medical presentation structure

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

How To Present a Patient: A Step-To-Step Guide

Last Updated on June 24, 2022 by Laura Turner

Updated and verified by Dr. Lee Burnett on March 19, 2022.

The ability to deliver oral case presentations is a core skill for any physician. Effective oral case presentations help facilitate information transfer among physicians and are essential to delivering quality patient care. Oral case presentations are also a key component of how medical students and residents are assessed during their training.

At its core, an oral case presentation functions as an argument. It is the presenter’s job to share the pertinent facts of a patient’s case with the other members of the medical care team and establish a clear diagnosis and treatment plan. Thus, the presenter should include details to support the proposed diagnosis, argue against alternative diagnoses, and exclude extraneous information. While this task may seem daunting at first, with practice, it will become easier. That said, if you are unsure if a particular detail is important to your patient’s case, it is probably best to be safe and include it.

Now, let’s go over how to present a case. While I will focus on internal medicine inpatients, the following framework can be applied to patients in any setting with slight modifications.

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. As the presenter, you should strive to deliver an interesting presentation that keeps your team members engaged. Here are a few things to keep in mind:

• Be confident: Speak clearly at the loudest volume appropriate to protect patient privacy, vary your tone to emphasize the most important details, and maintain eye contact with members of your team.
• Don’t fidget : Stand up straight and avoid unnecessary, distracting movements.
• Use your notes : You may glance at your notes from time to time while presenting. However, while there is no need to memorize your presentation, there is no better way to lose your team’s attention than to read your notes to them.
• Be honest: Given the importance of presentations in guiding medical care, never guess or report false information to the team. If you are unsure about a particular detail, say so.

The length of your presentation will depend on various factors, including the complexity of your patient, your audience, and your specialty. I have found that new internal medicine inpatients generally take 5-10 minutes to present. Internal medicine clerkship directors seem to agree. In a 2009 survey , they reported a range of 2-20 minutes for the ideal length of student inpatient presentations, with a median of 7 minutes.

While delivering oral case presentations is a core skill for trainees, and there have been attempts to standardize the format , expectations still vary among attending physicians. This can be a frustrating experience for trainees, and I would recommend that you clarify your attending’s expectations at the beginning of each new rotation. However, I have found that these differences are often stylistic, and content expectations are generally quite similar. Thus, developing a familiarity with the core elements of a strong oral case presentation is essential.

How to Present a Patient

You should begin every oral presentation with a brief one-liner that contains the patient’s name, age, relevant past medical history, and chief complaint. Remember that the chief complaint is why the patient sought medical care in his or her own words. An example of an effective opening is as follows: “Ms. X is a 78-year-old female with a past medical history of chronic obstructive pulmonary disease who presents to the hospital after she felt short of breath at home.”

Following the opener, elaborate on why the patient sought medical care. Describe the events that preceded the patient’s presentation in chronological order. A useful mnemonic to use when deciding what to report is OPQRST , which includes: • The Onset of the patient’s symptoms • Any Palliative or Provoking factors that make the symptoms better or worse, respectively • The Quality of his or her symptoms (how he or she describes them) • The Region of the body where the patient is experiencing his or her symptoms and (if the symptom is pain) whether the patient’s pain Radiates to another location or is well-localized • The Severity of the symptoms and any other associated Symptoms • The Time course of the symptoms (how they have changed over time and whether the patient has experienced them before) Additionally, include any other details here that may support your final diagnosis or rule out alternative diagnoses. For example, if you are concerned about a pulmonary embolism and your patient recently completed a long-distance flight, that would be worth mentioning.

The review of systems is sometimes included in the history of present illness, but it may also be separated. Given the potential breadth of the review of systems (a comprehensive list of questions that may be asked can be found here ), when presenting, only report information that is relevant to your patient’s condition.

The past medical history comes next. This should include the following information: • The patient’s medical conditions, including any that were not highlighted in the opener • Any past surgeries the patient has had and when they were performed • The timing of and reasons for past hospitalizations • Any current medications, including dosages and frequency of administration

The next section should detail the patient’s relevant family history. This should include: • Any relevant conditions that run in the patient’s family, with an emphasis on first-degree relatives

After the family history comes the social history. This section should include information about the patient’s: • Living situation • Occupation • Alcohol and tobacco use • Other substance use You may also include relevant details about the patient’s education level, recent travel history, history of animal and occupational exposures, and religious beliefs. For example, it would be worth mentioning that your anemic patient is a Jehovah’s Witness to guide medical decisions regarding blood transfusions.

Once you have finished reporting the patient’s history, you should transition to the physical exam. You should begin by reporting the patient’s vital signs, which includes the patient’s: • Temperature • Heart rate • Blood pressure • Respiratory rate • Oxygen saturation (if the patient is using supplemental oxygen, this should also be reported) Next, you should discuss the findings of your physical exam. At the minimum, this should include: • Your general impressions of the patient, including whether he or she appears “sick” or not • The results of your: • Head and neck exam • Eye exam • Respiratory exam • Cardiac exam • Abdominal exam • Extremity exam • Neurological exam Additional relevant physical examination findings may be included, as well. Quick note: resist the urge to report an exam as being “normal.” Instead, report your findings. For example, for a normal abdominal exam, you could report that “the patient’s abdomen is soft, non-tender, and non-distended, with normoactive bowel sounds.”

This section includes the results of any relevant laboratory testing, imaging, or other diagnostics that were obtained. You do not have to report the results of every test that was ordered. Before presenting, consider which results will further support your proposed diagnosis and exclude alternatives.

The emergency department (ED) course is classically reported towards the end of the presentation. However, different attendings may prefer to hear the ED course earlier, usually following the history of present illness. When unsure, report the ED course after the results of diagnostic testing. Be sure to include initial ED vital signs and any administered treatments.

You should conclude your presentation with the assessment and plan. This is the most important part of your presentation and allows you to show your team how much you really know. You should include: • A brief summary (1-2 lines) of the patient, the reason for admission, and your likely diagnosis. This should also include information regarding the patient’s clinical stability. While it can be similar to your opener, it should not be identical. An example could be: “Ms. X is a 78-year-old female with a past medical history of chronic obstructive pulmonary disease who presents with shortness of breath in the setting of an upper respiratory tract infection who is now stable on two liters of supplemental oxygen delivered via nasal cannula. Her symptoms are thought to be secondary to an acute exacerbation of chronic obstructive pulmonary disease.” • A differential diagnosis . For students, this should consist of 3-5 potential diagnoses. You should explain why you think each diagnosis is or is not the final diagnosis. Be sure to rule out potentially life-threatening conditions (unless you think your patient has one). For our fictional patient, Ms. X, for example, you could explain why you think she does not have a pulmonary embolism or acute coronary syndrome. For more advanced trainees, the differential can be more limited in scope. • Your plan . On regular inpatient floors, this should include a list of the patient’s medical problems, ordered by acuity, followed by your proposed plan for each. After going through each active medical problem, be sure to mention your choice for the patient’s diet and deep vein thrombosis prophylaxis, the patient’s stated code status, and the patient’s disposition (whether you think they need to remain in the hospital). In intensive care units, you can organize the patient’s medical problems by organ system to ensure that no stone is left unturned (if there are no active issues for an organ system, you may say so).

Presenting Patients Who Have Been in the Hospital for Multiple Days

After the initial presentation, subsequent presentations can be delivered via SOAP note format as follows:

• The  Subjective  section includes details about any significant overnight events and any new complaints the patient has.
• In the  Objective  section, report your physical exam (focus on any changes since you last examined the patient) and any significant new laboratory, imaging, or other diagnostic results.
• The  Assessment  and  Plan  are typically delivered as above. For the initial patient complaint, you do not have to restate your differential diagnosis if the diagnosis is known. For new complaints, however, you should create another differential and argue for or against each diagnosis. Be sure to update your plan every day.

Presenting Patients in Different Specialties

Before you present a patient, consider your audience. Every specialty presents patients differently. In general, surgical and OB/GYN presentations tend to be much quicker (2-3 minutes), while pediatric and family medicine presentations tend to be similar in length to internal medicine presentations. Tailor your presentations accordingly.

Presenting Patients in Outpatient Settings

Outpatients may be presented similarly to inpatients. Your presentation’s focus, however, should align with your outpatient clinic’s specialty. For example, if you are working at a cardiology clinic, your presentation should be focused on your patient’s cardiac complaints.

If your patient is returning for a follow-up visit and does not have a stated chief complaint, you should say so. You may replace the history of present illness with any relevant interval history since his or her last visit.

And that’s it! Delivering oral case presentations is challenging at first, so remember to practice. In time, you will become proficient in this essential medical skill. Good luck!

Kunal Sindhu, MD, is an assistant professor in the Department of Radiation Oncology at the Icahn School of Medicine at Mount Sinai and New York Proton Center. Dr. Sindhu specializes in treating cancers of the head, neck, and central nervous system.

2 thoughts on “How To Present a Patient: A Step-To-Step Guide”

To clarify, it should take 5-10 minutes to present (just one) new internal medicine inpatient? Or if the student had 4 patients to work up, it should take 10 minutes to present all 4 patients to the preceptor?

Good question. That’s per case, but with time you’ll become faster.

Comments are closed.

Presentation Skills Toolkit for Medical Students

New section.

The ability to design and deliver an effective presentation is an important skill for all learners to develop. The Undergraduate Medical Education Section of the Group on Educational Affairs developed this toolkit as a resource for medical students and health professions trainees as you learn to create and give effective presentations in the classroom, in the clinical setting, and at academic meetings and conferences. In this toolkit, you’ll find helpful resources on developing and delivering formal lectures and presentations, poster and oral abstract presentations, patient presentations, and leading small group sessions.

Please note: Availability of resources may change over time. To suggest edits or updates, email  [email protected] .

On this page:

Formal lectures and presentations, posters and abstracts, patient presentations.

• Leading Small Groups

Traditional academic presentations in medicine and the biomedical sciences are necessarily dense with complex content. Thus, slides tend to be wordy, and presenters may use their slides as cue cards for themselves rather than as tools to facilitate learning for their audience. With the necessary resources, medical students (and presenters at all levels) can better identify appropriate learning objectives and develop presentations that help learners meet those objectives. Organization of content, clarity of slide design, and professional delivery are all essential components to designing and giving effective formal presentations.

Achieving all of these elements can make creating and delivering a formal presentation challenging. The strategies and resources below can help you develop a successful formal presentation.

View long description of infographic .

Strategies for success

• Define the objectives of the presentation. Always define learning objectives for each of your lectures to make it clear what knowledge or skills the audience should acquire from your presentation. The best learning objectives define specific, measurable, or observable knowledge or skill gains. Furthermore, consider how to communicate the importance of the topic to your audience and how information should be arranged to best communicate your key points.
• Design an effective slide set. You should begin creating your slides only after defining your objectives and key points. The slides should support your talk but not be your talk. Keep slides simple. The audience should be able to review a slide and grasp key points quickly. Avoid lengthy text and distracting decorative fonts, clip art, graphs, and pictures. If additional wording or images are necessary, consider handouts or alternative methods of sharing this information. Lastly, design your slide deck to emphasize the key points, revisiting your outline as necessary, and summarize concepts at regular intervals throughout your presentation to strengthen knowledge gains.  
• Practice your performance. Effective public speaking starts with preparation and practice. Ensure there is enough time to create your lecture and a supporting slide deck. Know your lecture material and slides without prompts! Understand the audience and learning climate (the size and knowledge level of your audience) and be prepared for the venue (virtual, in-person, or both, lecture hall or classroom). Think about what effective audience engagement may look like and how to incorporate audience response systems, polling, etc., into the lecture.
• Create a positive learning environment. Anticipate questions and allocate sufficient time to answer them. Always repeat the questions being asked for the audience’s benefit and to ensure your understanding. Some questions may be challenging, so be prepared and answer honestly. It is acceptable not to know an answer.
• Demonstrate professionalism in presenting. Exhibit professionalism by being punctual and having appropriate time management. Remember that mistakes happen; be kind to yourself and remain calm and collected. Be enthusiastic: If you can enjoy the experience, so will your audience. Finally, be open to feedback following your presentation. 

Additional resources

Below is a collection of resources that further address the elements of creating and delivering a formal presentation. Each resource addresses a specific presentation skill or set of skills listed above and can be used to develop your understanding further. 

• Healthy Presentations: How to Craft Exceptional Lectures in Medicine, the Health Professions, and the Biomedical Sciences (requires purchase, book). This illustrated book is a practical guide for improving scientific presentations. It includes specific, practical guidance on crafting a talk, tips on incorporating interactive elements to facilitate active learning, and before-and-after examples of improved slide design. (Skills addressed: 1-3)
• American College of Physicians: Giving the Podium Presentation (freely available, website). This guide includes recommendations related to presentation delivery, including tips on what to wear, how to prepare, answering questions, and anticipating the unexpected. (Skills addressed: 3-5)
• The 4 Ps of Giving a Good Presentation (freely available, PDF). This simple guide on public speaking from the University of Hull covers such topics as positive thinking, preparing, practice, and performing. (Skills addressed: 3-5)
• Zoom Guides (freely available, website). This website from the University of California, San Francisco is one of many great resources created by universities for presenting on a virtual platform, specifically Zoom. (Skills addressed: 3-5)
• Writing Learning Objectives (freely available, PDF). This excellent resource from the AAMC defines Bloom’s Taxonomy and provides verbiage for creating learning objectives. (Skill addressed: 1)
• Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83 (freely available, article). This AMEE Guide explains and explores the more commonly used adult learning theories and how they can be used to enhance learning. It presents a model that combines many of the theories into a flow diagram that can be followed by those planning a presentation. (Skill addressed: 1)
• Assertion-Evidence Approach (freely available, website). This approach to slide design incorporates clear messaging and the strategic combination of text and images. (Skill addressed: 2)
• Multimedia Learning (requires purchase, book). This book outlines the learning theories that should guide all good slide design. It is an accessible resource that will help presenters of all levels create slide decks that best facilitate learning. (Skill addressed: 2)
• Collaborative Learning and Integrated Mentoring in the Biosciences (CLIMB) (freely available, website). This website from Northwestern University shares slide design tips for scientific presentations. Specific tips include simplifying messages and annotating images and tables to facilitate learning. (Skill addressed: 2)
• Clear and to the Point (freely available, online book). This book describes 8 psychological principles for constructing compelling PowerPoint presentations. (Skill addressed: 2)

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Presenting the results of the research projects, innovations, and other work you have invested in at regional and national meetings is a tremendous opportunity to advance heath care, gain exposure to thought leaders in your field, and put your evidence-based medicine and communication skills into practice in a different arena. Effective scientific presentations at meetings also provide a chance for you to interact with an engaged audience, receive valuable feedback, be exposed to others’ projects, and expand your professional network. Preparation and practice are integral to getting the most out of these experiences.  

The strategies and resources below will help you successfully present both posters and abstracts at scientific meetings. 

Strategies for success  

• Identify a poster’s/abstract’s purpose and key points . Determine the purpose of sharing your work (feedback vs. sharing a new methodology vs. disseminating a novel finding) and tailor the information in your poster or abstract to meet that objective. Identify one to three key points. Keep in mind the knowledge and expertise of the intended audience; the amount of detail that you need to provide at a general vs. specialized meeting may vary. 
• Design an effective poster . Design your poster to follow a logical flow and keep it uncluttered. The methods and data should support your conclusions without extraneous information; every chart or image should serve a purpose. Explicitly outline the key takeaways at the beginning or end.  
• Present in a conversational, informal style . Imagine you are explaining your project to a colleague. The purpose of your work and key points should guide your presentation, and your explanation of the methods and data should link to your conclusions. Be prepared to discuss the limitations of your project, outline directions for future research, and receive feedback from your audience. Treat feedback as an opportunity to improve your project prior to producing a manuscript.  

Additional resources  

These resources support the development of the skills mentioned above, guiding you through the steps of developing a poster that frames your research in a clear and concise manner. The videos provide examples that can serve as models of effective poster and abstract presentations. 

• How to design an outstanding poster (freely available, article). This article outlines key items for laying out an effective poster, structuring it with the audience in mind, practicing your presentation, and maximizing your work’s impact at meetings. (Skills addressed: 1-3) 
• Giving an Effective Poster Presentation (freely available, video). This video shows medical students in action presenting their work and shares strategies for presenting your poster in a conversational style, preparing for questions, and engaging viewers. (Skills addressed: 2,3) 
• Better Scientific Poster (freely available, toolkit). This toolkit includes strategies and templates for creating an effective and visually interesting scientific poster. Virtual and social media templates are also available. (Skill addressed: 2)

As with all presentations, it can be very helpful to practice with colleagues and/or mentors before the meeting. This will allow you to get feedback on your project, style, and poster design prior to sharing it with others outside of your institution. It can also help you prepare for the questions you may get from the audience.  

Patient presentation skills are valuable for medical students in the classroom and in the care of patients during clinical rotations. Patient presentations are an integral part of medical training because they combine communication skills with knowledge of disease manifestations and therapeutic strategies in a clinical scenario. They are used during active learning in both the preclinical and clinical phases of education and as students advance in training and interact with diverse patients.  

Below are strategies for delivering effective patient presentations. 

• Structure the presentation appropriately . The structure of your narrative is important; a concise, logical presentation of the relevant information will create the most impact. In the clinical setting, preferences for presentation length and style can vary between specialties and attendings, so understanding expectations is vital. 
• Synthesize information from the patient encounter . Synthesis of information is integral for effective and accurate delivery that highlights relevant points. Being able to select pertinent information and present it in an efficient manner takes organization and practice, but it is a skill that can be learned.  
• Deliver an accurate, engaging, and fluent oral presentation . In delivering a patient presentation, time is of the essence. The overall format for the presentation is like a written note but usually more concise. Succinctly convey the most essential patient information in a way that tells the patient’s story. Engage your listeners by delivering your presentation in an organized, clear, and professional manner with good eye contact. Presentations will go more smoothly with careful crafting and practice. 
• Adjust presentations to meet team, patient, and setting needs . Adaptability is often required in the clinical setting depending on attending preferences, patient needs, and location, making it imperative that you are mindful of your audience.  

The resources below provide samples of different types of patient presentations and practical guides for structuring and delivering them. They include tips and tricks for framing a case discussion to deliver a compelling story. Resources that help with adjusting patient presentations based on the setting, such as bedside and outpatient presentations, are also included. 

• A Guide to Case Presentations (freely available, document). This practical guide from the Ohio State University discusses basic principles of presentations, differences between written and oral communication of patient information, organization, and common pitfalls to avoid. (Skills addressed: 1-3) 
• Verbal Case Presentations: A Practical Guide for Medical Students (freely available, PDFs). This resource from the Augusta University/University of Georgia Medical Partnership provides a practical guide to crafting effective case presentations with an explanation of the goals of each section and additional tips for framing the oral discussion. It also provides a full sample initial history and physical examination presentation. (Skills addressed: 1-4) 
• Patient Presentations in Emergency Medicine (freely available, video). This training video for medical students from the Society for Academic Emergency Medicine demonstrates how to tell a compelling story when presenting a patient’s case. The brief video offers handy dos and don'ts that will help medical students understand how best to communicate in the emergency department efficiently and effectively. These skills can also be applied to patient presentations in other specialties. (Skills addressed: 1-4) 

Additional information and support on effectively constructing and delivering a case presentation can be found through various affinity support and mentorship groups, such as the Student National Medical Association (SNMA), Latino Medical Student Association (LMSA), and Building the Next Generation of Academic Physicians (BNGAP). 

Leading Small Groups

For physicians, working within and leading small groups is an everyday practice. Undergraduate medical education often includes small group communication as well, in the form of problem-based learning groups, journal clubs, and study groups. Having the skills to form, maintain, and help small groups thrive is an important tool for medical students.   

Below are strategies to provide effective small group leadership. 

• Outline goals/outcomes . Delineating the goals of a meeting ensures that everyone understands the outcome of the gathering and can help keep conversations on track. Listing goals in the agenda will help all participants understand what is to be accomplished. 
• Establish ground rules . Establishing explicit procedural and behavioral expectations serves to solidify the framework in which the conversation will take place. These include items such as attendance and how people are recognized as well as the way group members should treat each other.   
• Create an inclusive environment . In addition to setting expectations, group leaders can take steps to help all participants feel that their perspectives are valuable. Setting up the room so that everyone sits around a table can facilitate conversations. Having individuals introduce themselves can let the group understand everyone’s background and expertise. In addition, running discussions in a “round-robin style” (when possible) may help every person have an opportunity to express themselves. 
• Keep discussions constructive, positive, and on task . As meetings evolve, it can be easy for conversations to drift. Reminding the group of goals and frequently summarizing the discussion in the context of the planned outcomes can help redirect meetings when needed. 
• Manage virtual meetings . Online meetings present their own challenges. Adequate preparation is key, particularly working through technological considerations in advance. Explicitly discussing goals and ground rules is even more important in the virtual environment. Group leaders should be more patient with members’ response times and be especially diligent that all participants have an opportunity to be heard.   

The resources listed below outline additional helpful points, expanding on the skills described above and providing additional perspectives on managing small group meetings of different types. 

• Communication in the Real World: Small Group Communication (freely available, online module). This chapter includes an overview of managing small groups, including understanding the types and characteristics, group development, and interpersonal dynamics. (Skills addressed: 3,4) 
• Conversational Leadership (freely available, online book chapter). This short online resource provides guidance for determining group size and seating to best facilitate participation by all group members. (Skill addressed: 4) 
• Tips on Facilitating Effective Group Discussion (freely available, PDF). This resource from Brown University provides tips for effective group facilitation, creating an environment conducive for discussions, keeping conversations positive, and managing common problems. Also included is a valuable list of references for further exploration. (Skills addressed: 1-4) 
• Facilitating Effective Discussions: Self-Checklist (freely available, online checklist). This checklist from Brown University provides an easy-to-use, practical framework for preparing for, performing, and reflecting on small group facilitation. (Skills addressed: 1-4) 
• Sample Guidelines for Classroom Discussion Agreements (freely available, PDF). These guidelines from Brown University give useful tips for managing classroom discussions, including when disagreements occur among group participants. (Skill addressed: 2) 
• Fostering and assessing equitable classroom participation (freely available, online article). This online resource from Brown University includes methods to maximize group members’ participation in discussions and to communicate expectations. Also included is a valuable list of references for further exploration. (Skill addressed: 3) 
• Facilitating small group learning in the health professions (freely available, online article). The aim of this paper published in BMC Medical Education is to provide students involved in peer/near peer teaching with an overview of practical approaches and tips to improve learner engagement when facilitating small groups. It includes a discussion of the roles of facilitators, strategies for fostering interactions among the group, and methods for resolving common problems. (Skills addressed: 1-4) 
• Facilitating a Virtual Meeting (freely available, PDF). This infographic from the University of Nebraska Medical Center includes key points to consider when facilitating an online meeting, including technical considerations, preparation, and follow-up. (Skill addressed: 5) 
• Most universities have a communication department with faculty who specialize in small group communication. You may also find that these individuals are a valuable resource. 

This toolkit was created by a working group of the Undergraduate Medical Education (UME) Section of the Group on Educational Affairs (GEA). 

Working Group Members

• Geoffrey Talmon, MD, University of Nebraska Medical Center
• Jason Kemnitz, EdD, University of South Dakota Sanford School of Medicine 
• Lisa Coplit, MD, Frank H. Netter School of Medicine at Quinnipiac University 
• Rikki Ovitsh, MD, SUNY Downstate College of Medicine
• Susan Nofziger, MD, Northeast Ohio Medical University  
• Amy Moore, MEd, Cleveland Clinic Lerner College of Medicine 
• Melissa Cellini, MD, New York Medical College 
• Richard Haspel, MD, Harvard Medical School 
• Christine Phillips, MD, Boston University School of Medicine 
• Arvind Suresh, Geisel School of Medicine at Dartmouth 
• Emily Green, PhD, MA, Warren Alpert Medical School of Brown University 
• Holly Meyer, PhD, MS, Uniformed Services University of the Health Sciences 
• Karina Clemmons, EdD, University of Arkansas for Medical Sciences
• Shane Puckett, EdD, University of South Florida 
• Angela Hairrell, PhD, Burnett School of Medicine at Texas Christian University 
• Arkene Levy Johnston, PhD, Kiran C. Patel College of Allopathic Medicine
• Sarah Collins, PhD, UT Southwestern Medical Center 
• Patrick Fadden, MD, Virginia Commonwealth University School of Medicine 
• Lia Bruner, MD, Augusta University - University of Georgia Medical Partnership 
• Jasna Vuk, MD, PhD, University of Arkansas for Medical Sciences 
• Pearl Sutter, University of Connecticut School of Medicine 
• Kelly Park, Baylor University Medical Center

How to Give an Excellent Medical Presentation

• By Sulaiman Ahmad
• July 22, 2019
• Medical Student , Pre-med
• Self-improvement

In medicine, we are constantly learning from each other. Professors stand in front of lecture halls to teach the fundamental knowledge needed to pass board exams and to treat our patients. Outside of the classroom, medical students, researchers, and physicians attend conferences to communicate ideas and update their colleagues with oral and poster presentations. In the clinic, students and resident physicians relay pertinent patient information to the physician in charge. Eventually, you will find yourself in front of an audience listening to your talk or an attending grading your clinical presentation. First, I will discuss what it takes to make an excellent presentation.  I will then finish this topic by providing guidelines for perfecting different types of presentations.

Critical Elements of an Excellent Presentation

 do some research.

Your audience will consider you an expert on the information you deliver. It is your job to achieve the expected level of comprehension of the topic. After choosing a topic, gather enough background information from diverse but appropriate sources (e.g., journals articles, relevant chapters in textbooks, personal discussion with subject matter experts, online videos).  Your research should provide you with a thorough understanding of the topic and a list of the important facts supporting your take-home message . Any gaps in your knowledge will become evident during your presentation. The goal is to develop confidence in your understanding of the topic and ability to share what you know.

Know Your Audience

Before putting your presentation together, take a moment to assess the baseline understanding of your expected audience . Ultimately your audience should walk away having learned something new. Try to figure out their collective interest, reasons for attending, and prior experience with the topic. Knowing your audience will allow you to focus on information that will keep them engaged and interested. For example, premed students have a different understanding of medical topics than medical students.  A presentation on the same subject should be different for both groups. If your listeners have different levels of expertise, take a moment to explain the fundamental concept, then build up the language and complexity to allow everyone to benefit from the information shared. Your audience is the reason why you are presenting.

Tell a Story

The human brain is wired to remember stories , especially if presented logically. A presentation is about the information shared, but it should also include the presenters’ passion, excitement, and personal style. All topics can be formatted to include characters, a description of the setting, plot, conflict, and a resolution. The story should allow the audience to take a journey with you. The hardest part is identifying the start and endpoint of your story and which details are needed. Make every word count by checking if it adds value to your narrative. Consider using metaphors, real examples, and descriptions that give life to your words .

Practicing your presentation is a vital step in developing an excellent presentation. You can memorize a script. However, memorization can reduce your connection with the audience. But in certain situations, scripts are quick and effective means of communicating important facts. Another approach is drafting bullet points of the main ideas and practicing the natural flow of information . This method allows your personality to shine on stage. To become comfortable speaking, start by practicing on your own . You can also record yourself with a cellphone or tablet and review the recording to evaluate your performance. Next, find a small group to present in front of and ask for their honest assessment . Eventually, your presentation will feel natural, and your stage presence will aid in communicating your main idea.

Q&A Session

Usually, your presentation does not end until after a question and answer session. Most presentations should include approximately five minutes in the end for the audience to ask questions . This part of the presentation allows you to clarify or further explain any part of your presentation. A question can also lead to expanding your presentation beyond what you originally planned to discuss . It is important for you to understand what is being asked and address the specific question directly. And if you do not have an answer, it is okay to admit that you do not know . Questions will force you to be creative and truly test your knowledge of the topic.

Different Types of Presentations

Presentations have many different forms, each with different goals; thus, each form requires a unique approach. In medicine, professors and clinician often provide students with lecture objectives and PowerPoint presentations that guide the students in their hour-long lecture. Conferences are a researcher’s platform to share their lab’s progress and conclusions. The last presentation I will go into is the clinical presentation a student typically performs for the physician in charge.

The main purpose of the lecture is to educate the attendees. We all have had great professors captivate our attention and other experiences that were a complete waste of time. But what makes some lectures better than others? The lecturer’s knowledge on the topic becomes obvious, and their stage presence confirms how comfortable they are with the topic.  If you are tasked with lecturing on a topic or a series, ensure that you have a solid understanding and address your learning objectives in the time allotted . The main concepts should be repeated multiple times throughout the lecture, followed by examples . Your PowerPoint slides should be limited to only main points and images that support your talking points. After difficult concepts are covered, ask questions to gauge your audience’s understanding . It is better to reemphasize a concept before building up to more complex learning objectives.

Research Presentation

Attending a conference is exciting, especially if you are representing your lab with an oral presentation.  It is an opportunity to share your research story, from the point of identifying a question to the process of reaching a conclusion. Realize your audience will include Primary Investigators, post-docs, and Ph.D. students that are also experts in the field . Attempt to grab the audience’s attention from the beginning by providing them with a reason to care. Then continue to explain how your study relates to the published work . After building up the background, address how you arrived at your research question. The most exciting part of your presentation should be explaining your conclusions and the path you took to get there. Finish up strong by discussing the implications of your findings and how they will have an impact in the field . The natural flow of information will come with practice and a deep understanding of your research topic. Presenting as a student usually leads to networking with professors and clinicians that can help you progress in your career.

Patient Presentation

Medical students learn how to take a patient’s history and perform a physical exam, but it is more challenging to reason through your clinical findings and subsequently present to an attending . Your clinical presentation style will change depending on the environment, medical department, and supervising physician . Upon joining a medical team, discuss the expectations and preference with each physician . It may be a good idea to draft a script that can get you started on organizing your patient presentation. The success of your presentation is correlated to your knowledge of the basic sciences and ability to critically assess the patient’s history and physical exam; the more you learn and read, the easier decision making and producing a plan becomes. Another important element is practicing your presentation style until it comes out naturally . Take the time to listen to your peers and experienced colleagues; learn from their mistakes and strengths . After concluding your presentation, ask for feedback and practice implementing the suggestions. You will be the eyes and ears for the physicians in charge, perfecting your patient presentation will help get the care the patients need while making everyone’s job a little easier.

Final remarks

There are some basic steps to achieving an excellent presentation: know the topic well, understand who you’re presenting to, develop a memorable story, and practice until it comes out naturally. A career in medicine is very versatile; you can be at the forefront of the next generation of physicians sharing your experiences or updating the science community with your research conclusions. At the minimum, you will be presenting the patient in the clinic. Thus, presenting is a skill every physician must master.

Sulaiman Ahmad

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How to deliver an oral presentation

Georgina wellstead.

a Lister Hospital, East and North Hertfordshire NHS Trust

Katharine Whitehurst

b Royal Devon and Exeter Hospital

Buket Gundogan

c University College London

d Guy's St Thomas' NHS Foundation Trust, London, UK

Delivering an oral presentation in conferences and meetings can seem daunting. However, if delivered effectively, it can be an invaluable opportunity to showcase your work in front of peers as well as receive feedback on your project. In this “How to” article, we demonstrate how one can plan and successfully deliver an engaging oral presentation.

Giving an oral presentation at a scientific conference is an almost inevitable task at some point during your medical career. The prospect of presenting your original work to colleagues and peers, however, may be intimidating, and it can be difficult to know how to approach it. Nonetheless, it is important to remember that although daunting, an oral presentation is one of the best ways to get your work out there, and so should be looked upon as an exciting and invaluable opportunity.

Slide content

Although things may vary slightly depending on the type of research you are presenting, the typical structure is as follows:

• Opening slide (title of study, authors, institutions, and date)
• Methodology
• Discussion (including strengths and weaknesses of the study)

Conclusions

Picking out only the most important findings to include in your presentation is key and will keep it concise and easy to follow. This in turn will keep your viewers engaged, and more likely to understand and remember your presentation.

Psychological analysis of PowerPoint presentations, finds that 8 psychological principles are often violated 1 . One of these was the limited capacity of working memory, which can hold 4 units of information at any 1 time in most circumstances. Hence, too many points or concepts on a slide could be detrimental to the presenter’s desire to give information.

You can also help keep your audience engaged with images, which you can talk around, rather than lots of text. Video can also be useful, for example, a surgical procedure. However, be warned that IT can let you down when you need it most and you need to have a backup plan if the video fails. It’s worth coming to the venue early and testing it and resolving issues beforehand with the AV support staff if speaking at a conference.

Slide design and layout

It is important not to clutter your slides with too much text or too many pictures. An easy way to do this is by using the 5×5 rule. This means using no more than 5 bullet points per slide, with no more than 5 words per bullet point. It is also good to break up the text-heavy slides with ones including diagrams or graphs. This can also help to convey your results in a more visual and easy-to-understand way.

It is best to keep the slide design simple, as busy backgrounds and loud color schemes are distracting. Ensure that you use a uniform font and stick to the same color scheme throughout. As a general rule, a light-colored background with dark-colored text is easier to read than light-colored text on a dark-colored background. If you can use an image instead of text, this is even better.

A systematic review study of expert opinion papers demonstrates several key recommendations on how to effectively deliver medical research presentations 2 . These include:

• Keeping your slides simple
• Knowing your audience (pitching to the right level)
• Making eye contact
• Rehearsing the presentation
• Do not read from the slides
• Limiting the number of lines per slide
• Sticking to the allotted time

You should practice your presentation before the conference, making sure that you stick to the allocated time given to you. Oral presentations are usually short (around 8–10 min maximum), and it is, therefore, easy to go under or over time if you have not rehearsed. Aiming to spend around 1 minute per slide is usually a good guide. It is useful to present to your colleagues and seniors, allowing them to ask you questions afterwards so that you can be prepared for the sort of questions you may get asked at the conference. Knowing your research inside out and reading around the subject is advisable, as there may be experts watching you at the conference with more challenging questions! Make sure you re-read your paper the day before, or on the day of the conference to refresh your memory.

It is useful to bring along handouts of your presentation for those who may be interested. Rather than printing out miniature versions of your power point slides, it is better to condense your findings into a brief word document. Not only will this be easier to read, but you will also save a lot of paper by doing this!

Delivering the presentation

Having rehearsed your presentation beforehand, the most important thing to do when you get to the conference is to keep calm and be confident. Remember that you know your own research better than anyone else in the room! Be sure to take some deep breaths and speak at an appropriate pace and volume, making good eye contact with your viewers. If there is a microphone, don’t keep turning away from it as the audience will get frustrated if your voice keeps cutting in and out. Gesturing and using pointers when appropriate can be a really useful tool, and will enable you to emphasize your important findings.

Presenting tips

• Do not hide behind the computer. Come out to the center or side and present there.
• Maintain eye contact with the audience, especially the judges.
• Remember to pause every so often.
• Don’t clutter your presentation with verbal noise such as “umm,” “like,” or “so.” You will look more slick if you avoid this.
• Rhetorical questions once in a while can be useful in maintaining the audience’s attention.

When reaching the end of your presentation, you should slow down in order to clearly convey your key points. Using phases such as “in summary” and “to conclude” often prompts those who have drifted off slightly during your presentation start paying attention again, so it is a critical time to make sure that your work is understood and remembered. Leaving up your conclusions/summary slide for a short while after stopping speaking will give the audience time to digest the information. Conclude by acknowledging any fellow authors or assistants before thanking the audience for their attention and inviting any questions (as long as you have left sufficient time).

If asked a question, firstly thank the audience member, then repeat what they have asked to the rest of the listeners in case they didn’t hear the first time. Keep your answers short and succinct, and if unsure say that the questioner has raised a good point and that you will have to look into it further. Having someone else in the audience write down the question is useful for this.

The key points to remember when preparing for an oral presentation are:

• Keep your slides simple and concise using the 5×5 rule and images.
• When appropriate; rehearse timings; prepare answers to questions; speak slowly and use gestures/ pointers where appropriate; make eye contact with the audience; emphasize your key points at the end; make acknowledgments and thank the audience; invite questions and be confident but not arrogant.

Conflicts of interest

The authors declare that they have no financial conflict of interest with regard to the content of this report.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Published online 8 June 2017

3 types of medical presentations (and how to give them)

Here are some tips for presenting the top three types of medical presentations: lectures, research presentations, and case reports.

Derek Murray

Building presentations

With your long to-do list as a medical professional, giving presentations is probably not a high priority. Yet, medical presentations are inevitable. Are you ready to give them when your job requires it? If so, where do you even start?

We want to make it a little easier for you to present data-heavy medical topics in an easy-to-understand way.

So, let’s dive right in with the top three types of medical presentations.

Key Takeaways:

• Structure your medical presentation into a story to make it memorable.
• Medical presentations can be lectures, research, or case presentations.
• Customize the presentation based on the type and goal.

1. Lectures

Medical lectures educate an audience about a medical topic. They’re one of the most challenging presentations. According to the Learning Pyramid , lectures are the most passive learning techniques, which is also why they have the lowest retention rates.

There are several settings for educational lectures, including:

• Conferences
• University or school lectures

Medical lectures help students or an audience comprehend complex medical information and then turn what they learned into actionable strategies.

For example, you may teach students with little medical knowledge about a new medical concept. But they must understand the topic and be able to recall it for examinations.

Tips for giving medical lectures

How can you turn one of the most challenging presentations into an engaging, memorable lecture? Here are a few tips to ace your educational medical lectures:

• Be interactive : Use Q&As, activities, and open discussions.
• Hand out resources: Give physical booklets students can review after the presentation.
• Use multimedia: Add audio-visual elements like images, video, and audio clips.
• Use simple language: Your audience is learning, so they need simple language and plenty of definitions to understand the topic.
• Make it entertaining: Keep your audience’s attention with a more engaging and entertaining presentation.

UnitedHealth Group incorporated imagery and movement to show rather than tell about mental health in 2022 to boost their engagement on the topic.

2. Research presentations

The most information-heavy medical presentation is the research presentation. Research presentations share findings with experienced medical professionals, usually in conference settings. Some of the audience includes:

• Investigators
• Ph.D. students
• Medical professionals and experienced doctors

Research presentations can also be part of healthcare marketing . You may have to introduce a new process, pharmaceutical, or device to encourage other healthcare professionals to adopt it in their practices.

Tips for giving research presentations

Use these tips to improve your research presentations :

• Speak on a higher level: You’re talking to a knowledgeable audience, so they expect a higher level of research.
• Back all facts with data: Use statistics and research to back all claims.
• Use power poses: Build authority with a confident presentation.
• Grab the audience’s attention: Start your presentation by giving your audience a reason to care, like a problem you want to solve.
• Build up the conclusion: Structure the research in a natural, progressive order that builds up to your conclusion.
• Look at the future: Conclude with how the research findings will impact the future of medicine.
• Visualize data : Simplify findings and data with visuals and charts.

Cardinal Health transformed the complex research for Smart Compression into understandable slides using a mix of graphics and storytelling in their medical presentation.

3. Case reports

Medical professionals must give oral case reports when transferring information between providers or a team. These presentations are very brief and often don’t require visuals.

Sometimes a case is especially unique and offers educational value to others. In that case, presenters should transform their quick oral case reports into a longer presentation that incorporates data and visuals.

Tips for giving case reports

Case reports use a similar structure to oral patient presentations, except with more details about each point. You’ll still want to pack as much information in a short presentation as possible.

• Begin the presentation with a patient overview: Start by introducing the patient, including all relevant demographic details in summarized graphics and lists.
• Present the history of the patient: Describe the patient’s history, why they sought care, and the symptoms they presented in charts and visuals.
• Explore medical information: Dive into the medical details, like treatment and history, using a storytelling structure to connect the information.
• Offer a plan: Outline a treatment plan alongside proof.

Summarize details in charts: You’ll pack a large amount of information in a concise presentation, so use plenty of charts and diagrams to summarize data and simplify outcomes.

Tips for preparing engaging medical presentations

Your medical presentations have highly complex topics rich with data. These topics can easily feel overwhelming or even boring if they don’t have the right structure and appearance.

Here are three medical presentation tips we’ve learned to help you prepare and present high-quality medical presentations that engage AND inform.

Know your audience’s knowledge level

Before building and presenting a medical topic, you must know your audience’s knowledge level. A lecture to a class of first-year college students will sound far different from a presentation to doctors with 10+ years of industry experience.

Build a presentation around your audience’s knowledge, so it’s understandable yet challenging. By taking this extra step, you’ll know what points need more explanation and what topics you can dig deeper into based on your audience’s experience.

Build a structured story

A complex topic becomes easy to understand and follow if you use a storytelling structure . You might ask, “How can a lecture on a new treatment be a story?”

Any time you communicate, it’s a story: You have the challenge to solve, potential solutions to try, and a final winner (like when presenting medical research). You can structure that story in a progressive order or by announcing one primary outcome and providing a list of proofs (like with patient case studies).

Focus on a goal

The goal of medical presentations can be educating, training, or persuading the audience, depending on the type of medical presentation. Knowing your goal guides which data is most relevant to bring your desired outcome.

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Tools for the Patient Presentation

The formal patient presentation.

• Posing the Clinical Question
• Searching the Medical Literature for EBM

Sources & Further Reading

First Aid for the Wards

Lingard L, Haber RJ.  Teaching and learning communications in medicine: a rhetorical approach .  Academic Medicine. 74(5):507-510 1999 May.

Lingard L, Haber RJ.  What do we mean by "relevance"? 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, UCSD School of Medicine)  http://meded.ucsd.edu/clinicalmed/oral.htm

"Classically, the formal oral presentation is given in 7 minutes or less. Although it follows the same format as a written report, it is not simply regurgitation. A great presentation requires style as much as substance; your delivery must be succinct and smooth. No time should be wasted on superfluous information; one can read about such matters later in your admit note. Ideally, your presentation should be formulated so that your audience can anticipate your assessment and plan; that is, each piece of information should clue the listener into your thinking process and your most likely diagnosis."  [ Le, et al, p. 15 ]

Types of Patient Presentations

New Patient

New patients get the traditional H&P with assessment and plan.  Give the chief complaint and a brief and pertinent HPI.  Next give important PMH, PSH, etc.  The ROS is often left out, as anything important was in the HPI.  The PE is reviewed.  Only give pertinent positives and negatives.  The assessment and plan should include what you think is wrong and, briefly, why.  Then, state what you plan to do for the patient, including labs.  Be sure to know why things are being done: you will be asked.

The follow-up presentation differs from the presentation of a new patient.  It is an abridged presentation, perhaps referencing major patient issues that have been previously presented, but focusing on new information about these issues and/or what has changed. Give the patient’s name, age, date of admission, briefly review the present illness, physical examination and admitting diagnosis.  Then report any new finding, laboratory tests, diagnostic procedures and changes in medications.

The attending physician will ask the patient’s permission to have the medical student present their case.  After making the proper introductions the attending will let the patient know they may offer input or ask questions at any point.  When presenting at bedside the student should try to involve the patient.

Preparing for the Presentation

There are four things you must consider before you do your oral presentation

• Occasion (setting and circumstances)

Ask yourself what do you want the presentation to do

• Present a new patient to your preceptor : the amount of detail will be determined by your preceptor.  It is also likely to reflect your development and experience, with less detail being required as you progress.
• Present your patient at working or teaching rounds : the amount of detail will be determined by the customs of the group. The focus of the presentation will be influenced by the learning objectives of working responsibilities of the group.
• Request a consultant’s advice on a clinical problem : the presentation will be focused on the clinical question being posed to the consultant.
• Persuade others about a diagnosis and plan : a shorter presentation which highlights the pertinent positives and negatives that are germane to the diagnosis and/or plan being suggested.
• Enlist cooperation required for patient care : a short presentation focusing on the impact your audience can have in addressing the patient’s issues.

Preparation

• Patient evaluation : history, physical examination, review of tests, studies, procedures, and consultants’ recommendations.
• Selected reading : reference texts; to build a foundational understanding.
• Literature search : for further elucidation of any key references from selected reading, and to bring your understanding up to date, since reference text information is typically three to seven years old.
• Write-up : for oral presentation, just succinct notes to serve as a reminder or reference, since you’re not going to be reading your presentation.

Knowledge (Be prepared to answer questions about the following)

• Pathophysiology
• Complications
• Differential diagnosis
• Course of conditions
• Diagnostic tests
• Medications
• Essential Evidence Plus

Template for Oral Presentations

Chief Complaint (CC)

The opening statement should give an overview of the patient, age, sex, reason for visit and the duration of the complaint. Give marital status, race, or occupation if relevant.  If your patient has a history of a major medical problem that bears strongly on the understanding of the present illness, include it.  For ongoing care, give a one sentence recap of the history.

History of Present Illness (HPI)

This will be very similar to your written HPI. Present the most important problem first. If there is more than one problem, treat each separately. Present the information chronologically.  Cover one system before going onto the next. Characterize the chief complaint – quality, severity, location, duration, progression, and include pertinent negatives. Items from the ROS that are unrelated to the present problem may be mentioned in passing unless you are doing a very formal presentation. When you do your first patient presentation you may be expected to go into detail.  For ongoing care, present any new complaints.

Review of Systems (ROS)

Most of the ROS is incorporated at the end of the HPI. Items that are unrelated to the present problem may be briefly mentioned.  For ongoing care, present only if new complaints.  

Past Medical History (PMH)

Discuss other past medical history that bears directly on the current medical problem.  For ongoing care, have the information available to respond to questions.

Past Surgical History

Provide names of procedures, approximate dates, indications, any relevant findings or complications, and pathology reports, if applicable.  For ongoing care, have the information available to respond to questions.

Allergies/Medications

Present all current medications along with dosage, route and frequency. For the follow-up presentation just give any changes in medication.  For ongoing care, note any changes.

Smoking and Alcohol (and any other substance abuse)

Note frequency and duration. For ongoing care, have the information available to respond to questions.

Social/Work History

Home, environment, work status and sexual history.  For ongoing care, have the information available to respond to questions.

Family History Note particular family history of genetically based diseases.  For ongoing care, have the information available to respond to questions.

Physical Exam/Labs/Other Tests

Include all significant abnormal findings and any normal findings that contribute to the diagnosis. Give a brief, general description of the patient including physical appearance. Then describe vital signs touching on each major system. Try to find out in advance how thorough you need to be for your presentation. There are times when you will be expected to give more detail on each physical finding, labs and other test results.  For ongoing care, mention only further positive findings and relevant negative findings.

Assessment and Plan

Give a summary of the important aspects of the history, physical exam and formulate the differential diagnosis. Make sure to read up on the patient’s case by doing a search of the literature. 

• Include only the most essential facts; but be ready to answer ANY questions about all aspects of your patient.
• Keep your presentation lively.
• Do not read the presentation!
• Expect your listeners to ask questions.
• Follow the order of the written case report.
• Keep in mind the limitation of your listeners.
• Beware of jumping back and forth between descriptions of separate problems.
• Use the presentation to build your case.
• Your reasoning process should help the listener consider a differential diagnosis.
• Present the patient as well as the illness .
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How to Skillfully Present Patients in Medical School

Get 100+ free tips i wish i got on my first day of med school.

Disclosure: This post may contain affiliate links which means I may get a commission if you make a purchase through my link at no additional cost to you. Thank you for your support!

How do you present patients in medical school? Presenting in front of attendings often makes medical students tense up. It’s very uncomfortable to attempt to sound competent, concise, and thoughtful to a likely evaluator.

But what if I told you that the whole process could be stress-free and easy?

In this post, I’ll break down, step-by-step, exactly how to present patients in medical school to your attendings/residents. This will include the dos and the do not’s of presenting!

If you prefer a video format, check out the following video and more on my YouTube channel!

Tell a Story When Presenting Your Patient:

This is how I learned to present, and I believe it’s the best way to present patients.

Tell a story.

You know how easily we mentally check out during a boring lecture. They often just read off their slides. It becomes a bullet point presentation – just fact after fact.

Medical students are often the boring lecturer when they present. We become so worried about telling all the facts. But we suck at tying it all together.

Think about it; we don’t talk about patient experiences with our peers the way we present. We’re much more casual and hit the high points, Now no I’m not arguing that you should be too casual but learn how to tell a story without hitting unnecessary info.

I’ll break down exactly how I tell my patient’s medical story. Just remember that you want to be interesting and concise.

What Would I Want To Hear?

Imagine yourself as the attending. What would you want to hear?

You certainly wouldn’t want to hear your medical students telling you about lung sounds in a patient with a broken finger.

Ask yourself if a piece of info is important for your patient. You get better over time on identifying what’s important. I discuss some things you should always mention later in the post.

Write Out Your Presentation in Bullet Format

Too often I see my peers reading their typed notes word for word. They rarely look up and don’t even pretend like they’re not just regurgitating their progress note.

I get that it’s hard to memorize a presentation. It’s as scary as actually having to do one.

So use a bullet point outline.

Here’s what I do.

On the first bullet, I’ll often write a shrunk version of my one-liner. I’ll talk about mastering this later in the post.

The next few bullets I’ll break down symptoms, timeline, important features, etc. that I want to discuss when I’m telling my patient’s story.

In the next bullet points, I’ll write the vital ranges and underline anything I want to mention. I’ll also include physical exam findings and labs which are pertinent.

Finally, I’ll include a list of problems with Ddx and suggestions for the plan.

Here’s an example of what this would look like.

Honestly, this is probably more than I’d write down. I have created my abbreviations which tends to cut my bullet point to half what’s shown above.

Unless I’m lost,I don’t have to look down. Thus I’m always making eye contact with my attending – demanding attention.. This makes the presentation seem much more natural. You’re having a discussion with your attending.

Don’t read your note that they can read on their own.

S tep-By-Step Approach To Presenting Patients in Medical School  Master the One-Liner.

Your one-liner will tell the resident if they should take your presentation seriously or not. The same way a great singer grabs your attention with their first note, you have to impress with a solid one-liner.

Here’s how to do it.

Table Of Contents

Who are they?

Include their name, age, and demographics.

Why predisposes them to these symptoms/disease?

What comorbidities do they have? Which are important for their current chief complaint?

Provide some insight into severity here. Do they have HF? If so what’s their ejection fraction?

Do they have diabetes? What’s their A1C?

I discuss other examples later in the post.

Why are they here?

Their chief complaint is the most important part of your one-liner. Here are things you must include.

What caused them to come into the hospital/clinic?

Patients usually come in with symptoms, not diagnoses . So your patient comes in with a chief complaint of chest pain, not a heart attack.

Sometimes a patient may come in for one thing but are getting worked up for a different symptom altogether. You can state, “patient is being evaluated for (insert symptom) that was identified in the emergency room/clinic”. You can include in your HPI what the patient originally came in for to paint the full picture.

Master Your PHI (Present History of Illness)

I remember presenting once in the pediatric emergency room to an attending. My patient was a 6-year old girl with a cat scratch to her eye. It was my first rotation, and I had no idea what I was doing (Maybe I should have looked for such a post back then).

I began with a killer one-liner. But then, instead of talking about her eye, I began to talk about her flu-like symptoms. The attending immediately stopped me and said, “I don’t care! Tell me about her eye!”.

So learn from my mistake. Don’t talk about the flu on a patient with a scratched eye.

Keep your story to the point.

After you understand this important lesson, the next step is to begin to form the order of your story. Often this begins with how the long the symptoms are going and how they first presented. Then provide a chronological order of how the symptoms worsened/improved over time.

Make sure to include why the patient finally came to see a doctor. Why now instead of two days ago when the symptoms first started?

This is also where you include the rest of your PHI. There are several acronyms people use that I haven’t cared to remember. But here are the important details to discuss (if applicable).

How long have the symptoms lasted? How does the patient describe their symptoms/pain? (sharp, dull, throbbing, etc.) Where is it? Does it radiate? How severe on a scale of 1-10 is it? Has this number gotten worse or better over time? What makes it better and what makes it worse? Do they have any other associated symptoms? (Fevers, weakness, headaches, chest pain, etc.)

Remember not everything is important:

Let’s go back to our bullet point outline of our presentation. When you practice it in your head, ask if that fact you plan on saying is important to the person’s story.

Ever watch a movie and wonder why a scene was even needed? Don’t include extra scenes.

The attending should understand who the patient is, why they’re here, and the important events that led them to this point.

What is considered abnormal?

If something is abnormal to a patient, explain how it differs from normal for them. If a patient can’t walk without being SOB, you must explain how far could they walk before.

If they have a headache but also have a history of migraines, then you must include how this headache is different or similar to their condition.

Indicate Pertinent Positive and Negatives on

If a patient comes in with concerns of a heart attack, including the symptoms that they have which make you worried.

It’s equally as important to include symptoms of an MI that they don’t have.

But don’t go through the whole list and indicate random symptoms that don’t matter.

Become Efficient in Telling The Past Medical

Students love to list everything the patient has. But let’s be real, I don’t care if a patient has GERD and they’re coming in for osteomyelitis.

In your PMH include big comorbidities such as diabetes, asthma/COPD, heart failure, liver disease, and kidney issues.

If they do have the above comorbidities here are some things you should include.

For diabetes always include their most recent A1C. State when this was done. Also include what form of treatment they’re on (insulin, metformin, etc.), their dose, and their compliance with their medications. Also ask about their typical blood sugars, how often the measure them, and what time of the day these readings are taken.

For heart failure include their last ejection fraction and date. Indicate what medications they’re currently taking and how compliant they are. Ask the patient how many pillows they sleep with under their head as paroxysmal nocturnal dyspnea is a common symptom. Also, ask about their baseline weight (will go up in a heart failure exacerbation) and what their diet/fluid intake is like.

For asthma , you want to identify what severity they have. Are they severe persistent, moderate intermittent, or something else? How often do they use their rescue inhaler? How many times a week do they wake up at night. Also, ask if they’ve ever had to be intubated before.

Similar to asthma, for your COPD patient also include what GOLD stage they are. You’ll learn about this on your internal medicine rotation if you haven’t already.

These are some classic examples you want to hit every time.

Physical Exam

Start with their vitals.

Do you need to say everything? No.

Some attendings will want ranges for the heart rate and blood pressures. Others are fine if you say, “patient is afebrile, normotensive, and has a regular heart rate” or “vital signs are within normal limits”.

Regarding your physical – only say what you did. Again does everything matter? Nope.

Get away from sounding robotic. “Lungs clear to auscultation bilaterally” can just be “lungs clear bilaterally”.

If you don’t read your notes, you’ll seem more natural when presenting the physical.

What about labs?  Don’t present all labs obviously. No one cares about the WBC for a patient with a broken arm.

State labs of importance such as “lytes were stable; hemoglobin was decreased to (insert value) from (insert value) yesterday. Remaining labs of patients were within normal limits”.

If, however, you did a specific lab/test to confirm/rule out a disease then make sure you state the results. A common example is a urinalysis. If a patient has suspected UTI, make sure you state their UA came back without indications for an infection.

Certains labs are important to trend. This includes Creatinine, BNP, hemoglobin/hematocrit, WBC, Platelets, Lactate, and important electrolytes.

Assessment and

So you finished with the easy part. You knew the story and told it. Now you get to show you know how to doctor and not just interview.

Here’s my format to present my assessment and plan.

“This is Ms. who has (insert pertinent conditions and PMH) who came in for (symptoms). Given her symptoms and (physical exam/lab evidence A, B, C) I think she could have (differential A) given that she has (x,y, and z), she could also have (differential B) because of (x,y,z) and differential C (x,y,z).

To work her up I would do test/treatment (a,b,c) and reevaluate her (insert time frame).

I expect discharge for her pending treatment/workup and hopeful discharge (give a guess if possible).”

Boom! You just rocked that patient presentation!

If your patient has multiple problems, you can break your A/P by problem. For example, you can state, “For her back pain I think she could have (X,Y, or Z). I think we should give her treatment (A or B).” Keep going down her problem list. Some attendings like a system based but the method is the same.

Whenever you’re ready, there are 4 ways I can help you:

1.   The Med School Handbook :   Join thousands of other students who have taken advantage of the hundreds of FREE tips & strategies I wish I were given on the first day of medical school to crush it with less stress. 

2. The Med School Blueprint :  Join the hundreds of students who have used our A-Z blueprint and playbook for EVERY   phase of the medical journey so you can start to see grades like these. 

3.   ​ Med Ignite Study Program :  Get personalized help to create the perfect study system for yourself so you can see better grades ASAP on your medical journey & see results like these. 

4. Learn the one study strategy that saved my  grades in medical school here (viewed by more than a million students like you). 

So there you have it. Now you can present patients in medical school like a pro!

Here are other posts you may enjoy as well.

How to Build Strong Relationships with Your Patients Dealing With Death in Medical School Regaining Motivation in Medical School Top Resources to Honor Your Pediatrics Rotation

Until next time, my friend…

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Presentation skills: plan, prepare, phrase, and project

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• Laura Brammar , careers adviser, C2 Careers
• laura.brammar{at}careers.lon.ac.uk

In the third of her series on getting the dream job, Laura Brammar looks at giving an interview presentation

Many doctors have extensive experience of delivering presentations at conferences, during research projects, or to medical students during their training. Nevertheless, for many medical professionals having to deliver a presentation is still something they dread rather than relish. Equally, candidate presentations are becoming an established feature of selection and assessment for many roles within medicine.

Applicants may be asked to prepare and deliver a presentation as part of the interview process for anything from a salaried general practitioner post to a senior consultant post. For that reason alone, it’s vital to grasp the nettle and strengthen those presentation skills, which you can draw on throughout your medical career.

Break it down to just four P’s

To prepare most effectively for your presentation, you might find considering four main areas particularly useful: planning, preparation, phrasing, and projection.

Planning —A good presentation begins with the early stage of planning. Common complaints about ineffectual and dull presentations revolve around the apparent lack of structure shown by the presenter.

You will generally be given the topic of your presentation in advance. Topics vary, but they usually relate to your specialty—for example, “What do you see as the main current issues/future direction of this specialty?”—or link to contextual factors related to the role—“How, in your opinion, could the current system of X work more effectively?”

Think of the title as your research question or hypothesis and structure your presentation so that you answer that question directly. A simple but effective framework for any presentation is: tell them what you’re going to say, say it, and tell them what you’ve just said. Whether your presentation relates to the latest National Institute for Health and Clinical Excellence (NICE) guidelines for your specialty or a business plan in response to a proposed polyclinic, this structure will help keep your audience engaged and your presentation within the time limit.

Indeed, timing is crucial when giving a presentation. Most candidates are overambitious about what can be squeezed into just five to ten minutes. Be realistic about what you can achieve in the time limit and plan your presentation accordingly. As a rule of thumb, less is almost always more and remember to build in time for questions at the end.

Preparation —Having a clear structure can give you a useful framework that underpins your presentation. In a similar way, using particular resources to support your point can be a good method to employ during a presentation.

While the use of PowerPoint is becoming increasingly popular, in these circumstances you need to check before slaving over your slides. Remember that you are the focus of the presentation, not the screen; avoid distracting animations and excessive detail. Even if PowerPoint is an option you still need to plan for technological meltdowns; bring hard copies and overhead slides as a back-up.

You may consider it worth while to produce a brief summarising handout of the main points. Aim to distribute this before you begin so that you can create a clear and confident start, rather than compete with the rustle of paper as you try to introduce yourself.

Phrasing —Many candidates get anxious about the fact that they may “um” and “er” during a presentation. The vast majority of people feel nervous when they are presenting. Accept that and remember that, to an extent, it is what your audience will expect; from the selectors’ perspective, a completely laidback candidate might appear unmotivated and flippant. So while you want to aim for a fluid and articulate delivery, it’s not the end of the world if you occasionally need to pause between sentences. Indeed pauses can be an excellent way of emphasising your points and retaining your audience’s attention.

Essentially, use your structure to help you—for example, “First, I’d like to talk about . . .; next, let’s look at . . . ; and, finally, in summary . . ..”Also, be aware of your pace and volume.

Projection —Many people associate the term “presentation skills” with aspects of non-verbal communication, such as gestures and facial expression. Even when you feel nervous there are ways successfully to convey confidence to your audience. The following suggestions will help you to show a positive and calm attitude, which in turn will help you to maintain control over your presentation.

Breathe—If you are particularly nervous before you start, take a few moments to slow down your breathing; it may help to think about balancing the length of your inhalation and exhalation and breathe deeply and evenly.

Share your eye contact—If feasible, make eye contact with all your audience throughout your presentation; if you are presenting to a large group, make sure you address both sides of the room during your session.

Take time to pause—Use pauses to illustrate the structure of your session. Brief pauses can also help you to slow down your delivery and maintain the focus of your audience.

Project your voice—Check that those at the back can hear you before you start. Maintain your volume throughout and aim at projecting your voice to the back of the room.

Own the space—If possible, try not to stay stuck to one spot for the duration of the presentation. Clearly, now isn’t the time to try out gestures that feel unnatural or forced. However, convey your confidence through the way you stand and emphasise your message through your body language.

Smile—Despite feeling anxious, displaying a smile can make you feel more relaxed. Even better, it also gives your audience confidence in you and in your message.

Awkward audience moments

While you may have organised thoroughly your planning, preparation, phrasing, and projection, the one area you cannot control or necessarily predict is your audience’s reactions. Many people find the thought of their audience’s responses, especially during the question and answer session, far more terrifying than the presentation itself.

Here are a few suggestions for how to deal with some common difficult situations.

Random interruptions —If someone asks a question in the middle of your presentation, make a decision whether it would be appropriate to deal with it now or later. Don’t be forced to change your structure unless you believe it is really necessary. Acknowledge the question and reassure the person that there will be opportunities to discuss that later. Equally, if it is an unrelated or irrelevant question remember to acknowledge it but make it clear that such a topic isn’t going to be dealt with explicitly on this occasion. You can always offer to research that question for them at a later opportunity.

Audience looks bored —Many people feel they are poor presenters because their audiences can look distracted or even bored. The key thing here is to ask yourself if they are actually bored or whether they are just presenting you with a professional and impartial expression. In your clinical work you need to be able to focus on a task and not be distracted by personal emotional considerations or anxieties; this is no different. Treat the presentation as a professional exercise and move on.

Someone isn’t listening and is talking to someone nearby —Depending on your audience (senior consultants or medical students, for example) you may want to vary your specific response to this. However, a good technique with any audience is to pause in your delivery, look at the culprits while smiling, and wait for their attention before you start again. This is an effective (and non-aggressive) way of acknowledging that they are distracting both you and the rest of the group. That is usually all it takes to get their full attention. However, if they are persistent offenders maintain your professionalism and carry on regardless.

Questions you can’t answer —Sometimes the dread of the questions at the end of a presentation can overshadow the whole experience. Avoid this by framing your question and answer session with a reassurance that you’ll do your best to deal with any questions now and will guarantee to follow up any additional questions after the session. If you are asked a reasonable question which you genuinely can’t answer you may want to try the following:

Acknowledge that it’s a valid question

Invite any suggestions from the audience first

Admit that you can’t give a full answer at this moment; don’t bluff an answer

Offer to follow up a response and email the person later.

Remember that part of good medical practice is to know your limits and work within the parameters of your knowledge; it sounds far more confident and impressive to admit you can’t answer a question fully at this moment, rather than try to cobble together a poor answer and pretend you know.

Want to practise in a supportive environment?

The BMA Careers Service works with many individual medics who wish to improve their presentation skills through a tailormade practice presentation service. A bespoke practice presentation session, based on your actual material, can be excellent preparation for the real thing. During the session you can rehearse your presentation fully, practise answering focused questions, and gain immediate and constructive one to one feedback on your overall performance ( www.bma.org.uk/ap.nsf/Content/Hubcareersadvicefordoctors ).

Competing interests : None declared.

How to make an oral case presentation to healthcare colleagues

The content and delivery of a patient case for education and evidence-based care discussions in clinical practice.

BSIP SA / Alamy Stock Photo

A case presentation is a detailed narrative describing a specific problem experienced by one or more patients. Pharmacists usually focus on the medicines aspect , for example, where there is potential harm to a patient or proven benefit to the patient from medication, or where a medication error has occurred. Case presentations can be used as a pedagogical tool, as a method of appraising the presenter’s knowledge and as an opportunity for presenters to reflect on their clinical practice [1] .

The aim of an oral presentation is to disseminate information about a patient for the purpose of education, to update other members of the healthcare team on a patient’s progress, and to ensure the best, evidence-based care is being considered for their management.

Within a hospital, pharmacists are likely to present patients on a teaching or daily ward round or to a senior pharmacist or colleague for the purpose of asking advice on, for example, treatment options or complex drug-drug interactions, or for referral.

Content of a case presentation

As a general structure, an oral case presentation may be divided into three phases [2] :

• Reporting important patient information and clinical data;
• Analysing and synthesising identified issues (this is likely to include producing a list of these issues, generally termed a problem list);
• Managing the case by developing a therapeutic plan.

Specifically, the following information should be included [3] :

Patient and complaint details

Patient details: name, sex, age, ethnicity.

Presenting complaint: the reason the patient presented to the hospital (symptom/event).

History of presenting complaint: highlighting relevant events in chronological order, often presented as how many days ago they occurred. This should include prior admission to hospital for the same complaint.

Review of organ systems: listing positive or negative findings found from the doctor’s assessment that are relevant to the presenting complaint.

Past medical and surgical history

Social history: including occupation, exposures, smoking and alcohol history, and any recreational drug use.

Medication history, including any drug allergies: this should include any prescribed medicines, medicines purchased over-the-counter, any topical preparations used (including eye drops, nose drops, inhalers and nasal sprays) and any herbal or traditional remedies taken.

Sexual history: if this is relevant to the presenting complaint.

Details from a physical examination: this includes any relevant findings to the presenting complaint and should include relevant observations.

Laboratory investigation and imaging results: abnormal findings are presented.

Assessment: including differential diagnosis.

Plan: including any pharmaceutical care issues raised and how these should be resolved, ongoing management and discharge planning.

Any discrepancies between the current management of the patient’s conditions and evidence-based recommendations should be highlighted and reasons given for not adhering to evidence-based medicine ( see ‘Locating the evidence’ ).

Locating the evidence

The evidence base for the therapeutic options available should always be considered. There may be local guidance available within the hospital trust directing the management of the patient’s presenting condition. Pharmacists often contribute to the development of such guidelines, especially if medication is involved. If no local guidelines are available, the next step is to refer to national guidance. This is developed by a steering group of experts, for example, the British HIV Association or the National Institute for Health and Care Excellence . If the presenting condition is unusual or rare, for example, acute porphyria, and there are no local or national guidelines available, a literature search may help locate articles or case studies similar to the case.

Giving a case presentation

Currently, there are no available acknowledged guidelines or systematic descriptions of the structure, language and function of the oral case presentation [4] and therefore there is no standard on how the skills required to prepare or present a case are taught. Most individuals are introduced to this concept at undergraduate level and then build on their skills through practice-based learning.

A case presentation is a narrative of a patient’s care, so it is vital the presenter has familiarity with the patient, the case and its progression. The preparation for the presentation will depend on what information is to be included.

Generally, oral case presentations are brief and should be limited to 5–10 minutes. This may be extended if the case is being presented as part of an assessment compared with routine everyday working ( see ‘Case-based discussion’ ). The audience should be interested in what is being said so the presenter should maintain this engagement through eye contact, clear speech and enthusiasm for the case.

It is important to stick to the facts by presenting the case as a factual timeline and not describing how things should have happened instead. Importantly, the case should always be concluded and should include an outcome of the patient’s care [5] .

An example of an oral case presentation, given by a pharmacist to a doctor,  is available here .

A successful oral case presentation allows the audience to garner the right amount of patient information in the most efficient way, enabling a clinically appropriate plan to be developed. The challenge lies with the fact that the content and delivery of this will vary depending on the service, and clinical and audience setting [3] . A practitioner with less experience may find understanding the balance between sufficient information and efficiency of communication difficult, but regular use of the oral case presentation tool will improve this skill.

Tailoring case presentations to your audience

Most case presentations are not tailored to a specific audience because the same type of information will usually need to be conveyed in each case.

However, case presentations can be adapted to meet the identified learning needs of the target audience, if required for training purposes. This method involves varying the content of the presentation or choosing specific cases to present that will help achieve a set of objectives [6] . For example, if a requirement to learn about the management of acute myocardial infarction has been identified by the target audience, then the presenter may identify a case from the cardiology ward to present to the group, as opposed to presenting a patient reviewed by that person during their normal working practice.

Alternatively, a presenter could focus on a particular condition within a case, which will dictate what information is included. For example, if a case on asthma is being presented, the focus may be on recent use of bronchodilator therapy, respiratory function tests (including peak expiratory flow rate), symptoms related to exacerbation of airways disease, anxiety levels, ability to talk in full sentences, triggers to worsening of symptoms, and recent exposure to allergens. These may not be considered relevant if presenting the case on an unrelated condition that the same patient has, for example, if this patient was admitted with a hip fracture and their asthma was well controlled.

Case-based discussion

The oral case presentation may also act as the basis of workplace-based assessment in the form of a case-based discussion. In the UK, this forms part of many healthcare professional bodies’ assessment of clinical practice, for example, medical professional colleges.

For pharmacists, a case-based discussion forms part of the Royal Pharmaceutical Society (RPS) Foundation and Advanced Practice assessments . Mastery of the oral case presentation skill could provide useful preparation for this assessment process.

A case-based discussion would include a pharmaceutical needs assessment, which involves identifying and prioritising pharmaceutical problems for a particular patient. Evidence-based guidelines relevant to the specific medical condition should be used to make treatment recommendations, and a plan to monitor the patient once therapy has started should be developed. Professionalism is an important aspect of case-based discussion — issues must be prioritised appropriately and ethical and legal frameworks must be referred to [7] . A case-based discussion would include broadly similar content to the oral case presentation, but would involve further questioning of the presenter by the assessor to determine the extent of the presenter’s knowledge of the specific case, condition and therapeutic strategies. The criteria used for assessment would depend on the level of practice of the presenter but, for pharmacists, this may include assessment against the RPS  Foundation or Pharmacy Frameworks .

Acknowledgement

With thanks to Aamer Safdar for providing the script for the audio case presentation.

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Any training, learning or development activities that you undertake for CPD can also be recorded as evidence as part of your RPS Faculty practice-based portfolio when preparing for Faculty membership. To start your RPS Faculty journey today, access the portfolio and tools at www.rpharms.com/Faculty

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[1] Onishi H. The role of case presentation for teaching and learning activities. Kaohsiung J Med Sci 2008;24:356–360. doi: 10.1016/s1607-551x(08)70132–3

[2] Edwards JC, Brannan JR, Burgess L et al . Case presentation format and clinical reasoning: a strategy for teaching medical students. Medical Teacher 1987;9:285–292. doi: 10.3109/01421598709034790

[3] Goldberg C. A practical guide to clinical medicine: overview and general information about oral presentation. 2009. University of California, San Diego. Available from: https://meded.ecsd.edu/clinicalmed.oral.htm (accessed 5 December 2015)

[4] Chan MY. 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

[5] McGee S. Medicine student programs: oral presentation guidelines. Learning & Scholarly Technologies, University of Washington. Available from: https://catalyst.uw.edu/workspace/medsp/30311/202905 (accessed 7 December 2015)

[6] Hays R. Teaching and Learning in Clinical Settings. 2006;425. Oxford: Radcliffe Publishing Ltd.

[7] Royal Pharmaceutical Society. Tips for assessors for completing case-based discussions. 2015. Available from: http://www.rpharms.com/help/case_based_discussion.htm (accessed 30 December 2015)

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Oral Presentations: Tips, Significance, Design, Guidelines & Presentation

1) Know your audience

It is always a good idea to structure your talk so that anyone in the audience can understand  what you are presenting. A good scientist should be able to present complex, scientific ideas,  no matter how technical, in a simple, easy to follow manner. Complexity is not a necessity, it is an annoyance.

Understand your purpose. This way you can get the point of your talk across appropriately and affectively by  catering to your specific audience. 

2) Be organized

• Whether you are giving a 15 minute talk or a 45 minute talk, make sure you give yourself  enough time to deliver all the information you want in a calm manner. Allocate time for questions/answers.
• Be able to summarize your presentation in five minutes.
• Be concise. Use your space wisely. Use illustrations. Check grammar, spelling, and lay out of each slide.
• Keep an outline with you during the presentation; it will help you stay on track.
• Prepare back up slides. These will come in handy if a question comes up about a topic that needs  further explanation.

3) Presentation

Practice your talk enough so that you have flow, but no so much that you have the entire talk memorized.  Memorizing your talk will bore you and your audience, as it will be monotonous.

4) Be professional

• Know what you are presenting and be ready to answer question during and after the presentation.  Do not answer questions vaguely. A knowledgeable scientist is specific and accurate with his/her information.
• Dress up to present with confidence and respect for the audience and the science involved.
• Be enthusiastic. Scientific talks can be boring, as often they are full of technical jargon. Be clear and talk simplistically.
• Make sure the presentation is visually pleasing. Add pertinent graphics and use fewer words.

5) Be aware of technical problems.

Make sure the format you choose for your presentation is compatible with your style of speech.  Also, be prepared for technical disasters just before your talk. Be able to give your talk in another format  just in case your first choice (ex: PowerPoint presentation) fails to load.

Significance

Oral presentations are an excellent means of communicating basic science or clinical research.  Unlike a poster presentation or a written manuscript, the audience during an oral presentation is more  attentive as they are focused on the presenter. For the researcher, this is a rare opportunity to shine!  In as few as five minutes, the researcher can convey scientific information and give a years worth work  some meaning that can be useful to thousands of people. Of course, this also means that in as little as  five minutes, the researcher can cause a great deal of confusion by giving a bad presentation.

Just as is the case with written manuscripts and poster presentations, oral presentations must also  communicate research to include all aspects of the scientific method. There are, however, no rules as to  what order and which format this should be done in. In order to deliver a successful talk, the presenter  should be organized, prepared, and enthusiastic about the research being presented.

Design: A General Guideline

Regardless of whether you choose a PowerPoint presentation or transparencies to deliver your talk,  here are some general guidelines to keep in mind when designing your presentation.

1) Title (include authors and affiliations)

2) Introduction (Background, Purpose, Hypothesis)

3) Method (A brief introduction to the methodology without too much technical Jargon)

4) Results (Use graphs/charts/table, Provide an extra slide/transparency with a summary of the results, Explain the results)

5) Conclusions/Discussion (Clear explanation of the results, Clinical implications)

6) Future work (Provide information on where the project is headed)

7) Acknowledgment

Presentation

There some people for whom public speaking is as natural as having a conversation with their friends.  Conveniently, however, public speaking is an art that can be perfected with enough practice.  Here some things to consider before and during the presentation:

• Do not go over the time limit.
• Speak clearly and concisely. Be coherent. Do not ramble, play with the pointer, or move around in circles.
• Dress appropriately.
• Make eye contact.
• Make sure that each slide/transparency is not cluttered with too many points and ideas. Graphs, tables,  and charts should be clearly labeled and easy to interpret.
• Practice your talk, but do not memorize a script.
• Be visually and orally interesting.
• Answer questions in a calm, non-condescending manner; do not argue with or interrupt the questioner.
• Be polite and graceful.
• Give a presentation that is focused with one underlying message.

Medical Presentations: How to Present Effectively on Urgent Topics

In the face of the pandemic that consumed 2020, we saw an uptick in medical presentations. And rightfully so. The world was in a state of panic over the unknown of a new virus, people were craving information, and organizations like the World Health Organization (WHO) were scrambling to provide data and resources to help address questions and concerns. Whether it was news stories, or medical research, the world needed to understand what we were up against with COVID-19. Naturally, presentations helped to deliver that information. But this isn’t the first time a virus or disease has rattled communities, and it’s certainly not the first time professionals have used medical presentations to educate the masses. Medical presentations are a helpful tool for medical professionals, research clinics, and organizations to help inform and educate their communities on a wide variety of urgent topics. This can include patient treatment, clinical trial research and results, training for medical staff, general education, medical research, or important data regarding diseases. 

While medical presentations tend to be fundamentally different from normal presentations in that they include critical and sensitive information, there are still design best practices just like any other deck. That said, what works for a sales pitch might not resonate well with a medical presentation.

Keep these five things in mind when you want to present effectively on urgent medical presentation topics. 

Consider your audience

You may be presenting to a group of doctors within your organization to get the team up to speed on new practices, sharing treatment plans with a patient, or educating the community on new health threats. How you structure your medical presentation is not a one-size-fits-all situation. How you talk to internal staff, versus how you would deliver information to a scared patient is not the same. When you’re crafting your message, consider your audience, and tailor the narrative to their overarching concerns and needs. 

Keep things straightforward

Unless you’re presenting to third year residents, your audience probably won’t be able to digest complicated medical terminology. It’s important to avoid medical jargon, complex definitions, or overcomplicated explanations that will confuse your audience. Instead, break things down in layman's terms and relate the information back to your audience and how it will affect them. Keeping things straightforward, and clear, will help your audience digest and process the information quicker. The end goal is that your audience leaves with clarity, feeling more educated on the topic and its urgency. 

Use icons to reflect the urgency of the situation

The use of visual aids, such as compelling images or meaningful icons, can help paint the picture of urgency in any presentation. Things like clocks, alarms, lightning bolts, or exclamation points can depict emergencies and symbolize something significant in your presentation. The use of impactful visuals will help engage your audience and let them know what they absolutely need to pay attention to. It helps you control the narrative, and highlight any pertinent information or key takeaways. 

Beautiful.ai’s free library of hundreds of thousands of images and icons can help take your presentation to the next level. Our custom icons were thoughtfully created by one of our in-house designers, and are a great way to compliment your data and add urgency to your slide . 

Hit them with the facts

In most medical presentations, factual data carries the slides. Whether it’s a survey, research results, or statistics about a particular disease, numerical data will help people understand the urgency or severity of the topic. For example, it was common for nearly every COVID-19 presentation or article to include statistics of the percentage of the population infected, which regions were seeing the greatest spikes in cases, death tolls by county, and data relevant to high-risk individuals. While the numbers may not always be fun— especially as they pertain to a pandemic— they paint a clear picture of what the audience needs to understand. Seeing scary statistics can put into perspective just how real the situation is. 

Using the proper charts, graphs , or infographics allows you to dictate exactly what information the audience is consuming. Data visualization with infographics can also help the audience understand and retain otherwise complicated data. However, even with the best charts, you can still overwhelm the audience with information. Opt to include only the most relevant info and useful data.

Allow time to process

Regardless of what you’re presenting— big or small— you should leave time at the end for questions. Medical presentations can be paralyzing, and your audience will likely be seeking more answers. Give your audience a minute or two following the presentation to process what they learned, and then give them a chance to ask questions. You may need to elaborate on specific slides, or revisit a piece of data, to help provide clarification. When it comes to urgent topics, you want your audience to leave feeling more knowledgeable and at ease than they were prior to tuning in. 

Jordan Turner

Jordan is a Bay Area writer, social media manager, and content strategist.

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Ultimate Guide to Medical Presentations: Templates, Tutorials, Tips and Resources

About medical presentations.

Medical presentations are fundamentally different from other presentation types. In fact, they are one of the toughest type of presentations to design.

Medical slides have research facts, data charts, diagrams and illustrations that demand a totally different approach to design. You need a slide creation method that considers the unique problems you face as a medical presenter. In this guide, you will Tips, Tutorials and resources to get your started with making over your Medical slides.

We will start with some general tips and tricks on creating medical slides and then proceed to step by step tutorials. 

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Tips to create Medical Presentations

PowerPoint Tutorials for Medical Slides

How to Present Lists & Text

How To Showcase Pictures Creatively

How to use animations effectively, creative morph transition ideas, making medical slides easy to understand, powerpoint delivery tips, powerpoint tips & tricks, issue with typical medical slides, medical slides makeover examples, medical powerpoint templates, free medical & healthcare icons, free medical presentation images, more resources for medical presentations, tips to create medical presentations, how to avoid overwhelming audience in technical presentations.

Do you want to improve how you explain concepts in a technical presentation? In this article, you will find a powerful technique called ‘Telescopic explanation’ to make your technical presentations much clearer and more memorable for your audience. To know more, read this post over on PrezoTraining.com

Tips to present Scientific Information

There are two major facets to a presentation: the content and how you present it. Let’s face it, no matter how great the content, no one will get it if they stop paying attention.

Here are some pointers on how to create clear, concise content for scientific presentations – and how to deliver your message in a dynamic way.   Find the tips over on Elsevier connect .

Preparing a Research Presentation

If you have never presented a paper at a scientific meeting,  or would like to polish your research presentations, this post contains information that will improve your presentation.

This article contains a set of guides and checklists to help you in the preparation of your presentation.   Read this post on ACP .

10 Tips for Medical Presentations

Whether you are presenting an audit or a case report at a local meeting, presenting a paper at a conference, presenting a business case to your Trust, or even presenting on a hot topic at your medical interview, you will need to know how to prepare medical slides which attract your audience rather than distract it. This post on ISC Medical provides 10 tips for Medical presentations.

For a 5-Part series on how to make your Medical Slides Clear and Visual , sign up for our Free E-course.

In the following sections, you'll find step by step PowerPoint tutorials & Makeover Ideas to help you makeover different parts of your presentation. 

How To Present Lists and Text

Information presentations use a lot of text and bullet list. In this section, you will find some creative ways to design these type of slides.

PowerPoint Tip: How to Present Long Lists on One Slide

If you have a Long Lists of items on One Slide here is a one-click trick on how to do this. Watch the video below to know more.

PowerPoint Trick to Convert Text to Graphics

Find a useful PowerPoint SmartArt Trick to convert Bullet Point Text to Graphics quickly and easily. Learn how to take the graphics to the next level with some creative ideas from Ramgopal.

For a 5-Part series on how to make your Medical Slides Clear and Visual , sign up for our Free e-course.

Get access to exclusive members-only e-courses & downloads.

Medical presentations usually have a lot of pictures. Especially the training and informational slides. Here are some ways in which you can present the pictures in your presentations in a creative way. 

Right Way to Showcase Pictures

Learn the benefit of showcasing pictures using SmartArt tool in PowerPoint. In the video below we start with a typical picture Showcase slide used by presenters. Though the slide looks quite attractive in the first glance, there are some issues that makes the slide ineffective. Watch the video below to know more:

Cropping Pictures in PowerPoint

Learn a super easy trick to crop a picture in PowerPoint in a step by step way. This trick will help you crop a picture in the shape you want, in a single click.

A PowerPoint slide with too much content can be overwhelming for the audience. If you learn to sequence the way you present your information, you make it easy for your audience to understand your presentation.

Here are different ways you can use Custom Animations and Morph Transition effects to sequence information.

Animation for Process with Pictures

In this tutorial, you will find how to create a useful and practical slide with pictures and text to show a process or a timeline diagram. Learn how to create and present it to make an impact.

Animation for Highlighting Pictures

Learn to create an Animated Picture Reveal Effect in PowerPoint. Present your important picture with this effect. Watch the video to preview the effect and learn how to create it:

Sequential Fading technique in PowerPoint

This trick is super useful for medical presentations where you need to present an image step by step. Since it is an image you cannot break it up and present it in parts. However with this useful technique you can highlight one part of an image at a time with animation. 

For a 5-Part series on how to make your Medical Slides Clear and Visual , sign up for our Free e-course. Get access to exclusive members-only e-courses & downloads.

In PowerPoint for Office 365, Microsoft introduced the Morph Transition. It is an effective way to create animations fast. Here are some ideas on how you can use this feature to create your slides.

Pros & Cons with Morph Transition

Learn how to create an easy animated scales diagram with Morph Transition Effect. This effect is available in PowerPoint for Office 365. You can also sign up & download the original PowerPoint file over at our website .

Morph Transition To Present Pictures

In this video you will find how to use PowerPoint Morph Transition to replace Custom Animations. See how this can be done with this example of a slide with multiple pictures with text.

Convert your boring text-based slides, blog articles or research papers into clear & beautiful visual slides - even if you have zero Design skills, zero PowerPoint skills & very little time - using our ‘4-step Neuro Slide Design System for Medical Presentations’

Watch the video below to learn more:

Ideas to Present Data

Medical presentations also usually contain a component of data. This could be related to statistics or research. In this section, you will find some easy ways to makeover your slides with numbers.

Creating Pie & Donut Charts 

Learn how to create a Pie chart in PowerPoint with this step by step tutorial. This video also covers how to adjust the Pie chart settings and also how to add Donut charts.

How to Animate a PowerPoint Table

Learn a trick to Animate a PowerPoint Table. PowerPoint does not have the feature of animating parts of a table.

[Advanced] Conditional Formatting for Charts

Learn to create a PowerPoint conditional formatting chart that changes color and direction of bar chart automatically for negative values. The positive values are displayed in green color and the negative values in red color. 

Here are some tips for when you are actually delivering your presentation. Present confidently with these ideas!

Use Presenter View in PowerPoint like a PRO

How to use Presenter View in PowerPoint to present your slides like a PRO (Presentation Delivery Tips). This view is for the presenter only - when the slideshow This requires 2 monitors (your laptop and the projector screen). Even if you want to use Presenter View in 1 monitor it is possible.  Learn how with this video.

Use Hidden Slides to Present Confidently

In this video, you will find a PowerPoint Tip on how to use Hidden slides to present confidently. This feature is especially useful when creating business presentations.

PowerPoint Slideshow Shortcuts

Here are some useful PowerPoint Slideshow Shortcuts you can use when delivering your next presentation. Hope you find these PowerPoint tips useful.

If you wish to improve the quality of your medical slides in a reliable way, take a look at the first  video over on this page .

Here are some tips and tricks to reduce time taken to create your slides. 

Setting Up Quick Access Toolbar

In this PowerPoint tips tutorial, you will find how to set up the Quick Access Toolbar. It is a great time-saving tool for any version of PowerPoint.

Autocorrect Trick to Save Time

Learn this trick to use PowerPoint Auto-correct option to save time and effort in creating your presentations. Write complex medical terminology accurately & easily in PowerPoint!

Get access to exclusive members-only e-courses & offers.

Many of the medical slides you may see may look like this:

These slides are taken from various sources online like Slideshare and YouTube and represent various types of presentations. The common issues with such slides include:

• Issue with readability - due to poor color choices and font sizes
• Unprofessional design - with overlapping content, hard to read diagrams etc.
• Too much content - that overwhelms  the audience

It is quite common to see well researched medical content being totally ignored by the audience - because the presentation slides look busy and boring. And… You can’t blame your audience for tuning out of your presentation. 

The quality of your slides makes or breaks your medical presentations.

In this section, we'll makeover usual text filled PowerPoint slides into a visual and interesting slides. 

The original slides are taken from various sources online like Slideshare and YouTube and represent various types of presentations. 

Medical Title Slide

Original title slide:

Title slide after makeover:

Medical Training Presentation Slide

Original training slide:

Training slide after makeover:

Medical Slide With Quote

Original slide with quote:

Quote slide after makeover:

Health and Safety Training Slide

Slide after makeover:

In the  Medical Presentations Bundle with Neuro Slide Design Training, you can watch me make over Text-based slides, a Blog article, a Wikipedia article and a 11-page Research paper. I go through each of the 4 steps to transform these text-based documents to clear and beautiful visual slides.

The Bundle includes 900 Fully Editable PowerPoint Templates. Go over and checkout the bundle .

One of the ways to quickly improve the quality of your slides is to use good quality templates create with the needs of medical presenters in mind. Here are some resources...

Free Medical Title Templates

Leawo website provides free medical title templates for download. These templates are suitable for different type of medical presentations. You can preview and download them here .

FPPT website provides similar free title templates for use as well. You can find title templates related to medical and health fields over here on FPPT .

Premium Medical PowerPoint Templates

While free medical PowerPoint Templates are good enough for student or non-critical presentations, if you are consultant or specialist, you may prefer to use high-quality PowerPoint Templates. 

Preview Medical PowerPoint Templates Bundle

Create Medical Slides You Feel Proud to Present Using the Breakthrough Slide Design System created using proven Brain research principles. You can preview templates from our Medical Templates Bundle below:

Browse more templates and know more about the Medical PowerPoint Templates Bundle here .

Icons are useful to represent ideas on slides. Here are some useful links for downloading Healthcare and Medical Icons online. 

ICONFINDER : This website has a good collection of vector icons without too many ads or links to other websites.. You can search iconfinder by keyword and specifically look for free to use icons. You can also search by types of icons like glyphs, outline, flat, filled outline, 3D and more.

VECTEEZY : This website provides both free and premium icons. The license may require you to provide attribution to the author.  There are lot of popups and ads, and the focus in on their premium icons.

POWERPOINT : If you are using Office 365, you can find a lot of free icons right in PowerPoint. There are icons for people, technology and electronics, communication, business, analytics, commerce, education, signs and symbols, arrows, medical and much more.  You can edit the fill colors of these icons to customize them. 

Make your own icons in PowerPoint

Make your slides look professional and visual with these icons. Icons make it easy for your audience to remember the information you are presenting. Learn the secret to finding icons for free right within PowerPoint.

300+ Editable Icons for PowerPoint

The   Medical Presentations Bundle includes 300+ Medical Icons for PowerPoint. You can break these icons into individual components, mix and match them to create custom icons that meet your specific needs. As one of the doctors using this Bundle said, it is a “ ONE STOP SHOP” for every busy medical practitioner.

Medical presentations can be made more interesting and engaging by the addition of relevant images. If you are looking for high-quality free images, here are some suggestions:

FREEIMAGES.COM :  Images on this website are free for use for personal and commercial purposes. You can find a range of generic medical and healthcare images here.

PICJUMBO.COM :  This site provides free and interesting images for backgrounds. 

WIKIPEDIA is a great source for free images and illustrations. However, there are a couple of things to keep in mind when you use images from Wikipedia.

1) Please check the copyright terms for each image. You may need to provide attribution as per their terms.

2) Images may be of different formats, sizes, color schemes and quality. 

Here is a collection of images from Wikipedia related to Brain:

150+ Medical Illustrations | 170+ Medical Photos | 150+ Silhouettes

In the   Medical Presentations Bundle     we have already done the hard work of putting together a large collection of high quality Medical, Pharma and Science photos & editable illustrations to use in your presentations. 

Remember, these are not the usual photos of smiling Doctors and pretty handshakes. These are practical medical photos you can use in your medical slides to illustrate your ideas.  As one of the doctors using this Bundle said, it is a “ONE STOP SHOP” for every busy medical practitioner.

For a  5-Part series on how to make your Medical Slides Clear and Visual , sign up for our Free e-course. Get access to exclusive members-only e-courses & downloads.

PowerPoint Skills for Medical Professionals Learn the 14 essential PowerPoint techniques that every medical professional needs to know to design clear medical slides. This training is part of Medical Presentations Bundle .

Advanced PowerPoint Video Tutorials Enhance your presentations with these ideas. In this section you will find extensive video tutorials for 2D and 3D Diagrams, Models, Picture Effects, Animations and More… Click here to browse

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EmergencyPedia

Free open access medical education, basic presentation skills for medical students, case  presenting.

You are asked to briefly present the patient case you have just see on the ward round.

The consultant insists that you start with a concise summary of the patient’s care.

Presenting cases is both nerve inducing and challenging – but we have to start some where.

A snappy opening statement and summary not only leaves a good professional impression but is also very important in long case examinations and OSCE stations where presentation skills are expected.  Presentation skills are often assessed in these Exams as a part of the marking criteria so practice is important.  Furthermore, in Medical Emergencies when calling for help concise and accurate presentation is also very important.

These two essential skills do overlap but we will tackle the “stable” healthy patient and “unstable” critically unwell patient with separate approaches…

Depending on the acuity of the situation you should give a different ‘style’ of presentation:

Two Styles of Presentation

• If the patient is critically unwell or requiring early review and treatment brevity is very important
• Before you call ask yourself – what do we need from the person I am calling?
• In a stable ‘long case’ discussion then style and substance are required
• In the stable patient there should also be a focus on the patient’s social history
• When presenting a long case be sure you have obtained an accurate chronological order of events from the patient and addressed their patients Ideas, Concerns and Expectations

Stable Patient

Here is our guide to basic presentation skills for a long case:

We recommend giving a basic 30 second overview including a ‘social snapshot’, most important presenting complaint and relevant past medical history of the patient:

• Introduce yourself  as a medical student who would like to present a summary of a patient history
• State the patient’s identity and age:

I had the pleasure of meeting Mr Smith who is a 60 year old gentleman

• Mention a ‘social identifier’ or two:

Mr Smith lives with his wife and son and is a retired coal miner and has come to the hospital today for the purpose of the long-case examination

• State the Presenting Complaint(s):

Mr Smith states he presented to hospital one week ago with the following problems: – Firstly, Intermittent Pleuritic Sounding Chest pain for the last 2 days – and Secondly, a  gradual onset of  Shortness of Breath for 3 days 

• State the Relevant Past Medical History and Main Concern:

The patient has a relevant past medical history of Asbestosis and Emphysema He is worried about what his new diagnosis of pulmonary embolism means for his future travel plans In more detail…

• Finish your introduction with the phrase  ‘ In more detail ‘  before presenting the detailed presenting illness and the rest of the history in a systematic order.  Using careful pauses and short phrases such as “in more detail”, “moving on” and “in terms of the patient’s family history” can really help sign post the presentation for the listener.
• Talking reasonable quickly is ok as long as you have good pauses to help the listener digest the information
• In general, try to avoid abbreviations, jargon and overly rushing your introduction
• If you can make some eye contact but avoid overuse of hand gestures
• When I am nervous I consciously slow down and shuffle my papers slowly on the desk while I collect my thoughts

Unstable Patient

This is the situation where it is very important to be brief in your handover.  Grab the listeners attention by introducing yourself and emphasising why you are calling and what you believe is required for the patient.

ISBAR , SBAR and ISOBAR are widely used communication tools that are easily learned and applied when handing over a patient.  One of the key parts of ISBAR is the ‘R’ which stands for ‘recommendation’ or ‘response’.  This part of the handover mandates that you make a recommendation of what should happen now and what response you want from your senior colleague.

In conclusion, preparation and planning is key to a smooth medical presentation.

Practice a formula that works for a discussion with a senior for a stable patient (Long-case) and a method that works for an acutely unwell patient that needs urgent attention (ISBAR).

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7 thoughts on “ basic presentation skills for medical students ”.

Interesting and engaging tips, each point is noteworthy. thanks for sharing, i enjoyed reading your post

Very informative post….as presentation skills plays an importany role in each and every ones life…Through this blog you have shared very good info…..each and every point has some importance…..Very nice….

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Great post – http://rebelem.com/how-to-call-a-consult

Is it possible to have a structure for how to present a physical examination – particularly for OSCE format?

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• Open access
• Published: 20 July 2024

Eyesi direct ophthalmoscope simulator: an effective training tool for medical undergraduates

• Canying Liu 1   na1 ,
• Jicheng Lin 1   na1 ,
• Siting Wu 1 ,
• Yingting Zhu 1 ,
• Yuxian Zou 1 ,
• Qi Zhang 1 ,
• Zhidong Li 1 ,
• Yehong Zhuo 1 &
• Yiqing Li 1  

BMC Medical Education volume  24 , Article number:  783 ( 2024 ) Cite this article

203 Accesses

Metrics details

Introduction

Non-ophthalmologists often lack sufficient operational training to use a direct ophthalmoscope proficiently, resulting in a global deficit of basic ophthalmological skills among general practitioners. This deficiency hampers the timely diagnosis, referral, and intervention of patients. Consequently, the optimization of teaching tools and methods to enhance teaching efficiency is imperative. This study explores the effectiveness of the Eyesi Direct Ophthalmoscope Simulator (Eyesi) as an innovative tool for fundus examination training.

Medical undergraduates were randomly assigned to Group A or B ( n  = 168). All participants completed a pre-training questionnaire. Group A received Eyesi training, while Group B underwent traditional direct ophthalmoscope (TDO) training. Subsequently, participants answered questionnaires relevant to their respective training methods. Both groups exchanged training tools and completed a summary questionnaire.

After training, 54.17% of participants believed that images presented by the Eyesi were consistent with the real fundus. Group A scored significantly higher than Group B in fundus structure recognition and self-confidence in examination. The degree of mastery over fundus theory score increased from 6.10 ± 0.13 to 7.74 ± 0.16 ( P  < 0.001) in Group A, but Group B did not demonstrate a significant difference. We also compared undergraduates’ tendencies for different learning purposes, 75.59% of participants preferred the Eyesi to TDO as a training tool, and 88.41% of participants were receptive to introducing the Eyesi in training.

According to subjective participant feedback, Eyesi outperformed TDO in fundus observation, operational practice, and theoretical learning. It effectively equips undergraduates with fundus examination skills, potentially promoting the use of direct ophthalmoscopes in primary medical institutions.

Peer Review reports

The transparency of the tissues in front of the retina, along with retina itself, enables unhindered light transmission, facilitating direct visualization of the retina’s superficial vascular and neural structures. Direct ophthalmoscopes are portable devices for the observation of the fundus and the assessment of retinal diseases. A timely and precise direct ophthalmoscopy examination can not only safeguard a patients’ eyesight, such as instances of retinopathy of prematurity, retinal vascular obstruction and retinal detachment, but also their life in critical situations such as uveal melanomas, elevated intracranial pressure, malignant hypertension, and meningitis [ 1 , 2 , 3 , 4 ]. Direct ophthalmoscopy examination also plays an important role in the early diagnosis, follow-up, and efficacy evaluation of systemic and common eye diseases (i.e. diabetes, hypertension, atherosclerosis, and glaucoma) [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. Although studies have shown that direct ophthalmoscopy is less sensitive than fundus photography for screening eye diseases like diabetic retinopathy, this tool offers the advantages of of great availability, low operational costs, short examination times, and high specificity in detecting sight-threatening eye diseases [ 12 ]. For general practitioners and non-ophthalmologists, the direct ophthalmoscope is the preferred equipment for fundus examination and is particularly suitable for primary medical services. Therefore, the ability to utilize the direct ophthalmoscope is a required skill for medical undergraduates and general practitioners in many countries [ 13 , 14 , 15 ]. However, the operational training received by most clinical medical undergraduates and general practitioners is typically insufficient for the use of a direct ophthalmoscope, oftentimes leading to inaccurate identification of common fundus lesions. The lack of basic ophthalmological skills among general practitioners has become a global problem, affecting timely diagnosis, referral, and intervention of patients [ 7 , 13 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Optimizing the teaching tools and procedures in order to improve teaching efficiency has become a pressing issue that requires an alternative solution.

Problems exist in traditional direct ophthalmoscope (TDO) teaching, including learning difficulties that result in a lack of confidence, difficulty identifying fundus structures and diagnosing retinal diseases, and difficulty properly evaluating students’ fundus examination ability [ 24 , 25 , 26 ]. Moreover, TDO training may be hindered by limited access for students to practice on patients, due to the limited number of patients available with each disease at a given time and the reluctance of patients due to discomfort during the examination. In order to address these issues, we introduced the Eyesi Direct Ophthalmoscope simulator (Model EDO491 #03 × 0127, Platform 2.1, Software v1.8.0.113443, VRmagic GMBH, Mannheim, Germany) [ 27 ], which simulates the shape and all functions of a real direct ophthalmoscope and reaction of patients such as the changing of pupil size with the lighting level. It provides a built-in case database that allows students to learn independently, and offers a test mode that can be used to evaluate skill mastery. It can provide timely feedback on whether there is retinal diseases in the inspected area from the user’s perspective. Teachers can also provide guidance during the operation through the monitoring screen connected to the simulator, and can check the students’ operation scores in real-time through the VRmNet service [ 2 , 27 ]. Experienced doctors considered the simulator realistic and found it met the training needs on how to perform direct ophthalmoscopy [ 28 ]. Currently, the device is not widely used. The objective of this study was to evaluate whether the Eyesi, as a training tool for fundus examination, can address and rectify issues that currently exist in TDO teaching.

This prospective, randomized, controlled trial was conducted at Zhongshan Ophthalmic Center, Guangzhou, Guangdong, China.

Study participants

Fourth-year medical undergraduates at Sun Yat-Sen University who came to Zhongshan Ophthalmic Center for ophthalmic preclinical training were included in this study. The study received ethics approval via the Ethics Committee at Zhongshan Ophthalmic Center, Sun Yat-sen University and all participants provided written informed consent prior to taking part. All aspects of the study conformed to the tenets of the Declaration of Helsinki. Our inclusion criteria were as follows: (1) successfully completed the theoretical Ophthalmology course; (2) willingness to participate in the entire study. Our exclusion criteria were as follows: (1) refusal to participate; (2) those who had already learned to operate a direct ophthalmoscope prior to this study.

Questionnaires design

There were four questionnaires administered throughout the duration of the study: the pre-training questionnaire, the questionnaire after the Eyesi training, the questionnaire after TDO training, and the summary questionnaire (Supplementary Tables 1 – 4 ). By referring to relevant literatures, considering the difficulties expressed by students in the previous training and consulting clinical teachers and professors, we set up a series of questionnaires. Composed of basic information, views before and after different training, these questionnaires covered the content assessed in previous studies [ 24 , 29 , 30 ] and provided an assessment of teaching effectiveness based on participants’ self-perception. Consisting of single-choice questions, multiple-choice questions, and short answers, they were built according to the first two levels of Kirkpatrick model [ 31 , 32 ], a four-level evaluation model developed by Donald Kirkpatrick. The first level is about students’ reaction, such as their interest and motivation. The second level is to measure whether students have learned knowledge and/or skills. The questionnaire items were categorized into four dimensions: (1) the importance of learning direct ophthalmoscope operation, (2) competency in direct ophthalmoscope operation, (3) level of theoretical knowledge related to direct ophthalmoscope, and (4) interest in further learning. Questions for each dimension are listed in Supplementary Tables 1 – 4 . And the internal consistency analysis was performed by computing the Cronbach’s alpha and composite reliability statistics (Supplementary Table 5 ).

Instructional design

A total of 175 undergraduates who came for ophthalmic preclinical training were divided into six groups; approximately 30 students attended ophthalmic preclinical training at each designated teaching slot. Participants received theoretical teaching including the composition of TDO and its operation. And then one instructor demonstrated the operation of TDO and the Eyesi. The instructors and teaching content remained consistent across all students. Subsequently, students were randomly divided into the Eyesi (Group A) or TDO (Group B) group. Participants were required to complete their corresponding questionnaires, and thereafter the two groups exchanged their training tools. Students filled in the summary questionnaire after completing both training sessions and were given the test of standard operation procedure (SOP). The standards of grading are shown in Supplementary Table 6 . Instructional design of direct ophthalmoscope is shown in Fig.  1 .

Instructional design of direct ophthalmoscope

For Eyesi training, participants would undergo the following training programs (Fig.  2 ): (1) Learning the construction and usage of the direct ophthalmoscope handle of the Eyesi simulator; (2) Identifying scattered landmarks on retina (e.g., triangles, crosses) under mydriatic conditions and repeating the process under normal pupillary conditions; (3) Locating retinal landmarks (e.g., retinal arterioles and venules, macula, optic disc) on a simulated normal retina under both mydriatic and normal pupillary conditions and assessing the cup-to-disc ratio while improving the examination coverage by monitoring the examined area (bright zone) and the unexamined area (dark zone) displayed on the monitor; (4) Examining the retina of typical cases under normal pupillary conditions, identifying pathological areas, and making diagnoses of the lesions. Students also learned about the disease progression and retinal lesion descriptions through the simulator’s built-in case library. Throughout the process, the instructing teachers could monitor observed images of students on the monitor and provide timely assistance, such as helping students adjust the position of the ophthalmoscope to ensure a complete examination of the central and peripheral retina and pointing out any overlooked retinal anatomical structures or pathological areas.

Training Process of the Eyesi Simulator. A ) The Eyesi simulator consists of three main hardware components: a display monitor, a head-face model, and an ophthalmoscope handle. The screen displays fundus images observed through the ophthalmoscope, showing B ) blue landmark in droplet shapes, C ) optic disc structures, and D ) peripheral retinal hemorrhages. E ) The screen displays the currently examining area through the ophthalmoscope handle and the already examined area during the fundus examination. F ) The Eyesi simulator provides an introduction to various typical lesions. ( A : Image captured by the author; B - F : Screenshots from the Eyesi simulator display)

For TDO training included the following training programs: (1) Learning the construction and usage of the traditional direct ophthalmoscope; (2) Students observed each other’s fundus structures, and mydriatic eye drops were provided. Students were allowed to decide voluntarily whether to perform mutual mydriatic fundus examinations; (3) Instructors selected suitable and willing patients for examination, allowing students to study the fundus appearances based on patient medical records and direct ophthalmoscope observations.

Statistical analysis

Data were entered using Microsoft Excel 2017 and all statistical analyses were performed using IBM SPSS Statistics for Windows version 26 (IGM Corp.; Armonk, New York, USA). The Pearson correlation coefficient was used to assess the correlation between the four dimensions of the questionnaires and the training status as well as the training tools. One-way analysis of variation was performed to analyze the difference in the mean scores of undergraduates’ degree of mastery of theoretical knowledge, willingness to use the direct ophthalmoscope in future practice, and interest in further learning, before and after training with different tools. Since the data were not normally distributed, Tamhane’s T2 method was used for post hoc testing. An independent-sample t-test was performed to analyze the difference in the mean scores of fundus structure identification, ease of use, and operation confidence with different training tools. A p-value of < 0.05 was considered statistically significant. The mean (M) ± standard error of mean (SEM) is used to describe the mean of all scores in this paper.

Basic information

A total of 168 medical undergraduates were included in this survey, after excluding seven undergraduates with direct ophthalmoscope experience prior to the study. Participants were aged between 20 and 24 years, of whom 51.19% were male. All students had completed the theoretical ophthalmology course (the 9th Edition, published by the people’s Health Publishing House, China) prior to commencement of the study.

Correlation analysis

The results indicate a significant correlation between the training status (whether training was received or not) and three dimensions: the importance of learning direct ophthalmoscope operation, competency in direct ophthalmoscope operation, and the level of theoretical knowledge related to direct ophthalmoscope (Table  1 ). Additionally, there was a significant correlation between the type of training tool used and all four dimensions, encompassing interest in further learning as well as the aforementioned three dimensions (Table  2 ).

Views before training

Direct ophthalmoscopy was considered commonly used and effective clinically but difficult to learn.

92% of respondents agreed that the direct ophthalmoscope is one of the most commonly used inspection tools in clinical ophthalmology; 96% agreed that it is an effective inspection method for the diagnosis of retinal diseases (Fig.  3 AB). However, only 29.17% of the respondents believed that the tool was easy to operate while 44.64% believed that the examination was simple (Fig.  3 CD).

Respondents’ comments on the following statements: A Direct ophthalmoscope is one of the most commonly used inspection tools in clinical ophthalmology; B Direct ophthalmology is an effective inspection method for the diagnosis of retinal diseases; C Learning to use the direct ophthalmoscope is difficult; D The examination steps involved in using the direct ophthalmoscope are complex. The questionnaire response rates for the questions represented in this figure is 100%

Direct ophthalmoscopy was considered necessary to learn and attracted the interest of respondents

70% of the respondents rated a score of eight or higher with regard to the necessity for non-ophthalmologists to master operating a direct ophthalmoscope (Fig.  4 A). Similarly, 68.74% of the respondents gave a score of eight or higher with regard to their interest in learning to operate a direct ophthalmoscope (Fig.  4 B).

Percentage of each score given by respondents to the following questions: A Do you think it is necessary for non-ophthalmologists to master the use of the direct ophthalmoscope? B Are you interested in learning to operate the direct ophthalmoscope? The questionnaire response rates for the questions represented in this figure is 85.71%

Views after training

The fundus images presented by the eyesi resembled the real fundus.

After completing the training, 54.17% of the respondents believed that the images presented by the Eyesi were consistent with the real fundus, while 29.17% believed that the two images were discordant (Fig.  5 ).

The degree of similarity between the images presented by the simulator and the real fundus according to respondents’ comments on ‘Do you think the images presented by the simulator are consistent with the real fundus?’. The questionnaire response rates for the question is 100%

Kirkpatrick’s level 1 evaluation

The eyesi was easier to operate and improved users’ confidence.

Compared with Group B (4.71 ± 0.33), the students in Group A achieved higher scores (6.71 ± 0.21) in “the ease of use of training tool.” Furthermore, scores of “self-confidence to examine for healthy volunteers or patients with retinal diseases in future clinical practice” in Group A (7.47 ± 0.21; 6.93 ± 0.22) were higher relative to Group B (5.94 ± 0.35; 5.17 ± 0.34), P  < 0.001 (Table  3 ).

The Eyesi did not affect the willingness to use direct ophthalmoscope in future practice and improve interest for further learning

With regard to interest for further learning, scores of Group A (8.77 ± 0.15) were significantly higher than scores obtained before training (8.08 ± 0.14, P  < 0.01) and more than scores of Group B (7.49 ± 0.24, P  < 0.001) (Fig.  6 A). Scores of Group B about their willingness to use a direct ophthalmoscope in future clinical practice (7.00 ± 0.28) were significantly lower than that of pre-training scores (8.06 ± 0.15, P  < 0.01) and that of Group A (8.23 ± 0.18, P  < 0.01) (Fig.  6 B).

Influence of learning direct ophthalmoscope with different tools on the willingness to use the tool in the future and interest in further learning. Scores of A ‘Interest in further learning of direct ophthalmoscope’ and B ‘Willingness to use direct ophthalmoscope when fundus examination is needed in future clinical practice’ in Group A (after Eyesi training) and Group B (after TDO training) compared with that before training. The questionnaire response rates for the question represented in figure A are 85.71% before training, 96.94 in Group A and 92.86% in Group B. The questionnaire response rates for the question represented in figure B are 85.71% before training, 95.92 in Group A and 92.86% in Group B

The vast majority of respondents suggested adding the Eyesi training

For the item “Do you recommend adding Eyesi training to ophthalmic preclinical training?”, 145 (86.31%) respondents chose “Recommend”, while 19 (11.31%) chose “Do Not Recommend.” Among the reasons for recommending, 117 chose “being able to learn the normal and diseased fundus intuitively” and “easier to master the examination skills.” Among the reasons for not recommending, 11 chose “prolonging the learning time” and “increasing the learning difficulty” respectively (Fig.  7 ).

Respondents’ feedback on the inclusion of Eyesi training to ophthalmic preclinical training. A Percentage distribution of recommending, not recommending or expressing no difference. Reasons for B recommending and C not recommending the Eyesi direct ophthalmoscope simulator

Kirkpatrick’s level 2 evaluation

The eyesi was more conducive to identifying fundus structure.

In terms of the degree to which the Eyesi or TDO may help students, the average scores of the respondents in Group A were significantly higher than that of Group B ( P  < 0.001) (Table  4 ) with regard to: “focusing on the fundus and obtaining a clear image,” “finding the optic disc and correctly estimating the cup disc ratio,” “observing the morphology feature and distribution of retinal vessels and distinguishing between arteries and veins,” and “finding and identifying typical fundus manifestations of common retinal diseases.”

The Eyesi training was more helpful to consolidate theoretical knowledge than traditional training

After training, scores of Group A with regard to “the degree to which learning direct ophthalmoscope helps consolidate relevant theoretical knowledge” increased from 8.01 ± 0.14 to 8.95 ± 0.13 ( P  < 0.001). However, there was no significant change in scores of Group B (7.86 ± 0.22) (Fig.  8 A). In the self-evaluation of the degree of mastering the fundus course content, scores of Group A increased from 6.10 ± 0.13 to 7.74 ± 0.16 ( P  < 0.001); similarly, there was also no significant difference in Group B (6.43 ± 0.25) (Fig.  8 B).

Influence of learning to use direct ophthalmoscope with different tools on mastering theoretical knowledge. Scores of A ‘The degree to which learning to use the direct ophthalmoscope helps consolidate relevant theoretical knowledge’ and B ‘Your degree of mastery of the fundus course content’ in Group A (after Eyesi training) and Group B (after TDO training) compared with that before training. The questionnaire response rates for the question represented in figure A are 85.71% before training, 96.94 in Group A and 92.86% in Group B. The questionnaire response rates for the question represented in figure B are 85.71% before training, 95.92 in Group A and 92.86% in Group B

All participants passed the SOP test

A score of 80 or above in the sop test was considered acceptable, and all participants passed. The average score of SOP test was 93.71 ± 0.40. All operational errors were pointed out and corrected after the test of each person.

Respondents were inclined to combine training

Most participants believed that the Eyesi was more comprehensible (80.36%) and led to better learning (57.14%) and were more willing to use the tool for assessment (71.43%). However, 78.57% of respondents considered that TDO was closer to tools typically implemented in clinical practice. In terms of learning about the fundus of healthy volunteers, the proportion of the two options was similar, while 63.69% of the respondents preferred the Eyesi for learning retinal diseases (Table  5 ). In general, 75.59% of respondents felt inclined to practice with the Eyesi first before using TDO (Fig.  9 ).

Percentage distribution of answers to the following question: Overall, which one do you prefer to learn and practice the operation of the direct ophthalmoscope? The questionnaire response rates for the question is 100%

Medical undergraduates often have limited specialty knowledge, clinical experience, and confidence in practice [ 33 ]. Many of them consider becoming a doctor as their long-term career plan, with some aspiring to become general practitioners [ 34 , 35 , 36 , 37 ]. Therefore, the primary goal of undergraduate medical education is to deepen their understanding of disease signs and symptoms and train them to skillfully perform fundamental examinations to establish valuable diagnostic foundations. Achieving this objective requires systematic and efficient guidance from teachers.

Fundus examination is vital for the diagnosis of various ophthalmological and systemic diseases. It is widely recognized that all medical students and general practitioners should possess a solid understanding and proficiency in fundus examination [ 38 ]. In our study, a vast majority of respondents agreed that direct ophthalmoscopy is commonly used, effective, and an essential component of their training. However, it was also acknowledged that mastering this technique is challenging. The Eyesi presents various fundus findings to users, enabling them to observe what a traditional ophthalmoscope would reveal. Participants expressed that Eyesi provides realistic fundus images and offers significant advantages in identifying fundus structures compared to traditional direct ophthalmoscopy. Consequently, Eyesi training proves to be feasible and meets the needs of undergraduate medical students.

We conducted a comparative analysis of operational learning and theoretical knowledge between Eyesi and TDO. Novice learners practicing with TDO may experience discomfort and increased pressure due to repeating examination steps on volunteers or patients [ 39 ]. The lack of real-time observation sharing between teachers and students hampers timely guidance, impeding students’ progress.

In contrast, the Eyesi simulator addresses these challenges. While the Eyesi simulator simulates patients’ resistance to light after prolonged examination, it remains an unrestricted practice tool for students. The Eyesi can also automatically time the illumination of the fundus and display the already examined area, reducing patient discomfort due to inexperienced operation and alleviating the psychological burden during the learning process. Moreover, the Eyesi offers the option to simulate different pupil sizes and allows for dilation, enabling students to gradually practice and repeatedly examine until they can observe comprehensive fundus structures, even under smaller pupils, thereby facilitating the learning process. Furthermore, the Eyesi assists in the theoretical learning of relevant retinal diseases. Unlike directly showing fundus images on a screen, the Eyesi simulates the real clinical scenario of using a direct ophthalmoscope, presenting fundus lesions more realistically. Additionally, it displays relevant theoretical knowledge for learning after the user marks the lesions they observe. The Eyesi compensates for the limited availability of clinical patients or cases where patients may not cooperate with students, thereby enabling students to gain insight into typical pathological conditions and reinforce relevant theoretical knowledge. These factors collectively contribute to a more engaging and effective learning experience with the Eyesi simulator. It also emphasizes the importance of performing a comprehensive fundus examination without solely relying on retinal photography, using non-examined peripheral retinal lesions as reminders for students.

The increased confidence observed in Group A can be attributed to these advantages, potentially leading to an improved utilization rate and proficiency of the direct ophthalmoscope in primary medical practice. In conclusion, this training approach aids in identifying fundus structures, enhancing students’ operational abilities, and consolidating their theoretical knowledge of the fundus. Consequently, the Eyesi simulator is expected to be a suitable choice for novices.

The majority of respondents expressed a preference for the Eyesi simulator, considering it to be easier to understand and a more effective learning tool, while TDO is actually implemented in real-world clinical practice. However, starting with TDO as the initial training method may potentially impact participants’ interest in further learning. Therefore, we recommend that undergraduates practice with the Eyesi before transitioning to the traditional method, which is consistent with the preference of most participants in this study. This sequential training method may enhance the learning experience and better prepare students for future clinical settings.

The transition from Eyesi training to using TDO in clinical applications poses multiple challenges for students. They must effectively communicate with patients during the examination process, master precise positioning techniques due to potential instability in patients’ eyes, and adapt to varying pupil sizes. Additionally, the simulator’s limitation to simulating typical retinal lesions contrasts with the diverse and rare conditions encountered in actual clinical practice, necessitating comprehensive understanding and recognition abilities. Furthermore, this transition may lead to confidence and anxiety issues among students. It is important to emphasize that the Eyesi serves as a complement to, rather than a replacement for, real patient experiences in the clinical setting. To address these challenges, educators can offer practical opportunities through simulated clinical practices and real patient training, encouraging students to participate in clinical internships to enhance their clinical competence.

To further investigate whether the Eyesi is a superior training tool, we compared our study with previous studies. With the advancement of technology and the application of virtual reality (VR) in medical education, we have gradually phased out the use of slides or photographs to simulate the fundus in simulators, opting instead for designs that are more closely aligned with clinical practice [ 40 , 41 ]. In terms of its design advantages, the Eyesi distinguishes itself by closely simulating the shape and function of a real direct ophthalmoscope, utilizing a handheld device and a head-face model, making it more akin to the tools used in actual clinical practice compared to other devices [ 42 , 43 , 44 ]. Unlike other simulators utilizing VR technology, the Eyesi does not require wearing bulky VR goggles, and according to our questionnaire results, it more accurately simulates the real fundus state [ 45 ]. Additionally, the Eyesi’s feature of enabling teachers to provide real-time guidance through a monitoring screen is a valuable asset. Furthermore, its built-in case database of retinal diseases allows students to learn independently and addresses the limitations of TDO and other simulators [ 41 ]. In comparison to other study utilizing the Eyesi, and as opposed to conducting separate studies sequentially, our research adopted a parallel-group design to more comprehensively assess participants’ perceptions of different tools simultaneously [ 46 ]. Another study focusing on the Eyesi evaluated only the impact of different tools on students’ confidence but also concluded it to be a beneficial teaching tool [ 47 ]. Regarding the Eyesi’s indirect ophthalmoscope simulator, existing researches have compared the examination time and detection scores of physicians using this tool, which were superior to those of medical students, further supporting the effectiveness of incorporating the Eyesi simulator into training as a supplementary teaching tool [ 48 , 49 ]. The number of respondents in our study was significantly larger than that of past studies [ 25 , 50 ].

From the collected opinions, we found that participants appreciated the Eyesi’s user-friendliness, clarity, adjustable pupil size, and the presentation of typical cases. However, the limited time for practice was noted as an area of improvement. And some challenges with TDO were highlighted, such as a small vision field hindering the identification of common fundus lesions and greater difficulty in operation. Nevertheless, students appreciated its realism and the ability to receive feedback from volunteers. Despite the favorable feedback for the Eyesi, a few students did not fully support its use. To address these concerns, we plan to enhance future courses by allocating additional practice time and thoughtfully selecting built-in cases within the Eyesi.

As for study design, we designed four questionnaires to evaluate the subjective feelings of respondents before and after training and on different training tools, as well as their confidence and willingness to use a direct ophthalmoscope in future work. We also compared undergraduates’ tendencies for different learning purposes, and offered suggestions on learning sequences. Self-reporting questionnaires provide valuable insights into participants’ subjective perceptions, feedback, and satisfaction with course content and training methods [ 51 ]. These assessments shed light on the training’s potential benefits in enhancing learners’ skills and self-assurance, allowing us to optimize the program accordingly for a more engaging learning experience. In our study, we have implemented multiple strategies to mitigate potential biases. Firstly, random group assignment was employed to ensure balanced representation in each training group, minimizing selection bias. Secondly, we crafted unbiased survey questions to prevent information bias. Moreover, measures such as respondent anonymity, blind data entry, and analysis were implemented to mitigate response and observer bias during data processing. While we acknowledge the limitations of self-reporting, we have taken meticulous steps to enhance the validity and reliability of our findings within the scope of our study’s constraints.

However, it is essential to establish more objective evaluation indicators, such as written exams and scenario simulation assessments, to effectively measure the enhancement of participants’ theoretical knowledge and practical skills resulting from the utilization of various training methodologies. Additionally, for evaluating the effectiveness of the Kirkpatrick model’s third and fourth levels, long-term observations will be required to assess the participants’ skills and performance in their daily clinical practices. While we acknowledge the current limitations, it is also essential to conduct further research by integrating feedback from both supervising physicians and patients to achieve a comprehensive understanding of the training outcomes in clinical settings. Recognizing this, we are planning a follow-up study that will address these concerns by focusing on specialized physicians who have undergone the training and gathering insights from experienced providers or faculty regarding the Eyesi. This subsequent research will encompass a more comprehensive assessment, including evaluation by teachers in clinical practice and a blinded evaluation methodology. Furthermore, before commencing further research, we will validate the psychometrics of our questionnaires and further refine them to better meet our survey needs.

In general, the Eyesi has shown potential advantages over the traditional direct ophthalmoscope in fundus observation, operational practice, and theoretical learning. Its user-friendly interface and intuitive design indicate it might effectively assist medical students acquiring fundus examination skills during clinical training. The positive reception of the Eyesi by most undergraduates suggests it could be a valuable contribution to ophthalmic preclinical training. This may help promote the use of the direct ophthalmoscope in primary medical institutions and, as a result, contribute to facilitating the early screening and diagnosis of retinal diseases, and aid in evaluating retinal microvascular abnormalities among patients with systemic diseases. This, in turn, has the potential to reduce healthcare costs and preserve medical resources.

Data availability

The datasets used and analysed during the current study available from the corresponding author on reasonable request.

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Acknowledgements

We thank the effort of the teaching team and all of the internship tutors (Dan Ye, Xiaoqing Chen, Xia Gong, Shida Chen, Yunru Liao) at Zhongshan Ophthalmic Center for this study.

This research was supported by Teaching Quality Project of Sun Yat-sen University in 2024, the National Key R&D Project of China, No.2020YFA0112701 (to Y.Z.), the National Natural Science Foundation of China, No. 82171057 (to Y.Z.) and No. 81870657 (to Y.L.), Science and Technology Program of Guangzhou of China, No. 202206080005 (to Y.Z.) and No. 202201020492 (to Y.L.), the Natural Science Foundation of Guangdong Province of China, No. 2022A1515012168 (to Y.L.), and the Open Research Funds of the State Key Laboratory of Ophthalmology, No. 2023KF01 (to Y.L.), Guangdong Basic and Applied Basic Research Foundation, 2024A1515013296 (to Y.L.).

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Canying Liu and Jicheng Lin contributed equally to this work.

Authors and Affiliations

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, 510060, China

Canying Liu, Jicheng Lin, Siting Wu, Yingting Zhu, Yuxian Zou, Qi Zhang, Zhidong Li, Yehong Zhuo & Yiqing Li

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CL and JL contributed to the primary manuscript text, while SW, YZhu, YZou, and QZ assisted with data collection and analysis. ZL provided valuable insights and guidance throughout the research process. YZhuo and YL coordinated the study, oversaw data interpretation, and prepared the manuscript. All authors participated in reviewing and revising the manuscript for publication.

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The Eyesi is superior to TDO in fundus observation, operational practice, and theoretical learning.

We designed four questionnaires to evaluate the subjective feelings of respondents comprehensively.

We offered suggestions on learning sequence of the Eyesi and TDO.

The Eyesi may promote the use of TDO in primary medical institutions.

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Liu, C., Lin, J., Wu, S. et al. Eyesi direct ophthalmoscope simulator: an effective training tool for medical undergraduates. BMC Med Educ 24 , 783 (2024). https://doi.org/10.1186/s12909-024-05780-w

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Doctors warn of significant increase in people hospitalised with psychosis after being prescribed medicinal cannabis

Medicinal cannabis is causing harm to some patients, with doctors warning of a significant increase of people ending up in hospital with psychosis after being prescribed the drug.

Their concerns come amid a proliferation of "single-issue" cannabis clinics setting up in Australia, some of them willing to prescribe via telehealth consultations with few checks.

Brett Emmerson, Queensland chair of the Royal Australian and New Zealand's College of Psychiatrists, says the college wants stronger regulations of medicinal cannabis products and prescribing practices.

"We're seeing a lot of people getting medicinal cannabis who end up with their first psychotic episode, or we're seeing it dispensed to people who have psychotic conditions, and these people are relapsing," Professor Emmerson says.

"Part of the issue … are these single-issue clinics which, if you ring up, it doesn't matter what you say you want.

"They'll provide it for you even though there is probably no indication that it will work, and the prescribers never contact the person's treating doctor.

"You find out two or three months down the track that one of your patients has been on medicinal cannabis — not prescribed by you but by some other prescriber — usually a doctor who hasn't had the professional courtesy of contacting you and letting you know."

A lot of prescriptions happening over the internet

Professor Emmerson says Queensland's Metro North Health — Australia's largest public health service, based in north Brisbane and the surrounding region — is seeing increased presentations of psychosis due to medicinal cannabis.

"The Metro North early psychosis service reports 10 per cent of their new presentations — so these are kids aged 16 to 21 — are people who've ended up on medicinal cannabis and are becoming psychotic," the Brisbane-based psychiatrist says.

"A lot of other mental health services are reporting several admissions a week of people who have been placed on medicinal cannabis who shouldn't be on it.

"Medicinal cannabis is causing harm. The medication is unregulated, and it's being used widely for a whole range of conditions for which there is no evidence."

Jennifer Martin, a Newcastle-based general physician and clinical pharmacologist, says apart from triggering psychosis in some patients, hospital emergency departments are also seeing people presenting with a condition called cannabis hyperemesis syndrome after taking medical cannabis.

"That's when you vomit a lot when the potency is too high," Professor Martin, who is also the President of the Royal Australasian College of Physicians, says. 

"Some of these products have a lot of very psychoactive product in them.

"These are big problems for our hospital system, because those people sit in the emergency department [and] they potentially take up a bed for a long period of time."

Professor Martin, of the University of Newcastle, says a lot of medicinal cannabis prescriptions are being done on the internet, via "a web interaction or telehealth".

"It's actually very difficult to get access to the doctor that actually signed the script for a patient," she says.

What is medical cannabis prescribed for?

Medicinal cannabis was legalised in Australia in 2016.

Some products are based on the compound cannabidiol, or CBD, but others also contain tetrahydrocannabinol, or THC, the psychoactive ingredient in cannabis.

Professor Emmerson says the two most common reasons medicinal cannabis is prescribed are for anxiety and insomnia.

"There's no evidence that medicinal cannabis is helpful or treats those conditions," he says.

"Treatment for anxiety, and often insomnia, is cognitive behavioural therapy from a good psychologist.

"Getting people hooked on a drug of dependence when there are other non-drug treatments available, and haven't been accessed, is wrong. 

"The medicinal cannabis industry is marketing and making claims that cannabis can cure a whole range of different medical conditions and there's just no evidence for it."

Professor Emmerson likened medicinal cannabis companies to alcohol and tobacco retailers who "want people to end up on their product for their profit".

But he stressed he’s not calling for medicinal cannabis to be removed from the market altogether, given its legitimate uses in treating conditions such as severe childhood epilepsy and vomiting associated with cancer drugs.

Calls to regulate, not remove

In a clinical memorandum released in March, the RANZCP called for regulatory changes surrounding medicinal cannabis products and prescribing practices.

"There is insufficient evidence to support medicinal cannabis as a treatment for anxiety and other mental disorders," the memorandum says.

"As there are no restrictions on the medical conditions for which a prescriber can apply to use unapproved medicinal cannabis products, given the high rates of prescribing for anxiety, in particular, RANZCP is concerned that patients are not receiving evidence-based treatment.

"Refinements to legislation and treatment frameworks for medicinal cannabis should be considered in line with available evidence and harm minimisation strategies."

Professor Emmerson would like to see medicinal cannabis made a regulated medication like other drugs of dependence in Australia.

He also believes Australia's medicines regulator, the Therapeutic Goods Administration (TGA), should ban products containing THC, except for those used to treat nausea and vomiting associated with cancer drugs and spasticity in multiple sclerosis.

In February, the Australian Health Practitioner Regulation Agency (AHPRA) convened a forum of health regulators to share information and discuss how they could best work together to protect the public in relation to the prescribing and dispensing of medicinal cannabis.

"The use of unregistered medicinal cannabis products has spiralled in recent years, from around 18,000 Australian patients using products in 2019 to more than one million patients using medicinal cannabis up to January 2024," a communique from the forum says.

"The number of prescribers accessing the authorised prescriber and the special access scheme has also risen sharply to more than 5,700 medical and nurse practitioners using these schemes to prescribe and dispense medicinal cannabis products."

Only two medicinal cannabis products have been evaluated for safety, quality, and efficacy by the TGA — Epidyolex for severe childhood epilepsy and Sativex for spasticity in multiple sclerosis.

Data supplied by the TGA shows the total number of different medicinal cannabis products supplied in Australia increased from 504 in 2022 to 690 in 2023.

The TGA was unable to provide the ABC with information regarding the number of times medicinal cannabis has been dispensed in Australia.

"Data cannot be extracted from PBS (Pharmaceutical Benefit Scheme) information as they are purchased on private prescription," a spokesperson says.

"The TGA is not aware of a single source that can provide complete and accurate dispensing data on medicinal cannabis products."

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