oral case presentation rubric

Rubrics for Oral Presentations

Introduction.

Many instructors require students to give oral presentations, which they evaluate and count in students’ grades. It is important that instructors clarify their goals for these presentations as well as the student learning objectives to which they are related. Embedding the assignment in course goals and learning objectives allows instructors to be clear with students about their expectations and to develop a rubric for evaluating the presentations.

A rubric is a scoring guide that articulates and assesses specific components and expectations for an assignment. Rubrics identify the various criteria relevant to an assignment and then explicitly state the possible levels of achievement along a continuum, so that an effective rubric accurately reflects the expectations of an assignment. Using a rubric to evaluate student performance has advantages for both instructors and students.  Creating Rubrics

Rubrics can be either analytic or holistic. An analytic rubric comprises a set of specific criteria, with each one evaluated separately and receiving a separate score. The template resembles a grid with the criteria listed in the left column and levels of performance listed across the top row, using numbers and/or descriptors. The cells within the center of the rubric contain descriptions of what expected performance looks like for each level of performance.

A holistic rubric consists of a set of descriptors that generate a single, global score for the entire work. The single score is based on raters’ overall perception of the quality of the performance. Often, sentence- or paragraph-length descriptions of different levels of competencies are provided.

When applied to an oral presentation, rubrics should reflect the elements of the presentation that will be evaluated as well as their relative importance. Thus, the instructor must decide whether to include dimensions relevant to both form and content and, if so, which one. Additionally, the instructor must decide how to weight each of the dimensions – are they all equally important, or are some more important than others? Additionally, if the presentation represents a group project, the instructor must decide how to balance grading individual and group contributions.  Evaluating Group Projects

Creating Rubrics

The steps for creating an analytic rubric include the following:

1. Clarify the purpose of the assignment. What learning objectives are associated with the assignment?

2. Look for existing rubrics that can be adopted or adapted for the specific assignment

3. Define the criteria to be evaluated

4. Choose the rating scale to measure levels of performance

5. Write descriptions for each criterion for each performance level of the rating scale

6. Test and revise the rubric

Examples of criteria that have been included in rubrics for evaluation oral presentations include:

• Knowledge of content
• Organization of content
• Presentation of ideas
• Research/sources
• Visual aids/handouts
• Language clarity
• Grammatical correctness
• Time management
• Volume of speech
• Rate/pacing of Speech
• Mannerisms/gestures
• ​​​​​​​Eye contact/audience engagement

Examples of scales/ratings that have been used to rate student performance include:

• Strong, Satisfactory, Weak
• Beginning, Intermediate, High
• Exemplary, Competent, Developing
• Excellent, Competent, Needs Work
• Exceeds Standard, Meets Standard, Approaching Standard, Below Standard
• Exemplary, Proficient, Developing, Novice
• Excellent, Good, Marginal, Unacceptable
• Advanced, Intermediate High, Intermediate, Developing
• Exceptional, Above Average, Sufficient, Minimal, Poor
• Master, Distinguished, Proficient, Intermediate, Novice
• Excellent, Good, Satisfactory, Poor, Unacceptable
• Always, Often, Sometimes, Rarely, Never
• Exemplary, Accomplished, Acceptable, Minimally Acceptable, Emerging, Unacceptable

Grading and Performance Rubrics Carnegie Mellon University Eberly Center for Teaching Excellence & Educational Innovation

Creating and Using Rubrics Carnegie Mellon University Eberly Center for Teaching Excellence & Educational Innovation

Using Rubrics Cornell University Center for Teaching Innovation

Rubrics DePaul University Teaching Commons

Building a Rubric University of Texas/Austin Faculty Innovation Center

Building a Rubric Columbia University Center for Teaching and Learning

Rubric Development University of West Florida Center for University Teaching, Learning, and Assessment

Creating and Using Rubrics Yale University Poorvu Center for Teaching and Learning

Designing Grading Rubrics ​​​​​​​ Brown University Sheridan Center for Teaching and Learning

Examples of Oral Presentation Rubrics

Oral Presentation Rubric Pomona College Teaching and Learning Center

Oral Presentation Evaluation Rubric University of Michigan

Oral Presentation Rubric Roanoke College

Oral Presentation: Scoring Guide Fresno State University Office of Institutional Effectiveness

Presentation Skills Rubric State University of New York/New Paltz School of Business

Oral Presentation Rubric Oregon State University Center for Teaching and Learning

Oral Presentation Rubric Purdue University College of Science

Group Class Presentation Sample Rubric Pepperdine University Graziadio Business School

Creating an Oral Presentation Rubric

In-class activity.

This activity helps students clarify the oral presentation genre; do this after distributing an assignment–in this case, a standard individual oral presentation near the end of the semester which allows students to practice public speaking while also providing a means of workshopping their final paper argument. Together, the class will determine the criteria by which their presentations should–and should not–be assessed.

Guide to Oral/Signed Communication in Writing Classrooms

To collaboratively determine the requirements for students’ oral presentations; to clarify the audience’s expectations of this genre

rhetorical situation; genre; metacognition; oral communication; rubric; assessment; collaboration

• Ask students to free-write and think about these questions: What makes a good oral presentation? Think of examples of oral presentations that you’ve seen, one “bad” and one “good.” They can be from any genre–for example, a course lecture, a museum talk, a presentation you have given, even a video. Jot down specific strengths and weaknesses.
• Facilitate a full-class discussion to list the important characteristics of an oral presentation. Group things together. For example, students may say “speaking clearly” as a strength; elicit specifics (intonation, pace, etc.) and encourage them to elaborate.
• Clarify to students that the more they add to the list, the more information they have in regards to expectations on the oral presentation rubric. If they do not add enough, or specific enough, items, they won’t know what to aim for or how they will be assessed.
• Review the list on the board and ask students to decide what they think are the most important parts of their oral presentations, ranking their top three components.
• Create a second list to the side of the board, called “Let it slide,” asking students what, as a class, they should “let slide” in the oral presentations. Guide and elaborate, choosing whether to reject, accept, or compromise on the students’ proposals.
• Distribute the two lists to students as-is as a checklist-style rubric or flesh the primary list out into a full analytic rubric .

Here’s an example of one possible rubric created from this activity; here’s another example of an oral presentation rubric that assesses only the delivery of the speech/presentation, and which can be used by classmates to evaluate each other.

Oral Presentation Rubric

About this printout

This rubric is designed to be used for any oral presentation. Students are scored in three categories—delivery, content, and audience awareness.

Teaching with this printout

More ideas to try, related resources.

Oral presentation and speaking are important skills for students to master, especially in the intermediate grades. This oral presentation rubric is designed to fit any topic or subject area. The rubric allows teachers to assess students in several key areas of oral presentation. Students are scored on a scale of 1–4 in three major areas. The first area is Delivery, which includes eye contact, and voice inflection. The second area, Content/Organization, scores students based on their knowledge and understanding of the topic being presented and the overall organization of their presentation. The third area, Enthusiasm/Audience Awareness, assesses students based on their enthusiasm toward the topic and how well they came across to their intended audience. Give students the oral presentation rubric ahead of time so that they know and understand what they will be scored on. Discuss each of the major areas and how they relate to oral presentation.

• After students have completed their oral presentations, ask them to do a self-assessment with the same rubric and hold a conference with them to compare their self-assessment with your own assessment.
• Provide students with several examples of oral presentations before they plan and execute their own presentation. Ask students to evaluate and assess the exemplar presentations using the same rubric.
• Students can do a peer evaluation of oral presentations using this rubric. Students meet in partners or small groups to give each other feedback and explain their scoring.
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Reliability of rubrics in the assessment of orthodontic oral presentation

The aim of this study was to evaluate the reliability of using rubrics in dental education, specifically for undergraduate students’ assessment in orthodontic oral presentation.

A rubric-based case presentation assessment form was introduced to three contributing instructors. In each instructor’s group, the course director, along with the assigned instructor, assessed 8 randomly selected fourth year male dental students utilizing the same assessment form (total of 24 students). The two final scorings made by the assigned instructor and the course director were then gathered for each student. The data of this prospective comparative study then was analyzed using paired t -test to look for any significant differences in the scoring of the course director and each instructor in each group.

No significant statistical differences were detected in grading variables between the instructors and the course director. Furthermore, the data showed no significant correlations between the students’ final course grade, and their case presentation grades scored by instructors’/course director.

Despite the elaborate nature of the routine orthodontic case presentation, the use of rubrics was found to be a promising reliable assessment element.

1. Introduction

Teaching and healthcare practice are interrelated. This is due to the service delivery system that requires the attendance of different personal with different levels of knowledge and experience. Teaching in the clinical environment is defined as teaching and learning focused on, and usually directly involving, patients and their problems ( Spencer, 2003 ). And it is interesting to know that the word ‘doctor’ is derived originally from the Latin word “docere”, which means “to teach” ( Shapiro, 2001 ).

Whether in healthcare profession teaching or not, the process of learning and student comprehension is complicated. Many methods have classically proposed ways of thinking behaviors that is believed to be important to the process of learning. Bloom’s taxonomy was among the earliest and focused on the knowledge (cognitive) domain ( Bloom and Krathwohl, 1956 ). Other domains focused on the attitude (affective) domain ( Krathwohl and Bloom, 1964 ) and skills (psychomotor) domain ( Simpson, 1972 ). Curry Onion-Model of learning described further the different aspects (i.e. as layers of onion) of learner and how they learn ( Curry, 1983 ). Each style is characterized by specific features including the ability to acquire knowledge, sort and store information, learners’ interaction with peers and society. Making an assessment to test the learner should touch and consider these styles.

Based on the various domains incorporated into the leaning system, an ideal process of student assessment should cover the attitude, skills and knowledge domains. This can be a complex task, however, the awareness of the importance of these aspects in the assessment process is essential.

Assessment can be formative or summative. Formative assessment is essential for monitoring performance during a program of study, while summative assessment usually done at the end of a program such as competency and licensing examinations. Whether formative or summative, methods of assessment vary and require critical planning where any chosen method of assessment must reflect on the nature of the acquired knowledge being tested.

Many evaluation models were proposed based on each learning domain. The objectives approach ( Tyler, 1949 ) provide a consistency between goals, experience, and outcomes. It includes pretest and posttest design that students’ progress can be measured from. The Goal-Free Assessment model ( Scriven, 1991 ) advocates the implementation of an external evaluator whom is unaware of the stated goals and objectives. The value of a program will be determined based on the outcomes of a program and its quality. Unlike the CIPP model (context, input, process, and product), where the information for assessment is being gathered from a variety of sources to provide basis for making better decisions ( Stufflebeam, 2003 ). Other models were also proposed such as the Hierarchy of Evaluation model ( Kirkpatrick, 1979 ), and the Naturalistic model ( Guba, 1978 ). Additional assessment method that was found to be reliable in clinical setting for health care professional is the RIME method ( Pangaro, 1999 ). It has four stages of students’ development beginning with being a reporter, interpreter, manager, and then educator that leads to professionalism in medicine.

The assessment is the curriculum, as far as the students are concerned ( Ramsden, 1992 ). And whether or not any these assessment models are being adopted, the assessment process has to be undertaken properly to be reflective of the actual students’ actual learning. One of the tools used in assessment nowadays is the use of rubrics. Rubrics can be defined as: a scoring guide or scale consisting of a set of criteria that describe what expectations are being assessed/evaluated and descriptions of levels of quality used to evaluate students work or to guide students to desired performance levels.

The use of rubrics has many advantages such as enhancing the quality of direct instructions, save the time used for explanting the assignment, and increases the efficiency of marking ( Hancock and Brundage, 2010 ), and produce grading calibration( Turbow et al., 2016 ). It improves the quality of students’ projects outcomes by providing clear guidelines regarding the expected criteria. It simply fulfills the required need of shifting the assessment methods from being subjective, to fairly objective.

Rubrics are mainly of two types, analytic and holistic. The analytic type is a more of detailed version of rubrics that identifies and assesses the individual components of a completed project. While the holistic assesses student work as a whole. There are also some subtypes of rubrics such as weighting rubrics. Weighting rubrics is an analytic rubric in which certain concepts are judged more heavily than others ( Dong et al., 2011 ).

The process of formulating rubrics can be initially difficult; thus, it requires support, time, and practice. It mainly consists of three major steps. First, the evaluation criteria and the concept being taught have to be chosen. This step is followed by organizing these criteria, and developing a grid and inserting criteria.

In the last decade, rubrics were incorporated in the teaching curriculum of many fields. Recent literature shows its wide applicability and acceptance in the teaching of medicine ( Baldwin et al., 2009 , D'Antoni et al., 2009 ), nursing ( Daggett, 2008 ), and pharmacy ( Blommel and Abate, 2007 ). In dentistry, Assessment rubric was used for third year dental student in developing a course toward mastering sound communication skills with patients ( White et al., 2008 ). Also, scoring rubric was implemented to evaluate dental student portfolios as a mean of student competency assessment ( Gadbury-Amyot et al., 2003 ).

Oral case presentation typically included in most of healthcare taught courses. The task allows for initiation of self-learning process, and assess clinical reasoning competency ( Wiese et al., 2002 ), thus requires a crucial assessment tools to reflect student’s comprehension. Peer assessment is widely used in this felid as an effective formative assessment tool ( Speyer et al., 2011 ). Other methods including the use of rating scale ( Lewin et al., 2013 ). Whatever the assessment method used, objective reliability stands as important requirement. Although proposals to control such variability was introduced earlier ( Kroboth et al., 1992 ), a continued effort and search shall continue to ensure consistency and reproducibility of such process in the teaching and assessment of each discipline.

Oral case presentation is a vital component of teaching in the discipline of orthodontics. Due to the multiple elements required in its case presentations, the ambiguous level of knowledge display expected, and the increase number of students requiring multiple assessors, a form of rubric is needed to control the process of assessment. The primary aim of this study was to evaluate the reliability of using such a method in dental education, specifically for orthodontic oral case presentation for undergraduate students’ assessment. As a secondary aim, potential correlations between instructors’/course director grading and the students’ final course grade were investigated.

2. Materials and methods

During a series of three weeks orthodontic case presentation sessions, a new rubric-based case presentation assessment form ( Fig. 1 ) was designed and introduced to three contributing instructors (Instructor A, B, and C). The form included three major categories concerning the quality of records, accuracy of data, and display of understanding the materials being presented. Each category was subdivided for two items for the ease of grading. A simple grading scale (grid) was displayed at the bottom of the page. Additionally, the form included grading guidelines that contained a sample of questions that can be asked during the presentation.

Rubric-based orthodontic case presentation form used to evaluate students. Note categories distribution, grading guidelines, and the grading scale.

Prior to the beginning of the case presentation session, 5 min were spent with each instructor to introduce the form. The forms were also presented and supplied to the studied fourth year male dental students early before they started working on their presentation preparation. In each instructor’s group, the course director (C.D.), along with the assigned instructor, assessed the first eight students utilizing the same assessment form (total of 24 students). The two final scorings made by the assigned instructor and the course director were then gathered for each student. The instructors were blinded to the fact that the course director was also taking part of the assessment process.

The data of this prospective comparative study was then analyzed using paired t -test to look for any significant differences in the scoring of the course director and each instructor in each group. Furthermore, Pearson’s correlation was applied to test for any significant correlations between the instructors’/course director’s grading and the students’ final course grade. Also, correlations between the discrepancies of the instructors’/course director’s grading (Instructor’s grade – C.D. grade) and the students’ final course grade was investigated. All statistical analysis was performed using SPSS program (Version 16 SPSS Inc., Chicago, IL), as part of internal course quality assurance initiative.

Table 1 shows the mean grades scored for each pair of instructor and C.D. Some discrepancies were found, however, discrepancies were minimal and did not reflect any statistical significant when subjected to paired t -test analysis.

Means of course director’s and instructors’ A, B, and C scorings along with p-value for paired t -test statistics being applied for each pair of assessors.

No significant correlations have been detected between the instructors’/course director’s grading and the students’ final course grade. Furthermore, correlations between the discrepancies of the instructors’/course director’s grading (Instructor’s grade – C.D. grade) and the students’ final course grade did not show any significant correlations (p = 0.585).

4. Discussion

The use of rubric is well documented in the literature for not only formal course assessment, but also in online course evaluation and development ( Blood-Siegfried et al., 2008 ). The strength of this tool enabled its application in many aspects of the field of teaching. The present study attempted to investigate the reliability of its use to assess students’ orthodontics oral case presentation. The use of rubric-based method was applied in assessing other students' case and research presentations (in pharmacy, and surgery fields respectively) and was found to be a successful tool ( Musial et al., 2007 , O'Brien et al., 2008 ).

The assessment form contained specific criteria listed in three categories. This is in order to serve as a guide for instructors’ assessments and as a tool for student learning during their preparations. Therefore, a blank copy was introduced and supplied to the students early before they started preparing their presentations. Generally, students appreciate clear guidelines to help them complete procedures. Repeated use of the rubric provides opportunities for student to achieve competency ( Dong et al., 2011 ).

The results showed that there were no statistical significant differences between the scoring among each instructor and the course director. The form produced appeared to be reliable for assessing orthodontic case presentation. The process of grading was consistent, thus minimizing students’ complaints from inconsistent grading. Kruger & Dunning (1999) demonstrated that the poor students tend to overestimate themselves, and vice versa. Using rubric would get students’ attentions to appreciate their deficiencies from their own prospective ( Kruger and Dunning, 1999 ). Thus minimizing discomfort and criticism that is associated with the feedback delivery process ( Wood, 2000 ).

It was hypnotized that better performing students would display more consistent grading among different assessors. The present data however did not support this hypothesis. There was no significant correlation (p = 0.585) between the instructors’/course director’s grading discrepancies (Instructor’s grade – C.D. grade) and the students’ final course grade. Possibly due to the criteria listed in the form that controls the grading process regardless of the student’s overall knowledge and course standing as reflected by his/her final course grade.

In order for a rubric to be more efficient, sometimes students should participate in the formulation of their own assessment rubric. This would result in a use of a language of both faculty members and students that would clearly represent expectations of each criterion and standard ( Moni et al., 2005 ). Even that the results indicates reliable rubrics from the assessment side, a feedback must be always sought from student to aid in the upcoming revision process of the rubric. The presented rubric and its wording has been found to be fairly accepted by current students.

The mean grade the randomly selected students for the oral presentation ranged from 5.20 to 5.66 out of 6.00. This indicates that on average students have performed well in their presentations. This can be attributed to the rubric guidelines presented early for the students to set their expectations and guide them through the preparation process. The rubric supplied has served as instant student feedback tool. Providing effective feedback was shown to enable students to develop a deeper approach to their learning and improve learning outcomes ( Mohanna and Chambers, 2003 ).

The present study illustrated the applicability and value of using rubric in orthodontic case presentation assessment. It would stimulate further studies to propose rubric methods to be implemented in the teaching of orthodontics. Further studies can be initiated to re-evaluate the reliability of the presented form in different academic settings and larger sample size, given the limited current sample size number. Another limitation of the current study that can be considered in reproducing its method, is the inclusion of subjection from both genders. Furthermore, the current grading scale of the form (three categories), can be further expanded into four or five assessment’s ranking.

5. Conclusion

The use of rubrics was found to be a promising reliable element to be included in the assessment of orthodontic courses. This study would stimulate the development of a valid well-defined orthodontic oral case presentation assessment form that can be tested on a larger group. Such form can be developed not only for instructor’s use, but also for peer and self-assessment applications.

Peer review under responsibility of King Saud University.

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The Oral Case Presentation: A Key Tool for Assessment and Teaching in Competency-Based Medical Education

Affiliations.

• 1 Wilson Centre, University of Toronto, Toronto, Ontario, Canada3HoPingKong Centre, University Health Network, Toronto, Ontario, Canada.
• 2 Department of Medicine, University of Toronto, Toronto, Ontario, Canada3HoPingKong Centre, University Health Network, Toronto, Ontario, Canada.
• PMID: 27923097
• DOI: 10.1001/jama.2016.16415
• Clinical Competence*
• Competency-Based Education / methods*
• Education, Medical

Watch CBS News

The legal battle over the abortion pill has reached the Supreme Court. Here's what to know.

By Melissa Quinn

Updated on: March 26, 2024 / 11:25 PM EDT / CBS News

The following preview was published before the Supreme Court heard arguments in the case known as FDA v. Alliance for Hippocratic Medicine. Read coverage of the arguments here .

Washington — Twenty months after the Supreme Court ruled to return abortion policy to the states, the issue will be before the justices again on Tuesday, when they weigh a case that threatens to curtail access to a commonly used drug taken in a medication abortion .

The dispute involves a series of actions that the Food and Drug Administration took beginning in 2016 that made the pill, mifepristone, easier to obtain. A group of medical associations that oppose abortion rights have argued the agency acted unlawfully when it relaxed the rules surrounding mifepristone's use.

The justices will first have to consider a procedural issue — whether the doctors and their associations have legal standing to challenge the FDA's efforts in federal court — before deciding whether the FDA's changes complied with the law. 

Hanging in the balance is the availability of the pill nationwide. States that restrict abortion access and those that protect it would all be impacted by a decision that rolls back the FDA's recent moves.

"We know that reversing the changes made in 2016 and 2021 to access mifepristone will make reproductive care more resource-intensive and less safe," said Marsha Henderson, former FDA associate commissioner for women's health, during a call with reporters. "It will also undermine FDA's congressionally granted authority and confuse patients. 

Mifepristone, she said, has been regulated "more strictly and studied more intensely" than more other drugs. 

The rise of medication abortions

Medication abortions made up more than half of all abortions in the U.S. in 2023, according to new research from the Guttmacher Institute, an organization that supports abortion rights. The group found that abortions done by pills accounted for 63% of all that took place within the health care system last year, a jump from 2020, when more than 5 in 10 abortions were medication abortions.

The increase in medication abortions in the three-year span followed efforts by the FDA to make mifepristone easier to obtain, namely by allowing it to be sent through the mail. The agency temporarily lifted a requirement that the drug be dispensed in-person during the COVID-19 pandemic, and made the change permanent in late 2021.

The Supreme Court is now reviewing whether the FDA acted lawfully when it made that move, along with several other steps the agency took in 2016 surrounding mifepristone's use. As part of the 2016 actions, the FDA allowed mifepristone to be taken later in a pregnancy, increasing the gestational age limit from seven to 10 weeks. It also reduced the number of in-person visits required by a patient undergoing a medication abortion from three to one, and allowed more health care providers to prescribe the drug.

"This isn't just any method of abortion," said Mary Ziegler, a University of California, Davis, law professor who is a leading historian on the abortion debate in the U.S. Not only is it the most popular, but medication abortion is "one that is uniquely important at a time when abortion is a crime in a lot of places," she continued.

Twenty-one states have either banned or restricted abortion since the Supreme Court overturned Roe v. Wade in June 2022.

How the case arrived at the Supreme Court

The FDA first approved mifepristone in 2000. It's taken with a second drug, misoprostol, to terminate an early pregnancy. In the more than 20 years since mifepristone became available in the U.S., more than 5 million women have taken the drug, according to the agency .

Serious adverse events as a result of mifepristone are "exceedingly rare," the FDA said, and studies show that hospitalization of women who have taken the drug occurs in less than 1% of cases.

But in November 2022 — more than two decades after the FDA green-lighted mifepristone — a group of medical associations that oppose abortion rights filed a lawsuit in federal district court in Texas challenging both the 2000 approval and the more recent changes. The organizations claimed the FDA did not have the authority to approve mifepristone for sale and failed to adequately consider the drug's safety and effectiveness.

The federal judge overseeing the case, U.S. District Judge Matthew Kacsmaryk, agreed that the FDA's 2000 approval and subsequent actions were likely unlawful. He blocked the FDA's initial action allowing the drug to be sold in the U.S.

But Kacsmaryk put his ruling on hold for a week, setting off a frenetic series of decisions from a federal appeals court and the Supreme Court. In April 2023, the high court  preserved access to mifepristone while legal proceedings continued. 

Months after the Supreme Court issued its emergency relief, the U.S. Court of Appeals for the 5th Circuit upheld the FDA's 2000 approval of the abortion pill, but said the agency violated the law with its more recent changes to the rules for its use.

The 5th Circuit made clear that its decision was preempted by the Supreme Court's earlier order protecting access, which remains in effect until the justices issue a ruling in the case.

The Justice Department and Danco Laboratories — the maker of Mifeprex, the brand-name version of mifepristone — asked the Supreme Court to review the 5th Circuit's ruling, and it agreed to do so in December. A ruling is expected by the end of June.

The arguments in the mifepristone case

Before considering whether the FDA went too far with its 2016 and 2021 changes, the Supreme Court will first weigh whether the medical associations and their members sufficiently showed that they may be injured by the agency's actions, and that those alleged injuries can be traced to the FDA's relaxing of the rules for mifepristone.

The Justice Department argued in filings  that the doctors involved in the legal challenge do not prescribe the drug and haven't identified a single case where a member has been forced to complete an abortion for a woman who shows up at an emergency room with an ongoing pregnancy.

The associations' theory of how one of their members may be harmed rests on a "long and speculative chain of contingencies," Solicitor General Elizabeth Prelogar wrote. Under their theory, a woman who takes mifepristone must suffer an "exceedingly rare serious adverse event" that requires emergency care. Instead of returning to the provider who prescribed the drug, the woman must then seek care from one of the association members or show up in an emergency room where a member physician is working. 

The doctor would only be forced to complete the abortion if another physician wasn't available to help, or if the member couldn't invoke federal conscience protections for some reason, Prelogar reasoned.

But lawyers for the Alliance for Hippocratic Medicine told the court that their members object not only to abortion, but also to "complicity in the process." Even completing a medication abortion when the fetus is no longer alive harms doctors who consider abortion objectionable, said the group, which is represented by the conservative legal organization Alliance Defending Freedom.

"FDA has spent decades directing women harmed by abortion drugs to emergency rooms. Many of them have sought treatment from respondent doctors," the lawyers wrote. "Now that FDA is called to account for the harm caused, the agency cannot insist that the very treatment option it directed is somehow speculative."

If the Supreme Court finds that the doctors failed to show they would suffer a concrete injury, the justices would order the case to be dismissed without deciding whether the FDA acted lawfully when it relaxed the rules for mifepristone's use.

But if they reach the key legal issues in the case, the Justice Department and Danco told the justices that the FDA's changes were lawful.

The agency relied on a "voluminous body of medical evidence" on mifepristone's use over decades when it determined that the 2016 changes would be safe, Prelogar wrote. In any event, the district court was wrong to second-guess the determinations that Congress empowered the FDA to make, she said.

"To the government's knowledge, this case marks the first time any court has restricted access to an FDA-approved drug by second-guessing FDA's expert judgment about the conditions required to assure that drug's safe use," Prelogar wrote.

Lawyers for the physicians countered that the FDA failed to give a "satisfactory explanation" for its decision to lift the in-person dispensing requirement and called the studies the agency relied on "deeply problematic." 

Withdrawing the in-person visit requirement in 2021 eliminated the opportunity for health care workers to screen for ectopic pregnancies and other conditions, the associations argued. In 2016, the FDA removed "interrelated safeguards without studies" that examined the changes as a whole, they continued.

Warnings of chaos

The prospect of the Supreme Court allowing the 5th Circuit's decision to stand has raised concerns not only about the impact to medication abortion in the future, but also about what would happen to the mifepristone that's already available.

"One of the possibilities would be that mifepristone access would be limited or potentially eliminated nationwide, and that would create a lot of chaos," Ziegler said. "Even if the court did what the 5th Circuit is doing or wanted to do, that would cause a lot of issues too because all of the mifepristone on the market would be misbranded and mislabeled, and that would require both Danco and the FDA to take steps to comply with whatever the Supreme Court says."

Elisa Wells, the founder of Plan C, a website that provides information about how and where to get abortion pills, agreed that if the doctors prevail, it could cause "chaos, fear and harm" to those seeking medication abortions. But she said international telehealth providers and online vendors could help reduce the impact of a decision that unwinds the FDA's more recent changes.

"There will be an increase in demand and alternate routes of access," she told CBS News.

One of those organizations, Aid Access, is a major telemedicine provider of mifepristone, and has provided the pills to women across the U.S. Its founder, Dr. Rebecca Gomperts, said new shield laws in six states have allowed her group's prescribing to be done by domestic providers.

The shield laws offer protections to licensed health care providers in those states who prescribe and send abortion pills to patients living in states where abortion is restricted or banned.

"Doctors have the right to prescribe medication outside of the label, so in that sense, it really doesn't matter what the Supreme Court says, because that is the discretion of medical providers," Gomperts told CBS News. "We are just going to continue no matter what the decision is. It won't affect our work."

As a backup, Gomperts said Aid Access could always go back to its initial model, in which Gomperts herself prescribed mifepristone remotely from Europe.

"The reality is the pills are not going to go away," she said. "Women will always get them, and we will do whatever it takes to get them to them."

Controversy surrounding the case

Separate from concerns about the ramifications of a decision against the FDA, the dispute over mifepristone has been surrounded by controversy since the Alliance for Hippocratic Medicine brought the case 16 months ago.

The lawsuit was filed in Amarillo, Texas, where Kacsmaryk is the lone district judge and was effectively guaranteed to oversee the case. Appointed to the federal bench by former President Donald Trump in 2019, Kacsmaryk had written critically about abortion and Roe v. Wade.

The decision by the medical groups to file their case in Amarillo sparked accusations they engaged in "forum-shopping," a practice in which a party pursues a claim in the court that's most favorable to them. 

The Judicial Conference of the United States, the policy-making arm of the federal judiciary, announced  a new practice  earlier this month in which civil cases with statewide and nationwide implications will be assigned at random. The change is meant to curb judge-shopping, according to U.S. Senior District Judge Robert Conrad, secretary of the Judicial Conference.

Studies cited by Kacsmaryk and the 5th Circuit in their rulings in favor of the Alliance for Hippocratic Medicine have also faced scrutiny. The American Civil Liberties Union warned the Supreme Court in a filing that the lower court decisions relied on "patently unreliable witnesses" and "ideologically tainted junk science."

The group said doctors who submitted declarations during an earlier stage in the case have been criticized by judges in other cases involving abortion restrictions. Also, one study referenced by Kacsmaryk about the mental health impacts of medication abortion relied on 98 anonymous blog posts from women who shared their purported experiences with medication abortion between 2007 and 2018.

Additionally, the publisher of an academic journal retracted two studies from 2021 and 2022 that were cited by Kacsmaryk after a reader raised concerns about the data and whether the authors' affiliations with organizations that oppose abortion rights presented a conflict of interest. 

Two experts reviewed the articles, and they identified issues that "demonstrate a lack of scientific rigor and invalidate the authors' conclusions in whole or in part," according to the publisher, Sage Journals.

Haley Ott contributed to this report.

Melissa Quinn is a politics reporter for CBSNews.com. She has written for outlets including the Washington Examiner, Daily Signal and Alexandria Times. Melissa covers U.S. politics, with a focus on the Supreme Court and federal courts.

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