Presenting as a student

[EMapplicant117]

When going through patient presentations as a student, is it looked down upon to use notes that you gathered while taking an H&P? I tried going noteless for one patient with poor results (lost train of thought, rambled). I ask this because most attendings and residents I see do not use notes. I was advised that I should start transitioning to noteless as well. Thoughts or suggestions?

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[shoal]

Use notes. No harm, you shouldn't be reading but using notes is completely acceptable.

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[shouldigomd]

It depends on the situation really. In some of my rotations residents often gave full H&P's with all the details. They had notes. Also keep in mind that as a student (at least in my case) you often don't follow through with patients as much as residents who usually see the patients from start to finish. Thus it is easier for them to remember more details and they are already much more familiar with the system than a student doing a 6 week rotation in something they have never really seen before.

In other rotations it was only mentioned what was important. Also in many cases the attending already knows the patient so they don't want the resident to go through the whole thing again. Anyway easy fix to your dilemma. I always write notes when taking an H&P. I have it and glance at it as i present my cases but usually I don't have to read it word for word and can be looking at the attending for most of it.

 

[Xerxes1729]

I don't think I've ever noticed whether a student presenting to me was using notes or not.

But I'm not really a good teacher. So take that into consideration.

 

[TraumaLlamaMD]

Start with notes - it's better than forgetting or rambling. You'll likely find, as I did, that you use them less and less as you go along. By 4th year I was almost always noteless.

 

[emergentmd]

When going through patient presentations as a student, is it looked down upon to use notes that you gathered while taking an H&P? I tried going noteless for one patient with poor results (lost train of thought, rambled). I ask this because most attendings and residents I see do not use notes. I was advised that I should start transitioning to noteless as well. Thoughts or suggestions?

As a student, start with notes. Students may understand the Kreb cycle, can recite diseases in detail but getting a concise history/exam and then giving a precise and pertinent presentation requires ALOT of experience.

As a resident, you should start to get rid of notes completely. When you are a 3rd year resident, All I need is a 1-2 sentence presentation. Such as.

"Mr DOE in bed 4 isa 60 YO male, anginal CP x 2 dys, pain free after ED treatment. Labs benign, EKG benign, pt stable. Will admit to Medicine" or
"Mr Doe in bed 4 is a 60 YO male, abdominal pain x 2 dys, benign exam, workup benign, pain free at this time. Will discharge with follow up"

As an attending, my notes now consist of a Sticker with the pts demographics, Labs I ordered, and each gets a neg sign when they come back. IF something is positive, I write a 1-2 word note (such as H/H low). My presentation to consultants is usully 1-2 sentences. I frame my presentation towards an admission. Such as. Bed 4, 70 YO male, hypoxia pneumonia, stable. Thats it. Consultants needs no more than that. They can pull up the labs/nursing notes if they want detail. MOST do not want anything in detail such as specific labs unless VERY peritent (such as CP with elevated trop).

You will get better. No reason to rush it. NO reason to worry about it. Most will get better as time goes by. Most will be able to handle 10-15 patients simultaneously without much notes at all. Most will be able to complete a chart without very little notes.

As an attending, if you are carrying a sheet of note per patient (I have seen this), you are likely doing something wrong and possibly not fit to be an EM doc.

 

[winkleweizen]

As a student, start with notes. Students may understand the Kreb cycle, can recite diseases in detail but getting a concise history/exam and then giving a precise and pertinent presentation requires ALOT of experience.

As a resident, you should start to get rid of notes completely. When you are a 3rd year resident, All I need is a 1-2 sentence presentation. Such as.

"Mr DOE in bed 4 isa 60 YO male, anginal CP x 2 dys, pain free after ED treatment. Labs benign, EKG benign, pt stable. Will admit to Medicine" or
"Mr Doe in bed 4 is a 60 YO male, abdominal pain x 2 dys, benign exam, workup benign, pain free at this time. Will discharge with follow up"

As an attending, my notes now consist of a Sticker with the pts demographics, Labs I ordered, and each gets a neg sign when they come back. IF something is positive, I write a 1-2 word note (such as H/H low). My presentation to consultants is usully 1-2 sentences. I frame my presentation towards an admission. Such as. Bed 4, 70 YO male, hypoxia pneumonia, stable. Thats it. Consultants needs no more than that. They can pull up the labs/nursing notes if they want detail. MOST do not want anything in detail such as specific labs unless VERY peritent (such as CP with elevated trop).

You will get better. No reason to rush it. NO reason to worry about it. Most will get better as time goes by. Most will be able to handle 10-15 patients simultaneously without much notes at all. Most will be able to complete a chart without very little notes.

As an attending, if you are carrying a sheet of note per patient (I have seen this), you are likely doing something wrong and possibly not fit to be an EM doc.

Agree with above with the one caveat, presentations can vary greatly depending on the attending. Some attendings are OK with a one sentence presentation and some still want the whole shebang despite me working with them for over two years now. It all depends on their comfort level.

 

[DeadCactus]

As a sweeping generalization I made up with no evidence or consensus input:
MS3 = Clipboard with a sheet of paper per patient.
MS4 = Sheet of paper folded in 4 with a square for each patient.
Intern = Sheet of paper folded in 8 with a section for each patient.
Resident = A list with a line per patient working toward a paper folded in half with a list on each side.

I will add the caveat that, at least from my personal experience, leaning on the crutch of taking lots of notes too hard interferes with building a cohesive story around the patient...