Student Presentations

Has anyone else been frustrated by medical student presentations? Why can’t they distill the history down to the helpful parts, rather than repeating every word the family told them? Why can’t they interpret the exam a little, instead of reciting a checklist of normal findings? Why can’t they make an attempt to localize the lesion and then develop a differential diagnosis instead of jumping to the MRI findings?

It struck me the other day that the reason is obvious–no one has ever really taught them what to do. Yes, we give them a background in neuroscience, and Dr. Jensen’s new Integrated Neuroscience course gives them a very good introduction to clinical neurology. However, nowhere do they learn the nuts and bolts of “here’s how you present a case”, until they hit the wards and face our boredom and impatience at their novice efforts.

So, I sat down the other day to write up a page or two on how I’d like cases to be presented on the stroke service. Once I got started, however, mission creep set in and it morphed into a broader editorial on the clinical method stretching to 13 14 pages.

If anyone’s interested, take a look here and give me some feedback on how to make it better. If Drs. Chacon and Jensen like it, I’ll have Mary Beth distribute it to the stroke service students at the beginning of each rotation. Otherwise, I’ll just change the title to “Dr. Sattin’s idiosyncratic expectations for students who happen to be on the stroke service with him”.

Update 10/23/12 0100: I’ve updated the file to reflect the many good suggestions of Dr. Jensen. I continue to welcome additional feedback.

About Justin A. Sattin

I'm a vascular neurologist and residency program director. I created this blog in order to share some thoughts with my resident and other colleagues, and to foster my own learning as well.
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3 Responses to Student Presentations

  1. Khalid says:

    I think a major factor to this is actually the fact that the students has essentially no active rules in our team, they only present during rounds but they dont take responsibility of what they presented and also they dont do notes, so they dont put any thought process or spend any time on this because they know that they will add nothing to what already the resident presented or wrote about the patient. Also , the other point, which i think is different because of my background coming from almost a military treated medical school, were if i made a mistake i will be told that the hard way, but what i’m getting at if medical student says something that has nothing to do with the case he should be told that instead of ” yaah, maybe ? , possibly ? But can you think of something else” because by doing this we are actually teaching him something wrong i.e it is NOT right that the patient with vascular risk factors who is presenting with sudden onset of aphasia and right sided weakness to say that he has Dementia !!!!!

    • Justin A. Sattin says:

      Khalid, your first point gets right to the RIME (reporter, interpreter, manager, educator) framework that I referenced in the document. Right now, the students are functioning as reporters, and often not particularly good ones. What we’d like is for them to become interpreters and managers of their patients’ problems.

      I think you’re right that we need to expect more of them, but this requires that we set clear expectations and provide specific feedback that references those expectations. It occurs to me that as frustrated as I can get at their inchoate presentations, they must be equally frustrated to receive negative feedback for doing exactly what they’d been doing all along without incident. One student specifically stated to me something to the effect of, “gosh, I was always told I was doing a pretty good job before!” I hadn’t even provided particularly severe feedback–just mildly critical.

  2. Talha says:

    Having just rotated off the stroke service ,a lot of the things mentioned evoked a ‘de ja vu’ feeling. I think it reads very well and could be a helpful resource for the people coming on the stroke service and on neurology in general.

    When we get called about consults, it is very similar. What you often hear sounds like a random amalgam of some facts particularly the exam elements. It is rare to get a call where the other person can nicely put their exam in a mould. A badly called consult can lead to bad medicine and patient morbidity. If our students can only learn to interpret the exam and diagnose a few common neurological conditions, they will be in great shape. Who cares about the zebras?

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