Everytime I am asked a question by my attending I get nervous and end up looking like a deer in a tractor trailers headlights. Same when I am presenting a patient. I know the order of presentation but when I actually have to do it, my mind starts racing and I skip around and end up sounding like a moron. UGH.
It just takes time. With practice everything will flow. I still fumble with questions, even when I know what they are talking about (which thankfully is not as rare in final year). Sometimes it helps to just take a deep breath and collect your thoughts before answering. Also, some Doctors can be intimidating so just look away for a second. This helps me when I'm presenting histories. Obviously you have to glance at the Doctor every now and then but usually i'm focusing on the patient. I usually present to the other students too so I have everything straight, plus that way we get to know all the patient's on the ward without having to personally see them.
Take a deep breath and slow down. Go one step at a time. "Mr. Smith is a 56 yo male who presented last night complaining of shortness of breath." then focus on the next item (HPI) ... once that is done, pause, focus on the next item (PMH, PSH, etc). Focus on what you are currently presenting, then pause, gather your thoughts (or look down at the H&P), and then proceed to the next step. Trying to do too much or rushing things will lead to disorganization and your presentation will make absolutely no sense to the residents and attending. Don't worry if you forget to mention important details ... your intern or resident will jump in if it is important (ie if you forget to mention that the person has Stage 3 COPD with a FEV1 and FVC of blah) As for questions ... a good way to buy some time is to repeat the question. Often I see students NOT answer the question (and answer what they think the question was). And don't worry - most students at the very beginning of their clinical rotation sucks ... but you will get better.
Its amazing how we can spend undergrad and the 1st 2 years of medical school learning these incredibly complex and intricate mechanisms and quite easily regurgitate them on a test but when we get to the wards and are asked a relatively straight forward question we sound like bumbling idiots. Most of the pimping questions are usually basic and things we should know.
this is good advice because it really is true. no one (and I mean no one) ever presents a patient perfectly, especially during their first junior year rotation. don't be too hard on yourself. just keep practicing, and perhaps write little notes to yourself about things you think you need to work on. if possible, ask a resident or attending about how you can do better. they do appreciate initiative, and it makes you look good, overall
It's often because (1) public speaking doesn't come naturally to a lot of people, and (2) the stakes are higher, in a way (or at least a mere "pass" on any given clinical rotation seems much worse than a "B" in an undergrad class).
hey cerb, it takes a while, but you'll get there. For patient presentations practice helps. Go over the H&P enough times that you can go through it in your head without notes on your way into the hospital. That way if you get flustered on rounds you can take a deep breath, remind yourself that you know it backwards and forwards, and let it flow. Also resist that temptation to jump around. Even if nothing you say is particularly brilliant, if it is ORGANIZED and people can follow it you're 95% of the way to a good presentation. As for getting asked questions, I had two different strategies depending on whether I was on the floor or in the OR. On the floor you just need to keep talking until you hit on something that your attending would like to talk about. If you don't know the answer to the exact question the attending asks, start talking about a related subject you can say something intelligent about. This will calm you down and you may remember the answer to the question he actually asked. Alternatively, you'll say something that interests him and he'll start talking about it himself. If this doesn't happen, try to ask the attending a question of your own and try to make it as nuanced and academic as possible (this is essential, if it's a simple question he'll just ask you for the answer). You may also want to review this great article about the art of surviving the PIMP http://www.neonatology.org/pearls/pimping.html For the OR, surviving questions is even easier. Again, if you don't know the answer per se, start talking about a related topic you do know something about. Repeat as necessary until something starts bleeding and takes their attention away from you. By the time the complication is resolved they will have forgotten you were talking in the first place. good luck, I'm sure you'll find your voice eventually cerb!
Try looking at it as telling a story about the patient rather than as a presentation. Try to tie things together in your mind to paint yourself a good picture of the patient - for example, if the patient is admitted for an MI, it fits that the patient is also a diabetic, has HTN, and is a long-time smoker. It also makes sense that he's on anti-hypertensives and possibly anti-lipid meds. In otherwords, make sure you yourself know the patient inside and out. That's important both as a third year and beyond. Next, practice your presentation over and over again until it flows off your tongue and you're not reading it off a piece of paper. I actually found memorizing the presentations helps make the presentations go smoother on rounds. Since you're just starting out, you could try just memorizing as much of the HPI as possible and bullet point the rest onto an index card so you can use it as a reference the next morning for rounds. Again, the goal during rounds is to tell a succinct story of the patient in the proper order that the attending wants it in. Some residents and attendings also suggest practicing a couple times in front of a mirror, so you can try that too. Good luck! You'll get the hang of it!
Try this: "Mrs. X is a 47 y/o WF with a history of R breast cancer s/p MRM for which she is followed by [university hospital] surg onc. Today she is POD#2 from a pedicled TRAM. She states that her pain is well controlled with PO Percocet. She remains afebrile with stable vital signs and no laboratory abnormalities. On physical exam her flap is warm and pink with good cap refill and no signs of infection. The donor site is clean, dry and intact. Plan is to discharge home with follow-up in our clinic." Takes 5 seconds. You don't like 30 minute patient presentations? Hate rounding for 12 hours? Don't care that your patient has a family history of ADHD in her 3rd cousin or that she had mono in high school? DO SURGERY!
What helped me was realizing that some attendings can be antagonizing and that they will never, ever give you the benefit of the doubt. Trying to please some of the more toxic personalities in the profession is futile if not dangerous. Just do your job and change what they want you to change. Never let them get the best of you and never let them see that you are nervous or upset. That's blood in the water. Some bullies get their kicks from tearing into terrified med students. I think when you have very little clinical experience, it's difficult to determine what is important and what is not. Our presentations can seem a little redundant even when they are otherwise flowing and logical. We're taught over and over again in years one and two to leave behind no salient details of the case, but many an attending on rounds wants to hear just the most important information. "Should I say this is an 86 y/o M w h/o CAD presenting with abd pain, or should I wait until PMH to mention CAD along with everything else he has???" Can be tough for a new student to sort these sort of questions out. Some attendings don't believe in a differential diagnosis. Some don't want to ever hear about anything besides HPI, PMH, Meds and Allergies. Some just want you to spout the diagnosis without providing any background information, and then proceed directly to overnight events and plan. Others actually expect you to report every positive and negative finding on the review of systems and will all but hit you for leaving out parts of social and family history. Some are really into teaching but expect everyone to present exactly the same way they present and obsess over style. Some have zero interest in being your teacher and are in a hurry to get back to their office, leave work, etc. You can't do anything in their mind but waste their time. Their reactions vary: some teachers understand that you're a beginner and allow you to present the way you were taught. Some allow for mistakes. Some of them guide you with constructive criticism. Others interrupt you every other second, roll their eyes, and slam the hell out of you in front of the group and on evaluations, even if it was your first rotation. My solution was to stop caring about negative attitudes and gestures on rounds and focus on myself. Do what I was taught. Correct my mistakes. Maintain eye contact with the boss. Speak loud and don't drag on. Answer questions in a word or two, or say "Don't know." If they try to bully you, stand your ground but keep answers short and keep eye contact. They won't enjoy it as much and subsequently stop picking on people. Sometimes, the residents appreciate this, especially if they're also targets. These modifications to my own behavior earned me my favorite comment on all of my evals... "not afraid of attending," in reference to a particularly intimidating person we all had to work with. Had some attendings tell me I don't know how to present a history (this was early on and they were probably right). Had several other attendings, residents, etc tell me I present well enough. Had a chief stop rounds and have everyone listen to my presentation cuz that was "exactly what I'm expecting." Everyone's different. 3rd year = getting along with people. Can't please em all.
