Lifelong learning at work

Over and above the strategies mentioned by the authors, I would like to draw attention to the value of the "grand round" as a medium for life- long learning, transcending rank and transcending retirement. For juniors and seniors alike my advice is to attend as many grand rounds as possible and to participate in the discussion even if this is at the risk of making a fool of yourself. After all, the most fundamental and perceptive questions, such as "Why has the emperor got no clothes on?" are those which appear, at first sight to be absurd. After the grand round comes reflection. This is the opportunity to compile one's own portfolio of knowledge by undertaking a literature search relevant to the issues raised in the grand round. From small beginnings this has the potential to become a massive armamentarium, equipping one to cope not only with examiners in the MRCP, but also with the day to day realities of clinical problem solving."Just imagine", I used to say to my juniors, "how much more knowledgeable you would be in a year's time, if youn started compiling your portfolio at this instant!"

Finally, although the authors pitched their message at junior doctors and at those who are still at the workplace, the grand round model of learning transcends rank, because it is applicable to seniors and juniors alike. This is why it is always such a shame to see so few seniors at grand rounds, and always such a shame to have so few juniors participating in the discussion,the latter for fear of jeopardising their careers by "speaking out of turn".

The grand round model also transcends retirement, hence my regular attendance at the weekly grand round "at a hospital near me". I would, however, hasten to reassure the MRCP examiners that it is not my intention to intimidate them with my portfolio of knowledge; the knowledge is simply valuable for its own sake. I can, also, not truthfully answer the question "Where am I going?":the destination does not matter because the journey has its own intrinsic value. Simply, I am just so pleased that I took up medicine as a career because it offers limitless opportunities for life-long learning, transcending rank as well as retirement.

Competing interests: None declared