The virtual meeting space has eliminated many constraints, allowing us to host larger sessions than ever before and reach a broader audience. —Nicholas Rowan, MD
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February 2021
The reasons for those filled virtual seats are no mystery, especially in a large, spread-out city like Los Angeles where distance and traffic are major obstacles to early morning appearances. For USC, multiple campuses complicate matters further. “We have faculty that go to different satellite clinics around the city, and it wasn’t feasible for them to come to the main campus for grand rounds and then drive to their satellite clinic,” explained Dr. Oghalai. Now, invitees not only attend via a remote location, but they can actually listen in while commuting.
Even when distance doesn’t impede attendance, schedules often do, said Dr. Rowan. “Between early starts or late finishes to surgical cases, it was always challenging to find one time at which all members of our large department were completely available,” he said. “The virtual meeting space has eliminated many constraints, allowing us to host larger sessions than ever before and reach a broader audience.”
Holding grand rounds virtually also enables institutions to secure otherwise tough-to-get speakers, eliminating the hurdles of time, space, and cost, especially for those who would otherwise need to travel to attend. We’ve been able to invite speakers from across the globe,” said Sonya Malekzadeh, MD, residency program director and professor of otolaryngology–head and neck surgery at Georgetown University Medical Center in Washington, D.C.
Technology and Protocols
Surprisingly, program leaders say they’ve had few major connectivity problems among virtual grand rounds participants. “We were expecting a bigger technical challenge that we ended up having,” said Rodney C. Diaz, MD, professor and residency program director in the department of otolaryngology–head and neck surgery at the University of California Davis Medical Center. “But apart from that 50-millisecond lag with people talking on top of each other, it hasn’t been that bad. There’s an unnaturalness about it but we’ve gotten used to it.”
Some of the technological features of virtual platforms are proving useful during grand rounds sessions. Leaders report using functions such as screen sharing, direct audio-video, question-and-answer polls, and chat to enhance the effectiveness of their grand rounds. “The chat function can be helpful because it allows people to comment in real time and to ask questions that can be answered at the end of the presentation,” said Walter Kutz, MD, professor in the Department of Otolaryngology at University of Texas Southwestern Medical Center in Dallas.
Months of virtual grand rounds have helped program teams develop protocols for smoother implementation. Dr. Rowan notes that preparation on a departmental level is key. “Zoom links are sent well in advance, and we make sure to go over the objectives, timing, and goals with our speaker,” he said. “To avoid technical glitches, we test links, equipment, and slides in advance of the grand rounds sessions.” He adds that there’s always a dedicated moderator who has the ability to mute or unmute participants and speakers to facilitate active dialogue and to minimize disruptions.
Privacy and security are of primary importance when venturing into the virtual world, especially in the context of grand rounds, and adhering to HIPAA rules is paramount. “In cyberspace, you never know who’s out there so we have to be cognizant of how to lock the room and who we allow in and out,” said Dr. Diaz. At UC Davis, the IT person fulfills that role, he noted.
A clear advantage of technology is that it can ensure that content lives on and remains accessible to those who need it. Dr. Oghalai’s department at USC records and posts select, nonconfidential grand rounds on a quarterly basis to enable residents to enjoy unlimited open online access to the material. At Southwestern, grand rounds “are kept on our secure drives so our residents and faculty can view them later,” Dr. Kutz said. UC Davis has adopted a similar approach for its special guest lecturers.