Grand rounds is a long-standing teaching tradition in academic medicine where doctors, residents, and medical students gather to hear an in-depth presentation on a clinical topic, usually built around a real or representative patient case. The format has been a fixture of teaching hospitals for well over a century, and while the term sounds formal, the core idea is straightforward: bring clinicians together in one room to learn from an expert about a diagnosis, a treatment approach, or an evolving area of medicine. What makes grand rounds distinct from an ordinary lecture is its roots in bedside teaching and its emphasis on connecting clinical reasoning to real patient scenarios. The tradition has changed considerably from its origins, though, and whether it still serves its original purpose is a live debate in medical education.
How a Grand Rounds Session Works
A typical grand rounds session lasts about 45 to 60 minutes. Most follow a recognizable arc. A presenter, often a senior physician or invited expert, opens with a clinical case. They walk the audience through the patient’s history, physical exam findings, lab results, and imaging, usually withholding the final diagnosis at first. This creates a sense of diagnostic suspense that mirrors what clinicians actually experience when working through an unfamiliar case. After the audience has a chance to consider possible diagnoses, the presenter lays out the differential, walks through the workup that led to the answer, and then shifts into a broader discussion of the disease itself: how common it is, what drives it biologically, what the current evidence says about treatment, and what new therapies are on the horizon. The session typically closes with a return to the original case, a resolution, and a handful of practical takeaways the audience can apply in their own practice.
The audience at grand rounds is intentionally broad. Attending physicians from multiple specialties, residents at various training levels, medical students, nurses, and sometimes other health professionals all attend the same session. This mix is part of the point. A case that seems routine to a specialist might be eye-opening to a trainee, and the cross-pollination between specialties can surface questions that a single-department meeting would miss.
Grand rounds is distinct from a standard medical lecture in one important way: it is anchored to clinical decision-making rather than abstract science. The case is not decoration. It is the scaffold the whole presentation hangs on. Even when the talk veers into epidemiology or pathophysiology, the expectation is that the audience should be able to trace the information back to something that matters at the bedside.
What Grand Rounds Was Built to Do
The original grand rounds, as practiced in the 19th and early 20th centuries, literally involved rounding on patients. A senior physician would lead a group of trainees through a hospital ward, stopping at bedsides to examine patients, discuss findings, and teach clinical reasoning in real time. The “grand” distinguished these large teaching rounds from smaller, routine ward rounds. Over time, grand rounds migrated from the bedside to the lecture hall. Patients were sometimes brought to the front of an auditorium for examination and discussion, but by the mid-20th century, most institutions had shifted to a presentation-based format where the patient’s story was told through slides rather than in person.
The goals of grand rounds, as articulated in medical education research, go beyond simply transmitting facts. The format is designed to help clinicians follow current diagnostic and treatment methods, encourage knowledge sharing among faculty, contribute to lifelong learning for both students and established physicians, and create an active learning environment where trainees and faculty share experiences with a wider audience.1Tıp Eğitimi Dünyası. Grand Rounds Model in terms of Continuing Medical Education and Lifelong Learning In many institutions, grand rounds also serves as a venue for continuing medical education credit, which physicians need to maintain their licenses.
There is something else grand rounds does that is harder to quantify: it builds institutional culture. When a hospital’s entire medical staff gathers weekly to discuss a case, it reinforces shared standards of care, common vocabulary, and a collective sense of what the institution values. A department that takes grand rounds seriously signals that it cares about learning, not just throughput.
The Attendance Problem
For all its history and stated goals, grand rounds has a well-documented attendance problem. Multiple studies and commentaries over the past two decades have noted that attendance has been dropping at institutions worldwide. The reasons are practical and structural. Physicians are busier than they used to be, clinical schedules are packed tighter, and trainees working shift-based schedules often cannot attend a midday lecture. Sub-specialization has also played a role: as medicine has splintered into narrower and narrower fields, a general grand rounds session may feel irrelevant to a specialist whose daily work rarely overlaps with the topic being presented.
One widely cited analysis from the Journal of Graduate Medical Education described grand rounds as a “cornerstone of continuing medical education in academic medical centers” while acknowledging that its format and relevance have been questioned in recent years.2PubMed Central. Can we make grand rounds “grand” again? A commentary in Clinical Medicine went further, arguing that grand rounds has become “obsolete” in its traditional form, with dwindling attendance driven by an emphasis on sub-specialization, clinical governance pressures, rota conflicts, and trainee disengagement.3PubMed Central. Requiem for the grand round That same analysis noted that the tradition is “firmly rooted in medical education” but has “little evidence for its effectiveness or its impact on patient management.”
The attendance issue feeds on itself. When fewer senior faculty show up, the signal to trainees is that grand rounds is optional. When trainees stop coming, presenters feel less motivated to prepare compelling talks. Some institutions have responded by making attendance mandatory for residents, but forced attendance does not guarantee engagement, and it can breed resentment toward a format that is supposed to feel intellectually stimulating.
Does Grand Rounds Actually Change How Doctors Practice?
This is the question that hangs over the entire enterprise, and the honest answer is that the evidence is thin. Grand rounds was never designed with measurable clinical outcomes in mind. It grew out of a teaching tradition, not a research protocol, and most evaluations of its impact rely on self-reported surveys rather than tracked changes in patient care.
The strongest case for practical impact comes from survey data collected during COVID-era virtual grand rounds at one UK institution. When attendees were asked whether the presentations would inform their clinical practice, roughly 85% said “yes” or “maybe” for both local clinical updates and specialty presentations.4Future Healthcare Journal. Rebooting medical education with virtual grand rounds during the COVID-19 pandemic That is an encouraging number, but self-reported intention to change practice and actual behavior change are different things. A doctor who leaves grand rounds thinking “I should screen for that condition more aggressively” may or may not follow through the next morning in clinic. No large study has yet tracked whether grand rounds attendance correlates with measurable differences in patient outcomes like diagnostic accuracy, treatment choices, or complication rates.
The lack of hard evidence does not necessarily mean grand rounds is ineffective. It means the kind of impact it has is difficult to isolate. Medical education is cumulative. A physician who attends grand rounds every week for a decade absorbs thousands of cases, dozens of diagnostic frameworks, and a steady drip of updated guidelines. Teasing out the contribution of any single educational format from that lifelong process is nearly impossible. But the gap between tradition and evidence is real, and it makes it harder for grand rounds to compete for protected time on increasingly crowded clinical schedules.
How COVID Reshaped the Format
The pandemic forced most institutions to move grand rounds online almost overnight, and the shift produced some surprising results. Virtual grand rounds eliminated the biggest practical barrier to attendance: being physically present in a lecture hall at a specific time during a busy clinical day. Physicians could join from their offices, from home, or even between patient encounters. Recorded sessions could be watched later. Geographic barriers disappeared entirely, allowing institutions to invite speakers from anywhere in the world without travel costs.
The UK study that surveyed virtual grand rounds attendees during the pandemic found strong engagement with the online format, with the vast majority of respondents indicating the sessions were relevant to their practice.4Future Healthcare Journal. Rebooting medical education with virtual grand rounds during the COVID-19 pandemic Some institutions reported that virtual attendance numbers exceeded their pre-pandemic in-person counts, partly because the barrier to entry dropped so low.
The tradeoff is that virtual formats lose some of what made grand rounds valuable in the first place. The informal conversations that happen before and after a session, the body language of a room full of physicians reacting to a surprising diagnosis, the ability to ask a follow-up question of a colleague sitting nearby: none of that translates well to a video call. Many institutions have settled on hybrid models, offering both in-person and livestreamed options, but the sweet spot between accessibility and engagement is still being worked out.
Technology has also opened up possibilities for making grand rounds more interactive. Audience response systems, where attendees answer polling questions on their phones during the session, have been trialed in medical education settings more broadly. A systematic review found that implementing these tools in healthcare education was more difficult and had a less dramatic impact on engagement than in other educational fields, suggesting that the culture of medical education resists some of the participation tricks that work well in, say, undergraduate classrooms.5PubMed Central. Systematic review of the implementation of audience response systems and their impact on participation and engagement in the education of healthcare professionals
When Trainees Present Grand Rounds
At most institutions, grand rounds is dominated by senior faculty and visiting experts. A department chief or a distinguished professor delivers the talk, and everyone else listens. That pattern makes sense from an audience perspective, as you generally want the most knowledgeable person in the room at the podium. But it misses a significant educational opportunity for the people who arguably need it most: residents and fellows still in training.
A small number of programs have experimented with having trainees prepare and deliver grand rounds presentations. The experience of developing a talk for that setting is genuinely different from giving a case presentation on morning rounds. It requires deep engagement with the literature, synthesis across multiple sources, and the ability to communicate complex ideas to a mixed audience that includes people both more and less experienced than you. Programs that have reported on resident-led grand rounds have found positive perceptions from the residents themselves, improved retention of the material among learners in the audience, and more learner-centered topic selection.6The Journal of Pediatrics: Clinical Practice. Chief of Service: The Evolution of Grand Rounds and the Role of Resident Presenters at Columbia University Medical Center Topics chosen by residents tend to reflect what trainees are actually encountering and struggling with on the wards, which can be quite different from the topics senior faculty would select.
The resistance to resident-led grand rounds is partly cultural. There is an expectation that grand rounds should feature authority figures, and a third-year resident does not carry the same weight as a department chair. But the preparation process itself is where much of the learning happens. A resident who spends weeks building a grand rounds presentation on a disease they recently encountered will know that disease cold for the rest of their career, in a way that passively watching someone else’s slides rarely achieves.
Interprofessional Grand Rounds
Traditional grand rounds is a physician-centric event. The presenter is a doctor, the audience is mostly doctors, and the case discussion centers on medical decision-making. But patient care is not delivered by physicians alone, and some institutions have started experimenting with interprofessional grand rounds that deliberately bring in perspectives from pharmacy, social work, nursing, and other disciplines.
One published example involved integrating grand rounds into a pharmacy ethics course. Sessions paired a 30-minute presentation with a 40-minute interprofessional panel discussion, bringing together pharmacy students, social work students, and licensed social workers to discuss issues around social justice and access to care. After the panel, small mixed groups of students discussed how interprofessional collaboration could improve patient experiences.7Journal of Interprofessional Education & Practice. Incorporating grand rounds into an existing pharmacy ethics course: An interprofessional education opportunity The format deliberately broke out of the mold where one expert talks and everyone else takes notes.
Interprofessional grand rounds reflects a broader shift in medical education toward team-based care. The reality of modern hospital medicine is that treatment plans are shaped not just by the attending physician’s knowledge but by the pharmacist catching a drug interaction, the social worker identifying barriers to discharge, and the nurse flagging a subtle change in a patient’s condition overnight. A grand rounds session that only captures one of those perspectives is telling an incomplete story.
Grand Rounds Versus Morbidity and Mortality Conference
If you are new to academic medicine, the landscape of educational conferences can be confusing. Grand rounds is just one of several regular meetings where clinicians gather to learn. The most common point of confusion is between grand rounds and morbidity and mortality conference, usually called M&M.
M&M conference focuses specifically on cases where something went wrong: a patient who died unexpectedly, a complication that was potentially preventable, a diagnostic error that led to a delay in treatment. The tone is different from grand rounds. M&M is introspective and sometimes uncomfortable, designed to surface systems failures and individual decision points that contributed to a bad outcome. Grand rounds, by contrast, is typically built around teaching a topic rather than dissecting a specific failure.
The two formats can overlap. At some institutions, M&M cases have been presented within the grand rounds framework, combining the quality-improvement focus of M&M with the broader educational reach of grand rounds. One study found that when M&M cases were presented in a grand rounds format, the approach maintained support for quality improvement efforts within the department while also improving the educational impact of the conference.8PubMed Central. Morbidity and mortality conference, grand rounds, and the ACGME’s core competencies The hybrid approach makes sense in principle: M&M conferences are sometimes attended only by a single department’s faculty, while grand rounds draws a wider audience. Bringing a quality-improvement case to that larger stage can spread the lessons more widely.
Other regular educational conferences in academic medicine include journal club, where a group critiques a recently published study; tumor board, where oncologists and surgeons discuss individual cancer cases and decide on treatment plans; and case conferences, which are smaller and more focused than grand rounds. Each serves a different slice of the educational mission. Grand rounds is the most public-facing of these, often the one that visitors and medical students encounter first, and the one most associated with the identity of a clinical department.
Efforts to Revitalize the Format
Institutions that want to keep grand rounds relevant have tried a range of structural changes. Many have shifted from purely didactic lectures, where one person talks for an hour, to more interactive formats that incorporate case-based audience participation, panel discussions, or small-group breakout sessions. Some departments have moved grand rounds to earlier or later time slots to reduce conflict with clinical duties. Others have introduced topic selection processes that poll trainees about what they want to learn rather than relying solely on faculty preferences.
The shift from didactic to interactive formats is perhaps the most significant change. The Journal of Graduate Medical Education described how various specialties have moved toward multidisciplinary formats incorporating case-based discussions, morbidity and mortality reviews, and emerging clinical evidence.2PubMed Central. Can we make grand rounds “grand” again? These changes reflect a broader trend in medical education away from passive absorption of information and toward active learning, where the audience is doing cognitive work during the session rather than just listening.
Whether these adaptations are enough to reverse declining engagement remains to be seen. The fundamental tension is between the breadth that makes grand rounds distinctive, bringing together physicians from across an institution, and the depth that makes educational sessions feel relevant to any individual attendee. A cardiologist and a dermatologist sitting in the same room will inevitably find different sessions more or less useful. Solving that problem without fracturing grand rounds into a series of specialty-specific talks, which would defeat the purpose, is the core challenge facing the format going forward. Some institutions have experimented with rotating themes, ensuring that over the course of a month or a quarter, every major specialty gets at least one session tailored to its interests while maintaining the expectation that everyone attends every week. The results are mixed, but the experimentation itself suggests that the medical community is not ready to abandon grand rounds entirely, even if the version that survives looks quite different from the one that started at the bedside two centuries ago.