Monday, July 29, 2013

Communication Breakdown: Presentable Presentations

If you want to be a better clinician the most important area to improve your skills is communication.


Of course you need medical knowledge, but that takes a while to build.  And you need procedural proficiency but that also takes time and opportunities.  And you need to learn to function in different clinical environments, each with it's own set of processes, rules, and traditions.  That also takes time and  you start over with each new place.

But communication.  That is something you already have experience with and does not require a prolonged investment of time.  What it takes is the desire to actually communicate better.  With patients, with staff, with other services, and with your supervisors.

Not coincidentally, communication is also the skill that can most dramatically improve your evaluations during your EM rotations.  We will tackle the other areas of communication later.  Today we are diving into the art of presentations.

A really good, focussed, well organized presentation to your supervisor is the most effective way to convince them of your skills.  You will be evaluated in many areas.  Knowledge base, focussed history taking and exam skills, ability to form a differential, and ability to make a plan all being fairly typical of what your supervisors will be assessing you on.  To know exactly what they are asked to assess you on in writing you a "letter" take a look at the SLOE.

You will sometimes be directly observed to see how well you relate to patients and gather info from them.  However, in most rotations these skills will more often be assessed when you present to your supervisor.  More direct observation would be better, and as we will discuss below, more fair.  The pace of most ED's and a common belief that watching you will change your behavior (The Hawthorne Effect) prevents direct observation from happening more often.

If your presentations are going to be this important to the perception of your abilities then it is critically important that you make them good.  Relay only the pertinent HPI details and exam findings and you will appear able to distill information and focus.  Describe an appropriate DDx, giving weight to life threats and common problems, and they will believe you have a strong and well-organized knowledge base.  Share a plan that includes tests and treatment, and that is practical in the ED setting, and they will believe you understand EM practice.

Let's take two hypothetical students:  Student A and Student B, and put them on a hypothetical rotation together.  Student A is well read, with great board scores, and spends a lot of time with his patients getting their history and explaining their care.  Student A gives long, very detailed presentations, and does not suggest a DDX or plan because he does not feel confident that he knows enough to create a good one.  Student B prefers to learn by doing, has mediocre scores, and moves fast, talks fast, and is all over the department.  Student B gives short, focussed presentations and is willing to throw out a DDx and plan even though they are often wrong and get changed.  Student A may turn out to be the better physician but Student B is usually going to do much better on her ED rotation.  If you empathize with Student A this should seem patently unfair.  And that is because it is unfair.  Most emergency physicians are high energy, decisive, and direct people and they usually value those attributes in others.

This is not to say that the ideal is Student B.  Those who incorporate the best qualities of both Student A and Student B are those most likely to experience long term success.  Student B is just going to have an easier time getting in to EM.

If you believe your presentations need work, a good road map to get you started is The 3 Minute EM Presentation.

Good luck!

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