Improving medical grand rounds: barriers to change.
BACKGROUND
Grand rounds programs may not be consistently structured to bring benefit from evidence-based practices of effective continuing medical education. In order to make improvements in this common educational forum, educational leaders need to consider and possibly overcome some barriers as perceived by planners, presenters, and participants. Research on perceived barriers to improving grand rounds is lacking.


METHODS
Using an instrumental case-study approach, the investigators sought to describe perceived barriers to improving a Medical Grand Rounds program held at an academic medical center in the Northeast. Perceived barriers were identified by program planners, presenters, and participants. The study used qualitative data collected from each group via key informant interviews and a focus group to assess barriers in relation to five evidence-based practices: needs assessment, multifaceted intervention strategy, sequencing, interaction, and commitment to change. The study used an intensive, inductive approach to analyze data to determine barrier themes from each group.


RESULTS
Studied during 2007, program constituents of Medical Grand Rounds suggested a variety of important barriers. Understanding such barriers informs some recommendations to improve the program and possibly other programs similar to it.


CONCLUSIONS
This study has identified important barriers to improving a specific grand rounds program and discusses the implications of such barriers on recommendations for improvement.
Van Hoof
Thomas J
TJ
University of Connecticut School of Nursing, 231 Glenbrook Road, Unit 2026, Storrs, CT 06269-2026, USA. tom.vanhoof@uconn.edu
Monson
Robert J
RJ
Majdalany
Gibran T
GT
Giannotti
Tierney E
TE
Meehan
Thomas P
TP
D001291:Attitude of Health Personnel; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D019317:Evidence-Based Medicine / Q000193:education*; D017144:Focus Groups; D006801:Humans; D020380:Needs Assessment; D015397:Program Evaluation; D056164:Teaching Rounds / Q000458:organization & administration*