Friday, February 03, 2006

Friday: Intern Topic of the Day III “Where does Grand Rounds Go from Here?”

An interesting post from this week’s Grand Rounds. It seems the Grand Rounds are getting a little, how shall we say,…Grand!

From California Medicine Man:

Is it possible that Grand Rounds are getting too big? Perhaps those that host it might consider paring down the number of entries that are actually published more? It's getting difficult to separate the wheat from the chaff!

Perhaps we need to decide what the purpose of Grand Rounds should be? To increase the traffic of all who submit entries or to elevate and educate those that come to Grand Rounds to read and learn and gather insight from the many different perspectives represented (Physicians, nurses, researchers, administrators, payers and of course patients).

Personally, I'd opt for the latter. The great thing about the blogosphere is its democratic nature. Traffic comes to those who write clearly and have something to say. Grand Rounds should be one more way of bringing readers to the "best" of the medical blogs. Far be it for me to define what the "best" is. I'm perfectly content to have the criteria for that decision vary from week to week depending on who the host is.

I'd simply recommend that those hosts limit the number of entries on each given week. It's unrealistic to expect that every entry (or given the explosion of medical blogs, even most entries) are of equivalent interest to readers. I'd like to see the hosts worry less about potentially offending bloggers whose entries on a given edition were rejected.

I'm not in any way advocating a form of elitism here. Each blog entry should be taken at its face value for consideration. Each participant in the world of medical blogging should be judged on an equal footing by the hosts.

I think this will move us away from the more superficial objective of simply increasing traffic to our own blogs.
I thought about it for a while and found that the proposal would pose a set of problems:

1. Those who write well, write well: Isn’t it possible, or even probable, that the same bloggers would get picked to be included every week. That instead of Grand Rounds reflecting the medical blogosphere that it would end up being a compilation of the ten, consistently, best bloggers. Wouldn’t that be a contradiction to why carnivals were created in the first place?

I always thought it was to give the small guys a little exposure and maybe, eventually, a bigger following.

2. The blogosphere depends on links: And although I have nothing but the highest respect for everyone involved in putting the rounds together each week. Could the prospect of a lucrative link (big blogger, lots of traffic) loom in the back of the hosts’ mind and, let’s just say, slightly bias the selection process? It’s not double blind you know.

This week’s host addressed the issue on his own blog after the carnival:

When determining what to include in Grand Rounds this week I decided to be ruthless in my exclusion decisions. I excluded posts from many bloggers including those who make up some of my most prominent sidebar links and are on my blogroll (my favorite bloggers). I hope that those whose posts were excluded don't take offense or think that I don't like your blogs. This certainly isn't the case.
No offense taken, my submission was omitted, so what? But I have a level head and knew that I’d been included in the Rounds before, many times. I have a readership, a pretty good one. So I wasn’t offended.

But what about the little guy? If this was the first or second time he/she submits and he gets rejected once or twice, he may just never submit again. Well, he wouldn’t link to Grand Rounds, he wouldn’t support it. Wouldn’t we then be losing readership?

So Nick, whataya gonna do now?

And, what do you think?


Blogger coturnix said...

I am hosting next week's Grand Rounds. Unless I am extremely uncomfortable with an entry (in which case I will consult the Grand Rounds proprietor), all entries will be included.

I am in the school of thought that carnivals are a democratizing fenomenon and the opportunity for new and/or small blogs to get a lot of new eyes. So, bigger the better.

Of course, as the carnival grows bigger, it becomes important that hosts organize the topics well. A narrative style that works with a small carnival does not work if there are 60 entries.

It is especially tricky to make a switch on an already established carnival. Carnival of Liberals was designed from Day One to be a competitive, peer-reviewed carnival limited to ten best entries, and it appears it is working fine so far, though , perhaps due to it being pretty new, there is a repetition of entrants. The Big Liberal Blogs do not enter - they do not need to, so it works fine for promoting little ones. I do not think we can do this with Grand Rounds - The Big Medbloggers need to be in just as much as the little ones, and it is too late to make a switch to an edited/competitive carnival.

6:53 AM  
Anonymous Moof said...

Personally, I look forward to Grand Rounds - there's almost always something or someone new. My blogroll gets longer with each new cycle.

Although I've only been blogging for a relatively short time, I was under the impression that the idea of Grand Rounds (and Carnivals in general) was to provide a "forum," or a meeing place, for those who are interested in the theme - not a contest that a blogger has to win in order to make the cut.

What one person finds interesting - captivating ... may not strike every reader; likewise, posts which might leave some nonplussed may be of great interest to other people. I believe that it would be arrogant to pick and choose, using personal criteria in order to decide what others may or may not enjoy.

Interesting and not ... are relative to the tastes the individual. If a host has a problem with "too many" submissions, then perhaps they shouldn't host ... and if a reader has a problem with not enjoying all of the posts, then they're free to skip those which don't please them.

And if it's a matter of someone simply not having the time to go through all of the Grand Rounds posts, and is upset because they've "wasted" some of their precious free moments on posts which didn't tickle their fancy, then perhaps they should just stick with their own Blogroll.

How boring it would be if accepted submissions were to be trimmed back to some particular individual's time limit: "I only have 1/2 hour to read this stuff, so it'd better all be good!" Hey! Life just isn't like that ... and thank heaven, Grand Rounds isn't either.

7:22 AM  
Anonymous Anonymous said...

i dont have the answers, but i would favor a bland of the two approaches, perhaps with a ceiling of 30-35 posts. after that it gets overwhelming, democracy or not.

8:45 PM  
Blogger Echo Mouse said...

Well, Dr. C's comment seems a good idea. I hadn't thought of it until I saw what he said. I agree with you too though. The GR give the little guy a chance to develop readership and enjoy blogging.

I know myself, I scroll through all the links until I hit a description which interests me. I just can't read all of them. But having the choice is what I appreciate. That *I* can decide and not have a heavily edited GR, where someone chose for me. If that makes sense.

In any case, since I'm not a doctor or in medicine, I'm not sure if my opinion factors into any of this. But you have it for what it's worth :)

1:42 AM  
Blogger Internal Medicine Doctor said...

Thanks fro responding to the post guys. I found all of your input intersting and representing both sides of the issue.

In the end I thnk it will be up to the host of the rounds to decide what to do.

5:21 AM  
Anonymous Clinical Cases and Images said...

Dr. Charles' approach is the best, I think. Let any medical blogger participate and limit the number of published Grand Rounds entries to 30.

I wouldn't mind at all if my entry is omitted as long as the quality of Grand Rounds is good.

More than 30 entries makes the Rounds close to unreadable, we all have daily jobs, you know, it's hard to spend 4 hours just reading blogs. Of course, nobody makes you do it but I still prefer Grand Rounds to be a showcase of the diverse medical blogosphere in a succinct form.

When I hosted GR last month, I left about 10 entries out and published close to 40-50. Next time, it will be 30-35.

2:14 PM  
Anonymous Anonymous said...

I must admit, being one of the "small guys" I submitted an article to grand rounds way back around #12, was included, and it encouraged me to submit again, and keep reading the rounds.

Having had two entries not included in a row has now caused me to pretty much stop chasing the grand rounds "around". If they fall on a site I read regularly (You, Dr Charles, Geena, The Cheerful Oncologist, Maria) I read them. If not, I don't. And I haven't submitted to it in several months.
(of course, my blog is not strictly medical, which may lead to my getting quickly left off the GR)


1:56 PM  
Anonymous Jay said...

Here are comments I left elsewhere, then expanded on somewhere else, on the topic of limiting GR, based on my experience with Carnival of the Capitalists:

As I said elsewhere:

It's fascinating to see each major carnival have this debate after reaching a certain size, usually sparked by a host who takes liberties in excluding valid entries when the guidelines and/or traditions promote inclusiveness.

I favor inclusiveness, but even more not being arbitrary. So when you normally get 50 entries and a rogue host decides he's only going to include his favorite 20 (all of which he had to read to determine, already doing most of the work involved in including them all), it's a shock. It also appears to be nigh impossible to change the rules of a carnival once it is well established, so it is well, for those who like a "best of" approach, that some of the newer, more minor carnivals have been organized as limited up front.

I'm currently as concerned with the sheer proliferation of carnivals for every niche, cranny and whim as I am with the limit or not debate afflicting Vanities, Capitalists, Grand Rounds, and presumably others. It takes attention off of the majors, and drives heavy hitters like Glenn Reynolds into linking none of them.

In the case of Carnival of the Capitalists, so far we haven't changed the rules. However, we've started a site named Jotzel that is intended to be a Slashdot-like, day-to-day CotC-esque, ultimately commercial place where "best of" business and economics blog posts and MSM articles are decided by the readers. For those who like hosting, entering and reading the weekly roundup, CotC still exists and thrives. But day to day there is something else, similar, yet ultimately more selective, that goes beyond what CotC could ever be.

Still, back in carnival world, I think half the problem now is the major, older carnivals versus the "me too" explosion.
[end of original paste]

What happened with CotC, a good comparison for GR, is the number of entries reached 50 - 60 and then stabilized, as if that's the critical mass of bloggers who will want to enter on the relevant topics each week. It's probably been about the same for over a year. (pauses to look at Gmail archives) It looks like our high might have approached 70, and that was back in 2004, at the first anniversary.

So what may happen is that nothing need be done except the hosts steel themselves for handling a pretty large but not necessarily growing number of entries.

10:01 AM  
Blogger Dr. Andy said...

FWIW, I'm hosting on 2/21 and I'm going to try out a bit of a hybrid approach.

I'll feature a "top ten" of the posts I liked best, but still list all appropriate submissions with a brief description. I figure it's worth trying.

Dr. Andy

2:59 PM  
Blogger Kim said...

Well, I read them all. Yes, I do have a life! LOL!

First of all, some of the posts are from bloggers I already keep up with, so those posts I have already read. then I divide up the rest and read them with my coffee in the morning or at 0500 before I go to bed after work.

Now mind you, if the title of the post is: "The Percentage of Health Insured With Negative Perspectives on the Integrated Subset of the Previous Proposals" I WILL pass.

Even I have standards! LOL!

7:30 PM  
Anonymous Medicine said...

Each blog entry should be taken at
its face value for consideration.

2:10 AM  

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