Last Wednesday, we had a case presentation at the hospital that was held live on Microsoft Teams with the Maudsley Hospital / IoPPN Grand Rounds. It was hybrid, meaning some psychiatrists participated online (103) and some did in person at our conference room (25) and at the Wolfson Lecture Theatre in London (80).

We were invited by the Academic Lead for the Maudsley Grand Rounds, who was chairing the event, based on the recommendation from one of a Maudsley staff member who had trained at our hospital early in her career. I began with a 5-minute presentation on the history of psychiatry from ancient Egypt to the present day. Which, I must confess, is not something that I know very well at all but it was fun. Then two of our registrars presented a case of clozapine-resistant schizophrenia. After that we had a 30 minute discussion.

There were some changes from our usual format. We invited the patient's parents to attend and the registrars worked together as a team to prepare the case. It was a huge case, as the patient was hospitalised several times. They did a great job and we had wonderful feedback from everyone who participated.

During the discussions we received so many interesting and valid questions and suggestions. Some were about polypharmacy, the possible use of ECT as augmentation strategy, trans-cultural questions about religious delusions and questions about local mental health laws. If I must name-drop, Professor Robin Murray was one of the participants and he mentioned a very recent RCT on the value of ECT as augmentation in clozapine-resistant treatment.

Although we managed to make the event happen. Nothing went smoothly, in particularly technically. Everything was held with a string and chewing-gum. We had terrible echo because the administration made the mistake of renting audio-visual equipment for a local event (including a huge 4 by 3 meters stacking LED screen!) so the microphones came with XLR jacks that only plugs into the large speakers so they wouldn't work with the PC. We had to use another MS Teams account for the microphone input of another laptop. So one of my colleagues volunteered himself to manage the volume knob on a huge speaker in our conference room to try to mitigate echo. This was all very stressful but fortunately people in London could hear us and we could hear them.

I really really hope that we can hold similar events with other institutions around the world. Either as an audience for their case presentations / grand rounds / journal club or as presenters. I am also considering some changes in the format of our usual presentations to include patients and their families but this will be a big cultural change and will take some time to help the patients or their families understand all the discussions and jargon that is thrown around.