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Presentation at Grand Rounds

1.Introduction « 2. FORMAT OF THE PRESENTATION » 3. Common Problems


Choice of Case and Preparation

Your object is not to present a case. It is to present a message. What is the message of the case that you hope the audience will pick up and take way with them? Ensure that you have decided what the message is and that your whole presentation, including the discussion, revolves round this.

Example: Your case has rheumatoid arthritis and improved on infliximab.

You will suppress irrelevant data about her previous hysterectomy etc. You will not present an undergraduate lecture on the definition, pathogenesis, clinical features etc of rheumatoid arthritis. You can assume your postgraduate audience knows this. What you may do is to describe how infliximab is believed to interrupt the inflammatory pathways operative in rheumatodi arthritis (but only briefly), and then review the published experience withinfliximab in RA (in more detail), concentrating on efficacy, complications etc, At all times relate the case you have presented to the discussion.

The value of a presentation lies in the discussion which arises from the case material, and not in the case itself. Remember that you should be presenting a problem or a subject rather than a person – the clinical details are only there to illustrate the message.

You can maximise the impact of your presentation by:

  • Keeping it short so as to maximise time for discussion.
  • Including only those clinical details essential to the message of the case.
  • Highlighting the interesting aspects of particular cases as you go along with the presentation.
  • Priming key people to contribute to the discussion.

Adequate preparation makes all the difference. Choose which of the following preparatory steps are most likely to make your presentation an excellent one and follow them:

  • Thoughtful preparation of the case material.
  • Rearranging order of information so as to make comprehension easier for the audience.
  • Ruthlessly suppressing unnecessary data.
  • Bringing out the underlying message.
  • Careful preparation of audio-visual material.
  • Discussing the presentation in advance with a senior colleague.
  • Practising the presentation out loud either in private or with a small audience.

Presentation of the Clinical Material

This is a public meeting – not a bedside presentation on a working ward round! The case must be prepared to be informative and entertaining – not a dry, undigested recital of the clerking notes. Present the case in chronological or logical order – beginning at the start of the illness or with the factors that gave rise to it.

Ruthlessly suppress all information not essential to an understanding of the case. If the audience wish to know something you haven’t mentioned, they are free to ask. This does not imply failure on your part. Your history-taking and examining ability are not the point at issue during a public presentation – rather your ability to abstract the important points and build them into a coherent presentation.

Remember that it is a subject or principle that we wish to discuss at the meeting – not the patient him/herself – indeed, the patient can even be a distraction. For example, every minute spent ploughing doggedly ahead with very correct and no doubt worthy but unimportant information about Granny’s bowel habits is a minute lost that experts in the audience could put to better use enlightening everyone about the finer points of her illness!

Shorter is better. With few exceptions, cases should be presented in no more than 10 minutes, leaving adequate time for discussion. Get to the point, stay on the point and ignore all that lies beside the point.

Presentation of Laboratory Data and Special Investigations

  • Confine yourself to the relevant data only: omit any normal results with no direct bearing on the presentation.
  • Provide normal ranges for less common tests.
  • There is no need to group all the special investigations together – introduce them where the impact is greatest. For example, it is often better to show the chest X ray immediately after you describe the physical findings in the chest.
  • Make use of graphs (best) or tables (second best) to show how values changed with time: do not clutter the table with normal values or values that remained unchanged.

The presentation is meant to make a point: not to represent a faithful record of how things unfolded in the order in which they unfolded.

Introducing the discussion

Dry summaries of textbooks or journal articles are forbidden.

Never insult the intelligence of your consultant audience by giving a lecture at undergraduate level on a particular disease. Either inform the audience briefly of some facts of which because of their rarity or novelty they may be unaware, or better still, merely supply sufficient background for a self-sustaining discussion to follow. Don’t try to pre-empt the experts In the audience. Do not encroach on the final 15 minutes which is reserved for discussion from the floor.

In particular, note the following:

1. Limit your discussion to one or two most relevant areas of the subject: clinical signs or complications or diagnosis or treatment or whatever. Do not plogh through Definition, Aetiology, Pathogenesis, Presentation, Diagnosis, Complications, Therapy as though you were writing a textbook. This is not the purpose of a presentation at Grand Rounds.

2. It may make more sense to begin with your discussion or literature review; when the audience has digested this, they may be in a better position to see the relevance of your case.

3. Be prepared to be interrupted as you present. The greatest educational impact of discussion of a particular point is when it is freshest in people’s memories – when the CT scan or the lab results are up on the screen, or when you have just said something (which you yourself may not realise is) interesting.

4. Do not give lectures on subjects which the experts in the audience can summarise far more appropriately and efficiently than you. The purpose of your presentation is not to show how conscientious you are, but to facilitate discussion.

Appropriate use of audio-visual aids

See the section Appropriate use of audio-visual aids

Style of presentation

The presentation should be entertaining. Relax, speak idiomatically (though avoid slang), comment as you go along, allow a little humour to creep in. Avoid flippant or inappropriate remarks. Replace a boring introduction with something both more interesting and more informative, as illustrated here:

Standard introduction (boring): “The patient I wish to present is a 54 year old man from Umlazi with renal failure secondary to hypertension and poor compliance.”

Intelligent introduction: “Though we may sometimes wonder what good we achieve with the millions of rands spent on antihypertensive medication, my patient, a 54 year old man from Umlazi, is an unfortunate example of the consequences of ignoring this common, silent but potentially deadly disease.” (Not only is this more interesting, but it is more profound in that it argues from this specific case to general experience.)

Avoid jargon. Why say “Further questioning revealed a history of significant ethanol consumption which may have played a role in the pathogenesis of his cirrhosis” when you can say “He finally admitted to heavy drinking, which probably accounts for his cirrhosis”?

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