Tips on how to present on Mr Moore’s ward rounds

What Mr Moore looks for in a consultant ward round presentation

There is a long tradition of consultant surgeon teaching ward rounds in the UK.  Students and trainee doctors gain from them by seeing numerous patients with differing pathologies and by having teaching from an experienced consultant.  Consultants gain from them because information is presented that helps a consultant decide on further medical management.  Nurses gain from them by learning directly about the consultants opinions on their patient’s care and by being able to directly give their own opinions to the consultant surgeon. The patient gains from them by listening to the multi-disciplinary team and by learning more about their own condition and the medical plans.

The best way for medical students and trainee doctors to get the most out of the consultant ward round is not to stand at the back and let their imagination drift off but to present a patient to the consultant.  This will allow the consultant to specifically focus on that individual student or trainee and give them teaching about their presentation skills and the patient’s medical condition.  It is a scarey business standing up and presenting in front of a big group of people but as with a lot of things in life, practice makes perfect and the more you do it the easier it becomes.

Please remember that Mr Moore’s consultant ward rounds are not official exams and you have the space to hone your presentation skills in a supportive environment.  You also have the space to highlight anything that you were not certain about or anything that you found particularly difficult.  Mr Moore is very happy for any questions, no matter how stupid they may seem, to be asked at any time.  You should also feel free to ask questions to any member of the team.

Mr Moore likes patient presentations to be conducted in front of the patient so that the patient has the opportunity to correct any information if they feel that it is wrong.  It also allows patients to be a part of their medical management development process.

Here are some tips for that prized first class patient presentation!……

Choosing a patient

It is better to have one high quality patient presentation rather than multiple low quality presentations so pick just one patient to present at first.  Contact Mr Moore’s firm doctors to find out the list of patients to be presented.  You may need to come in early at 7am and check before the 8am post take ward round for a patient to present from the on-call night F1 and then you could go home early to make up for that early start another day.  Pick a patient that interests you and pick a patient that will definitely need to be presented on the consultant ward round by avoiding handbacks and patients that are going home.

Alternatively, if you are not ready by the start of the ward round, then you can find out which patients are not taken by the other medical students at 8am on the level 9 bridge and then you can go off to clerk in one of those patients and you can then present what you have gathered so far when Mr Moore or Mr lamah comes by your patient on their post take ward round.

See the patient

Make sure that you go to see the patient yourself.  Introduce yourself and ask if you can interview them.  Conduct your own history and examination and formulate your own differential diagnosis and management plan before reading the hospital notes so you get in to the discipline of trying to make your own mind up before being affected by the opinions of others.  Check the nursing observations chart, fluid balance chart and the drug chart.

Read the hospital notes and nursing notes

Now read the doctors clerking and nursing notes and see whether other health professionals agree with your own opinions.  If they do not then you should question why and ask someone if you do not understand.  Take note of any investigation results and if you do not see them ask a doctor or nurse to help you.

Write up your presentation

Now write up your presentation and this would ideally be filed in to the hospital notes with the date, time, your name in clear writing, your title in clear writing (eg medical student) and your signature included at the end.  The following subheadings are recommended:

Presenting complaint, History of presenting complaint, Functional or systems enquiry, Past medical history, Family history, Drug history and allergies, Smoking and alcohol history, Social history

Examination and observations

Investigations (blood tests, radiology)

Differential diagnosis (list three possibilities-see surgical sieve link below)

Medical management so far delivered

One sentence summary (not a whole paragraph!)

Giving your presentation

Make sure you let Mr Moore know that you would like to present after he has introduced himself to the patient.  Medical students are given first priority for presenting followed by F1 house officers.  Stand up straight, take a deep breath and go for it!  It is not cheating to read from your notes while you present and this will make sure that you remember to mention all of the recommended subheadings above.  Medical students should try to give detailed presentations to show that they know the relevant subheadings but F1s and more experienced doctors should practice concentrating on the positives in the history and examination and being more efficient with their presentation time.  Use professional medical language because this is a formal presentation and pretend that you are on the phone to everyone so you do not start pointing to places on your own body while you present.  Avoid fidgeting!  Make sure that the endpoint of your presentation is clear by using the one sentence (only one sentence!) summary and let Mr Moore know if you do not understand any aspects of the case or if there was something that you found particularly difficult.  To start with you will find presenting on the ward round quite stressful but those that put themselves forward will be rewarded with dedicated teaching tailored to their personal presentation and case and they will find that the stress starts to melt away with each subsequent presentation.  Students and trainee doctors who practise presenting on the consultant ward round will also find that they cope much better with consultant examiner conversations.  At the end listen to Mr Moore’s patient management plan and make sure that you ask if you have any questions about this.

Good luck and go for it!