Great advice above. Another thing to keep in mind is that every attending has their own preferences. DocIvy's style is to just mention pertinent positives/negatives on the vitals and exam, some people like all the vitals and general exam findings every day, some people like "vital signs stable". So don't beat yourself up if you're corrected about these things-- just pick something to start with and adapt quickly.
I'm not a natural public speaker myself, and my first presentations were pretty painful. I also memorized a "skelleton" presentation and transition phrases to help get from one part to another. I would use my H&P to make a large notecard with an outline of everything I was going to say, then practice once or twice. Inside the skelleton, think about telling a coherent story that can "sell" the A/P by mentioning items that are pertinent to the ddx. Also, try to get all of the really pertinent facts in early... much like the rhinoseros in that old far side cartoon, attendings do not like surprizes. Here's my outline:
H&P:
CC/Reason for admission:
Mr. x is a 67 y/o man with a PMH significant for (add pertinent items and chronic conditions like DM, HTN, etc), who (explain in 1 sentence what the cheif complaint is, and how they got from home to the admission... such as "came to ED with SOB 4 days ago and was admitted to the CCU for management of an anterior MI, now transfered to medicine."
In his usual state of health, Mr X *** (explain what the person was like before the sx started that brought him/her to the hospital).
3 weeks ago, he began to notice **** (then tell the story of what happened to bring the pt to where he or she is now).
Otherwise, he notes no leg edema, palpitations... (give a breif, pertinent ROS).
In the ED, he was given *** (give a breif ED or ICU course.)
PMH:
In his past medical history, Mr. X has (list in order of relevance to the CC and give pertinent facts about each. In medicine, I list surgeries here as well.)
Medications:
His medications include **** (This makes more sense to the listener after the PMH).
Allergies: He is allergic to X which causes Y.
SH and habits:
Mr x lives in Honolulu with his wife and 7 children. He works as a landscaper. He has a 12 pack year smking history, and drinks 1 glass of beer/night ... etc.
FH:
In his family hx, Mr. X's mother died at 55 of CLL, and his father died at age 72 of an MI. He has 2 siblings who are ***....
ROS:
On ROS, Mr. X notes L arm pain at his IV site. ROS is otherwise negative. (Everything important should be in the HPI).
Vitals: (Pick a style-- list everything, pertinent only, VSS...)
Exam: (same thing-- I always say at least a few words for the general impression, HEENT, resp, CV, GI, and extremities, and expand on anything else for pertinent + or - findings.)
Labs: (I was taught to always list the WBC count, Hct, platelets, Na, K, BUN, and Cr in that order, then list anything else relevant.)
A/P: So in summary, this is a (repeat same 1-line sentence you began with, plus the major points of other findings from your H&P. "a 67 y/o man with a PMH significant for DMII and HTN admitted with and anterior MI and a UTI.
(then list your plan by system if in the ICU or on general medicine if they are complicated and by problem if in general medicine)
1. Anterior MI - **
2. UTI - **
3. ...
have fun-- it definitely gets easier!!
