grand rounds and a visiting professorship program in a department of radiology
TRANSCRIPT
Grand Rounds and a VisitingProfessorship Program in aDepartment of Radiology:
How We Do It
Srini Tridandapani, MD, PhD, Mark E. Mullins, MD, PhD, Carolyn C. Meltzer, MD, FACR
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We discuss the benefits of maintaining an active, rigorous, and highly structured grand rounds (GR) program in an academic radiology
department. These benefits include education for faculty (continuing medical education), fellows, and residents and a venue for building
collaboration and camaraderie within the department and institution, while also allowing for building ties with the radiology community atlarge. In addition, we illustrate how to build and sustain a dynamic GR program based on our collective 6-year experience in running such a
program at our institution that has offered more than 180 GR and hosted more than 90 visiting professors during this period. Maintaining
such a program requires infrastructure, financial support, careful planning, and considerable effort. We believe that this article can serve as
a ‘‘how-to’’ guide or framework to initiate and maintain such a program.
Key Words: Continuing medical education (CME); education; faculty; grand rounds; radiology resident; visiting professor.
ªAUR, 2012
ver the past 6 years (2006–2011), we have developed a the country. We strive for a balanced representation of the
O rigorous and active grand rounds (GR) and visiting
professor (VP) program in our academic radiology
department. This has become an integral part of the educational
programs in our department and GR are attended regularly by
faculty and trainees, and on many occasions, by technologists,
nurses, and nonclinical staff. Initiating and sustaining this pro-
gram has required considerable thought and effort and we have
learned many lessons in the process. We continue to streamline
our program to make it more efficient and useful. The purpose
of this article is to describe our experience in developing and
implementing a consistent program and to encourage other
departments to consider investing in such an educational pro-
gram. We welcome feedback and shared wisdom from readers
involved in running GR and VP programs at their departments.
ORGANIZATION, CONTENT, AND RATIONALE
We offer about 30 GR during the academic year, which
extends from September through May. About 18 of these
GR are presented by VPs from academic institutions around
ad Radiol 2012; 19:1415–1420
om the Departments of Radiology and Imaging Sciences (S.T., M.E.M.,C.M.), Neurology (M.E.M., C.C.M.), Neurosurgery (M.E.M.), and Psychiatryd Behavioral Sciences (C.C.M.), Emory University, Atlanta, GA; School ofectrical and Computer Engineering, Georgia Institute of Technology (S.T.),lanta, GA 30322. Received May 1, 2012; accepted August 7, 2012. Addressrrespondence to: S.T. e-mail: [email protected]
AUR, 2012tp://dx.doi.org/10.1016/j.acra.2012.08.003
10 clinical subspecialty areas of radiology (Fig 1). It is not
always possible to have an even distribution between these
10 areas, either because we do not have sufficient nominations
for a certain area or we are unable to schedule the nominated
speakers in a given year. Thus some areas may be dispropor-
tionately represented in any given year, but we strive for a bal-
ance over 2 to 3 years.
There is an 11th area of interest, which does have more rep-
resentation in any given year. This provides the ‘‘big picture’’
and involves knowledge relevant to our practice and profes-
sion in general. Included in this group of GR is an annual lec-
ture on sleep Deprivation–a requirement of the Accreditation
Council for Graduate Medical Education (ACGME) (1). We
also have a dedicated annual GR on ‘‘The State of the Depart-
ment Address’’ by the chair, which is attended by a much
broader segment of our department in addition to clinical
and research personnel. There are other GR on radiology
education, quality in clinical care, and ethics and professional-
ism. In addition, each year, we try to identify gap areas of clin-
ical and scientific knowledge in our department and target
specific topics.
Strategic Organization
Our year-long program is divided into four tracks.
1. Building Foundations: In this track, speakers from within
our department, including faculty and trainees, present
their work. These GR have ranged from clinical to scien-
tific discussions, but are generally basic lectures that are of
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Figure 1. Grid depicting the conceptual organization of our grand
rounds series by discipline and track.
TRIDANDAPANI ET AL Academic Radiology, Vol 19, No 11, November 2012
relevance to a large subset of our radiologists. As a specific
example, we recently had ultrasonologists, neuroradiolo-
gists, and nuclear medicine specialists provide a series of
lectures on thyroid disease. Participation especially by
trainees and junior faculty helps build confidence and pre-
pares them for public speaking at larger venues such as na-
tional meetings.
2. Building Bridges: In this track, faculty colleagues from re-
ferring clinical departments at our institution present a
view of their clinical world and how imaging can assist
them with patient care. We have found this to be an effec-
tive way to build both clinical and research collaborations
between the speakers’ departments and ours. Some recent
speakers have included faculty from the divisions of surgi-
cal oncology, general surgery, and the departments of oto-
laryngology and emergency medicine.
3. Building Lookouts: This track is our clinical VP pro-
gram, which generally includes about 10 speakers. Clin-
ical radiologists from around the world give us their
perspective on the advances being made in clinical
radiology.
4. Building Skyscrapers:With about four speakers a year, this
is our distinguished speaker series, which consists of talks
provided by VPs who are distinguished scientists. These
talks are more forward-looking, and we encourage speak-
ers to speculate on the likely future course of imaging.
Example topics in the past few years include ‘‘Future of
Ultrasound Imaging,’’ ‘‘Re-engineering Radiology for
an Electronic and Flattened World: Radiology as Value
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Innovator,’’ and ‘‘Time-Resolved Digital Angiography:
Past, Present, and Future.’’
In addition to these four tracks, we have four named
lectures, either endowed or supported by the department,
and emphasizing the areas of neuroradiology, gastrointestinal
radiology, medical physics, and innovative applications of
imaging, not always related to medical imaging, and thus
not eligible for continuing medical education (CME) credit.
Content
Although we do not control the exact content of what GR
speakers discuss, we do provide program curriculum structure
by very carefully choosing the speakers. Nominations for both
internal and external speakers are solicited from the department
each year. From these nominations, the director of the GR and
VP program selects speakers with an aim to balance the content
among the various subspecialties. The named lectureship
speakers are selected by faculty committees after receiving
nominations from the department at large. Once a speaker
has accepted an invitation and a date is confirmed, we request
the speaker to provide us with a list of potential GR titles. We
then assist the VPs in selecting from this list based on the needs
and interests in our department, thus complementing and
enriching the training mission of our department.
Organizational Team
Organizing such an extensive program requires a well-
coordinated team. The team is headed by a junior faculty
member who requests and gathers nominations from the
department, invites speakers, and supervises the organization
for each VP’s visit. We have a program coordinator who
spends approximately one quarter of her effort on this pro-
gram. Her tasks include collating documents, ensuring com-
pliance with the CME office, coordinating with faculty in
drawing up the itinerary, and making hotel, restaurant, and
transportation reservations. Each VP has a faculty host, who
usually takes the VP to dinner and introduces the VP at
GR, and a resident host, who escorts the VP to the various
lectures and hosts a lunch. An events coordinator spends about
an hour each week in preparing informational flyers on the
GRs. Distinguished speakers and named lecturers are selected
by committees, which meet once a year.
Rationale
Some important reasons for an academic department to invest
in a strong GR program include CME for faculty and fellows,
building camaraderie within the department, building ties
with colleagues around the country, and recruitment of future
radiologists.
CME. Our GR program provides CME in the form of
approximately 30 American Medical Association Physician
Recognition Award–eligible Category 1 CreditsTM over the
Academic Radiology, Vol 19, No 11, November 2012 GRAND ROUNDS AND A VISITING PROFESSORSHIP PROGRAM
year. At a cost of $45,000, we are able to provide approximately
20 faculty members with up to 30 CME credits per year; thus,
such a program may be more cost-effective than most CME
meetings across the country, at least in terms of cost per
CME credit. The average (standard deviation) of clinical fac-
ulty attendance over 30 GR in our department for the 2010–
2011 academic year was 22 (+/�8). Thus it costs us �$75
per CME credit. This does not capture the benefit of providing
these outstanding lectures to residents, fellows, and medical
students. A sample of expense reports of five randomly selected
radiologists in our department showed an average cost of
�$2000 to attend a CME meeting within the United States.
Thus our faculty attending CME meetings out of town will
have to claim at least 26 credits at each meeting for these meet-
ings to be competitive with our GR program.
The 30 or more yearlyCMEcredits alone cover the require-
ments of most state medical licensing authorities. It satisfies the
current CME requirements for maintenance of certification
with the American Board of Radiology, which currently
requires 25 earned CME credits per calendar year (2).
Because academic radiologists do not usually attend outside
CME meetings that are outside their subspecialty, a well-
rounded GR program may provide them with CME experi-
ence that they may not otherwise experience. An added
benefit of our GR CME is that we retain copies of these
lectures on DVD and as podcasts for internal departmental
use, so anyone who missed a lecture is able to view it on their
own time.
Networking. Our GRs are preceded by a half-hour breakfast,
providing an opportunity for faculty, fellows, and residents
to meet informally. This chance to meet weekly would other-
wise not be available in a busy clinical department that serves
several hospitals. A carefully planned GR program can provide
a good venue for bringing together radiologists from the var-
ious subspecialties and sites. Furthermore, many of the GR are
often attended and given by faculty from other departments,
further enriching the experience.
In addition to internal networking, the VP program pro-
vides faculty and trainees with the opportunity to interact
with outstanding clinical radiologists and imaging scientists
from around the world. The benefits of such interactions are
incalculable. However, we must acknowledge that GR and
VP programs cannot entirely replace faculty/trainee attend-
ance at national meetings; the benefits of national meetings
include networking with a larger group and obtaining oppor-
tunities to speak at a national level.
Recruitment. Our GR are also attended by medical students,
particularly those enrolled in radiology clerkships, giving
our department a closer relationship with our medical school
and students. We believe it is important to project a positive
view of radiology so that students can consider a career in
our specialty.
The VP program has another potential recruitment benefit.
If VPs go back with positive thoughts about our institution,
they are more likely to encourage their trainees to consider
our institution for a career. On occasion, recruitment of a fac-
ulty member originated from exposure to the department
through the VP program.
We strongly believe in the benefits listed and thus the
department administration funds this program through the
research budget (for distinguished speakers) and education
budget for other speakers. Named lectures are funded partly
by endowment and partly by the department general funds.
GR PROGRAM TIMELINE
Careful advance planning is required to ensure a smooth pro-
gram. Our GR series extends from the beginning of Septem-
ber through the end of May. In general, VPs and distinguished
scientists are invited more than a year in advance, because it is
difficult to schedule VPs with shorter notice. We attempt to
do this one speaker at a time to avoid double-booking of
speakers.
Once the VP and distinguished scientist list for an academic
year is completed, the speakers for the Building Bridges and
Building Foundations series are scheduled; this generally
occurs just before the beginning of the fall academic semester
(September through December) and the spring semester
(January through May). Once the list of speakers for the
semester is completed, it is posted on our department website.
About 3 months before a GR, we ask that internal GR
speakers fill out a single form that gives us the following infor-
mation: details on the GR (title, learning objectives, and what
ACGME core competency the lecture will fulfill), signed dis-
closures including financial conflict of interest, and release
forms for taping the lecture for internal use. This allows us
to publish the titles for the upcoming month in our monthly
department newsletter. As a result, potential audience mem-
bers within and outside our department can plan their sched-
ules to attend lectures that are of interest to them. In addition,
a weekly e-mail reminder is sent on the departmental mailing
list with information on the upcoming week’s GR; generally,
this is in the form of a PDF flyer that includes the speaker’s
name, affiliation, picture, and a brief professional biography.
The two to three brief learning objectives provided by the
speakers are listed on the speaker evaluation sheet that audi-
ence members fill out at the end of the GR. These evaluation
sheets with the learning objectives are required by our institu-
tion’s CME office in order for the lecture to be eligible for
CME credit.
VP Timeline and Tasks
In addition to the tasks detailed in scheduling GR, the VP
schedule has several more tasks that need to be completed in
a timely manner. The form that VPs fill out is an expanded
one including a W-9 form to process their honorarium.
This expanded form also requests information on other lec-
tures that they may provide to the residents.
Along with the form, we remind the VPs about their
upcoming trip and encourage them to initiate travel plans
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TABLE 1. Typical Visiting Professor Schedule
Tuesday
1) Arrival in late morning/early afternoon
2) If time, consider an optional noon conference (12:15–1:15 pm)
3) Senior case review (4:00–6:00 pm)
4) Dinner with radiology faculty
Wednesday
1) Breakfast 7:00–7:30 am
2) Grand rounds and Q&A (7:30–8:30 am)
3) Meet with faculty (8:30–11:30)
4) Noon conference (12:15–1:15)
5) Lunch with residents (1:15–2:15)
6) Leave for airport
TRIDANDAPANI ET AL Academic Radiology, Vol 19, No 11, November 2012
by purchasing airline tickets. Once we obtain the flight sched-
ule, we begin the task of assembling the itinerary, which usu-
ally is a lengthy process because several people within our
institution need to be consulted. In general, the division
director of the subspecialty closely aligned with the VP’s
area of technical interest or the person who nominated the
VP plays the host, particularly for the VP dinner with faculty.
The typical VP schedule (Table 1) generally includes a case-
based review session with senior residents. This is followed by
dinner with radiology faculty where there is opportunity for
exchange of ideas and other beneficial interactions with the
VP. Some of our recent VPs have provided great mentorship
advice to junior faculty in our department. VPs also provide a
noon conference to the radiology residents and medical stu-
dents. Residents then get a chance to interact with the VPs
in an informal setting at lunch. A senior resident is also
assigned to escort each VP to and from meetings on campus
and also pick up the VP before the early morning GR. We
believe that these interactions are very important in allowing
our residents to get a perspective on academic life in radiology
and perhaps encourage them to consider careers in academic
radiology.
Breakdown of average costs for a VP to visit us is as follows:
airfare and ground transportation $500; honorarium ranging
from $500 to $1250, depending on number of lectures pro-
vided; hotel ranging from $150 to $350 depending on number
of nights and season; and meals $350.
ADMINSTRATIVE REQUIREMENTS
As with other aspects of medical education, we have found
that an enormous amount of paperwork needs to be com-
pleted for compliance with our CME office requirements.
This is likely the case around the country and preplanning
can make the process simpler. Before the start of each aca-
demic year, we have to renew our application for CME par-
ticipation. At our institution, this involves filling out a
seven-page form. Two aspects of this form include the educa-
tional planning and the evaluation and improvement sections.
For the educational planning section, we are required to
perform a needs assessment, which enables us to ‘‘identify
and measure gaps between what is and what ought to be,’’
from which program goals and objectives can then be identi-
fied. For our CME office, the needs could be demonstrated
through any two of the following: survey of target audience,
minutes of departmental meetings, research findings, patient
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care audits/quality improvement data, review of board exami-
nations and/or recertification requirements, regulatory legis-
lative requirements, expert opinion from those in the field or
related medical societies, and technology updates. It is prob-
ably easiest to print off copies of the American Board of Radi-
ology maintenance of certification requirements to satisfy one
of these requirements (1); state medical licensure requirements
may also suffice. For one of our other requirements, we pro-
vided an expert opinion from Kruskal et al (3) who developed
a number of strategies for improving quality and performance
in radiology departments. One of the key strategies outlined
by Kruskal et al (3) is the use of educational components,
where they note that GR by departments of radiology elevate
the message about how highly a department’s leadership values
quality assurance. For good measure, we provided a third
need: for this year, we included findings by Neymayer et al
(4) who used the example of computed tomography scanning
in appendicitis and showed that discussion of a subject during
GR can affect practice patterns and outcomes.
Educational planning also requires identification of profes-
sional practice gaps, educational needs, learning objectives,
and desired results for the series as related to the educational
needs.
For evaluation and measurement, we use the standard eval-
uation form that is provided by our CME office for each GR.
All GR speakers are also required to fill out financial disclosure
forms and include a financial disclosures slide in their
presentation.
There are other forms of paperwork involved, particularly
related to the VP expenses. To comply with tax regulations,
two checks are usually produced for our VPs, one for travel
expenses (reimbursement) and one for an honorarium. Pay-
ment procedures in academic institutions can involve unfore-
seen delays, leading to delayed reimbursements. This year we
have instituted two approaches: we obtain the VP’sW-9 forms
about 6 weeks before the planned visit and process the hono-
rarium check in advance so that the check is available at the
time of the visit and we minimize the VP’s out-of-pocket
expenses by having airline tickets and hotel expenses directly
billed to our department.
TECHNIQUES TO ENCOURAGE ATTENDANCE
Increasing GR attendance is a constant challenge (5). We have
employed several strategies to address this.
Academic Radiology, Vol 19, No 11, November 2012 GRAND ROUNDS AND A VISITING PROFESSORSHIP PROGRAM
Build a Routine
Our rationale for having weekly GR was to instill a routine in
our attendees. Although a much sparser program may be eas-
ier to coordinate, we believe that a weekly program increases
attendance.We have no strong scientific method of measuring
this because it is unlikely that we will reduce the number of
GR at this time. But departments considering a new GR pro-
gram, or interested in ramping up an existing program, may
find it beneficial to monitor attendance as the number of
GR slots increase; we would be very interested in learning
from this experiment.
Food
Food encourages attendance, particularly by trainees. Segovis
et al (6) concluded through a prospective study that compli-
mentary food may be an effective strategy for increasing
attendance at medical GR. Careful thought has gone toward
ensuring that the GR breakfast menu included mainly healthy
options.
Advertising
As discussed earlier in the timeline section, we have a stream-
lined method of advertising the semester’s schedule, the
upcoming month’s schedule, and the upcoming week’s sched-
ule. This allows attendees to better plan for and attend GR.
Faculty Incentive Plan
Faculty GR attendance is a component of our department’s
faculty incentive. The department administration recently
approved publishing quarterly divisional attendance at GR.
It is hoped that this will increase faculty attendance at GR.
A consistent challenge is to get audience members to sit up
front. When all audience members sit at the rear, this may
reduce the speaker’s energy level. Some institutions tackle
this issue by strategically placing the refreshments and sign-
in sheets in the front of the auditorium, but this is not always
possible depending on the auditorium layout.
Another way of ensuring that the speaker is energized is to
provide a laudatory introduction of the VP before the GR (7);
it is best to choose someone in the department who admires
the VP’s work (and perhaps the person who nominated the
VP) to provide the introduction.
Another challenge that we facewith keeping the roomfilled
is that our GR are webcast to four affiliated hospitals. Room
selection thus can have a significant impact in the perception
the VP has of the audience interest in his/her presentation.
LESSONS LEARNED AND CONCLUSIONS
Based on our experience, we offer the following tips to make a
GR and VP program successful.
1. Plan the program at least a year in advance. It is easier
to get speakers to commit far in advance than it is to
get them to commit for the next week or month.
Likewise, having a schedule months in advance in-
creases attendance. We suggest scheduling VPs on a
2-year cycle. This should improve chances to book
‘‘famous’’ VPs, presumably in high demand for their
services.
2. Keep the lines of communication open within the de-
partment. When VPs are visiting, the subspecialty divi-
sion aligned with the VP’s area of interest should be
given advance notice of at least 8 weeks. This will ensure
that a reasonable number of faculty members from that
division will be able to attend GR and to meet with
the VP.
� Corollary 1: Grow a thick skin. You will never be able
to please everyone in the department with the choice of
speakers or the amount of time you give them to pre-
pare for a visit.
� Corollary 2: Make full use of shared electronic calen-
dars. In our department all information pertaining to
a GR or VP is stored on a shared calendar and everyone
involved with organizing the event can obtain a quick
snapshot of tasks to be done to keep the program on
track.
3. Keep the lines of communication open with the VP. VPs
have to send several pieces of information in order for the
program to be put together successfully. Such informa-
tion includes: GR title, biosketch and picture for adver-
tising, learning objectives for CME office compliance, a
biosketch for a proper introduction, flight information
for a solid itinerary, any dietary restrictions, and names
of people the VP wants to meet with during the visit.
Realize that VPs are incredibly busy, and many of these
may slip through the cracks. It helps to send concurrent
copies of email to the VPs and to their administrative as-
sistants, who can be very useful in keeping the VPs on
schedule.
� Corollary 1: Enlist the help of senior faculty in the de-
partment who may know the VP. These faculty mem-
bers can add the personal touch during the invitation
process and assist with gently reminding VPs to send
in the required documentation. Furthermore, these se-
nior faculty members can provide great introductions to
the VPs at the GR.
4. Ensure that you have consistent technical support for the
GR, especially if the talk is to be webcast to other sites.
Although all of our GR are held in the main university
hospital, we webcast to four hospitals affiliated with our
institution. In our case, we need to know a few days in ad-
vance if the speaker is planning on using a MAC versus a
PC, and if they plan on using any multimedia tools for
their presentation.
In summary, we find the GR and VP programs a
rewarding part of the educational program in our depart-
ment, even though it costs time, effort, and money. We
continue to make improvements to make the process a
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TRIDANDAPANI ET AL Academic Radiology, Vol 19, No 11, November 2012
smooth one. With careful planning, we feel that all aca-
demic radiology departments can enjoy a similar
program.
REFERENCES
1. ACGME Task Force on Quality Care and Professionalism: Process for
Developing Recommendations on new Supervision and Resident Duty
Hour Standards. http://acgme-2010standards.org/pdf/Impact_Statement.
pdf. Accessed February 6, 2012.
2. American Board of Radiology MOC. http://www.theabr.org/moc/moc_dr_
landing.html. Accessed February 6, 2012.
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3. Kruskal JB, Anderson S, Yam CS, et al. Strategies for establishing a com-
prehensive quality and performance program in a radiology department.
RadioGraphics 2009; 29:325–329.
4. Neymayer L, Wako E, Fergestaad J, et al. Impact of journal articles and
grand rounds on practice: CT scanning in appendicitis. J Gastrointestinal
Surg 2002; 6:338–341.
5. Mueller PS, Litin SC, SowdenML, et al. Strategies for improving attendance
at medical grand rounds at an academic medical center. Mayo Clin Proc
2003; 78:549–553.
6. Segovis CM, Mueller PS, Rethlefsen ML, et al. If you feed them, they will
come: a prospective study of the effects of complimentary food on attend-
ance and physician attitudes at medical grand rounds at an academic med-
ical center. Br Med Educ 2007; 7:22.
7. Levine MS. The visiting professorship: to Fargo and beyond. Acad Radiol
2010; 17:808–809.