Guest Editorial: Ode to Grand Rounds

By Marc S. Levine, MD
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Dr. Levine is Professor of Radiology and Advisory Dean at the University of Pennsylvania School of Medicine and Chief of Gastrointestinal Radiology at the Hospital of the University of Pennsylvania, Philadelphia, PA. He is also a member of the editorial board of this journal.

There are grand pianos, grandstands and granddaddies, but the grandest of them all is that hallowed entity known in radiology circles simply as Grand Rounds. With its daunting moniker, Grand Rounds has become to academic radiology departments what Oscarnight is to the film industry. Whether on a weekly, biweekly or monthly basis, Grand Rounds is when the radiology faculty, fellows and residents are treated to a special presentation from the best of the best, which is why so many Grand Rounds speakers are former Special Forces ops. Yet it’s more than just a conference — any radiologist with a flair for teaching can give a lecture — but only those rare individuals with stellar academic credentials, seminal research contributions and their own personal travel agent can give Grand Rounds. While there is no guarantee Grand Rounds will be entertaining, informative or even comprehensible, that’s to be expected. Not all Grand Rounds speakers have the gift of gab (some don’t even speak English), but it doesn’t matter. Grand Rounds speakers are invited to your department from the far corners of the earth for one reason and one reason only — they know things you don’t — whether you know it or not.

Grand Rounds is not without its share of controversy. Every department faces the age-old dilemma of when to have it. One faction favors the crack of dawn, before work starts, but this is not necessarily an ideal time, as half the audience is sound asleep and the other half is in a vegetative state. Even the few audience members who are actually awake and alert may not be able to hear anything over all the snoring. Another faction favors the end of the day, when the work is theoretically done, except many radiologists don’t finish until 7 p.m. or later because of burgeoning clinical workloads and a mandate from Congress that radiologists take primary responsibility for eliminating the national deficit. This creates an unavoidable rift with PhDs and other researchers who are more than a little perturbed about attending Grand Rounds after 5 p.m. when they could be safely ensconced in their homes, watching reruns of Gilligan’s Island. A seemingly reasonable compromise is to have Grand Rounds in the middle of the day at noon, more commonly known as lunch time, but that’s too early for the night owls and too late for the early birds; it also begs the serious administrative question of whether or not to spring for pizza.

Ironically, Grand Rounds speakers have no control over the one thing that ultimately determines the success or failure of their presentation: The introduction. Before André Agassi retired from professional tennis at the advanced age of 30 (a retirement age that would even be considered early, by the way, for some radiologists in private practice), he coined a phrase in a famous Canon TV commercial that could be the mantra for radiology Grand Rounds, “Image is everything.” That’s why the introduction is so crucial. A spellbinding introduction can instill in the audience a degree of respect normally reserved for popes, presidents and JCAHO inspectors. That doesn’t mean it’s not possible to go overboard. As a general rule, the introduction shouldn’t last longer than the actual presentation. I remember one introduction in which the host radiologist went on for so long about the speaker’s credentials, I began to wonder if in a previous life he (the host, not the speaker) did background checks for the CIA. When the speaker finally stepped to the podium, he politely thanked the host for his introduction, grinned at the audience and said, “I see we’re out of time.”

After the introduction, another important element of Grand Rounds is its content. What does that mean? It means speakers shouldn’t just be reviewing the literature in their area of expertise, they should be writing it. For us mere mortals in the audience to be suitably impressed, these speakers need to tell us about their contributions to radiology and claims to immortality, not those of other radiologists we haven’t met and wouldn’t recognize if we bumped into them at the supermarket. Put another way, Alexander Graham Bell shouldn’t be giving Grand Rounds on the invention of the light bulb, nor Thomas Alva Edison on the invention of the telephone. Nobody wants to hear Edison yap about telephones or Bell blab about light bulbs. I don’t know how to make it any clearer.

But content alone isn’t enough to guarantee success. Even more important is the delivery.The best speakers always have the audience in the palm of their hand, hanging on every word. They tell an exciting story, weaving a tapestry that is intricate, riveting, and, occasionally, even informative. The last part isn’t mandatory. What is essential is that the audience is glued to its seats. Grand Rounds speakers who truly entertain us are assured a place in the Radiology Grand Rounds Hall of Fame. It’s even better if the speakers are funny. Remember, the average radiologist won’t pony up a dime for radiology Grand Rounds but will gladly pay an arm and a leg to see Robin Williams in concert.

Where are you going? We’re not finished. Even more critical than the delivery is the timing, which brings us to the one paramount and sacred rule for giving a successful Grand Rounds — a rule more important than the introduction, content and delivery combined. It’s a short and simple rule, only two words: Finish on time. Okay, three. Audiences can forgive painfully dull, long-winded, obnoxious, even incomprehensible Grand Rounds speakers, so long as they stay on schedule. For those of you who were daydreaming during the last sentence, I repeat: All will be forgiven so long as the speakers FINISH ON TIME! Whatever their foibles as teachers and human beings, Grand Rounds speakers who adhere to this rule will receive rave reviews.

On the other hand, the worst sin Grand Rounds speakers can ever commit is to exceed their allotted time. When our Grand Rounds were at 5 p.m., I remember one speaker whose presentation lasted so long I got home after David Letterman’s monologue. And nothing puts me in a worse mood than missing David Letterman’s monologue. That’s like going to the movies and missing the opening credits. When the Grand Rounds speaker who committed this egregious sin at long last wrapped up his talk and asked for questions, one exhausted member of the audience asked in a deadpan voice, “Can we go home now?”

Speaking of home, if I don’t wrap up this editorial, I might not get home in time for today’s rerun of Gilligan’s Island. Till next time.

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Guest Editorial: Ode to Grand Rounds.  Appl Radiol. 

June 09, 2010

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