How to Master Oral Case Presentations

 

HPI:

  • Goals:  accurate, chronological, concise, builds an argument

  • Two paragraph method:

    • Paragraph 1:   Chronological history

      • Characterize the pt’s complaint (chronological story); use this to mentally generate & help your listeners to generate a top 5 DDx.

    • Paragraph 2:   Symptoms, risk factors, PMH relevant to the DDx

      • Discuss the Sx/ROS that would argue for/against each item in your DDx.

      • Discuss any risk factors/PMH that would argue for/against each item in your DDx.

ROS:

  • If pertinent to CC, include in Paragraph 2 of HPI.  Otherwise, state here if will be on the problem list.

PMH, SHx, FamHx, etc.:

  • Should NOT be a regurgitation of the note (we’ll read that later)

  • 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)

  • 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:

  • List names (be prepared to give doses/frequency if asked).  Indicate if recent change/problem.

Physical Exam:

  • Report positive or negative findings related to most likely diagnosis

  • Report pertinent positive or negative findings that argue for/against other possible diagnoses in top 5

  • Report any other significant (abnormal) exam findings (will it be on the problem list?)

Diagnostic Studies:

  • Report labs/studies that argue for/against the most likely diagnosis

  • Report labs/studies that for/against other possible diagnoses in top 5

  • Are there any other abnormal labs or studies that we will think/worry about or address?

ED Course:

  • 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:

  • Assessment

    • Identify Problem #1, give leading diagnosis.  Briefly state evidence supporting this.

    • State top 3-4 other leading diagnoses, with brief evidence against.

  • Plan

    • Diagnostic studies (completed or to do)

    • Therapeutic plan

  • Repeat for Problem #2, etc.

 

Time Frame:  around 9 minutes total

  • HPI:  2 min

  • ROS, PMH, Meds:  30-45 sec

  • SHx, FamHx, etc.:  15-30 sec

  • Physical Exam:  60-75 sec

  • Labs/Studies:  30 sec

  • 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