Friday, August 7, 2015

Improving Attitudes and Behaviors towards Internal Medicine Grand Rounds by Incorporating the Theory of Planned Behavior

James Michael Fuller, MD, MEd
Greenville Hospital System

Background: Many institutions have noted a decline in Grand Rounds attendance. There is little data exploring factors that influence the decision to attend Grand Rounds.

Objective: A formal evaluation was undertaken to assess the factors leading to declining Grand Rounds attendance. An intervention was planned that incorporated a theory of attitude formation to determine if Grand Rounds attendance could be impacted.

Methods: This study applied a simple time-series design with the addition of qualitative data through mixed methodology. Pre-interventional data was obtained through archived Grand Rounds records, multiple intelligences testing, and a survey administered to potential participants. An intervention based on the theory of planned behavior was formulated. Pre- and post-intervention Grand Rounds attendance was documented. A post-intervention focus group interview with participants was also conducted.

Results: The pre-intervention survey elucidated many of the factors impacting attendance. The multiple intelligences profiles demonstrated a strikingly high percentage of participants are kinetic, self, social, and naturalist learners, while surprisingly few are verbal. A review of formats during the pre-intervention study period revealed that nearly all of the presentations were lecture-based. Post-intervention, the presentation formats changed dramatically, largely employing active learning modalities. Post-intervention Grand Rounds attendance increased by 54.4% (p<0.5). The post-intervention focus group interview revealed seven emerging themes with striking parallels and complementarity with the quantitative data sets.

Conclusions: This study demonstrated that an intervention based on the strategic theory of planned behavior can be developed to reach the goal of increasing attendance at Grand Rounds.