On Rounds With Baylor College of Medicine
September marks the start of a second full year of the Medscape Gastroenterology original content series, Grand Rounds in Gastroenterology from Baylor College of Medicine. Since the launch of its first case, "Bleeding From Gastric Varices," this interactive, case-based series has evolved to perhaps ideally reflect the depth and strength of the clinical material we hope to make reliably available to you as our audience. With this in mind, I'd like to spend my time with you this month exploring what I believe to be the core assets of this patient-centered educational initiative.

This monthly series of practice-oriented case presentations developed for Medscape Gastroenterology draws from provocative, unusual, and exemplary cases presented by GI fellows and attending GI faculty from the consultation services at the Baylor-affiliated hospitals and medical centers during their weekly clinical conferences. The series, as produced in collaboration with Series Editor Richard Goodgame, MD, Professor of Medicine and Gastroenterology Fellowship Program Director in the Department of Medicine, Gastroenterology Section, at Baylor College of Medicine, in Houston, Texas, represents an ideal venue for fostering evidence-based medicine because each case places the patient at the center of focus and challenges the reader's skill in diagnosis and management.

The series makes use of case histories to demonstrate the clinical presentation of diseases, to provide a relevant context in which the physician-reader may interpret clinical information, and to focus discussion on potential ways to frame and approach the clinical problem, as based on the current, best evidence published in the literature. As a result, such a patient-driven series can enhance the physician's clinical problem-solving skills as well as alter the physician's approach to practice, teaching, and research -- all with the goal of improving the care of patients with diseases of the gastrointestinal tract and liver.

Each problem-solving scenario in this ongoing original series requires that the physician-reader effectively integrate sound use of current best evidence with clinical expertise to make decisions in diagnosis and management as they apply to the individual patient setting. In this way, each case in our Grand Rounds series is intended as a teaching or educational tool that can provide the physician with a framework within which to refine how he/she looks for answers to clinical challenges that present in everyday practice.

Perhaps the greatest facilitator of such a clinical conference-based series is the use of the Internet as the medium for delivery. An online medium offers the value-added element of interactivity. In this respect, each case may be presented so as to essentially parallel the everyday challenges facing the physician in clinical practice. That is, each day, the physician faces the task of interpreting patient history, the results of diagnostic studies, critically assessing potential preventive or therapeutic interventions, and knowing whether the evidence upon which these evaluations is based is valid. Additionally, an online medium offers the opportunity to expand the reach of such information to a degree not possible with conventional print publication. Dr. Goodgame underscores these reasons for bringing Baylor's Grand Rounds to Medscape Gastroenterology: "We recognized that the quality of material presented each week at rounds, both the clinical data from patients and the discussion generated by the fellows and attending physicians, was exceptional. Therefore, it made sense to try to widen the audience."

In line with the goal of paralleling true-life scenarios, Medscape Gastroenterology's Grand Rounds in Gastroenterology from Baylor College of Medicine series hopes to reinforce this approach by having the physician-reader progress through a series of discrete sections -- much in the same way as a true clinical encounter would be approached. Each of these sections presents specific information in the relevant clinical context and then key questions in diagnosis and management are posed. Therefore, each case presentation may be viewed as a discrete practice scenario that places the patient at the center of focus, with the emphasis being on patient-oriented outcomes.

It is hoped then that these cases appropriately reflect the same goals and objectives of any live Grand Rounds conference service: to provide a forum for the presentation of relevant, timely, valid, and diverse, case-based teaching scenarios that focus on the information needs of physicians. And this rationale is further reinforced by Dr. Goodgame: "A very important element in learning is the 'need to know.' We tend to remember things that meet a need, and this element is often missing in a lecture or article. Cases from real life create the 'need to know.' The imaging material can hardly be learned in any other way -- what is the meaning of this x-ray, endoscopic image, or pathology slide? The dilemmas posed by the cases in this series mimic real-life scenarios, and the answers satisfy the real-life needs of the clinicians in a way that information can be retained."

Now that we have had the chance to revisit this Medscape Gastroenterology original clinical content series, I invite you to review our full inventory of cases in this series, as well as the most recently posted installment, "Dysphagia in a Patient With Rheumatoid Arthritis and Iron Deficiency Anemia."

I thank you for again lending me your time and allowing me to bring you on this virtual tour of sorts, of our Grand Rounds in Gastroenterology from Baylor College of Medicine series. Medscape Gastroenterology is fortunate to be able to bring you this strong clinical product for yet another season. I continue to look forward to these monthly columns and the opportunity to keep you informed of my continuing efforts to expand and improve Medscape Gastroenterology so that it works best for you. And, as always, your comments and feedback are welcome and encouraged. You may contact me directly at gastroeditor@webmd.net. (If your concern is technical, however, please contact our customer support staff at mpmailings@webmd.net.)