At Lowell General Hospital, Lowell, Mass., the big issue three years ago was how to liven up its grand rounds programs. Donna Beales, MLIS, librarian and CME coordinator for the hospital, says the audience-response system they bought to perk things up has really made a difference by bringing interactivity to grand rounds — but only when it's used right.

“In order to use an audience-response system effectively, the speaker has to have an understanding of what does and doesn't work with this technology,” says Beales. “We never have the same faculty presenting twice, so there's a constant learning curve, even though most presenters are enthusiastic and interested in trying it out.”

The best way to use ARSs, says Beales, is to ask questions with no right or wrong answers, such as a case presentation scenario. “People respond well when the question allows them to choose various ways to respond to a case.” Another good use, something “the docs absolutely love,” she says, is when you ask their opinion of an important matter, such as how they feel about a single-payer system. “There are no right or wrong answers, and you can get a quick temperature read of the audience.” You also can get a deeper understanding of their factual knowledge by following up with a “why do you think that?” type of question, she says.

What doesn't work quite so well is when a presenter asks a question before making the presentation that could invalidate the reason for listening to the session. For example, if the presenter asks the audience what drug they should use to treat a certain condition, and 90 percent get it right, they'll see no need to sit through the lecture to learn what they had just demonstrated that they already know. “The other awful way to use an ARS is to lecture about how XYZ drug is effective for ABC state, then ask them what you just said,” says Beales. “These are physicians, not grade-school kids. They get it — they don't need a rehash.”

Another potentially sticky wicket is integrating an ARS with the ubiquitous PowerPoint presentation. “Most lecturers come in with a canned lecture, and they find it hard to deviate when the audience already knows the answers. PowerPoint locks you into a certain path, because you can't shift directions to go with what the participants' answers show they already know or still need to learn.”

When used well, Beales says, an ARS can be a beautiful tool. In her case, it's doubly beautiful because it not only makes the grand rounds more interesting and interactive, but also, by including a Q&A session as a basis for the post-test, the videotaped sessions can qualify for Category 1 CME credit for those who couldn't physically attend the lecture. But doesn't this fly in the face of how to use ARS effectively, which entails opinion questions rather than the fact-based multiple-choice tests needed to qualify for CME credit?

“We have come up with a compromise, though we haven't completely resolved that one,” says Beales. “What we do is ask lecturers who are interested in using the ARS to intersperse case- or opinion-based questions with a certain number of factual questions. Then we eliminate the opinion questions and just include the true-false factual types of questions for the post-test. But you can't just use factual questions during the activity — the audience will snore through the whole thing,” she adds.