Neurology Trainees' Perceptions of the Educational Value of the Grand Round: A Qualitative Focus Group Study

Background Grand rounds remain an important educational forum within academic medical centres and a longstanding component of postgraduate medical education. At the study centre, the weekly neurology grand round represented the principal recurring organised teaching session available to neurology trainees. Its educational value has not previously been formally explored from the perspective of trainees. Educational commentaries have raised concerns regarding increasing reliance on didactic teaching formats and the impact of public questioning on psychological safety and learning. This study therefore aimed to explore neurology trainees' perceptions of the educational value of the grand round, identify factors influencing its educational value, and examine whether these perceptions varied according to trainee seniority. Methods A qualitative study using semi-structured focus groups was conducted at a tertiary neuroscience centre in North West England. All eligible neurology trainees within the regional training programme were invited to participate using a purposive sampling strategy. Eight trainees participated across two focus groups. Discussions were audio-recorded, transcribed verbatim, and analysed using an inductive conventional content analysis approach. Two reviewers independently coded the transcripts before reaching consensus on higher-order categories and subcategories, which are presented as themes and subthemes. Results Eight neurology trainees participated across two focus groups. Five themes were identified: educational role of consultants, questioning style, learning format, learning environment and trainee anxiety, and the role of time and experience. Participants valued the case-based format of grand rounds, particularly its ability to contextualise theoretical knowledge and provide insight into consultant-level clinical reasoning and management decisions. Consultant involvement was perceived as an important educational aspect of the grand round. However, participants also identified barriers to learning, including anxiety associated with the learning environment, broad open-ended questioning, and repeated targeting of individual trainees during public questioning. Perceptions varied according to trainee seniority, with junior trainees reporting greater anxiety and reduced engagement, whereas senior trainees increasingly valued grand rounds as preparation for independent consultant practice. Conclusion Neurology trainees viewed the grand round as a valued educational activity, particularly for contextualising theoretical knowledge and observing consultant-level clinical reasoning and management decision-making. However, trainees perceived the educational value of grand rounds to be influenced by questioning style, psychological safety, and trainee seniority. Greater consideration of these factors may help optimise the perceived educational value of grand rounds. Further evaluation in other neuroscience centres would help determine the transferability of these findings.