Template For Success: The Medical Student Guide To Presenting During Bedside Rounds

“Before anything else, preparation is the key to success”, as inventor of the first telephone, Alexander Bell, would say. Especially on your first inpatient wards rotation, the feeling of going down the patient list and knowing you will be presenting next can be nerve-racking. What I have learned is that the more prepared I was to present, the less sweaty palms I would have before presenting. After a few inpatient medicine rotations, I started to get the hang of how I like to gather and organize information to present later. My main tool was a template I would use every morning during chart review and after visiting my patients.
Everyone has their own version of a “template”. At every inpatient rotation, I watched interns, seniors, and fellows jot down notes in their own style. I realized that I started adopting their different styles, but realized that every template has a backbone to ensure success at presenting at rounds. The backbone consists of a simple order of information for every patient presentation. Unlike presenting for a new admission, presentations during bedside rounds tend to focus more on interval events mainly in the past 24 hours, how the patient is progressing, and changes to the assessment and plan based on recent findings.

TEMPLATE ESSENTIALS:
  1. HPI – One liner that generally consists of a standard backbone of “Mr. Doe is a XX-year-old male with history of _____ who presented on (date of admission) with ____. “
PRO TIP: Some past medical history can be more detailed, but offer important information about the patient’s current state. Consider, what kind of heart failure? (It is better to say HFpEF or HFrEF, rather than CHF.) Are they taking insulin? (If so, mention insulin-dependent type 2 diabetes, rather than just diabetes.)
  1. Interval events – chronological list of pertinent events that happened since admission
PRO TIP: If you are presenting the same patient again with the same attending, you often do not need to say the interval events since admission again. But you should be prepared to say if any new events occurred since the last time you presented.
  1. Overnight events
  2. Subjective – how patient is doing this morning
PRO TIP: Give yourself enough time to see every one of your patients before bedside rounds.
  1. Objective – Vitals, pertinent physical exam findings
  2. Any new labs and imaging – write them all down, present the pertinent findings. PRO TIP: If you are trending a certain value (i.e. hemoglobin in a patient with a possible acute bleed), present it as higher or lower relative to the last value. 
  3. Assessment and Plan – Do not skip this, and try not to say the same plan as yesterday. Attendings often judge a medical student’s ability to reason by this section.
PRO TIP: Meet with your resident ahead of rounds to discuss possible changes to the management in care. Do not expect your resident to give you answers. Try to formulate them on your own as this is the best way to learn.

Other tips to keep in mind:
  • It is absolutely imperative to know EVERYTHING about your patient. Although you might not present the patient’s extensive list of medications during rounds, your attending may ask about what medications the patient is currently on. You want to be prepared for these questions by writing them down somewhere.
  • That being said, it is perfectly okay and human to miss a detail. If your attending poses a question that you do not know, it is better to be honest and say you will follow up on that. If you round with computers at bedside, you may get a chance to look up the needed information. Do not forget to update the team with your findings.
  • LEARN TO ADAPT – Bedside rounds are often dependent on the attending. Sometimes they are table rounds. Sometimes they are less formal and require a short mention of the current status and plan. Rather than being thrown off, learn to adapt by taking cues from the rest of the team. 
  • For the new patient (or for the new attending):
    • Be more thorough with your presentation. You may need to present all pertinent interval events since admission in order to accurately narrate the patient’s story.
  • Write notes during rounds. Use a different colored pen to jot down notes that you may need to follow up on.

I hope these quick and easy tips help you shine on your rotations!
 
Posted by Pamela Vila on Jan 31, 2019 11:43 AM America/New_York