oral presentations medicine

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.

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How to prepare and deliver an effective oral presentation

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• Peer review
• Lucia Hartigan , registrar 1 ,
• Fionnuala Mone , fellow in maternal fetal medicine 1 ,
• Mary Higgins , consultant obstetrician 2
• 1 National Maternity Hospital, Dublin, Ireland
• 2 National Maternity Hospital, Dublin; Obstetrics and Gynaecology, Medicine and Medical Sciences, University College Dublin
• luciahartigan{at}hotmail.com

The success of an oral presentation lies in the speaker’s ability to transmit information to the audience. Lucia Hartigan and colleagues describe what they have learnt about delivering an effective scientific oral presentation from their own experiences, and their mistakes

The objective of an oral presentation is to portray large amounts of often complex information in a clear, bite sized fashion. Although some of the success lies in the content, the rest lies in the speaker’s skills in transmitting the information to the audience. 1

Preparation

It is important to be as well prepared as possible. Look at the venue in person, and find out the time allowed for your presentation and for questions, and the size of the audience and their backgrounds, which will allow the presentation to be pitched at the appropriate level.

See what the ambience and temperature are like and check that the format of your presentation is compatible with the available computer. This is particularly important when embedding videos. Before you begin, look at the video on stand-by and make sure the lights are dimmed and the speakers are functioning.

For visual aids, Microsoft PowerPoint or Apple Mac Keynote programmes are usual, although Prezi is increasing in popularity. Save the presentation on a USB stick, with email or cloud storage backup to avoid last minute disasters.

When preparing the presentation, start with an opening slide containing the title of the study, your name, and the date. Begin by addressing and thanking the audience and the organisation that has invited you to speak. Typically, the format includes background, study aims, methodology, results, strengths and weaknesses of the study, and conclusions.

If the study takes a lecturing format, consider including “any questions?” on a slide before you conclude, which will allow the audience to remember the take home messages. Ideally, the audience should remember three of the main points from the presentation. 2

Have a maximum of four short points per slide. If you can display something as a diagram, video, or a graph, use this instead of text and talk around it.

Animation is available in both Microsoft PowerPoint and the Apple Mac Keynote programme, and its use in presentations has been demonstrated to assist in the retention and recall of facts. 3 Do not overuse it, though, as it could make you appear unprofessional. If you show a video or diagram don’t just sit back—use a laser pointer to explain what is happening.

Rehearse your presentation in front of at least one person. Request feedback and amend accordingly. If possible, practise in the venue itself so things will not be unfamiliar on the day. If you appear comfortable, the audience will feel comfortable. Ask colleagues and seniors what questions they would ask and prepare responses to these questions.

It is important to dress appropriately, stand up straight, and project your voice towards the back of the room. Practise using a microphone, or any other presentation aids, in advance. If you don’t have your own presenting style, think of the style of inspirational scientific speakers you have seen and imitate it.

Try to present slides at the rate of around one slide a minute. If you talk too much, you will lose your audience’s attention. The slides or videos should be an adjunct to your presentation, so do not hide behind them, and be proud of the work you are presenting. You should avoid reading the wording on the slides, but instead talk around the content on them.

Maintain eye contact with the audience and remember to smile and pause after each comment, giving your nerves time to settle. Speak slowly and concisely, highlighting key points.

Do not assume that the audience is completely familiar with the topic you are passionate about, but don’t patronise them either. Use every presentation as an opportunity to teach, even your seniors. The information you are presenting may be new to them, but it is always important to know your audience’s background. You can then ensure you do not patronise world experts.

To maintain the audience’s attention, vary the tone and inflection of your voice. If appropriate, use humour, though you should run any comments or jokes past others beforehand and make sure they are culturally appropriate. Check every now and again that the audience is following and offer them the opportunity to ask questions.

Finishing up is the most important part, as this is when you send your take home message with the audience. Slow down, even though time is important at this stage. Conclude with the three key points from the study and leave the slide up for a further few seconds. Do not ramble on. Give the audience a chance to digest the presentation. Conclude by acknowledging those who assisted you in the study, and thank the audience and organisation. If you are presenting in North America, it is usual practice to conclude with an image of the team. If you wish to show references, insert a text box on the appropriate slide with the primary author, year, and paper, although this is not always required.

Answering questions can often feel like the most daunting part, but don’t look upon this as negative. Assume that the audience has listened and is interested in your research. Listen carefully, and if you are unsure about what someone is saying, ask for the question to be rephrased. Thank the audience member for asking the question and keep responses brief and concise. If you are unsure of the answer you can say that the questioner has raised an interesting point that you will have to investigate further. Have someone in the audience who will write down the questions for you, and remember that this is effectively free peer review.

Be proud of your achievements and try to do justice to the work that you and the rest of your group have done. You deserve to be up on that stage, so show off what you have achieved.

Competing interests: We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: None.

• ↵ Rovira A, Auger C, Naidich TP. How to prepare an oral presentation and a conference. Radiologica 2013 ; 55 (suppl 1): 2 -7S. OpenUrl
• ↵ Bourne PE. Ten simple rules for making good oral presentations. PLos Comput Biol 2007 ; 3 : e77 . OpenUrl PubMed
• ↵ Naqvi SH, Mobasher F, Afzal MA, Umair M, Kohli AN, Bukhari MH. Effectiveness of teaching methods in a medical institute: perceptions of medical students to teaching aids. J Pak Med Assoc 2013 ; 63 : 859 -64. OpenUrl

Posters & Oral Presentations

Good scientific research involves a sound methodology and a novel idea that can be tested simply and repeatedly to give valid, trustworthy results. However, even the most clinically significant research is useless if it is not communicated successfully. Scientific ideas are novel, sometimes simple in theory, but most always complex in technique. These attributes of research make it necessary to use all available means of presentation. The most common media for scientists to communicate with the general public is primary journal articles. However, posters and oral presentations are also affective because they allow scientists to be in direct contact with their audience. This provides both parties an opportunity to ask pertinent questions to add clarity to the work being presented.

A poster is an exciting way for scientists to present their research. It, just as a primary research article, includes all aspects of the scientific method. A title that is brief, but specific, an abstract, an introduction, material and methods, results, and a conclusion are some headings that can appear on a poster. Also, references and acknowledgments are sometimes are included. A poster is different from a written manuscript or an oral presentation because it is mostly graphical. As such, it is important to design a poster that is visually pleasing by focusing on charts, graphs, and pictures and minimizing lengthy introductions and discussions. Highlighting all significant information with the use of bullets is essential because if further explanation is needed the audience will simply ask for it.

Oral presentations are yet another avenue for scientists to share their findings with the world. Although it can be challenging to present years of works within fifteen minutes, oral presentations can be a rewarding experience because you are the only one front of an audience whose attention you know have. Of course this emphasizes the need to speak clearly and concisely with choice words that engross the audience. Again, just as with written manuscript and posters the format of oral presentations can also vary, but essentially it must include logical, easy-to-understand events that are presented in a matter with respect to the scientific method.

Electronic Resources

Poster Presentation http://www.ncsu.edu/project/posters

This is an excellent site that covers all aspects of a poster presentation from creating a poster to presenting one. It also provides several examples with critiques for each sample. Lastly, it has a quick reference page with helpful tips for delivering a successful poster presentation.

Oral Presentation http://www.kumc.edu/SAH/OTEd/jradel/Preparing_talks/103.html

This site is cited by the NIH and is quite useful when designing an oral presentation. It addresses all aspects of a scientific talk from planning and preparing to practicing and presenting. It is brief and easy to follow with helpful tips on how to prepare for the question/answer session.

Document Resources  

Scientific Poster: Tips, Significance, Design, Templates and Presentation

This document provides tips and temples for designing a poster presentation. It also discusses the significance of a poster presentation and includes a section that gives advice on how to present successfully.

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

This document provides tips and guidelines for designing an oral presentation. It also discusses the significance of an oral presentation and includes a section that gives advice on how to present successfully.

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Evaluating Oral Case Presentations Using a Checklist

How do senior student-evaluators compare with faculty.

Kakar, Seema P. MD; Catalanotti, Jillian S. MD, MPH; Flory, Andrea L. MD; Simmens, Samuel J. PhD; Lewis, Karen L. PhD; Mintz, Matthew L. MD; Haywood, Yolanda C. MD; Blatt, Benjamin C. MD

Dr. Kakar is assistant professor, Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC.

Dr. Catalanotti is assistant professor, Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC.

Dr. Flory is assistant professor, Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC.

Dr. Simmens is research professor, Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, Washington, DC.

Dr. Lewis is director of administration, Clinical Learning and Simulation Skills (CLASS) Center, The George Washington University School of Medicine and Health Sciences, Washington, DC.

Dr. Mintz is associate professor, Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC.

Dr. Haywood is assistant dean for student and curricular affairs, The George Washington University School of Medicine and Health Sciences, Washington, DC.

Dr. Blatt is professor, Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC.

Funding/Support: None.

Other disclosures: None.

Ethical approval: This study was approved by the institutional review board of The George Washington University.

Previous presentations: The abstract of an earlier version of this article was presented at the May 2011 Northeastern Group on Educational Affairs meeting, Washington, DC, and at the November 2011 Research in Medical Education Conference, Denver, Colorado.

Correspondence should be addressed to Dr. Kakar, Department of Medicine, The George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave., NW, Washington, DC 20037; e-mail: [email protected] .

Purpose 

Previous studies have shown student-evaluators to be reliable assessors of some clinical skills, but this model has not been studied for oral case presentations (OCPs). The purpose of this study was to examine the validity of student-evaluators in assessing OCP by comparing them with faculty.

Method 

In 2010, the authors developed a dichotomous checklist. They trained 30 fourth-year medical students (student-evaluators) to use it to assess 170 second-year medical students’ OCPs in real time during a year-end objective structured clinical examination. Ten faculty physicians then scored videos of a random sample of these OCPs. After discarding items with poor faculty reliability, the authors assessed agreement between faculty and student-evaluators on 18 individual items, total scores, and pass/fail decisions.

Results 

The total score correlation between student-evaluators and faculty was 0.84 ( P < .001) and was somewhat better than the faculty–faculty intraclass correlation ( r = 0.71). Using a 70% pass/fail cutoff, faculty and student-evaluator agreement was 74% (Kappa = 0.46; 95% CI, 0.20–0.72). Overall, student-evaluator scores were more lenient than faculty scores (72% versus 56% pass rates; P = .03).

Conclusions 

Senior student-evaluators were able to reliably assess second-year medical students’ OCP skills. The results support the use of student-evaluators for peer assessment of OCPs in low-stakes settings, but evidence of leniency compared with faculty assessment suggests caution in using student-evaluators in high-stakes settings. Extending peer assessment to OCPs provides a practical approach for low-resource evaluation of this essential skill.

Oral communication between physicians plays a vital role in patient care. 1 , 2 The oral case presentation (OCP) is a common vehicle for such communication, and its importance has been recognized by the Clerkship Directors in Internal Medicine, 3 , 4 the Association of American Medical Colleges, 5 and the Accreditation Council for Graduate Medical Education. 6 The published literature, however, includes little about OCP teaching and evaluation. 1 , 7 , 8 Existing studies focus on third-year medical students or residents and address improving OCPs through rhetorical analysis, 2 note card guidelines, 9 , 10 clinical reasoning curricula, 9–11 and a structured method. 12 To the best of our knowledge, no studies to date have addressed OCP training for preclinical medical students. This may reflect a tradition in which preclerkship clinical skills courses focus on history taking and physical examination, 13 leaving OCP teaching to the clerkship years.

Yet, expecting students to learn OCP skills on the fly during clinical rotations is problematic. At The George Washington University School of Medicine and Health Sciences (GW), clerkship directors reported that third-year students were not adequately prepared to give OCPs—an observation that is not unique to our institution. 4 , 14 In response, in 2009 we added formal OCP training to the preclerkship clinical skills course taken by all second-year GW medical students. This training includes a lecture on OCP early in the course, followed by multiple practice opportunities throughout the year: Students are assigned, on a rotating basis, to present cases at the beginning of problem-based learning class sessions. The objective—consistent with the reporter/interpreter/manager/educator (RIME) developmental scheme 15 —is to teach second-year medical students to report cases using a basic structure designed for completeness and “easy listening.” If students enter their clinical years as competent reporters of cases, they may more easily progress to developing interpretation-guided presentations that incorporate sound clinical reasoning. 2 , 4

To evaluate our students as reporters during the course’s year-end objective structured clinical examination (OSCE), we sought a dichotomous checklist. Although there is evidence that the dichotomous checklist is not a valid measure of clinical reasoning and increasing clinical competence, 16 this type of instrument fit our need to assess student mastery of a simple information-reporting structure. When we reviewed the published literature, we found only global or Likert-type scales with a focus on targeting higher-level clinical reasoning. 9 , 11 , 17–20 As we were unable to identify a published or unpublished checklist whose psychometric properties had been assessed, we developed our own.

Because of limited faculty time and resources, having faculty assess individual students’ OCP skills during the OSCE was not feasible. We therefore decided to train fourth-year (senior) medical students to act as student-evaluators. Research has shown that trained nonfaculty evaluators can reliably assess clinical skills using detailed checklists. 13 Although prior studies 21–23 have demonstrated reliable results using senior medical students, medical students previously trained as tutors, and laypeople to assess history-taking and physical examination skills in OSCEs, we found no studies that used this model for evaluating OCP skills. In this article, we report the results of a pilot study in which trained senior medical students used a checklist to evaluate second-year students’ OCP skills during a year-end OSCE. The purpose of this study was to examine the validity of student-evaluators in assessing OCP by comparing them with faculty.

Checklist development

To construct an appropriate OCP skills checklist, we first reviewed the published literature in search of a validated 11–15 dichotomous (yes/no) checklist assessing students as reporters of information. As indicated above, we found no appropriate published instruments. We also requested unpublished instruments through the DR-ED listserv, an electronic discussion group for medical educators sponsored by Michigan State University College of Human Medicine. Listserv members from nine medical schools and a regional performance assessment consortium sent us examples, most of which used global or Likert-type assessment scales.

As we were unable to identify an existing instrument that addressed our needs, we created our own 23-item checklist. This checklist was informed by our experience as clinical skills faculty, the literature, and unpublished examples (in particular, the Northwestern University School of Medicine’s “Oral Presentation Checklist for M2 Clinical Skills” 24 ). We refined the items on our checklist through discussion until reaching consensus.

Participant recruitment and training

To study whether senior students could reliably assess second-year students’ OCP skills using our checklist, we recruited both fourth-year students from GW’s Teaching and Learning Knowledge and Skills (TALKS) program 25 and a comparison group of faculty physicians from GW’s Division of General Internal Medicine and dean’s office. The TALKS program trains senior medical students in education theory and teaching skills. Ten faculty and 30 fourth-year students volunteered to participate.

In two separate two-hour workshops in 2010, we provided the same training for student-evaluators and faculty. After an orientation to the checklist, participants evaluated video presentations—one excellent, one intermediate, and one poor—in which three student-actors presented an abdominal pain case. Participants rated each video independently and then discussed their scores until they reached consensus on the correct scoring (yes or no) for each checklist item.

Use of checklist to assess OCPs

At the end of the 2009–2010 academic year, all 170 second-year GW medical students participated in the clinical skills course four-station OSCE. At the OCP station, they presented an abdominal pain case to one of the student-evaluators, who scored them in real time by marking items as completed (yes) or not completed (no) on the OCP skills checklist. All of the OCPs were videotaped.

We randomly selected 43 of the videotaped OCPs for faculty participants to view and score using the checklist. To simulate real-time assessment, we asked faculty to watch the videos without pausing or rewinding.

To evaluate our checklist, we first examined interrater reliability among faculty members. Accordingly, we had assigned pairs of faculty members to independently score 35 of the 43 videos. (Because of scheduling difficulties, 8 videos were scored by single faculty members and were not used for this reliability assessment.) We determined interrater reliability for each of the original 23 checklist items using percent agreement. (Kappa statistic produced confidence intervals too wide to be of use.) Following this analysis, we excluded 5 items with ≤ 75% agreement between faculty pairs, leaving the remaining 18 items to serve as the final checklist. We then used those in our comparisons of student-evaluator and faculty scoring to assess agreement on individual items, total score, and pass/fail decisions.

To determine item agreement between faculty and student-evaluators, we used percent agreement. For the 35 OCPs that two faculty members evaluated, we compared the student-evaluator’s scoring with that of each faculty member separately, resulting in two distinct percent agreement estimates. We then averaged those two estimates to arrive at a single percent agreement estimate between faculty and student-evaluators for each item.

To determine total score agreement , we defined total score as the percentage of checklist items marked by the evaluator as completed (percent correct). To assess faculty–faculty agreement, we calculated the intraclass correlation between the faculty pairs for the 35 OCPs that two faculty members evaluated. To assess faculty–student agreement for the 43 OCPs that both students and faculty evaluated, we calculated a Pearson correlation; for 35 OCPs, the faculty total scores were the average of the scores of two faculty members, whereas for the remaining 8 OCPs, the faculty total scores were those of a single faculty member. In addition, to determine whether one group was more lenient than the other, we compared faculty and student-evaluator total score means using a paired t test.

Finally, we determined agreement on pass/fail decisions. We designated a total score of 70% as passing, which is common practice at our institution, and then used McNemar’s test to compare the pass rates assigned by faculty with those assigned by student-evaluators. We evaluated faculty–student agreement on pass/fail decisions using the kappa statistic.

This study was approved by the institutional review board of The George Washington University.

Faculty and student-evaluators agreed closely (agreement > 75%) on most individual items in the final 18-item checklist ( Table 1 ). The total score correlation between student-evaluators and faculty was 0.84 ( P < .001), which is somewhat better than the between-faculty intraclass correlation for total score (0.71).

The mean total score assigned by student-evaluators (76.6%, SD 11.8%) was slightly higher than the mean score assigned by faculty (74.0%, SD 10.2%; P = .02). However, in our analysis of pass/fail agreement, in which we set 70% as the total score cutoff, we found that the student-evaluator scores were more lenient than faculty scores (pass rates of 72% versus 56%; P = .03). Agreement between faculty and student-evaluators using the pass/fail cutoff was 74% (Kappa = 0.46; 95% CI, 0.20–0.72).

This pilot study demonstrates that trained senior medical students and faculty assessed second-year students’ OCP skills similarly using our checklist. The correlation between total scores assigned by student-evaluators and faculty was very good in absolute terms ( r = 0.84) as well as in comparison with the faculty intraclass correlation ( r = 0.71). Although there is no gold standard for assessing oral presentation skills, we chose as our standard the judgment of attending physicians because it is the usual and accepted method for evaluating clinical performance. The good agreement between faculty on total scores suggests that faculty scoring provides a reasonable benchmark for assessing student-evaluator scoring.

Similar to prior studies, 3 , 22 close agreement between student-evaluators and faculty on individual items and on total scores did not translate into close agreement on pass/fail decisions. The more lenient student-evaluator scoring suggests that senior students should only score low-stakes examinations. In the case of high-stakes examinations, we recommend supplementing student-evaluator assessment with faculty video review of presentations that students score close to the pass/fail line.

Our checklist did not employ a global evaluation score. Prior studies suggest that a global score would not have improved the correlation of student-evaluator and faculty scoring. Chenot and colleagues, 21 for example, found that although student-evaluators and faculty had acceptable interrater agreement for global ratings (0.66), student-evaluators consistently awarded higher global ratings than did faculty. Humphrey-Murto and colleagues 22 reported a similar finding in their study comparing physician examiners with trained assessors in a high-stakes OSCE. We speculate that global scores may be more vulnerable to rater bias than individual checklist items.

Overall, we believe our preliminary findings support further study of this less resource-intensive, peer-assessment approach to evaluating essential OCP skills. Our study also adds to a rapidly growing literature on peer education, 26–28 an area in which 43% of U.S. medical schools now have formal programs. 29

One virtue of this peer-assessment approach is its efficiency. As medical education evolves toward competency-based education and assessment, we must seek creative solutions to avoid overburdening faculty. Following a two-hour training session, 30 student-evaluators were able to reliably assess the OCP skills of 170 second-year students during an OSCE. Another virtue of this approach is that it is standardized. Typically, during clinical clerkships, students receive nonstandardized, subjective faculty evaluations of their OCP skills. Introducing rigorous faculty development with the goal of standardizing feedback would be a major challenge because of limited resources and time. Although our study focused on assessment of preclinical students, a similar peer-assessment system could be used during clerkships to supplement faculty evaluations.

This study has a number of limitations. First, scoring may have been influenced by the assessment method: Student-evaluators assessed OCPs in real time, whereas faculty completed their ratings while watching video recordings. Second, our checklist had not been evaluated previously. To address this, we removed from our checklist the five items with ≤ 75% agreement between two faculty evaluators, which is consistent with cutoffs in other studies using checklists for OSCEs (e.g., Chenot and colleagues 21 ). Third, some of our checklist items contained compound or subjectively worded items (e.g., items 8 and 17, respectively; see Table 1 ). As others have found, 8 such items can be hard for the evaluator to assess. To optimize reliability, compound items should be minimized (although this must be balanced against the competing need to limit checklist length), and subjective terms (e.g., “good”) should be clearly defined. Additional training with practice cases may improve interrater reliability. Finally, our results may not be generalizable to other institutions.

Future studies are needed to further refine our checklist and to evaluate larger numbers of students to confirm our conclusions. Also, research is needed to examine whether student-evaluators can reliably assess clinical reasoning as well as the structural elements of OCPs which they assessed in this study. In addition, although previous studies have shown that student-evaluators can provide valuable real-time feedback on history-taking and physical examination skills, 21 , 23 further work is needed to determine whether they can also give meaningful real-time feedback on OCPs. Peer-assisted evaluation, or more specifically “near-peer” evaluation, also has potential to benefit the student-evaluators themselves 27 ; further investigation is needed to explore whether acting as evaluators leads to improvements in senior students’ own OCP abilities.

In summary, this preliminary study suggests that trained senior medical students are reliable evaluators, compared with faculty, when using a dichotomous checklist to evaluate OCP skills during a low-stakes OSCE. Caution should be applied when using student-evaluators in high-stakes examinations.

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Ten Simple Rules for Making Good Oral Presentations

Continuing our “Ten Simple Rules” series [ 1 – 5 ], we consider here what it takes to make a good oral presentation. While the rules apply broadly across disciplines, they are certainly important from the perspective of this readership. Clear and logical delivery of your ideas and scientific results is an important component of a successful scientific career. Presentations encourage broader dissemination of your work and highlight work that may not receive attention in written form.

We do not mean face the audience, although gaining eye contact with as many people as possible when you present is important since it adds a level of intimacy and comfort to the presentation. We mean prepare presentations that address the target audience. Be sure you know who your audience is—what are their backgrounds and knowledge level of the material you are presenting and what they are hoping to get out of the presentation? Off-topic presentations are usually boring and will not endear you to the audience. Deliver what the audience wants to hear.

Rule 2: Less is More

A common mistake of inexperienced presenters is to try to say too much. They feel the need to prove themselves by proving to the audience that they know a lot. As a result, the main message is often lost, and valuable question time is usually curtailed. Your knowledge of the subject is best expressed through a clear and concise presentation that is provocative and leads to a dialog during the question-and-answer session when the audience becomes active participants. At that point, your knowledge of the material will likely become clear. If you do not get any questions, then you have not been following the other rules. Most likely, your presentation was either incomprehensible or trite. A side effect of too much material is that you talk too quickly, another ingredient of a lost message.

Do not be overzealous about what you think you will have available to present when the time comes. Research never goes as fast as you would like. Remember the audience's time is precious and should not be abused by presentation of uninteresting preliminary material.

A good rule of thumb would seem to be that if you ask a member of the audience a week later about your presentation, they should be able to remember three points. If these are the key points you were trying to get across, you have done a good job. If they can remember any three points, but not the key points, then your emphasis was wrong. It is obvious what it means if they cannot recall three points!

Think of the presentation as a story. There is a logical flow—a clear beginning, middle, and an end. You set the stage (beginning), you tell the story (middle), and you have a big finish (the end) where the take-home message is clearly understood.

Presentations should be entertaining, but do not overdo it and do know your limits. If you are not humorous by nature, do not try and be humorous. If you are not good at telling anecdotes, do not try and tell anecdotes, and so on. A good entertainer will captivate the audience and increase the likelihood of obeying Rule 4.

This is particularly important for inexperienced presenters. Even more important, when you give the presentation, stick to what you practice. It is common to deviate, and even worse to start presenting material that you know less about than the audience does. The more you practice, the less likely you will be to go off on tangents. Visual cues help here. The more presentations you give, the better you are going to get. In a scientific environment, take every opportunity to do journal club and become a teaching assistant if it allows you to present. An important talk should not be given for the first time to an audience of peers. You should have delivered it to your research collaborators who will be kinder and gentler but still point out obvious discrepancies. Laboratory group meetings are a fine forum for this.

Presenters have different styles of presenting. Some can captivate the audience with no visuals (rare); others require visual cues and in addition, depending on the material, may not be able to present a particular topic well without the appropriate visuals such as graphs and charts. Preparing good visual materials will be the subject of a further Ten Simple Rules. Rule 7 will help you to define the right number of visuals for a particular presentation. A useful rule of thumb for us is if you have more than one visual for each minute you are talking, you have too many and you will run over time. Obviously some visuals are quick, others take time to get the message across; again Rule 7 will help. Avoid reading the visual unless you wish to emphasize the point explicitly, the audience can read, too! The visual should support what you are saying either for emphasis or with data to prove the verbal point. Finally, do not overload the visual. Make the points few and clear.

There is nothing more effective than listening to, or listening to and viewing, a presentation you have made. Violations of the other rules will become obvious. Seeing what is wrong is easy, correcting it the next time around is not. You will likely need to break bad habits that lead to the violation of the other rules. Work hard on breaking bad habits; it is important.

People love to be acknowledged for their contributions. Having many gratuitous acknowledgements degrades the people who actually contributed. If you defy Rule 7, then you will not be able to acknowledge people and organizations appropriately, as you will run out of time. It is often appropriate to acknowledge people at the beginning or at the point of their contribution so that their contributions are very clear.

As a final word of caution, we have found that even in following the Ten Simple Rules (or perhaps thinking we are following them), the outcome of a presentation is not always guaranteed. Audience–presenter dynamics are hard to predict even though the metric of depth and intensity of questions and off-line followup provide excellent indicators. Sometimes you are sure a presentation will go well, and afterward you feel it did not go well. Other times you dread what the audience will think, and you come away pleased as punch. Such is life. As always, we welcome your comments on these Ten Simple Rules by Reader Response.

Acknowledgments

The idea for this particular Ten Simple Rules was inspired by a conversation with Fiona Addison.

Dr. Philip E. Bourne is a Professor in the Department of Pharmacology, University of California San Diego, La Jolla, California, United States of America. E-mail: ude.csds@enruob

Competing interests. The author has declared that no competing interests exist.

Funding. The author received no specific funding for this article.

• Bourne PE. Ten simple rules for getting published. PLoS Comp Biol. 2005; 1 :e57. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Bourne PE, Chalupa LM. Ten simple rules for getting grants. PLoS Comp Biol. 2006; 2 :e12. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Bourne PE, Korngreen A. Ten simple rules for reviewers. PLoS Comp Biol. 2006; 2 :e110. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Bourne PE, Friedberg I. Ten simple rules for selecting a postdoctoral fellowship. PLoS Comp Biol. 2006; 2 :e121. [ PMC free article ] [ PubMed ] [ Google Scholar ]
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Oral Presentation in Medicine

• © 2002
• Abe Fingerhut 0 ,
• François Lacaine 1

Centre Hospitalier Intercommunal, Louisiana State University, Poissy Cedex, France

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Hôpital Tenon, Service de chirurgie digestive et générale, Pierre et Marie Curie University (Paris VI), Paris Cedex 20, France

• This manual lists and warrants different manners of spoken communication, offers practical advice on giving a scientific message
• It is aimed at a varied medical audience ranging from the student to the instructor, and from the practitioner to the researcher

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Strategies for the Preparation and Delivery of Oral Presentation

Oral Presentations

How to Prepare and Give a Scholarly Oral Presentation

• communication

Table of contents (9 chapters)

Front matter, introduction.

• Abe Fingerhut, François Lacaine

The Free Paper

The lecture, the panel discussion, roundtable, symposium, and colloquium, other forms of communication, what to do when something goes wrong or not as planned, the speaker’s appearance, tips for your trip, back matter, authors and affiliations.

Abe Fingerhut

François Lacaine

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Book Title : Oral Presentation in Medicine

Authors : Abe Fingerhut, François Lacaine

DOI : https://doi.org/10.1007/978-2-8178-0843-7

Publisher : Springer Paris

eBook Packages : Springer Book Archive

Copyright Information : Springer-Verlag France 2002

Softcover ISBN : 978-2-287-59686-5 Published: 01 February 2002

eBook ISBN : 978-2-8178-0843-7 Published: 21 November 2013

Edition Number : 1

Number of Pages : VII, 70

Topics : Language Education , General Practice / Family Medicine , Medicine/Public Health, general

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Oral presentation resources, oral podium presentations.

If your abstract has been selected for an oral podium presentation at a local, regional or national meeting, the research chief resident and program director can offer you guidance to create your slides and prepare for your presentation.  **We recommend that you practice giving your presentation to colleagues and chief residents for feedback well before the conference!** For all work done at GW, you should include the  GW logo  on your presentation.  

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The following links discuss tips on presentation skills. Some of them are not from the science world, but they all provide insights on the elements that make a presentation bad, good, or great. You will also find them useful for other presentation situations: Chairman's Rounds, M&M, CPC, etc.

The real entertainment gimmick is the excitement, drama and mystery of the subject matter. People love to learn something, they are "entertained" enormously by being allowed to understand a little bit of something they never understood before. One must have faith in the subject and in people's interest in it. Otherwise just use a Western to sell telephones! The faith in the value of the subject matter must be sincere and show through clearly. All gimmicks, etc. should be subservient to this. They should help in explaining and describing the subject, and not in entertaining. Entertaininment will be an automatic byproduct."

- Richard Feynman , Letter to Mr. Ralph Brown, Advisory Board in Connection with Programs on Science (in Perfectly Reasonable Deviations from the Beaten Track)

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What’s the Story? Expectations for Oral Case Presentations

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Michael Dell , Linda Lewin , Joseph Gigante; What’s the Story? Expectations for Oral Case Presentations. Pediatrics July 2012; 130 (1): 1–4. 10.1542/peds.2012-1014

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This article focuses on teaching and evaluating oral presentation skills as part of the ongoing Council on Medical Student Education in Pediatrics (COMSEP) series on skills and strategies used by superb clinical teachers. While oral presentations by students can be used to enhance diagnostic reasoning, 1 we will focus this article on the characteristics of high-quality oral presentations by medical students, highlight several common pitfalls, and reinforce the connection between effective oral presentations and clinical reasoning. A model for evaluating student clinical performance, the RIME model, will be reviewed.

Students often struggle with what is expected of them when asked to give an oral presentation of a patient encounter. Many preceptors have asked a student to present a case, only to be answered with the question, “What would you like to hear?” Students frequently perceive the oral presentation as “a rule-based, data-storage activity governed by order and structure.” 2 Clinicians,...

Re:What is the Story Behind the Story

I appreciated reading this article and will use it with my first year medical students especially because of the authors discussion of epidemiology in the context of formulating a good summary statement. This year I am working on integrating concepts of epidemiology,prevention and biostats as the students learn the medical history. I definitely agree with the letter highlighting the importance of the social and family histories which we do focus on but then are down played by the hidden and not so hidden curiculia.

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None declared

What is the Story Behind the Story

Letter to the Editor:

I read with great interest the COMSEP Perspective written by Dell, Lewin and Gigante online June 18, 2012 DOI: 10.1542/peds. 2012-1014. The authors have provided an excellent article that offers many important tips for students and principles for those who supervise and teach them. In addition to the many pearls offered by the authors, I would add important emphases on the family and social history. These elements of the patient evaluation are often overlooked or cursorily reviewed. Frequently I will hear a social history that includes "Lives with mom and dad and 2 year old sibling. No pets or foreign travel". The family history "Non contributory". In an era where psychosocial considerations play an important role in both the etiology of illness/injury and the adjustment to illness/injury, we can do better. Students should attempt to know the lives their patients and families are living. In an era of genetic understanding of diseases and therapeutics a more detailed family history is also a worthy goal. When attending physicians have expectations that these are important parts of the presentation, student will comply. Stephen Ludwig, MD Children's Hospital of Philadelphia Philadelphia, Pa.

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Division of Bone and Mineral Diseases

Celebrating Excellence: Khushpreet Kaur’s Award-Winning Oral Presentation at the 9th International Conference on Osteoimmunology

The 9th International Conference on Osteoimmunology: Interactions of the Immune and Skeletal Systems took place in Greece this past month, drawing together the world’s leading scientists and researchers from both the immunology and osteology fields. This conference is dedicated to fostering collaboration and accelerating progress in understanding the complex interactions between the immune and skeletal systems.

A highlight of the conference was the recognition of Khushpreet Kaur from the Mbalaviele Lab, who was honored with the esteemed Aegean Conference Oral Presentation Award. This award celebrates outstanding contributions to research presented at the conference. Kaur received the award for her presentation, titled “The NLRP3 Inflammasome is Tightly Regulated in the Osteoclast Cell Lineage to Avoid Unnecessary Osteolysis,”.

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Click Here to download Application for the McGill DOM World Class Teams Process

This World Class Team process relates to a key objective from the DOM’s strategic plan-to become the most research-intensive DOM in Canada. The McGill DOM strives for excellence and we recognize that promoting growth in areas where we lead the world, or can lead the world, is/will be a key driver of reaching our strategic aspirations.

DOM World Class Teams are multi-disciplinary teams of scientists working in a specific “area” of focus, led by McGill DOM members. We are embarking on a process to identify our top 3 established world class teams and our top 3 emerging world class teams across the McGill DOM ecosystem. Established world class teams include multiple scientists collaborating and generating world leading outputs in an area. Emerging world class include multiple scientists collaborating in an area with clear and attainable plans to become world leaders.

Once we identify our world class teams, they will be given priority in areas under the DOM’s direct control such as fellowship support (salary and operating)​, recruitment (including future tenure slots, CAS Research start-up packages), etc. Successful teams will also benefit from DOMs advocacy for support from McGill, our affiliated institutions, and their affiliated Foundations.

To identify our teams, we will hold an open and transparent competition with written submissions and oral presentations by self-identified groups working in an “area” led by McGill DOM members. The submissions will articulate the structure (who), function (how), funding (with what), recent and upcoming outputs and the world comparable of their “world class team” in “area X” (i.e. identify/describe top 3 competitors in “area X”.). A 15-min presentation or “elevator pitch” to our DOM World Class Teams panel will be required as part of the process. The DOM World Class Teams panel will include the McGill FMHS Dean (or delegate), our affiliated Research Institute (RI) CSOs/CEOs (or delegates) and 3 external reviewers (senior, mid and early career).

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Takeda’s TAK-861 Phase 2b Late-Breaking Data Presentations at SLEEP 2024 Demonstrate Clinically Meaningful Impact of Oral Orexin Agonist in Narcolepsy Type 1 Compared to Placebo

Phase 2b Trial Demonstrated Statistically Significant and Clinically Meaningful Improvements Across Primary and all Secondary Endpoints up to 8 Weeks

TAK-861 is the First Oral Orexin Receptor 2 Agonist to Potentially Address the Underlying Pathophysiology of NT1

Safety Results Indicated TAK-861 is Generally Safe and Well Tolerated

Phase 3 Trials of TAK-861 to be Initiated in 1H FY2024

OSAKA, Japan and CAMBRIDGE, Massachusetts, June 3, 2024 – Takeda ( TSE: 4502/NYSE:TAK ) will present today positive results from its Phase 2b trial of TAK-861 in narcolepsy type 1 (NT1) as late-breaking data presentations at SLEEP 2024, the 38th annual meeting of the American Academy of Sleep Medicine and the Sleep Research Society. TAK-861 is an investigational oral orexin receptor 2 (OX2R) agonist and, based on the results, has the potential to provide transformative efficacy in addressing the overall disease burden in people with NT1. The randomized, double-blind, placebo-controlled, multiple dose trial, TAK-861-2001 ( NCT05687903 Go to https://classic.clinicaltrials.gov/ct2/show/NCT05687903?term=TAK-861&draw=2&rank=3 ), in 112 patients with NT1 demonstrated statistically significant and clinically meaningful improvements across primary and secondary endpoints, with efficacy sustained over 8 weeks of treatment.*

NT1 is a chronic, rare neurological central disorder of hypersomnolence caused by a significant loss of orexin neurons, resulting in low levels of orexin neuropeptides in the brain and cerebrospinal fluid. No currently approved treatments target the underlying pathophysiology of NT1. People with NT1 suffer from excessive daytime sleepiness (EDS), cataplexy (sudden loss of muscle tone), disrupted nighttime sleep, hypnagogic and hypnopompic hallucinations and sleep paralysis. These debilitating symptoms lead to a markedly reduced quality of life and can severely impact job performance, academic achievement and personal relationships. TAK-861 is designed to address the orexin deficiency in NT1 by selectively stimulating the orexin receptor 2.

The presentation highlights results from the Phase 2b trial including:

The primary endpoint demonstrated statistically significant and clinically meaningful increased sleep latency on the Maintenance of Wakefulness Test (MWT) versus placebo across all doses (LS mean difference versus placebo all p ≤0.001). Improvements were sustained over 8 weeks.

Consistent results were achieved in the key secondary endpoints including the Epworth Sleepiness Scale (ESS) and Weekly Cataplexy Rate (WCR), demonstrating significantly improved subjective measures of sleepiness and cataplexy (sudden loss of muscle tone) frequency versus placebo that were also sustained over 8 weeks.

The majority of NT1 patients in the trial were found to be within normative ranges for MWT and ESS by the end of the 8-week treatment period as a result of these sustained improvements.

The majority of the participants who completed the trial enrolled in the long-term extension (LTE) study with some patients reaching one year of treatment.

The trial also included additional exploratory endpoints that showed meaningful improvements in narcolepsy symptoms and functioning according to most participants. These data will also be presented in poster presentations at SLEEP and at future scientific congresses.

The dataset showed that TAK-861 was generally safe and well tolerated during the study, with no treatment-related serious treatment-emergent adverse events (TEAEs) or discontinuations due to TEAEs.

No cases of hepatotoxicity or visual disturbances were reported in the Phase 2b trial or in the ongoing LTE study. The most common TEAEs were insomnia, urinary urgency and frequency, and salivary hypersecretion. Most TEAEs were mild to moderate in severity, and most started within 1-2 days of treatment and were transient.

“In this trial, TAK-861's profile balanced efficacy and safety with the potential to establish a new standard of care for people with NT1,” said Sarah Sheikh, M.D., M.Sc., B.M., B.Ch., MRCP, Head, Neuroscience Therapeutic Area Unit and Head, Global Development at Takeda. “We are dedicated to investigating the full potential of orexin biology and advancing TAK-861 to late-stage clinical trials, with the ultimate goal of delivering a potential first-in-class treatment that can make a meaningful difference for patients.”

Based on these results, and in consultation with global health authorities, Takeda plans to initiate global Phase 3 trials of TAK-861 in NT1 in the first half of its fiscal year 2024. The Phase 2b data also supported the recent Breakthrough Therapy designation for TAK-861 for the treatment of EDS in NT1 from the U.S. Food and Drug Administration (FDA). Breakthrough Therapy designation is a process designed to expedite the development and review of a drug that is intended to treat a serious or life-threatening condition, for which preliminary clinical evidence indicates that the drug may demonstrate substantial improvement over available therapies on at least one clinically significant endpoint.

Takeda will be hosting a call to discuss these data this evening, June 3, at 7:30 p.m. CT for investors and analysts. Presentation slides and a virtual meeting link will be available here .

Additional presentations on TAK-861 will be shared during the SLEEP 2024 poster presentation session on Tuesday, June 4, from 10:00 to 11:45 a.m. CT, assessing function and health-related quality of life in individuals with NT1, as well as patient satisfaction with TAK-861 treatment. There is no change in Takeda’s full year consolidated forecast for the fiscal year ending March 31, 2025 (FY2024), announced on May 9, 2024.

About Takeda’s Orexin Franchise

Takeda is advancing the field of orexin therapeutics with a multi-asset franchise offering tailored treatments to unlock the full potential of orexin. Orexin is a key regulator of the sleep-wake cycle and is involved in other essential functions, including respiration and metabolism. TAK-861 is the leading program in this franchise. The company is also progressing multiple orexin agonists in patient populations with normal levels of orexin neuropeptides and other indications where orexin biology is implicated. This includes TAK-360, an oral OX2R agonist being investigated for narcolepsy type 2 and idiopathic hypersomnia, which recently initiated a Phase 1 trial and received Fast Track designation from the U.S. FDA, and danavorexton (TAK-925), an intravenously administered OX2R agonist being investigated in a Phase 2 trial in patients with moderate to severe obstructive sleep apnea undergoing general anesthesia.

About Takeda

Takeda is focused on creating better health for people and a brighter future for the world. We aim to discover and deliver life-transforming treatments in our core therapeutic and business areas, including gastrointestinal and inflammation, rare diseases, plasma-derived therapies, oncology, neuroscience and vaccines. Together with our partners, we aim to improve the patient experience and advance a new frontier of treatment options through our dynamic and diverse pipeline. As a leading values-based, R&D-driven biopharmaceutical company headquartered in Japan, we are guided by our commitment to patients, our people and the planet. Our employees in approximately 80 countries and regions are driven by our purpose and are grounded in the values that have defined us for more than two centuries. For more information, visit www.takeda.com .

* The topline results were announced on February 8, 2024, via a press release, “Takeda Intends to Rapidly Initiate the First Global Phase 3 Trials of TAK-861, an Oral Orexin Agonist, in Narcolepsy Type 1 in First Half of Fiscal Year 2024."

Media Contacts:

Japanese media.

Yuko Yoneyama

[email protected]

+81 70-2610-6609

U.S. and International Media

Rachel Wallace

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