Requiem for the grand round.

The time-honoured tradition of Grand Round is firmly rooted in medical education, but has little evidence for its effectiveness or its impact on patient management. A mode of didactic teaching, Grand Round has lost its appeal in modern medical education with dwindling attendance at Grand Rounds worldwide. Once a platform for eminence-based medicine and a cross fertilisation of medical ideas, emphasis on sub-specialisation and clinical governance, combined with rota, trainee engagement and attendance failures has made Grand Round obsolete. To survive, Grand Round must have evidence for its effectiveness in medical education. It must be able to compete with other forms of teaching and adapt by using technology to reach trainees. Engaging the audience and encouraging participation needs to be woven into the fabric of the modern Grand Round, alongside learning clinical skills and developing clinical reasoning. Understanding the needs of today's trainees and their involvement in formulating the Grand Round programme is vital. Attendance at Grand Round is a recognised measure of its success and will be used in its evaluation. Questions still remain regarding the future of Grand Round. Its survival will depend upon its ability to change with time and reclaim its place as a credible tool to promote learning.

Low dose amiodarone causing pseudo-alcoholic cirrhosis.

Amiodarone is a commonly used anti-arrhythmic in elderly patients. Abnormal liver function is frequently reported with its use but clinically symptomatic disease is rare. Hepatomegaly, cholestasis, acute hepatitis and rarely fulminant liver failure have been recorded [1, 2], however amiodarone toxicity presenting with cirrhosis is exceedingly rare. Toxic effects of amiodarone are well described with higher dosage but severe hepatic toxicity and cirrhosis with low dose amiodarone has not been reported in the English language literature. We present a report on a patient with pseudo-alcoholic cirrhosis with low dose amiodarone.