Needs Assessment and Grand Rounds: How to Do It
Jocelyn Lockyer


You have been asked by your department head to chair the grand rounds committee. She says, "The Royal College has new guidelines for grand rounds that will make them eligible for section 1 study credits under the new Maintenance of Certification program. I want you to work on the rounds so that they are accredited."

You read the "rules." You know you can ask a few friends to help you plan rounds. You can write learning objectives. Evaluation should be easy; you have filled in lots of those forms yourself. Your colleagues will sign in for rounds so that you can keep attendance.

But you are unsure how to plan and implement "the series of educational activities, based on the identified needs of the target audience." You remember filling in forms that were going to be used to create educational programs based on needs assessment. In one, you ranked your interest on a five-point scale on topics such as asthma, chronic obstructive pulmonary disease, and community-acquired pneumonia. In another, you completed a set of multiple-choice questions related to new asthma guidelines.

You decide that you had better ask for help before you have your first committee meeting.

What is Needs Assessment? Why is it Important?

A needs assessment is an analysis of current performance and desired performance ("current practice" and "optimal practice").1 Discussions about needs often compare what the learner knows with what the learner needs to know.

Studies2,3 have been done to determine how physicians make changes in their practice. These show that physicians often start by reflecting on troublesome cases that they have seen. Other physicians have a performance goal that is related to the care they provide. These acts allow physicians to work towards a new standard of care.

Similarly, studies of successful continuing medical education (CME) interventions show that focused needs assessments are most likely to produce changes in physicians' behaviour and patients' outcomes.4,5

Needs-Assessment Methods

There are many ways to assess learning needs for groups. You can use subjective, self-report methods, such as questionnaires in which physicians rank their preferred topics for learning or topics that perplex them. You can use objective methods, such as chart review or chart reviews combined with interviews, to determine the process of care and patients' outcomes. Since no method is universally effective, it is optimal to use a combination of needs-assessment methods to determine the content of your rounds program.

Hospital- and Committee-Based Data
What chart audits are being done in the hospital? Do any of the chart audits lie in your discipline? Do their topics (or findings) suggest content that should be included in the rounds program? What drugs is your pharmacy and therapeutics committee studying? Can these compounds be misused by your colleagues? Do the morbidity and mortality rounds or tumour boards suggest topics? What about critical incident reports?

Research in Your Field
What topics are being presented at meetings in your specialty? What topics are being covered in your leading journals? Does this suggest topics for rounds?

Research in "Adjacent" Fields of Medicine
Is there research being conducted in related fields of medicine that might be helpful to you or warrant a lively discussion? Are you as a gynecologist using the same surgical techniques for urinary incontinence as the urologists? Do the endocrinologists, oncologists, and cardiologists perceive the risks and benefits of hormone-replacement therapy in a similar way, and adopt similar approaches to management?

Clinical Trials
What trials are being conducted in your field? What is the science behind the trials? What phase III studies have been completed and warrant discussion at rounds before the release of the compounds?

Practice in "Adjacent" Fields of Medicine and Surgery
What advances have occurred in other fields that may have affect your patients, particularly those whom you co-manage with other specialists? Are you aware of the drugs that your patients with asthma are taking to handle depression? Could these products interfere with asthma control? Have the radiologists developed new uses for ultrasound that could help orthopedic surgeons in the diagnosis of shoulder and ankle problems? What is happening in genetics? Should you include updates from other fields in your rounds program?

New Skill and Competency Areas
In its CanMEDS report,6 the Royal College identify several competencies for all specialists. These include communicator, collaborator, health-care advocate, manager, professional, and scholar. Do these themes suggest ideas for a clinical topic? Similarly, legal cases in the U.S. or Canada may indicate topics for consideration.

Special Studies and Government Reports
Do any of the government reports, health statistics, health-services research studies, or technology assessments identify areas for consideration in the rounds program?

Unsolicited Suggestions
Pharmaceutical and surgical supply companies, voluntary health and social agencies, and other organizations can suggest speakers and topics. Which offer is suitable for grand rounds and fit into your plan for an organized curriculum?

Asking for Suggestions
Your colleagues have ideas for rounds. You can solicit these on evaluation sheets by asking, "What would you like included in upcoming rounds"?

The Lay Press
The lay press is fertile ground for your patient's questions. Do their questions provide suggestions that might warrant consideration? Is it time for an evidence-based presentation about the complementary approaches your patients are using that might be affecting the care you are providing?

The Survey
Surveys are an inexpensive method of determining topics. They can be used to validate topics and identify clinical problems that physicians want covered in rounds. Departments may find an annual survey to be a helpful way to elicit ideas. The survey should include potential topics and leave space for the physician to clarify the aspects of that condition or disease to be covered. This information will guide the planning committee in refining the topic. Space should be left for other topics and ideas; your list may not be exhaustive. In planning surveys, it is worthwhile to consult someone who is experienced in design to avoid common pitfalls, or to read a book or article on writing questionnaires.7

The Education Planning Cycle

In planning rounds, it is important to think of the planning process as a cyclical, iterative process with several steps:

  • needs assessment
  • data analysis
  • planning that is based on the needs assessment
  • implementation or running of the rounds
  • evaluation.

The discussion during rounds and the evaluation may provide data that can be used as part of the needs assessment process or to direct the needs assessment.

Selecting a Committee

The Royal College requires that a planning committee be established, and that its activities be documented, so minutes must be kept of the committee's deliberations. The committee is the chair's greatest strength in planning and running the rounds program. It is important to select colleagues who are committed to high-quality education. They should be able to commit the time to think about the needs of the departmental members, and to speak to presenters before rounds to ensure that they understand the objectives (and issues).

Membership should be diverse in terms of clinical and scholarly expertise. The grand rounds committee for a cancer centre might include specialists from pediatric and adult medical oncology, radiation oncology, surgery, and epidemiology. The rounds committee for obstetrics might be limited to obstetricians and gynecologists, or broadened to include family physicians. A medical librarian on the committee can help with searches and locate information. Clinical pharmacists, nurse clinicians, and medical-records personnel may be members too. A resident would also be helpful.

A committee of four to eight committed individuals is optimal to ensure diversity of ideas and to spread the workload.

Committee Work

The rounds committee has several tasks. By using multiple data sources for the needs assessment, many good topics will emerge. Your minutes must document the data sources. It is then up to the committee to identify speakers for each topic. The committee may choose to determine the optimal learning format depending on the issues to be considered. Case studies, debates, lectures with discussion, and panel discussions can be used, remembering that 25 per cent of the time is to be allocated to participant (audience) discussion.

Regardless of the source, the committee must analyse each topic. Is it worthy of presentation? What are the learning objectives? What is the most effective way to convey the message(s)? Who are the most effective speaker(s)?

Contact with the speaker is critical to the success of rounds. Someone from the committee should be responsible for inviting the speaker and ensuring that he or she understands the objectives for the session. The speaker should know how you arrived at the topic and why it is included in grand rounds. This is best done verbally so that the committee member and the speaker can exchange ideas about the topic, the objectives, and the intended audience, and note that at least 25 per cent of the time should be available for discussion. A follow-up letter can be used to confirm the topic and other pertinent information.

The rounds, accompanied by the learning objectives, should be advertised as an accredited group-learning activity. The committee must decide how the rounds are to be evaluated. Mechanisms should be established to ensure that evaluation is done for each round, and that your speaker receives feedback about the presentation. The evaluation form should include space for participants to suggest other topics for the future. Attendance records must be kept.

The best rounds are those that are thoughtfully shaped based on your colleagues' professional needs. The structure should not become so rigid, however, that there are no opportunities to take advantage of visits to your institutions by distinguished clinicians and researchers. There must be opportunities to add topics that arise during the year. Ongoing reflection by and with your committee will ensure that you and your department members are on the cutting edge of professional practice.

References

  1. Moore DE. Needs assessment in the new health-care environment: combining discrepancy analysis and outcomes to create more effective CME. J Continuing Educ Health Professions 1998;18(3):133-41.
  2. Campbell C, Parboosingh J, Gondocz T, Babitskaya G. A study of the factors that influence physicians' commitments to change their practices using learning diaries. Acad Med 1999;74:S34-6.
  3. Slotnick HB. How doctors learn: self-directed learning episodes. Acad Med 1999;74:1106-17.
  4. Davis D, Thomson MA, Freemantle N, Wolf FM, Mazmanian PE, Taylor-Vaisey A. Impact of formal continuing medical education. Do conferences, workshops, rounds and other traditional continuing education activities change physician behaviour or health-care outcomes? JAMA 1999;282(9):867-74.
  5. Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance: a systematic review of the effect of continuing medical education strategies. JAMA 1995;274:700-5.
  6. Skills for the new millennium: report of the societal needs working group CanMEDS 2000. The Royal College of Physicians and Surgeons of Canada, 1996 September.
  7. Woodward CA. Questionnaire construction and question writing for research in medical education. Med Educ 1988;22:347-63.

Copyright © 2012 Royal College of Physicians and Surgeons of Canada. All Rights Reserved.