Teaching Rounds

Teaching rounds are an opportunity to practice the art of the oral presentation, to ask questions in an environment that is less hurried than work rounds, to develop a differential diagnosis for each patient presented, and to discuss issues that are raised throughout the medicine rotation. Think of the attending as a resource to tap by asking questions. Get the most out by challenging the attending with questions.

Patient Presentations

Each student should present at least three patients.

Presenter:

  • Don’t present the same patient twice (don’t present the 76 y/o WM with the interesting history and diagnosis during teaching rounds and then again during Chairman Rounds). Each patient is interesting in their own way and you will learn much more by presenting a different patient (Ann Intern Med. 1999;130:70-72).
  • End each presentation with a question (why did we do this? What did that result mean?)
  • Develop a differential diagnosis for each patient presented that includes the two to three most likely diagnoses. It is ok to ask for help from your residents and interns.
  • The presentation should be no longer than ten minutes. The data (HPI, PE, labs, tests) should take five minutes. The last five minutes should be spent discussing your clinical reasoning (give a DDx with two to three possibilities and your justification for each). Finally, give a plan for how to further workup the patient.

Listeners:

  • Ask questions – if you don’t know the meaning of a sign, symptom, medication, illness or test, don’t be afraid to ask questions during someone else’s presentation. If you don’t understand something, you are probably not alone.
  • Expand on the differential diagnosis, if appropriate, and justify your additions.
  • As you listen, think about:
    • Was the presentation about ten minutes, with half the time spent on data and half the time used to explain clinical reasoning?
    • Did the story (HPI) flow? Could you follow it? Was it chronological?
    • Was there unnecessary data? Was important information left out (pertinent +’s and –‘s)?
    • Did the differential diagnosis include at least two to three relevant possibilities? Did it flow from the data?
    • Did the presentation end with a question?
  • Finally, formulate your own question based on the presentation and ask it.