rounds presentation style

Overview and General Information about Oral Presentation

• Daily Presentations During Work Rounds
• The New Patient Presentation
• The Holdover Admission Presentation
• Outpatient Clinic Presentations
• The structure of presentations varies from service to service (e.g. medicine vs. surgery), amongst subspecialties, and between environments (inpatient vs. outpatient). Applying the correct style to the right setting requires that the presenter seek guidance from the listeners at the outset.
• Time available for presenting is rather short, which makes the experience more stressful.
• Individual supervisors (residents, faculty) often have their own (sometimes quirky) preferences regarding presentation styles, adding another layer of variability that the presenter has to manage.
• Students are evaluated/judged on the way in which they present, with faculty using this as one way of gauging a student’s clinical knowledge.
• Done well, presentations promote efficient, excellent care. Done poorly, they promote tedium, low morale, and inefficiency.

General Tips:

• Practice, Practice, Practice! Do this on your own, with colleagues, and/or with anyone who will listen (and offer helpful commentary) before you actually present in front of other clinicians. Speaking "on-the-fly" is difficult, as rapidly organizing and delivering information in a clear and concise fashion is not a naturally occurring skill.
• Immediately following your presentations, seek feedback from your listeners. Ask for specifics about what was done well and what could have been done better – always with an eye towards gaining information that you can apply to improve your performance the next time.
• Listen to presentations that are done well – ask yourself, “Why was it good?” Then try to incorporate those elements into your own presentations.
• Listen to presentations that go poorly – identify the specific things that made it ineffective and avoid those pitfalls when you present.
• Effective presentations require that you have thought through the case beforehand and understand the rationale for your conclusions and plan. This, in turn, requires that you have a good grasp of physiology, pathology, clinical reasoning and decision-making - pushing you to read, pay attention, and in general acquire more knowledge.
• Think about the clinical situation in which you are presenting so that you can provide a summary that is consistent with the expectations of your audience. Work rounds, for example, are clearly different from conferences and therefore mandate a different style of presentation.
• Presentations are the way in which we tell medical stories to one another. When you present, ask yourself if you’ve described the story in an accurate way. Will the listener be able to “see” the patient the same way that you do? Can they come to the correct conclusions? If not, re-calibrate.
• It's O.K. to use notes, though the oral presentation should not simply be reduced to reading the admission note – rather, it requires appropriate editing/shortening.
• In general, try to give your presentations on a particular service using the same order and style for each patient, every day. Following a specific format makes it easier for the listener to follow, as they know what’s coming and when they can expect to hear particular information. Additionally, following a standardized approach makes it easier for you to stay organized, develop a rhythm, and lessens the chance that you’ll omit elements.

Specific types of presentations

There are a number of common presentation-types, each with its own goals and formats. These include:

• Daily presentations during work rounds for patients known to a service.
• Newly admitted patients, where you were the clinician that performed the H&P.
• Newly admitted patients that were “handed off” to the team in the morning, such that the H&P was performed by others.
• Outpatient clinic presentations, covering several common situations.

Key elements of each presentation type are described below. Examples of how these would be applied to most situations are provided in italics. The formats are typical of presentations done for internal medicine services and clinics.

Note that there is an acceptable range of how oral presentations can be delivered. Ultimately, your goal is to tell the correct story, in a reasonable amount of time, so that the right care can be delivered. Nuances in the order of presentation, what to include, what to omit, etc. are relatively small points. Don’t let the pursuit of these elements distract you or create undue anxiety.

Daily presentations during work rounds of patients that you’re following:

• Organize the presenter (forces you to think things through)
• Inform the listener(s) of 24 hour events and plan moving forward
• Promote focused discussion amongst your listeners and supervisors
• Opportunity to reassess plan, adjust as indicated
• Demonstrate your knowledge and engagement in the care of the patient
• Rapid (5 min) presentation of the key facts

Key features of presentation:

• Opening one liner: Describe who the patient is, number of days in hospital, and their main clinical issue(s).
• 24-hour events: Highlighting changes in clinical status, procedures, consults, etc.
• Subjective sense from the patient about how they’re feeling, vital signs (ranges), and key physical exam findings (highlighting changes)
• Relevant labs (highlighting changes) and imaging
• Assessment and Plan : Presented by problem or organ systems(s), using as many or few as are relevant. Early on, it’s helpful to go through the main categories in your head as a way of making sure that you’re not missing any relevant areas. The broad organ system categories include (presented here head-to-toe): Neurological; Psychiatric; Cardiovascular; Pulmonary; Gastrointestinal; Renal/Genitourinary; Hematologic/Oncologic; Endocrine/Metabolic; Infectious; Tubes/lines/drains; Disposition.

Example of a daily presentation for a patient known to a team:

• Opening one liner: This is Mr. Smith, a 65 year old man, Hospital Day #3, being treated for right leg cellulitis
• MRI of the leg, negative for osteomyelitis
• Evaluation by Orthopedics, who I&D’d a superficial abscess in the calf, draining a moderate amount of pus
• Patient appears well, states leg is feeling better, less painful
• T Max 101 yesterday, T Current 98; Pulse range 60-80; BP 140s-160s/70-80s; O2 sat 98% Room Air
• Ins/Outs: 3L in (2 L NS, 1 L po)/Out 4L urine
• Right lower extremity redness now limited to calf, well within inked lines – improved compared with yesterday; bandage removed from the I&D site, and base had small amount of purulence; No evidence of fluctuance or undrained infection.
• Creatinine .8, down from 1.5 yesterday
• WBC 8.7, down from 14
• Blood cultures from admission still negative
• Gram stain of pus from yesterday’s I&D: + PMNS and GPCs; Culture pending
• MRI lower extremity as noted above – negative for osteomyelitis
• Continue Vancomycin for today
• Ortho to reassess I&D site, though looks good
• Follow-up on cultures: if MRSA, will transition to PO Doxycycline; if MSSA, will use PO Dicloxacillin
• Given AKI, will continue to hold ace-inhibitor; will likely wait until outpatient follow-up to restart
• Add back amlodipine 5mg/d today
• Hep lock IV as no need for more IVF
• Continue to hold ace-I as above
• Wound care teaching with RNs today – wife capable and willing to assist. She’ll be in this afternoon.
• Set up follow-up with PMD to reassess wound and cellulitis within 1 week

The Brand New Patient (admitted by you)

• Provide enough information so that the listeners can understand the presentation and generate an appropriate differential diagnosis.
• Present a thoughtful assessment
• Present diagnostic and therapeutic plans
• Provide opportunities for senior listeners to intervene and offer input
• Chief concern: Reason why patient presented to hospital (symptom/event and key past history in one sentence). It often includes a limited listing of their other medical conditions (e.g. diabetes, hypertension, etc.) if these elements might contribute to the reason for admission.
• The history is presented highlighting the relevant events in chronological order.
• 7 days ago, the patient began to notice vague shortness of breath.
• 5 days ago, the breathlessness worsened and they developed a cough productive of green sputum.
• 3 days ago his short of breath worsened to the point where he was winded after walking up a flight of stairs, accompanied by a vague right sided chest pain that was more pronounced with inspiration.
• Enough historical information has to be provided so that the listener can understand the reasons that lead to admission and be able to draw appropriate clinical conclusions.
• Past history that helps to shed light on the current presentation are included towards the end of the HPI and not presented later as “PMH.” This is because knowing this “past” history is actually critical to understanding the current complaint. For example, past cardiac catheterization findings and/or interventions should be presented during the HPI for a patient presenting with chest pain.
• Where relevant, the patient's baseline functional status is described, allowing the listener to understand the degree of impairment caused by the acute medical problem(s).
• It should be explicitly stated if a patient is a poor historian, confused or simply unaware of all the details related to their illness. Historical information obtained from family, friends, etc. should be described as such.
• Review of Systems (ROS): Pertinent positive and negative findings discovered during a review of systems are generally incorporated at the end of the HPI. The listener needs this information to help them put the story in appropriate perspective. Any positive responses to a more inclusive ROS that covers all of the other various organ systems are then noted. If the ROS is completely negative, it is generally acceptable to simply state, "ROS negative.”
• Other Past Medical and Surgical History (PMH/PSH): Past history that relates to the issues that lead to admission are typically mentioned in the HPI and do not have to be repeated here. That said, selective redundancy (i.e. if it’s really important) is OK. Other PMH/PSH are presented here if relevant to the current issues and/or likely to affect the patient’s hospitalization in some way. Unrelated PMH and PSH can be omitted (e.g. if the patient had their gall bladder removed 10y ago and this has no bearing on the admission, then it would be appropriate to leave it out). If the listener really wants to know peripheral details, they can read the admission note, ask the patient themselves, or inquire at the end of the presentation.
• Medications and Allergies: Typically all meds are described, as there’s high potential for adverse reactions or drug-drug interactions.
• Family History: Emphasis is placed on the identification of illnesses within the family (particularly among first degree relatives) that are known to be genetically based and therefore potentially heritable by the patient. This would include: coronary artery disease, diabetes, certain cancers and autoimmune disorders, etc. If the family history is non-contributory, it’s fine to say so.
• Social History, Habits, other → as relates to/informs the presentation or hospitalization. Includes education, work, exposures, hobbies, smoking, alcohol or other substance use/abuse.
• Sexual history if it relates to the active problems.
• Vital signs and relevant findings (or their absence) are provided. As your team develops trust in your ability to identify and report on key problems, it may become acceptable to say “Vital signs stable.”
• Note: Some listeners expect students (and other junior clinicians) to describe what they find in every organ system and will not allow the presenter to say “normal.” The only way to know what to include or omit is to ask beforehand.
• Key labs and imaging: Abnormal findings are highlighted as well as changes from baseline.
• Summary, assessment & plan(s) Presented by problem or organ systems(s), using as many or few as are relevant. Early on, it’s helpful to go through the main categories in your head as a way of making sure that you’re not missing any relevant areas. The broad organ system categories include (presented here head-to-toe): Neurological; Psychiatric; Cardiovascular; Pulmonary; Gastrointestinal; Renal/Genitourinary; Hematologic/Oncologic; Endocrine/Metabolic; Infectious; Tubes/lines/drains; Disposition.
• The assessment and plan typically concludes by mentioning appropriate prophylactic considerations (e.g. DVT prevention), code status and disposition.
• Chief Concern: Mr. H is a 50 year old male with AIDS, on HAART, with preserved CD4 count and undetectable viral load, who presents for the evaluation of fever, chills and a cough over the past 7 days.
• Until 1 week ago, he had been quite active, walking up to 2 miles a day without feeling short of breath.
• Approximately 1 week ago, he began to feel dyspneic with moderate activity.
• 3 days ago, he began to develop subjective fevers and chills along with a cough productive of red-green sputum.
• 1 day ago, he was breathless after walking up a single flight of stairs and spent most of the last 24 hours in bed.
• Diagnosed with HIV in 2000, done as a screening test when found to have gonococcal urethritis
• Was not treated with HAART at that time due to concomitant alcohol abuse and non-adherence.
• Diagnosed and treated for PJP pneumonia 2006
• Diagnosed and treated for CMV retinitis 2007
• Became sober in 2008, at which time interested in HAART. Started on Atripla, a combination pill containing: Efavirenz, Tonofovir, and Emtricitabine. He’s taken it ever since, with no adverse effects or issues with adherence. Receives care thru Dr. Smiley at the University HIV clinic.
• CD4 count 3 months ago was 400 and viral load was undetectable.
• He is homosexual though he is currently not sexually active. He has never used intravenous drugs.
• He has no history of asthma, COPD or chronic cardiac or pulmonary condition. No known liver disease. Hepatitis B and C negative. His current problem seems different to him then his past episode of PJP.
• Review of systems: negative for headache, photophobia, stiff neck, focal weakness, chest pain, abdominal pain, diarrhea, nausea, vomiting, urinary symptoms, leg swelling, or other complaints.
• Hypertension x 5 years, no other known vascular disease
• Gonorrhea as above
• Alcohol abuse above and now sober – no known liver disease
• No relevant surgeries
• Atripla, 1 po qd
• Omeprazole 20 mg, 1 PO, qd
• Lisinopril 20mg, qd
• Naprosyn 250 mg, 1-2, PO, BID PRN
• No allergies
• Both of the patient's parents are alive and well (his mother is 78 and father 80). He has 2 brothers, one 45 and the other 55, who are also healthy. There is no family history of heart disease or cancer.
• Patient works as an accountant for a large firm in San Diego. He lives alone in an apartment in the city.
• Smokes 1 pack of cigarettes per day and has done so for 20 years.
• No current alcohol use. Denies any drug use.
• Sexual History as noted above; has sex exclusively with men, last partner 6 months ago.
• Seated on a gurney in the ER, breathing through a face-mask oxygen delivery system. Breathing was labored and accessory muscles were in use. Able to speak in brief sentences, limited by shortness of breath
• Vital signs: Temp 102 F, Pulse 90, BP 150/90, Respiratory Rate 26, O2 Sat (on 40% Face Mask) 95%
• HEENT: No thrush, No adenopathy
• Lungs: Crackles and Bronchial breath sounds noted at right base. E to A changes present. No wheezing or other abnormal sounds noted over any other area of the lung. Dullness to percussion was also appreciated at the right base.
• Cardiac: JVP less than 5 cm; Rhythm was regular. Normal S1 and S2. No murmurs or extra heart sounds noted.
• Abdomen and Genital exams: normal
• Extremities: No clubbing, cyanosis or edema; distal pulses 2+ and equal bilaterally.
• Skin: no eruptions noted.
• Neurological exam: normal
• WBC 18 thousand with 10% bands;
• Normal Chem 7 and LFTs.
• Room air blood gas: pH of 7.47/ PO2 of 55/PCO2 of 30.
• Sputum gram stain remarkable for an abundance of polys along with gram positive diplococci.
• CXR remarkable for dense right lower lobe infiltrate without effusion.
• Monitored care unit, with vigilance for clinical deterioration.
• Hypertension: given significant pneumonia and unclear clinical direction, will hold lisinopril. If BP > 180 and or if clear not developing sepsis, will consider restarting.
• Low molecular weight heparin
• Code Status: Wishes to be full code full care, including intubation and ICU stay if necessary. Has good quality of life and hopes to return to that functional level. Wishes to reconsider if situation ever becomes hopeless. Older brother Tom is surrogate decision maker if the patient can’t speak for himself. Tom lives in San Diego and we have his contact info. He is aware that patient is in the hospital and plans on visiting later today or tomorrow.
• Expected duration of hospitalization unclear – will know more based on response to treatment over next 24 hours.

The holdover admission (presenting data that was generated by other physicians)

• Handoff admissions are very common and present unique challenges
• Understand the reasons why the patient was admitted
• Review key history, exam, imaging and labs to assure that they support the working diagnostic and therapeutic plans
• Does the data support the working diagnosis?
• Do the planned tests and consults make sense?
• What else should be considered (both diagnostically and therapeutically)?
• This process requires that the accepting team thoughtfully review their colleagues efforts with a critical eye – which is not disrespectful but rather constitutes one of the main jobs of the accepting team and is a cornerstone of good care *Note: At some point during the day (likely not during rounds), the team will need to verify all of the data directly with the patient.
• 8-10 minutes
• Chief concern: Reason for admission (symptom and/or event)
• Temporally presented bullets of events leading up to the admission
• Review of systems
• Relevant PMH/PSH – historical information that might affect the patient during their hospitalization.
• Meds and Allergies
• Family and Social History – focusing on information that helps to inform the current presentation.
• Habits and exposures
• Physical exam, imaging and labs that were obtained in the Emergency Department
• Assessment and plan that were generated in the Emergency Department.
• Overnight events (i.e. what happened in the Emergency Dept. and after the patient went to their hospital room)? Responses to treatments, changes in symptoms?
• How does the patient feel this morning? Key exam findings this morning (if seen)? Morning labs (if available)?
• Assessment and Plan , with attention as to whether there needs to be any changes in the working differential or treatment plan. The broad organ system categories include (presented here head-to-toe): Neurological; Psychiatric; Cardiovascular; Pulmonary; Gastrointestinal; Renal/Genitourinary; Hematologic/Oncologic; Endocrine/Metabolic; Infectious; Tubes/lines/drains; Disposition.
• Chief concern: 70 yo male who presented with 10 days of progressive shoulder pain, followed by confusion. He was brought in by his daughter, who felt that her father was no longer able to safely take care for himself.
• 10 days ago, Mr. X developed left shoulder pain, first noted a few days after lifting heavy boxes. He denies falls or direct injury to the shoulder.
• 1 week ago, presented to outside hospital ER for evaluation of left shoulder pain. Records from there were notable for his being afebrile with stable vitals. Exam notable for focal pain anteriorly on palpation, but no obvious deformity. Right shoulder had normal range of motion. Left shoulder reported as diminished range of motion but not otherwise quantified. X-ray negative. Labs remarkable for wbc 8, creat 2.2 (stable). Impression was that the pain was of musculoskeletal origin. Patient was provided with Percocet and told to see PMD in f/u
• Brought to our ER last night by his daughter. Pain in shoulder worse. Also noted to be confused and unable to care for self. Lives alone in the country, home in disarray, no food.
• ROS: negative for falls, prior joint or musculoskeletal problems, fevers, chills, cough, sob, chest pain, head ache, abdominal pain, urinary or bowel symptoms, substance abuse
• Hypertension
• Coronary artery disease, s/p LAD stent for angina 3 y ago, no symptoms since. Normal EF by echo 2 y ago
• Chronic kidney disease stage 3 with creatinine 1.8; felt to be secondary to atherosclerosis and hypertension
• aspirin 81mg qd, atorvastatin 80mg po qd, amlodipine 10 po qd, Prozac 20
• Allergies: none
• Family and Social: lives alone in a rural area of the county, in contact with children every month or so. Retired several years ago from work as truck driver. Otherwise non-contributory.
• Habits: denies alcohol or other drug use.
• Temp 98 Pulse 110 BP 100/70
• Drowsy though arousable; oriented to year but not day or date; knows he’s at a hospital for evaluation of shoulder pain, but doesn’t know the name of the hospital or city
• CV: regular rate and rhythm; normal s1 and s2; no murmurs or extra heart sounds.
• Left shoulder with generalized swelling, warmth and darker coloration compared with Right; generalized pain on palpation, very limited passive or active range of motion in all directions due to pain. Right shoulder appearance and exam normal.
• CXR: normal
• EKG: sr 100; nl intervals, no acute changes
• WBC 13; hemoglobin 14
• Na 134, k 4.6; creat 2.8 (1.8 baseline 4 m ago); bicarb 24
• LFTs and UA normal
• Vancomycin and Zosyn for now
• Orthopedics to see asap to aspirate shoulder for definitive diagnosis
• If aspiration is consistent with infection, will need to go to Operating Room for wash out.
• Urine electrolytes
• Follow-up on creatinine and obtain renal ultrasound if not improved
• Renal dosing of meds
• Strict Ins and Outs.
• follow exam
• obtain additional input from family to assure baseline is, in fact, normal
• Since admission (6 hours) no change in shoulder pain
• This morning, pleasant, easily distracted; knows he’s in the hospital, but not date or year
• T Current 101F Pulse 100 BP 140/80
• Ins and Outs: IVF Normal Saline 3L/Urine output 1.5 liters
• L shoulder with obvious swelling and warmth compared with right; no skin breaks; pain limits any active or passive range of motion to less than 10 degrees in all directions
• Labs this morning remarkable for WBC 10 (from 13), creatinine 2 (down from 2.8)
• Continue with Vancomycin and Zosyn for now
• I already paged Orthopedics this morning, who are en route for aspiration of shoulder, fluid for gram stain, cell count, culture
• If aspirate consistent with infection, then likely to the OR
• Continue IVF at 125/h, follow I/O
• Repeat creatinine later today
• Not on any nephrotoxins, meds renaly dosed
• Continue antibiotics, evaluation for primary source as above
• Discuss with family this morning to establish baseline; possible may have underlying dementia as well
• SC Heparin for DVT prophylaxis
• Code status: full code/full care.

Outpatient-based presentations

There are 4 main types of visits that commonly occur in an outpatient continuity clinic environment, each of which has its own presentation style and purpose. These include the following, each described in detail below.

• The patient who is presenting for their first visit to a primary care clinic and is entirely new to the physician.
• The patient who is returning to primary care for a scheduled follow-up visit.
• The patient who is presenting with an acute problem to a primary care clinic
• The specialty clinic evaluation (new or follow-up)

It’s worth noting that Primary care clinics (Internal Medicine, Family Medicine and Pediatrics) typically take responsibility for covering all of the patient’s issues, though the amount of energy focused on any one topic will depend on the time available, acuity, symptoms, and whether that issue is also followed by a specialty clinic.

The Brand New Primary Care Patient

Purpose of the presentation

• Accurately review all of the patient’s history as well as any new concerns that they might have.
• Identify health related problems that need additional evaluation and/or treatment
• Provide an opportunity for senior listeners to intervene and offer input

Key features of the presentation

• If this is truly their first visit, then one of the main reasons is typically to "establish care" with a new doctor.
• It might well include continuation of therapies and/or evaluations started elsewhere.
• If the patient has other specific goals (medications, referrals, etc.), then this should be stated as well. Note: There may well not be a "chief complaint."
• For a new patient, this is an opportunity to highlight the main issues that might be troubling/bothering them.
• This can include chronic disorders (e.g. diabetes, congestive heart failure, etc.) which cause ongoing symptoms (shortness of breath) and/or generate daily data (finger stick glucoses) that should be discussed.
• Sometimes, there are no specific areas that the patient wishes to discuss up-front.
• Review of systems (ROS): This is typically comprehensive, covering all organ systems. If the patient is known to have certain illnesses (e.g. diabetes), then the ROS should include the search for disorders with high prevalence (e.g. vascular disease). There should also be some consideration for including questions that are epidemiologically appropriate (e.g. based on age and sex).
• Past Medical History (PMH): All known medical conditions (in particular those requiring ongoing treatment) are listed, noting their duration and time of onset. If a condition is followed by a specialist or co-managed with other clinicians, this should be noted as well. If a problem was described in detail during the “acute” history, it doesn’t have to be re-stated here.
• Past Surgical History (PSH): All surgeries, along with the year when they were performed
• Medications and allergies: All meds, including dosage, frequency and over-the-counter preparations. Allergies (and the type of reaction) should be described.
• Social: Work, hobbies, exposures.
• Sexual activity – may include type of activity, number and sex of partner(s), partner’s health.
• Smoking, Alcohol, other drug use: including quantification of consumption, duration of use.
• Family history: Focus on heritable illness amongst first degree relatives. May also include whether patient married, in a relationship, children (and their ages).
• Physical Exam: Vital signs and relevant findings (or their absence).
• Key labs and imaging if they’re available. Also when and where they were obtained.
• Summary, assessment & plan(s) presented by organ system and/or problems. As many systems/problems as is necessary to cover all of the active issues that are relevant to that clinic. This typically concludes with a “health care maintenance” section, which covers age, sex and risk factor appropriate vaccinations and screening tests.

The Follow-up Visit to a Primary Care Clinic

• Organize the presenter (forces you to think things through).
• Accurately review any relevant interval health care events that might have occurred since the last visit.
• Identification of new symptoms or health related issues that might need additional evaluation and/or treatment
• If the patient has no concerns, then verification that health status is stable
• Review of medications
• Provide an opportunity for listeners to intervene and offer input
• Reason for the visit: Follow-up for whatever the patient’s main issues are, as well as stating when the last visit occurred *Note: There may well not be a “chief complaint,” as patients followed in continuity at any clinic may simply be returning for a visit as directed by their doctor.
• Events since the last visit: This might include emergency room visits, input from other clinicians/specialists, changes in medications, new symptoms, etc.
• Review of Systems (ROS): Depth depends on patient’s risk factors and known illnesses. If the patient has diabetes, then a vascular ROS would be done. On the other hand, if the patient is young and healthy, the ROS could be rather cursory.
• PMH, PSH, Social, Family, Habits are all OMITTED. This is because these facts are already known to the listener and actionable aspects have presumably been added to the problem list (presented at the end). That said, these elements can be restated if the patient has a new symptom or issue related to a historical problem has emerged.
• MEDS : A good idea to review these at every visit.
• Physical exam: Vital signs and pertinent findings (or absence there of) are mentioned.
• Lab and Imaging: The reason why these were done should be mentioned and any key findings mentioned, highlighting changes from baseline.
• Assessment and Plan: This is most clearly done by individually stating all of the conditions/problems that are being addressed (e.g. hypertension, hypothyroidism, depression, etc.) followed by their specific plan(s). If a new or acute issue was identified during the visit, the diagnostic and therapeutic plan for that concern should be described.

The Focused Visit to a Primary Care Clinic

• Accurately review the historical events that lead the patient to make the appointment.
• Identification of risk factors and/or other underlying medical conditions that might affect the diagnostic or therapeutic approach to the new symptom or concern.
• Generate an appropriate assessment and plan
• Allow the listener to comment

Key features of the presentation:

• Reason for the visit
• History of Present illness: Description of the sequence of symptoms and/or events that lead to the patient’s current condition.
• Review of Systems: To an appropriate depth that will allow the listener to grasp the full range of diagnostic possibilities that relate to the presenting problem.
• PMH and PSH: Stating only those elements that might relate to the presenting symptoms/issues.
• PE: Vital signs and key findings (or lack thereof)
• Labs and imaging (if done)
• Assessment and Plan: This is usually very focused and relates directly to the main presenting symptom(s) or issues.

The Specialty Clinic Visit

Specialty clinic visits focus on the health care domains covered by those physicians. For example, Cardiology clinics are interested in cardiovascular disease related symptoms, events, labs, imaging and procedures. Orthopedics clinics will focus on musculoskeletal symptoms, events, imaging and procedures. Information that is unrelated to these disciples will typically be omitted. It’s always a good idea to ask the supervising physician for guidance as to what’s expected to be covered in a particular clinic environment.

• Highlight the reason(s) for the visit
• Review key data
• Provide an opportunity for the listener(s) to comment
• 5-7 minutes
• If it’s a consult, state the main reason(s) that the patient was referred as well as who referred them.
• If it’s a return visit, state the reasons why the patient is being followed in the clinic and when the last visit took place
• If it’s for an acute issue, state up front what the issue is Note: There may well not be a “chief complaint,” as patients followed in continuity in any clinic may simply be returning for a return visit as directed
• For a new patient, this highlights the main things that might be troubling/bothering the patient.
• For a specialty clinic, the history presented typically relates to the symptoms and/or events that are pertinent to that area of care.
• Review of systems , focusing on those elements relevant to that clinic. For a cardiology patient, this will highlight a vascular ROS.
• PMH/PSH that helps to inform the current presentation (e.g. past cardiac catheterization findings/interventions for a patient with chest pain) and/or is otherwise felt to be relevant to that clinic environment.
• Meds and allergies: Typically all meds are described, as there is always the potential for adverse drug interactions.
• Social/Habits/other: as relates to/informs the presentation and/or is relevant to that clinic
• Family history: Focus is on heritable illness amongst first degree relatives
• Physical Exam: VS and relevant findings (or their absence)
• Key labs, imaging: For a cardiology clinic patient, this would include echos, catheterizations, coronary interventions, etc.
• Summary, assessment & plan(s) by organ system and/or problems. As many systems/problems as is necessary to cover all of the active issues that are relevant to that clinic.
• Reason for visit: Patient is a 67 year old male presenting for first office visit after admission for STEMI. He was referred by Dr. Goins, his PMD.
• The patient initially presented to the ER 4 weeks ago with acute CP that started 1 hour prior to his coming in. He was found to be in the midst of a STEMI with ST elevations across the precordial leads.
• Taken urgently to cath, where 95% proximal LAD lesion was stented
• EF preserved by Echo; Peak troponin 10
• In-hospital labs were remarkable for normal cbc, chem; LDL 170, hdl 42, nl lfts
• Uncomplicated hospital course, sent home after 3 days.
• Since home, he states that he feels great.
• Denies chest pain, sob, doe, pnd, edema, or other symptoms.
• No symptoms of stroke or TIA.
• No history of leg or calf pain with ambulation.
• Prior to this admission, he had a history of hypertension which was treated with lisinopril
• 40 pk yr smoking history, quit during hospitalization
• No known prior CAD or vascular disease elsewhere. No known diabetes, no family history of vascular disease; He thinks his cholesterol was always “a little high” but doesn’t know the numbers and was never treated with meds.
• History of depression, well treated with prozac
• Discharge meds included: aspirin, metoprolol 50 bid, lisinopril 10, atorvastatin 80, Plavix; in addition he takes Prozac for depression
• Taking all of them as directed.
• Patient lives with his wife; they have 2 grown children who are no longer at home
• Works as a computer programmer
• Smoking as above
• ETOH: 1 glass of wine w/dinner
• No drug use
• No known history of cardiovascular disease among 2 siblings or parents.
• Well appearing; BP 130/80, Pulse 80 regular, 97% sat on Room Air, weight 175lbs, BMI 32
• Lungs: clear to auscultation
• CV: s1 s2 no s3 s4 murmur
• No carotid bruits
• ABD: no masses
• Ext; no edema; distal pulses 2+
• Cath from 4 weeks ago: R dominant; 95% proximal LAD; 40% Cx.
• EF by TTE 1 day post PCI with mild Anterior Hypokinesis, EF 55%, no valvular disease, moderate LVH
• Labs of note from the hospital following cath: hgb 14, plt 240; creat 1, k 4.2, lfts normal, glucose 100, LDL 170, HDL 42.
• EKG today: SR at 78; nl intervals; nl axis; normal r wave progression, no q waves
• Plan: aspirin 81 indefinitely, Plavix x 1y
• Given nitroglycerine sublingual to have at home.
• Reviewed symptoms that would indicate another MI and what to do if occurred
• Plan: continue with current dosages of meds
• Chem 7 today to check k, creatinine
• Plan: Continue atorvastatin 80mg for life
• Smoking cessation: Doing well since discharge without adjuvant treatments, aware of supports.
• Plan: AAA screening ultrasound

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For junior doctors, an opportunity to present in a grand round is a benchmark of professional and presentation skills. These are my tips.

Choose your topic carefully—your case presentation need not necessarily be weird or wonderful but needs to be useful for those attending.

Include facts and figures from your literature review. Using references gives your presentation a stamp of authority.

Give yourself adequate preparation time and improve your presentation skills.

Rehearse several times for timing, speed, and fluency. If possible, practise where you are going to present as this gives you a chance to use the work facilities in the room.

Show your presentation to someone you respect and take their advice.

Have plans B and C in place, especially for presentations using computers. Back up on email, on a disk, or on a CD.

Do not annoy people by saying “sorry for the busy slide”—it's your job to make it less busy.

Don't repeat what's written in the slides. Say “nearly one third of” instead of “30% of”; it's more informal and easier to remember.

Don't prepare too many slides. Twenty is ideal for a 15 minute presentation.

If you are using overhead transparencies, hold onto the next one before removing the previous one, so that you can replace it immediately to avoid people staring at a blank light box.

If you have shaky hands and use a laser pointer, first point to the area you would like to highlight before pressing the button for the laser beam, and then release before you move away from it; this will avoid the laser beam going all over the place.

If you follow these tips, anticipate lots of questions from the audience; they might think you are an expert.

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Baylor College of Medicine

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How to give a “killer” grand rounds presentation.

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In this presentation, Dr. Hashem B. El-Serag, Margaret M. and Albert B. Alkek Chair and Professor, Department of Medicine, Baylor College of Medicine, outlines several tips for giving an excellent Grand Rounds presentation.

The Book of Lists ranks speaking in front of groups as the number one fear of American adults. A successful presenter is able to learn how to structure and illustrate concepts in order to inform, influence, and entertain the audience. Dr. El-Serag discusses strategies for starting a presentation, engaging the audience, ensuring that the presentation flows smoothly and tells a story, avoiding clichés and slide-talk dissociation, how to conclude the presentation, and how to address questions from the audience. He also offers guidelines for preparing visually-pleasing slides with effective graphics, finalizing content, and rehearsing the presentation.

Target Audience

This CME/CE activity is designed to meet the educational needs of physicians, residents, fellows, and community providers.

Faculty and trainees within the Department of Medicine who are involved in the care of patients need to be regularly updated with the recent advances and guidelines in the fields of internal medicine and quality improvement to increase clinical knowledge, and to implement the advances and guidelines in clinical practice to enhance the quality of patient care and outcomes.

Learning Objectives

At the conclusion of this activity, the participant should be able to:

List a few tips about public speaking.

Show how to prepare an effective PowerPoint presentation.

Summarize some common presentation “Do’s and Don’ts.

• 1.00 AMA PRA Category 1 Credit™
• 1.00 Participation

Richard J. Hamill, M.D., Planning Committee Member  Professor Department of Medicine Baylor College of Medicine Houston, Texas Disclosure: Nothing to disclose.

Erica Lescinskas, M.D., Planning Committee Member Assistant Professor Department of Medicine Baylor College of Medicine Houston, Texas Disclosure: Nothing to disclose.

Zaven Sargsyan, M.D., Planning Committee Member Assistant Professor Department of Medicine Baylor College of Medicine Houston, Texas Disclosure: Nothing to disclose.

Chirayu Shah, M.D., M.Ed., Planning Committee Member Associate Professor Department of Medicine Baylor College of Medicine Houston, Texas Disclosure: Nothing to disclose.

Stephanie Sherman, M.D., Planning Committee Member Assistant Professor Department of Medicine Baylor College of Medicine Houston, Texas Disclosure: Nothing to disclose.

Jefferson Triozzi, M.D., Planning Committee Member Internal Medicine Resident Department of Medicine Baylor College of Medicine Houston, Texas Disclosure: Nothing to disclose.

Baylor College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Baylor College of Medicine designates this enduring material activity for a maximum of 1.0  AMA PRA Category 1 Credit(s)™ .  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Available Credit

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Helpful materials for your grand rounds presentation.

We are thrilled you are sharing your knowledge with the Psychiatry Department! On this page are a few resources that could be helpful as you work on your presentation. 

Academic knowledge is powerful, keep it interesting! Clarity, case studies, along with a nice mix of visuals and storytelling will make for an engaging Grand Rounds. 

• Start by defining your learning goals, objectives, and expectations . 
• Here is a Banner - University Medicine Center Powerpoint template .
• This is a guide on designing a slide presentation .
• Review this virtual speaker guide from the Association of American Medical Colleges  speaker resources webpage.

Additionally, our audience participates via Zoom & through a streaming link which is also how the presentation is recorded. This screenshot  shows what people see when they are streaming the Grand Rounds and what they will see when they watch the recording. Please don’t put important information in the upper right-hand corner of your slide deck.

For our residents and interns, please reach out to your Program Director (s) if you have questions regarding creating your presentation. For our faculty, please reach out to the Grand Rounds Committee Chair if you have questions regarding your presentation.

Sincerely, The Psychiatry Grand Rounds Committee

Research and Scholarly Activity Guide for Psychiatry Faculty, Residents, Fellows, and Students

• Reviewing the Literature
• Finding the Best Evidence
• Databases for Literature Reviews
• Additional resources for Psychiatry searches
• Managing Your Literature

Prepare to Present

Tips for giving a great presentation, case conferences, grand rounds and morbidity & mortality case review, scientific meetings.

• Preparing to Publish
• Doing Research or Quality Improvement Projects
• Other Helpful Resources

Preparation is often key to developing and delivering a successful presentation.  Here we outline key questions and activities to guide your planning and preparation.

Consider your audience, their prior knowledge, and expectations.

The information you need to provide and contextualize often differs by the audience and the setting.  For example, below you'll find some tips for giving a grand rounds talk and presenting at a morbitiy and mortality (M&M talk)

Consider the logistics

Have a short bio, headshot photo, and name pronunciation available on a public facing site like ORCID, LinkedIn profile or a personal web site (see University Librarian Kris Alpi's personal example below). 

• This makes it easy for moderators to promote your talk and introduce you. 
• Organizers are often looking for this at the last minute or you can offer it in advance. 
• You can always add a sentence or two particular to the topic or setting.

How do you want to handle questions ?  Is there a norm for that type of event, or is it up to you?

• If you are comfortable with the norm, great, if you need to change the norm, say so up front.
• Do you want to invite questions as you go along in the talk, or will that impact your flow or timing?
• Do you want to set certain checkpoints for yourself to ask for questions? How much time do you want to leave in the end?
• Can you see the questions as they are asked in the chat window,?
• Can you enlist a collaborator to address questions in the chat and surface any that need to be asked right away? Or is it important that you show you can answer them yourself. If you can share the load, you can let people know, e.g. the attending and chief resident on this case are also in the audience and may address some of your questions in chat. 

Understand whether the session will be recorded and prepare accordingly. 

What will the experience be for those who do not attend live or just get the slides?

• Consider making the authorship and acknowledgment of the care team on the beginning slides rather than the end in case you run out of time. Be clear whether you are speaking for yourself or on behalf of the team, and whether the team has reviewed your presentation.
• Link the references in your slides
• Decide whether to make any of your notes visible if sharing either a PDF or the PPT or other format of your slides. 
• Strong Example of a Personal Website
• OHSU Psychiatry Grand Rounds Archive
• Other OHSU Grand Rounds

Look at the archived, online OHSU Psychiatry Grand Rounds above.

It is helpful to have observed others giving Grand Rounds-type presentations to understand the norms, formality, depth and style. Above is a list of several ongoing grand rounds and other conferences at OHSU that you can attend .

Engaging the care team that saw the case with you is an important part of the preparation for a case conference, and some of the conversations about presenting the case are also applicable to writing a case report. 

Depending on the type of conference, your audience is a mixture of fellows, faculty, residents, and students, they are all here to learn from you. Questions are a gift. As you prepare, think about what questions you might be asked and be ready to answer them.  

For a Grand Rounds presentation, you are typically being invited because you are very knowledgeable on the subject at hand.  Build your confidence by a thorough review of the literature and being able to speak from broader experiences than your own.  People often come to Grand Rounds to hear from experts on a topic and expect the latest information. Here are some additional tips:

• Be interactive as people are here to learn with you. Using cases, prep questions, and discussion will keep your audience active, involved, and interested.
• Practice your presentation.  Grand Rounds are often attached to CME and recorded.  Your presentation should flow well and keep to the time allotted.
• Repeat or at least summarize the question being asked if it comes from chat.  Many people are not following the chat especially if they are connected via phone.
• Thank your audience. 

Morbidity and Mortality Case Review or Conference 

This carries a special weight for you and your fellow members of the care team. Self-care and wellness resources are also important. 

Here are some resources to help you prepare:

• Presenting a Case Report
• OHSU Wellness Resources
• Presenting your first M&M conference? 5 things you need to know
• Stop the Blame Game: Restructuring Morbidity and Mortality Conferences to Teach Patient Safety and Quality Improvement to Residents

The UAMS Guide does a great job overviewing all the steps below. If you have questions, the Library offers workshops and consultations on:

• Writing an abstract
• Identifying and submitting to a conference as a presentation, poster or lightning talk
• Looking for travel grants (other than those specific to the conference -- many conferences have scholarships!)
• Creating your presentation / Designing your poster
• Making a good oral presentation
• UAMS Library Guide We acknowledge the UAMS Library guide, which inspired much of the structure of this guide.
• << Previous: Managing Your Literature
• Next: Preparing to Publish >>
• Last Updated: Apr 5, 2023 11:42 AM
• URL: https://libguides.ohsu.edu/researchscholarlyactivity

3/27/2023 | BY Michael Benvenuti, MD

5 tips for mastering your grand rounds presentation.

Giving a grand rounds presentation

Affiliation.

• 1 Department of Medicine, Section of Geriatrics, Baylor College of Medicine, Houston, Texas 77030, USA. [email protected]
• PMID: 21155643
• DOI: 10.1089/jpm.2010.0133

Giving a Grand Rounds presentation provides the hospice and palliative medicine subspecialist with the occasion to participate in a time-honored and respected event. It remains an opportunity to promote the discipline, support institutional culture change, and favorably influence the attitudes, knowledge, skills, and performance of colleagues. For those pursuing academic careers, it also is a chance to establish academic currency and develop teaching and presentation skills. In most academic settings, the format of Grand Rounds has shifted over time from a patient and problem-based discussion to a didactic, topic-focused lecture. A body of literature questions the value of this shift toward a more passive learner. Limited evidence prevents a definitive answer but many advocate for the integration of more interactive methods to improve the effectiveness of Grand Rounds. This article provides a flexible framework to guide those preparing to give a Grand Rounds and those teaching and supporting others to do so. To do this well, adult learning principles must be thoughtfully incorporated into a presentation style and method appropriate to the venue. The approach emphasizes learner-centeredness, interactive strategies, and evaluation. Room for creativity exists at every step and can add enjoyment and challenge along the way.

Publication types

• Research Support, U.S. Gov't, P.H.S.
• Guidelines as Topic*
• Medical Staff, Hospital
• Professional Competence
• Teaching Rounds / methods
• Teaching Rounds / organization & administration*

Grants and funding

• K01 HP 00077/PHS HHS/United States

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VCS 495: Grand Rounds

Slide shows.

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Although it is not a requirement, most presentations for Grand Rounds are likely to be some sort of slide presentation created using PowerPoint or similar software following a format something like this:

• Title slide
• Introduction and/or background information regarding project
• Methods and findings
• References and/or acknowledgements

It is important to remember that this is an oral presentation--your slides do not need to contain every nugget of information you want to share. They should be focused on the most important points you wish to make while the spoken part of the presentation expands on these points and provides supplementary content.

Online Tutorials and Videos

Building your slide deck is an important part of your presentation and these resources can help.

• LinkedIn Learning LinkedIn Learning is a collection of software training videos that you as a member of Iowa State University have free access to. Log in using your ISU NetID and password and search for PowerPoint (or whatever else you may be interested in). Find a training video that's right for you!
• PowerPoint for Windows training Microsoft offers training support for its Office 365 family of software. Utilize their PowerPoint training videos and articles to help you start building your presentation.
• Google Slides Training and Help Using Google Slides? This training website can help you get started.

Online Books

These books are good for novice users of slide show software such as PowerPoint and Google Slides, but they can also be instructive for advanced users.

Tips for Presentations

These are just general guidelines and not hard and fast rules. When preparing your presentation, consider the following:

• keep font to size 20 and higher
• use bullet points for key ideas
• use phrases instead of sentences
• make sure graphics are clear and easy to read
• practice your presentation out loud several times
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• Next: Images and Figures >>

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• v.5(4); 2013 Dec

Can We Make Grand Rounds “Grand” Again?

Introduction.

In many teaching institutions, grand rounds are a weekly educational activity and a time-honored tradition. 1 – , 7 A 2006 article in the New York Times criticized grand rounds, noting “Socratic dialogue [has given way] to PowerPoint presentation” and “grand rounds are not so grand anymore.” 8 The literature also suggests that the relevance of grand rounds is declining. 1 , 5 , 7 , 9 – , 12 With decreasing attendance and a format that is drastically different from its original design, some have proposed forgoing the term “grand rounds.” 5 , 13 , 14

Several studies, surveys, and editorials have tried to explain the possible reasons for the declining relevance of grand rounds and identified different strategies to make them more effective, but to date no scholarly work has systematically aggregated this information. In this article, we review the history of grand rounds and how they evolved into the current state. We also identify problems with the current design and offer strategies for more effective grand rounds sessions.

To aggregate this information, we conducted a review of the literature on grand rounds, using Google (Scholar and Search) and PubMed. The initial search utilized the terms grand rounds , origin , and history . References of the articles obtained from this search were then searched to further study the topic, and studies on grand rounds from a range of specialties and subspecialties were included.

Ethical approval was waived by the Institutional Review Board at the State University of New York (SUNY) Upstate Medical University.

Grand Rounds: The History

Classic grand rounds.

In the late 19th century, the Johns Hopkins Medical School, led by Sir William Osler, introduced bedside teaching as a new approach to clinical education. 15 , 16 Residents learned as faculty passed from patient to patient, explaining their methods of diagnosis and treatment. 17 Participation increased, and when these rounds moved from the bedside to an auditorium, the traditional approach to grand rounds was created. 1 , 10 , 17 – , 19 It is not known who coined the term.

Traditional grand rounds were a “well-organized, decorous, stately, and punctual exercise” conducted by residents. 9 Patients were present during the resident's presentation or immediately after. 1 , 3 , 8 , 10 Senior physicians questioned the patient and observed any physical findings demonstrated by the resident. 1 , 3 , 10 After the patient exited, his or her problems were discussed in what was described as a “free discussion between thinking men of widely different interests and experience” that instilled character and inspired future physicians. 1 – 3 , 8 , , 10 , 19 The patient, the “theoretic focus of all clinic activity,” remained the principal topic. 1

The Graying of Grand Rounds

The mid to late 20th century has been described as the “graying of grand rounds.” 9 Patients were no longer present, nor were they (or their attitudes, feelings, and social issues) the focus, as the diseases had taken precedence in the discussions. 1 , 5 , 8 , 10 , 18 , 20 This paradigm shift was noted in several editorials and in a 1982 questionnaire of chief residents, which found that patients were rarely or never present at grand rounds in 78% of institutions. 1

What prompted this change? One explanation is that some believed the classic approach to grand rounds could lead to erroneous or conflicting information. 6 Additionally, there was no evidence in the literature for the educational efficacy of grand rounds. 21 Opponents of grand rounds argued that a “short appearance of a patient at one end of the hall was not sufficient to let the learners exercise their 5 senses.” 22 Cases described were often rare and uncharacteristic of what affected most patients. 19 Other concerns related to patient participation. Having patients disrobe in the presence of an audience was thought to be unacceptable, 23 and some thought patients might be troubled by recounting their history and being examined in an auditorium. 23 Economic pressures may also have played a role, as patients presented at grand rounds had longer hospital stays. 19 , 22

Translational Seminars

In the late 20th century and the first decade of the 21st, grand rounds had become a forum for “translational” seminars about clinical advances and research. 7 , 10 , 13 , 18 , 24 , 25 In a 2003 survey, 95% of programs had shifted to a didactic format, and only 42% incorporated cases about half the time. 18 In the following section, we will explore the implications of these changes.

Grand Rounds: The Issues

A 1978 editorial on grand rounds noted that neither the presenters nor the audience were punctual; attendees stood in the back, answered pages (described as an “acoustic distraction” and the “most erosive feature”), and expressed an “egalitarian disdain of courtesy” toward the presenter. 9 A 1988 study showed that only 40% of residents, 10% of faculty, and 44% of medical students attended greater than 60% of grand rounds, 5 and a 2001 study reported 45% of faculty physicians were absent from more than 50% of grand rounds, compared with 20% of residents and 21% of medical students. 24 Similar data were presented in a 2003 study. 18 Reasons cited for declining attendance are summarized in box 1 . 1 – , 3 , 5 – , 11 , 18 – , 21 , 24 , , 26– , 33

Box 1 Reasons Cited for Declining Relevance of Grand Rounds and Poor Attendance

• Poor organization
• Presenter's poor teaching skills
• Lack of patient-centered focus
• Monotonous, boring sessions
• Busy schedules/interfere with commitments and clinical duties
• Declining relevance to subspecialty practice
• Unappealing subject
• Lack of participation by departmental leaders/faculty
• Little interaction between presenters and attendees
• Food consumption
• Lack of punctuality/improper decorum
• Interruptions by pagers/noise
• Inconvenient location
• Lack of seating at the auditorium
• Lack of parking around the auditorium

Grand rounds are also reported to be the most expensive type of conference in most academic departments; external speakers and complimentary food account for much of the cost, 5 , 12 , 18 , 24 , 29 while other costs include the time and opportunity costs for faculty attendees, which could be spent on compensated clinical activities. 24

Support by pharmaceutical vendors may offset some of the financial burden of grand rounds; however, an inherent conflict occurs as content presented may be influenced by the company's interests. 5 , 18 , 20 , 24 Two studies found that attendees were more likely to prescribe a presented drug (regardless of expense) when a pharmaceutical company's employee presented at grand rounds. 34 , 35

Restoring the Grand in Grand Rounds

The Accreditation Council for Graduate Medical Education mandates that residents and faculty regularly attend didactic sessions and conferences. 36 box 2 summarizes the objectives of grand rounds. Education is the most important, but updates in diagnosis, treatment, and research have gained importance over the past 20 years. 3 , 5 , 18 , 20 , 21 , 24 , 37 , 38 Effective grand rounds should disseminate knowledge, change physician behavior, and improve patient outcomes. 26 – , 28 , 39 In the next sections we suggest strategies to alleviate some of the barriers to conducting effective grand rounds.

Box 2 Objectives of Grand Rounds

• Provide updates in diagnosis and treatment
• Provide updates in medical research
• Promote collegiality among faculty
• Provide continuing medical education credit
• Educate residents and faculty
• Provide income and generate referrals
• Make departmental announcements
• Mentor residents
• Highlight expertise in the faculty
• Showcase the department to residency applicants

Poor planning and preparation are reported to be a big barrier, and experts recommend planning grand rounds content at least 1 year in advance. 4 , 7 , 27 , 30 , 39 A study at 1 institution found that careful planning improved attendance 39% over a 3-year period. 30

Understanding Adult Learning

Research on adult learning has shown that adult learners must feel the need to learn, participate actively in the learning process, and have a sense of progress toward their goals. 40 They also prefer to share in the responsibility for planning and organizing their learning experiences. Undergraduate medical education has adapted to adult learning principles in the form of problem-based learning. 37 Experts have suggested incorporating the principles of adult learning in preparing for grand rounds as the current format is mostly based on a pedagogic strategy and may have limited appeal to adult learners compared with other approaches. 12 , 38 , 39

Offering Continuing Medical Education Credit and Other Incentives

Most departments provide continuing medical education (CME) credit for attending grand rounds. 5 , 18 , 24 , 30 One study reported that half of the faculty used attendance at grand rounds for CME credit. 30 Yet studies have suggested that many grand rounds are not conducted in accordance with Accreditation Council for Continuing Medical Education criteria. 18 One study found that 16 grand rounds sessions at 1 institution minimally reflected accepted educational practices, 26 and another showed that educational needs assessments, program evaluations, and knowledge assessments were used in only 73%, 59%, and 17% of departments, respectively. 24 Complimentary food can increase attendance at grand rounds. 18 , 30 , 41

The role of departmental leaders has been emphasized in making grand rounds more effective as they can promote discussion, involve the audience, and insist on regular and punctual attendance. 1 , 6 , 13 , 18 , 20 , 31 , 39 Departmental leaders should take an active leadership role and minimize delegation to presenters who may be unable to make important educational decisions. 4 , 28

In addition, department leaders should adopt policies that discourage scheduling of departmental meetings and other activities at the same time as grand rounds. 7 , 30 A multifaceted approach to publicity, such as e-mail announcements, flyers, brochures, and posters, may improve attendance. 30 Modern techniques, such as teleconferencing, DVDs, handouts, and web-based resources may expand the audience base beyond those able to attend in person. 37 , 42 – , 44 Planning multiple brief talks, scheduling grand rounds less frequently, and finding suitable times are other strategies mentioned in the literature for enhancing attendance and interest in grand rounds. 7 , 43 , 45

Presentation

Lecture-based instructional formats have been the mainstay of education. 46 Lectures are a practical, relatively easy, and efficient method of disseminating information. 7 , 24 , 44 Recently, however, the value of this technique has been called into question. One study found that physicians were more likely to correctly answer questions, retain information, and change their practice behavior after interactive sessions as opposed to lectures. 47 A systematic review noted that mixed interactive and didactic education was more effective than interactive education alone. 48 Emphasis should be placed on tools and teaching styles that stimulate learners and make grand rounds more “crisp, lively, and interactive.” 7 , 31 Microburst teaching and learning is a suggested model based on adult learning theory; it recommends combining various teaching and learning styles in bursts to enhance the learning process and to address the potential variability in preferred learning style among learners. 39 , 49

Patient Participation

Patient participation was the norm in traditional grand rounds, and some have proposed reinstating a short appearance by a patient whose case is being discussed to emphasize the relevance of the topic and to demonstrate clinical teaching to residents. 5 , 10 , 14 , 17 , 20 Patients with a complicated illness may benefit from a second opinion in case of diagnostic doubt and may feel more involved in their care. 50 A study in which patients attended and participated in clinical grand rounds showed that 91% felt relaxed and 62% believed the meeting was useful. 23 At minimum, grand rounds should focus on carefully selected clinical cases, and formal discussion should be intimately related. 20 , 25

Often, grand rounds topics are chosen by the presenters, who may select topics that are convenient, leading to learner dissatisfaction. 18 , 20 , 21 , 24 , 26 – , 28 , 39 A needs assessment should help address this problem. 30 Needs assessments are an important part of curricular development that can help identify educational needs and guide the choice of grand rounds topics. 14 , 24 , 30 , 39 , 42 In the past decade, the number of departments conducting needs assessments to select grand rounds topics has increased. 12 , 18 , 21 , 24 Needs assessment was 1 of several strategies used at 1 institution to improve attendance at grand rounds, resulting in a 39% increase in attendance over 3 years. 30

Grand rounds should summarize advances across a specialty and its subspecialties, help facilitate interaction among faculty members, and integrate different subspecialties. 5 , 31 , 51 Another novel way to integrate different specialties is to ask specialists what common errors in treatment are made by nonspecialists and conduct a grand rounds on these topics. 14

Attributes of the Presentation

An uninspired presenter often has a negative impact on an educational session. 18 , 20 , 24 , 26 – , 30 Presenters should be selected based on their ability to hold the audience's attention rather than their level of expertise. Where this strategy has been implemented, attendance at grand rounds has improved. 4 Frequently, presenters speak until the end of the grand rounds session. 52 Ending with an interactive question-and-answer session, however, allows active participation that may help listeners to assimilate new information and is consistent with adult learning theory. 7 , 39 , 52 In addition, some have suggested that, an “early stopping” rule should be upheld and at least 15 minutes should be reserved for discussion at the end of the session. 20 , 52 Shorter lectures would also better suit adult learners. 52 , 53

An important part of curricular development is the evaluation of both the content and the presenter of the grand rounds. 4 , 39 Research on evaluating lectures has led to recommendations that the evaluation encompass the lecture objectives and whether the lecture demonstrated thorough knowledge of the presenter, demonstrated clarity and organization, stimulated enthusiasm, had an appropriate level of depth and detail, included effective visuals and presentation style, was at least 25% interactive, established rapport with audience, and had an overall effectiveness. 51

The format and objectives of grand rounds and the expectations for what this type of lecture is intended to accomplish have changed since the inception of this approach to group teaching in medicine in the late 19th century, and these changes have paralleled changes in the practice of medicine. Despite the costs of these sessions and declines in attendance, most departments continue to support grand rounds. The strategies for restoring grand rounds proposed in our review may help clinical departments revitalize this once important approach for teaching and promoting professional development in medicine.

Shaifali Sandal, MD, was Internal Medicine Resident, Department of Medicine, SUNY Upstate Medical University, and is now Nephrology Fellow, University of Rochester; Michael C. Iannuzzi, MD, MBA, is Edward C. Reifenstein Professor and Chair of Medicine, SUNY Upstate Medical University; and Stephen J. Knohl, MD, is Associate Professor of Medicine and Medicine Vice-Chair for Education, SUNY Upstate Medical University.

The authors wish to thank Dr Archana Rao.

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Grand Rounds Presentation Template

Grand Rounds Presentation

Transcript: Grand Rounds Joanna Davenport Anna Heller Introduction Introduction Joanna Davenport is an 18 year old caucasion woman who was self reffered with support from her mother and school teacher. Joanna is experiencing anger, anxiety, social withdrawl, and has a difficult time expressing and understanding her emotions. Referral Question- How can Joanna learn to control her anger? Background Background Medical Hisory- no serious illnesses, accidents or surgeries. No medications Developmental History- Uncomplicated birth, reached developmental milestones on time. She began having tantrums at the age of 3. An articulation disorder (lisp) also began at the age of 3 which persisted until she began speech therapy classes in the 8th grade. Family and Social History- Raised by bilogical mother and father whom had a conflictual relationship. She is close with her mother who is supportive of her. Her father has trouble understanding her and impliments a lot of tough love and punishment. Background Continued She fights with her two older sisters often. Hitting and throwing things at them in earlier years but now just gets in verbal altercations with them. She was often bullied for her lisp growing up which would trigger tantrums. She had a hard time making friends. She has one close friend who she is able to confide in and would stick up for her in school but she recently moved to a different town and now they rarely talk or see each other. She is also feels close to her school teacher. She is not involved in any clubs, social activities, or church. Background Continued Background Continued Abuse History- Her father paddled her on the bottom as a child as a form of discipline. Occupational Hisory- employed through Dairy Queen. She is not satisfied as she does not get along with her coworkers and has a hard time controlling her anger with customers. Mental Helth History- Her mother is diagnosed with anxiety. Joanna has never sought mental health services before this time. Substance use History- No history of substance abuse. Educational History- Senior at St. Clairsville HIghschool. No learning problems, usually averaging C's. Has trouble focusing in class because a lack of sence of belonging socially. Background Continued Mental Status On time Neetly groomed Dressed appropriately Cooperative and eager to participate Appropriate eye contact Some psychomotor agitation, playing with her hair and shirt Mental Status Kaufman Brief Intelligence Test, Second Edition (KBIT-2): Interpretation of Tests Verbal Intelligence Standard Score- 126 (above average) Nonverbal Intelligence Standard Score- 108 (average) IQ- 120 (above average) Minnesota Multiphasic Personality Inventory- Third Edition (MMPI-3) Interpretation of Tests She read items carefully and responded in a consistent and thoughtful manner, neither overstaing or understating. Should be assessed for: Internalizing disorders, depression related disorders, anxiety related disorders including PTSD, anger related disorders, personality disorders involving detachment such as avoidant and schizoid, attention related disorders, externalizing disorders, impulse control disorders, disorders associated with interpersonal aggression, personality disorders involving mistrust of and/ or hostility toward others and acting out behaviors personality disorders involving disinhibited behavior such as antisocial and borderline disorders, disorders involving excessively assertive or domineering behavior, personality disorders involving antagonistic behavior such as narcissistic and antisocial Conceptualization Conceptualization Presentation- anger, anxiety, socially avoidant. Precipitant- Lisp, best friend moving, socially avidant, not expressing her emotions accurately, parents conflictual relationship Bilogical predisposition- anxiety Pattern- acting out aggressively (yelling); maintained by having a small support system Highly acculturated, no evidence of prejudice or conflicting cultural expectations Personality structure- avoidant Self schemas- Nobody understands me or likes me Other schemas- my parents fight because of me Skill Defecits- emotional regulation, expressing emotions, social skills Conceptualization Contunued Social- (current) small support system, mother and teacher are supportive, bullied and outcasted by classmates for anger outbursts. (past) best friend moved away recently. Challenges- ambivalent resistence, may not take well to any constructive criticism may benefit from having a female therapist Conceptualization Continued Diagnosis Intermittent Explosive Disorder Meets all criteria- 1. A. verbal aggression (tantrums verbal arguments). B. aggression is out of proportion to precipitating stressors. C. aggressive outbursts are not premeditated (impulsive/ anger based). D. Aggressive outbursts cause disress in the individual and impairment in occupational and interpersonal functioning. E. At least 6 years old. F. Not better explained by another mental disorder Diagnosis

Transcript: Balance Pt responded very well to treatment. Frequent breaks. Comfortable with stairs. Very comfortable with the rollator walker. ~The End~ Group 12: Sam Seratelli, Sarah Sergeant, Mike Stasik Intervention What else could we have done? Goal Interventions Stair training COPD Spontaneous pneumothorax (2) Any Questions? Grand Rounds Presentation Pt will be able to ambulate 100ft independently with a rollator walker and oxygen by increasing his strength and respiratory endurance in 2 weeks so that he can be a community ambulator. Assessment Gait training Patient Description Any Ideas?! 82 year old male Focus of our treatment? Take aways: Communication Style Adaptation

Transcript: Patient, Mr. I.P, week 6 clinical placement Admitted to Medical Floor after undergoing a frontal twist drill craniostomy to relieve a subdural hematoma caused by fall-related injury with direct impact to the head. NURSING INTERVENTIONS INTERCONNECTIONS Place pt. bed in lowest possible position and use a floor pad at side of bed. (Doenges et al., 2016) R/T insufficient fluid intake, dysuria, incontinence AEB urinary retention, urinary tract infection, catheterization Provide pt. with frequent teaching of the consequences of falling, and importance of safety. measures red blood cell, count, white blood cell count, and platelet count. A low red blood cell count indicates significant blood loss. captures image of the brain and depicts bleeding around the brain, confirms the presence of the subdural hematoma. b | Twist drill craniostomy showing a single twist drill hole created over the thickest portion of the hematoma with a minimally invasive hollow screw in place. a | Burr hole craniostomy with subdural drain. Figure shows two burr holes created with a perforator. GRIEVING ACUTE CONFUSION Medications List Visual impairment R/T macular degeneration Has eye glasses- often forgets to put on No hearing impairment Cognition fluctuates throughout the day Disoriented to date/time; oriented to person/event 'Pleasantly confused' Some word-finding difficulties Dx dementia 2010 Risk for Falls CT Image of Chronic Subdural Hematoma Reduce clutter in pt. room by putting shoes under bed, and ensuring clear path from bed to door/commode. Foley catheter (emptied: 0700hr 800cc, 1900hr 500cc) with 'leg bag' Often forgets about catheter and complains of having to urinate Small type 1 BM found in bed 0730hr Urinary retention prior to hospitalization Wears incontinence briefs at all times Typically uses commode for bowel movements Priority problem: Using proper mobility device will improve balance and gait reducing likelihood of falling. Lowering the bed and providing a floor pad will decreass the severity of injury if pt. were to fall out of bed. Sex: Male Age group: 80-90 Diagnoses: Chronic subdural hematoma, benign prostatic hyperplasia, dementia, urinary retention, COPD, UTI (ESBL E. Coli) Vitals (2/13/17 0800hr): BP 114/60 T 36.6 C R 18/min R.A HR 88 bpm O2 Sat 96% Concept Map RISK FOR FALLS Health Perception- Management c | Minicraniotomy with subdural drain. This procedure is usually reserved for recurrent CSDH with extensive organization and membrane formation, or primary evacuation of a CSDH that has a substantial acute component. tests the patients' mental status by observing quality of speech, level of consciousness, Glasgow Coma Scale score, orientation to time, place and person, memory, and attention span as well as nerve functioning. DIAGNOSTIC TESTS Advair Diskus (fluticasone, salmeterol)- inhaled corticosteroid and bronchodilator; opens airways for gas exchange Allopurinol (Zyloprim)- xanthine oxidase inhibitor decreases high uric acid levels to treat gout and kidney stones Clotrimazole (Canesten)- anti-fungal cream to treat candidiasis yeast infection Dutasteride (Avodart)- to treat benign prostatic hyperplasia (enlarged protate) PEG 3350 prn- osmotic laxative draws large amount of water into to colon to evacuate stool Risperidone prn- antipsychotic medication administered prn to manage behaviours such as aggression Tamsulosin- for urinary retention- relaxes muscles of the bladder neck to ease passage of urine Tiotropium Bromide (Spiriva)- anticholinergic bronchodilator Regular diet- requires set up and cuing to eat a meal or will not eat Allergy to Codeine Upper and lower full dentures Insufficient fluid consumption- 400 mL over 12 hours Urinary Tract Infection (ESBL+) History of GI Bleeds Abdominal assessment findings: audible normal bowel sounds in all 4 quadrants (02/13/17 1140hr) April 10, 2017 Amanda Hill, SPN2 Common treatment options for Subdural Hematoma http://emedicine.medscape.com/article/344482-overview#a2 R/T loss of spouse, anticipatory loss of friends, anticipatory loss of current home, movement to LTC AEB altered sleep pattern, pt. expression of distress regarding moving and loss of spouse Living at retirement home in Arthur, ON prior to hospitalization Verbalized he is sad to be leaving his friends at the home and moving to LTC post hospital discharge Reports his family lives within 10 minutes of him Married for over 50 years to his late wife One biological son with wife, and two step-children from wife's previous marriage Six granddaughters, two grandsons, 18 great-grandchildren Career Hx of truck driving and volunteer fire fighting Recovering from twist drill craniostomy, on contact isolation precautions Proud to discuss his large family, especially his two granddaughters that are nurses Social, talkative, and enjoys reminiscing about Hx of travel with wife and family Expresses loneliness resulting from current loss of wife and current hospitalization and isolation Expressed feelings of sadness

Transcript: Physical Assessment History of Present Illness Last visit with Ms. "E" VS Stable Labs: patient refuses phlebotomy sticks for lab values Discharge to boyfriend's home per pt. request Continue Methadone outpatient in Watts Abscess D/C IV Vanco Rx: PO Bactrim UTI Urine Culture + E. Coli D/C IV Vancomycin Rx: PO Cipro Wound care education Fu in clinic 3-4 days for symptoms check and to establish primary care Abscess Management Active Diagnoses Abscess of right hip PICC line Surgery Consult for I & D Vancomycin IV Thorazine PO Drug abuse Methadone Acute UTI Bactrim PO Repeat UA Urine Cx Gentamicin IV Acute pain Norco PO only NO IV pain meds Morphine sulfate sub Q Acute hypokalemia Potassium PO Acute hyponatremia NS Bolus IVFs Cardiovascular BP 103 Respiratory Clubbing of nails Integumentary R hip: 20 x 15 erythematous lesion blanching warmer fluctuant mass No necrosis No crepitus L hip: multiple older lesions Thank You! HPI Continued Report Labs Blood Cultures Lactate Renal Function CK to rule out Rhabdomyolysis Diagnostics Ultrasound distinguishes cellulitis vs abscess Lymph node enlargement and lymphatic streaking confirm cellulitis Dx Management Antibiotics **MRSA** PO Bactrim, doxycycline, Linezolid IV Vanco, Daptomycin, Linezolid, Clindamycin IVFs I&D surgery Ellipitical incision Loop drainage technique O2 CVP monitoring Loose packing Past Medical History Taj Price-Gibson California State University, Los Angeles Ms. "E" 37 y.o. Caucasian Female English Speaking Single No children Admitted to WMMC ED CC: Right hip abscess Admission date: 4/16/17 CC: Abscess LOS: 3 days Day 1: April 16 Day 2: April 17 Day 3: April 18 April 16, 2017 CC: R hip Abscess x 1 week w/ non radiating pain To WMMC ED Constitutional + Diffuse body aches x 1 week + Fatigue x 1 week + Subjective fever x 1 week + Chills + Diaphoresis + weakness + diffuse pain + throbbing pain to abscess site non radiating 8/10 - no exudate or leakage + Severe withdrawal + heroin use 2 hours ago ENT + Nasal congestion + Sore throat Respiratory + Sputum production + Cough Pus accumulation within tissue of body Furuncle or Carbuncle Cellulitis Signs & Symptoms Warmth Redness Pain Swelling Fluctuant fluid Purulent odor or pus drainage Sub Q Air Associated Cellulitis Etiology Staph Aureus Chronic: E. Coli** Risk factors IVDA& Chemical irritants PMH IVDA heroin & methadone 40 cc/day or 2 “packs”/ day Methadone clinic last time 3 mos ago Endocarditis ECHO ORDERED PSH Appendectomy Cholcystectomy Hysterectomy Allergies Penicillin Toradol Home Medications: None Cardiovascular + Palpitations Gastrointestinal + Nausea GU + Dysuria + Polyuria Lymphatics + Swollen lymph glands MS + Joint pain + Muscle pain + Claudication + Decreased ROM Integumentary + Rashes + Needle tracks in bilateral upper extremities + L hip multiple old abscesses or indurations non infected + R hip multiple abscesses redness, warmth Psychiatric +Anxiety +Depression What is an Abscess? Continuity of Care History The Patient CC: Abscess Surgery Consult Ruled out Necortizing fasciitis, DVT & osteomylitis Recommendation: I&D R hip & bilateral buttocks Rx: PO Doxycycline CV EKG - Endocarditis hx ECHO - Ruled out Endocarditis GU Dysuria & pyuria UA Orange color Turbid appearance Moderate leukocyte esterase Blood Rx: PO Bactrim Blood Cx’s Lab Values WBC 15.3 Hct 29.8 Na 128 K 3.0 Day 2 Grand Rounds Presentation Abscess Day 1 Day 3 Med Surge Awaiting Urine Cx Continue IV Vanco & Gent Increase Methadone to 80 Discharge Planning Case Management Consult Wound care 62 ECG bpm

Transcript: Alfred Mathew Grand Rounds Presentation James Zhao MD HPI HPI The patient is a 30 year old male with no relevant past medical history, presenting after a motor vehicular accident with an emergent cricothyrotomy placed. He presents with several severe lacerations to the face. The patient is stabilized in the utmb OR. More recently, the patient is recovering and is able to shake yes or no to questions. The patient is a welder was past ocular history of far sightedness and early signs of cataracts. Other past medical history, ocular history, family history, and social history is currently unknown. Only a brief history was taken due to patient's mental status. History History Medications taken for severe automobile injuries include: -Albuterol 20-100 mcg -Esomeprazole 40 mg -Fentanyl 250 mL -Levetiracetam 100mg/mL -Lidocaine 1% -Piperacillin 3.375 gram/50 mL The patient has no known allergies. Medications Meds/Allergies Pupils: OD: dark: 3 mm light: 1 mm rAPD: no OS: dark: 3mm light: 1 mm rAPD: no Intraocular Pressure: soft to palpation, low pressure Motility OD: full OS: -2 restriction to left gaze Forced adduction OS with restriction to left gaze Negative oculocardiac reflex during EOM and forced abductions Anterior Exam and Fundus Exam was could not be conducted Visual EXAM Visual Exam Ocular Movements Normal Ocular Movements TIME Doctor's Name Patient CT Differential Differential A tumor in the orbit of a 62-year-old man compresses a structure that runs through both the superior orbital fissure and the common tendinous ring. Which of the following structures is most likely damaged? A-Frontal Nerve B-Lacrimal Nerve C-Trochlear Nerve D-Abducens Nerve E-Ophthalmic Vein OKAP Question OKAP D Answer Is this a nerve or a muscular issue? How can you tell? Differential Differential List -Muscle entrapment (Lateral Rectus) -Cranial Nerve VI Defect -Cranial Nerve III Defect -Duane Syndrome Type 1 -Duane Radial Ray Syndrome -Blowout Fracture Differential List List History History/Pathophysiology NOW 1957 1844 2015 Orbital floor fractures Originally described in 1844 by Dr. MacKenzie in Paris The term blow-out fracture was coined around 1957 by Dr. Smith The lateral rectus muscle is innervated by the abducens nerve and controls movement of eye away from the midline (abduction) An entrapment of the muscle would prevent the leftward or rightward gaze of the left or right eye respectively. Very commonly seen in trauma patients Treatments Treatments Conservative Treatments -Smoothing of bony contour -Reduction in Orbital Content Herniation -Spontaneous Improvement Surgical Repair Research Article Young et al -Compares conservative treatment with surgical repair in patient cohort -Conclusions showed the treatments were equally as effective, with reduced side effects from the conservative approach -Possible issues include the small sample size

Transcript: Clarkson University Class of 2019 Christina Vogel-Rosbrook, PA-S2 Life Is Like a Box of Chocolates Patient Info 69 y/o CM presents to ER CC: "constipated for three days" Differential Differential Diagnosis Appendicitis Abdominal Hernia Diverticulitis Crohn Disease Ulcerative Colitis Perforation Ileus Irritable Bowel Syndrome Large Bowel Obstruction Spontaneous Bacterial Peritonitis Toxic Megacolon Volvulus Ogilvie Syndrome Multiple Sclerosis Lupus Scleroderma Amyloidosis Spinal Cord Injury Parkinson Disease Neuropathy Hypothyroidism Colon Cancer Medication-Induced Hypercalcemia Anal Fissure Fecal Impaction Renal Insufficiency Achalasia Portal Hypertension Cholelithiasis Cholecystitis Celiac Disease Liver Cirrhosis Alcoholic Fatty Liver Disease Non-Alcoholic Fatty Liver Disease Hyperparathyroidism Uremia HPI HPI: Pt reported to ER after 3 days of constipation. Insidious onset of abdominal distention beginning last fall worsened over the past 3-4 days. Associated symptoms include SOB, decreased appetite, severe abdominal distention, and weight fluctuation. He reported first time occurrence. Sxs worsened with time; nothing improved sxs. Medications Medications Neurontin (Gabapentin) - 300 mg PO TID Lipitor (Atorvastatin Calcium) - 40 mg PO daily Synthroid (Levothyroxine) - 175 mcg PO daily Flomax (Tamsulosin) - 0.4 mg PO daily Medical marijuana - for PTSD Intolerance/ Allergies Simvastatin - Headache Pollen Allergy - Congestion. PMH & PSH Past Medical History Frozen Shoulder - Hypertension Hyperlipidemia Type 2 Diabetes Mellitus Post Traumatic Stress Disorder Past Surgical History FH & SH Family History Father 50's y/o. Helicopter accident. Mother 60's. Alcoholism. Brother HTN. Sister Unknown. Sister Alive and well. Sister Alive and well. Daughter 37 y/o. Alive and well. Daughter 34 y/o. Alive and well. Daughter 32 y/o. Alive and well. Daughter 28y/o. Alive and well. Denies family history of liver cancer, cirrhosis, hepatitis, pancreatic cancer, crohn's disease, ulcerative colitis, congestive heart failure. Vietnam Veteran and Retired plumber. Married. Lives with wife, two wolves. Former tobacco and alcohol use. Stopped smoking and drinking about 10 years ago. Registered NYS medicinal marijuana. Denies cocaine or heroin use. Diet: Regular. Exercise: Active with projects around house. Leisure: Enjoys cooking, fixing motorcycles, spending time with family. Safety: Drives with seatbelt. Social History Review of Systems ROS General: +poor appetite, fatigue. No fever, chills. Skin: No open wounds, rashes, lesions, ecchymosis. Head: No headache, trauma, pain. Eyes: No vision changes, blurred vision, photophobia. Ears: No hearing changes, vertigo, tinnitus. Nose: No rhinorrhea, changes in smell, epistaxis. Throat: No dysphagia, sore throat, hoarseness. Neck: No nuchal rigidity, stiffness, lumps. Cardiovascular: No palpitations, chest pain, chest wall pain, orthopnea. Pulmonary: +Dyspnea. No cough, hemoptysis, pleuritic chest pain. Gastrointestinal: +Abdominal distention, diffuse abdominal pain, constipation, early satiety, passing flatus. No nausea, vomiting, diarrhea, hematochezia, melena. Genitourinary: +Rentention. No dysuria, hematuria, frequency, incontinence. Musculoskeletal: +Left leg pain. No arthralgia, muscle atrophy, myalgia. Neuro: No weakness, numbness, confusion, change in speech. Vascular: +Mild leg edema bilaterally. No increased vascularity, claudication. Endocrine: No heat/ cold intolerance, diaphoresis, polyuria, polydipsia. Psychiatric: No feeling of depression, anxiety, memory loss, harmful thoughts. ROS Physical Exam Exam Vital Signs Blood Pressure - 135/67 Pulse - 72 Temperature - 97.7 degrees Farenheit Respirations - 18 Oxygen Saturation - 96% Room Air Vital Signs Physical Exam Physical Exam General: Skin: Head: Eyes: Ears: Nose: Throat: Neck: Pulmonary: Cardio: Abdomen: Extremities: Msculoskeletal: Neuro: Endocrine: Psych: Tests Labs CBC, CMP, other chemistries Blood Cultures Urinalysis Coagulation Serology Labs CBC, CMP CBC, CMP 13.2 16.2 38.7 285 129 4.6 94 4 113 0.6 29 MCV - 83.2 MCH - 28.4 MCHC - 34.1 RDW - 13.7 MPV - 8.4 Neutorphil% - 84 Lymph% - 7.7 Mono% - 6.8 Eos% - 0.6 Baso% - 0.3 Lactic Acid - 1.0 Calcium Adj for Alb - 11.7 Mag - 1.70 Total Bili - 0.5 AST - 31 ALT - 25 Alk Phos - 89 LDH - 164 Total PRO - 6.8 Albumin - 3.8 Lipase - 57 C-Reactive Protein - 9.11 Other CHEM Other CHEM Lipase - 57 TSH - 24.700 T4 - 10.8 TBG Color - Yellow Clarity - Clear pH - 8.0 Specific Gravity - 1.028 Ketones - Negative Blood - Negative Nitrite - Negative Bilirubin - Negative Urobilinogen - 1.0 Leukocyte Esterase - Negative Total PRO - Negative Urinalysis UA Serology Serology Imaging Imaging EKG EKG Chest X-Ray No Acute Disease. Abdominal CT with contrast "Large 10 cm liver lesion with subhepatic space extension into the small bowel mesentery with changes of perotineal carcinomatosis identified with omental caking and studding as well as ascites. I am concerned about primary cholangiocarcinoma of the

Transcript: Past Medical History: Hx of smoking (1 pack a day) no known cardiovascular disease no known respiratory disease no Hx can be gathered on scene no fall earlier no slurred speech no new activities low probability of drugs or ETOH intox A - alcohol, acidosis, arrythmia E - electrolytes, encephalopathy, endocrine I - infection O - oxygen, overdose U - UTI, uremia T - trauma, temperature, thrombus, toxins, tumor I - insulin P - psychiatric, poison S - sepsis, stroke, seizue, syncope Trauma Assessment: head & neck patient grimaces and says "pain" when you palpate behind his head and down his neck no deformities, discolouration chest equal bilateral chest wall movement equal clear lung sounds apices to bases abdomen patient grimaces and says "pain" upon palpation of the upper and lower left quadrats pelvis & extremities unremarkable pedal pulses present Patient Presentation: sitting on the ground outside the transport van eyes closed, visibly in pain GSC 9 eye - open to pain verbal - words motor - localizes pain patent airway shallow respirations palpable pulses no bleeding or incontinence no smell of alcohol no facial droop Call Info: code 4 ottawa carleton detention centre patient altered "not acting himself" History of Present Illness: Elgin Toole patient transported by OPP from courthouse to innes detention centre patients mentation and LOA begins to decline during transportation begins complaining of head/neck pain becomes confused and then unresponsive detention centre staff say he is typically very chatty, likes to go out for smokes, social guy patient goes from GSC 15 to GSC 9 in 30 mins paramedics called shortly after Vital Signs & 12-Lead: Grand Rounds - Altered Patient Skin - PWD Pupils - left 2mm right 4 mm, sluggish Temp - 36.5 C RR - 18, shallow BP - 112/86 HR - 98 bpm, NSR SPO2 - 96% RA, 98% 4 lpm ETCO2 - 40 mmHg BGL - 5 mmol Treatment & Transport: oxygen therapy, NC, 4lpm supine, head elevated 45 degrees Code 4, CTAS 2 Ottawa Hopsital General Campus QUESTIONS??

Grand rounds presentation

Transcript: Sling support for first few days until balance is gained. Exercise restrictions- no vigorous activity for at least 4 weeks post-surgery Weight control to minimize damage to weight bearing joints A follow up phone call was made 4 days post-splint application. The owner stated that "Xena" was doing well. Several days later the owner noticed a laceration on the leg just above the splint and applied a bandage. The homemade bandage was taped too tightly and it tourniqueted the hock just proximal to the hock joint. After several more days the owner noticed a bad smell and brought "Xena" in to have the leg rechecked. "Xena" 2 y/o FS German Shepherd Mix Day 3 pm Amputation of the metatarsals- digits 4 and 5 Example of hind leg splint Treatments: Daily TPR,monitoring input and output-eating, drinking, urination and defecation, administration of oral medications- Clindamycin, Carprofen, IV medication- Cefazolin. Buprenex IM for pain control and Enrofloxacin IM. Continued IV Fluids. Monitored for fluid overload and IV catheter complications and patency. Removal of bandage, hydrotherapy of wounds and reapplication of wet/dry bandage every 12 hours. "Xena" Dorsoplantar View of Left pelvic limb Grand Rounds Presentation Heather Stitzel Summer 2015 *Bandages must be kept clean and dry- place a moisture resistant wrapping over the bandage before going outside or bathing pet *Check bandage frequently for tissue swelling above or below bandage *Bandages must be rechecked by veterinarian if swelling develops, unusual smell is present or if the bandage slips or gets wet History References Day 4 Questions? Kahn, Cynthia M. The Merck Veterinary Manual. Whitehouse Station, NJ: Merck, 2005. Print. Hospitalization Hydrotherapy and Lavage progression Possible complications Treatments: Daily TPR,monitoring input and output-eating, drinking, urination and defecation, administration of oral medications- Clindamycin, Carprofen, IV medication- Cefazolin. Buprenex IM for pain control and Enrofloxacin IM were added to drug regimen. IV Fluids were continued. Patient monitored for fluid overload and IV catheter complications and patency. Removal of bandage, hydrotherapy of wounds and reapplication of wet/dry bandage every 12 hours. Hot spot developing on chin and neck Daily TPR. Monitored input and output- eating, drinking, urination and defecation. Administered oral medications- Carprofen, Clindamycin, Enrofloxacin and Gabapentin, injectable medication- Hydromorophone and topical medication to chin/neck- Betagen Spray. Monitored incision site and cold packed area to reduce swelling. Encouraged patient to eat by offering variety of enticing foods. "Xena" Left lateral Day 2 Lavage and hydrotherapy Post-op care Amputation of Canine Pelvic Limb. Online Surgical Videos for Healthcare Professionals. N.p., n.d. Web. 11 July 2015. <http://www.surgerytheater.com/users/ShinkisMovies/> Treatments: IV catheter placed , IV Fluids administered @ 85 ml/hr (2x maintenance), Hydromorphone IM, Cefazolin IV, Convenia SQ, hydrotherapy of wound, chlorhexidine soak, Carprofen and Clindamycin PO. A wet/dry bandage was placed, with orders to change every 12 hours. Long term care Reason for Visit "OrthoVetSuperSite." OrthoVetSuperSite. N.p., n.d. Web. 11 July 2015. <http://www.orthovetsupersite.org/> Day 1 Client Education Temperature was increased 102.5, pain tolerance has decreased, replaced catheter pre-surgically, cleaned and dried chin and neck due to irritation from e-collar PE: The patient was QAR and inappetent. A necrotic smell was coming from the bandage. "Xena" had a weight loss of 6.4# in 2 weeks. The bandage and splint were removed- bandage exhibited staining at distal end, the rolled cotton was hardened and stained, tissue edema noted proximal to hock, skin discoloration and skin sloughing observed on the dorsal aspect of the left hind foot as well as necrotic tissue on the plantar aspect at the metatarsal pad and digital pad #5. T-99.3 P-100 R- 40 Weight- 37.4# Plumb, Donald C. Plumb's Veterinary Drug Handbook. Stockholm, WI: PharmaVet, 2005. Print. Day 3 am "CHAPTER 48 AMPUTATION." N.p., n.d. Web. 21 July 2015. <http://cal.vet.upenn.edu/projects/saortho/chapter_48/48mast.htm>. 2 weeks prior the patient was presented to the clinic for limping on the left pelvic limb. PE was performed and radiographs were taken to determine the cause. Soft tissue swelling and a fracture of metatarsal #2 was discovered. A spoon splint, 2 layers of rolled cotton, 1 layer of conforming gauze and vetwrap were applied extending from the phalanges to the hock. Elasticon was placed at the top of splint to prevent slippage and a small amount of elasticon placed on the bottom of the foot for traction. Carprofen was prescribed to control pain and inflammation. The patient was fitted for an e-collar. Optional treatments Non-adherent foam dressing Vacuum assisted wound closure Mid shaft amputation with prosthetic limb Skin grafting Sugar/honey dressing The patient has a good

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How to Make a “Good” Presentation “Great”

• Guy Kawasaki

Remember: Less is more.

A strong presentation is so much more than information pasted onto a series of slides with fancy backgrounds. Whether you’re pitching an idea, reporting market research, or sharing something else, a great presentation can give you a competitive advantage, and be a powerful tool when aiming to persuade, educate, or inspire others. Here are some unique elements that make a presentation stand out.

• Fonts: Sans Serif fonts such as Helvetica or Arial are preferred for their clean lines, which make them easy to digest at various sizes and distances. Limit the number of font styles to two: one for headings and another for body text, to avoid visual confusion or distractions.
• Colors: Colors can evoke emotions and highlight critical points, but their overuse can lead to a cluttered and confusing presentation. A limited palette of two to three main colors, complemented by a simple background, can help you draw attention to key elements without overwhelming the audience.
• Pictures: Pictures can communicate complex ideas quickly and memorably but choosing the right images is key. Images or pictures should be big (perhaps 20-25% of the page), bold, and have a clear purpose that complements the slide’s text.
• Layout: Don’t overcrowd your slides with too much information. When in doubt, adhere to the principle of simplicity, and aim for a clean and uncluttered layout with plenty of white space around text and images. Think phrases and bullets, not sentences.

As an intern or early career professional, chances are that you’ll be tasked with making or giving a presentation in the near future. Whether you’re pitching an idea, reporting market research, or sharing something else, a great presentation can give you a competitive advantage, and be a powerful tool when aiming to persuade, educate, or inspire others.

• Guy Kawasaki is the chief evangelist at Canva and was the former chief evangelist at Apple. Guy is the author of 16 books including Think Remarkable : 9 Paths to Transform Your Life and Make a Difference.

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Center for Community Health & Prevention

Public health grand rounds.

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Through this series, UR faculty, staff, students and community partners can hear about community-based initiatives to reduce health inequities, improve access to care and tackle some of our toughest health challenges.  Public Health Grand Rounds   (PHGR) are a collaborative effort between the Center for Community Health & Prevention and the Department of Public Health Sciences , and are intended to highlight the link between research, clinical medicine and community health improvement.   

We look forward to providing Public Health Grand Rounds both virtually and in person on Fridays, from noon – 1 p.m. Details will be provided for each event in the box below.

Join us for lively discussions with some of Rochester’s community health champions, both URMC faculty and staff, as well as expert community leaders. Recordings for most sessions can be found below.

You can earn continuing education credits at PHGR! Information about continuing education credits can be found below.

This seminar series is funded in part by the University of Rochester Clinical & Translational Science Institute via grant UL1 TR002001 from National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Additional financial support is provided by gifts to the Department of Public Health Sciences and an endowment to the Center for Community Health & Prevention by Brewster C. Doust, M.D. All support is greatly appreciated.

Join us for the our next Public Health Grand Rounds, the Dr. Bernard Guyer Lecture Series, at noon Friday, April 19 . 

Featured Speaker: Michelle A. Williams, ScD, Joan and Julius Professor of Epidemiology and Public Health at Harvard TH Chan School of Public Health and visiting professor of Epidemiology and Population Health at Stanford University School of Medicine

Presentation: "Bold Steps American Health Care Systems Must Take to Ensure an Equitable and Healthier Future"

It’s time to take bold steps to prevent diseases caused by poverty, inequality, racism, and loneliness - those upstream drivers of poor health. Despite spending $4 trillion a year on health, American health outcomes lag far behind our peers on critical metrics including avoidable deaths, obesity, and infant mortality. The problem isn’t how much we’re spending - the issue is how we are spending our money. In 2021, only 4.5% of our health care dollars were spent on the preventative measures associated with public health. That lopsided ratio has contributed to America’s worsening life expectancy – not just for people of color, but for all people.

We have the knowledge and resources to create a stronger, healthier, and more equitable America.

Register today!

* ASL interpreters have been requested. A good faith effort (up until the time of the webinar) will be made to provide accommodations.

Live closed captioning provided.

Spring 2024 Public Health Grand Rounds 

We look forward to providing some of these events in a hybrid format. The format of each event and how to register will be shared with other event details in the box above.

*Captions for each linked presentation can be turned on during viewing by clicking ‘Captions’ in the top left corner of the screen.

Fall 2023 Public Health Grand Rounds

ACCREDITATION - The University of Rochester School of Medicine and Dentistry is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

CERTIFICATIONS

The University of Rochester School of Medicine and Dentistry designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The University of Rochester Center for Nursing Professional Development is accredited with distinction as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. This offering provides 1.0 nursing contact hours. An evaluation must be completed within 30 days and attendance is required for at least 90% of the activity.

University of Rochester Medical Center, Center for Experiential Learning is recognized by the New York State Education Department's State Board for Social Work as an approved provider of continuing education for licensed social workers #SW-0005. This activity is approved for 1.0 Social Work continuing education hour(s). Attendance at the entire program is required (no partial credit can be awarded).

University of Rochester Medical Center Department of Psychiatry is recognized by the New York State Education Department's State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0117. This course has been approved for 1.0 contact hours. Attendance at the entire program is required (no partial credit can be awarded).

University of Rochester Medical Center, Center for Experiential Learning is recognized by the New York State Education Department's State Board for Mental Health Practitioners as an approved provider of continuing education for licensed marriage and family therapists #MFT-0107.

Strong Memorial Hospital, Strong Recovery is recognized by the New York State Education Department's State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors #MHC-0250.

Past Public Health Grand Rounds Presentations

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ABC Updates

Watch the 2024 nfl draft on abc & espn april 25-27.

Wondering when, where and how to watch the 2024 NFL Draft? All three days of the NFL Draft will air on ABC and ESPN. Distinct telecasts will air on each network the first two nights - Thursday, April 25 and Friday, April 26. ABC will simulcast ESPN's coverage of Day 3 on Saturday, April 27. ESPN and The Walt Disney Company will present the 2024 NFL Draft across ESPN, ABC, ESPN Radio, ESPN Deportes and ESPN's social media platforms, as the NFL takes their marquee offseason event to Detroit (April 25-27). On-site studio programming will surround the multiplatform presentation as ESPN further deepens its commitment to the annual NFL tentpole event. ESPN's long-standing NFL Draft tradition will reach 45 consecutive years in Detroit, dating back to 1980. Be sure to watch on the  ABC app  from your smartphone and tablet ( iOS  and  Android ), computer on  ABC.com  and connected devices (Roku, AppleTV and  Amazon Fire TV ).  Access everything you need to know about the 2024 NFL Draft here .

WATCH THE LIVESTREAM OF THE 2024 NFL DRAFT HERE!

For the first two nights, Thursday, April 25 (8 p.m. EDT), and Friday, April 26 (7 p.m. EDT), ESPN and ABC will provide fans two broadcast options, a tradition dating back to the 2019 NFL Draft, and new this year a third option with "The Pat McAfee Show Draft Spectacular." ESPN's presentation will focus on areas of need for each team, the draftee's football resume – with highlights and analysis on his playing style, technique and physical attributes – and how he will fit in with the team that drafted him. ABC will provide player analysis with a deeper emphasis on storytelling, providing viewers insight into the draftee's background and journey to the NFL. On day three of the Draft, Saturday, April 27 (12 p.m. EDT), ESPN's presentation will be simulcast on ABC.

Nick Saban, legendary former Alabama Crimson Tide head coach, will make his ESPN debut as an analyst on "College GameDay" and the ABC broadcast after it was announced he would be joining ESPN in February 2024. Mel Kiper Jr., officially in his fourth decade as an NFL Draft staple, returns to the ESPN broadcast. The 2009 NFL draftee Pat McAfee and his crew will bring fans "The Pat McAfee Show Draft Spectacular," a night 1 special telecast available on YouTube and TikTok and streaming on ESPN+ (Thursday, 8 p.m. EDT). Live from Detroit, the show will utilize a wide range of personalities and analysts to breakdown picks while also emphasizing the Draft experience from a fan perspective.  

The 2024 NFL Draft will also be televised on NFL Network and streamed live via NFL digital properties. ESPN Radio, ESPN Deportes and ESPN digital shows will cover every round and pick as well. ESPN's DraftCast, a live tool that includes analysis of each prospect and a scouting reporting, will be available on ESPN.com.

On the eve of the NFL Draft, Wednesday, April 24, Kevin Negandhi will co-host "SportsCenter" (6- 7 p.m. EDT) from inside the NFL Draft theater. Negandhi, will remain on-site for the entirety of the Draft, bringing fans live action from Detroit on ESPN's flagship show. Thursday, "SportsCenter" will have an extended edition (12-3 p.m. EDT).

Five hours of wall-to-wall live studio show programming from Detroit, beginning with "NFL Live," and followed by "College GameDay" and "NFL Draft Countdown Presented by EGO" will air leading up to the Chicago Bears officially being on the clock. Analysts on the ground in Detroit will contribute to additional ESPN studio shows, including "Get Up," "First Take," "SportsCenter" and "ESPN BET Live." "The Pat McAfee Show" will originate from Detroit on Friday, enhancing ESPN's massive on-site presence even further.

Before the Chicago Bears officially submit their pick, "NFL Draft Countdown Presented by EGO," with ESPN's main set of commentators, will take fans right up to the opening of the Draft (Thursday, 7-8 p.m. EDT and Friday, 6-7 p.m. EDT).

Please Note: ESPN's Friday draft coverage may air on ESPN2 pending NBA Playoff telecasts.

On Location in the Heart of Detroit:  ESPN's set will be inside the NFL draft theater at Campus Martius Park, located in downtown Detroit, while ABC's will originate from just beyond the theater in Cadillac Square. On Saturday, ESPN's coverage will originate from the ABC set. "The Pat McAfee Show" and the "Draft Spectacular" will be situated at the Detroit Ice Rink, adjacent to the ABC set. ESPN Radio will broadcast from the media center at One Campus Martius for all three days.

ESPN Analysts and Hosts March on Down to Motown To Bring Fans the NFL Draft:  On Thursday and Friday, ESPN's set will once again be filled with industry-leading NFL Draft commentators, as draft guru Kiper Jr. takes a seat alongside 1999 NFL draftee Booger McFarland and 1991 NFL draftee Louis Riddick. For the fourth consecutive year, Mike Greenberg will anchor ESPN's presentation of the NFL draft on the first two nights. 

NFL senior insider Adam Schefter will be ready to bring fans all the latest news from Detroit – including information on any impending trades. Molly McGrath, ESPN college football reporter, will make her NFL draft debut, interviewing prospects following their selection on the main stage.

On ABC, alongside Kirk Herbstreit and 1992 NFL draftee Desmond Howard , seven-time college football national champion head coach, Saban , will be at the desk offering a coach's perspective to the group. "College GameDay"'s Rece Davis will host ABC's presentation for the sixth time while NFL draft analyst Field Yates will join ABC's draft coverage, partaking in the company's draft night coverage for the first time. 

Laura Rutledge , reporter and host of "NFL Live" and "SEC Nation," will be stationed in the green room interviewing prospects' families once their loved one is selected, while college football insider Pete Thamel will contribute the latest news and information to the ABC broadcast.

ESPN will have six reporters stationed at team facilities across the country – including at the locations of the teams with the top three picks – ensuring fans have access to immediate reaction from team Draft rooms.

Courtney Cronin – Chicago Bears

Jeff Darlington – Minnesota Vikings

Kimberley A. Martin – Washington Commanders

Sal Paolantonio – New York Giants

Mike Reiss – New England Patriots

Ed Werder – Denver Broncos

Pat McAfee will be joined on "The Pat McAfee Show Draft Spectacular" by Conor Campbell , Ty Schmit , Tone Digs and AJ Hawk . Additional guests will be announced in the coming days.

For the NFL Draft's final day on Saturday, Kiper Jr., Riddick, Yates, NFL Draft analyst Matt Miller and Davis will bring fans coverage of rounds 4-7 on ESPN and ABC from the ABC set.

Multiple ESPN Studio Shows Head to Detroit:  "NFL Live" (Thursday and Friday, 3-5 p.m. EDT), "College GameDay" (Thursday, 5-7 p.m. EDT and Friday, 5-6 p.m. EDT) and "The Pat McAfee Show" (Friday, noon-2 p.m. EDT on ESPN, noon-3 p.m. EDT on ESPN+ and ESPN on YouTube) will be live all afternoon from Detroit, filling the intrigue before the Draft commences with all the latest news, information and analysis. "Get Up," "First Take," "SportsCenter" and "ESPN BET Live" will also have a presence in Detroit, with a constant slew of analysts joining the shows live from the site of the Draft.

The knowledgeable and charismatic, 2024 Sports Emmy ® Award-nominated cast of " NFL Live," consisting of 2005 NFL draftee  Dan Orlovsky , 2024 Sports Emmy-nominated analysts Ryan Clark and Mina Kimes , 2005 NFL draftee Marcus Spears  and host Rutledge will be live from ESPN's main set for the special two-hour editions of the daily NFL show.

Coming off their second most-watched season since 2011, ESPN's "College GameDay" crew of Davis, Herbstreit and Howard will star in two spring editions of their weekly pregame show, joined by Saban in his "GameDay" debut. McAfee will join for Thursday's edition, along with Rutledge will be live from the NFL Draft red carpet, interviewing prospects as they arrive, and 1995 NFL draftee Joey Galloway , Thamel and Yates joining the desk throughout the show.

On " The Pat McAfee Show ," McAfee will be joined by Hawk, Campbell, Schmit, Digs, Darius Butler and Evan Fox. Fans can expect many notable guests, which will be announced in the coming days.

ESPN Radio, ESPN Social Platforms and ESPN Deportes Add to List of NFL Draft Distributors:  ESPN Radio will broadcast every pick of the NFL Draft from Detroit, providing an additional medium for fans to consume the Draft. Chris Carlin will host alongside 2005 NFL draftee Chris Canty , ESPN NFL front office insider Mike Tannenbaum , ESPN Radio college football reporter Ian Fitzsimmons and ESPN NFL Draft analyst Jordan Reid . Positioned inside the NFL media center, all on-site draftees will complete an interview with the crew after being selected.

Fans will hear ESPN Radio's "UnSportsmanLike," hosted by Evan Cohen and Michelle Smallmon, live from ESPN Bet Sportsbook in Greektown-Detroit, on Thursday and Friday (6-10 a.m. EDT). The hosting duo will be joined by Canty, Joe Fortenbaugh , Carlin, Fitzsimmons and Tannenbaum . On both days following " UnSportsmanLike , " Cohen and Q Myers will host "Greeny" (10 a.m.-noon EDT).  

Throughout NFL Draft week, live ESPN digital shows and podcasts – available on YouTube, Facebook and the ESPN App – will feature an array of ESPN personalities:

• Monday (11 a.m.-noon EDT): "First Draft" – Yates and Kiper Jr. break down their final mock Drafts before heading to Detroit.
• Wednesday (7:30-9:00 p.m. EDT): "First Draft" – Yates, 2005 NFL draftee Domonique Foxworth , Kimes and Kiper Jr. host "First Draft" in front of a live audience at the ESPN Bet Sportsbook in Greektown-Detroit.
• Thursday (at the conclusion of round 1): NFL Draft Round 1 Reactions – Douglas, Harry Lyles Jr., Spencer Hall and Kevin Clark discuss all of the major storylines from Round 1 of the NFL Draft.
• Friday (7 p.m.-midnight EDT): Live coverage of the NFL Draft – Douglas, Lyles Jr., Hall and Clark analyze and discuss every pick in Rounds 2 and 3.

On ESPN Deportes, "Monday Night Football" voices Eduardo Varela and Pablo Viruega will deliver exclusive Spanish-language coverage from ESPN's headquarters in Bristol, Connecticut, alongside NFL experts Sebastián M. Christensen and Miguel Pasquel . Reporter Carlos Nava will be on-site in Detroit. ESPN.com DraftCast Returns; Nightly Recaps Available on ESPN+:  Fans can track every pick of the Draft with real-time data via ESPN.com's DraftCast , which will provide instant analysis from ESPN draft analysts on how the draftee will fit with his new team. ESPN NFL Nation reporters will also keep fans up to date throughout the draft, providing rapid reaction for all 257 picks.

Available on ESPN+, recaps of all three days of the Draft will be published each night. Upon the conclusion of the Draft on Saturday, Kiper Jr. will give each team a post-Draft grade and explanation, while Miller and Reid will pick steals, surprises and more.

Extensive Coverage Leads into NFL Draft:  ESPN will have additional information on NFL Draft content throughout the week of the draft, with full programming details announced in the coming days.