AJCP / Editorial
Teaching Rounds A New Approach Michael L. Wilson, MD From the Department of Pathology & Laboratory Services, Denver Health, Denver, CO, and Department of Pathology, University of Colorado School of Medicine, Aurora, CO. DOI: 10.1309/AJCP7QCKMQ2JDVME
In this issue of the Journal, we present the second article in our special series on education and training in pathology and laboratory medicine. In this article, Spicer and colleagues1 describe the use of case-based teaching vignettes in clinical microbiology rounds. Both approaches to teaching will be familiar to readers of the Journal: case-based teaching has been a mainstay of medical education for decades, particularly as an exercise in small-group teaching. In the same way, laboratory rounds have been used as an effective teaching tool for many years. What may be new to readers is the idea of combining the two approaches in one setting. Some obvious questions are whether the approach is effective, what are the benefits, and what, if any, are the alternatives. Rounds, either clinical or laboratory based, are by their nature not nearly as structured compared with other teaching or training methods. This is because the very nature of rounds is ad hoc: one cannot predict the types of patients or patient specimens that will be presented from day to day. Moreover, because rounds are conducted in small groups and retain some hierarchical structure, they are more likely to be affected by the preferences and style of the attending physician or the laboratory scientist directing them. Not surprisingly, some have questioned the effectiveness of rounds, particularly in light of recent proposals to base medical training more on objective assessments of skills and less on evaluations by more senior trainees or attending physicians. There also is a perception that recent changes in graduate medical education, as well as other factors, have adversely affected laboratory rounds.2 Although a systematic study of laboratory rounds has yet to be conducted, it is clear that in many instances, they have been shortened or disappeared altogether. 300 300
Am J Clin Pathol 2014;141:300-301 DOI: 10.1309/AJCP7QCKMQ2JDVME
What, then, can be done to save or, at the least, improve rounds? Providing some structure to an inherently unstructured event is one approach, because with structure one can much more easily define goals and objectives, develop objective ways to assess effectiveness (ie, what works and what does not), prevent unnecessary repetition of topics, ensure that a breadth of topical content is covered over a given period, and facilitate scheduling for faculty members with particular interests in specific topics. The use of case-based vignettes, as described by Spicer and colleagues,1 is one obvious way to provide such a structure. There would not appear to be much downside to this approach. One can imagine a perceived loss of autonomy or flexibility for those presenting rounds or complaints about the administrative burden of tracking topics, scheduling, and so forth. As to the former, adding some structure might result in some loss of autonomy or flexibility, but the trade-off of improved scheduling and less need to prepare at the last minute would seem to be worth it. With regard to the former, any administrative burden is likely minimal and certainly no more than what most of us already do on a daily basis for many other teaching or training activities. On balance, therefore, it seems that the idea of incorporating case-based teaching with rounds has much to be said for it and little to be said against it. The study of effectiveness in teaching and training is challenging, because so much depends on personal impression. That said, the assessment used by Spicer and colleagues1 is similar to that used in other studies. In this case, the results showed that trainees perceived rounds to be improved by adding the case-based curriculum and that pathology residents perceived the new curriculum to enhance their ability to retain knowledge. One can always debate the scientific or © American Society for Clinical Pathology
AJCP / Editorial
methodologic merits of such an approach, but that must be offset by the practical realization that perception is a valid measure of outcomes. Perhaps the most important benefit to this approach is that it preserves the traditional teaching method of rounds at a time when so much of medical education and training is changing. Moreover, there do not seem to be many practicable alternatives. Simply standing by and watching further erosion of the time and resources allocated to teaching rounds is not an acceptable alternative. Neither is further erosion of the opportunities for direct teaching and training. There is much to be said for face-to-face interactions during rounds, the ability to question and challenge ideas and concepts, and
© American Society for Clinical Pathology
explaining how personal views and experience color the way one thinks and how one interprets laboratory findings. Despite our advances in diagnostic testing, there is still a great deal of subjectivity in laboratory medicine, particularly with interpretation of test results. Teaching rounds are one of the best ways to learn about those issues.
References 1. Spicer JO, Kraft CS, Burd EM, et al. The value of case-based teaching vignettes in clinical microbiology rounds. Am J Clin Pathol. 2014;141:318-322. 2. Fekete T. Who killed lab rounds? Pharos. 2013;76:32-34.
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Am J Clin Pathol 2014;141:300-301 DOI: 10.1309/AJCP7QCKMQ2JDVME
301 301
Teaching Rounds A New Approach Michael L. Wilson, MD From the Department of Pathology & Laboratory Services, Denver Health, Denver, CO, and Department of Pathology, University of Colorado School of Medicine, Aurora, CO. DOI: 10.1309/AJCP7QCKMQ2JDVME
In this issue of the Journal, we present the second article in our special series on education and training in pathology and laboratory medicine. In this article, Spicer and colleagues1 describe the use of case-based teaching vignettes in clinical microbiology rounds. Both approaches to teaching will be familiar to readers of the Journal: case-based teaching has been a mainstay of medical education for decades, particularly as an exercise in small-group teaching. In the same way, laboratory rounds have been used as an effective teaching tool for many years. What may be new to readers is the idea of combining the two approaches in one setting. Some obvious questions are whether the approach is effective, what are the benefits, and what, if any, are the alternatives. Rounds, either clinical or laboratory based, are by their nature not nearly as structured compared with other teaching or training methods. This is because the very nature of rounds is ad hoc: one cannot predict the types of patients or patient specimens that will be presented from day to day. Moreover, because rounds are conducted in small groups and retain some hierarchical structure, they are more likely to be affected by the preferences and style of the attending physician or the laboratory scientist directing them. Not surprisingly, some have questioned the effectiveness of rounds, particularly in light of recent proposals to base medical training more on objective assessments of skills and less on evaluations by more senior trainees or attending physicians. There also is a perception that recent changes in graduate medical education, as well as other factors, have adversely affected laboratory rounds.2 Although a systematic study of laboratory rounds has yet to be conducted, it is clear that in many instances, they have been shortened or disappeared altogether. 300 300
Am J Clin Pathol 2014;141:300-301 DOI: 10.1309/AJCP7QCKMQ2JDVME
What, then, can be done to save or, at the least, improve rounds? Providing some structure to an inherently unstructured event is one approach, because with structure one can much more easily define goals and objectives, develop objective ways to assess effectiveness (ie, what works and what does not), prevent unnecessary repetition of topics, ensure that a breadth of topical content is covered over a given period, and facilitate scheduling for faculty members with particular interests in specific topics. The use of case-based vignettes, as described by Spicer and colleagues,1 is one obvious way to provide such a structure. There would not appear to be much downside to this approach. One can imagine a perceived loss of autonomy or flexibility for those presenting rounds or complaints about the administrative burden of tracking topics, scheduling, and so forth. As to the former, adding some structure might result in some loss of autonomy or flexibility, but the trade-off of improved scheduling and less need to prepare at the last minute would seem to be worth it. With regard to the former, any administrative burden is likely minimal and certainly no more than what most of us already do on a daily basis for many other teaching or training activities. On balance, therefore, it seems that the idea of incorporating case-based teaching with rounds has much to be said for it and little to be said against it. The study of effectiveness in teaching and training is challenging, because so much depends on personal impression. That said, the assessment used by Spicer and colleagues1 is similar to that used in other studies. In this case, the results showed that trainees perceived rounds to be improved by adding the case-based curriculum and that pathology residents perceived the new curriculum to enhance their ability to retain knowledge. One can always debate the scientific or © American Society for Clinical Pathology
AJCP / Editorial
methodologic merits of such an approach, but that must be offset by the practical realization that perception is a valid measure of outcomes. Perhaps the most important benefit to this approach is that it preserves the traditional teaching method of rounds at a time when so much of medical education and training is changing. Moreover, there do not seem to be many practicable alternatives. Simply standing by and watching further erosion of the time and resources allocated to teaching rounds is not an acceptable alternative. Neither is further erosion of the opportunities for direct teaching and training. There is much to be said for face-to-face interactions during rounds, the ability to question and challenge ideas and concepts, and
© American Society for Clinical Pathology
explaining how personal views and experience color the way one thinks and how one interprets laboratory findings. Despite our advances in diagnostic testing, there is still a great deal of subjectivity in laboratory medicine, particularly with interpretation of test results. Teaching rounds are one of the best ways to learn about those issues.
References 1. Spicer JO, Kraft CS, Burd EM, et al. The value of case-based teaching vignettes in clinical microbiology rounds. Am J Clin Pathol. 2014;141:318-322. 2. Fekete T. Who killed lab rounds? Pharos. 2013;76:32-34.
301
Am J Clin Pathol 2014;141:300-301 DOI: 10.1309/AJCP7QCKMQ2JDVME
301 301
