Development Strategies in Medical Education

Introduction
Medical education includes two theoretical and practical education [1-3]. One of the most important environments where students can acquire the necessary skills is the bedside, where medical students learn many aspects of medical knowledge as well as history-taking and physical examination skills in the presence of their teachers [4]. Educational Grand Rounds are a special method of clinical education that is used in many medical, surgical, and academic departments across the country. Since the introduction of educational grand rounds in the late 19th century by Sir William Osler, they have become popular [5, 6, 7]. To achieve an efficient clinical education, it is necessary to continuously evaluate the state of training, especially the grand rounds, and identify the strengths and weaknesses. This study aims to survey the perceptions of faculty members, assistants, interns, and students in the internal department of Seyyed al-Shohada Hospital affiliated to Jahrom University of Medical Sciences (JUMS) regarding the held Grand Rounds.

Methods
This analytical cross-sectional study was conducted on 83 people (faculty members, residents, interns, externs, and students) in the internal department of Seyyed al-Shohada Hospital in 2023. The data collection tools included a demographic form and a standard grand round questionnaire with 13 items. The demographic form surveys information such as age, sex, educational level, academic degree, and duration of stay in the internal department. Data analysis was done in SPSS software,  version 21 using descriptive statistics (frequency and percentage). The significance level was set at 0.05.

Results
According to the majority of participants, the held grand rounds were at a good or very good level. Most of them perceived the presence of the intern in the grand rounds as useful and necessary. Moreover, 62% perceived that holding the Grand Round in a classroom and presentation by the professors was more efficient. Also, 58.9% perceived the discussion about differential diagnoses as the best strategy for introducing the patient. According to the most of participants, grand rounds could be held more actively when faculty members sit in front of students compared to other modes. They perceived it more appropriate to hold grand rounds in less than an hour and at 9:00 a.m.

Conclusion
According to the results of this study, 63.9% of students, 62.2% of interns, 77.8% of residents, and 100% of professors perceived the held grand rounds as good or very good. This is consistent with the results of Rohani et al., Alaa et al., and Heidari et al. [17-19]. It seems that the lower level of satisfaction with the held grand rounds among students  is due to their higher expectations. The majority of faculty members, students, externs and interns perceived the intern's presence in the grand rounds as useful and necessary. This indicates that a significant part of clinical training takes place in internship, which is necessary for medical students to acquire clinical competence [20]. Therefore, improving the clinical competence of medical students in different clinical fields requires improving the quality of grand rounds in the internship courses [21]. 
Overall, the perceptions of the majority of faculty members, residents, externs and interns of JUMS regarding the held grand rounds are higher than perceptions of students. Therefore, it seems important to carry out further studies with the aim of determining the appropriate standards of holding ground rounds for students.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Jahrom University of Medical Sciences (Code: IR.JUMS.REC.1402.043).

Funding
This study was funded by Jahrom University of Medical Sciences.

Authors' contributions
The authors contributed equally to preparing this article.

Conflicts of interest
The authors declare no conflict of interest

Acknowledgements
The authors would like to thank the Clinical Research Development Unit of Peymaniyeh Hospital in Jahrom county for their cooperation.


References

1. Jamshidy L, Mozaffari H, Sharifi R, Hamzeh H, Moradpoor H. [Assessing viewpoints of dental students about factors affecting bridge the gap between theoretical education and practical training in Kermanshah University of Medical Sciences (Persian)]. Educ Strategy Med Sci. 2019; 11(6):107-113. [Link]
2. Sharafi S, Chamanzari H, Pouresmail Z, Rajabpour M, Razi M. [Evaluation of coordinate Theoretical training with clinical training in nursing students from the perspective of teachers of Nursing and Midwifery Mashhad (Persian)]. Navid No. 2016; 19(62):33-40. [Link]
3. Salari N, Rafati F, Ahmadi Darrehsima S, Pilevarzadeh M, Mehralizadeh A, Dastyar N. [Investigating the factors creating a gap between theoretical knowledge and clinical practice from the viewpoint of students of Jiroft University of Medical Sciences: A descriptive cross-sectional study (Persian)]. Dev Strateg Med Educ. 2021; 8(4):40-8. [Link]
4. Faustinella F, Jacobs RJ. The decline of clinical skills: A challenge for medical schools. Int J Med Educ. 2018; 9:195-7. [DOI:10.5116/ijme.5b3f.9fb3] [PMID] 
5. Altman LK. Socratic dialogue gives way to PowerPoint [Internet].2006 [Updated 2006 December 12]. Available from: [Link]
6. Sandal S, Iannuzzi MC, Knohl SJ. Can we make grand rounds “grand” again? J Grad Med Educ. 2013; 5(4):560-3. [DOI:10.4300/JGME-D-12-00355.1] [PMID] 
7. Hebert RS, Wright SM. Re-examining the value of medical grand rounds. Acad Med. 2003; 78(12):1248-52. [DOI:10.1097/00001888-200312000-00013] [PMID]
8. Mueller PS, Segovis CM, Litin SC, Habermann TM, Parrino TA. Current status of medical grand rounds in departments of medicine at US medical schools. Mayo Clin Proc. 2006; 81(3):313-21. [DOI:10.4065/81.3.313] [PMID]
9. Van Hoof TJ, Monson RJ, Majdalany GT, Giannotti TE, Meehan TP. A case study of medical grand rounds: Are we using effective methods? Acad Med. 2009; 84(8):1144-51. [DOI:10.1097/ACM.0b013e3181ad1c0e] [PMID]
10. Riley HD Jr. Grand rounds revisited: Some comments on current practices. South Med J. 1992; 85(10):1001-2. [DOI:10.1097/00007611-199210000-00016] [PMID]
11. Bogdonoff MD. A brief look at medical grand rounds. Pharos Alpha Omega Alpha Honor Med Soc. 1982; 45(1):16-8. [PMID]
12. Crossman M, Papanagnou D, Sullivan T, Zhang XC. Virtual grand rounds in COVID-19: A financial analysis. Acad Emerg Med. 2021; 28(4):480-2. [DOI:10.1111/acem.14224] [PMID] 
13. Abdullahi Sh, Khoshbaten M, Hatami F. [Assessment of basic clinical skills of vision of the internet of Tabriz University of Medical Sciences (Persian)].Iran J Med Educ. 2002; 8(30):4-9.
14. Adibi P, Anjevian M. [The clinical rounds on patients’ bedside in internal ward from patients’ viewpoints (Persian)]. Iran J Med Educ. 2006; 6(1):15-21. [Link]
15. Beigzadeh A, Yamani N, Sharifpoor E, Bahaadinbeigy K, Adibi P. Trauma: Teaching and learning in clinical rounds: A qualitative metaanalysis. J. Emerg Pract Trauma. 2021; 7(1):46-55. [DOI:10.34172/jept.2020.32]
16. Beigzadeh A, Yamani N, Bahaadinbeigy K, Adibi P. Challenges and strategies of clinical rounds from the perspective of medical students: A qualitative research. J Educ Health Promot. 2021; 10:6. [DOI:10.4103/jehp.jehp_104_20] [PMID] 
17. Rohani M, Baradaran HR, Sanagoo A, Sarani M, Yazdani S, Alizadeh HR. [Attitudes of medical students , interns, residents and attending professors toward grand rounds in Iran University of Medical Sciences (Persian)]. Razi J Med Sci. 2016; 23(147):115-24. [Link]
18. Alaa M, Khashayar P, Baradaran H, Larijani B,  Aghayee HR. [Factors affecting the quality of the educational grand round of endocrinology from the perspective of trainees, interns, specialized and sub-specialized assistants (Persian)]. Iran J Diabetes Metab. 2013; 12(2):160-6. [Link]
19. Heidari E, Ahsani F, Rakhshanizadeh F, Emadzadeh M, Faramarzi Garmroudi R, Peyvandi Najjar A. [Comparison of the views of faculty members, assistants, interns and stagers of the Pediatrics Department of Mashhad University of Medical Sciences regarding the grand rounds held in this department (Persian)]. Horiz Med Educ Dev. 2020; 11(3):20-32. [Link]
20. Shahbazi L, Salimi T. [Clinical Education from the Viewpoints of Nursing and Midwifery Students (Persian)]. J Yazd Univ Med Sci. 2001; 8(2):97- 103. [Link]
21. Harden RM. Outcome-based education—the ostrich, the peacock and the beaver. Med Teache. 2007; 29:666-71. [Link]
22. Beigzadeh A, Bahaadinbeigy K, Adibi P, Yamani N. Identifying the challenges to good clinical rounds: A focus-group study of medical teachers. J Adv Med Educ Prof. 2019; 7(2):62-73. [PMID]
23. Arabshahi KS, Haghani F, Bigdeli S, Omid A, Adibi P. Challenges of the ward round teaching based on the experiences of medical clinical teachers. J Res Med Sci. 2015; 20(3):273-80. [DOI:10.4103/1735-1995.156176] [PMID] 
24. Gonzalo JD, Heist BS, Duffy BL, Dyrbye L, Fagan MJ, Ferenchick G, et al. Identifying and overcoming the barriers to bedside rounds: A multicenter qualitative study. Acad Med. 2014; 89(2):326-34. [DOI:10.1097/ACM.0000000000000100] [PMID]
25. Force J, Thomas I, Buckley F. Reviving post-take surgical ward round teaching. Clin Teach. 2014; 11(2):109-15. [DOI:10.1111/tct.12071] [PMID]
26. Gonzalo JD, Masters PA, Simons RJ, Chuang CH. Attending rounds and bedside case presentations: Medical student and medicine resident experiences and attitudes. Teach Learn Med. 2009; 21(2):105-10. [DOI:10.1080/10401330902791156] [PMID] 
27. Raiman L, Antbring R, Mahmood A. WhatsApp messenger as a tool to supplement medical education for medical students on clinical attachment. BMC Med Educ. 2017; 17(1):7. [DOI:10.1186/s12909-017-0855-x] [PMID] 
28. Minasyan E, editor Speech-Making Skills: Innate or Nurtured 2016
29. Claridge A. What is the educational value of wardrounds? A learner and teacher perspective. Clin Med. 2011; 11(6):558-62. [DOI:10.7861/clinmedicine.11-6-558] [PMID]