
How to Master Oral Case Presentations
HPI:
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Goals: accurate, chronological, concise, builds an argument
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Two paragraph method:
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Paragraph 1: Chronological history
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Characterize the pt’s complaint (chronological story); use this to mentally generate & help your listeners to generate a top 5 DDx.
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Paragraph 2: Symptoms, risk factors, PMH relevant to the DDx
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Discuss the Sx/ROS that would argue for/against each item in your DDx.
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Discuss any risk factors/PMH that would argue for/against each item in your DDx.
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ROS:
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If pertinent to CC, include in Paragraph 2 of HPI. Otherwise, state here if will be on the problem list.
PMH, SHx, FamHx, etc.:
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Should NOT be a regurgitation of the note (we’ll read that later)
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If pertinent to HPI/top 5 DDx, discuss in paragraph two of HPI … do NOT need to repeat here (we can remember from the HPI)
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Otherwise, will we think about it/treat it during this hospitalization? Will it be on the problem list? If so, then state briefly. If not, then leave it for the note.
Meds:
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List names (be prepared to give doses/frequency if asked). Indicate if recent change/problem.
Physical Exam:
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Report positive or negative findings related to most likely diagnosis
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Report pertinent positive or negative findings that argue for/against other possible diagnoses in top 5
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Report any other significant (abnormal) exam findings (will it be on the problem list?)
Diagnostic Studies:
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Report labs/studies that argue for/against the most likely diagnosis
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Report labs/studies that for/against other possible diagnoses in top 5
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Are there any other abnormal labs or studies that we will think/worry about or address?
ED Course:
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It depends but usually discuss right before the A&P (or can talk with your attending about possibly building into your A&P). If ED vitals very abnormal, can state this in PE. State results of studies/labs obtained above.
Assessment/Plan:
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Assessment
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Identify Problem #1, give leading diagnosis. Briefly state evidence supporting this.
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State top 3-4 other leading diagnoses, with brief evidence against.
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Plan
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Diagnostic studies (completed or to do)
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Therapeutic plan
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Repeat for Problem #2, etc.
Time Frame: around 9 minutes total
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HPI: 2 min
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ROS, PMH, Meds: 30-45 sec
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SHx, FamHx, etc.: 15-30 sec
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Physical Exam: 60-75 sec
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Labs/Studies: 30 sec
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Assessment/Plan: 2-3 min
Practice, Practice, Practice! Present to your intern/senior resident before rounds, ask for feedback regularly, etc.
--Drs. Bergin and Mallin