Grand rounds are regularly scheduled educational presentations held at hospitals and medical schools where a clinical case or medical topic is discussed in depth before an audience of physicians, trainees, and other healthcare professionals. They serve as one of the oldest and most widespread traditions in medical education, blending real patient scenarios with expert analysis to keep practicing doctors up to date and give trainees exposure to complex clinical reasoning.
How Grand Rounds Started
The tradition traces back to the late 19th century at Johns Hopkins Medical School, where Sir William Osler pioneered bedside teaching as a core part of medical training. Faculty would walk from patient to patient with their residents, explaining how they arrived at a diagnosis and what treatment they chose. As more people wanted to participate, these sessions outgrew the bedside and moved into auditoriums and lecture halls. That shift, from intimate bedside discussion to a larger audience format, created what we now recognize as grand rounds. No one knows exactly who coined the term.
What Happens During a Session
A typical grand rounds session lasts about an hour. It usually centers on a clinical case or a focused medical topic presented by a faculty member, visiting expert, or senior trainee. In the classic format, a case is presented in a structured way covering the patient’s symptoms, test results, assessment, and treatment plan. The presenter then opens the floor for discussion, drawing on the collective knowledge in the room to explore what went right, what could have been done differently, or what the case reveals about a broader medical question.
Some grand rounds feature a single expert lecturing on recent advances in a specialty. Others involve panel discussions or even live patient interviews, though that practice has become less common. The two stated goals that department leaders most consistently identify are educating attendees about clinical topics and having faculty model the importance of lifelong learning. In other words, grand rounds are meant to show that staying curious and continuing to learn isn’t optional in medicine.
Who Attends
Grand rounds draw a wide range of professionals. Physicians at every career stage attend, from medical students and residents to senior attending doctors. Nurses, pharmacists, social workers, and case managers also participate, especially when the discussion touches on coordinated patient care. In academic medical centers, grand rounds often function as the main weekly gathering for an entire department, making them part professional development and part community ritual.
Attendance typically earns continuing medical education (CME) credit. At the NIH Clinical Center, for example, each session is designated for a maximum of one AMA PRA Category 1 Credit, the standard unit used to track a physician’s ongoing education requirements. Most hospitals offer a similar arrangement, giving doctors a formal incentive to show up beyond the educational value itself.
Grand Rounds vs. Other Types of Rounds
The word “rounds” gets used for several different things in a hospital, and they serve distinct purposes. Daily clinical rounds are when a care team moves through the unit discussing each patient’s status. These happen at the bedside or in a conference room (sometimes called table rounding), and they’re focused on immediate decisions: adjusting medications, planning discharges, flagging concerns. Per-patient rounding time averages around nine to ten minutes.
Morbidity and mortality conferences (M&M) are another common format. These zero in on cases where something went wrong or a patient died, with the goal of identifying errors, improving systems, and learning from mistakes. The tone is more forensic than educational.
Grand rounds sit at a higher altitude than either of these. They’re less about managing today’s patients and more about deepening knowledge, whether that means exploring a rare diagnosis, reviewing new evidence on a common condition, or hearing a nationally recognized researcher explain their work. Think of daily rounds as tactical, M&M as corrective, and grand rounds as broadly educational.
A separate variation called Schwartz Rounds borrows the grand rounds format but shifts the focus entirely away from clinical details. In Schwartz Rounds, staff from across the hospital share stories about the emotional impact of their work. The goal is reflection and mutual support rather than medical problem-solving. These sessions are open to everyone in the organization, not just clinicians, and they typically run monthly.
The Shift to Virtual Grand Rounds
The COVID-19 pandemic forced most hospitals to move grand rounds online, and the results surprised a lot of people. One hospital that tracked attendance found that virtual sessions on Zoom drew an average of 384 viewers per week, compared to just 44 for in-person grand rounds held during the same time period in previous years. Some sessions topped 1,000 viewers.
The quality held up, too. Over 80% of respondents said the sessions would or might inform their clinical practice. More than 92% reported no difficulty accessing the technology. Nearly 89% said they would be very likely to attend future virtual sessions. One of the most notable effects was that community-based doctors, including general practitioners who could rarely justify traveling to a hospital for a midday lecture, suddenly had easy access. As one GP put it in feedback: “It is so much easier to attend a grand round via Zoom. It allows those not based in Cambridge or without time to attend in person to benefit from them.”
Many institutions now offer a hybrid model, streaming sessions live while also holding them in person. This has effectively turned grand rounds from a local event into something closer to a broadcast, with some major medical centers making recordings publicly available online.
Patient Privacy and Presentations
When grand rounds involve real patient cases, privacy becomes a serious consideration. Surprisingly, there are no universally agreed-upon guidelines for how patient information should be handled in these settings. The core tension is straightforward: medical education relies on discussing individual patients in detail, but patients have a right to privacy and may not want their case presented to a large audience. Most institutions anonymize cases by removing names and identifying details, but the NIH has noted that even de-identified presentations can sometimes allow patients to recognize themselves, raising questions about whether explicit consent should be required. In practice, policies vary from hospital to hospital, and the issue remains an active area of ethical discussion.