Requiem for the grand round

The time-honoured tradition of Grand Round is firmly rooted in medical education, but has little evidence for its effectiveness or its impact on patient management. A mode of didactic teaching, Grand Round has lost its appeal in modern medical education with dwindling attendance at Grand Rounds worldwide. Once a platform for eminence-based medicine and a cross fertilisation of medical ideas, emphasis on sub-specialisation and clinical governance, combined with rota, trainee engagement and attendance failures has made Grand Round obsolete. To survive, Grand Round must have evidence for its effectiveness in medical education. It must be able to compete with other forms of teaching and adapt by using technology to reach trainees. Engaging the audience and encouraging participation needs to be woven into the fabric of the modern Grand Round, alongside learning clinical skills and developing clinical reasoning. Understanding the needs of today’s trainees and their involvement in formulating the Grand Round programme is vital. Attendance at Grand Round is a recognised measure of its success and will be used in its evaluation. Questions still remain regarding the future of Grand Round. Its survival will depend upon its ability to change with time and reclaim its place as a credible tool to promote learning.

大查房（Grand Round）这一历史悠久的传统在医学教育中根深蒂固，但其有效性及其对患者管理的影响却缺乏证据。作为一种讲授式教学模式，大查房在现代医学教育中已失去吸引力，全球大查房的参与人数不断减少。大查房曾经是精英医学的平台以及医学理念交流融合的场所，然而对亚专科化和临床管理的强调，加上值班安排、学员参与度和出勤不佳等问题，使得大查房已经过时。为了生存，大查房必须有其在医学教育中有效性的证据。它必须能够与其他教学形式竞争，并通过利用技术来适应以触及学员。吸引听众并鼓励参与需要融入现代大查房的结构中，同时还要学习临床技能和培养临床推理能力。了解当今学员的需求以及他们在制定大查房计划中的参与至关重要。大查房的出席情况是衡量其成功的一个公认标准，并将用于对其进行评估。关于大查房的未来仍然存在一些问题。它的生存将取决于其与时俱进的能力以及重新获得其作为促进学习的可靠工具的地位。