Setting the Scene
Most students would agree that presenting a patient on rounds or to your attending is one of the scariest parts of being a third or fourth year medical student. Whether you are in a group or one-on-one, all eyes and attention are on you. There is the potential to do or say something incorrect, embarrassing, or perhaps you might not know the answer to a question that you are asked. Also, depending on the level of responsibility that you are given, what you say can have a large impact on the course of a patient’s visit. As if this was not enough, there is the fact that you are being evaluated. And in a busy environment like an emergency department (ED), this may be the only interaction that you have with your attending physician.
Being in the environment of the ED adds a few more factors into the equation. You may have been rushed and your history or physical may feel incomplete. Or as you are getting ready to present, your attending may say, “just give me the pertinent information; nothing else.” And last but not least, your patient may be really sick and in need of immediate help. If your patient is truly sick and needs immediate attention, it is important to get your attending (or resident) in the room before you even complete your history and physical. Not only is this the right thing to do for your patient, but also you will demonstrate your ability to recognize an unstable patient.
10 Tips
Now that we’ve established the importance of giving good presentations, I have compiled a list of 10 tips that will help you succeed. These tips come from an article titled “The 3-Minute Emergency Medicine Medical Student Presentation: A Variation on a Theme.” I highly recommend reading this article before starting your EM clerkship, but here are a few highlights:
- Your history of present illness (HPI) should contain the chief complaint, past medical, surgical, social, and family history. To keep your story concise, only include information that is relevant to the chief complaint. You then don’t need to mention each of these section headings after your HPI.
- If there are 2 chief complaints (and they are both important), separate them into two HPIs.
- Obtain as much of a complete history as possible. You often will not have up-to-date medical records and your patient may not volunteer details unless you specifically ask.
- Do a focused review of systems (ROS) and only present pertinent findings. As you gain experience, your presentation of ROS should become shorter and shorter as you incorporate your findings into the HPI.
- Always include medications and allergies. If there is a long list of medications, ask your attending how you should present them (e.g., only relevant medications, organized by what they are treating, etc).
- Your presentation of the physical exam should include only pertinent positives and negatives.
- A summary statement should include the most important complaints, exam findings, studies, and/or labs. Some would argue that you don’t even need a summary statement if your presentation has been concise and has kept your listener’s attention.
- The assessment is the first section where you give your opinion. The history is for communicating information from the patient and medical records. The physical exam is for reporting objective findings.
- There are multiple different ways to list your differential diagnosis. Ask your attending what he/she prefers. Many attendings will prefer for you to list your differential in order from the most life-threatening to least-life threatening (rather than in order from most likely to least likely) because it shows that you are thinking like an EM physician.
- Present in 5 minutes or less (ideally, 3 minutes!)
Practice!
Finally, remember that you will not achieve excellence without plenty of practice. Do not expect to be great at presenting on the first day of your clerkship. It will take weeks, months, and even years to perfect your presentation skills.
Hopefully by using these tips in combination with plenty of experience, you will stop seeing presentations as the enemy and start viewing them as an opportunity to show off your knowledge. A great presentation will help to not only enhance teaching and learning, but it will also help to provide quality care to your patients.
Author: Jennifer Stancati, Midwest Regional Representative, AAEM/RSA Medical Student Council
Reference: Davenport C, Honigman B, Druck J. The 3-minute emergency medicine medical student presentation: A variation on a theme. Acad Emerg Med. 2008; 15(7): 638-7.