If you’re on your clinical rotations and you want to know how to give better patient presentations on your rotations to make sure your presentations are pristine (so you can get honors and avoid people falling asleep on you!), this is the perfect post for you.
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Now, this post is really going to be about how to present better, but if you’re interested in watching a video on how to give a step-by-step presentation, you can try these popular videos below.
Advice On What To Do And Not To Do
As an internal medicine resident, I actually have to give grades to medical students on a lot of things, including their presentations. So I thought I’d make this post to tell you a few things to think about: things not to do as well as a step-by-step way of how to present both new and old patients on a daily basis.
3-Step Rotations Process
In this first part of the post, we’re going to talk about a 3-step process that I used myself as a medical student, and advice that I also give to medical students whom I have to evaluate.
And hopefully, you can use them to help you do better on your presentations.
Step #1. Start With The End In Mind
Focus On Your Assessment And Plan
Step one is to start with the end in mind and make sure all your details focus on it. This means to make sure you focus on your assessment and plan first before you even think about giving your presentation.
A lot of medical students are really good about giving the information of how a patient did overnight, their history, or physical exam results — basically, that’s simply regurgitating the facts. Med students don’t have a hard time with that.
What med students have difficulty with is taking all that information, breaking them down into all the medical problems, and deciding what they’re going to do for each one.
Address The Problems Of Your Patients First
The first thing that you need to do before you even get to your patient presentations is to address all the problems that you’re helping address for that patient at the current moment.
So if you’re on a rotation like internal medicine, this may be a really long problem list with all the medical problems that you’re solving at the moment, as well as chronic ones that you still have to solve while they’re in the hospital.
For example, if they come in with a pulmonary embolism, that’s going to be the problem you’re going to be solving while they’re in house.
For rotations like surgery, your problems may be smaller. But you need to make sure to focus on the active surgery they’ve had as well as any surgical history. These are things like pain, constipation, and if they are able to eat or not.
Be Specific And Break Down Each Problem
Once you have a list of all the problems you’re addressing for that specific patient, break down each problem with everything you want to address in that specific situation.
A patient you may see on your internal medicine rotation is somebody with heart failure. In heart failure, there are very specific things that you have to think about. For example, what’s their volume status? Is it up? Is it down? Is it stable? And so, what are you going to do about it? That’s part number one of heart failure.
Part number two: Are they on a beta-blocker? Are they on an ACE inhibitor? Are they on SGLT2?
If there are certain medications you think they need to have, you need to really go through your checklist for heart failure. Is this patient getting everything done under the checkbox of heart failure?
The same thing applies to a patient on your surgery rotation. What surgery do they have? On what post-op day are they? Are they in pain? Are they able to eat? Constipated? Having diarrhea? Are they moving around? There are certain checkboxes you have to have on a surgical rotation for every single patient.
Step #2. Relevant Reporting
Present Your Assessment Based On The Patient Problems
The nice thing about this is once you have all the problems the patient has and the things you need in terms of management, you can then focus on part number two. That is making sure that every element of your patient presentation goes to ultimately helping some segment of your assessment and plan.
For example, when you’re presenting a surgical patient, you need to make sure that you tell the attending about whether or not they’re pooping, whether or not they’re eating, whether or not they’re moving around, and how their pain is.
Those are only things your surgeon probably wants to know on a surgical rotation.
Let’s compare that to an internal medicine rotation. If you identify that the patient has a PE, something your attending would want to know is, are they short of breath or not?
Pro Tip: Create A Checkbox For Your Plans
If you’re having difficulties as a medical student on your rotations, whether or not you should include something, consider doing this:
Start with your assessment and plan first and then create a mini checkbox for each plan. You can think, “What piece of information do I need to give to my attending to explain the situation?” If it’s a heart failure patient, I need to include, “Do they look volume up or volume down?”
In that case, it’s going to go under your physical exam. But you may not have to present their iron labs or their liver labs if it doesn’t really pertain to anything in their problem list. It’s worth having down, but not necessarily mentioning.
Everything You Present Should Be Relevant To The Problem
So as a summary, step number two is to make sure that while you’re giving your patient presentation, every phrase, every piece of data is going to help your assessment and plan.
Step #3. Read The Room
Finally, step number three is to make sure you are constantly reading the room. That includes having good eye contact.
That way, if people need to, they can be recaptured into your presentation. That also helps you decide and think something like, “All right, I got to go. I’ll only talk about the top two problems, and I’ll take these labs away.”
And if somebody asks for them, you can always have them handy and be ready to present them.
So always make sure you start with the end in mind, and for each problem have a mini checkbox of all the things that you need to do in terms of management: things that you need to work up, consults that need to be followed up, etc.
Then ask yourself, “Are all the elements in my presentation actually contributing to the end goal?” If not, remove it and just have it handy in case your attending wants to know.
Finally, make sure you read the room so people are kind of checking out. That’s probably a good sign that you need to catch their attention by having some good eye contact and also making sure that you’re only including elements that are important and more focused.
Tips And Common Mistakes
So those are usually the top three things I teach a lot of my medical students to do. But I really want to talk about a few other things that are important to keep in mind because these are common mistakes med students make that really do bug residents.
This is not because med students are doing them incorrectly. But sometimes they have no idea that they’re even happening or that they’re bugging their upper levels or their attendings.
It’s a problem because it is inefficient and costs a lot of time that the interns, residents, and attendings could have spent on the patient or spent teaching the student.
Tip #1. Avoid Being Repetitive
One of the first things that I really want to mention because it bugs me a lot is to avoid being repetitive.
A lot of things I see medical students do is this: There is a patient who has been in the hospital for 10 days, and still the med student thinks that it’s important to tell the attending, “This is Mr. Johnson, 48 years old, who has been here for 10 days. Post-op day 10 from a surgery…”
You don’t need to go through that roundabout again.
But I’m like, “Goodness gracious. Just tell me what you want to do.” That’s what the attending really cares about.
Of course, make sure that you take this advice with a grain of salt. Everyone works differently, and your attending may give you something totally opposite from what I’ve mentioned earlier, and if they do, make sure you pay attention to them.
Otherwise, take my advice.
Tip #2. Be Efficient And Summarize Key Details
In a similar fashion, if your attending was involved with a major update from the day before — for example, if they had a major surgery, procedure, or some complication that they were aware of — you don’t necessarily need to repeat the whole ordeal again, because again, it’s inefficient.
It doesn’t really tell the attending very much.
Really, what they want to know — and what I, as your resident, want to know — is what are we going to do now? What do you, as a potential healthcare provider, as a future physician, want to do? And that’s really the main goal of a patient presentation.
Ask yourself, “Do I really need to talk about this?” And if so, summarize it in one sentence.
For example, “Yesterday, Mr. Johnson had some chest pain and all of his troponins and workups have been negative, and is still experiencing some chest pain for today.”
That’s it. Move on.
Tip #3. Don’t Be A Show-Off
Now, another thing to make sure you’re always mindful of is where to inject knowledge from what you have read or things that you know from personal experience. How to show off to your attending without being a little extra showy?
Some med students do this on one extreme or another. For example, a student may have read a journal and say, “Well, although it’s not related to this patient whatsoever, I read an article about this one gene impacts so-and-so. What are your thoughts?”
You’re almost having a conversation with the attending about nothing related to your patient care and the attending is usually caught off guard, and it seems like a med student that’s really just trying to suck up.
Don’t do that.
Make sure that any time you’re trying to inject your knowledge in a form of an educated question, always involve something about what your attending is teaching you or caring for your patient.
For example, you may have a patient with aortic stenosis, which can have a lot of complexities depending on who the patient is, how stable they are, as well as the degree of stenosis that they have in the aortic valve.
You may then be able to ask your attending, “Hey, even after reading some things about the aortic stenosis yesterday, I’m still not sure what options, procedures, or evaluations they would still need in order to determine if they deserve a valve replacement.”
That’s a good educated question from somebody who’s interested in their patient and has read something to be able to ask a follow-up question.
The attending can then partake on and educate both you, your peers, as well as the residents.
So that’s a very long fancy way of saying, make sure you only show off your knowledge in the context of something that you’ve read and also in the setting of helping your patients.
Make sure you’re not that student who’s just trying to inject journal articles that have nothing to do with the care of your patient.
I promise you, that’s going to make your residents like you much more because things are going to progress much more efficiently. We can also see that you’re interested and curious when it truly does matter.
Tip #4. Focus On The Plans That Are Relevant In The Context
Now, a few more things before we wrap up. One thing I do notice a lot of my med students do is they have a problem with 3 to 6 different things, and they’ll talk about each and every single one every single day.
Now I know I said, “Focus on assessment and plan,” at the start of this video, but not every assessment or plan is relevant every single day.
Let’s say you have a patient who comes in hypertensive and you start new medications on them. But come post-op day five, that’s no longer a problem and they are well-controlled. You don’t need to talk about it again unless, obviously, if your attending asks.
So have that in your note, have it ready, make sure you know what medications they’re on, but again, you don’t need to focus on that every single day.
If your patient is anemic or has iron deficiency, you don’t need to say a patient is still on iron. Your attending knows that and hopefully, that’s true.
You’ll notice that the common theme of this post is: Is it important to my patient? Is this something worth discussing? Is there any new information to really give in the form of a progress for your patient?
And obviously, all of their H&P’s are acceptable to be presented. But make sure you read the room because if they’re not paying attention, you probably can skip on some of the things that are later in the problem list.
Tip #5. Run Your Plan With The Upper Levels
Finally, last and most importantly, make sure to run the plan with your residents and your upper levels every single day.
I know it can be hard depending on the rotation and maybe your residents are busy. But simply focus with the end in mind and say:
“Hey, can I just quickly run the plan with you? I don’t need to talk about that whole presentation, but the top three things I think we’re doing is we’re managing this guy’s pulmonary embolism. He has some heart failures so we’re doing that. And he’s still hypertensive. Those are the three problems over the PE. Not much changing or keeping them on these medications for his heart failure. I want to do this. And for his hypertension, he’s stable. So is that good for this patient?”
As a resident, I do appreciate that you’re thinking about multiple problems, you’re only focusing on the ones that you actually want to contribute on in that day, and you’re actually giving me suggestions before you’re asking me “Hey, what are we doing today?”
Doing that also helps your grade. They’re not only going to help you in your patient presentation, but it’s going to show your residents that this person truly cares about their patients.
I think much more highly of med students when they do that.
And those are all of my tips on how to give patient presentations on your rotations.
If you liked this post, go ahead and check out Crush Your Rotations in Med School! Tips and Tricks, a playlist of all the different things that you should know depending on the rotation you’re on as well as things like how to write notes better, how to present better, how to impress your attendings, etc.
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Enjoyed this post on how to give patient presentations on your rotations? If you did, check out these posts below:
- What Are Clinical Rotations Like? [Detailed Breakdown]
- How To Study For Shelf Exams For Your Rotations Effectively [How To Get Honors]
- How To Study For Rotations In Medical School (Step-By-Step Method)
- How To 10x Your Clinical Rotations Results: A Simple System
- How To Be More Efficient On Your Rotations [Medical Students And Residency]
Until the next one my friend…