Have you ever had a medical student give you a presentation on chest pain that involved various aspects of the patients hobby of collecting Star Trek memorabilia? Have you received way too much information about the patients pet cat for a chief complaint of toothache? This may leave you thinking what’s pertinent here? I like to focus on the differential and pathophysiology to guide the medical student to pertinent information.
The 3 Minute Emergency Medicine Medical Student Presentation by Davenport et. al. delves into this topic with three objectives: to make the presentation <3 minutes in order to begin patient treatment immediately, including only pertinent information, the presentation must be given confidently and without hesitation.
In my experience most students have difficulty with teasing out the pertinent information in a patients history. If the patient has multiple complaints it’s a wrap! But this is to be expected the student is in the beginning stages of learning to synthesize the patient history. Pertinent information is described to the student as anything that can contribute to the pathophysiology of the disease processes on their differential.
I like to have a test run with each student they see the patient return and present the case. To some this may be difficult but I listen to the presentation in its entirely without interruptions. This allows time to assess the students baseline history taking skills. If the overall order of the presentation was spot on the students will end the presentation at the assessment. Asking what was on the students differential diagnosis is a great follow up question.
This is the point where I introduce the idea that the emergency department is the danger zone, each and every patient should be assumed to have a life or limb threatening illness.
Life Threatening Processes:
The patient presents with chest pain or headache and fever what should we be worried about in this patient?
What are some concerning signs and symptoms of these dangerous processes?
Rule out Differential Diagnoses:
Finding areas in the presentation where the student identified pertinent information to help rule out diagnoses on the differential followed by questions on any pertinent information that was missed.
Ask pointedly about any information that was included that may not be helpful what was the thought behind adding the information?
Prepare:
Have the student then give his revised presentation emphasizing all the pertinent details to give the listener the sense that they thought about the most dangerous chief complaint specific diagnoses.
Practice:
For the students next patient encounter asking what is on their differential from the chief complaint, past medical history and triage vitals can help guide what would be pertinent before entering the room.
Observe the fruits of your labor on your second encounter!
If done with proper feedback I feel that this method fosters confidence, helps to fine tune their physician to physician communication skills, gives the student a sense of what we do as ED doctors as well as opens academic discussion about various disease processes. I have found that the next step of assessment and plan is easier for the medical student after going through this process.
References
Davenport Chip , BA, Honigman Benjamin,Druck Jeff. “The 3-Minute Emergency Medicine Medical Student Presentation: A Variation on a Theme”. ACADEMIC EMERGENCY MEDICINE 2008; 15:683–687.
When it comes to the ever vital physician skill of communicating patient information there are various skill levels and styles. What are some thoughts on getting your medical students or even residents to present better information?
melton
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1 Comment
Javier Benitez · April 15, 2013 at 9:25 pm
Great post and one of my favorite topics as well. That’s a great article to give to the medical students and interns. I also direct them to this video by Reuben Strayer where he gives a presentation on how to think like an emergency physician:
I covered the Davenport article at ALiEM: http://academiclifeinem.blogspot.com/2012/08/the-3-minute-em-student-presentation.html
Reuben Strayer’s post can be found at emupdates.com
Hope this helps too.