How to do an Oral Case Presentation
The main purpose of a case presentation is to convey important clinical information about a patient to the attending physician and other members of the healthcare team.
The presentation should be concise and well-organized, highlighting the most pertinent aspects of the patient's case.
Here we’ll cover:
What is a Case Presentation?
The Purpose of a Case Presentation
Outline of a Case Presentation
Tips to Excel on a Case Presentation
Example Case Presentations
I. What is a Case Presentation?
Case presentations are an essential part of clinical clerkship and serve as a tool for you to learn and be assessed.
Excellent oral case presentation conveys pertinent information about the patient, their presentation, diagnosis, and proposed treatment.
What a Case Presentation is Not
A case presentation is not you reading off your SOAP note word for word, including every single detail that you may have noted during your assessment of the patient.
You have to take time to think about what details are relevant to share with your attending staff and other health care providers of the team.
How long should a case presentation be?
It’s best to speak to your attending to ask for tips and recommendations on how they like their case presentations to be delivered.
The length of a case presentation also depends on how far you are in your training, the teaching style of your attending staff and what specialty you will be working in.
How far you are in clerkship: If you are at the beginning of clerkship in your first few rotations, or just starting a new clerkship rotation, you will find that your case presentations may be too brief or too long. As you progress and your clinical reasoning skills become stronger through clerkship, you’ll notice your case presentation skills will be more succint, precise and focused.
The teaching style of your attending staff: Some attendings don’t mind if you take your time going through your entire SOAP note, others prefer an abbreviated version only highlighting important points that will allow clinicians to determine the diagnosis and decision making.
Time constraints in the Practice Setting: If there is a 20-patient clinic you are running that day, there may not be time to do a 10 minute case presentation for each patient that you’ve seen. In other settings where there is less of a patient load you may be able to take that time.
Specialties: Here are some examples of lengths of presentations in different specialties based on my own experience in clerkship:
Family Medicine: 5 minutes
Emergency Medicine: 3-5 minutes
Internal Medicine: 7-10 minutes
Orthopaedic Surgery: 2 minutes
II. Purpose of a Case Presentation
By participating in case presentations, you can improve their clinical reasoning, communication, and presentation skills.
Here are some specific learning objectives that clinical clerks can aim to achieve through case presentations:
To Develop Clinical Reasoning Skills
By presenting the relevant information about the patient's case, including the medical history, physical exam findings, and diagnostic test results, you can demonstrate how you arrived at your assessment and differential diagnosis.
Here you will practice generating a differential diagnosis and with guidance from your attending, arrive at a working diagnosis. Attendings may prompt you to discuss the rationale for your diagnosis and suggestions for further investigations or treatment.
To Improve your Communication Skills
Another important purpose of a case presentation is to ensure that all members of the healthcare team are aware of the patient's condition, treatment plan, and any other pertinent information.
This can include things like the patient's chief complaint, the reason for admission, past medical history, allergies, medications, and any other relevant details.
By presenting this information in a clear and concise manner, you can help to ensure that everyone is on the same page and working together towards the best possible outcomes for the patient.
To Receive Constructive Feedback
Finally, case presentations provide an opportunity for you to receive feedback and guidance from your attending staff and other members of the healthcare team.
Feedback and clarifying questions from your attending will help you develop clinical reasoning in the assessment, diagnosis and treatment of patient’s conditions.
This can include suggestions for further diagnostic tests, adjustments to the treatment plan, or advice on how to communicate with the patient or family members.
By being open to feedback and taking it into account, you can continue to improve your clinical skills and provide better care to your patients!
III. Outline of a Case Presentation
A well-organized and concise case presentation is essential for conveying important clinical information to the attending staff and other members of the healthcare team.
Similar to documentation of a patient encounter, you can use the “SOAP” acronym to organize your case presentation:
Subjective
Intro: Patient Name
Diagnosis: This can be chief complaint, reason for admission, or start with the diagnosis
History of Presenting Illness: A brief description of patient’s symptoms (OPQRSTUV), pertinent positives and pertinent negatives (explained below).
Past Medical History: Relevant medical conditions that may affect patient’s symptoms, surgeries, ad past hospitalizations. Current medications, allergies.
Social History: If relevant, occupation and environmental exposure, recent travel, immunization status, smoking/EtOh, recreational drug use, functional baseline (independent with ADLs? walking aids?)
Objective
Physical Examination: Include a description of all relevant findings. It's important to document the patient's vital signs, as well as any abnormal or concerning findings.
Investigations: Summarize results of relevant diagnostic tests (labs, imaging)
Assessment and Plan
Your working diagnosis and differential: Summarize your clinical reasoning process and propose 1-3 differential diagnoses.
Plan: The plan should include any treatment recommendations, such as medications, procedures, or consultations.
Optional: Conclusion
The conclusion should provide a brief summary of the patient's case and key takeaways.
Following this the attending staff and members of the health care team will asking clarifying questions and provide feedback and guidance on your case presentation.
But what if I don’t know what the diagnosis is or what the plan should be?
Clerkship is not just about taking history and performing a physical examination and documenting your encounter, a huge component is developing your clinical reasoning skills.
Even if you are not certain what the diagnosis or plan is, try to propose a diagnosis and a few ideas on what you think the treatment plan would be.
Remember that clerkship is a safe learning environment and the attendings understand you are a medical learner trying to develop your clinical reasoning skills. There is no shame if you get the “Assessment and Plan” wrong, or if you are a bit disorganized with your case presentation. With practice you will get better with time!
If you find yourself struggling with this part, consider going back and reviewing some common conditions pertinent to the specialty you are completing your clinical rotation in.
IV. Tips to Excel on Case Presentations
Experienced clinicians often go directly from seeing the patient to providing an effective case presentation without referring to notes, or taking time to organize their thoughts. THIS IS THE GOAL!
But when you are first starting, it’s not uncommon for clinical clerks to take some time to review the patient’s notes, and practice the presentation.
Here are some tips to help you deliver a more organized and comprehensive presentation:
Organize your Oral Case Presentation: Choose an outline for your case presentation and stick to it (e.g. like “SOAP” note above!”). This helps you organize the information about the patient in neat categories, and allow you to convey information more clearly.
Keep in mind some attendings have different preferences for how they like to organize case presentations. They may start with conclusion first (e.g. Patient ID, age, relevant comorbidities, and your working Diagnosis FIRST, before diving into the rest of the case presentation). Request feedback or guidance around how they prefer their case presentations to be done!
Review relevant patient information and decide on what’s important to include so that the attending knows enough about the patient to make decision about treatment: A case presentation should not be you simply including everything the patient conveyed to you in your patient assessment. You have to decide what is important to include.
Include “Pertinent Positives”: a pertinent positive refers to a finding on clinical examination that is considered significant for the diagnosis of a particular condition. (For example: If a patient is complaining of chest pain, a “pertinent positive” would be chest pressure that radiates to the left arm or jaw, indicating a potential MI. This is a RELEVANT finding that can help you narrow the potential causes of the patient’s symptoms. )
Include “Pertinent Negatives”: A pertinent negative is a finding on clinical examination that is considered significant for excluding a particular condition from the list of differential diagnoses. (For example: in a patient with right lower quadrant abdominal pain, a pertinent negative would the absence of fevers or chills, which could help rule out an infectious process such as acute appendicitis, which would help focus on other possible causes like diverticulitis, constipation or kidney stones).
Only reference your notes occasionally for case presentations: Try not to read off your notes for the entirety of your case presentation. Only glance down once in a while for pertinent details.
V. Example Case Presentations
Case presentations will look different depending on what specialty or practice setting you are in. You’ll note in these examples that not all components listed in our outline above are included in the case presentations (and that’s okay!).
Case Presentation - Asthma Presentation in a Family medicine Office
Jane is a 28-year-old female who presents for a routine visit for her asthma.
She has a past medical history of asthma since childhood and has been using an albuterol inhaler as needed. She reports experiencing mild shortness of breath and wheezing with occasional coughing and chest tightness for the past week, but denies any difficulty breathing at rest. She has been using her inhaler more frequently than usual with some relief of symptoms.
The patient denies any recent upper respiratory infections or exposure to environmental irritants or allergens. She has no other significant medical history, takes no medications other than her albuterol inhaler, and has no known allergies.
On examination, the patient has bilateral expiratory wheezing and mild tachypnea, but no signs of respiratory distress or accessory muscle use. Her oxygen saturation is 98% on room air. She has no other significant findings on examination.
Based on the history and physical examination, my differential diagnosis includes poorly controlled asthma exacerbation, viral upper respiratory tract infection with reactive airway disease, or environmental trigger exposure.
I would like to request further workup with pulmonary function testing and consider adjusting the patient's asthma management plan with a stepwise approach to medication therapy.
Case Presentation of a Patient Presenting to the Emergency Department with acute onset chest pain
“Jack is a 56-year-old male who presented to the ED with acute onset chest pain.
The patient has a past medical history of hypertension and hyperlipidemia, for which he takes lisinopril and atorvastatin respectively. He reports sudden onset, crushing chest pain that radiated to his left arm and jaw, associated with sweating and shortness of breath. The pain started 2 hours ago while he was watching TV and has not improved with rest or nitroglycerin.
On examination, the patient is alert and oriented but appears uncomfortable due to chest pain. His vital signs are within normal limits, except for a blood pressure of 190/110 mmHg. He has normal heart sounds but has diffuse ST-segment elevation on the ECG. He has no peripheral edema or JVD on examination.
Based on the history and physical examination, my differential diagnosis includes acute coronary syndrome, myocardial infarction, and unstable angina.
I would like to request urgent cardiology consultation, repeat ECG, and cardiac enzyme tests, as well as provide aspirin and heparin therapy.”
Case Presentation of an Internal Medicine Patient hospitalized for COPD exacerbation.
Jayden is a 65-year-old male who was recently admitted for COPD exacerbation.
The patient has a past medical history of COPD, hypertension, and type 2 diabetes mellitus. He was initially admitted for increased shortness of breath, wheezing, and productive cough. During his hospitalization, he was treated with inhaled bronchodilators, systemic steroids, and antibiotics, and he demonstrated clinical improvement with resolution of his symptoms. His oxygen requirement decreased from 4L to 2L nasal cannula, and he was discharged home on the fourth day of admission.
The patient was readmitted 3 days later with worsening dyspnea and cough. His vital signs are within normal limits except for a low-grade fever of 100.4°F. On examination, he is sitting upright, using accessory muscles to breathe, and has decreased breath sounds with scattered wheezing. His oxygen saturation is 90% on 2L nasal cannula.
Based on the history and physical examination, my differential diagnosis includes recurrent COPD exacerbation, pneumonia, and pulmonary embolism.
I have requested a repeat chest x-ray, arterial blood gas analysis, and sputum culture. I would also like to request a consultation with the pulmonary team and infectious disease specialists for further evaluation and management. In the meantime, I have started the patient on supplemental oxygen, inhaled bronchodilators, and antibiotics.
Case Presentation - Shoulder Pain Example
The 5 minute Ortho Case Presentation:
“John Smith is a 52 year old right hand dominant male who presents with acute onset right shoulder pain. Pain is localized to the right subacromial space, worse with overhead activity and lifting, alleviated with rest. No inciting event or injury, this is gradual onset. No history of previous shoulder pain, no dislocations, no stiffness and no pain at rest. Treatments to date include NSAIDs and modified activities.
He is otherwise healthy. No medications. No known drug allergies.
He is right hand dominant, works full duties as a carpenter. Smokes 1 pack per day. Has not been able to participate in overhead weight lifting at the gym, or planks during yoga.
On exam, shoulder ROM is full with the exception of limited forward flexion and abduction measured at 120 degrees. Tenderness over the right subacromial space. Passively I was able to get full shoulder ROM. 4+/5 Rotator cuff strength testing. Positive Hawkin’s Kennedy Test, negative O’Brien’s and negative Apprehension. Patient is distally neurovascularly intact.
X-ray is within normal limits, with normal glenohumeral joint space, no evidence of bone spurs, there is a type 2 down sloping acromion.
In conclusion, John is a pleasant 52 year old male who presents with likely right shoulder impingement syndrome. My differential diagnosis includes rotator cuff tear, SLAP tear and adhesive capsulitis.
I would like to order an ultrasound and/or MRI of the right shoulder to rule out rotator cuff or labral tear, depending on findings of the ultrasound/MRI perhaps perform a diagnostic/therapeutic cortisone injection. I would also like the patient to start on some initial non-operative management such as modified activities or modified duties at work, a course of physiotherapy, topical or oral anti-inflammatories, and RICE. “
The 2-minute Ortho case presentation
52 year old RHD male presents with right shoulder pain, consitent with likely rotator cuff tear. Pain started 6 months ago, localized to right subacromial space. Worse with overhead activities and lifting. Has tried modified activities and NSAIDs. Patient is otherwise healthy. Shoulder ROM full and pain free with exception of forward flexion and abduction. 4+/5 RC strength. Positive Hawkin’s Kennedy. X-rays show type 2 acromion. I think this may be a rotator cuff tear, differential may be labral tear, adhesive capsulitis. I’d liek to order ultrasound/MRI, start physiotherapy, modified work duties, and NSAIDs. Follow-up after MRI completion to discuss potential diagnostic injection.
Final notes
Oral case presentations are an essential part of your clinical clerkship and medical education. They provide you with an opportunity to demonstrate your understanding of patient care and management and to receive feedback from attending staff.
By following the learning objectives, outline/template, and tips described in this post, you can develop the skills necessary to deliver effective case presentations. With practice and preparation, you can build your confidence and expertise and succeed in your clinical clerkship and beyond!
