Oral Case Presentation 2024 PDF

Introduction to The Oral Case Presentation Lauren Clemmons, DO, FACOFP [email protected] Objectives Describe the components of the oral case presentation. Describe the elements of a good oral case presentation. Describe some of the common pitfalls of the oral case presentat...

Introduction to The Oral Case Presentation Lauren Clemmons, DO, FACOFP [email protected] Objectives Describe the components of the oral case presentation. Describe the elements of a good oral case presentation. Describe some of the common pitfalls of the oral case presentation. Demonstrate good oral presentations skills given a sample case. Perform self-reflection to identify areas for improvement in your oral presentation skills. 2 The Oral Case Presentation A Good Oral Case Presentation… Tells the patient’s story Paints a picture of the patient for the listener Follows a logical format Is organized and concise Uses standard medical terms Demonstrates professionalism 3 The Oral Case Presentation Is NOT A recitation of your SOAP note Is Concise Edited Essential information Memorized as much as possible 4 The Oral Case Presentation May vary depending on: Setting Hospital rounds – short Conference presentation - longer Audience Specialty Interprofessional team Urgency Clinical situation New patient Follow-up Transition of care Shift change/evening sign-out 5 The Oral Case Presentation: Components The Introduction (includes chief concern) History of the Present Illness PMSFH ROS Physical Exam Labs, imaging, and other test results Assessment Plan 6 The Introduction A one sentence description of the patient and the reason prompting their evaluation Should contain the patient’s identifying data (name and age), chief concern, and any other agenda items Should set the stage for the rest of the presentation Example: Mr. John Jones is a 56-year-old man with a past medical history of hypertension and diabetes who presented toto the ED last night feeling “like an elephant was sitting on my chest”. 7 Introduction Mneumonic C character, circumstances L location – deep or superficial, well or poorly localized E exacerbating factors A alleviating factors R radiation of pain A associated sx S severity on a 1-10 scale T temporal features - timing (intermittent/constant), duration, frequency, changes over time (progressive, stable or improving) 8 History of the Present Illness (HPI) The major focus of the presentation Must include all essential elements: OPPQRRSTA Tell the story in chronologic order, not as it was told to you Can include pertinent positives and negatives from ROS to make your case Can include baseline functional status (previously healthy, for example) When multiple problems exist, begin with the most important. “Mr. Jones had been feeling fine until yesterday about 5 p.m. when he was push mowing his yard and the chest discomfort started. It was about a 7/10 at onset and dropped to a 5/10 after a few minutes rest. It radiated to his left arm and jaw. He describes the pain as a pressure and tightness. His wife gave him an aspirin which did not help and so she drove him to the ED. He did experience nausea and diaphoresis at symptom onset…” This will get easier with time, clinical experience and practice!! 9 Past Medical History- “Significant” Problems List all medical problems starting with most important and/or Use chronological order May need to be Specialty specific (Pediatrics and OB additional info) “Mr. Jones has a history of uncontrolled hypertension and diabetes for 15 years.” 10 Past Medical History- Medications/Allergies Report all current medications along with dose, route and frequency: “Mr. Jones takes Metformin 1000 mg by mouth BID and Celebrex 200 mg by mouth once a day.” Report allergies including reaction: “Mr. Jones has no known drug allergies” or “Mr. Jones is allergic to penicillin which causes a rash” 11 Past Medical History- Surgeries/Hospitalizations Report all surgeries and hospitalizations. Note: This may vary by attending on clerkships. “His surgical history is remarkable for a cholecystectomy in 2001. Outpatient, no complications. No previous ER visits or hospitalizations.” 12 Social History Always report tobacco, alcohol, and illicit drug use history. Report pertinent/relevant additional information- work, exposures, diet, activity, caffeine, home life (if not already reported with HPI). Which of these should these be mentioned for Mr. Jones? Past smoking history of 40 pack years Drinks a glass of wine with dinner Went to Auburn University Has a new puppy Eats mainly fast food You get to decide!! Doesn’t exercise Does it help with the diagnosis? The plan? Happily married Take advantage of our Small Group case days. 13 Family History Highlight diseases that may be related to the Chief Concern Think: What’s most important in this case? Heart disease, osteoporosis or breast cancer? You do not have to share the entire family history even if you gathered it. Do NOT say “Family history noncontributory” “Mr. Jones’ parents both have significant heart disease. His father had his first MI at age 55 and his mother has congestive heart failure. His younger brother is 52 and had an MI at age 50.” Mr. Jones’ mom may have a history of osteoporosis and breast cancer also, but you can leave that out of your presentation. 14 Review of Systems Will vary by presenting complaint Relevant ROS only Include pertinent positives and negatives You can exclude symptoms reported in the HPI May want to say “As above plus” or “Also positive for” Do NOT say “Review of Systems was negative” List the symptoms that you asked Your listener needs to hear your thought process “Review of systems was also positive for weekly headaches and intermittent diarrhea. Patient currently feels very tired. He denies fever, chills, recent change in weight, cough, leg swelling, or vomiting.” 15 Physical Examination Follow a familiar and logical format (like SOAP note) Start with vital signs and general appearance Give pertinent present and absent exam findings Report in head-to-toe order Focus on findings that help establish or exclude a diagnosis. Avoid phrases like these: “Vital signs are normal.” “Physical exam was unremarkable.” Vital Signs: BP 120/72, HR 82, RR 16, T 98.6, O2 Sat 98% on RA Appears comfortable, but tired Heart exam: Regular rate and rhythm without murmur, gallop, or rub. PMI non-displaced. Breathing is even and unlabored. Lungs are clear to auscultation bilaterally. There is no pitting edema of the lower extremities. 16 Labs, Imaging, and other test results Mention all tests that are pending/performed. Labs Report all abnormal lab findings with specific values. “Hemoglobin is low at 10.1” You can group the normal labs together. “WBCs, Platelets, Sodium, Potassium, and Creatinine all within normal range” Report labs that are still pending “Blood cultures are still pending.” Imaging Use radiologist’s “official” wording when possible. Identify your interpretation as your own, to be confirmed later. EKG Interpretation Rate, rhythm, axis, intervals, identify specific abnormal findings Avoid saying “EKG was normal” Make sure to report pertinent normal findings. In our case, for example, EKG with NSR, no ST changes, No Q waves, etc. should be reported. These are all reported AFTER you report the physical exam findings. 17 The Assessment Identify all major problems relevant to the patient’s visit Chest Pain HTN Diabetes Suggest differential diagnosis for chief concern “Chest Pain: MI vs. PE vs… Assessment should be congruent with history, physical examination, labs and other diagnostic results Don’t try to “look smart” by putting unrealistic options For an OSCE, you would generally present the working diagnosis or the plausible diagnoses that you are considering. 18 The Plan Plan should reflect the assessment Include an action step to address each item on Problem List Meds Tests Fluids OMT Include contingencies – “what if” “If patient not responding to xxx, will consider yyy…” 19 Tips for Great Presentations Engage your listeners Make the patient come alive Speak crisply and clearly Not too fast or too slow Use positive statements Practice and review your presentations Self-assessment Seek feedback Peer assessment Be as brief as possible without omitting necessary information Goal: 4 minutes or less 20 Pitfalls to Avoid: Non-Standard Medical Terms Some abbreviations are appropriate for use in both oral and written presentations. CHF, MI, RA Other abbreviations are by convention only used in written form. DM, s/p, RRR Be sure you use medical language! “On his belly exam,…” or “previous heart attack” versus “On abdominal exam,…” or “previous myocardial infarction” 21 More Pitfalls Slow labored rhythm HPI too brief – 1/3 to ½ time of presentation Failure to use parallel reference points – no specific days/dates Editorializing in the middle of the presentation (want to hear, I thought I heard, but X didn’t…) Use of negative statements instead of positive statements Repetition – vary sentence structure (PE) Disorganization Physical findings presented without proper terminology Diagnoses used instead of descriptions in the physical examination (description vs. type of murmur) 22 Pitfalls to Avoid: Non-Professional Behavior Avoid stereotypes and negative biases that can adversely impact patient care. A positive tox screen on a prior admission doesn’t mean the patient is a “drug seeker” this time Try not to let your feelings influence your presentation. Separate the personality from the problem. Refer to patients as Mr., Mrs., or Ms. unless the patient expressly requests otherwise. Remember to always ask the patient’s preference. Make sure you respect patient privacy and confidentiality when presenting. Hallway presentations should be done with a low voice, away from other patients or families. 23 The Oral Case Presentation: Components The Introduction (includes chief concern) History of the Present Illness PMSFH ROS Physical Exam Labs, imaging, and other test results Assessment Plan 24 Oral Presentation Example Mr. John Jones 25 Additional Resources 26 27 Small Groups Small Groups tomorrow in Small Group Rooms Practice oral case presentations! Continue to work on developing an assessment and plan. Review posted document to find your assigned case number. Review case prior to small group, you may bring notes. Be prepared to present case to the group and critique others’. 28 Questions? General course or grading questions? ACOM PCS Course Director email: [email protected] Office hours available by appointment: Lauren Clemmons, DO [email protected] 29