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I'm doing peds and asked for feedback on how I'm doing. My attending's response was imroving how I present my patients. Any advice/suggestions
help with presenting patients
- Thread starter kanyanta
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my advice is to learn how to tailor your presentation to the situation. learn how to make a one line summary, a 2 minute presentation, a 4-5 minute presentation, and a 7+ minute ICU presentation. one of the most annoying things is hearing a medical student talk 10 minutes for something really basic, painfully going over all the negative exam findings and listing off serum electrolytes one by one. for example if you have an ICU presentation, know everything and go over your plan by systems. however, if your patient basically has a few hours left to live, it's probably not the best idea to talk about prevacid and sequential compression devices for prophylaxis, or painfully going over their respiratory rate. if the RR has been 14-18 in the past 12 hrs, no one wants to know that it was 16 an hour ago, and 14 two hours ago, or 18 three hours ago.
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The above poster offers a very good suggestion with the practice a two minute presentation. I find most attendings are good for about two minutes, and then they just want to go and see the patient.
That's too bad your attending didn't give you more to go on than just "improve your presentations." But here are some things that I learned that served me well.
The attending really needs you to paint a picture of "sick versus not sick." And in order to do that, he needs some history. Of course, in most kids, that's almost nothing, unless there were significant issues with the pregnancy or birth. So always remember:
Birth history is important.
Immunization status is important.
Past illnesses are important (not every little cold, but if a three year old has RSV twice and 8 ear infections a year, that's pointing to a problem.)
Behavioural issues are important (we don;t hospitalize kids with gastroenteritis because we want the whole hospital and staff to get rotavirus. really. We do it because kids who are sick and vomiting and have diarrhea stop drinking and get dehydrated...and need IV fluids. So part of your algorithm for "admit or not" is behavioral.
So, here goes.
This is a four year old male child with chief complaint of cough and fever. His mother states the fever has been present for three days and rages from 10.5 to 101.7. He also has a harsh cough with yellow sputum. He was born premature at 32 weeks and was in the NICU for six weeks; one week on a ventilator. He has had RSV and pneumonia twice, requiring hospitalization. He also was diagnosed with asthma and uses a nebulizer twice a day, almost every day.
OK, you might not get that much info all the time. But really,look how much info you did give. Obviously this is a sick child who has a history of bad upper respiratory stuff. So you can sort of predict what the outcome will be (you bought him a bed).
A big part of it is just time and practice. Don't get flustered, try to know the important stuff about your patient, and you will be fine.
That's too bad your attending didn't give you more to go on than just "improve your presentations." But here are some things that I learned that served me well.
The attending really needs you to paint a picture of "sick versus not sick." And in order to do that, he needs some history. Of course, in most kids, that's almost nothing, unless there were significant issues with the pregnancy or birth. So always remember:
Birth history is important.
Immunization status is important.
Past illnesses are important (not every little cold, but if a three year old has RSV twice and 8 ear infections a year, that's pointing to a problem.)
Behavioural issues are important (we don;t hospitalize kids with gastroenteritis because we want the whole hospital and staff to get rotavirus. really. We do it because kids who are sick and vomiting and have diarrhea stop drinking and get dehydrated...and need IV fluids. So part of your algorithm for "admit or not" is behavioral.
So, here goes.
This is a four year old male child with chief complaint of cough and fever. His mother states the fever has been present for three days and rages from 10.5 to 101.7. He also has a harsh cough with yellow sputum. He was born premature at 32 weeks and was in the NICU for six weeks; one week on a ventilator. He has had RSV and pneumonia twice, requiring hospitalization. He also was diagnosed with asthma and uses a nebulizer twice a day, almost every day.
OK, you might not get that much info all the time. But really,look how much info you did give. Obviously this is a sick child who has a history of bad upper respiratory stuff. So you can sort of predict what the outcome will be (you bought him a bed).
A big part of it is just time and practice. Don't get flustered, try to know the important stuff about your patient, and you will be fine.
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kanyanta said:
how about asking your attending what he/she thinks is important?
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automaton said:
I really wish medical students made there presentations succint and to the point!!!
I hate listening to some of these students read every single line and miss the most pertinent info about a case.
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dont worry, as a 3rd year they expect you to not get it right the first time. heck, even as a 4th year sometimes i dont even get it right. just keep at it and youll get a lot better. some suggestions are listen to the residents when they present and then tailor your presentations to fit theirs. different attendings will have their own preferences about what they want to know, unfortunately its really subjective and you have to kinda figure out what they want.
the pointers others gave are very good in that keep your presentation short and give the attending an overall picture of the patient. some attendings will want all the numbers, some wont and will be satisfied with a phrase like "cbc and chemistries are within normal limits" you just have to figure out what they want. when you get to surgery they will want very short presentations, but on peds you can take your time and learn how to do it the loooong way.
a lot of it is just getting used to the attending, so dont beat yourself up over it if youre not hitting the ground running.
the pointers others gave are very good in that keep your presentation short and give the attending an overall picture of the patient. some attendings will want all the numbers, some wont and will be satisfied with a phrase like "cbc and chemistries are within normal limits" you just have to figure out what they want. when you get to surgery they will want very short presentations, but on peds you can take your time and learn how to do it the loooong way.
a lot of it is just getting used to the attending, so dont beat yourself up over it if youre not hitting the ground running.
