Making SOAPS SAFER A model for Teaching and Evaluating Oral Case Presentations

Making SOAPS SAFER

A model for Teaching and Evaluating Oral Case Presentations

Faculty Eric H. Green Linda DeCherrie Mark Fagan Warren Hershman Brad Sharpe Jeffrey Wiese

In absentia Jeffrey Greenwald Sandhya Wahi-Gururaj Nancy Torres-Finnerty

For more information contact

Eric H. Green MD, MSc

[email protected]

718-920-5619

Context

Increasing emphasis on patient-doctor communication. ACGME competencies. USMLE Clinical Skills Assessment.

Premium on accurate, pertinent and cogent MD to MD communication. Dizzying pace of clinical care. Frequent patient ‘handoffs’---RRC Work Hours

Regulations, Night Float Systems.

“This is not easy”

Presentation skills are a complex synthesis: Knowledge and experience. Clinical reasoning. Speaking skills. Expectations.

What are your experiences?

RIME: Framework for Student Progress Reporter: Consistently good in Interpersonal skills:

reliably obtains and communicates clinical findings Interpreter: Able to prioritize and analyze patient

problems Manager: Consistently proposes reasonable options

incorporating patient preferences Educator: Consistent level of knowledge of current

medical evidence; can critically apply knowledge to specific patients

Our Model: Making SOAPS SAFER

Teaching & Evaluating Oral Presentations is a complex process Bad presentations are obvious

“I know it when I see it” Next questions

What was good and bad about it? What knowledge, skills or attitude deficit caused this

pattern? How can this deficit be remediated?

Challenges Many things wrong Where to start

Schematic model: What usually occurs

Recommend changesHow can it be fixed?

Schematic model: Proposal

Cite specific examples

Recommend changes

Clarifying Questions

What is good and bad?

What caused this?

How can it be fixed?

Identifying Strengths and Weaknesses 5 basic qualities of an oral presentation

SOAPS Frame evaluation and feedback Provide a basis for didactic instruction

5 Basic Qualities of an Effective Presentation: SOAPS Story: Identify and describe complaints

Organization: Facts are where the listener expects.

Argument: “Makes the Case” for assessment and plan

Pertinence: Only includes information relevant to the assessment and plan

Speech: Fluent, well spoken

Story Key elements

Accurate Detailed Chronologic

Problems: Hard-to-follow

Organization

Key elements Standardized Logical

Problems “All over the place” “Worksheet”

Argument Key elements

Commits to a patient-specific assessment/plan Presentation leads listener to this conclusion

Problems “Scavenger Hunt” generic

Pertinence Key elements

Relevant facts included Irrelevant facts excluded

Problems “All inclusive” Smorgasbord

Speech Key elements

Speed and tone Spoken, not read

Problems “Garbled” Read


Cite specific examples

Recommend changes



What caused this?


SOAPS

What deficit caused this Most problems in presentation can have

multiple etiologies 5 potentially correctable deficits (SAFER)

Possible Correctable Deficit: SAFER Speaking: Poor elocution skills Acquisition of Knowledge: Topic specific knowledge

deficits (facts or experience) Facts: Reports incorrect facts or omits facts Expectations: Unaware of needs of listener or

standards Reasoning: Omits or incorrectly applies clinical

reasoning

What deficit caused this Most problems in presentation can have

multiple etiologies 5 potentially correctable deficits (SAFER)

Use iterative questions

Speaking Clarifying questions

Tell me in your own words what you think when…. Potential areas of remediation

Insufficient preparation time Anxiety

Acquisition of Knowledge Clarifying Questions

Explain for me how…? Potential areas of remediation

Knowledge deficit (basic science or beyond) Over reliance on previous experience (n=1 trials)

Facts Clarifying Questions

Did you obtain any information about…? Potential areas of remediation

Poor data acquisition (Hx or PE, “night float”) Poor data retention (memory, notes, fatigue,

patient volume)

Expectations Clarifying questions

What information do you think the attending needs to…

Potential areas of remediation Incomplete or conflicting knowledge regarding

conventions Inaccurate beliefs regarding needs of the listener

Reasoning Clarifying Questions

How did you interpret…? Potential areas of remediation

Poor understanding of clinical reasoning techniques

Incomplete understanding of appropriate applications for clinical reasoning


Cite specific examples +/-

Recommend changes



What caused this?


SOAPS

SAFER


Cite specific examples +/-

learner suggests remediation strategies



What caused this?

SOAPS

SAFER

Support and follow-up

Pearls for the learner

Story: Think of the oral case presentation as building a

case as an attorney wouldin a court of law. You are providing information to allow others to come tothe assessment and plan you did. You are also providing enough informationto have them help you care for your patient.


Organization Starting with the chief complaint orients your listeners and

prepares them for what follows. “Don’t eat the dessert before the salad” – never change the

basic format of the presentation – it is always the same. (ID, HPI, PMH, MEDS, ALL, SH, etc.).

Use standard headings to keep your listeners oriented. The relevant past medical history is... On physical exam I found… In summary...

If you put family history, social history, or parts of the review of systems into the history of present illness, there is no need to repeat it later in presentation


Argument An oral presentation is supposed to be a bedtime story not

a suspense thriller. Everything is designed to support an assessment and plan that should never be a surprise.

Pertinence If you’re not sure if a detail is relevant leave it out of the

oral presentation. Your listener can always ask for more. Think of the oral presentation as the “Cliff’s notes” version

of the written H&P – it includes all the details you need to understand the plot but not much more.


Speech Practice your presentation at least once before giving it.

General: If you lose people's attention, think about what part of the

presentation lost them. If preceptors keep asking for the same types of information after

your presentation then include it! The assessment and plan is a wonderful opportunity for you to

demonstrate your clinical reasoning and medical knowledge. Don't miss this chance to shine!

Always know what your listener is expecting to hear – 2 minutes or 7 minutes? All of the labs or just the abnormal ones?

Never “act out” the physical exam while you are presenting. Use your words, not your hands.

Pearls for the teacher

Teaching Remind learners this is a standard of the medical

profession that they will be using throughout their careers. This is not the teacher’s personal style or just another requirement to pass a rotation.

Try to avoid teaching solely by example (“you could say it like this . . . “). Instead, identify the deficit and have the learner try again.


Evaluation Use your interactions with the learner outside of the

presentation to help inform you as to which deficit they have.

Allow the learner to identify their weaknesses before you comment

Concentrate on identifying the biggest problem in the presentation and start to intervene there.

Feedback Take notes during a presentation. When providing

feedback, refer to specific things the learner said.

Documents

Making SOAPS SAFER A model for Teaching and Evaluating Oral Case Presentations