Often just behind a challenge waits an opportunity ready to be discovered. The Wilmer Eye Institute’s current chief resident (also known as the assistant chief of service), Thomas Johnson III, M.D., Ph.D., recently found such an opportunity after new policies instituted because of COVID-19 radically transformed the education of Wilmer’s residents. In addition to moving most patient visits to telemedicine, Wilmer leadership moved a hallmark of medical education — Grand Rounds — to a virtual format.
During Grand Rounds, speakers present clinical cases of patients they have examined and treated. While clinical fellows and guest lecturers present some cases, residents present the majority of them during this series held every Thursday from 7:30–8:30 a.m. “Presenting a case requires first developing a comprehensive and detailed understanding of the patient’s disease process, and then researching extensively what is known about that disease, what is not known and what is under active research,” says Johnson.
The key ingredient for an effective Grand Rounds, however, is an active audience. “The residents know that the faculty will ask probing questions, so they go to great lengths to prepare by reading as much as they can about the particular eye disease that they are presenting,” explains Johnson.
In the past, the audience has primarily been seated in the Patz Lecture Hall, located in the Wilmer building on The Johns Hopkins Hospital’s East Baltimore campus. Because of social-distancing guidelines and strict regulations about who can be in the hospital and for what purpose, Grand Rounds is now conducted entirely via Zoom webinar.
Previously, a virtual participation option existed but, “At any given time, there were between one to four people viewing it online,” says Johnson. Necessity is the mother of invention, of course, but it also seems to be the mother of tech savviness. Now that most communication — both work and personal — has moved to virtual, Johnson has seen a large uptick in the number of virtual viewers and the quality of those interactions.
“People are figuring out how to engage remotely,” he says. “It's not just that you're sitting by yourself listening to the residents talk, but people can ask questions through the computer that everyone else can hear.” During a recent Grand Rounds, 105 people were together on a call. “It really was an amazing collaborative discussion,” Johnson says, “and no two people on the call were in the same room.”
“It's not just the residents,” he says. “The faculty learn from each other as well.” Johnson cites Morton Goldberg, M.D., Wilmer director emeritus, as a particularly enthusiastic attendee. “Dr. Goldberg remarks routinely that he learns something new every time he sits in on a Grand Rounds, which is virtually every week,” says Johnson.
The growth of the Grand Rounds’ virtual audience and the blossoming of the interactive discussions have inspired Johnson to look beyond the present moment to future opportunities for this new format. “If we can take this as a modality for teaching ophthalmology and spread it to people that, geographically, are well away from us but have access through the computer to learn from what we're talking about and doing here, I think that would be a huge boon for the institute,” he says.
Wilmer has always been at the forefront of scientific and clinical discovery in ophthalmology, and expanding Grand Rounds to a wider audience will allow the institute to continue to play a leading role in ophthalmology’s growth and progress. “The incorporation of a greater range of experience, opinion and knowledge will enrich the discussions that we have during Grand Rounds,” says Johnson. “The idea is to make this a worldwide event.”