The medical grand round is under attack—not least by Dr Jack Gilbert (Medical Teacher, 1979, 1, 314-315). The round forms a convenient symbol for the academic medical centre, for it fills a role as the showpiece of such institutions. It is impossible not to suspect that the assault on the round is a vicarious exercise: the real target is the academic centre itself, which must be exposed as an overprivileged, overspecialized ivory tower, lacking relevance to the community at large and diverting the medical student from the problems of primary health care.