Year 2 Session 4: Presenting patients
Session 4
Presenting patients
Introduction (5 mins)
Activity 1: Case presentations: What, why, when and where? (15 mins)
Brainstorming exercise in which students define case presentations, identify why they are
used in practice, for whom, and the settings in which they take place.
Activity 2: Effective presentation skills (20 mins)
Students work in small groups to review features of effective presentation skills. This draws
heavily on work from 1st year.
Activity 3: Presenting patients (75 mins)
Students work in small groups and make a presentation to the rest of their group. Tutors
give feedback on content and performance.
Activity 4: Reflection on performance (10 mins)
Students complete a brief written reflection that aims to focus each student’s thoughts on
their own presentation skills. Not for submission.
Summary (5 mins)
Total: 130 mins
Session requirements
 Powerpoint presentation on CD ROM
 Videotape
 Blank OHPs and pens
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Year 2 Session 4: Presenting patients
Introduction
Until the current session, you have been learning how to interview patients as well as
considering the role of written communications in health care. This session aims to help you
with your presentation skills. The session concentrates on case presentations as you will
increasingly be called on to use these skills in clinical education. The principles of an
effective presentation can be generalised across all types of presentation. We draw on your
experiences from 1st year when you covered effective presentation skills as part of your
session on non-verbal communication.
Presenting patients is an essential skill for medical students to acquire not only to pass
examinations but as a life-long professional skill. Junior doctors will routinely participate in
case based discussions as part of their assessment in the Foundation Programme.
Aim
To provide you with an opportunity to practise presenting patients and reflect on the features
of effective presentations
Learning objectives
After this session, you should be able to:
 List the contexts in which you will present patients
 List reasons why oral case presentations are used in medical education
 Identify key aspects of effective presentations
 Outline your own strengths in presentation skills
 Identify areas in which your own presentation skills may improve
Activities
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Case presentations: what, why, when and where?
Effective presentation skills
Presenting patients
Reflection on performance
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Year 2 Session 4: Presenting patients
Activity 1: Case presentations: what, why, when and where?
Aim: To raise your awareness of the content, purpose, timing and context of a case
presentation
A case presentation is a verbal description of a patient and his/her medical problem.
Answer the following questions:
1. What topics are usually included in a case presentation?
2. Why are case presentations used in medical education?
3. What are the contexts in which case presentations take place?
4. Who attends case presentations?
5. Where do case presentations take place?
What topics are usually included in a case presentation?
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a description of the diagnosis (if known) and its presentation in the patient
clinical reasoning (how was the diagnosis confirmed - history, clinical tests)
treatment including pharmacological, surgical &/or other interventions
recovery (response to treatment - psychological and physiological)
discharge plan (ability of patient to manage)
notable points including features of the patient’s past medical history, occupation, unique
life experience etc.
However, content is context and audience specific.
Consider:
 omission of irrelevant material (for that audience)
 commence with a summary statement
 presentation has bearing on the present illness, relevant past medical history, social and
family history and systems review
 separate/distinguish subjective from objective data
 concise/compressed amount of facts
 present the most important information first
 similarities with written presentations
o an orderly, familiar organisational format
o a full characterisation of symptoms
o reconstruction of the patient’s narrative into a coherent description of an illness
There are different types of case presentations: bullet presentations (<1 minute) are
typically given either in stand-up ward rounds, in the corridor, or over the telephone. It is a
very brief description often used to introduce the patient briefly to a new audience.
Here is an example of the bullet
presentation. This could be over the telephone:
 “Mr Lucas is a 42-year-old journalist who presents with knee problems for three months
and was found for the first time to be hypertensive. As an enthusiastic jogger, Mr Lucas
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Year 2 Session 4: Presenting patients
is anxious to have the knee problem resolved.”
 “Mrs O’Connor is a 56-year-old widowed telephone operator with long-standing insulindependent diabetes who now complains of weekly dizzy spells over the past two
months.”
A formal case presentation (sometimes called the short case) (5-7 minutes) is usually
given to supervisors and colleagues at the bedside or in a sit-down conference.
A complete case presentation (sometimes called the long case) might last 10
minutes and will typically outline the written medical record. Junior doctors are expected to
make case presentations as part of the Foundation Programme.
Consider the limitations of the listener – clear; uncluttered; easily grasped; guided through a
reasoning process
Why are case presentations used in medical education?
One of the most frequent presentations that doctors are involved in is the case presentation.
It is the primary means by which clinicians convey information about patients to each other.
Medical education has a long history of apprenticeship-type education. That is, knowledge,
attitude and skills acquired by working alongside qualified practitioners. So, by observing
case presentations, students are expected to learn what it contains and the skills of making a
presentation (“See one, do one”).
What are the contexts in which case presentations take place?
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Vivas
Examinations
Seminars
Tutorials
PBL
Ward rounds
Grand rounds
Conferences
Communication skills sessions
Telephone calls
Opening for an extended discussion/teaching session
Obtaining consultation on a difficult/troublesome feature of a patient’s problem
Who attends case presentations?
Case presentations are an important forum for inter-professional communications:
Students, house officers, consultants, doctors, social workers, nurses, physiotherapists and
other healthcare professionals. Patients and their relatives may sometimes attend as well.
Where do they take place?
Wards, clinics and other healthcare settings, medical school
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Year 2 Session 4: Presenting patients
Junior doctors are expected to make case presentations as part of the Foundation
Programme in “Case based discussions”. This is an important part of your work. In these
assessments you will be expected to identify a patient for whom you have cared and use the
medical record to describe your actions and their rationale. You will be assessed on your
medical record keeping, your clinical assessment, investigation and referrals, treatment,
follow-up and future planning, professionalism and overall clinical judgement. Your assessor
will work with you to identify anything that you did which was especially good and make
suggestions for development. See www.mmc.nhs.uk
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Year 2 Session 4: Presenting patients
Activity 2: Effective presentation skills
Aim: To review features of an effective presentation
List the characteristics of effective presentations using the following headings as a guide.
Content
Presentation materials
Personal presentation
Content is context specific
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Introduce self and patient (using patient’s name only where appropriate)
State purpose of the presentation (context E.g. assess treatment, planning for
discharge, unusual medical problem etc.)
Present the information in a structured and logical manner (with flexibility to respond
to questions)
Emphasise notable points
Give specific information
Summarise key points
State if there are any outstanding issues or points about which you would like input
Clear statement of closure
Exclude jargon
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Year 2 Session 4: Presenting patients
Presentation materials - when making a visual presentation
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Overheads, slides, flip charts, multi-slide and sound system, computer presentations
etc
Legible to everyone in the audience (if audience is 10m away, use font size 5mm; 1015m, use 10mm; 15-20m, use 15 mm)
Consistent in appearance – colour, size, titles, style
Amount of information on each visual – 6 words per line; 6 lines per visual
Personal presentation
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Voice – clear and audible; neither too loud or too soft
Speech – speed – neither too fast or too slow; tone – varied to maintain interest
Eye contact – look at audience and engage them
Appearance should not distract the audience – hairstyles; keys/money jangling in
pocket etc.
Stature - hold yourself upright in a relaxed posture and facing the audience
Timing – start and finish on time
Rehearsing presentations is important. Consider doing this:
 In head
 Out loud
 On audio/videotape
 In front of colleagues
 On site
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Year 2 Session 4: Presenting patients
Activity 3: Presenting patients
Aim: To practise giving a case presentation
You will be divided into four groups.
It can be helpful to number students off as 1,2,3 and 4. Then all the “ones” work together, the
“twos” and so on. This ensures that students mix rather than just remaining with their friends.
All students watch a videotape of a medical interview. Within the four groups, students then
spend 35 minutes preparing one case presentation based on the interview.
Within the four groups, encourage students to nominate one or two presenters, who should
rehearse and give and receive feedback on their performance before returning to the large
group to demonstrate.
All students will be asked to nominate the best performance.
The context for the interview:
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You have just conducted an interview (imagine you were the interviewer as featured
in the videotape)
Your consultant will be here in 35 minutes and expects you to make a 5-minute
presentation to him/her
You may want to take notes while watching the video.
Each group has five minutes to make their presentation.
There is no set format for making a case presentation but the following structure might be
helpful:
 Identify date and reason for visit
 History
 Physical examination
 Lab Data
 Assessment
 Plan
The appendix contains a format for presenting written information about patients. This is not
necessarily how you would present information verbally. What differences might you need to
make?
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Year 2 Session 4: Presenting patients
Activity 4: Reflection on performance
Aim: To encourage you to take time to reflect on your strengths and weaknesses as a
presenter
You have ten minutes to reflect on your strengths and weaknesses as a presenter.
Not all students will have had a chance to present. However, you will all have had to present
information in some other forum.
Record their reflections below. You may be asked to share some of your writings with your
colleagues.
What do I usually do well when I make presentations?
What do I need to improve?
How am I going to improve?
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Year 2 Session 4: Presenting patients
Summary and review of learning objectives
 List the contexts in which you will present patients
Ward rounds, seminars, conferences, PBL etc.
 List reasons why case presentations are used in medical education
Long history of apprenticeship in medicine
Reflective
Assess practice – diagnostic skills, clinical decision-making etc
Foundation programme for junior doctors requires that case presentations are made several
times a year and will also be assessed
 Identify key aspects of effective case presentations
Content, aids, personal characteristics
 Outline your own strengths in case presentation
You may want students to identify a strength, a weakness and how they intend to improve
 Identify areas in which their own presentations may improve
Recommended reading
Billings J, Stoeckle J. The Clinical Encounter: A Guide to the Medical Interview and Case
Presentation. Mosby: St Louis. 1999, pp 294-305.
www.mmc.nhs.uk – See Case based discussions
Complete your reflective evaluation form
and submit before you leave the session
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Year 2 Session 4: Presenting patients
Appendix: Format for written case presentation
Name
Date of birth
Sex
Marital status
Address
Religion/spiritual beliefs
Ethnic background
Medical and surgical history
 Presenting complaint (confirm the presenting condition – site and side)
o History
o Symptoms
o Duration
o Onset
 Systematic enquiry of systems
o Cardiovascular
o Respiratory
o Alimentary
o Genito-urinary
o Central nervous
o Endocrine
o Locomotor
o Psychiatric/mental health
 Past medical history
o Previous illness episodes
o Previous treatment
o Previous anaesthetics and operations
 Difficulties with general anaesthetics (Mask ventilation or endotracheal
intubation)
Drugs
 Current medication – name, prescription, OTC or alternative remedies (always use
generic drug names), dose, frequency, allergies (including nature)
 Recent medication
Allergy history
 Substance – medications (antibiotics), foods
 Reaction
 Triggers for asthma and eczema
Personal and social history
 Occupation
 Hobbies
 Housing
 Level of independence
 Support from relatives, neighbours
 Support from social services
 Marriage
 Children
Lifestyle factors
 Alcohol
 Tobacco
 Drug use
Family history
 Number of siblings
 Inherited disorders (including reactions to general anaesthetic)
 Family illnesses
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Year 2 Session 4: Presenting patients
 Causes of death
Nutritional status
 Risk
 Need for intervention
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Year 2 Session 4: Presenting patients
Reflection and evaluation
Please help to identify the strengths and weaknesses in the CP by completing the following
evaluation form.
1. To what extent did you meet the following learning objectives?
a. List the contexts in which information about patients will be presented
Not at all
Partially
Completely
1
2
3
b. List reasons why oral case presentations are used in medical education
Not at all
Partially
Completely
1
2
3
c. Identify key aspects of effective presentations
Not at all
Partially
1
2
Completely
3
d. Identify personal strengths in presentation skills
Not at all
Partially
1
2
Completely
3
e. Identify areas for development in presentation skills
Not at all
Partially
1
2
Completely
3
2.
How effective do you think the following educational techniques were in relation to
meeting the learning objectives?
a. Session notes
Not at all
1
Partially
2
Completely
3
b. Discussion to identify presentation skills
Not at all
Partially
1
2
Completely
3
c. Student presentation of patients
Not at all
Partially
1
2
Completely
3
d. Summary and reflection
Not at all
1
Completely
3
Partially
2
Please record any other comments below.
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