BACKGROUND Grand rounds are a time-honored continuing medical education activity that is intended to keep doctors current and competent. In addition, health care leaders and medical educators often rely on grand rounds to change physician behavior and improve patient outcomes. However, the extent to which grand rounds programs are consistent with evidence-based educational practices is unknown. METHOD The authors used an instrumental case study approach in 2007 to determine whether one grand rounds program, such as medical grand rounds held at a U.S. academic medical center, adhered to well-accepted educational practices. Qualitative data collected from program planners, presenters, and participants via structured observations, key informant interviews, and a focus-group session allowed an assessment of consistency with five evidence-based practices. The authors used an intensive, inductive approach to analyze data to determine the extent to which the medical grand rounds program incorporated the five practices. RESULTS Studied during 2007, this traditional medical grand rounds program only minimally reflected the five evidence-based educational practices of needs assessment, multifaceted intervention strategy, sequencing, interaction, and commitment to change. Authors found grand rounds sessions to be slide-driven, passive presentations reflecting a broad range of subspecialty topics. Opportunities for questions were limited, and audience attendance was inconsistent and varied, particularly for nonfaculty participants. CONCLUSIONS This study has identified important opportunities for improving a specific grand rounds program and for researching similar examples of this common, traditional educational forum for physicians.