International Collaborative Grand Rounds (ICGRx)

The World’s first Grand Round – ICGRx

What is a Grand Round?

Grand Rounds are case presentations that have been traditionally used in hospital settings and medical training to impart knowledge and keep healthcare professionals up-to-date with the latest developments (Mueller et al., 2003 and 2006). Topics can include any specialty but usually focus on ‘interesting’ cases involving atypical clinical presentations or novel aspects to conventional management. Grand Rounds take place universally in most hospitals and form part of the training of Doctors in the UK, India, Australia, America and beyond.

In recent years the value of Grand Rounds has been debated with the advent of newer modern methods for learning (Herbet and Wright, 2003. Van Hoof et al., 2009). There remains considerable variety in what Grand Rounds involve and how they are organised. For instance, at the All India Institute of Medical Sciences in Delhi, patients can form a part of the presentation and may be examined by the Doctors in attendance. This was common across the medical World, however with the evolution of power point presentations, some would say we have lost touch with the ‘real life’ aspect. In most cases in the UK, Grand Round presentations will be based on actual patients but these will be presented anonymously, thus avoiding the need for patient consent. This is odd as we claim to be patient centred in the 21st century, so why aren’t patients included?

The internet and digital revolution has brought about an explosion of health information where anyone can access information on diseases, drugs and management. This is not limited to the guidelines for healthcare professionals but extends to the latest research as well as what patients in other countries can access. There is a rising burden of long term conditions and non- communicable diseases. Coupled with rising life expectancy, we are seeing people living longer with more complex health needs, this presents an opportunity for patients and professionals to form supportive communities through technology in order to exchange information and best practice. For instance, the treatment for conditions such as Diabetes is becoming more standardised on a universal scale. We are also seeing more collaboration on a global level with research studies and the management of health conditions.

In addition to the digital revolution we also have increased migration and travel, truly globalising diseases. Thus, healthcare professionals should have the ability and knowledge to deal with this. An example was the recent Ebola outbreak and the need for up-to-date information to be made available for not only professionals but also the general public.

The World has changed a lot and society continues to evolve at a rapid pace. We set out to bring Healthcare up to speed with these changes and break the traditional silos of Medicine through International Collaborative Grand Rounds (ICRGx). ICGRx is creating global all-inclusive participatory conversations about health where all are welcome – patients, students and professionals. ICGRx drew inspiration from social media hashtags on Twitter such as #meded #ukmeded #patientsafety and #medx.

On the 1st of March 2016, we were privileged to design and host the first International Collaborative Grand Round (ICGRx). This was a case discussion we streamed, from the Gordon Museum in London, live across the globe with people tuning in from as far away as Delhi and San Francisco. Viewers could get involved in the discussion via Google or twitter using the hashtag ‘#ICGR1’.  As the case unfolded we were amazed by the whole process and humbled to see the power of collaboration. We collaborated with King’s College London and the British Medical Journal to host the discussion on clinical reasoning and how healthcare professionals make decisions.

Whether we like to admit it or not, healthcare can be a competitive environment. Throughout training you are forever being assessed and ranked, once you qualify you are competing for training posts and job opportunities. Whilst this competition can drive improvements to patient care we believe collaboration can do so to a greater extent. During #ICGR1, everyone’s approach to the patient was different; gaps in our own knowledge were filled in by others and vice versa. It was fascinating to see how the experience of those from other countries differed to our own and to think about how we could apply it to our own practice. The power of social media removed job titles and demolished hierarchy allowing all participants to ask questions and interact with each other.

What made ICGRx possible though was the technology, social media and connectivity. Being able to communicate with a large, distant audience is something that we as healthcare students and clinicians should embrace going into the future. Doing so will strengthen ties within the profession, share experience and ultimately benefit our patients.

Our next International Collaborative Grand Round on Mental Health #ICGR2 is being held in Manchester at a national conference in October 2017. This will continue to break traditional barriers by involving students, patients, professionals and the public. We hope that ICGRx will offer disruptive innovation and help lead the conversation for improving healthcare.

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