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The Ultimate Patient Case Presentation Template for Med Students

by Neelesh Bagrodia
Apr 06, 2024
Reviewed by: Amy Rontal, MD

Knowing how to deliver a patient presentation is one of the most important skills to learn on your journey to becoming a physician. After all, when you’re on a medical team, you’ll need to convey all the critical information about a patient in an organized manner without any gaps in knowledge transfer.

One big caveat: opinions about the correct way to present a patient are highly personal and everyone is slightly different. Additionally, there’s a lot of variation in presentations across specialties, and even for ICU vs floor patients.

My goal with this blog is to give you the most complete version of a patient presentation, so you can tailor your presentations to the preferences of your attending and team. So, think of what follows as a model for presenting any general patient.

Here’s a breakdown of what goes into the typical patient presentation.

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7 Ingredients for a Patient Case Presentation Template

1. the one-liner.

The one-liner is a succinct sentence that primes your listeners to the patient.

A typical format is: “[Patient name] is a [age] year-old [gender] with past medical history of [X] presenting with [Y].

2. The Chief Complaint

This is a very brief statement of the patient’s complaint in their own words. A common pitfall is when medical students say that the patient had a chief complaint of some medical condition (like cholecystitis) and the attending asks if the patient really used that word!

An example might be, “Patient has chief complaint of difficulty breathing while walking.”

3. History of Present Illness (HPI)

The goal of the HPI is to illustrate the story of the patient’s complaint.

I remember when I first began medical school, I had a lot of trouble determining what was relevant and ended up giving a lot of extra details. Don’t worry if you have the same issue. With time, you’ll learn which details are important.

The OPQRST Framework

In the beginning of your clinical experience, a helpful framework to use is OPQRST:

Describe when the issue started, and if it occurs during certain environmental or personal exposures.

P rovocative

Report if there are any factors that make the pain better or worse. These can be broad, like noting their shortness of breath worsened when lying flat, or their symptoms resolved during rest.

Relay how the patient describes their pain or associated symptoms. For example, does the patient have a burning versus a pressure sensation? Are they feeling weakness, stiffness, or pain?

R egion/Location

Indicate where the pain is located and if it radiates anywhere.

Talk about how bad the pain is for the patient. Typically, a 0-10 pain scale is useful to provide some objective measure.

Discuss how long the pain lasts and how often it occurs.

A Case Study

While the OPQRST framework is great when starting out, it can be limiting.

Let’s take an example where the patient is not experiencing pain and comes in with altered mental status along with diffuse jaundice of the skin and a history of chronic liver disease. You will find that certain sections of OPQRST do not apply.

In this event, the HPI is still a story, but with a different framework. Try to go in chronological order. Include relevant details like if there have been any changes in medications, diet, or bowel movements.

Pertinent Positive and Negative Symptoms

Regardless of the framework you use, the name of the game is pertinent positive and negative symptoms the patient is experiencing.

I’d like to highlight the word “pertinent.” It’s less likely the patient’s chronic osteoarthritis and its management is related to their new onset shortness of breath, but it’s still important for knowing the patient’s complete medical picture. A better place to mention these details would be in the “Past Medical History” section, and reserve the HPI portion for more pertinent history.

As you become exposed to more illness scripts, experience will teach you which parts of the history are most helpful to state. Also, as you spend more time on the wards, you will pick up on which questions are relevant and important to ask during the patient interview.

By painting a clear picture with pertinent positives and negatives during your presentation, the history will guide what may be higher or lower on the differential diagnosis.

Some other important components to add are the patient’s additional past medical/surgical history, family history, social history, medications, allergies, and immunizations.

The HEADSSS Method

Particularly, the social history is an important time to describe the patient as a complete person and understand how their life story may affect their present condition.

One way of organizing the social history is the HEADSSS method:

– H ome living situation and relationships – E ducation and employment – A ctivities and hobbies – D rug use (alcohol, tobacco, cocaine, etc.) Note frequency of use, and if applicable, be sure to add which types of alcohol consumption (like beer versus hard liquor) and forms of drug use. – S exual history (partners, STI history, pregnancy plans) – S uicidality and depression – S piritual and religious history

Again, there’s a lot of variation in presenting social history, so just follow the lead of your team. For example, it’s not always necessary/relevant to obtain a sexual history, so use your judgment of the situation.

4. Review of Symptoms

Oftentimes, most elements of this section are embedded within the HPI. If there are any additional symptoms not mentioned in the HPI, it’s appropriate to state them here.

5. Objective

Vital signs.

Some attendings love to hear all five vital signs: temperature, blood pressure (mean arterial pressure if applicable), heart rate, respiratory rate, and oxygen saturation. Others are happy with “afebrile and vital signs stable.” Just find out their preference and stick to that.

Physical Exam

This is one of the most important parts of the patient presentation for any specialty. It paints a picture of how the patient looks and can guide acute management like in the case of a rigid abdomen. As discussed in the HPI section, typically you should report pertinent positives and negatives. When you’re starting out, your attending and team may prefer for you to report all findings as part of your learning.

For example, pulmonary exam findings can be reported as: “Regular chest appearance. No abnormalities on palpation. Lungs resonant to percussion. Clear to auscultation bilaterally without crackles, rhonchi, or wheezing.”

Typically, you want to report the physical exams in a head to toe format: General Appearance, Mental Status, Neurologic, Eyes/Ears/Nose/Mouth/Neck, Cardiovascular, Pulmonary, Breast, Abdominal, Genitourinary, Musculoskeletal, and Skin. Depending on the situation, additional exams can be incorporated as applicable.

Now comes reporting pertinent positive and negative labs. Several labs are often drawn upon admission. It’s easy to fall into the trap of reading off all the labs and losing everyone’s attention. Here are some pieces of advice:

You normally can’t go wrong sticking to abnormal lab values.

One qualification is that for a patient with concern for acute coronary syndrome, reporting a normal troponin is essential. Also, stating the normalization of previously abnormal lab values like liver enzymes is important.

Demonstrate trends in lab values.

A lab value is just a single point in time and does not paint the full picture. For example, a hemoglobin of 10g/dL in a patient at 15g/dL the previous day is a lot more concerning than a patient who has been stable at 10g/dL for a week.

Try to avoid editorializing in this section.

Save your analysis of the labs for the assessment section. Again, this can be a point of personal preference. In my experience, the team typically wants the raw objective data in this section.

This is also a good place to state the ins and outs of your patient (if applicable). In some patients, these metrics are strictly recorded and are typically reported as total fluid in and out over the past day followed by the net fluid balance. For example, “1L in, 2L out, net -1L over the past 24 hours.”

6. Diagnostics/Imaging

Next, you’ll want to review any important diagnostic tests and imaging. For example, describe how the EKG and echo look in a patient presenting with chest pain or the abdominal CT scan in a patient with right lower quadrant abdominal pain.

Try to provide your own interpretation to develop your skills and then include the final impression. Also, report if a diagnostic test is still pending.

7. Assessment/Plan

This is the fun part where you get to use your critical thinking (aka doctor) skills! For the scope of this blog, we’ll review a problem-based plan.

It’s helpful to begin with a summary statement that incorporates the one-liner, presenting issue(s)/diagnosis(es), and patient stability.

Then, go through all the problems relevant to the admission. You can impress your audience by casting a wide differential diagnosis and going through the elements of your patient presentation that support one diagnosis over another.

Following your assessment, try to suggest a management plan. In a patient with congestive heart failure exacerbation, initiating a diuresis regimen and measuring strict ins/outs are good starting points.

You may even suggest a follow-up on their latest ejection fraction with an echo and check if they’re on guideline-directed medical therapy. Again, with more time on the clinical wards you’ll start to pick up on what management plan to suggest.

One pointer is to talk about all relevant problems, not just the presenting issue. For example, a patient with diabetes may need to be put on a sliding scale insulin regimen or another patient may require physical/occupational therapy. Just try to stay organized and be comprehensive.

A Note About Patient Presentation Skills

When you’re doing your first patient presentations, it’s common to feel nervous. There may be a lot of “uhs” and “ums.”

Here’s the good news: you don’t have to be perfect! You just need to make a good faith attempt and keep on going with the presentation.

With time, your confidence will build. Practice your fluency in the mirror when you have a chance. No one was born knowing medicine and everyone has gone through the same stages of learning you are!

Practice your presentation a couple times before you present to the team if you have time. Pull a resident aside if they have the bandwidth to make sure you have all the information you need.

One big piece of advice: NEVER LIE. If you don’t know a specific detail, it’s okay to say, “I’m not sure, but I can look that up.” Someone on your team can usually retrieve the information while you continue on with your presentation.

Example Patient Case Presentation Template

Here’s a blank patient case presentation template that may come in handy. You can adapt it to best fit your needs.

Chief Complaint:

History of Present Illness:

Past Medical History:

Past Surgical History:

Family History:

Social History:

Medications:

Immunizations:

Vital Signs : Temp ___ BP ___ /___ HR ___ RR ___ O2 sat ___

Physical Exam:

General Appearance:

Mental Status:

Neurological:

Eyes, Ears, Nose, Mouth, and Neck:

Cardiovascular:

Genitourinary:

Musculoskeletal:

Most Recent Labs:

Previous Labs:

Diagnostics/Imaging:

Impression/Interpretation:

Assessment/Plan:

One-line summary:

#Problem 1:

Assessment:

#Problem 2:

Final Thoughts on Patient Presentations

I hope this post demystified the patient presentation for you. Be sure to stay organized in your delivery and be flexible with the specifications your team may provide.

Something I’d like to highlight is that you may need to tailor the presentation to the specialty you’re on. For example, on OB/GYN, it’s important to include a pregnancy history. Nonetheless, the aforementioned template should set you up for success from a broad overview perspective.

Stay tuned for my next post on how to give an ICU patient presentation. And if you’d like me to address any other topics in a blog, write to me at [email protected] !

Looking for more (free!) content to help you through clinical rotations? Check out these other posts from Blueprint tutors on the Med School blog:

How I Balanced My Clinical Rotations with Shelf Exam Studying
How (and Why) to Use a Qbank to Prepare for USMLE Step 2
How to Study For Shelf Exams: A Tutor’s Guide

About the Author

Hailing from Phoenix, AZ, Neelesh is an enthusiastic, cheerful, and patient tutor. He is a fourth year medical student at the Keck School of Medicine of the University of Southern California and serves as president for the Class of 2024. He is applying to surgery programs for residency. He also graduated as valedictorian of his high school and the USC Viterbi School of Engineering, obtaining a B.S. in Biomedical Engineering in 2020. He discovered his penchant for teaching when he began tutoring his friends for the SAT and ACT in the summer of 2015 out of his living room. Outside of the academic sphere, Neelesh enjoys surfing at San Onofre Beach and hiking in the Santa Monica Mountains. Twitter: @NeeleshBagrodia LinkedIn: http://www.linkedin.com/in/neelesh-bagrodia

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How to Present a Case Study like a Pro (With Examples)

By Danesh Ramuthi , Sep 07, 2023

Okay, let’s get real: case studies can be kinda snooze-worthy. But guess what? They don’t have to be!

In this article, I will cover every element that transforms a mere report into a compelling case study, from selecting the right metrics to using persuasive narrative techniques.

And if you’re feeling a little lost, don’t worry! There are cool tools like Venngage’s Case Study Creator to help you whip up something awesome, even if you’re short on time. Plus, the pre-designed case study templates are like instant polish because let’s be honest, everyone loves a shortcut.

Click to jump ahead:

What is a case study presentation?

What is the purpose of presenting a case study, how to structure a case study presentation, how long should a case study presentation be, 5 case study presentation examples with templates, 6 tips for delivering an effective case study presentation, 5 common mistakes to avoid in a case study presentation, how to present a case study faqs.

A case study presentation involves a comprehensive examination of a specific subject, which could range from an individual, group, location, event, organization or phenomenon.

They’re like puzzles you get to solve with the audience, all while making you think outside the box.

Unlike a basic report or whitepaper, the purpose of a case study presentation is to stimulate critical thinking among the viewers.

The primary objective of a case study is to provide an extensive and profound comprehension of the chosen topic. You don’t just throw numbers at your audience. You use examples and real-life cases to make you think and see things from different angles.

The primary purpose of presenting a case study is to offer a comprehensive, evidence-based argument that informs, persuades and engages your audience.

Here’s the juicy part: presenting that case study can be your secret weapon. Whether you’re pitching a groundbreaking idea to a room full of suits or trying to impress your professor with your A-game, a well-crafted case study can be the magic dust that sprinkles brilliance over your words.

Think of it like digging into a puzzle you can’t quite crack . A case study lets you explore every piece, turn it over and see how it fits together. This close-up look helps you understand the whole picture, not just a blurry snapshot.

It’s also your chance to showcase how you analyze things, step by step, until you reach a conclusion. It’s all about being open and honest about how you got there.

Besides, presenting a case study gives you an opportunity to connect data and real-world scenarios in a compelling narrative. It helps to make your argument more relatable and accessible, increasing its impact on your audience.

One of the contexts where case studies can be very helpful is during the job interview. In some job interviews, you as candidates may be asked to present a case study as part of the selection process.

Having a case study presentation prepared allows the candidate to demonstrate their ability to understand complex issues, formulate strategies and communicate their ideas effectively.

The way you present a case study can make all the difference in how it’s received. A well-structured presentation not only holds the attention of your audience but also ensures that your key points are communicated clearly and effectively.

In this section, let’s go through the key steps that’ll help you structure your case study presentation for maximum impact.

Let’s get into it.

Open with an introductory overview

Start by introducing the subject of your case study and its relevance. Explain why this case study is important and who would benefit from the insights gained. This is your opportunity to grab your audience’s attention.

Explain the problem in question

Dive into the problem or challenge that the case study focuses on. Provide enough background information for the audience to understand the issue. If possible, quantify the problem using data or metrics to show the magnitude or severity.

Detail the solutions to solve the problem

After outlining the problem, describe the steps taken to find a solution. This could include the methodology, any experiments or tests performed and the options that were considered. Make sure to elaborate on why the final solution was chosen over the others.

Key stakeholders Involved

Talk about the individuals, groups or organizations that were directly impacted by or involved in the problem and its solution.

Stakeholders may experience a range of outcomes—some may benefit, while others could face setbacks.

For example, in a business transformation case study, employees could face job relocations or changes in work culture, while shareholders might be looking at potential gains or losses.

Discuss the key results & outcomes

Discuss the results of implementing the solution. Use data and metrics to back up your statements. Did the solution meet its objectives? What impact did it have on the stakeholders? Be honest about any setbacks or areas for improvement as well.

Include visuals to support your analysis

Visual aids can be incredibly effective in helping your audience grasp complex issues. Utilize charts, graphs, images or video clips to supplement your points. Make sure to explain each visual and how it contributes to your overall argument.

Pie charts illustrate the proportion of different components within a whole, useful for visualizing market share, budget allocation or user demographics.

This is particularly useful especially if you’re displaying survey results in your case study presentation.

Stacked charts on the other hand are perfect for visualizing composition and trends. This is great for analyzing things like customer demographics, product breakdowns or budget allocation in your case study.

Consider this example of a stacked bar chart template. It provides a straightforward summary of the top-selling cake flavors across various locations, offering a quick and comprehensive view of the data.

Not the chart you’re looking for? Browse Venngage’s gallery of chart templates to find the perfect one that’ll captivate your audience and level up your data storytelling.

Recommendations and next steps

Wrap up by providing recommendations based on the case study findings. Outline the next steps that stakeholders should take to either expand on the success of the project or address any remaining challenges.

Acknowledgments and references

Thank the people who contributed to the case study and helped in the problem-solving process. Cite any external resources, reports or data sets that contributed to your analysis.

Feedback & Q&A session

Open the floor for questions and feedback from your audience. This allows for further discussion and can provide additional insights that may not have been considered previously.

Closing remarks

Conclude the presentation by summarizing the key points and emphasizing the takeaways. Thank your audience for their time and participation and express your willingness to engage in further discussions or collaborations on the subject.

Well, the length of a case study presentation can vary depending on the complexity of the topic and the needs of your audience. However, a typical business or academic presentation often lasts between 15 to 30 minutes.

This time frame usually allows for a thorough explanation of the case while maintaining audience engagement. However, always consider leaving a few minutes at the end for a Q&A session to address any questions or clarify points made during the presentation.

When it comes to presenting a compelling case study, having a well-structured template can be a game-changer.

It helps you organize your thoughts, data and findings in a coherent and visually pleasing manner.

Not all case studies are created equal and different scenarios require distinct approaches for maximum impact.

To save you time and effort, I have curated a list of 5 versatile case study presentation templates, each designed for specific needs and audiences.

Here are some best case study presentation examples that showcase effective strategies for engaging your audience and conveying complex information clearly.

1 . Lab report case study template

Ever feel like your research gets lost in a world of endless numbers and jargon? Lab case studies are your way out!

Think of it as building a bridge between your cool experiment and everyone else. It’s more than just reporting results – it’s explaining the “why” and “how” in a way that grabs attention and makes sense.

This lap report template acts as a blueprint for your report, guiding you through each essential section (introduction, methods, results, etc.) in a logical order.

College Lab Report Template - Introduction

Want to present your research like a pro? Browse our research presentation template gallery for creative inspiration!

2. Product case study template

It’s time you ditch those boring slideshows and bullet points because I’ve got a better way to win over clients: product case study templates.

Instead of just listing features and benefits, you get to create a clear and concise story that shows potential clients exactly what your product can do for them. It’s like painting a picture they can easily visualize, helping them understand the value your product brings to the table.

Grab the template below, fill in the details, and watch as your product’s impact comes to life!

3. Content marketing case study template

In digital marketing, showcasing your accomplishments is as vital as achieving them.

A well-crafted case study not only acts as a testament to your successes but can also serve as an instructional tool for others.

With this coral content marketing case study template—a perfect blend of vibrant design and structured documentation, you can narrate your marketing triumphs effectively.

4. Case study psychology template

Understanding how people tick is one of psychology’s biggest quests and case studies are like magnifying glasses for the mind. They offer in-depth looks at real-life behaviors, emotions and thought processes, revealing fascinating insights into what makes us human.

Writing a top-notch case study, though, can be a challenge. It requires careful organization, clear presentation and meticulous attention to detail. That’s where a good case study psychology template comes in handy.

Think of it as a helpful guide, taking care of formatting and structure while you focus on the juicy content. No more wrestling with layouts or margins – just pour your research magic into crafting a compelling narrative.

5. Lead generation case study template

Lead generation can be a real head-scratcher. But here’s a little help: a lead generation case study.

Think of it like a friendly handshake and a confident resume all rolled into one. It’s your chance to showcase your expertise, share real-world successes and offer valuable insights. Potential clients get to see your track record, understand your approach and decide if you’re the right fit.

No need to start from scratch, though. This lead generation case study template guides you step-by-step through crafting a clear, compelling narrative that highlights your wins and offers actionable tips for others. Fill in the gaps with your specific data and strategies, and voilà! You’ve got a powerful tool to attract new customers.

Modern Lead Generation Business Case Study Presentation Template

Related: 15+ Professional Case Study Examples [Design Tips + Templates]

So, you’ve spent hours crafting the perfect case study and are now tasked with presenting it. Crafting the case study is only half the battle; delivering it effectively is equally important.

Whether you’re facing a room of executives, academics or potential clients, how you present your findings can make a significant difference in how your work is received.

Forget boring reports and snooze-inducing presentations! Let’s make your case study sing. Here are some key pointers to turn information into an engaging and persuasive performance:

Know your audience : Tailor your presentation to the knowledge level and interests of your audience. Remember to use language and examples that resonate with them.
Rehearse : Rehearsing your case study presentation is the key to a smooth delivery and for ensuring that you stay within the allotted time. Practice helps you fine-tune your pacing, hone your speaking skills with good word pronunciations and become comfortable with the material, leading to a more confident, conversational and effective presentation.
Start strong : Open with a compelling introduction that grabs your audience’s attention. You might want to use an interesting statistic, a provocative question or a brief story that sets the stage for your case study.
Be clear and concise : Avoid jargon and overly complex sentences. Get to the point quickly and stay focused on your objectives.
Use visual aids : Incorporate slides with graphics, charts or videos to supplement your verbal presentation. Make sure they are easy to read and understand.
Tell a story : Use storytelling techniques to make the case study more engaging. A well-told narrative can help you make complex data more relatable and easier to digest.

Ditching the dry reports and slide decks? Venngage’s case study templates let you wow customers with your solutions and gain insights to improve your business plan. Pre-built templates, visual magic and customer captivation – all just a click away. Go tell your story and watch them say “wow!”

Nailed your case study, but want to make your presentation even stronger? Avoid these common mistakes to ensure your audience gets the most out of it:

Overloading with information

A case study is not an encyclopedia. Overloading your presentation with excessive data, text or jargon can make it cumbersome and difficult for the audience to digest the key points. Stick to what’s essential and impactful. Need help making your data clear and impactful? Our data presentation templates can help! Find clear and engaging visuals to showcase your findings.

Lack of structure

Jumping haphazardly between points or topics can confuse your audience. A well-structured presentation, with a logical flow from introduction to conclusion, is crucial for effective communication.

Ignoring the audience

Different audiences have different needs and levels of understanding. Failing to adapt your presentation to your audience can result in a disconnect and a less impactful presentation.

Poor visual elements

While content is king, poor design or lack of visual elements can make your case study dull or hard to follow. Make sure you use high-quality images, graphs and other visual aids to support your narrative.

Not focusing on results

A case study aims to showcase a problem and its solution, but what most people care about are the results. Failing to highlight or adequately explain the outcomes can make your presentation fall flat.

How to start a case study presentation?

Starting a case study presentation effectively involves a few key steps:

Grab attention : Open with a hook—an intriguing statistic, a provocative question or a compelling visual—to engage your audience from the get-go.
Set the stage : Briefly introduce the subject, context and relevance of the case study to give your audience an idea of what to expect.
Outline objectives : Clearly state what the case study aims to achieve. Are you solving a problem, proving a point or showcasing a success?
Agenda : Give a quick outline of the key sections or topics you’ll cover to help the audience follow along.
Set expectations : Let your audience know what you want them to take away from the presentation, whether it’s knowledge, inspiration or a call to action.

How to present a case study on PowerPoint and on Google Slides?

Presenting a case study on PowerPoint and Google Slides involves a structured approach for clarity and impact using presentation slides :

Title slide : Start with a title slide that includes the name of the case study, your name and any relevant institutional affiliations.
Introduction : Follow with a slide that outlines the problem or situation your case study addresses. Include a hook to engage the audience.
Objectives : Clearly state the goals of the case study in a dedicated slide.
Findings : Use charts, graphs and bullet points to present your findings succinctly.
Analysis : Discuss what the findings mean, drawing on supporting data or secondary research as necessary.
Conclusion : Summarize key takeaways and results.
Q&A : End with a slide inviting questions from the audience.

What’s the role of analysis in a case study presentation?

The role of analysis in a case study presentation is to interpret the data and findings, providing context and meaning to them.

It helps your audience understand the implications of the case study, connects the dots between the problem and the solution and may offer recommendations for future action.

Is it important to include real data and results in the presentation?

Yes, including real data and results in a case study presentation is crucial to show experience, credibility and impact. Authentic data lends weight to your findings and conclusions, enabling the audience to trust your analysis and take your recommendations more seriously

How do I conclude a case study presentation effectively?

To conclude a case study presentation effectively, summarize the key findings, insights and recommendations in a clear and concise manner.

End with a strong call-to-action or a thought-provoking question to leave a lasting impression on your audience.

What’s the best way to showcase data in a case study presentation ?

The best way to showcase data in a case study presentation is through visual aids like charts, graphs and infographics which make complex information easily digestible, engaging and creative.

Don’t just report results, visualize them! This template for example lets you transform your social media case study into a captivating infographic that sparks conversation.

Choose the type of visual that best represents the data you’re showing; for example, use bar charts for comparisons or pie charts for parts of a whole.

Ensure that the visuals are high-quality and clearly labeled, so the audience can quickly grasp the key points.

Keep the design consistent and simple, avoiding clutter or overly complex visuals that could distract from the message.

Choose a template that perfectly suits your case study where you can utilize different visual aids for maximum impact.

Need more inspiration on how to turn numbers into impact with the help of infographics? Our ready-to-use infographic templates take the guesswork out of creating visual impact for your case studies with just a few clicks.

Related: 10+ Case Study Infographic Templates That Convert

Congrats on mastering the art of compelling case study presentations! This guide has equipped you with all the essentials, from structure and nuances to avoiding common pitfalls. You’re ready to impress any audience, whether in the boardroom, the classroom or beyond.

And remember, you’re not alone in this journey. Venngage’s Case Study Creator is your trusty companion, ready to elevate your presentations from ordinary to extraordinary. So, let your confidence shine, leverage your newly acquired skills and prepare to deliver presentations that truly resonate.

Go forth and make a lasting impact!

Overview and General Information about Oral Presentation

Daily Presentations During Work Rounds
The New Patient Presentation
The Holdover Admission Presentation
Outpatient Clinic Presentations
The structure of presentations varies from service to service (e.g. medicine vs. surgery), amongst subspecialties, and between environments (inpatient vs. outpatient). Applying the correct style to the right setting requires that the presenter seek guidance from the listeners at the outset.
Time available for presenting is rather short, which makes the experience more stressful.
Individual supervisors (residents, faculty) often have their own (sometimes quirky) preferences regarding presentation styles, adding another layer of variability that the presenter has to manage.
Students are evaluated/judged on the way in which they present, with faculty using this as one way of gauging a student’s clinical knowledge.
Done well, presentations promote efficient, excellent care. Done poorly, they promote tedium, low morale, and inefficiency.

General Tips:

Practice, Practice, Practice! Do this on your own, with colleagues, and/or with anyone who will listen (and offer helpful commentary) before you actually present in front of other clinicians. Speaking "on-the-fly" is difficult, as rapidly organizing and delivering information in a clear and concise fashion is not a naturally occurring skill.
Immediately following your presentations, seek feedback from your listeners. Ask for specifics about what was done well and what could have been done better – always with an eye towards gaining information that you can apply to improve your performance the next time.
Listen to presentations that are done well – ask yourself, “Why was it good?” Then try to incorporate those elements into your own presentations.
Listen to presentations that go poorly – identify the specific things that made it ineffective and avoid those pitfalls when you present.
Effective presentations require that you have thought through the case beforehand and understand the rationale for your conclusions and plan. This, in turn, requires that you have a good grasp of physiology, pathology, clinical reasoning and decision-making - pushing you to read, pay attention, and in general acquire more knowledge.
Think about the clinical situation in which you are presenting so that you can provide a summary that is consistent with the expectations of your audience. Work rounds, for example, are clearly different from conferences and therefore mandate a different style of presentation.
Presentations are the way in which we tell medical stories to one another. When you present, ask yourself if you’ve described the story in an accurate way. Will the listener be able to “see” the patient the same way that you do? Can they come to the correct conclusions? If not, re-calibrate.
It's O.K. to use notes, though the oral presentation should not simply be reduced to reading the admission note – rather, it requires appropriate editing/shortening.
In general, try to give your presentations on a particular service using the same order and style for each patient, every day. Following a specific format makes it easier for the listener to follow, as they know what’s coming and when they can expect to hear particular information. Additionally, following a standardized approach makes it easier for you to stay organized, develop a rhythm, and lessens the chance that you’ll omit elements.

Specific types of presentations

There are a number of common presentation-types, each with its own goals and formats. These include:

Daily presentations during work rounds for patients known to a service.
Newly admitted patients, where you were the clinician that performed the H&P.
Newly admitted patients that were “handed off” to the team in the morning, such that the H&P was performed by others.
Outpatient clinic presentations, covering several common situations.

Key elements of each presentation type are described below. Examples of how these would be applied to most situations are provided in italics. The formats are typical of presentations done for internal medicine services and clinics.

Note that there is an acceptable range of how oral presentations can be delivered. Ultimately, your goal is to tell the correct story, in a reasonable amount of time, so that the right care can be delivered. Nuances in the order of presentation, what to include, what to omit, etc. are relatively small points. Don’t let the pursuit of these elements distract you or create undue anxiety.

Daily presentations during work rounds of patients that you’re following:

Organize the presenter (forces you to think things through)
Inform the listener(s) of 24 hour events and plan moving forward
Promote focused discussion amongst your listeners and supervisors
Opportunity to reassess plan, adjust as indicated
Demonstrate your knowledge and engagement in the care of the patient
Rapid (5 min) presentation of the key facts

Key features of presentation:

Opening one liner: Describe who the patient is, number of days in hospital, and their main clinical issue(s).
24-hour events: Highlighting changes in clinical status, procedures, consults, etc.
Subjective sense from the patient about how they’re feeling, vital signs (ranges), and key physical exam findings (highlighting changes)
Relevant labs (highlighting changes) and imaging
Assessment and Plan : Presented by problem or organ systems(s), using as many or few as are relevant. Early on, it’s helpful to go through the main categories in your head as a way of making sure that you’re not missing any relevant areas. The broad organ system categories include (presented here head-to-toe): Neurological; Psychiatric; Cardiovascular; Pulmonary; Gastrointestinal; Renal/Genitourinary; Hematologic/Oncologic; Endocrine/Metabolic; Infectious; Tubes/lines/drains; Disposition.

Example of a daily presentation for a patient known to a team:

Opening one liner: This is Mr. Smith, a 65 year old man, Hospital Day #3, being treated for right leg cellulitis
MRI of the leg, negative for osteomyelitis
Evaluation by Orthopedics, who I&D’d a superficial abscess in the calf, draining a moderate amount of pus
Patient appears well, states leg is feeling better, less painful
T Max 101 yesterday, T Current 98; Pulse range 60-80; BP 140s-160s/70-80s; O2 sat 98% Room Air
Ins/Outs: 3L in (2 L NS, 1 L po)/Out 4L urine
Right lower extremity redness now limited to calf, well within inked lines – improved compared with yesterday; bandage removed from the I&D site, and base had small amount of purulence; No evidence of fluctuance or undrained infection.
Creatinine .8, down from 1.5 yesterday
WBC 8.7, down from 14
Blood cultures from admission still negative
Gram stain of pus from yesterday’s I&D: + PMNS and GPCs; Culture pending
MRI lower extremity as noted above – negative for osteomyelitis
Continue Vancomycin for today
Ortho to reassess I&D site, though looks good
Follow-up on cultures: if MRSA, will transition to PO Doxycycline; if MSSA, will use PO Dicloxacillin
Given AKI, will continue to hold ace-inhibitor; will likely wait until outpatient follow-up to restart
Add back amlodipine 5mg/d today
Hep lock IV as no need for more IVF
Continue to hold ace-I as above
Wound care teaching with RNs today – wife capable and willing to assist. She’ll be in this afternoon.
Set up follow-up with PMD to reassess wound and cellulitis within 1 week

The Brand New Patient (admitted by you)

Provide enough information so that the listeners can understand the presentation and generate an appropriate differential diagnosis.
Present a thoughtful assessment
Present diagnostic and therapeutic plans
Provide opportunities for senior listeners to intervene and offer input
Chief concern: Reason why patient presented to hospital (symptom/event and key past history in one sentence). It often includes a limited listing of their other medical conditions (e.g. diabetes, hypertension, etc.) if these elements might contribute to the reason for admission.
The history is presented highlighting the relevant events in chronological order.
7 days ago, the patient began to notice vague shortness of breath.
5 days ago, the breathlessness worsened and they developed a cough productive of green sputum.
3 days ago his short of breath worsened to the point where he was winded after walking up a flight of stairs, accompanied by a vague right sided chest pain that was more pronounced with inspiration.
Enough historical information has to be provided so that the listener can understand the reasons that lead to admission and be able to draw appropriate clinical conclusions.
Past history that helps to shed light on the current presentation are included towards the end of the HPI and not presented later as “PMH.” This is because knowing this “past” history is actually critical to understanding the current complaint. For example, past cardiac catheterization findings and/or interventions should be presented during the HPI for a patient presenting with chest pain.
Where relevant, the patient's baseline functional status is described, allowing the listener to understand the degree of impairment caused by the acute medical problem(s).
It should be explicitly stated if a patient is a poor historian, confused or simply unaware of all the details related to their illness. Historical information obtained from family, friends, etc. should be described as such.
Review of Systems (ROS): Pertinent positive and negative findings discovered during a review of systems are generally incorporated at the end of the HPI. The listener needs this information to help them put the story in appropriate perspective. Any positive responses to a more inclusive ROS that covers all of the other various organ systems are then noted. If the ROS is completely negative, it is generally acceptable to simply state, "ROS negative.”
Other Past Medical and Surgical History (PMH/PSH): Past history that relates to the issues that lead to admission are typically mentioned in the HPI and do not have to be repeated here. That said, selective redundancy (i.e. if it’s really important) is OK. Other PMH/PSH are presented here if relevant to the current issues and/or likely to affect the patient’s hospitalization in some way. Unrelated PMH and PSH can be omitted (e.g. if the patient had their gall bladder removed 10y ago and this has no bearing on the admission, then it would be appropriate to leave it out). If the listener really wants to know peripheral details, they can read the admission note, ask the patient themselves, or inquire at the end of the presentation.
Medications and Allergies: Typically all meds are described, as there’s high potential for adverse reactions or drug-drug interactions.
Family History: Emphasis is placed on the identification of illnesses within the family (particularly among first degree relatives) that are known to be genetically based and therefore potentially heritable by the patient. This would include: coronary artery disease, diabetes, certain cancers and autoimmune disorders, etc. If the family history is non-contributory, it’s fine to say so.
Social History, Habits, other → as relates to/informs the presentation or hospitalization. Includes education, work, exposures, hobbies, smoking, alcohol or other substance use/abuse.
Sexual history if it relates to the active problems.
Vital signs and relevant findings (or their absence) are provided. As your team develops trust in your ability to identify and report on key problems, it may become acceptable to say “Vital signs stable.”
Note: Some listeners expect students (and other junior clinicians) to describe what they find in every organ system and will not allow the presenter to say “normal.” The only way to know what to include or omit is to ask beforehand.
Key labs and imaging: Abnormal findings are highlighted as well as changes from baseline.
Summary, assessment & plan(s) Presented by problem or organ systems(s), using as many or few as are relevant. Early on, it’s helpful to go through the main categories in your head as a way of making sure that you’re not missing any relevant areas. The broad organ system categories include (presented here head-to-toe): Neurological; Psychiatric; Cardiovascular; Pulmonary; Gastrointestinal; Renal/Genitourinary; Hematologic/Oncologic; Endocrine/Metabolic; Infectious; Tubes/lines/drains; Disposition.
The assessment and plan typically concludes by mentioning appropriate prophylactic considerations (e.g. DVT prevention), code status and disposition.
Chief Concern: Mr. H is a 50 year old male with AIDS, on HAART, with preserved CD4 count and undetectable viral load, who presents for the evaluation of fever, chills and a cough over the past 7 days.
Until 1 week ago, he had been quite active, walking up to 2 miles a day without feeling short of breath.
Approximately 1 week ago, he began to feel dyspneic with moderate activity.
3 days ago, he began to develop subjective fevers and chills along with a cough productive of red-green sputum.
1 day ago, he was breathless after walking up a single flight of stairs and spent most of the last 24 hours in bed.
Diagnosed with HIV in 2000, done as a screening test when found to have gonococcal urethritis
Was not treated with HAART at that time due to concomitant alcohol abuse and non-adherence.
Diagnosed and treated for PJP pneumonia 2006
Diagnosed and treated for CMV retinitis 2007
Became sober in 2008, at which time interested in HAART. Started on Atripla, a combination pill containing: Efavirenz, Tonofovir, and Emtricitabine. He’s taken it ever since, with no adverse effects or issues with adherence. Receives care thru Dr. Smiley at the University HIV clinic.
CD4 count 3 months ago was 400 and viral load was undetectable.
He is homosexual though he is currently not sexually active. He has never used intravenous drugs.
He has no history of asthma, COPD or chronic cardiac or pulmonary condition. No known liver disease. Hepatitis B and C negative. His current problem seems different to him then his past episode of PJP.
Review of systems: negative for headache, photophobia, stiff neck, focal weakness, chest pain, abdominal pain, diarrhea, nausea, vomiting, urinary symptoms, leg swelling, or other complaints.
Hypertension x 5 years, no other known vascular disease
Gonorrhea as above
Alcohol abuse above and now sober – no known liver disease
No relevant surgeries
Atripla, 1 po qd
Omeprazole 20 mg, 1 PO, qd
Lisinopril 20mg, qd
Naprosyn 250 mg, 1-2, PO, BID PRN
No allergies
Both of the patient's parents are alive and well (his mother is 78 and father 80). He has 2 brothers, one 45 and the other 55, who are also healthy. There is no family history of heart disease or cancer.
Patient works as an accountant for a large firm in San Diego. He lives alone in an apartment in the city.
Smokes 1 pack of cigarettes per day and has done so for 20 years.
No current alcohol use. Denies any drug use.
Sexual History as noted above; has sex exclusively with men, last partner 6 months ago.
Seated on a gurney in the ER, breathing through a face-mask oxygen delivery system. Breathing was labored and accessory muscles were in use. Able to speak in brief sentences, limited by shortness of breath
Vital signs: Temp 102 F, Pulse 90, BP 150/90, Respiratory Rate 26, O2 Sat (on 40% Face Mask) 95%
HEENT: No thrush, No adenopathy
Lungs: Crackles and Bronchial breath sounds noted at right base. E to A changes present. No wheezing or other abnormal sounds noted over any other area of the lung. Dullness to percussion was also appreciated at the right base.
Cardiac: JVP less than 5 cm; Rhythm was regular. Normal S1 and S2. No murmurs or extra heart sounds noted.
Abdomen and Genital exams: normal
Extremities: No clubbing, cyanosis or edema; distal pulses 2+ and equal bilaterally.
Skin: no eruptions noted.
Neurological exam: normal
WBC 18 thousand with 10% bands;
Normal Chem 7 and LFTs.
Room air blood gas: pH of 7.47/ PO2 of 55/PCO2 of 30.
Sputum gram stain remarkable for an abundance of polys along with gram positive diplococci.
CXR remarkable for dense right lower lobe infiltrate without effusion.
Monitored care unit, with vigilance for clinical deterioration.
Hypertension: given significant pneumonia and unclear clinical direction, will hold lisinopril. If BP > 180 and or if clear not developing sepsis, will consider restarting.
Low molecular weight heparin
Code Status: Wishes to be full code full care, including intubation and ICU stay if necessary. Has good quality of life and hopes to return to that functional level. Wishes to reconsider if situation ever becomes hopeless. Older brother Tom is surrogate decision maker if the patient can’t speak for himself. Tom lives in San Diego and we have his contact info. He is aware that patient is in the hospital and plans on visiting later today or tomorrow.
Expected duration of hospitalization unclear – will know more based on response to treatment over next 24 hours.

The holdover admission (presenting data that was generated by other physicians)

Handoff admissions are very common and present unique challenges
Understand the reasons why the patient was admitted
Review key history, exam, imaging and labs to assure that they support the working diagnostic and therapeutic plans
Does the data support the working diagnosis?
Do the planned tests and consults make sense?
What else should be considered (both diagnostically and therapeutically)?
This process requires that the accepting team thoughtfully review their colleagues efforts with a critical eye – which is not disrespectful but rather constitutes one of the main jobs of the accepting team and is a cornerstone of good care *Note: At some point during the day (likely not during rounds), the team will need to verify all of the data directly with the patient.
8-10 minutes
Chief concern: Reason for admission (symptom and/or event)
Temporally presented bullets of events leading up to the admission
Review of systems
Relevant PMH/PSH – historical information that might affect the patient during their hospitalization.
Meds and Allergies
Family and Social History – focusing on information that helps to inform the current presentation.
Habits and exposures
Physical exam, imaging and labs that were obtained in the Emergency Department
Assessment and plan that were generated in the Emergency Department.
Overnight events (i.e. what happened in the Emergency Dept. and after the patient went to their hospital room)? Responses to treatments, changes in symptoms?
How does the patient feel this morning? Key exam findings this morning (if seen)? Morning labs (if available)?
Assessment and Plan , with attention as to whether there needs to be any changes in the working differential or treatment plan. The broad organ system categories include (presented here head-to-toe): Neurological; Psychiatric; Cardiovascular; Pulmonary; Gastrointestinal; Renal/Genitourinary; Hematologic/Oncologic; Endocrine/Metabolic; Infectious; Tubes/lines/drains; Disposition.
Chief concern: 70 yo male who presented with 10 days of progressive shoulder pain, followed by confusion. He was brought in by his daughter, who felt that her father was no longer able to safely take care for himself.
10 days ago, Mr. X developed left shoulder pain, first noted a few days after lifting heavy boxes. He denies falls or direct injury to the shoulder.
1 week ago, presented to outside hospital ER for evaluation of left shoulder pain. Records from there were notable for his being afebrile with stable vitals. Exam notable for focal pain anteriorly on palpation, but no obvious deformity. Right shoulder had normal range of motion. Left shoulder reported as diminished range of motion but not otherwise quantified. X-ray negative. Labs remarkable for wbc 8, creat 2.2 (stable). Impression was that the pain was of musculoskeletal origin. Patient was provided with Percocet and told to see PMD in f/u
Brought to our ER last night by his daughter. Pain in shoulder worse. Also noted to be confused and unable to care for self. Lives alone in the country, home in disarray, no food.
ROS: negative for falls, prior joint or musculoskeletal problems, fevers, chills, cough, sob, chest pain, head ache, abdominal pain, urinary or bowel symptoms, substance abuse
Hypertension
Coronary artery disease, s/p LAD stent for angina 3 y ago, no symptoms since. Normal EF by echo 2 y ago
Chronic kidney disease stage 3 with creatinine 1.8; felt to be secondary to atherosclerosis and hypertension
aspirin 81mg qd, atorvastatin 80mg po qd, amlodipine 10 po qd, Prozac 20
Allergies: none
Family and Social: lives alone in a rural area of the county, in contact with children every month or so. Retired several years ago from work as truck driver. Otherwise non-contributory.
Habits: denies alcohol or other drug use.
Temp 98 Pulse 110 BP 100/70
Drowsy though arousable; oriented to year but not day or date; knows he’s at a hospital for evaluation of shoulder pain, but doesn’t know the name of the hospital or city
CV: regular rate and rhythm; normal s1 and s2; no murmurs or extra heart sounds.
Left shoulder with generalized swelling, warmth and darker coloration compared with Right; generalized pain on palpation, very limited passive or active range of motion in all directions due to pain. Right shoulder appearance and exam normal.
CXR: normal
EKG: sr 100; nl intervals, no acute changes
WBC 13; hemoglobin 14
Na 134, k 4.6; creat 2.8 (1.8 baseline 4 m ago); bicarb 24
LFTs and UA normal
Vancomycin and Zosyn for now
Orthopedics to see asap to aspirate shoulder for definitive diagnosis
If aspiration is consistent with infection, will need to go to Operating Room for wash out.
Urine electrolytes
Follow-up on creatinine and obtain renal ultrasound if not improved
Renal dosing of meds
Strict Ins and Outs.
follow exam
obtain additional input from family to assure baseline is, in fact, normal
Since admission (6 hours) no change in shoulder pain
This morning, pleasant, easily distracted; knows he’s in the hospital, but not date or year
T Current 101F Pulse 100 BP 140/80
Ins and Outs: IVF Normal Saline 3L/Urine output 1.5 liters
L shoulder with obvious swelling and warmth compared with right; no skin breaks; pain limits any active or passive range of motion to less than 10 degrees in all directions
Labs this morning remarkable for WBC 10 (from 13), creatinine 2 (down from 2.8)
Continue with Vancomycin and Zosyn for now
I already paged Orthopedics this morning, who are en route for aspiration of shoulder, fluid for gram stain, cell count, culture
If aspirate consistent with infection, then likely to the OR
Continue IVF at 125/h, follow I/O
Repeat creatinine later today
Not on any nephrotoxins, meds renaly dosed
Continue antibiotics, evaluation for primary source as above
Discuss with family this morning to establish baseline; possible may have underlying dementia as well
SC Heparin for DVT prophylaxis
Code status: full code/full care.

Outpatient-based presentations

There are 4 main types of visits that commonly occur in an outpatient continuity clinic environment, each of which has its own presentation style and purpose. These include the following, each described in detail below.

The patient who is presenting for their first visit to a primary care clinic and is entirely new to the physician.
The patient who is returning to primary care for a scheduled follow-up visit.
The patient who is presenting with an acute problem to a primary care clinic
The specialty clinic evaluation (new or follow-up)

It’s worth noting that Primary care clinics (Internal Medicine, Family Medicine and Pediatrics) typically take responsibility for covering all of the patient’s issues, though the amount of energy focused on any one topic will depend on the time available, acuity, symptoms, and whether that issue is also followed by a specialty clinic.

The Brand New Primary Care Patient

Purpose of the presentation

Accurately review all of the patient’s history as well as any new concerns that they might have.
Identify health related problems that need additional evaluation and/or treatment
Provide an opportunity for senior listeners to intervene and offer input

Key features of the presentation

If this is truly their first visit, then one of the main reasons is typically to "establish care" with a new doctor.
It might well include continuation of therapies and/or evaluations started elsewhere.
If the patient has other specific goals (medications, referrals, etc.), then this should be stated as well. Note: There may well not be a "chief complaint."
For a new patient, this is an opportunity to highlight the main issues that might be troubling/bothering them.
This can include chronic disorders (e.g. diabetes, congestive heart failure, etc.) which cause ongoing symptoms (shortness of breath) and/or generate daily data (finger stick glucoses) that should be discussed.
Sometimes, there are no specific areas that the patient wishes to discuss up-front.
Review of systems (ROS): This is typically comprehensive, covering all organ systems. If the patient is known to have certain illnesses (e.g. diabetes), then the ROS should include the search for disorders with high prevalence (e.g. vascular disease). There should also be some consideration for including questions that are epidemiologically appropriate (e.g. based on age and sex).
Past Medical History (PMH): All known medical conditions (in particular those requiring ongoing treatment) are listed, noting their duration and time of onset. If a condition is followed by a specialist or co-managed with other clinicians, this should be noted as well. If a problem was described in detail during the “acute” history, it doesn’t have to be re-stated here.
Past Surgical History (PSH): All surgeries, along with the year when they were performed
Medications and allergies: All meds, including dosage, frequency and over-the-counter preparations. Allergies (and the type of reaction) should be described.
Social: Work, hobbies, exposures.
Sexual activity – may include type of activity, number and sex of partner(s), partner’s health.
Smoking, Alcohol, other drug use: including quantification of consumption, duration of use.
Family history: Focus on heritable illness amongst first degree relatives. May also include whether patient married, in a relationship, children (and their ages).
Physical Exam: Vital signs and relevant findings (or their absence).
Key labs and imaging if they’re available. Also when and where they were obtained.
Summary, assessment & plan(s) presented by organ system and/or problems. As many systems/problems as is necessary to cover all of the active issues that are relevant to that clinic. This typically concludes with a “health care maintenance” section, which covers age, sex and risk factor appropriate vaccinations and screening tests.

The Follow-up Visit to a Primary Care Clinic

Organize the presenter (forces you to think things through).
Accurately review any relevant interval health care events that might have occurred since the last visit.
Identification of new symptoms or health related issues that might need additional evaluation and/or treatment
If the patient has no concerns, then verification that health status is stable
Review of medications
Provide an opportunity for listeners to intervene and offer input
Reason for the visit: Follow-up for whatever the patient’s main issues are, as well as stating when the last visit occurred *Note: There may well not be a “chief complaint,” as patients followed in continuity at any clinic may simply be returning for a visit as directed by their doctor.
Events since the last visit: This might include emergency room visits, input from other clinicians/specialists, changes in medications, new symptoms, etc.
Review of Systems (ROS): Depth depends on patient’s risk factors and known illnesses. If the patient has diabetes, then a vascular ROS would be done. On the other hand, if the patient is young and healthy, the ROS could be rather cursory.
PMH, PSH, Social, Family, Habits are all OMITTED. This is because these facts are already known to the listener and actionable aspects have presumably been added to the problem list (presented at the end). That said, these elements can be restated if the patient has a new symptom or issue related to a historical problem has emerged.
MEDS : A good idea to review these at every visit.
Physical exam: Vital signs and pertinent findings (or absence there of) are mentioned.
Lab and Imaging: The reason why these were done should be mentioned and any key findings mentioned, highlighting changes from baseline.
Assessment and Plan: This is most clearly done by individually stating all of the conditions/problems that are being addressed (e.g. hypertension, hypothyroidism, depression, etc.) followed by their specific plan(s). If a new or acute issue was identified during the visit, the diagnostic and therapeutic plan for that concern should be described.

The Focused Visit to a Primary Care Clinic

Accurately review the historical events that lead the patient to make the appointment.
Identification of risk factors and/or other underlying medical conditions that might affect the diagnostic or therapeutic approach to the new symptom or concern.
Generate an appropriate assessment and plan
Allow the listener to comment

Key features of the presentation:

Reason for the visit
History of Present illness: Description of the sequence of symptoms and/or events that lead to the patient’s current condition.
Review of Systems: To an appropriate depth that will allow the listener to grasp the full range of diagnostic possibilities that relate to the presenting problem.
PMH and PSH: Stating only those elements that might relate to the presenting symptoms/issues.
PE: Vital signs and key findings (or lack thereof)
Labs and imaging (if done)
Assessment and Plan: This is usually very focused and relates directly to the main presenting symptom(s) or issues.

The Specialty Clinic Visit

Specialty clinic visits focus on the health care domains covered by those physicians. For example, Cardiology clinics are interested in cardiovascular disease related symptoms, events, labs, imaging and procedures. Orthopedics clinics will focus on musculoskeletal symptoms, events, imaging and procedures. Information that is unrelated to these disciples will typically be omitted. It’s always a good idea to ask the supervising physician for guidance as to what’s expected to be covered in a particular clinic environment.

Highlight the reason(s) for the visit
Review key data
Provide an opportunity for the listener(s) to comment
5-7 minutes
If it’s a consult, state the main reason(s) that the patient was referred as well as who referred them.
If it’s a return visit, state the reasons why the patient is being followed in the clinic and when the last visit took place
If it’s for an acute issue, state up front what the issue is Note: There may well not be a “chief complaint,” as patients followed in continuity in any clinic may simply be returning for a return visit as directed
For a new patient, this highlights the main things that might be troubling/bothering the patient.
For a specialty clinic, the history presented typically relates to the symptoms and/or events that are pertinent to that area of care.
Review of systems , focusing on those elements relevant to that clinic. For a cardiology patient, this will highlight a vascular ROS.
PMH/PSH that helps to inform the current presentation (e.g. past cardiac catheterization findings/interventions for a patient with chest pain) and/or is otherwise felt to be relevant to that clinic environment.
Meds and allergies: Typically all meds are described, as there is always the potential for adverse drug interactions.
Social/Habits/other: as relates to/informs the presentation and/or is relevant to that clinic
Family history: Focus is on heritable illness amongst first degree relatives
Physical Exam: VS and relevant findings (or their absence)
Key labs, imaging: For a cardiology clinic patient, this would include echos, catheterizations, coronary interventions, etc.
Summary, assessment & plan(s) by organ system and/or problems. As many systems/problems as is necessary to cover all of the active issues that are relevant to that clinic.
Reason for visit: Patient is a 67 year old male presenting for first office visit after admission for STEMI. He was referred by Dr. Goins, his PMD.
The patient initially presented to the ER 4 weeks ago with acute CP that started 1 hour prior to his coming in. He was found to be in the midst of a STEMI with ST elevations across the precordial leads.
Taken urgently to cath, where 95% proximal LAD lesion was stented
EF preserved by Echo; Peak troponin 10
In-hospital labs were remarkable for normal cbc, chem; LDL 170, hdl 42, nl lfts
Uncomplicated hospital course, sent home after 3 days.
Since home, he states that he feels great.
Denies chest pain, sob, doe, pnd, edema, or other symptoms.
No symptoms of stroke or TIA.
No history of leg or calf pain with ambulation.
Prior to this admission, he had a history of hypertension which was treated with lisinopril
40 pk yr smoking history, quit during hospitalization
No known prior CAD or vascular disease elsewhere. No known diabetes, no family history of vascular disease; He thinks his cholesterol was always “a little high” but doesn’t know the numbers and was never treated with meds.
History of depression, well treated with prozac
Discharge meds included: aspirin, metoprolol 50 bid, lisinopril 10, atorvastatin 80, Plavix; in addition he takes Prozac for depression
Taking all of them as directed.
Patient lives with his wife; they have 2 grown children who are no longer at home
Works as a computer programmer
Smoking as above
ETOH: 1 glass of wine w/dinner
No drug use
No known history of cardiovascular disease among 2 siblings or parents.
Well appearing; BP 130/80, Pulse 80 regular, 97% sat on Room Air, weight 175lbs, BMI 32
Lungs: clear to auscultation
CV: s1 s2 no s3 s4 murmur
No carotid bruits
ABD: no masses
Ext; no edema; distal pulses 2+
Cath from 4 weeks ago: R dominant; 95% proximal LAD; 40% Cx.
EF by TTE 1 day post PCI with mild Anterior Hypokinesis, EF 55%, no valvular disease, moderate LVH
Labs of note from the hospital following cath: hgb 14, plt 240; creat 1, k 4.2, lfts normal, glucose 100, LDL 170, HDL 42.
EKG today: SR at 78; nl intervals; nl axis; normal r wave progression, no q waves
Plan: aspirin 81 indefinitely, Plavix x 1y
Given nitroglycerine sublingual to have at home.
Reviewed symptoms that would indicate another MI and what to do if occurred
Plan: continue with current dosages of meds
Chem 7 today to check k, creatinine
Plan: Continue atorvastatin 80mg for life
Smoking cessation: Doing well since discharge without adjuvant treatments, aware of supports.
Plan: AAA screening ultrasound

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How to present...

How to present clinical cases

Related content
Peer review
Ademola Olaitan , medical student 1 ,
Oluwakemi Okunade , final year medical student 1 ,
Jonathan Corne , consultant physician 2
1 University of Nottingham
2 Nottingham University Hospitals

Presenting a patient is an essential skill that is rarely taught

Clinical presenting is the language that doctors use to communicate with each other every day of their working lives. Effective communication between doctors is crucial, considering the collaborative nature of medicine. As a medical student and later as a doctor you will be expected to present cases to peers and senior colleagues. This may be in the setting of handovers, referring a patient to another specialty, or requesting an opinion on a patient.

A well delivered case presentation will facilitate patient care, act a stimulus for timely intervention, and help identify individual and group learning needs. 1 Case presentations are also used as a tool for assessing clinical competencies at undergraduate and postgraduate level.

Medical students are taught how to take histories, examine, and communicate effectively with patients. However, we are expected to learn how to present effectively by observation, trial, and error.

Principles of presentation

Remember that the purpose of the case presentation is to convey your diagnostic reasoning to the listener. By the end of your presentation the examiner should have a clear view of the patient’s condition. Your presentation should include all the facts required to formulate a management plan.

There are no hard and fast rules for a perfect presentation, rather the content of each presentation should be determined by the case, the context, and the audience. For example, presenting a newly admitted patient with complex social issues on a medical ward round will be very different from presenting a patient with a perforated duodenal ulcer who is in need of an emergency laparotomy.

Whether you’re presenting on a busy ward round or during an objective structured clinical examination (OSCE), it is important that you are concise yet get across all the important points. Start by introducing patients with identifiers such as age, sex, and occupation, and move on to the complaint that they presented with or the reason that they are in hospital. The presenting complaint is an important signpost and should always be clearly stated at the start of the presentation.

Presenting a history

After you’ve introduced the patient and stated the presenting complaint, you can proceed in a chronological approach—for example, “Mr X came in yesterday with worsening shortness of breath, which he first noticed four days ago.” Alternatively you can discuss each of the problems, starting with the most pertinent and then going through each symptom in turn. This method is especially useful in patients who have several important comorbidities.

The rest of the history can then be presented in the standard format of presenting complaint, history of presenting complaint, medical history, drug history, family history, and social history. Strictly speaking there is no right or wrong place to insert any piece of information. However, in some instances it may be more appropriate to present some information as part of the history of presenting complaints rather than sticking rigidly to the standard format. For example, in a patient who presents with haemoptysis, a mention of relevant risk factors such as smoking or contacts with tuberculosis guides the listener down a specific diagnostic pathway.

Apart from deciding at what point to present particular pieces of information, it is also important to know what is relevant and should be included, and what is not. Although there is some variation in what your seniors might view as important features of the history, there are some aspects which are universally agreed to be essential. These include identifying the chief complaint, accurately describing the patient’s symptoms, a logical sequence of events, and an assessment of the most important problems. In addition, senior medical students will be expected to devise a management plan. 1

The detail in the family and social history should be adapted to the situation. So, having 12 cats is irrelevant in a patient who presents with acute appendicitis but can be relevant in a patient who presents with an acute asthma attack. Discerning the irrelevant from the relevant is not always easy, but it comes with experience. 2 In the meantime, learning about the diseases and their associated features can help to guide you in the things you need to ask about in your history. Indeed, it is impossible to present a good clinical history if you haven’t taken a good history from the patient.

Presenting examination findings

When presenting examination findings remember that the aim is to paint a clear picture of the patient’s clinical status. Help the listener to decide firstly whether the patient is acutely unwell by describing basics such as whether the patient is comfortable at rest, respiratory rate, pulse, and blood pressure. Is the patient pyrexial? Is the patient in pain? Is the patient alert and orientated? These descriptions allow the listener to quickly form a mental picture of the patient’s clinical status. After giving an overall picture of the patient you can move on to present specific findings about the systems in question. It is important to include particular negative findings because they can influence the patient’s management. For example, in a patient with heart failure it is helpful to state whether the patient has a raised jugular venous pressure, or if someone has a large thyroid swelling it is useful to comment on whether the trachea is displaced. Initially, students may find it difficult to know which details are relevant to the case presentation; however, this skill becomes honed with increasing knowledge and clinical experience.

Presenting in an exam

Although the same principles as presenting in other situations also apply in an exam setting, the exam situation differs in the sense that its purpose is for you to show your clinical competence to the examiner.

It’s all about making a good impression. Walk into the room confidently and with a smile. After taking the history or examining the patient, turn to the examiner and look at him or her before starting to present your findings. Avoid looking back at the patient while presenting. A good way to avoid appearing fiddly is to hold your stethoscope behind your back. You can then wring to your heart’s content without the examiner sensing your imminent nervous breakdown.

Start with an opening statement as you would in any other situation, before moving on to the main body of the presentation. When presenting the main body of your history or examination make sure that you show the examiner how your findings are linked to each other and how they come together to support your conclusion.

Finally, a good summary is just as important as a good introduction. Always end your presentation with two or three sentences that summarise the patient’s main problem. It can go something like this: “In summary, this is Mrs X, a lifelong smoker with a strong family history of cardiovascular disease, who has intermittent episodes of chest pain suggestive of stable angina.”

Improving your skills

The RIME model (reporter, interpreter, manager, and educator) gives the natural progression of the clinical skills of a medical student. 3 Early on in clinical practice students are simply reporters of information. As the student progresses and is able to link together symptoms, signs, and investigation results to come up with a differential diagnosis, he or she becomes an interpreter of information. With further development of clinical skills and increasing knowledge students are actively able to suggest management plans. Finally, managers progress to become educators. The development from reporter to manager is reflected in the student’s case presentations.

The key to improving presentation skills is to practise, practise, and then practise some more. So seize every opportunity to present to your colleagues and seniors, and reflect on the feedback you receive. 4 Additionally, by observing colleagues and doctors you can see how to and how not to present.

Remember the purpose of the presentation

Be flexible; the context should dictate the content of the presentation

Always include a presenting complaint

Present your findings in a way that shows understanding

Have a system

Use appropriate terminology

Additional tips for exams

Start with a clear introductory statement and close with a brief summary

After your summary suggest a working diagnosis and a management plan

Practise, practise, practise, and get feedback

Present with confidence, and don’t be put off by an examiner’s poker face

Be honest; do not make up signs to fit in with your diagnosis

Originally published as: Student BMJ 2010;18:c1539

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

See “Medical ward rounds” ( Student BMJ 2009;17:98-9, http://archive.student.bmj.com/issues/09/03/life/98.php ).

↵ Green EH, Durning SJ, DeCherrie L, Fagan MJ, Sharpe B, Hershman W. Expectations for oral case presentations for clinical clerks: Opinions of internal medicine clerkship directors. J Gen Intern Med 2009 ; 24 : 370 -3. OpenUrl CrossRef PubMed Web of Science
↵ Lingard LA, Haber RJ. What do we mean by “relevance”? A clinical and rhetorical definition with implications for teaching and learning the case-presentation format. Acad Med 1999 ; 74 : S124 -7. OpenUrl CrossRef PubMed Web of Science
↵ Pangaro L. A new vocabulary and other innovations for improving descriptive in-training evaluations. Acad Med 1999 ; 74 : 1203 -7. OpenUrl CrossRef PubMed Web of Science
↵ Haber RJ, Lingard LA. Learning oral presentation skills: a rhetorical analysis with pedagogical and professional implications. J Gen Intern Med 2001 ; 16 : 308 -14. OpenUrl CrossRef PubMed Web of Science

Mastering the Art of Case Presentations: A guide for allied health students

Understanding the Purpose of Case Presentations

As allied health students progress through training and begin clinical experience, case presentations become important to communicate with clinical supervisors effectively . Mastering the art of case presentations allows students to succinctly convey patient information, including relevant history, symptoms, and examination results. Additionally, case presentations allow students to demonstrate their clinical reasoning skills, including their ability to formulate differential diagnoses and develop evidence-based treatment plans.

The Patient Information Pyramid

At its core, a case presentation is a patient history summary, with all of the clinically irrelevant information omitted. Similarly, a clinical impression is a distilled case presentation. This is represented graphically below:

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How To Present Your Case In The ED

As a medical student, presenting history and physical exam of a patient to the attending can be nerve-wracking. In the ED, physicians typically prefer an even more succinct presentation than usual, ideally less than 3 min. Case presentations are a great opportunity to show that you understand what the pertinent positives and negatives for the patient’s presenting complaint are and that you can summarize a large amount of information collected in an organized manner. Case presentations are your opportunity to impress your preceptor, so it is an important skill to master. It will also be the mode of communicating with the rest of the healthcare team throughout your career in medicine. Better communication = better patient care!

Before we get started, it is important to recognize that every physician may have their own preference for how they would like case presentations organized. Some prefer more details, and some prefer a specific order. Therefore, it is always a smart idea to ask your preceptor at the beginning of your ED shift if they have a preference for how they like cases to be presented.

The One Liner

State the patient’s name, age, sex, chief complaint, and any pertinent medical history. E.g., John Doe is a 16-year-old male with a history of eczema presenting with wheezing.

History of Presenting Illness (HPI)

Why did this patient present to the ED today?
For pain, it is helpful to describe OPQRSTU – Onset, Position, Quality, Radiation, Severity, Temporal, déjà vU (has it ever happened before).
Any associated symptoms
Any relevant past medical history (e.g. chronic conditions, hospitalizations, surgeries, etc.), family history, or social history (e.g. habits, living situation, alcohol consumption, smoking history, illicit drug usage)?

Review of Systems

Describe any other symptoms here.

Note that some ED physicians may not want a review of systems included in the oral case presentation if it does not include any additional pertinent information, but a review of systems should always be included in your written patient note.

Medications

if the patient states that they do not have any allergies, this can be recorded and/or stated as “NKDA” which stands for No Known Drug Allergies.

Physical Exam Findings

Start off by stating the most updated set of vitals.
Next, state the patient’s general appearance as this helps decide between sick vs. not sick. E.g., patient is alert, oriented, and in no apparent respiratory distress.
Then, delve into the pertinent details of the physical exam. E.g. for a cardiac complaint, it is important to include the specific details of the cardiovascular exam and respiratory exam, but not of all the other systems.
A brief overview of the other systems that a physical exam was conducted for can be useful, but be as concise as possible, and organize information in a head-to-toe fashion if needed. If there were no other findings, you can state that the remainder of the physical exam was unremarkable.

In 2-3 sentences, gather the main findings of your history and physical exam. Be sure to restate the initial one-liner sentence, other pertinent positives and negatives, and any important test results so far.

Impression/Assessment

State your differential diagnosis for each problem.

Start off by stating what you think the most likely diagnosis is, and why you think it is the most likely.
Then, state any other likely diagnoses you are suspecting.
Lastly, state the deadly diagnoses that could be possible with this patient’s chief complaint. In some cases, this can be the first thing you may want to say. It is important to specify why you do or do not feel confident in ruling these out. E.g., in a baby presenting with fever of unknown origin, it is important to state why you are not (or are) suspecting meningitis, encephalitis, malignancy, or autoimmune conditions.
Many medical students will shy away from stating their impression of what could be going on in terms of differential diagnosis, but this is an important thing to attempt. Preceptors will appreciate your effort in synthesizing what could be going on and be impressed by it, even if your impression is incorrect. This is often what sets apart students that “meet expectations” vs. students that are considered “outstanding”.

What do you want to do next?

Plan includes anything from the tests you want to order (including repeat vitals, bloodwork, and imaging), immediate treatment (including analgesics and fluids), and referrals you want to make (including consults, admission/discharge plan, and referral to allied health professionals such as social work, speech-language pathology, occupational therapy, and physiotherapy).
Do not forget to take the patient’s social history into account when deciding what to do next.

Congrats – you have now completed your oral case presentation! This is a skill you will continue to develop with practice, so do not worry and keep working at it. It is also a good idea to always ask your preceptor for feedback on your case presentation once it is complete, as that will help you identify your strengths and weaknesses.

References and Further Reading

Davenport C, Honigman B, Druck J. The 3-minute emergency medicine medical student presentation: a variation on a theme. Acad Emerg Med . 2008 Jul;15(7):683-7. doi: 10.1111/j.1553-2712.2008.00145.x. PMID: 18691216.
Oral Presentations in Emergency Medicine. FlippedEM Classroom. 2013. https://flippedemclassroom.files.wordpress.com/2013/08/acem_145_sm_datasupplements1.pdf
Ramsden S. How to Present a Case in the Emergency Department. CanadiEM . 2020. https://canadiem.org/how-to-present-a-case-in-the-emergency-department/ Accessed 08 November, 2020.
Williams DE, Surakanti S. Developing Oral Case Presentation Skills: Peer and Self-Evaluations as Instructional Tools. Ochsner J . 2016;16(1):65-69.

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Indian J Psychiatry
v.61(6); Nov-Dec 2019

Case presentation in academic psychiatry: The clinical applications, purposes, and structure of formulation and summary

Narayana manjunatha.

Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

INTRODUCTION

Case presentation in an academic psychiatry traditionally follows one of the following three formats: 4DP format (ideal and lengthy format; described in the following section), “Case Summary” (CS) (medium format), or “Case Formulation” (CF) (short format), in order of the decreasing length, duration, and the gradual transition from the use of layman terms (in the history with a goal of layman understanding) to technical terms (in diagnostic formulation [DF] with a goal to communicate with professionals). However, the medium and short formats (CS and CF) are often preferred as a rule rather than exception routinely than the ideal and lengthy 4DP format in the area of academic psychiatry.

An ideal case presentation in academic psychiatry follows 4DP format: first is the “Detailed presentations of all clinical information,” second is the “Diagnostic summary” (DS) (it is optional, see below), third is the “Diagnostic formulation,” fourth is the Diagnosis or differential diagnosis (usually International Classification of Diseases-10 (ICD-10)/Diagnostic and Statistical Manual of Mental Disorders-5 [DSM-5]) and discussion of diagnosis with points in favor and against, and finally is the “Plan of management.” The goal of this article is to overview the clinical applications, purposes, and structure of the “formulation” and “summary” in this article with review from published literatures. Table 1 represents these formats of presentation graphically.

Graphical representation of different formats of case presentations in psychiatry

*Includes complete history, physical examination, and detailed mental status examination. DD – Differential diagnosis

CONCEPTS OF “FORMULATION” AND “SUMMARY:” SHORTCOMINGS

Despite the availability of substantial literatures, the concepts of “formulation” and “summary” are rather confusing concepts in academic psychiatry, especially with psychiatric residents. There are few shortcomings of these concepts causing this confusion. The presence of various models of formulations in psychiatric literatures is one of the reasons for this confusion such as “psychodynamic formulation,” “psychotherapeutic formulation,” and “cultural formulation.” It is essential to understand the purposes of the existing models of these psychiatric formulations. The “psychodynamic formulation” focuses on psychodynamic understanding of the problems of patients and may involve interventions with psychodynamic psychotherapy, the “psychotherapeutic formulation” aims to understand the problems of patients and helps to choose the different schools of psychotherapy, and the “cultural psychiatric formulation” focuses on understanding of the patient's problems from his/her cultural background. Lack of clarity on this pair of terminologies such as “case formulation” versus “diagnostic formulation” and “case summary” versus “diagnostic summary” in published literatures is another significant reason for confusion. Kuruvilla and Kuruvilla[ 1 ] in their article entitled “diagnostic formulation” denotes the inclusion of diagnosis (at least the differential diagnosis) and plan of management in the formulation. The author wishes to convey that “diagnostic formulation” and “case formulation” (formulating a case) are rather different concepts with different purposes. The concept “CF” denotes for formulating a case for the purpose of both diagnostic and management purposes, whereas “DF” with the term “diagnostic” denotes diagnostic point of view only (where term itself denotes diagnosis), which excludes the “plan of management.” The similar explanation is offered to differentiate “CS” and “DS.” Often, these pairs of terminology are used synonymously causing confusion. Further discussion in this article is based on the above explanations of all these four terms. However, if examiners/teachers ask to present DF, it means formulating his/her case for the purpose of diagnostic purpose, which need not include the management plan. For the sake of better clarity, the author wishes to discuss student-friendly models of formulation, summary, and diagnosis, edited by Professor David Goldberg. Along with experienced teachers, trainees themselves are involved in deriving these concepts in explaining Professor D. Goldberg's concepts which is an interesting point.

CLINICAL APPLICATION OF DIAGNOSTIC FORMULATION AND SUMMARY

Often, the choice of presentation from one of either “DS” or “DF” in academic psychiatry depends on whether the detailed clinical information is presented or not. If detailed clinical information is presented, “DS” may be skipped and proceed directly to presentation of the third step of ideal 4DP format, i.e., “DF.” In case detailed clinical information is not presented for any reasons, the case presentation may begin with “DS” and then may proceed to “DF” (however, it is optional). In either of the ways, both “DS” and “DF” are followed by the fourth step of ideal 4DP format, i.e., the “diagnosis or differential diagnosis” (usually ICD-10 and DSM 5) and discussion of diagnosis with points in favor and against, and finally is the “plan of management.”

The choice of the presentation either “DS”/“DF”, at times, depends on the availability of time with examiners/listeners/faculties. When ample of time are available, the examiners/teachers ask residents to present a detailed presentation of all clinical data in the usual 4DP format of “presenting complaint,” “history of presenting illness,” etc., followed by “DF,” and then plan of management, and this format has the minimal scope of “DS” presentation. However, whenever time is a constraint, residents shall be asked to present the “DS” without a detailed presentation of clinical data followed by with or without “DF.” In any case, psychiatric residents shall be encouraged to learn both DS and DF for any eventuality during examination.

As discussed above, the “CF” traditionally includes only the last three steps (3 rd , 4 th , and 5 th ) of 4DP format of psychiatric case presentation. This has relevance from psychodynamic explanation of psychiatric disorders. In view of the significant development in the neurobiology of psychiatric disorders in the last few decades and high dependency of making clinical diagnosis based on the current classificatory system (ICD-10 and DSM 5), the “DF” is preferred which excludes the plan of management than the “CF” as authors believe that the presentation of the “plan of management” itself is an important skill which is expected from psychiatric residents during training and examination. However, whenever a psychiatric resident is asked to present “CF,” he/she shall include the third to fifth steps of ideal format.

PURPOSE OF DIAGNOSTIC FORMULATION AND SUMMARY

The important goal of the “DF” is to facilitate the communication of clinical information of patients with another professional/s who are familiar with technical jargons (i.e., psychopathological/psychiatric terminology), whereas the purpose of “DS” is to convey the clinical information of patients to lay persons and/or nonprofessionals and comprises all the components of a DF, but in layman's terminology. The contents of DS may be used for the purpose of psychoeducation to patients and their family.

STRUCTURE OF DIAGNOSTIC FORMULATION AND SUMMARY

The purposes of “DF” and “DS” are important to understand their structure or contents. Since “DF” is targeted for professionals, the technical jargons are used in its content, whereas “DS” is targeted for lay persons or nonprofessionals, and then layman terms are used in its content. The “DF” should be quite brief to just re-orientating the listener to the salient features of the case, often just the key demographics and major diagnostic criteria described in technical terms in as less words as possible without repetition of any word/s. The technical jargons in “DF” often include the terminology of descriptive psychopathology or diagnostic points of classificatory system (ICD-10 and DSM-5). In simple words, the structure of both DF and DS is, more or less, similar in contents, but the difference lies in the use of technical terms and layman's terms, respectively, in its structure/contents. Further details of the structure of DF and DS are discussed below in the proposed format and case vignettes.

RECOMMENDED SIZE AND TIME TO PRESENT “DIAGNOSTIC FORMULATION AND “DIAGNOSTIC SUMMARY

The completed DF shall last for about 5 min, and the recommended length for a written version is not more than one side of a A4 paper when typed,[ 1 ] which is equivalent to 10 to 15 sentences, whereas the completed DS should be short enough to cover about two sides of a A4 paper when typed,[ 2 ] which should not be more than 10 min.

SUMMARY, FORMULATION, AND DIAGNOSIS: MODEL BY PROFESSOR DAVID GOLDBERG

The following paragraphs exerted in italic (without any edition to preserve the semantic) from “ The Maudsley Handbook of Practical Psychiatry ” were edited by Professor David Goldberg. The author feels that these paragraphs are important to understand the difference between the process of summary, formulation, and diagnosis. The author intentionally deleted diagnostic points and management plan from the discussion to keep focus on DF only.

A SUMMARY is a descriptive account of collected data: Objective and impartial. In contrast, a FORMULATION is a clinical opinion: Weighing up the pros and cons of conflicting evidence, that leads to a diagnostic choice. An opinion inevitably implies a subjective view point, by virtue of assigning relative importance to each piece of evidence; in doing so, both theoretical bias and past personal experience invariably come to play. No matter how accurate the final verdict, an analysis is inextricably bound up with subjective judgments and decisions. When assigning the same patient, two experts may produce two similar summaries, but two different formulations with divergent conclusions. This is the fundamental difference: A SUMMARY is a descriptive, whereas a formulation is analytical. Therefore, a summary calls for the qualities of thoroughness, restraint, and objectivity, while a formulation demands the composite skill of methodological thinking, incisive analysis and intelligent presentation.

THE SUMMARY

It is an important document which should be drawn up with care. Its purpose is to provide a concise description of all the important aspects of the case, enabling others who are unfamiliar with the patient to grasp the essential features of the problem without needing to search elsewhere for further information. The completed summary should be short enough to cover about two sides of A4 paper when typed.

THE FORMULATION

Formulating a case with clarity and precision is probably the most testing yet challenging and crucial part of a psychiatric assessment. The skills of writing a good formulation depend upon the ability to differentiate what are merely the incidental and circumstantial biographical details from what are the salient and discriminatory features and it is this that forms the cornerstone of a clinical diagnosis. Certain features are discriminatory because they support one diagnosis as more likely candidate and discount another diagnosis as less likely.

THE DIAGNOSIS AND FORMULATION

A diagnosis involves a nomothetic (literally “law-giving”) process. This means that all cases included within the identified category have one or more properties in common. By contrast, the formulation is an idiographic process (literally “picture of the individual”). This means that it includes the unique characteristics of each patient's case which are needed for the process of management. So, while nomothetic processes are the only way we can advance knowledge about a disease, we use idiographic methods to understand and study the individual.

THE FORMAT OF THE FORMULATION

The formulation follows a logical sequence.

Demographic data: Begins with name, age, occupation, and marital status of the patient.

Descriptive formulation: Describe the nature of onset,– for example, acute or insidious; the total duration of the present illness; and course; for instance, cyclic or deteriorating. Then list of the main phenomena (namely, symptoms and signs) that characterize the disorder. As you become more experienced you should try to be selective by featuring those phenomena that are most important, either because of their diagnostic specificity or because of their predominance in severity or duration. Avoids long lists of minor or transient symptoms and negative findings. These basic data are chiefly derived from history of the present illness; the mental state and physical examinations are used to determine the syndrome diagnosis in the next section. Note that this is not usually the place to bring in other aspects of the history: That comes later. If we know the diagnosis of a previous episode of mental illness, this should also be taken into account, but remember, the present disorder may not be connected and the diagnosis may be different.

Etiology: The various factors that have contributed should be evident mainly from the family and personal histories, the history of previous illness, and the premorbid personality. Try to answer two questions: Why this patient developed this particular disorder, and why has the disorder developed at this particular time?

PROPOSED FORMATS OF “DIAGNOSTIC SUMMARY” AND “DIAGNOSTIC FORMULATION”

The general formats of “DS” and “DF” are essentially similar with slight changes in order of the presentation, which aim to reduce the number of words as well as to avoid the repetition of words.

Sociodemographic data
Elaboration of chief complaint with focus on positive aspects with relevant negative aspects: Presenting the long list of minor or transient symptoms and negative findings is advisable in DS to differentiate in the differential diagnosis which may be avoided in DF. Treatment history also needs to be briefed here. Please note that layman terms shall be used in DS, whereas technical jargons are used in DF
Past psychiatric and medical history: Briefly describe the symptoms of the past psychiatric disorder and then write possible name for that psychiatric disorder in DS, whereas directly write psychiatric diagnosis in DF
Family history: Briefly describe symptoms and age of the onset of psychiatric disorder, and then write possible name of that psychiatric disorder in DS, whereas directly write psychiatric diagnosis in DF
Personal history: Briefly describe the positive aspects of personal history in DS, whereas the use of possible technical jargon in DF is advised
Premorbid personality: Describe briefly each headings of premorbid personality followed by impression in DS, whereas give directly the impression in DF, i.e., well-adjusted or schizoid/schizotypal/anxious avoidant/personality traits/disorder
Physical examination: Briefly describe positive findings in DS, whereas technical comments in DF using medial jargons
Mental Status Examination (MSE): Briefly describe positive findings first, then give impression of that finding using psychopathological terms in DS, whereas directly write technical jargons using psychopathological terms in DF. Please note here that, in case of DF, the psychopathological findings in MSE may be similar to the history of presenting illness (HOPI). In this case, mention as “concurred with HOPI findings” in order to avoid repetition of terms (see in case vignette of DF).

Note: Please note that findings from the family and personal histories, the history of previous illness, and the premorbid personality give the etiology of presentation of case. The sequence in the format of DS may be preferred in the same way as above, whereas in DF, etiology-related history such as past, family, and personal histories as well as premorbid personality may be presented before presenting complaints, which reduce the number of words by avoiding the repetition of words (please see in case vignettes of DS and DF).

CASE VIGNETTES: DEMONSTRATION OF THE STRUCTURE OF “DS “ AND “DF “

Diagnostic summary.

A 36-year-old married and postgraduation-completed male, currently working as a software professional hailing from urban-middle socioeconomic background from Bengaluru, presented with adequate and reliable information of 20-day illness of abrupt onset and continuous course characterized by overcheerfulness, hyperactivity, and unable to sit at one place, overtalkativeness, overfamiliarity, and overspending most of the time in the last 20 days and false and firm claims that he is a minister and demand respect from people in the last 12 days, with decreased need of sleep and appetite disturbance along with socio-occupational dysfunction in the absence of organicity and schizophrenic and depressive symptoms. There was a family history of episodic mental illness suggestive of bipolar disorder in first-degree relative with age of onset at about 23 years with maintaining asymptomatic with lithium prophylaxis and past history suggestive of episodic mental illness of bipolar disorder in the last 12 years with four similar manic episodes with each 3–5 months' duration and another three depressive episodes characterized by depressed mood, reduced interest, easy fatiguability, and early-morning awakening for about 6–8 months with poor medication adherence, with nil significant personal history and well-adjusted premorbid personality. No abnormality was found in physical examination. MSE reveals overfamiliarity; easily established rapport; increased tone, tempo, and volume in speech; pacing around excessive suggestive of increased psychomotor activity; expression and observation of overcheerfulness suggestive of elated mood and affect; and delusion of grandiosity of identity for the above claim with impaired judgment and partial insight (total 250 words).

Diagnostic formulation

Mr. Sri, a 36-year-old married and postgraduation-completed male, currently working as a software professional hailing from urban-middle socio-economic status from Bengaluru, with a family history of bipolar disorder in first-degree relative with maintaining remission on lithium prophylaxis, with past history of four manic episodes and three depressive episodes in last 12 years with poor medication adherence, with nil significant personal history and well-adjusted pre-morbid personality, presented with adequate and reliable information of 20-day illness of abrupt onset and continuous course with characterized by elated mood, increased psychomotor activity, inflated self-esteem, excessive and rapid speech, overfamiliarity, and delusion of grandiosity of identity in the last 12 days with severe bio-socio-occupational dysfunction. No abnormality was found in physical examination. MSE is concurred with the above psychopathology with impaired judgment and impaired insight (total 131 words).

Please note that the above case vignettes are not exclusive and minor variation/s are still possible.

The aims of CF/CS are different from that of DF/DS. CF/CS focuses on understanding of the case-as-whole, but DF/DS aims for diagnostic points of view. The clinical applications, purposes, and structure of DF and DS are different. The authors explained hypothetical explanation of case presentation in academic psychiatry, which we feel is relevant in order to reduce the confusion in minds of present and prospective psychiatric residents. The author hope that these hypothetical explanations explained here is welcomed by the community of academic psychiatry.

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Conflicts of interest.

There are no conflicts of interest.

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The Oral Case Presentation : A Key Tool for Assessment and Teaching in Competency-Based Medical Education

1 Wilson Centre, University of Toronto, Toronto, Ontario, Canada
2 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
3 HoPingKong Centre, University Health Network, Toronto, Ontario, Canada

Oral case presentations by trainees to supervisors are core activities in academic hospitals across all disciplines and form a key milestone in US and Canadian educational frameworks. Yet despite their widespread use, there has been limited attention devoted to developing case presentations as tools for structured teaching and assessment. In this Viewpoint, we discuss the challenges in using oral case presentations in medical education, including lack of standardization, high cognitive demands, and the role of trust between supervisor and trainee. We also articulate how, by addressing these tensions, case presentations can play an important role in competency-based education, both for assessment of clinical competence and for teaching clinical reasoning.

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Published: 24 May 2023

Comparing oral case presentation formats on internal medicine inpatient rounds: a survey study

Brendan Appold 1 ,
Sanjay Saint 1 , 2 ,
David Ratz 2 &
Ashwin Gupta 1 , 2

BMC Medical Education volume 23 , Article number: 377 ( 2023 ) Cite this article

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Oral case presentations – structured verbal reports of clinical cases – are fundamental to patient care and learner education. Despite their continued importance in a modernized medical landscape, their structure has remained largely unchanged since the 1960s, based on the traditional Subjective, Objective, Assessment, Plan (SOAP) format developed for medical records. We developed a problem-based alternative known as Events, Assessment, Plan (EAP) to understand the perceived efficacy of EAP compared to SOAP among learners.

We surveyed (Qualtrics, via email) all third- and fourth-year medical students and internal medicine residents at a large, academic, tertiary care hospital and associated Veterans Affairs medical center. The primary outcome was trainee preference in oral case presentation format. The secondary outcome was comparing EAP and SOAP on 10 functionality domains assessed via a 5-point Likert scale. We used descriptive statistics (proportion and mean) to describe the results.

The response rate was 21% (118/563). Of the 59 respondents with exposure to both the EAP and SOAP formats, 69% ( n = 41) preferred the EAP format as compared to 19% ( n = 11) who preferred SOAP ( p < 0.001). EAP outperformed SOAP in 8 out of 10 of the domains assessed, including advancing patient care, learning from patients, and time efficiency.

Conclusions

Our findings suggest that trainees prefer the EAP format over SOAP and that EAP may facilitate clearer and more efficient communication on rounds, which in turn may enhance patient care and learner education. A broader, multi-center study of the EAP oral case presentation will help to better understand preferences, outcomes, and barriers to implementation.

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Excellent inter-physician communication is fundamental to both providing high-quality patient care and promoting learner education [ 1 ], and has been recognized as an important educational goal by the Clerkship Directors in Internal Medicine, the Association of American Medical Colleges, and the Accreditation Council for Graduate Medical Education [ 2 ]. Oral case presentations, structured verbal reports of clinical cases [ 3 ], have been referred to as the “currency with which clinicians communicate” [ 4 ]. Oral case presentations are a key element of experiential learning in clinical medicine, requiring learners to synthesize, assess, and convey pertinent patient information and to formulate care plans. Furthermore, oral case presentations allow supervising clinicians to identify gaps in knowledge or clinical reasoning and enable team members to learn from one another. Despite modernization in much of medicine, oral case presentation formats have remained largely unchanged, based on the traditional Subjective, Objective, Assessment, Plan (SOAP) format developed by Dr. Lawrence Weed in his Problem Oriented Medical Record in 1968 [ 5 ].

Given that the goals of a medical record are different than those of oral case presentations, it should not be assumed that they should share the same format. While Dr. Weed sought to make the medical record as “complete as possible,” [ 6 ] internal medicine education leaders have expressed desire for oral case presentations that are succinct, with an emphasis on select relevant details [ 2 ]. Using a common SOAP format between the medical record and oral case presentations risks conflating the distinct goals for each of these communication methods. Indeed, in studying how learners gain oral case presentation skills, Haber and Lingard [ 7 ] found differences in understanding of the fundamental purpose of oral case presentations between medical students and experienced physicians. While students believed the purpose of oral case presentations was to organize the large amount of data they collected about their patients, experienced physicians saw oral case presentations as a method of telling a story to make an argument for a particular conclusion [ 7 ].

In accordance with Dr. Weed’s “problem-oriented approach to data organization,” [ 6 ] but with an eye toward optimizing for oral case presentations, we developed an alternative to SOAP known as the Events, Assessment, Plan (EAP) format. The EAP format is used for patients who are already known to the inpatient team, and may also be utilized for newly admitted patients for whom the attending physician already has context (e.g., via handoff or review of an admission note). As the EAP approach is utilized by a subset of attending physicians at our academic hospital, we sought to understand the perceived effectiveness of the EAP format in comparison to the traditional SOAP format among learners (i.e., medical students and resident physicians).

EAP is a problem-based format used at the discretion of the attending physician. In line with suggested best practices [ 8 ], the EAP structure aims to facilitate transmission of data integrated within the context of clinical problem solving. In this format, significant interval events are discussed first (e.g., a fall, new-onset abdominal pain), followed by a prioritized assessment and plan for each relevant active problem. Subjective and objective findings are integrated into the assessment and plan as relevant to a particular problem. This integration of subjective and objective findings by problem is distinct from SOAP, where subjective and objective findings are presented separately as their own sections, with each section often containing information that is relevant to several problems (Fig. 1 , Additional file 1 : Appendix A).

Overview: comparing EAP to SOAP

Settings and participants

We surveyed third- and fourth-year medical students, and first- through fourth-year internal medicine and internal medicine-pediatrics residents, caring for patients at a large, academic, tertiary care hospital and an affiliated Veterans Affairs medical center. Internal medicine is a 12-week core clerkship for all medical students in their second year, with 8 weeks spent on the inpatient wards. All student participants had completed their internal medicine clerkship rotation at the time of the survey. We did not conduct a sample size calculation at the outset of this study.

Data collection methods and processes

An anonymous, electronic survey (Qualtrics, Provo, UT) was created to assess student and resident experience with and preference between EAP and SOAP oral case presentation formats during inpatient internal medicine rounds (Additional file 2 : Appendix B). Ten domains were assessed via 5-point Likert scale (1 [strongly disagree] to 5 [strongly agree]), including the ability of the format to incorporate the patient’s subjective experience, the extent to which the format encouraged distillation and integration of information, the extent to which the format focused on the assessment and plan, the format’s ability to help trainees learn from their own patients and those of their peers, time efficiency, and ease of use. Duration of exposure to each format was also assessed, as were basic demographic data for the purposes of understanding outcome differences among respondents (e.g., students versus residents). For those who had experienced both formats, preference between formats was recorded as a binary choice. Participants additionally had the opportunity to provide explanation via free text. For participants with experience in both formats, the order of evaluation of EAP and SOAP formats were randomized by participant. For questions comparing EAP and SOAP formats directly, choice order was randomized.

The survey was distributed via official medical school email in October 2021 and was available to be completed for 20 days. Email reminders were distributed approximately one week after distribution and again 48 h prior to survey conclusion.

The primary outcome was trainee preference in oral case presentation format. Secondary outcomes included comparison between EAP and SOAP on content inclusion/focus, data integration, learning, time efficiency, and ease of use.

Statistical analyses

Descriptive statistics were used to describe the results (proportion and mean). For comparative analysis between EAP and SOAP, responses from respondents who had experience with both formats were compared using the Wilcoxon Signed Rank Test to evaluate differences. All statistical analyses were done using SAS V9.4 (SAS Institute, Cary, NC). We considered p < 0.05 to be statistically significant.

The overall response rate was 21% (118/563). The response rate was 14% ( n = 62/441) among medical students and 46% ( n = 56/122) among residents. Respondents were 61% ( n = 72) female. A total of 98% ( n = 116) and 52% ( n = 61) of respondents reported experience with SOAP and EAP formats, respectively. Among medical students, 60% ( n = 37) reported experience with SOAP only while 39% ( n = 24) had experience with both formats. Among residents, 36% ( n = 20) and 63% ( n = 35) had experience with SOAP only and both formats, respectively (Table 1 ). Most students (93%) and residents (96%) reported > 8 weeks of exposure to the SOAP format. Duration of exposure to the EAP format varied (0 to 2 weeks [32% of students, 17% of residents], 2 to 4 weeks [36% of students, 47% of residents], 4 to 8 weeks [16% of students, 25% of residents], and > 8 weeks [16% of students, 11% of residents]).

Of the 59 respondents with exposure to both the SOAP and EAP formats, 69% ( n = 41) preferred the EAP format as compared to 19% ( n = 11) preferring SOAP ( p < 0.001). The remainder ( n = 7, 12%) indicated either no preference between formats or indicated another preference. Among residents, 66% ( n = 23) favored EAP, whereas 20% ( n = 7) and 14% ( n = 5) preferred SOAP or had no preference, respectively ( p < 0.001). Among students, 75% ( n = 18) favored EAP, whereas 17% ( n = 4) and 8% ( n = 2) favored SOAP or had no preference, respectively ( p < 0.001).

Likert scale ratings for domains assessed by trainees who had experience in either format are shown in Table 2 . In general, scores for each domain were higher for EAP than SOAP, with the exception of perceived ease of use among students. Among those with experience using both formats, EAP outperformed SOAP most prominently in time efficiency (mean 4.39 vs 2.59, p < 0.001) and encouragement to: focus on assessment and plan (4.64 vs 3.05, p < 0.001), distill pertinent information (4.63 vs 3.17, p < 0.001), and integrate data (4.58 vs 3.31, p < 0.001) (Table 3 ). Respondents also ranked EAP higher in its effectiveness at advancing patient care (4.31 vs 3.71, p < 0.001), its capacity to convey one’s thinking (4.53 vs 3.95, p < 0.001), and its ability to facilitate learning from peers (4.10 vs 3.58, p < 0.001) and one’s own patients (4.24 vs 3.78, p = 0.003). There were no significant differences in the amount of time allotted for discussing the patient’s subjective experience or in ease of use.

Evaluation of trainee free text responses regarding oral case presentation preference revealed several general themes (Table 4 ). First, respondents generally felt that EAP was more time efficient and less repetitive, allowing for additional time to be spent discussing pertinent patient care decisions. Second, several respondents indicated that EAP aligns well with how trainees consider problems naturally (as a single problem in completion). Finally, respondents generally believed that EAP allowed learners to effectively communicate their thinking and demonstrate their knowledge. Those preferring SOAP most often cited format familiarity and the difficulty in switching between formats in describing their preference, though some also believed SOAP was more effective in describing a patient’s current status.

Our single site survey comparing 2 oral case presentation formats revealed a preference among respondents for EAP over SOAP for those medical students and internal medicine residents who had experience with both formats. Furthermore, EAP outperformed SOAP in 8 out of 10 of the functionality domains assessed, including areas such as advancing patient care, learning from patients, and, particularly, time efficiency. Such a constellation of findings implies that EAP may not only be a more effective means to accomplish the key goals of oral case presentations, but it may also provide an opportunity to save time in the process. In line with SOAP’s current de facto status as an oral case presentation format, almost all respondents reported exposure to the SOAP format. Still, indicative of EAP’s growing presence at our academic system, more than one third of medical students and more than one half of residents also reported having experience with the EAP format.

While limited data exist that compare alternative oral case presentations to SOAP on inpatient medicine rounds, such alternatives have been previously trialed in other clinical venues. One such format, the multiple mini-SOAP, developed for complex outpatient visits, encourages each problem to be addressed “in its entirety” before presenting subsequent problems, and emphasizes prioritization by problem pertinency [ 9 ]. The creators suggest that this approach encourages more active trainee participation in formulating the assessment and plan for each problem, by helping the trainee to avoid getting lost in an “undifferentiated jumble of problems and possibilities” [ 9 ] that accumulate when multiple problems are presented all at once. On the receiving end, the multiple mini-SOAP enables faculty to assess student understanding of specific clinical problems one at a time and facilitates focused teaching accordingly.

Another approach has been assessed in the emergency department. Specifically, Maddow and colleagues explored assessment-oriented oral case presentations to increase efficiency in communication between residents and faculty at the University of Chicago [ 10 ]. In the assessment-oriented format, instead of being presented in a stylized order, pertinent information was integrated into the analysis. The authors found that assessment-oriented oral case presentations were about 40% faster than traditional presentations without significant differences in case presentation effectiveness.

Prior to our study, the nature of the format for inpatient medicine oral case presentations had thus far escaped scrutiny. This is despite the fact that oral case presentations are time (and therefore resource) intensive, and that they play an integral role in patient care and learner education. Our study demonstrates that learners favor the EAP format, which has the potential to increase both the effectiveness and efficiency of rounding.

Still, it should be noted that a transition to EAP does present challenges. Implementing this problem-based presentation format requires a conscious effort to ensure a continued holistic approach to patient care: active problems should be defined and addressed in accordance with patient preferences, and the patient’s subjective experience should be meaningfully incorporated into the assessment and plan for each problem. During initial implementation, attending physicians and learners must internalize this new format, often through trial and error.

From there, on an ongoing basis, EAP may require more upfront preparation by attending physicians as compared to SOAP. While chart review by attendings in advance of rounding is useful regardless of the format utilized, this practice is especially important for the EAP format, where trainees are empowered to interpret and distill – rather than simply report a complete set of – information. Therefore, the attending physician must be aware of pertinent data prior to rounds to ensure that key information is not neglected. Specifically, attendings should pre-orient themselves with laboratory values, imaging, and other studies completed, and new suggestions from consultants. More extensive pre-work may be required if teams wish to employ the EAP format for newly admitted patients, as attending physicians must also familiarize themselves with a patient’s medical history and their current presentation prior to initial team rounds.

Our findings should be interpreted within the context of specific limitations. First, low response rates may have led to selection bias within our surveyed population. For instance, learners who desired change in the oral case presentation format may have been more motivated to engage with our survey. Second, there could be unmeasured confounding variables that could have skewed our results in favor of the EAP format. For example, attendings who utilized the EAP format may have been more likely to innovate in other ways to create a more positive experience for learners, which may have influenced the scoring of the oral case presentation format. Third, our findings were largely based on subjective experience. Objective measurement (e.g., duration of rounds, patient care outcomes) may lend additional credibility to our findings. Lastly, our study included only a single site, limiting our ability to generalize our findings.

Our study also had several strengths. Our learner participant pool was broad and included all third- and fourth-year medical students and all internal medicine residents at a major academic hospital. Participation was encouraged regardless of the nature of a participant’s prior exposure to different oral case presentation formats. Our survey was anonymous with randomization to mitigate order bias, and we focused our comparison analysis on those who had exposure to both the EAP and SOAP formats. We collected data to compare EAP with SOAP in 2 distinct ways: head-to-head preference and numeric ratings amongst key domains. Both of these methods demonstrated a significant preference for EAP among learners in aggregate, as well as for students and residents analyzed independently.

Our findings suggest a preference for the EAP format over SOAP, and that EAP may facilitate clearer and more efficient communication on rounds. These improvements may in turn enhance patient care and learner education. While our preliminary data are compelling, a broader, multi-center study of the EAP oral case presentation is necessary to better understand preferences, outcomes, and barriers to implementation. Further studies should seek to improve response rates, for the data to represent a larger proportion of trainees. One potential strategy to improve response rates among medical students and residents is to survey them directly at the end of each internal medicine clerkship period or rotation, respectively. Ultimately, EAP may prove to be a much-needed update to the “currency with which clinicians communicate.”

Availability of data and materials

The data that support the findings of this study are available from the corresponding author, AG, upon reasonable request.

Kihm JT, Brown JT, Divine GW, Linzer M. Quantitative analysis of the outpatient oral case presentation: piloting a method. J Gen Intern Med. 1991;6(3):233–6.

Article Google Scholar

Green EH, Durning SJ, DeCherrie L, Fagan MJ, Sharpe B, Hershman W. Expectations for oral case presentations for clinical clerks: opinions of internal medicine clerkship directors. J Gen Intern Med. 2009;24(3):370–3.

Daniel M, Rencic J, Durning SJ, Holmboe E, Santen SA, Lang V, et al. Clinical Reasoning Assessment Methods: A Scoping Review and Practical Guidance. Acad Med. 2019;94(6):902–12.

Lewin LO, Beraho L, Dolan S, Millstein L, Bowman D. Interrater reliability of an oral case presentation rating tool in a pediatric clerkship. Teach Learn Med. 2013;25(1):31–8.

Wright A, Sittig DF, McGowan J, Ash JS, Weed LL. Bringing science to medicine: an interview with Larry Weed, inventor of the problem-oriented medical record. J Am Med Inform Assoc. 2014;21(6):964–8.

Weed LL. Medical records that guide and teach. New Engl J Med. 1968;278(12):652–7.

Haber RJ, Lingard LA. Learning oral presentation skills: a rhetorical analysis with pedagogical and professional implications. J Gen Intern Med. 2001;16(5):308–14.

Wiese J, Saint S, Tierney LM. Using clinical reasoning to improve skills in oral case presentation. Semin Med Pract. 2002;5(3):29–36.

Google Scholar

Schillinger E, LeBaron S. The multiple mini-SOAP format for student presentations of complex patients. Fam Med. 2003;35(1):13–4.

Maddow CL, Shah MN, Olsen J, Cook S, Howes DS. Efficient communication: assessment-oriented oral case presentation. Acad Emerg Med. 2003;10(8):842–7.

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Acknowledgements

The authors would like to thank Jason M. Engle, MPH, who helped edit, prepare, format, and submit this manuscript and supporting files.

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Conceptualization: BA SS AG. Data curation: BA DR AG. Formal Analysis: BA SS DR AG. Funding acquisition: SS AG. Investigation: BA SS AG. Methodology: BA SS AG. Project administration: BA SS AG. Resources: SS AG. Software: DR. Supervision: SS AG. Validation: BA SS DR AG. Visualization: BA SS DR AG. Writing – original draft: BA AG. Writing – review & editing: BA SS DR AG. The author(s) read and approved the final manuscript.

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Correspondence to Ashwin Gupta .

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Dr. Saint, Mr. Ratz, and Dr. Gupta are employed by the US Department of Veterans Affairs. Dr. Saint reports receiving grants from the Department of Veterans Affairs and personal fees from ISMIE Mutual Insurance Company, Jvion, and Doximity. Dr. Appold, Mr. Ratz, and Dr. Gupta report no conflict of interest.

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Supplementary Information

Additional file 1:.

Appendix A. Exemplar Transcripts (EAP, SOAP).

Additional file 2:

Appendix B. Survey Instrument.

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Appold, B., Saint, S., Ratz, D. et al. Comparing oral case presentation formats on internal medicine inpatient rounds: a survey study. BMC Med Educ 23 , 377 (2023). https://doi.org/10.1186/s12909-023-04292-3

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Received : 24 August 2022

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Published : 24 May 2023

DOI : https://doi.org/10.1186/s12909-023-04292-3

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