a Mean scores to the prompt: “The ‘___’ presentation format…”
(1 = strongly disagree, 2 = disagree, 3 = neither disagree nor agree, 4 = agree, 5 = strongly agree)
EAP vs SOAP head-to-head for all respondents who experienced both formats a
Allowed you to adequately convey your thought process | 4.50 | 4.04 | 0.07 | 4.54 | 3.89 | 4.53 | 3.95 | ||
Allowed adequate time for discussion of the patient’s subjective experience | 4.04 | 4.13 | 0.69 | 4.34 | 3.89 | 4.22 | 3.98 | 0.17 | |
Encouraged you to distill pertinent information in your presentation | 4.67 | 3.13 | 4.60 | 3.20 | 4.63 | 3.17 | |||
Encouraged you to integrate information from the history, exam, and studies in developing an assessment and plan | 4.67 | 3.13 | 4.51 | 3.43 | 4.58 | 3.31 | |||
Encouraged you to focus on your assessment and plan | 4.63 | 3.17 | 4.66 | 2.97 | 4.64 | 3.05 | |||
Helped you learn from your own patients | 4.25 | 3.88 | 0.09 | 4.23 | 3.71 | 4.24 | 3.78 | ||
Helped you learn from your peers | 4.13 | 3.58 | 4.09 | 3.57 | 4.10 | 3.58 | |||
Is effective in advancing patient care | 4.42 | 3.83 | 4.23 | 3.63 | 4.31 | 3.71 | |||
Is time-efficient | 4.46 | 2.58 | 4.34 | 2.60 | 4.39 | 2.59 | |||
Is easy to use | 3.88 | 4.04 | 0.55 | 4.00 | 3.82 | 0.62 | 3.95 | 3.91 | 0.98 |
Evaluation of trainee free text responses regarding oral case presentation preference revealed several general themes (Table (Table4). 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.
Themes related to format preference
Theme | Representative Quotations |
---|---|
EAP is time efficient and less repetitive, allowing for discussion of critical components of patient care |
|
EAP follows a more natural thought process |
|
EAP allows for communication of thinking and demonstration of knowledge |
|
SOAP is more familiar and switching between formats can be difficult |
|
SOAP helps illuminate the 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.”
The authors would like to thank Jason M. Engle, MPH, who helped edit, prepare, format, and submit this manuscript and supporting files.
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.
Declarations.
All methods were carried out in accordance with relevant guidelines and regulations. The need for ethical approval was waived by the ethics committee/Institutional Review Board of the University of Michigan Medical School. The need for informed consent was waived by the ethics committee/Institutional Review Board of the University of Michigan Medical School.
Not applicable.
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.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
IMAGES
COMMENTS
Purpose of case presentation - to concisely summarize 4 parts of your patient's presentation: (1) history, (2) physical examination, (3) laboratory results, and (4) your understanding of these findings (i.e., clinical reasoning). The oral case presentation is a story that leads to the diagnosis you have chosen. B.
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.
While I will focus on internal medicine inpatients, the following framework can be applied to patients in any setting with slight modifications. Style. Oral case presentations are generally made to a medical care team, which can be composed of medical and pharmacy students, residents, pharmacists, medical attendings, and others.
The oral presentation is a critically important skill for medical providers in communicating patient care wither other providers. It differs from a patient write-up in that it is shorter and more focused, providing what the listeners need to know rather than providing a comprehensive history that the write-up provides.
On completion of Foundations of Clinical Medicine, students should be able to perform an accurate, complete and well organized comprehensive oral case presentation for a new clinic or hospital patient, and adapt the case presentation to different clinical settings. A comprehensive OCP includes each of these sections:
2. Basic principles. An oral case presentation is NOT a simple recitation of your write-up. It is a concise, edited presentation of the most essential information. A case presentation should be memorized as much as possible by your 3rd year rotations. You can refer to notes, but should not read your presentation.
The oral case presentation: toward a performance-based rhetorical model for teaching and learning. Medical Education Online 2015;20. doi: 10.3402/meo.v20.28565. McGee S. Medicine student programs: oral presentation guidelines. Learning & Scholarly Technologies, University of Washington. Available from: https: ...
The oral case presentation is an art and a skill that has endured through the technological transformation of medicine and takes practice to master. Its most important function is for listeners to absorb key information to determine if the inferences and plans need modification.
case presentations fit within 5 minutes. The longer a presentation is, usually means that it has too much in it. 9) The key to a great presentation is excellent and aggressive editing. 10) The goal of the write up is very different from the presentation. The write up documents the complete database, the oral case presentation highlights the ...
Oral communication between physicians plays a vital role in patient care. 1, 2 The oral case presentation (OCP) is a common vehicle for such communication, and its importance has been recognized by the Clerkship Directors in Internal Medicine, 3, 4 the Association of American Medical Colleges, 5 and the Accreditation Council for Graduate Medical Education. 6 The published literature, however ...
Oral case presentations are the fundamental way in which we communicate in medicine. To do this effectively, the content should be organized, clear, succinct, and with sufficient repetition to ensure understanding. Experts build OCPs by first considering the diagnoses they have in mind, then distilling the narrative in a way that implicitly ...
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.
The oral case presentation (OCP) is a key genre in medical communication among medical practitioners. ... The oral case presentation: what internal medicine clinician-teachers expect from clinical clerks. Teach Learn Med. 2011; 23: 58-61. Google Scholar. Haber RJ , Lingard LA . Learning oral presentation skills: a rhetorical analysis with ...
Oral case presentation is an essential skill in clinical practice that is decidedly varied and understudied in teaching curricula. We developed a curriculum to improve oral case presentation skills in medical students. As part of an internal medicine clerkship, students receive instruction in the elements of a good oral case presentation and ...
Background: The oral case presentation (OCP) is a fundamental communication skill that frequently is taught as part of internal medicine clerkships.However, little is known about the optimal content for an OCP. Purpose: We hypothesized that internal medicine clinician-teachers have common expectations regarding OCPs by 3rd-year medical students. ...
CONCLUSION. The oral case presentation is an art and a skill that has endured through the technological transformation of medicine and takes practice to master. Its most important function is for listeners to absorb key information to determine if the inferences and plans need modification. It is also a stressful experience for early learners ...
A clinical and rhetorical definition with implications for teaching and learning the case-presentation format. Academic Medicine. 74(10):S124-S127. The Oral Presentation (A Practical Guide to Clinical Medicine, ... for oral presentation, just succinct notes to serve as a reminder or reference, since you're not going to be reading your ...
This protocol includes the content areas usually included in an oral case presentation for a patient who is newly admitted to the hospital or seen for the first time in the office. Case presentations on rounds in the hospital would generally be much shorter and include a brief summary of the patient's history followed by new information ...
Background: The oral case presentation (OCP) is a fundamental communication skill that frequently is taught as part of internal medicine clerkships. However, little is known about the optimal content for an OCP. Purpose: We hypothesized that internal medicine clinician-teachers have common expectations regarding OCPs by 3rd-year medical students.
The oral case presentation (OCP) plays an essential role in communication between physicians. 1-3 Medical students learn the skill of presenting a patient's case early and hone it over many years. 4 OCPs require trainees to integrate many skill sets, including the refinement of clinical knowledge, patient communication, data gathering, interpretation, and verbal presentation. 4, 5 Further ...
Basic written and oral case presentation skills, obtained in physical diagnosis courses. Specific Learning Objectives. Knowledge: Each student should be able to describe: ... Division of General Medicine 5034 Old Clinic Bldg. CB#7110 Chapel Hill, NC 27599 Phone: (919) 966-7776 Fax: (919) 966-2274 . SOM General Policies
The Patient Presentation Rating (PPR) tool can be used to evaluate oral case presentations, and was developed using focus groups of medical school educators from several medical disciplines including pediatrics, internal medicine, psychiatry, surgery, and neurology. Methods: The PPR includes 18 items, comprising six sections and an overall ...
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 ...