 So if you're on your clinical rotations and you want to make sure your presentations are pristine so you can get honors and avoid people falling asleep on you, this is the video for you. Let's get into it. All right guys, welcome to the MD journey channel completely dedicated to helping you succeed on your medical journey with less stress. My name is Laksh. I'm an internal medicine physician and resident in training, and I've been making videos just like this twice a week to help you on your medical journey. So if you're new here, consider hitting that like and subscribe button and let's get to today's video. Now today's video is really going to be about how to present and how to present better. Now I made videos on my channel of how to really give a step-by-step presentation and honestly it was broken down into two parts. It was really popular on this channel. I'll link them down below. But now as an internal medicine resident, I actually have to give grades to medical students on a lot of things, including their presentations. So I thought I'd make this video to tell you a few things to think about, things not to do as well as a step-by-step way of how to present both new and old patients on a daily basis. The first part of this video, we're going to talk about a three-part process that I use myself as a medical student, things and advice that I also give to medical students who I have to evaluate and hopefully you can use them to help you do better on your presentation. So step number one is to really start with the end in mind and make sure all your details focus on it. And this is really a long way of saying make sure you focus on your assessment and plan first before you even think about giving your presentation. A lot of medical students are really good about giving the information of how a patient did overnight or the history and physicality. That's exactly what somebody told you and you're able to essentially regurgitate it. Med students don't have a hard time with that. Really where med students, including myself when I was in your shoes, have difficulty with is to take all that information and break it down into all the medical problems they have, as well as what you're going to do for each and every single one. The first thing that you need to do before you even get to your patient presentations is to address all the problems that you're helping address for that patient at the current moment. So if you're on a rotation like internal medicine, this may be a really long problem list of all the medical problems that you're solving at the moment, as well as chronic ones that you still have to solve while they're in the hospital, like hypertension, if they come in with a pulmonary embolism, that's going to be the problem you're going to be solving while they're in the house. And for rotations like surgery, your problem list may be smaller, but you definitely need to make sure you focus on active surgery they had, as well as any surgical history and things like pain, constipation, if they're able to eat or not, those are typical things that you need to focus on every surgical patient. But once you have a list of all the problems you're addressing for that specific patient, part one A or part one B, I guess, in the situation is to really break down each problem of everything you want to address in that specific situation. So for example, a great advice for a patient you may see on your internal medicine rotation is somebody with heart failure. Now, in heart failure, there's very specific things that you have to think about in these patients. For example, what's their volume status? Is it up? Is it down? Is it stable? And so what are you going to do about it? Are you going to give them diarieses or keep them on the same medications that are at home? Or do you think that they're a little bit too diariesed and actually need to hold off on medication? That's part number one of heart failure. Part number two, are they on a beta blocker? Are they on ACE inhibitor? Are they on a STL2? There are certain medications that you think that they need to have. You need to really go through your checklist for heart failure. Is this patient getting everything done under the checkbox of heart failure? Same thing for a patient on your surgery rotation. What surgery do they have? What post-op day are they? Are they in pain? Are they able to eat? Are they constipated? Are they having diarrhea? Are they moving around? There are certain checkboxes you have to have on a surgical rotation for every single patient. Now, the nice thing about this is that once you have all the problems a patient has and know what type of things you have to think about in terms of management, then you can focus on part number two, which is make sure that every element of your patient presentation goes to ultimately helping some segment of your assessment and plan. So for example, when you're presenting a surgical patient, you need to make sure that you tell the tending about whether or not they're pooping, whether or not they're eating, whether or not they're moving around, how their pain is. Those are really the only things your surgeon probably wants to know on a surgical rotation. Compared to an internal medicine rotation, if you identify that the patient has a PE, something your tending is going to want to know is, are they short of breath or not? So if you're having difficulties as a medical student on your rotations of whether or not you should include something, if you start with your assessment and plan first and then create a mini checkbox for each plan, then you can say, okay, what piece of information do I need to give to my tending, if any, to explain this element? If it's a hard failure patient, I need to say, do they look volume up or volume down? In that case, it's going to go under your physical exam. But you may not have to present their iron labs or their liver labs. If it doesn't really pertain to anything in their problem list, it's worth having down, but not necessarily mentioning. So as a review, step number two is to make sure that while you're giving your patient presentation, and again, I have full videos of step by step of how to do this, I'll link them down below, is to make sure that every phrase, every kind of piece of data is going to help your assessment and plan the ultimately. And finally, step number three is make sure you're constantly reading the room that includes having good eye contact, that way of people need to, they can be recaptured into your presentation. And two, that also helps you understand like, all right, well, we gotta go. Let's maybe only talk about the top two problems. Let's take these labs away. If somebody asks them, again, you can always have them handy and be ready to present them, just in case. So always make sure you start with the end in mind. And for each problem, kind of have a mini checkbox of all the things that you need to do in terms of management, things that you need to work up in consults that are need to be followed up, that specific problem. And then ask yourself, step number two, is all the elements in my presentation actually contributing to the end goal? If not, remove it and just have it handy, just in case your attending wants to know. And finally, make sure you read the room. So if people are kind of checking out, that's probably a good sign that you need to either cash their attention by having some good eye contact, and or also making sure that you're only including elements that are even more important and more focused. So those are usually the top three things that I teach a lot of my medical students to do. But I really want to talk about a few other things that are important to keep in mind, because these are common mistakes that med students make that really do bug residents, not because you guys are doing them incorrectly or you know not to do them. Just sometimes you just have no idea that they're even happening or that they're bugging your upper levels or your 10ings. And usually it's just a problem because it's inefficient and it costs a lot of the times that the interns that residents that 10ings would have instead be spending on the patient or teaching you. So one of the first things that I really want to mention because it bugs me a lot is avoid being repetitive. A lot of things that I'll see medical students do for example is you'll have a patient who's been with you for like six days, 10 days in the hospital and still the med student thing said it's important to tell the attending who's also been with you on service for that long. This is Mr. Johnson, 48 year old who you know has been here for 10 days post-op day 10 from a surgery had because of A, B and C. Like you don't need to go through that roundabout again. And in a similar fashion when you are giving your presentation and then you start your assessment and plan, I know medical students are kind of trained to say okay in our assessment this is Mr. Johnson, 48 year old. I was like, goodness gracious, tell me what you want to do. Like that's really what I care for, that's really what the attending cares for. And always make sure that you take this with a grain of salt. I wish I said this earlier in the video but you know your attending may give you something totally opposite from this guy on YouTube and if they do make sure you pay attention to them. But otherwise take my advice. In a similar fashion of avoid being a repetitive, if your attending was involved with a major kind of update from the day before, for example, if they had a major surgery, they had a procedure or if they had some complications and they were kind of aware of it, maybe they're at bedside and happened to an early afternoon, you don't necessarily need to repeat the whole ordeal again because again it's inefficient, it doesn't really tell the attending very much. Really what they want to know and really what I as your resident want to know is what are we going to do now? What does you as a potential healthcare provider as a future physician want to do? That's really the main goal of a patient presentation. So make sure do I really need to talk about this and if so summarize in one sentence. For example, yesterday Mr. Johnson had some heart or chest pain excuse me and all of his troponins and workups have been negative and he has chest pain for today. Still, that's it. Move on. Now another thing to make sure you're always mindful of is it's always hard to understand where can I inject knowledge or things that I've looked up or things that I've read in articles or things that I all know from personal experience to show off to my attending without being a little extra showy. Some of that students do this on one extreme or another. Some you know read a journal and say well although it's not related to this patient whatsoever I read an article about this one gene impacts so and so like what are your thoughts? Like you're almost like having a conversation with the attending about nothing related to your patient care and the attending is usually caught off guard and it seems like a med student that's really just trying to suck up. Don't do that. Make sure that anytime you're trying to inject your knowledge or inject your knowledge in the form of an educated question there's always kind of involved in some form or fashion to either what your attending is teaching you or specifically in this situation to the care of your patient. So for example you may have a patient with aortic stenosis which can have a lot of complexities depending on who the patient is, how stable they are, as well as the degree of stenosis that they have in the aortic valve. You may not be able to ask your attending saying hey even after reading some things about the aortic stenosis yesterday I'm still not sure what options or procedures or valuations they would still need in order to determine if they deserve a valve replacement. That's a good educated question on somebody who's interested in one their patient and two has read something to be able to ask a follow-up question that the attending can then partake on and educate both you your peers as well as their residents as well. So that's a very long fancy way of saying make sure you really only show off your knowledge in the context of either something you've read and also in the setting of helping your patient. Make sure you're not that student who's just trying to inject internal articles from nature that have nothing to do with the care of your patient. I promise you that's going to make your residents like you much more because things are going much more efficient yet we can also see that you're interested and curious when it truly does matter. Now a few more things before we wrap up. One thing I do notice a lot of my med students do is they'll have a problem with three to five to six different things and they'll talk about each and every single one every single day. You know I know I said focus on the assessment plan at the start of this video but not every assessment or plan is relevant every single day. For example if you have a patient who comes in hypertensive and you start new medications on them but then post-op day or you know hospital day four or five that's no longer a problem they're well controlled you don't need to talk about it again unless obviously if you're attending that so have that in your note have it ready make sure you know what medications they're on but again you don't need to focus on something every single day so if your patient was anemic or had iron deficiency you don't need to say a patient is still on iron your attending knows that and hopefully that's true. So really you'll find that the common theme of this video is is it important to my patient is it something worth discussing and two is there any new information to really give in the form of a progress kind of patient presentation if you're talking about a patient you've already taken care of and obviously if it's a history and physical then all of their H&P is acceptable to percent but obviously make sure you read the room because if I'm not paying attention you probably can skip on some of the things that are later in the problem list. And finally last and most importantly make sure to run the plan with your residents your upper levels every single day I know it can be hard depending on what rotation you are and maybe your residents are busy but if you focus with the end in mind and say hey can I just quickly run the plan with you I don't need to talk about my whole presentation but the top three things I think we're doing is we're managing this guy's pulmonary embolism he has some heart failure so we're doing that and he's still hypertensive those are the three problems over the PE not much changing we're keeping him on these medications for his heart failure I want to do this and for his hypertension he's stable so is that good for this patient and then just talk about all of yours as a resident I do appreciate that one you're thinking about multiple problems two you're only focusing on the ones that you actually want to contribute on in that day and three you're actually giving me suggestions before you're asking me hey like what are we doing today you know that also helps your grade not only going to help you in your patient presentation but it's going to show to your residents this person truly cares about their patients you know I think much more highly of them because of that but those guys are all of my tips to how to get better presentation now again including this video there are going to be more videos down below youtube that recorded absolutely free part one and part two as well as probably some other patient presentation videos I'll try to find um through our whole youtube library that I've done over the last few years to help you just crushing on your rotation if you like those and check out the actual clinical rotation playlist of all the different things that you should know depending on the rotation you're on as well as things like how to write notes better how to present better how to impress your attendings all that and if you're still interested I'll link down below a few other things like our b-book bundle which includes things like how to do better on every single rotation possible and finally one of our top tier courses on how to really just crush your clinical rotations and ideally get into your number one residency I'll be linked down below that's called crushing clinicals for any of you guys are interested but with all that being said hopefully you guys enjoyed this video make sure if you did enjoy it and you're somehow to the end of this video hit that like button if you did enjoy this content one it just helps to support the channel tells me if you guys like this kind of material you want more and on that note make sure you go ahead and comment down below any questions you have about clinical rotations medical school residency I'm happy to help you guys in future videos and make sure you hit that like and subscribe button really helps support the channel I truly appreciate it but with that being said guys thank you so much for watching this video thanks for making to the end and the support hopefully I've been a little help to you on your journey I'll see you guys later in my take care please