LACES Grand Rounds: Do not miss the opportunities!

Grandes Sesiones LACES: No pierdas las oportunidades!

Consulta de Grupo LACES: Não perca as oportunidades!

Carlos – A. Mestres MD PhD FETCS^1,2, Miguel Piñón MD PhD FETCS³, Eduard Quintana MD PhD FETCS⁴

¹Department of Cardiac Surgery, University Hospital Zürich, Zürich (Switzerland)

²Department of Cardiothoracic Surgery, The University of the Free State, Bloemfontein (South Africa)

³Department of Cardiac Surgery, Hospital Universitario “Alvaro Cunqueiro”, Vigo (Spain)

⁴Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona (Spain)

Corresponding author:

Carlos – A. Mestres MD PhD FETCS

Department of Cardiac Surgery

University Hospital Zürich

Rämistrasse 100

8091 Zürich (Switzerland)

Tel.:                 +41 44 255 95 82

Fax:                 +41 44 255 44 67

E-mail:            Carlos.Mestres@usz.ch

Key words:

English: Grand Rounds; medical education; transfer of knowledge; virtual meeting; distancing

Español: Grandes Sesiones; educación médica; transferencia de conocimiento; encuentro virtual; distancia

Português: Consulta de Grupo; educação médica; transferência de conhecimento; encontro virtual; distanciar

English

Grand Rounds are an important part of medical education. In its classical format, they evolved from ward rounds to an educational activity hold away from the ward and the patient. Direct interpersonal interaction was the foundation for discussions on the clinical aspects of the disease, findings from direct physical examination and supportive investigations, proposed therapeutical pathways and outcomes. The pandemic led to cancellation of all educational activities with interpersonal contact worldwide. An immediate reaction was seen aiming at avoid interruption in delivery of information and transfer of knowledge. The Latin-American Society of Cardiac and Endovascular Surgery promptly reacted and established a solid programme of online education of which webinars and Grand Rounds are it successful backbone.

Español

Las Grandes Sesiones Clínicas son una parte importante de la educación medica. En su formato clásico, evolucionaron desde las visitas en la sala de hospitalización a pie de cama hacia una actividad educativa lejana físicamente del paciente. La interacción interpersonal directa ha sido el fundamento para las discusiones sobre los aspectos clínicos de la enfermedad, los hallazgos de la exploración física y exploraciones complementarias, las propuestas terapéuticas y los resultados del tratamiento. La pandemia obligo a cancelar todas las actividades educativas con relación interpersonal directa en todo el mundo. Se observó una reacción inmediata global para evitar interrupciones en la transmisión de información y conocimiento. La Sociedad Latino-Americana de Cirugia Cardiaca y Endovascular reaccionó con prontitud y estableció un programa sólido de educación en línea, del que los seminarios y las Grandes Sesiones Clínicas son su columna vertebral.

Português

As Consultas de Grupo são uma parte importante da educação médica. No seu formato clássico, evoluíram das visitas na enfermaria cara a uma atividade educativa fisicamente distante do doente. A interpretação interpessoal direta foi o fundamento para as discussões acerca dos aspetos clínicos da doença, os achados da exploração física e as explorações complementares, os tratamentos propostos e os resultados dos mesmos. A pandemia levou a cancelar todas as atividades educativas com interação interpessoal direta em todo o mundo. Observou-se uma reação imediata global para evitar interrupções na transmissão de informação e conhecimento. A Sociedade Latino-americana de Cirurgia Cardíaca e Endovascular reagiu prontamente e estabeleceu um programa sólido de educação em linha, do qual os seminários e as Consultas de Grupo são a sua coluna vertebral.

Grand Rounds (GR) are a historically integrated component of medical education (1), especially in major teaching Institutions. Ward rounds represent for already a couple of centuries a solid, flexible, immediate approach to teaching and transfer of knowledge. In other words, an important part of physician education is based on direct contact and interaction with patients and attending faculty. Many of us have gone through this classical way of teaching and learning. Under different formats, ward rounds are a part of daily routine globally. Ward rounds aimed at analyzing the patient medical history, identifying the diagnostic problems, eventual therapy and prognostics of a given disease (2). As an instrument of medical education, its value must not be neglected.

Medical education has changed over time reaching high degrees of sophistication in current times. Grand Rounds evolved from bedside ward rounds towards a more stable, organized model to learn clinical skills and underwent a number of transformations according to the specialty and objectives (3). The GR framework as training model has been discussed extensively in the literature (1, 3, 4) since its introduction by Osler (5). Further discussions about GR have even addressed its effectiveness and usefulness as a Continuous Medical Education (CME) tool (1).

Grand Rounds, as an educational instrument have been classically conducted face-to-face. The aim was driving the audience towards learning from interesting case discussions. Competence-based skills can developed through GR, too (3, 7) and have impact on quality (8). Grand Rounds have the same basic components as ward rounds, the clinical case, the students and the teacher or in other words, residents, clinicians and faculty. The major difference is the physical distance from the ward.

Definition

Although some definitions may be brought for discussion aiming at understand what a GR is, GR have been defined as an ongoing activity that includes the formal presentation of clinical cases with supporting basic science information (1). There is still no consensus, with definitions focusing on specific objectives (9-11). Others adapt their definitions to broader objectives in times of a global medical community (12).

LACES Grand Rounds

The Latin-American Society of Cardiac and Endovascular Surgery (LACES) is a young professional gathering in which all dedicated to cardiovascular care are welcome. Cardiac, thoracic or vascular surgeons, cardiologists, cardiac anesthesiologists, residents and perfusionists and cardiovascular nurses are those who should gather to make LACES stronger in the years to come (13). LACES aims at hold scientific meetings, featuring free discussion of problems and developments related to cardiac and endovascular surgery (13). The LACES Twitter account was officially opened on January 31, 2020.

The COVID-19 pandemic forced LACES to adapt to a newer form of professional discussions. Adaptation to unforeseen and dramatic situations has been necessary during the disastrous year 2020. LACES activities in the past 15 months have been hit by the pandemic, as there were cancellations of physical meetings leading to delay of its foundational session. We, LACES members, know this. The response of LACES was fast and energetic and from March 2020 we witnessed professional exchange and teaching activities flourishing for the benefit of members and friends and the patients, the ultimate goal of our professional efforts.

LACES and the LACES Residents Committee announced what we consider a giant step forward, launching regular LACES Grand Rounds to be held virtually once monthly for the time being. Preserving the philosophy of a GR, namely presenting challenging and interesting clinical cases by residents with the supervision of experienced staff surgeons and additional moderation by a worldwide known expert, is of utmost importance for our young Society.

Comment

The format of medical education has sustained profound transformation in the past decade. Classical approaches to transfer of knowledge like ward and GR remain a substantially important part of the process. However, the era of information technology has disrupted the entire world and radically transformed human relationships. Education is not an exception and it is clear that our ability to learn from and exchange with the others has progressed at an uncontrolled speed.

Grand Rounds are an example of interdisciplinary work, too. Interdisciplinary teamwork in healthcare has been shown to improve patient outcomes (14). As GR entails teaching and learning, this will influence future care. LACES Grand Rounds are interactive discussions, based on the latest scientific evidence available (13).  Providing the best patient care often requires physicians from different specialties to combine different skills and knowledge (15, 16). The virtual GR conducted over an internet-based platform have great performance. We have to understand that, regardless of adaption to an exceptional situation like the pandemic, virtual activities miss the most important factor, the interpersonal exchange. In the meantime and although currently under investigation, virtual educational sessions themed around a specific topic are a good alternative to physical meetings (17).

The COVID-19 pandemic has brought disarray at an unimaginable level. Education has not been an exception. The cessation of traditional GR and other educational activities at the beginning of the pandemic required immediate adaption to a new unexpected scenario (18, 19). Currently available platforms allow for, likely, more participation and possible more interactivity as posting of questions and suggestions for discussion is immediate and they are filed. Another issue is how questions can be handled when the virtual audience is large enough not to have the ability and time to address all.

LACES Grand Rounds benefit from the advantages of virtual conferencing. Broadcasting to virtual audiences beyond the boundaries of the departments or institutions seeking for transfer of knowledge and improving quality is an excellent opportunity to engage people at any age; however, those going through a training process should understand that engagement is a form of investment. Young physicians in training are well trained and exposed to all advances in information technology. LACES is an example of societal modern style, distributing information and promoting engagement in any activity using all possible social media (Facebook, Twitter, Instagram,…) and tools (20). Although the pandemic has brought disarray, poverty, social unrest and death (21, 22) on the other hand as in any crisis, it has also given the opportunity to revamp GR seeking for new and updated models of medical education that will likely stay (18, 20).

The so-called “social distancing” is a very unfortunate, equivocal and absurd term that has been coined during the pandemic, even if described by the Centers for Disease Control in the US (23). We need to understand that social distancing is actually a physical distancing mandatory as part of prevention of transmittable diseases (24), something well known for decades. Grand Rounds have adapted and mandatory distance, of course, influenced on such educational activities. LACES Grand Rounds are a good example of immediate response to crisis. It will be important to look after attendance data during the first year to understand how useful this format will be. Awaiting for the chance to be back to direct physical interaction and having a look at those LACES Grand Rounds since they were launched a few months back, we have to go back to the title of this contribution and shout out the young: Do not miss the opportunity!