worried about my patient presentation skillz

[Aclamity]

So I'm a few weeks into my FM rotation (1st rotation) and I'm still having some trouble with presenting patients. I've never been amazing at impromptu stuff, and started stumbling around with it at the beginning. I feel like I'm getting better, but I'm nowhere near as good as I want to be in terms of naming all the pertinent positives/negatives, knowing where to incorporate different pieces of info (in the HPI or save it for later), or just making it flow and not sound so n00bish.

I'm worried that FM is the time when everyone begins to hone their presentation skills (because of the significantly larger patient load than in IM) and I feel like I've wasted it just learning the basics. Also contributing to the problem is that I'm usually seeing patients at the same time as my attending, so I usually have like 10 seconds to prep my presentation before I give it.

My question is: at what point--or rotation--during third year (or fourth year) did you feel much more confident about presentations? FM or IM?

Also, why are they PGY1s able to present so seamlessly like a bunch of pros?? I know they have 2 years on me, but the way I see it, FM is really my only opportunity over the next 2 years to get any sort of experience with outpatient problems. And I'm definitely nowhere near their level.

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[45408]

Haha, the PGY-1's are not able to present like pros. They're just better than the students.

Your presentation skills probably peak in the middle/end of your intern year or second year and go downhill after that. Part of the reason is that by then, your senior residents/attendings trust that you've asked/assessed a lot of things that you're not bothering to mention, so your presentation is pretty brief. Attendings often give terrible presentations to each other! "Yeah, got this guy, perfed diverticulitis, pelvic abscess, gonna see if IR can drain him, otherwise we're just watching him." That might be the entirety of the presentation...


To answer your question, I started feeling better about patient presentations after several months of rotations, probably.

 

[diagonal]

The formality of med student presentation sucks and I never got used to it. Especially when you have some FOB attending that blankly stares at you throughout the entire process without giving any non-verbal feedback. It also doesn't help that as a third year it feels very forced to start saying all this nonsense that you know is basically unimportant, but you have to play the game and awkwardly dance through the routine.

It's much easier when you have an attending that isn't so stupidly rigid and allows you to explain things in a manner that is consistent with your personality. Then it becomes more of a conversation.

 

[armybound]

My experience was that the FM attending was too busy for me to give a real, formal presentation. You'll get a lot more experience on medicine, neuro, and peds.

It will come, don't worry.

 

[OveractiveBrain]

My experience was that the FM attending was too busy for me to give a real, formal presentation. You'll get a lot more experience on medicine, neuro, and peds.

It will come, don't worry.

As an M4 my FM preceptor handed me a perscription pad (already signed) and said "these are your rooms." I asked him if he wanted me to present to him, and he just said to move patients through... Maybe I impressed him with my ability to speak english, or something, but there was no presenting on FM.


Obviously it is going to be school dependent. Students learn how to present on my IM rotations. That is one of the few goals I have for them; clinical reasoning, and to show that they have it, their oral presentations.

And hell, I was confident on my medicine rotations, only to realize how foolish I was when I became an intern. THEN i was confident in my presentations, only to realize how foolish that was when I came closer to resident. The reason why our training is so long is because what we do is so hard. Speak with confidence, not because you have it, but because people will listen to you more if you do.

Most importantly: if you have the data in an organized fashion, you are about 150 paces ahead of everyone else.

 

[tco]

I just finished the first month of my family medicine rotations. I feel that it was a fantastic mix of clinic and wards, and was great to start off on. At the beginning, I had no clue what I was doing with my presentations (started in clinic). It took around a week to get some kind of feel for what the attendings want when you present to them. Wards was slightly different, as it's usually just recaps of what happened to your patient(s) overnight, but it's the same general idea. Subjective, Objective (including labs), Assessment/Plan.

As an M4 my FM preceptor handed me a perscription pad (already signed) and said "these are your rooms." I asked him if he wanted me to present to him, and he just said to move patients through... Maybe I impressed him with my ability to speak english, or something, but there was no presenting on FM.


Obviously it is going to be school dependent. Students learn how to present on my IM rotations. That is one of the few goals I have for them; clinical reasoning, and to show that they have it, their oral presentations.

And hell, I was confident on my medicine rotations, only to realize how foolish I was when I became an intern. THEN i was confident in my presentations, only to realize how foolish that was when I came closer to resident. The reason why our training is so long is because what we do is so hard. Speak with confidence, not because you have it, but because people will listen to you more if you do.

Most importantly: if you have the data in an organized fashion, you are about 150 paces ahead of everyone else.

This is the feedback that I received. The bar is set very low for us as third years. I don't know if I'm "ahead of the curve" or of the attendings were just exceptionally nice, but they consistently complemented me on my organization during presentations. Based on this feedback, I'm thinking that's what they care about the most.

My advise is 1. Pertinent things ONLY. 2. Try to correlate things from the ROS into the HPI if presenting a patient, but don't drag in physical exam findings. For example, when presenting a patient with chest pain, be sure to mention nausea, vomiting, diaphoresis, etc. I realize that it's probably something that you do during your H&P write up, but it's very easy to forget when presenting. 3. Notes are okay, at least for lab values. Don't try to memorize everything. 4. Be familiar with your patients on wards, don't memorize their story. If you spend enough time with them, you'll remember their story well enough to not need notes when presenting their history.