katılımıyla gerçekleştiği görülmüştür. Grand Rounds öğrenme döngülerinin en önemli aşaması planlamadır. Dolayısıyla, planlamayı gerçekleştirecek komitenin göz önünde bulundurulması gereken bazı temel öğeler bulunmaktadır. Bu öğelerden en önemlisi içeriğin katılımcıların ihtiyaçlarına cevap verecek temalar etrafında şekillendirilmesi, uygun öğrenme hedeflerinin belirlenmesi ve gerçekleştirilecek sunumların öğrencilerin klinik akıl yürütme, problem çözme ve karar verme gibi becerilerinin gelişmesine katkı sağlayacak nitelikte seçilmesidir. Uygulama sürecinde katılımcıların konu hakkında tartışması, etkileşime girebilmesi ve bilgi paylaşımı yapabilmesi için yeterli süre tanınmalıdır. Uygulama sonrasında ise, hem öğrenme döngülerinde yer alan içerik hem de sunum yapan kişiler geçerli ve güvenilir araçlarla değerlendirilmelidir.
Sonuç: Tıp fakültesi öğrencileri, asistanlar ve tıp eğitimcilerine yaşam boyu öğrenme fırsatı sunması nedeniyle, Grand Rounds öğrenme döngüsü modelinin Türkiye’de sürekli tıp eğitimine entegrasyonunun sağlanması önerilmektedir.

Anahtar Kelimeler

Tıp Eğitimi, Sürekli Tıp Eğitimi, Yaşam Boyu Öğrenme, Grand Rounds Öğrenme Döngüsü

Kaynakça

• Sayek İ. Tıp Eğitiminin gelişimi ve değişim: 21. Yüzyılda tıp eğitimi. İçinde: Sayek, İ. (Ed.). Tıp Eğiticisi El Kitabı. 1.Baskı. Ankara: Güneş Tıp Kitabevleri. 2016; 3-11.
• Özdemir ST. Tıp eğitimi ve yetişkin öğrenmesi. Uludağ Üniversitesi Tıp Fakültesi Dergisi. 2003; 29(2): 25-28.
• Dokur M, Ulutaşdemir N. Mezuniyet öncesi tıp eğitimi ulusal çekirdek eğitim programı-2014 ve acil tıp eğitimi: acil tıp ile ilgili temel hekimlik uygulamalarının değerlendirilmesi. Sağlık Akademisi Kastamonu. 2018; 3(2): 115-129.
• Gülpinar MA. Yeni Bir Anlam Çerçevesi/Paradigma Arayışı. Tıp Eğitimi Dünyası. 2021; 20(60): 82-100.
• Terzioğlu F, Aktaş D, Ertuğ N, Boztepe H.. Interdisciplinary education perception scale: validity and reliability studies. Journal of Education and Research in Nursing. 2019; 16(1): 15-21.
• Uysal O A. Tıp Fakültelerinde Tıp Eğitimi Anabilim Dalı İşlevi. Tıp Fakültesi Klinikleri Dergisi. 2019; 2(1): 1-6.
• Steinert Y. Faculty development: from rubies to oak. Medical Teacher. 2020; 42(4): 429-435.
• Steinert Y. Developing medical educators: A journey, not a destination. Understanding Medical Education. 2014; 2, 455-72.
• Knowles M. The adult learner: A neglected species. American society for training and development. Madison: Gulf; 1973. https://files.eric.ed.gov/fulltext/ED084368.pdf
• Conner M L. Andragogy and pedagogy: Ageless learner; 1997. http://tlr.hccs.edu/facultyportal/pdf/Andragogy_Pedagoy.pdf
• Knowles MS. The modern practice of adult education, Cambridge; 1980.
• McGrath V. Reviewing the evidence on how adult students learn: an examination of Knowles' model of andragogy. Adult Learner: The Irish Journal of Adult and Community Education. 2009; 99-110.
• Merriam SB. Andragogy and self‐directed learning: Pillars of adult learning theory. New Directions for Adult and Continuing Education. 2001; 2001(89): 3-14.
• Ross‐Gordon JM. Adult learners in the classroom. New Directions for Student Services. 2003; 2003(102): 43-52.
• Çakmakkaya ÖS. Kanıta Dayalı Tıp: Temel Kavramlar, Öğrenme Teorileri, Eğitim Yaklaşımları ve Ölçme-Değerlendirme Yöntemleri ile İlgili Derleme. Tıp Eğitimi Dünyası. 2021; 20(60): 122-136.
• Leamy M, Reynolds E, Robert G, Taylor C, Maben J. The origins and implementation of an intervention to support healthcare staff to deliver compassionate care: exploring fidelity and adaptation in the transfer of Schwartz Center Rounds® from the United States to the United Kingdom. BMC Health Services Research. 2019; 19(1): 1-11.
• Resmi Gazete. Yataklı tedavi kurumları işletme yönetmeliği. Ankara: Resmi Gazete; 1983.
• Sandal S, Iannuzzi MC, Knohl SJ. Can we make grand rounds “grand” again?. Journal of Graduate Medical Education. 2013; 5(4): 560.
• Allen M, Sargeant J, MacDougall E, O'Brien B. Evaluation of videoconferenced grand rounds. Journal of Telemedicine and Telecare. 2002; 8(4): 210-216.
• Hull AL, Cullen RJ, Hekelman FP. A retrospective analysis of grand rounds in continuing medical education. Journal of Continuing Education in the Health Professions. 1989; 9(4): 257-266.
• Mann K V. Educating medical students: lessons from research in continuing education. Academic Medicine: Journal of the Association of American Medical Colleges. 1994; 69(1): 41-47.
• Dorman T, Angood PB, Angus DC, Clemmer TP, Cohen N H, Durbin Jr CG, Napolitano L M. Guidelines for critical care medicine training and continuing medical education. Critical Care Medicine. 2004; 32(1): 263-272.
• Walters WA, Bailey H, Kaplan LJ. Can preclinical medical students be integrated into the continuing medical education process by instructing prehospital care providers?. The American Journal of Surgery. 2000; 179(3): 229-233.
• Terzi C, Eryılmaz M, Anadol Z, Kaya F. Sürekli tıp eğitimi etkinlikleri, tanımlar ve özellikler; 2009. https://www.turkcer.org.tr/files/files/43_09_26_tanim.pdf
• Beeson P B. One hundred years of American internal medicine. A view from the inside. Ann Intern Med. 1986; 105(3): 436–444.
• Gray AZ, Modak M, Connell T, Enright H. Structuring ward rounds to enhance education. The Clinical Teacher. 2020; 17(3): 286-291.
• McLeod PJ, Gold P. Medical grand rounds: alive and well and living in Canada. CMAJ: Canadian Medical Association Journal. 1990; 142(10): 1053.
• Lehmann LS, Brancati FL, Chen MC, Roter D, Dobs AS. The effect of bedside case presentations on patients' perceptions of their medical care. New England Journal of Medicine. 1997; 336(16): 1150-1156.
• Simons R J, Baily RG, Zelis R, Zwillich CW. The Physiologic and Psychological Effects of the Bedside Presentation. New England Journal of Medicine. 1989; 321(18): 1273-1275. doi:10.1056/nejm198911023211821
• Dam M, Ramani S, Ten Cate O. An EPA for better Bedside Teaching. The Clinical Teacher. 2021: 1-6.
• Dent J, Harden RM, Hunt D. A practical guide for medical teachers. Elsevier health sciences; 2017.
• Caldwell G. The process of clinical consultation is crucial to patient outcomes and safety: 10 quality indicators. Clinical Medicine. 2019; 19(6): 503-506.
• Pennell CE, Kluckow H, Chen SQ, Wisely KM, Walker BL. Live-streamed ward rounds: a tool for clinical teaching during the COVID-19 pandemic. Med J. 2020; 213: 306-308.
• Walton V, Hogden A, Long JC, Johnson JK, Greenfield D. How do interprofessional healthcare teams perceive the benefits and challenges of interdisciplinary ward rounds. Journal of Multidisciplinary Healthcare. 2019; 12: 1023.
• Artis KA, Dyer E, Mohan V, Gold JA. Accuracy of laboratory data communication on ICU daily rounds using an electronic health record. Critical Care Medicine. 2017; 45(2): 179-186.
• Hofmann H, Harding C, Youm J, Wiechmann W. Virtual bedside teaching rounds with patients with COVID‐19. Medical Education. 2020; 54(10): 959-960.
• Somasundram K, Spence H, Colquhoun AJ, Mcilhenny C, Biyani CS, Jain S. Simulation in urology to train non‐technical skills in ward rounds. BJU International. 2018; 122(4): 705-712.
• Stollings JL, Devlin JW, Lin JC, Pun BT, Byrum D, Barr J. Best practices for conducting interprofessional team rounds to facilitate performance of the ICU Liberation (ABCDEF) Bundle. Critical Care Medicine. 2020; 48(4): 562-570.
• Andrew C. What is the educational value of ward rounds? A learner and teacher perspective. Clinical Medicine. 2011; 11(6): 558-562.
• Crowe A, Dotson-Blake KP, Vazquez M, Malone A. Enhancing clinical training with video grand rounds in counselor education. Journal of Creativity in Mental Health. 2018; 13(4): 479-489.
• Ramani S. Twelve tips to improve bedside teaching. Medical Teacher. 2003; 25(2): 112-115.
• Libman H, Jiang ZG, Tapper EB, Reynolds EE. How would you manage this patient with nonalcoholic fatty liver disease? Grand rounds discussion from Beth Israel Deaconess Medical Center. Annals of Internal Medicine. 2019; 171(3): 199-207.
• Matamoros L, Cook M. A nurse-led innovation in education: Implementing a collaborative multidisciplinary grand rounds. The Journal of Continuing Education in Nursing. 2017; 48(8): 353-357.
• Omar F, Zaheer M, Ahmed, M. Effectiveness of peer teaching in medical education: medical student’s perspective. Advances in Medical Education and Practice. 2018; 9: 199-201.
• Hebert RS, Wright SM. Re-examining the value of medical grand rounds. Academic Medicine. 2003; 78(12): 1248-1252.
• Burns RB, Waikar SS, Wachterman MW, Kanjee Z. Management Options for an Older Adult With Advanced Chronic Kidney Disease and Dementia: Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Annals of Internal Medicine. 2021; 173(3): 217-225.
• Edwards H, Laird A, Burton Z, Hobson A. Medical grand rounds–assessing the impact and improving attendance. BMJ Leader. 2018; 2(Suppl 1): A1–A45
• Chapman KB. Improving communication among nurses, patients, and physicians. AJN The American Journal of Nursing. 2009; 109(11): 21-25.
• Wachter RM, Shojania KG, Markowitz AJ, Smith M, Saint S. Quality grand rounds: the case for patient safety. Annals of Internal Medicine. 2006; 145(8): 629-630.
• Crossman M, Papanagnou D, Sullivan T, Zhang XC. Virtual grand rounds in COVID‐19: A financial analysis. Academic Emergency Medicine. 2021: 1-3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014643/pdf/ACEM-9999-0.pdf
• Kandiah DA. Clinical reasoning and knowledge management in final year medical students: the role of Student-led Grand Rounds. Advances in Medical Education and Practice, 2017; 8: 683-689.
• Mueller PS, Segovis CM, Litin SC, Habermann TM, Parrino TA. Current status of medical grand rounds in departments of medicine at US medical schools. Mayo Clinic Proceedings. 2006; 81(3): 313-321.
• Kravet SJ, Howell E, Wright SM. Morbidity and mortality conference, grand rounds, and the ACGME’s core competencies. Journal of General Internal Medicine. 2016; 21(11): 1192-1194.
• Morrison, LJ, Portenoy R. Giving a grand rounds presentation. Journal of Palliative Medicine. 2010; 13(12): 1477-1484.
• Richards J, Schwartzstein R, Irish J, Almeida J, Roberts D. Clinical physiology grand rounds. The Clinical Teacher. 2013; 10(2): 88-93.
• Roegman R, Riehl C. Playing doctor with education: Considerations in using medical rounds as a model for instructional rounds. Journal of School Leadership. 2012; 22(5): 922-952.
• Tridandapani S, Mullins ME, Meltzer CC. Grand rounds and a visiting professorship program in a department of radiology: How we do it. Academic Radiology. 2012; 19(11): 1415-1420.
• Valizadeh L, Zamanzadeh V, Namadi M, Alizadeh S. Nursing grand rounds: an integrative review. Medical-Surgical Nursing Journal. 2019; 8(3): e97107. https://sites.kowsarpub.com/msnj/articles/97107.html
• Stephens MB, McKenna M, Carrington K. Adult learning models for large-group continuing medical education activities. Family Medicine-Kansas City. 2011; 43(5): 334-337.
• Salinas D, Johnson SC, Conrardy JA, Adams TL, Brown JD. Sustaining nursing grand rounds through interdisciplinary teamwork and interorganizational partnership. AJN The American Journal of Nursing. 2019; 119(4): 41-48.
• Ramaswamy R, Dix EF, Drew JE, Diamond JJ, Inouye SK, Roehl BJ. Beyond grand rounds: a comprehensive and sequential intervention to improve identification of delirium. The Gerontologist. 2011; 51(1): 122-131.