Wednesday, January 25, 2006

Grand Rounds: Room for Improvement?

Although I have been an infrequent poster to my own blog and an equally infrequent poster to Grand Rounds, I will say that I am nonetheless an avid reader. I'd like to make three comments on the latest edition of Grand Rounds, one positive and obvious and two that may be controversial but worth throwing out for general consumption:

1) Excellent set of posts this week.
2) Is it possible that Grand Rounds are getting too big? Perhaps those that host it might consider paring down the number of entries that are actually published more? It's getting difficult to separate the wheat from the chaff!

Perhaps we need to decide what the purpose of Grand Rounds should be? To increase the traffic of all who submit entries or to elevate and educate those that come to Grand Rounds to read and learn and gather insight from the many different perspectives represented (Physicians, nurses, researchers, administrators, payers and of course patients).

Personally, I'd opt for the latter. The great thing about the blogosphere is its democratic nature. Traffic comes to those who write clearly and have something to say. Grand Rounds should be one more way of bringing readers to the "best" of the medical blogs. Far be it for me to define what the "best" is. I'm perfectly content to have the criteria for that decision vary from week to week depending on who the host is.

I'd simply recommend that those hosts limit the number of entries on each given week. It's unrealistic to expect that every entry (or given the explosion of medical blogs, even most entries) are of equivalent interest to readers. I'd like to see the hosts worry less about potentially offending bloggers whose entries on a given edition were rejected.

I'm not in any way advocating a form of elitism here. Each blog entry should be taken at its face value for consideration. Each participant in the world of medical blogging should be judged on an equal footing by the hosts.

I think this will move us away from the more superficial objective of simply increasing traffic to our own blogs.

3) I have very mixed feelings about the involvement WebMD in this edition of Grand Rounds. As a commercial website, I think its representation here again raises questions about the purpose of Grand Rounds. I'd like to see a "purer" Grand Rounds that doesn't become yet another marketing tool for different aspects of the healthcare industry.

Please don't take this as in any way impuning the very nice entries of the various WebMD blogs of this edition. I'm just expressing my personal vision of where I'd like to see Grand Rounds go. I think it would be nice to exclude"commercial" websites from these pages. Maybe I'm wrong about this but I think it's worth throwing the idea out.

Again, I'd hate to have anyone accuse me of being elitist here or of in any way promoting elitism. The quality of the blogosphere I enjoy and admire the most is its all encompassing nature. I read medical blogs from many different countries, from both providers and consumers of healthcare, from different medical specialties, etc. Grand Rounds is a great opportunity for me to get introduced to perspectives and blogs I've never been aware of before.

I only want Grand Rounds to continue to serve that function, both for myself and also for all who come here to be enlightened, entertained and occasionally inspired.


Anonymous Anonymous said...

As a reader who isn't in the medical profession, I really like Grand Rounds because there is such a variety of perspective to choose from and such a broad range of topics. When it's packaged into one nice post every week, I've got the option to click through when I have a moment or two to read without having to hunt it down.

If you're not impugning WebMD's posts, then what do you mean by keeping Grand Rounds "pure"? Are their experts not practitioners in the medical field? How are they tainted by having a WebMD logo at the top of their blog?

January 25, 2006 7:47 PM  
Blogger PaedsRN said...

Definitely a good idea to consider the future. It would be great to hear what Nick has in store for Grand Rounds, as he may already have cunning plans for his project!

The WebMD question is a tricky one. I tend to agree with John but then, the line may be a difficult one to draw as time goes on. Allowing or disallowing submissions based on the status of the author implies a level of scrutiny I'm not sure I'm comfortable with.

The other significant issue with rounds for some bloggers is going to be time! It's an increasingly large committment to host, and while I don't think I'll struggle personally I can imagine those with greater family and work committments might be discouraged by the sheer volume of submissions.

I'd be interested in seeing more use of themes, whereby those submissions that were 'on-topic' for the week were featured first, and the remainder were dropped in a 'link bucket' at the end of rounds (which in theory increases traffic but probably not to the same degree).

Likewise, a host could judge the 10 most interesting submissions and present them prominently, then list the rest for reference. This would be in keeping with the 'interesting cases' model that grand rounds In Real Life are supposed to follow, though of course they wouldn't necessarily need to be cases in the blog version.

In summary, I'm not sure there's a need to start rejecting entries but there may certainly be room for hosts to use discretion in presenting what they find interesting, relevant, thought-provoking, timely, or on theme. It's not difficult to then present each link, while only choosing to focus on a few.

January 26, 2006 12:26 PM  
Anonymous Anonymous said...

Whether entries are included or not, it's still quite a chore for the host to weed through all of the many entries now being submitted. Maybe there is a way to divide the "labor" and have "secondary" hosts to help determine which posts are worthy--perhaps the upcoming host? The "secondary" host could be listed first and prominantly and included in Nick's Pre-rounds. Just a thought . . . ;o)

January 26, 2006 4:37 PM  
Blogger Unknown said...

This is a lot of entries put in each week for Grand Rounds. I wouldn't want to tackle it until I get more time on my hands. I agree with Paedsrn regarding "Likewise, a host could judge the 10 most interesting submissions and present them prominently, then list the rest for reference. This would be in keeping with the 'interesting cases' model that grand rounds In Real Life are supposed to follow, though of course they wouldn't necessarily need to be cases in the blog version."
Nice blog by the way!

January 27, 2006 2:08 PM  
Blogger Kim said...

Interesting - I never assumed that my entry would be accepted into the Grand Rounds! I thought the hosts WERE weeding! LOL! Good lord, I might be chaff!

I agree that the number of submissions are sometimes enormous and that it takes me literally all week to get through them (but I do!).

Early on in my blogging I thought that perhaps Grand Rounds could be split into two posts: one would come out on Tuesday, one on Friday and both could be from the same host.

But here is something that worries me.
I'm an RN. I don't know a lot about Hospital or Medical Policy-type issues and so I may not be able to tell what is wheat-from-chaff in areas I'm not familiar with, so in not posting some of the entries I am be inadvertently holding back some great blogging!

Then again, why not leave it up to the reader? For instance, out of ALL the posts this week, yours was the one I came to first! I might check out the post on "Physician Regulations in Antartica" (not a real post, btw)later, or maybe not at all.

I once considered whether we should have a "Nursing Grand Rounds" - but still anyone could submit as long as the topic pertained to nursing - suggestions, stories, commiseration, patient experiences, doctors' experiences, etc.

I like the idea that whether you're the hottest blogger this side of the Mississippi or a newbie who has just discovered that the internet is more than AOL, we all have something to say.

The question becomes: how do we make it manageable.

Maybe I'll have more ideas when I host in February....
Lord knows we all have something to say

January 30, 2006 9:34 PM  
Blogger Dr Dork said...

Interesting thoughts.

As an avid reader but only a very recent contributor, I don't consider myself a learned person on the history of Grand Rounds. But, as is the beauty of the blogosphere, I'll chuck in my two cents regardless.

Excluding those with a commercial link is a dangerous precedent. Do we also exclude those that run ads on their site ? They're "making a profit" just like WebMD bloggers. Do we exclude those who aren't anonymous, on the premise they are potentially boosting their "offline" business ? Those who have a particular medicopolitical axe to grind that we might disagree with ?

I think the current system of categorizing works quite well...That way the reader can pick and choose their particular interest.

But I think you make some interesting suggestions...and pose a difficult question. The way the blogosphere is growing, there will needs be some limitation eventually. I wonder what Nick Genes thinks.

January 31, 2006 6:06 AM  
Blogger ElisaC said...

I'm an avid participant in many Carnivals. But I only submit to *and* only read carnivals that do not have some limited, mysterious, ever-changing criteria for inclusion. It submitted posts fall within the defined Carnival topic, then I want to see them included.

There are two things I most enjoy as a Carnival reader:

1. Seeing how each host rises to the challenge to categorize and organize their Carnival...sometimes the most creative thing in a Carnival is what the host does with it.

2. Having tons of links, most hopefully new to me, to choose from.

I don't want or need someone I usually don't know to be the arbiter of quality for me. It's easy to say that elitism isn't the goal, but most hosts are going to feel far more pressure to include submissions from prominent bloggers than bloggers they've never heard of.

I think the spirit of blog carnivals was originally one of inclusivity and equal exposure for all. Other kinds of carnivals don't interest me.

January 31, 2006 10:27 AM  
Anonymous Anonymous said...

Becoming more selective is the key to making Grand Rounds interesting to read and not just a laundry list of links.

A great model for interesting "Best of" blogs is the Wall Street Journal's free "Best of the Web Today" column ( It takes a bit more effort to use such a format, but it is vastly more interesting to read and could attract a much wider readership.

January 31, 2006 12:39 PM  
Blogger Barbados Butterfly said...

I think most readers do want some form of selectivity. Having 70-100 posts is too many. Not all of them can be wheat. The devil is in the detail, however.

I have excluded some excellent posts this week and included some posts that others think should have been excluded. I have included posts from bloggers I had never come across and excluded posts from some of my favourite bloggers. So be it.

While I didn't set out to make any controversial decisions I would like to encourage debate about this issue. I have posted some thoughts and will be following this thread.

Some Thoughts From This Week's Grand Rounds Host.

January 31, 2006 2:30 PM  
Blogger marcus said...

Mine is not a popular or widely read blog but I do have one simple message. Health promotion, healthy lifestyles and primary prevention must have a higher priority. This is not a medical care issue, it is a health and community issue.

There are communities that are actively pursuing this course of action. Finland started 35 years ago with worthy results. CardioVision 2020 is a project for Olmsted County in MN and there is an informal health challenge with a similar project in Greenville County, SC.

Governor Huckabee is chairman of the National Governors' Association. He has selected Healthy America as the topic for the NGA Forum to be held in Washington DC later in February. Arkansas and SC have launched statewide initiatives.

I am involved in the Greenville and SC projects and have been invited to the NGA Forum.

My proposal is to initiate a second (companion) grand rounds dedicated to health promotion, healthy lifestyles, primary prevention and community health. This is truly where health professionals and the lay public can meet for common purpose.

I am proud to have been included in Grand Rounds and will continue to participate however it may be organized in the future. It serves a valuable purpose and the hosts have done a remarkable job.

I would actively participate in the initiation and development of a companion grand rounds dedicated to prevention.

January 31, 2006 4:38 PM  
Blogger Kim said...

I just posted over at Dr. Barbados'blog
the what seem to be the three possibilities:

(a) Selection from different topics by the host - any number they want

(b) Topic of the Week selection - all blogs must address topic. Decided by host, realizing that not all specialties will necessarily care to post on that topic.

(c) Include them all and let the reader decide.

As an upcoming host I like (a) and (b) but as a reader, with everyone else doing the work, I like (c) because I read blogs that normally would not cross my sphere of interest.

So, how about we keep it flexible and the host announces ahead of time what type of Rounds they will be. You can be a host-with-the-most or you can go with quality as opposed to quantity, understanding both as submitters and hosts that omission doesn't mean worthless and that the omitted post may be perfect for Grand Rounds at another time?

January 31, 2006 4:56 PM  
Blogger Barbados Butterfly said...

Sounds good to me, Kim. I think it clear that hosts are likely, if choosing on their own preferences, to choose posts written in the style of their own blogs and the blogs they link to.

When you submit an article to a journal you are expected to read the advice the journal gives to authors and to submit in the way the journal demands. I suspect that GRs could be run in the same fashion - the host could indicate where the goal posts are (with respect to topics, style, length, intended audience, number of posts that will be included) and the submitters give their best kick. Having posts with 100 links (or more as GRs gets bigger) is probably not desirable.

I think it must be made clear that omission doesn't mean that there was anything wrong with the post or submitter.

Interestingly, the posts I included got varying hits - at one point I saw that one post had 137 hits and another none... just goes to show that the posts I want to read aren't necessarily what the Grand Rounds audience wants to click on. And I think this would be true for every selective host.

As far as finding new and interesting blogs, most hosts have links and/or a blogroll in the sidebar which provides another avenue to explore new blogs, even if they're not linked to in the Grand Rounds post.

February 01, 2006 12:56 AM  
Blogger The Medicine Man said...

I actually like the idea of having the host set the standards for that week and limit the number of posts in the main, prominent part of Grand Rounds and then list the links of every submission at the end.

This would appear to satisfy the groups that prefer either selectivity or inclusivity.

I still have mixed feelings about including blogs from commercial websites like WebMD. The idea that a corporation (or academic institution for that matter) may have direct influence on the content of the blog doesn't sit well with me.

I noticed for example, that Dr. Bill Lloyd's post on Powerpoint presentations began with the admonition that it wouldn't be about eyes or vision disorders. "WebMD encourages us to talk about other experiences from time to time." Do I care about what WebMD encourages or discourages? No. I only care about what Dr. Bill Lloyd wants to write about!

Yes, I understand the "slippery slope" argument (what about blogs that have ads for example?) However, this isn't the future of western civilization we're talking about here. I'm perfectly content to have the host of the week make those determinations on an ad hoc basis.

Apparently most people disagree with me on this point. I can live with that. It was just a thought.


February 01, 2006 6:42 AM  
Blogger Dr Dork said...

I don't personally agree or disagree with you, John.

I think some kind of a guideline is a great idea. The specifics of this are highly debatable.

But a structure, a guideline, would only add value and depth to the concept. In my dorky opinion.

February 01, 2006 7:36 AM  
Anonymous Anonymous said...

Before hosting Grand Rounds 2:2 I solicited the advise of Edward Tufte, who moderates a superb forum. He was quite clear that moderation is important. In my case there were sufficiently few submissions that my only forms of moderation were to place better posts higher, and write some biasing comments about each post. It sounds like Grand Rounds submissions have increased substantially since then (October), probably due in part to Nick's work with Medscape. The degree of moderation is a function of the enterprise's scale. It sounds like we have arrived at the point that more than organization and commentary is merited. To be clear, the ultimate moderation is the peer-reviewed journal, and Grand Rounds is nowhere near that level of moderation. Yet. Imagine establishing an editorial board, referees, submissions due a year in advance. Oh, my. Perhaps someone could go through this thread, now or later, and collate all the moderation methods suggested, including a count of how many times each method was suggested. What would also be helpful is if hosts (like me) could mine their log files to figure out how many posts becomes "too many".

February 01, 2006 5:34 PM  
Blogger Internal Medicine Doctor said...

The only thing I would surely be afraid of when leaving to the host woud be that it can lead to corruption. ie: including posts from bloggers you favor in the hope of getting a link to increase your traffic.

this would surely lead to bias on the part of the hosts and also to the same bloggers getting picked over and over.

Leave it to the reader I say.

February 02, 2006 8:51 AM  
Anonymous Anonymous said...

It is pretty clear that the challenges have risen over the threshold of tolerance. The list keeps getting longer and longer. Seems like we need some real action to make this work:

Grand Rounds: Has Med-Blogosphere Outgrown This Format ?

February 06, 2006 11:00 PM  
Anonymous Anonymous said...

It's fascinating to see each major carnival have this debate after reaching a certain size, usually sparked by a host who takes liberties in excluding valid entries when the guidelines and/or traditions promote inclusiveness.

I favor inclusiveness, but even more not being arbitrary. So when you normally get 50 entries and a rogue host decides he's only going to include his favorite 20 (all of which he had to read to determine, already doing most of the work involved in including them all), it's a shock. It also appears to be nigh impossible to change the rules of a carnival once it is well established, so it is well, for those who like a "best of" approach, that some of the newer, more minor carnivals have been organized as limited up front.

I'm currently as concerned with the sheer proliferation of carnivals for every niche, cranny and whim as I am with the limit or not debate afflicting Vanities, Capitalists, Grand Rounds, and presumably others. It takes attention off of the majors, and drives heavy hitters like Glenn Reynolds into linking none of them.

In the case of Carnival of the Capitalists, so far we haven't changed the rules. However, we've started a site named Jotzel that is intended to be a Slashdot-like, day-to-day CotC-esque, ultimately commercial place where "best of" business and economics blog posts and MSM articles are decided by the readers. For those who like hosting, entering and reading the weekly roundup, CotC still exists and thrives. But day to day there is something else, similar, yet ultimately more selective, that goes beyond what CotC could ever be.

Still, back in carnival world, I think half the problem now is the major, older carnivals versus the "me too" explosion.

February 12, 2006 9:43 AM  

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