HR

1. R e s i d e n c y T r a i n i n g
PRESENTED BY KROMA
Grand Round Presentation
Methodology of medical education and inpatient care.

2. Grand rounds are methodology of medical
education and inpatient care, consisting of
presenting the medical problems and
treatment of a particular patient to an
audience consisting of doctors, pharmacists,
residents, and medical students.
Today, Grand Rounds coordinates member
care across specialties, provides Expert Second
Opinions, fights inflated medical bills, and even
helps members make sense of their health
benefits. We're available 24/7 as an employer
benefit to over six million people and growing.
Summary

3. LEARN
Adult learners need to feel the need to learn,
participate actively in the learning process, and have
a sense of progress toward their goals. Here are a
few ...
UNDERSTAND
A formal meeting at which physicians discuss the
clinical case of one or more patients. Grand rounds
originated as part of residency training wherein new
information was taught and clinical reasoning skills
were enhanced.
RECOGNIZE
Objectives will clearly and concisely communicate
what an attendee is expected to know and/or do at
the conclusion of an activity. Objectives must be
included in the brochure so the attendees may
evaluate the relevance of attending a CME activity
IDENTIFY
Present evidence-based information for providing
patient-centered care in Family Medicine
ambulatory and hospital settings. Provide evidence-
based guides for diagnosing and managing
common diseases in patients from both genders,
across the life span.
Objectives

4. A formal meeting at which physicians discuss the
clinical case of one or more patients.
MEDICAL HISTORY
Grand rounds today are an integral component of
medical education. They present clinical problems in
medicine by focusing on current or interesting cases
ENVIRONMENTAL CONSIDERATIONS
heart rate 88;
Symptom
Respiratory rate, 22;
Symptom
Blood pressure 130/86
Symptom
AGE: 62
SEX: Male
WEIGHT: 150lbs
COMPLAINT: Feeling dizzy upon standing up. Swelling in
lower legs after sitting for long periods of time.
Temperature, 97.8 F
Patient Description
Case Presentation
Symptom

5. During a grand round, physicians present
(a) digital images using an electronic
projector, (b) examinations in
transparency films
OBSERVATION
Imaging
As a proof of concept, we have
developed a prototype application which
automatically captures, registers and
documents users interactions in a
medical grand round scenario.
OBSERVATION
In order to tackle the issue of single
identification of digital radiology images,
the healthcare industry developed the
Digital Imaging and Communications in
Medicine (DICOM) standard [1]
OBSERVATION

6. Biopsy Analysis
■ TRUS-guided prostate biopsy remains the principal method for prostate tissue evaluation.
As an outpatient procedure done under local anesthesia, it is accessible and scalable
approach to the sizeable patient population that requires prostate cancer evaluation.
■ However, this method remains hindered by issues such as false-negative rates and
incorrect disease grading.
■ Despite the addition of repeat TRUS biopsies performed in a patient, cancer detection
does not necessarily improve.
■ While the introduction of multiparametric MRI into the diagnostic pathway has shown to
improve the detection of clinically significant disease and decrease the detection of
insignificant disease, there are still unresolved factors influencing the accuracy of targeted
prostate biopsy sampling. Currently, concerns including needle deflection and variability
of results based on operator experience continue to pose challenges

7. ■ All of us in health care want to provide excellent, high-quality medical care, but
despite all of our patient safety work, patient harm is too common.
■ Organizations have quality and safety programs, but many struggle to ensure that
solutions to errors are really addressing the cause of the error .
■ Not just checking the box on their process when they do their analysis of the error.
■ Patients want a health care organization, physician, and/or care provider to be fully
transparent when an error occurs, but often this doesn’t happen.
■ We haven’t made headway on safety, in part because we’ve struggled with
transparency.
Procedure Notes

8. Grand Rounds is a teaching
methodology that has existed
in
various forms in medical
education for centuries.
01
02
03
Procedure Notes
The Student Board divided the
student physical therapists and
the clients into three teams.
Each team of students would
meet every three weeks to
discuss the clients on their
caseload.
More advanced students
helped to mentor the more
novice students and a faculty
member would facilitate the
discussions.
04
05
06
After eight months of
implementation, the Student
Board gathered evaluative
data from students, supervisors
and client.
The program evaluation
confirmed that the
implementation of teams and
Grand Rounds positively
impacted students' confidence

9. The Proof Is in the Data: How Grand Rounds
Takes a Data-driven Approach to Quality
Health Care
Gross Data
40%
30%
30%
As a data scientist, I was especially excited to be at a conference
dedicated to what my team and I strive to do every day: finding
innovative ways to use health data to improve patient outcomes
and eliminate wasteful health care spending.
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10. Grand Rounds helps employers
optimize the value of their
health care by ensuring their
members have access to the
most appropriate medical
guidance and care at the right
time. We
cover millions of Americans
through employer customers
including: Fortune 50
companies,
government entities, public
education consortia, and across
industries including
transportation,
telecommunications, hospitality,
manufacturing, consumer
packaged goods, finance, and
retail.
PROPOSAL
Alternate
Proposals
A designated Grand Rounds
Implementation and Account
Manager is responsible for all
aspects of the implementation,
and also for ongoing account
management after launch. The
Implementation and Account
Manager directs a team of
specialists that will support
Larimer County’s
implementation and ongoing
program success.
PROPOSAL

11. Participants in the evaluation
included 45 first-year students, 42
second-year students, and 43
third- year students.
01
02
03
Four clinic supervisors who
volunteered at the Clinic both
before and after the
implementation of Grand Rounds,
16 client satisfaction surveys, which
encompassed clients who had
received therapy both before
After the implementation of Grand
Rounds, were also part of the
evaluation
04
05
06
The third-year students participating in
Grand Rounds were required to submit
a reflection of their experience in
Grand Rounds.
They provided informed consent to use
their reflection in the evaluation.
On Improving Clinical Outcomes Using Risk Adjustment. Healthcare in
America has been transitioning from the traditional fee-for-service
reimbursement model to a value-based care delivery model for over a
decade.
07
Outcomes
The second-year students were
informally surveyed by two of the
Student Board members before and 8
months after the implementation of
Grand Rounds.
The electronic survey was created by
the two Student Board members
08

12. ■ Rogel Cancer Center Grand Rounds
■ Grand rounds revisited: Results of a survey of U.S. Departments of Medicine
■ Grand Rounds: Multidisciplinary Management of the Patient With Metastatic
Colorectal Adenocarcinoma
■ Yale Cancer Center Grand Rounds: "Lung Cancer Clinical Care and Research at Yale:
The Center for Thoracic Cancers"
■ CDC Grand Rounds: Family History and Genomics as Tools for Cancer Prevention
and Control
References

13. DIAGNOSIS NAME
Establishing DGRs proofed to be an effective way of
successfully improving both students' diagnostic reasoning
and the ability to select the appropriate test method in
routine clinical practice.
Final Diagnosis

14. P R E S E N T E D B Y K R O M A
Thank You
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