clinical presentation definition in science

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Effectiveness of Clinical Presentation (CP) Curriculum in teaching clinical medicine to undergraduate medical students: A cross-sectional study.

Saroj adhikari yadav, sangeeta poudel, swotantra gautam, sanjay kumar jaiswal, samikchya baskota, aaradhana adhikari, binod duwadi, nischit baral, sanjay yadav.

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Email: [email protected]

Competing interests: 4 authors, SAY, SKJ, AA, and BD have been involved as trainees, tutors or volunteers of CP curriculum teaching sessions at PAHS.

Accepted 2022 Jan 26; Collection date 2022.

This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction:  The Clinical Presentation (CP) curriculum was first formulated in 1990 at the University of Calgary, Canada. Since then, it has been adopted at various medical schools, including Patan Academy of Health Sciences (PAHS), a state-funded medical school in a low-income country (LIC), Nepal. This study aims to evaluate the perceived effectiveness of the CP curriculum by students and faculty at PAHS, and test knowledge retention through a surprise non-routine exam administered to students. 

Method:  This is a cross-sectional study to evaluate the efficacy of the CP curriculum in teaching clinical medicine to the first batch of MBBS students of PAHS School of Medicine. Ethical approval was obtained from the Institutional Review Committee (IRC)-PAHS (Ref no std1505911069). Perceived effectiveness was evaluated using a set of questionnaires for faculty and students. A total of 33 students and 34 faculty filled the perception questionnaires. Subsequently, a questionnaire consisting of 50 Multiple Choice Questions (MCQs) from different clinical medicine disciplines was administered to test students’ knowledge retention. Out of 49 students, 38 participated in the surprise non-routine exam.  

Result:  A significantly higher number of faculty preferred the CP curriculum compared to the traditional system of teaching clinical medicine (16 vs 11, Kruskal Wallis: 0.023, ie. P-value < 0.05). A significantly higher number of the students liked and recommended CP curriculum in the clinical year of medical education (20 vs. 13 with p-value < 0.05). In the non-routine surprise exam, two thirds of the students scored 60% or above. 

Conclusion: Both faculty and students perceive that the CP curriculum system is an effective teaching and learning method in medical education, irrespective of their different demographic and positional characteristics. The students’ overall performance was good in surprise, non-routine exams taken without scheduling or reminders.

Keywords: Clinical Presentation Curriculum, CP Curriculum, and Medical Education

Introduction

Sir William Osler, considered the father of modern medicine, emphasized the teacher's role in helping students to observe and reason. He recommended abolishing the traditional lecture method of instruction. 1 Medical education is evolving in response to scientific advances and societal needs. 2 A well-organized comprehensive knowledge domain has practical implications in clinical problem solving, and appropriate teaching and learning methods play an important role in achieving the educational goals. 3

Clinical presentation (CP) is a relatively new and innovative approach to teaching medicine. CP engages medical students in their understanding of the disease process from clinical feature to diagnosis. Students begin studying abnormalities of complaints, examination, and laboratory findings; i.e., signs, symptoms, and laboratory investigations which a patient presents to the doctor with. Students then progress towards diagnosis. The underlying philosophy of the CP Curriculum is that: “The reaction of the human body to an infinite number of insults is always finite and stable over time”. 4 For example, if there is any attack on the respiratory system, whether infectious, inflammatory, immunological, traumatic, or iatrogenic; the respiratory system responds through coughing, cyanosis, chest pain, difficulty breathing, noisy breathing, or hemoptysis. 4 Thus, the CP Curriculum aims to help students understand the process of moving from “symptoms to diagnosis.”

The CP curriculum was first formulated in 1990 at the University of Calgary Faculty of Medicine in Canada. 5 The curriculum was adopted and redesigned based on local needs at various medical schools worldwide. Patan Academy of Health Sciences (PAHS), a state-funded medical school in Nepal, has adopted several new and innovative approaches in teaching and learning medicine. The CP Curriculum is one of the several approaches adopted by PAHS. 6

PAHS medical education team assumes that the CP curriculum is better than traditional lecture-based teaching. In this study we are testing the perceived effectiveness of students and faculty, and the level of knowledge among the students trained by the CP curriculum. The level of knowledge was assessed by marks scored by the students in a surprise non-routine exam without prior information. Perceived effectiveness was based on the thinking/perception of the students and faculty on the effectiveness of the CP curriculum. We assume the CP curriculum is at least not inferior to traditional lecture-based teaching.

Study design

This is a cross-sectional study that aims to evaluate the efficacy of the CP curriculum in teaching different disciplines of clinical medicine to undergraduate medical students of PAHS, which is currently the only medical school implementing the CP-curriculum in undergraduate medical education. A new Multiple-Choice Question (MCQ) based questionnaire was designed to evaluate the level of knowledge and two separate questionnaires were developed for faculty to evaluate perception about CP-curriculum.

Study population

All consenting medical students from 2016 of PAHS School of Medicine currently in clinical clerkship years and all clinical sciences faculty who had delivered at least one teaching-session with the CP curriculum to these students were included in the study. Consenting students were asked to fill the questionnaire together in class, whereas faculty were approached personally and asked to complete the questionnaires. Students and faculty who were part of the study team, those who didn’t provide consent, and those who participated in the pilot survey section of the questionnaire developed for this study were excluded. All 34 faculty completed the perception questionnaires, with zero non-response rate. Out of 49 students, 33 completed the perception questionnaires and 38 turned up to the surprise non-routine exam for assessment of knowledge retention.

Ethics and consent

This study was approved by the Institutional Review Committee (Ethical Committee) of Patan Academy of Health Sciences (PAHS), Kathmandu, Nepal (Ref No std1505911069). Written informed consent was obtained from all participants before completing the questionnaire. Students who gave verbal consent were asked to complete the questionnaire together in class. Faculty were approached personally and requested to complete the questionnaires. At the start of each questionnaire, a tick box was used for participants to indicate written consent. Participants were informed verbally and in writing that their names and identifiying information would be kept anonymous, and their data would only be used for research purposes.

Data collection

Three sets of questionnaires were used. The first set of questionnaires were designed to test the perceived effectiveness of the CP curriculum from the faculty perspective. It contained seven questions on background information (age, sex, job position, highest academic degree, etc) and 13 questions on perceived effectiveness.

Similarly, the second set of questionnaires for the students included 11 questions on background information and 15 questions on perceived effectiveness. The perception questionnaire had questions about effectiveness or satisfaction in regard to different aspects of the CP curriculum. Participants had to respond with a tick mark in a Likert scale ranging from one (strongly agree) to five (strongly disagree) for each question.

The third set of questionnaires tested the students' clinical knowledge and contained 50 MCQs from different clinical medicine disciplines. Based on curriculum of the university, there were seven MCQs each from surgery, medicine, pediatrics, obstetrics and gynecology, and two questions each from orthopedics, emergency medicine, general practice, otolaryngology, anesthesiology, dermatology, dentistry, psychiatry, radiology, ophthalmology, and forensic medicine. The questions were randomly selected from the question pool of the Examination section of university. The selected questions were randomly arranged, and a surprise non-routine written exam was conducted with this questionnaire. A maximum time of one hour was provided to solve these 50 questions.

These questionnaires were compiled and discussed in the research group and reviewed by the research advisors to establish content validity. Copies of all three questionnaires can be found under Extended data. 10 They were administered to randomly selected 15 students and 15 faculty in a pilot study to establish the face validity and feasibility. The students and faculty randomly selected for the pilot study were administered the questionnaires to complete. Then they were asked in detail about the questionnaire and any suggestions for revisions or editing needed. The pilot survey was not powered for statistical comparisons. Only a few grammatical corrections were made after review and feedback from the pilot study. Subsequently, the final study was conducted.

The faculty participants were also involved in the development of the CP curriculum at PAHS, hence, responder bias in favor of CP curriculum may be present in this study.

The data collected were digitalized using Epi-Info version 7 software. These raw data were exported to MS-Excel. The excel sheet is made available in the public domain for readers. 10 SPSS version 13.0 was used for statistical test and analysis. Shapiro-Wilk test was used first to test the normality. Non-parametric tests (Mann-Whitney and Kruskal Wallis) was used for normal distribution. Classical ANOVA for equal variance and Welch ANOVA for unequal variance were used after testing the homogeneity of variance, and post-hoc/tukey test was used for significant classical ANOVA results.

In this study, we calculated the total score via forced Likert scale, ranging from 1 (strongly agree) to 5 (strongly disagree) for each respondent determined as the dependent variable, and compared it with other variables i.e., background information. The total score of all the Likert scale questions was calculated, and the normality test was performed, keeping “total score” as the dependent variable. The full dataset can be found under Underlying data. 10

Response from faculty on perceived effectiveness of the CP curriculum

The data of the total score did not follow a normal distribution (Shapiro-Wilk Test, p < 0.05), so a non-parametric test was used to compare the dependent variable. We used Mann-Whitney and Kruskal Wallis tests for the variables containing two groups and more than two groups, respectively.

Among the 34 respondents from the faculty group, 24 (70.59%) were male, and 10 (29.41%) were female. 20 (58.82%) of the faculty respondents were lecturers, and the remaining 14 (41.18%) were senior professors, associate professors, and assistant professors. Out of the 34 respondents, 31 (91.18%) were involved in developing the CP curriculum at PAHS. However, 3 (8.82%) were involved in teaching the curriculum but not in developing the CP curriculum.

As many as 15 (44.12%) respondents favored the CP curriculum system over the traditional system, 11 (32.35%) preferred the traditional teaching system, and 8 (23.53%) preferred both. Overall, the faculty liked the CP curriculum more than the traditional system of teaching clinical medicine (Kruskal Wallis = 0.023, p-value < 0.05). The majority of faculty, 27 (79.41%), would suggest future students to join a medical school that implemented the CP curriculum system rather than the traditional system. Only 12 (35.29%) of them thought that the CP curriculum system should be the sole leading teaching and learning system in clinical medicine, meaning more faculty preferred a hybrid system of both the CP curriculum and the traditional system. However, these differences were not statistically significant (p-value > 0.05).

As shown in Table 1 , a significant number of faculty (p values > 0.05) perceive the CP curriculum to be more effective than the traditional system for teaching clinical medicine to undergraduate medical students. There is no significant difference in the perception of the effectiveness of the CP curriculum among faculty based on academic rank, gender, highest academic degree, or the institution of their residency training (p-value > 0.05). The median number of faculty who perceive the CP curriculum system to be more effective and suggest future students to study medicine in this system rather than the traditional system is higher. But, the difference was not statistically significant (p > 0.05). There was no significant difference in faculty foreseeing the CP curriculum as the leading method of teaching and learning medical education in the future (p > 0.05).

Table 1. Comparison of demography of the faculty based on forced Likert scale total scores of perception questionnaire for faculty.

Response from students on perceived effectiveness of the cp curriculum.

The normality test shows that the total score data follows a normal distribution (Shapiro-Wilk, p > 0.05) with a mean value of 50.57 with a standard deviation of 8.17. Therefore, we used a parametric test to compare the test variable with others. We subsequently tested for homogeneity of variance: we used classical ANOVA for equal variance, and Welch ANOVA for unequal variance. Finally, if significant classical ANOVA results were obtained, we used the post-hoc/tukey test.

There were 33 respondents, among which 23 (69.70%) were males, and 10 (30.30%) were females. The age group of respondents was between 20 to 30 years. A significantly higher number (20 i.e., 60.61%) of the respondents recommended studying in a medical school implementing CP curriculum (p < 0.05). No significant differences were seen between educational or geographical backgrounds and scholarship categories (p > 0.05) as shown in Table 2 .

Table 2. Comparison between total score and demographic variables of students based on the perception questionnaire for students.

Assessment for knowledge retention of the students.

An hourly surprise non-routine written exam was conducted to test the knowledge of the students. A copy of this exam can be found under Extended data. 10 The exam included 50 MCQs from different disciplines of clinical medicine. The surprise test was conducted without prior reminders, and 38 out of 49 students participated. The findings, as outlined in Table 3 , show that 24 out of 38 (65.79%) of the students scored 60% or higher. The results demonstrate that approximately two-thirds of the students passed the surprise test, indicating good test performance.

Table 3. Results of the students’ score in non-routine surprise exam based on the MCQ questionnaires for students.

The current study shows a higher preference for the CP curriculum by undergraduate medical students and faculty at PAHS for teaching and learning clinical medicine in medical school. These findings further substantiate previous reviews on the principles of teaching methods and the acceptability of the curriculum.

This curriculum was chosen in part because of confidence in the comprehensiveness of the knowledge it encompasses. Equally important was the organization of medical knowledge that this curriculum engenders: each clinical presentation is organized according to a variable number of causal diagnostic categories. Each of these categories is identified by a prototype. Exhaustive lists of diagnoses belonging to a given category are avoided. As students' clinical experiences increase and they encounter more diagnoses, the students can add them to the appropriate causal categories stored in their memories. How the diagnostic prototypes are presented allows students to identify the discriminating features within and between each. The process by which students can compare and contrast the distinctive features of each disease is facilitated. It is so because the CP curriculum is well organized and comprehensive. 3 , 7 Since the CP curriculum is simple to follow and to organize the learning content, students in the CP curriculum also reported less stress due to the volume and complexity of study materials and examinations. 7

Prior studies at the University of Calgary demonstrated a substantial effect size on students’ retention of basic science knowledge while participating in the CP curriculum. 8 Our study conducted on clinical clerkship year participants showed that two-thirds of students achieved 60% (passing scores) or more in the surprise non-routine exam, signifying a high retention of clinical discipline knowledge. Findings from the current study expand on the effectiveness of the curriculum across medical school years with respect to knowledge retention.

A study done among medical students utilizing the CP curriculum showed a favorable response to the use of schema in the CP curriculum. 9 In our study, we could not evaluate the use the schemas of CP to perform clinical assessment in order to reach the appropriate diagnosis. We recommend further studies in this respect. Additionally, long-term knowledge retention was not tested in our study, which could be another important area of investigation.

This study has several other limitations as well. The study was conducted at a single institution, thereby potentially reducing the overall generalizability of the findings. The faculty members recruited as participants for assessing the perceived effectiveness of the curriculum were also involved in the adaptation and development of curriculum at PAHS, hence, potentially increasing responder’s bias in the study by some degree. The cross-sectional nature of the study provides only a limited understanding of the effects of the curriculum over the long term.

Based on this study, we can conclude that both faculty and students perceive the CP curriculum system as an effective teaching and learning method in medicine, irrespective of their demographic and positional characteristics. The findings suggest higher knowledge retention in knowledge by implementing the CP curriculum during clinical clerkship years. Since the 1990s, CP Curriculum has been established as a multidimensional teaching-learning method in many medical school systems. In the evolving medical education world with rapid digitization, massive turnover of medical and education data, and increased use of remote learning methods, a deeper understanding of influencing variables will help effectively utilize this highly valued curriculum.

Data availability

Underlying data.

Figshare: CP Curriculum Raw data updated in Excel and PDF. https://doi.org/10.6084/m9.figshare.18666410.v1 10

This project contains the following underlying data:

Analysis and Raw data.xlsx

Extended data

This project contains the following extended data:

CP Questionnaire for Faculties.pdf

CP Questionnaire for students.pdf

CP Surprise exam Questionnaire.pdf

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Authors' contributions

SAY, SKJ, AA, and BD conceptualized and designed the study. All 9 authors; SAY, SJ, SP, SG, SB, AA, BD, NB, and SY contributed to data analysis and interpretation. SAY and SP wrote the first draft of the article. All 9 authors, SAY, SP, SG, SJ, SB, AA, BD, NB, and SY critically revised the manuscript and approved the final version of manuscript for publication.

Acknowledgements

We thank Prof. Dr. Kedar Prasad Baral and Prof. (Associate) Shital Bhandary for their immense help during this research. We thank all respondent faculty and medical students of PAHS for participating in the study.

Funding Statement

The author(s) declared that no grants were involved in supporting this work.

[version 1; peer review: 1 approved

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Reviewer response for version 1

Competing interests: No competing interests were disclosed.

This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Dear author(s),

Thank you for your hard work on this research manuscript. Please find my comments/ queries below.

The research article deals with the effectiveness of Clinical Presentation (CP) curriculum in teaching clinical medicine to undergraduate medical students. CP curriculum is yet to be adopted in many low- and middle-income countries. The results show that the medical students and the faculty were satisfied with the CP curriculum and believed CP as a stand-alone method of teaching as well as in conjunction with traditional methods of teaching could benefit medical students.

Study design:

“This is a cross-sectional study that aims to evaluate the efficacy of the CP curriculum in teaching different disciplines of clinical medicine to undergraduate medical students of PAHS, which is currently the only medical school implementing the CP-curriculum in undergraduate medical education.”

Is PAHS the only medical school implementing the CP-curriculum in Nepal or worldwide?

Ethics and consent:

“Students who gave verbal consent were asked to complete the questionnaire together in class.”

Please elaborate on this sentence.

Was any faculty member present in the class?

Was the test compulsory or optional?

Did the students have the right to refuse the test or leave the test in between?

Data collection:

Was the questionnaire in English?

How long did the questionnaire take to complete?

How much time were the respondents given to complete the questionnaire?

What were the minimum and maximum possible scores (total or based on questionnaire sets)?

I hope the comments are useful and would enable the author(s) to strengthen this study.

Is the work clearly and accurately presented and does it cite the current literature?

If applicable, is the statistical analysis and its interpretation appropriate?

Are all the source data underlying the results available to ensure full reproducibility?

Is the study design appropriate and is the work technically sound?

Are the conclusions drawn adequately supported by the results?

Are sufficient details of methods and analysis provided to allow replication by others?

Reviewer Expertise:

Global health, gerontology, cancer

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Jayadevan Sreedharan

Title: Effectiveness of Clinical Presentation (CP) Curriculum in teaching clinical medicine to undergraduate medical students: A cross-sectional study.

This study aimed to assess the perceived effectiveness of students and faculty and the level of knowledge among the students trained by the CP curriculum. The authors assume the CP curriculum is not inferior to traditional lecture-based teaching.

Are sufficient details of methods and analysis provided to allow replication by others?: 

It is not clear why the authors have given MCQ to the faculty (their score is given and statistical test done).

If applicable, is the statistical analysis and its interpretation appropriate?:

The authors mentioned in the article that "Classical ANOVA for equal variance and Welch ANOVA for unequal variance were used after testing the homogeneity of variance, and post-hoc/Tukey test was used for significant classical ANOVA results", where they have used this test is not clear in the manuscript.

The p-value is given in exact value; the importance of p-value is to check whether to accept the null or alternate hypothesis. In the methodology, they mentioned that p-value >0.05 is not significant. Then what more information do the readers get if they include the actual p-value? 

The sample size of this study is very small and the conclusion from this study can not be generalised to the entire population. 

The authors mentioned in the conclusion that "The findings suggest higher knowledge retention in knowledge by implementing the CP curriculum during clinical clerkship years" . How the authors reach this conclusion is unclear.

Epidemiology, Biostatistics, Medical education, Public health

Priyanka Panday

This article focuses on the importance of the clinical presentation (CP) curriculum in a particular institute (Patan Academy of Health Sciences (PAHS)) among medical students and faculty in terms of their preference and performance on a surprise non-routine exam. 

Cross-sectional study is appropriate as a study design for this article.

Relevant articles from 2020, 2019, and 2004 have been appropriately cited as references.

The methods used for data collection, as well as the result of the study has been elaborated in detail to ensure accuracy.

Results are presented in a tabular form and the conclusion derived coincides with the results indicating the effectiveness of the CP curriculum system as an effective teaching and learning method in medicine.

As far as the statistical analysis is concerned, it is not my area of expertise. However, p< 0.05 for response of effective implementation of the CP curriculum and the response from faculty is statistically significant.

I cannot comment. A qualified statistician is required.

Endocrine disorders, Heart conditions, Medications, COVID-19, Obstetric conditions, Epilepsy, HIV, etc.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

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Introduction

Presentation methods, delivering a presentation, study methods, discussion: transform, acknowledgements, how to prepare and deliver a scientific presentation : teaching course presentation at the 21st european stroke conference, lisboa, may 2012.

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Andrei V. Alexandrov , Michael G. Hennerici; How to Prepare and Deliver a Scientific Presentation : Teaching Course Presentation at the 21st European Stroke Conference, Lisboa, May 2012 . Cerebrovasc Dis 1 April 2013; 35 (3): 202–208. https://doi.org/10.1159/000346077

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Background: A scientific presentation is a professional way to share your observation, introduce a hypothesis, demonstrate and interpret the results of a study, or summarize what is learned or to be studied on the subject. Presentation Methods: Commonly, presentations at major conferences include podium (oral, platform), poster or lecture, and if selected one should be prepared to PRESENT: P lan from the start (place integral parts of the presentation in logical sequence); R educe the amount of text and visual aids to the bare minimum; E lucidate (clarify) methods; S ummarize results and key messages; E ffectively deliver; N ote all shortcomings, and T ransform your own and the current thinking of others. We provide tips on how to achieve this. Presentation Results: After disclosing conflicts, if applicable, start with a brief summary of what is known and why it is required to investigate the subject. State the research question or the purpose of the lecture. For original presentations follow a structure: Introduction, Methods, Results, Conclusions. Invest a sufficient amount of time or poster space in describing the study methods. Clearly organize and deliver the results or synopsis of relevant studies. Include absolute numbers and simple statistics before showing advanced analyses. Remember to present one point at a time. Stay focused. Discuss study limitations. In a lecture or a podium talk or when standing by your poster, always think clearly, have a logical plan, gain audience attention, make them interested in your subject, excite their own thinking about the problem, listen to questions and carefully weigh the evidence that would justify the punch-line. Conclusions: Rank scientific evidence in your presentation appropriately. What may seem obvious may turn erroneous or more complex. Rehearse your presentation before you deliver it at a conference. Challenge yourself to dry runs with your most critically thinking colleagues. When the time comes, ace it with a clear mind, precise execution and fund of knowledge.

Over time communication standards between -scientists have evolved along with improved scientific method, increasing scrutiny of analyses and upholding to the highest level of evidence anything we call research. Scientific presentation is a professional way of sharing your observation, introducing a hypothesis, demonstrating and interpreting the results of a study, or -summarizing what has been learned or is to be studied on the subject. Professional presentations help disseminate research, make peers aware of novel approaches, findings or problems. These presentations make conferences memorable for both presenters and the audience. Anyone can recall the most exciting and most boring, the most clear and most convoluted, the most ‘-seriously?!' and the most ‘wow!!' presentations. Most presentations, however, fall in the in-between level of ‘so what?', ‘I did not quite get it …', or ‘maybe'. This means that all the work the authors have put in did not result in a paradigm shift, -advancement, or even ‘well, this is good to know' kind of an impact. We struggle to shape up our young presenters to make their science clear and visible, their presence known and their own networks grow.

Having initially struggled in preparing and delivering presentations ourselves, and having seen the many baby steps of our trainees now accomplished or shy of a track record, we have put together these suggestions on how to start, organize and accomplish what at first sight looks like a daunting task: presenting in front of people, many of whom may have expertise way beyond your own or who are scrutinizing every bit of data and ready to shred any evidence you might have to pieces. Unfortunately, there is no other way to advance science and become recognized than to survive this campaign from conception of a project to publication. This campaign has its own (often interim and hopefully not singular) culmination in a scientific presentation. This presentation also comes with question and answer sessions and importantly, with you and the audience possibly coming out of it with new messages, new thinking and even energy for breakthroughs, no matter how small or large the leap would be. So let's explore how to prepare and deliver a scientific presentation.

Currently, the common types of presentations at major conferences include podium (oral, platform), poster or lecture. Although seemingly different and at times some being more desirable over others, they all share the same prerequisites and challenges for successful execution. We will examine common threads and identify unique aspects of each type of these presentations. However, the first prerequisite for any scientific presentation (successful or not) is you, the presenter.

An effective presenter should have led the study, participated in the analysis and drafting of the abstract and manuscript, i.e. the presenter should know the subject of his or her talk inside out. One should therefore be prepared to PRESENT:

P lan from the start (place integral parts of the presentation in logical sequence);

R educe the amount of text and visual aids to the bare minimum;

E lucidate (clarify) methods;

S ummarize results and key messages;

E ffectively deliver;

N ote all shortcomings, and

T ransform your own and the current thinking of others.

So, as the scuba-diving instructors say: plan the dive, and dive the plan. The most important parts of scientific presentations should follow the logic of delivering the key messages. For the original presentations (platforms or posters), it is easy to simply follow the accepted abstracts, most often structured following the IMRaD principle: Introduction, Methods, Results and Discussion (Conclusions).

Lecture format, content and logical flow of information often depend on the topic choice, which should be appropriate to the level of audience [ 1 ], time allotment and the target audience. Most competitive conferences offer short times even for invited lecturers as experts are expected to demonstrate cutting edge science, which assumes that the audience is already knowledgeable and the expert is capable of delivering information that sparks new thinking. The suggestion here to both novice and experienced speakers is to quickly summarize why the subject of presentation is important (catch audience attention [ 2,3 ]), where we are now (show the landscape of completed studies that established the common knowledge or conundrums, equipoise, etc.) and to move then to the latest advancements (this may include just-in publications, ongoing or planned future research or the most provocative take on the evidence out there).

Turning back to original presentations, advice is available on how to write abstracts following the IMRaD principle [ 4 ] and how to draft subsequent manuscripts [ 5 ]. We cannot stress enough the need to quickly follow-up the abstract submission with drafting the full manuscript. If the authors complete a manuscript before the presentation at a conference, the presenter will have a luxury of material to work with to compile either a set of slides for the podium or text and illustrations for the poster. If a manuscript was drafted and reviewed by coauthors, the challenge for a presenter is going to be a good one: trim down most sentences as both slides and posters benefit from short statements (not even full sentences) and large font sizes so that text can be easily read from a distance. Put yourself into the audience: your slides should be readable from the last row of a large room or a huge ballroom and your poster should be still readable from at least 2 m. The latter will allow better poster viewing by several people during guided poster tours or when a small group gathers spontaneously to view it.

This logically brings us to the second step: use bare minimum of any type of information to deliver your -presentation. Minimum text, minimum lines, minimum images, graphs, i.e. provide only the essential information as the audience attention span is short. Brevity, however, should not compromise quality: you should always stride to have the highest quality visual aids since these leave an impression on the audience [ 6 ] and good quality graphics are attributes of effective presentations [ 3 ].

At the same time, we cannot overemphasize the need to stick to time limits set for a specific presentation. Presenters should test their presentation in ‘real life' at home to their friends or at work in front of colleagues and ask for criticism. It is better to get criticism from members of the department (including your boss) than in a huge auditorium. Use a simple rule: an average talking time is 1 min per slide in oral presentations. You can then see how little you really can allocate to each slide if you load your talk with the most complicated visual presentation of data.

Let's go to the specifics. The ‘Introduction' slide usually includes a very brief description of background and should explicitly state the research question. Call it ‘Introduction and Study Purpose'. Adding a separate slide for study aims lengthens the talk. Fewer slides also reduce the chance of making an error when advancing them on the podium that can send presenters into further time deficit and stress, a commonplace even with those who know how to right-click.

Methods should have bullet points, not necessarily full sentences since you will be speaking over slides projecting or in front of the poster to connect brief statements showing behind you. The basic rule is not to read your slides or poster, nor tell the audience to read what the slide or poster says. Think of your slides or display material as a reminder to yourself of what you are supposed to say in detail and leave the noncritical words out of the slide and off the poster as it is an even easier source to pack with unreadable information. When you develop a presentation imagine you are a novice to the field who would like to be educated and taken on a journey while seeing and hearing the presentation. What can I learn in these few minutes? As the presenter, also think ‘what can I pass to the audience in these few minutes?' Further advice on how to plan, focus and arrange material to support key messages is available [ 7,8 ].

Results are the key part of any scientific presentation, podium, poster or lecture, and the most time, space and careful ascertainment should be allotted to this section as is necessary and feasible. It is vital to pack your presentation with data that support your key messages. Remember, a picture is worth a thousand words but show only quint-essential images or graphs. If appropriate include statistics and make this easy in structure, i.e. use formats or values known by everybody such as odds ratios, Kaplan Meier curves, etc. (do not forget to include these data in the abstract as abstracts without data, numbers and calculations are often low rated or rejected). After presenting data, show what you think of that or what the limitations are since you thought more about this than the audience, at least through preparation of your own presentation.

The last two concluding paragraphs (poster), comments (this section of a lecture), or slides (podium) are supposed to cover study limitations and conclusions. These should be the most carefully thought through, strategically worded and evidence-based part of your presentation. Your reputation depends on the quality of data interpretation. Also, think about a take-home message with the main message you want to be remembered. When practicing your presentations, deliver your talk to your nonmedical spouse, boyfriend or girlfriend: by the end of your presentation he or she should be able to repeat the take home message with best-prepared presentations.

After conclusions, an ‘Acknowledgements' slide is nice to have at the end showing whom you are grateful to, but it will not rescue a hopeless presentation. The ‘thanks to my colleagues' should not come at the expense of time, quality and content of your scientific presentation. There is no need to thank multiple people like they often do at the Oscars. You have to rationally consider who and when to acknowledge if their functions were important to your work but they were not listed among coauthors. If you received funding to support your work, it is very important where appropriate or at the end of the presentation to acknowledge your sponsors or grant providers (such as NIH Institute and grant number, MRC grant, INSERM or DFG labels, etc.). The higher the scientific level of the grant donors, the more your presentation will be recognized.

While preparing any part of your presentation, remind yourself to check whether the included material is any good and worthy of inclusion. You can simply ask, ‘am I wasting time during the oral presentation or space in the poster by including this and that?' The answer lies in checking if this material is directly related to the study aim, data obtained, or in support of conclusions drawn.

Table 1 summarizes how you should structure the sequence of slides for the podium presentation. If you are only given 8 min to present + 2 min for questions (10 min total), you can see that with 8 mandatory slides you are already at the limit of 1 min per slide. In due course, we will give you tips on how to reallocate time within your presentation to expand the Methods and, most importantly, the Results section as needed.

Basic structure for a podium presentation of an original paper

Always clarify study methods. Posters offer a greater freedom since you can show details of your experimental setup or the methodology of your study design. A podium presentation often requires abbreviated mention of key elements of design, scales, inclusion/exclusion criteria, intervention or dependent variables and outcomes. This requires diligent work with your coauthors and biostatisticians to make sure that you are brief but clear and sufficient.

A well-assembled Methods section will lead to a shorter Results summary since your clear statement of the study aim and key methodology logically leads to audience anticipation of the primary end-point findings. There are key messages and delivered data points that distinguish effective and clear presentations from those resulting in confusion and further guesswork.

Effective presenters capture audience attention and stay focused on key messages [ 1,2,3,6,7,8 ]. A study was performed at scientific conferences asking reviewers to identify the best features of effective presentations [ 3 . ]The most frequent comments on best features of presentations with respect to ‘content' were identifying a key concept (43% of presentations) and relevance (43%). Best features in evaluations of ‘slides' were clarity (50%), graphics (27.3%) and readability of the text and font size (23%). Finally, best features in ‘presentation style' were clarity (59%), pace (52%), voice (48%), engaging with the audience (43%), addressing questions (34%) and eye contact (28%) [ 3 ].

Here are some tips on how to avoid forcing yourself to rush during a talk. Before you start (usually in the intermission or just before your session) familiarize yourself with the podium and learn how to advance slides and operate the pointer or point with the mouse. If you stumble at the beginning, you start your presentation with a time deficit.

Get to the podium while you are being introduced and start right away (it is the responsibility of the moderator to properly announce you, your team and the title of the talk and it is the responsibility of the conference organizers to have your title slide showing during the moderator's announcement). Do not read or repeat your study title. Thank the moderators and while the title slide is showing you may consider briefly thanking your coauthors/mentor here in just a few seconds.

Show the ‘Conflicts of Interest' slide next and disclose if any conflicts are related to the study subject. If they exist, conflicts should be acknowledged briefly but clearly. Do not show a slide with several conflicts and tell the audience ‘here are my conflicts' and switch to the next slide. It is important to simply say, ‘pertinent to this study I have …' or ‘this study includes an off-label or investigational use of …'. Now you are logically ready to turn to the subject of your presentation.

Start with a brief summary of what is known and why is it important to investigate the subject. This -introduces the audience to the subject of research and starts the flow of logic. If you are facing a challenge to present a complex study within in a short allotted period of time (such as 8 min for podium or a just a few minutes during a guided poster tour), do not waste time. You may cut to the chase and simply say why you did the study. Coming with straight forward messages, which are authentic and concerned about the scientific question, gets you more credit with the audience than careful orchestration of a perceived equipoise. However, we have digressed.

For an effective message delivery, identify two people towards opposite far ends of the audience and speak as if you are personally talking to one of them at a time and alternate between them. If lights shining in your face are too bright, still look towards the back of the room (or from time to time directly into the camera if your talk is being shown on monitors in a large ballroom) and do not bury your head into the podium or notes that you might have brought with you. The nonverbal part of any presentation and the presenter's body language are also important [ 6 ]. At all cost avoid bringing notes with you to any scientific presentation since you should have practiced your talk enough to remember it or you should be familiar with the subject of your lecture to the point that even if you have just been woken up, you can still maintain an intelligent conversation. Do not count on ‘it will come to me' - practice your talk! Further advice on effective presenting skill is available [ 2 ].

Remember that at international conferences many attendees are not native English-speaking people. Thus speak slowly and train your voice for best possible pronunciation! This recommendation is applicable to natives of English-speaking countries too. Native English speakers from the UK, Commonwealth countries and the USA tend to speak fast, with a variety of accents that international audiences may not understand easily while the interpreters may not be able to keep up. When speaking, do not turn away from the audience and look at your slide projection on the main screen or at your poster all the time. If it is necessary to remind yourself what to talk about next, advance the slide, briefly glance at it, turn to the audience and continue your presentation. Turn to your slide again only if you have to use a laser pointer or a mouse on the computer screen. Do so briefly, underline the important finding, point to the key part of an image and avoid long circular pointer motions around the whole text line or big areas of graphic illustrations. It is distracting. Try to use the pointer only when necessary and do not read your slides with the pointer constantly aiming at where you are reading.

When presenting your methods, clearly state the type of study, e.g. retrospective analysis, case series, -cohort or controlled trials, etc., and describe patient inclusion/exclusion criteria. If too numerous, only list the major ones. As an example, in a clinical trial of a fibrinolytic agent the list of exclusion criteria could be very extensive, so how can you present this on a dime? Your slide should focus on the key inclusion criteria since a patient who did not have those was obviously excluded, and an audience at a stroke conference is generally familiar with multiple exclusion criteria for tissue plasminogen activator treatment. So, your slide or poster may have the following in it (highlighted in bold ) to which you may add the plain text in your (limited) verbal statements:

Our Major Inclusion Criteria: were

• total Pre-treatment NIHSS score >6 points

• Presence of mismatch on MRI determined by -( EPTITHET ) trial criteria

• Age <80 years and

• Time from symptom onset <8 h

After that, you may omit including a slide with the long list of exclusions in favor of time. If there is a -specific contraindication new to the treatment agent in your study, you could say ‘in addition to well-known contraindications for systemic thrombolysis, patients were excluded if they had …' at the end of showing the ‘Major Inclusion Criteria' slide as shown above. Similarly, in a poster, list only the most relevant inclusion and exclusion criteria and walk the audience through the methods without stumbling on too many detail -disclosures. The audience will lose track of where you are going.

It is important to keep a balance between sufficient disclosure of study methods and the length of this part of your presentation. It is always helpful if you have a prior study that used a similar or from which you developed your methodology that has already been published - you may show a reference to this study and move on faster without sacrificing the quality. For example, ‘ultrasound tests were done by experienced sonographers using a previously published standard protocol', ‘CT scans were read independently using the ASPECTS score', and ‘sICH was defined by the SITS-MOST criteria'. Say this while showing or pointing to the line and published source reference on your visual aid.

Clearly organize and deliver the Results section. Include absolute numbers and simple statistics before showing advanced analyses. Remember not to show data in Methods and equally so do not introduce new methods when presenting Results. As a rule, describe characteristics of the general study population or balance/imbalances between target and control groups. Follow this by a slide that shows the primary end-point findings or observations that directly address the study aim or research question. This follows the logic of a scientific presentation and will help you avoid deviations to side observations no matter how unexpected or valuable they seem. Stay the course, address the main question first and only then show additional findings. When presenting a poster, point to the area where the key results are displayed. Unlike a slide presentation or lecture where the audience is forced to see one slide at a time, busy posters could be distracting. Posters that are heavily packed with graphs, images, tables and text are often difficult to follow during a brief guided poster presentation tour. It is the presenter's responsibility to drive the audience attention to key results in a logical sequence. When you present a graph, start by telling the audience what is shown and in what units on each access, and briefly point to the numbers on each axis.

Remember to present one point at a time. It makes common sense but sometimes may be difficult to follow if complex experiments or studies with multiple confounding variables have to be navigated through a brief presentation. Do not lose sight of your original research question or the objective of your lecture. Remember what you have shown so far, and what logically should be shown next. If you are pressed on time or made a mistake while advancing slides, take a deep breath and relax. Clear state of mind will buy you time. Racing thoughts such as ‘I have to cover that and that, and oh, that too' are not helpful. Dry runs, or practice presentations are essential for you to master the material that you need to present.

After finishing the Results part of your presentation, remember not to introduce more new results in Discussion and Conclusions. That surprise is hard for the audience to process. If you'd like to reemphasize the main finding, use the following suggestion. Let's say your goal was to show the prevalence of a new syndrome in your study population and you found it to be 24% (your primary research question). Unexpectedly, you also found that patients with this syndrome have an increased risk of dying (RR 2.08, 95% CI 1.23-4.34). These numbers and statistics obviously belong to the Results section. However, you want to stress in your conclusion once again how important your finding is. You can present it as follows: ‘Conclusions: nearly a quarter of stroke patients can be affected by this new syndrome and, if present, it doubles the patient chance of dying in hospital'. This recaps the main finding and makes practical interpretation of the relative risk estimate.

Before you jump into Conclusions, however, we always encourage presenters to note and openly discuss current study limitations. This improves your own assessment for biases and ranking of the level of obtained evidence. If you do not disclose the obvious study limitations, you will most likely receive questions after your presentation that will point to these shortcomings. Thus, instead of a positive discussion of how your study advances our knowledge, the discussion with the audience will focus on shortcomings and the key message may be lost with the negative audience response. Unlike Twitter™ or future media-based quick popularity scores, science can only advance when it endures the highest scrutiny (even though in the future presenters may be concurrently judged by the audience as our technologies improve). Regardless, if you are a good scientist, prepare yourself to stand the ground if the evidence is behind you. Be proactive, acknowledge study limitations and how you attempted to control for biases, etc.

In a lecture or a podium talk or when standing by your poster, always think clearly, have a logical plan for presentation parts that should be covered next, gain audience attention, make them interested in your subject, excite their own thinking about the problem, listen to questions and carefully weigh the evidence that would justify the punch-line. This will support your conclusions!

With posters, we often see a Discussion section but no conclusions listed, or they are listed in the abstract but not in the poster itself. This will lead to an obvious question after you stop presenting: ‘So, what is your take on this?' Our advice is, have your conclusions listed and be prepared to defend them point-by-point as the question and answer part could be challenging. If you do not understand the question, ask for clarification rather than talk nonsense.

To arrive at the right conclusions, you have to rank scientific evidence in your presentation appropriately. What may seem obvious may turn erroneous or more complex at a closer look by experts. Helpful hints here include you maintaining careful documentation while you are conceiving the project, designing it with your colleagues and consulting with a biostatistician on all steps taken in ascertaining the study population, interventions, end-point data collection and bias verification. Put all methodological issues against your findings and this will give you an idea of the strengths and weaknesses of your study. Preparing and delivering your presentation is a great experience to see if your knowledge and gained expertise stand up to peer scrutiny.

Rehearse your presentation before you deliver it at a conference. Challenge yourself to dry runs with your most critically thinking colleagues. Quite often, it is not the presentation itself but these questions, comments and subsequent late night debates with your colleagues that bring new thinking, advance our understanding and spark new ideas. This is the chance to transform your own current thinking and that of your peers. Think about your upcoming presentation, whether it is a podium, poster or lecture, as an opportunity, a launch pad, a reward for the hard work you did to bring this project to the attention of the scientific community.

When time comes, ace it with a clear mind, precise execution and fund of knowledge.

Before his first oral presentation in English, Dr. Alexandrov was nervous and asked his mentor, Dr. John W. Norris, for a dry run. Dr. Norris generously came to listen to him at 10 p.m. the night before, and Dr. Alexandrov survived his talk.

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How to present clinical cases

• Related content
• Peer review
• Ademola Olaitan , medical student 1 ,
• Oluwakemi Okunade , final year medical student 1 ,
• Jonathan Corne , consultant physician 2
• 1 University of Nottingham
• 2 Nottingham University Hospitals

Presenting a patient is an essential skill that is rarely taught

Clinical presenting is the language that doctors use to communicate with each other every day of their working lives. Effective communication between doctors is crucial, considering the collaborative nature of medicine. As a medical student and later as a doctor you will be expected to present cases to peers and senior colleagues. This may be in the setting of handovers, referring a patient to another specialty, or requesting an opinion on a patient.

A well delivered case presentation will facilitate patient care, act a stimulus for timely intervention, and help identify individual and group learning needs. 1 Case presentations are also used as a tool for assessing clinical competencies at undergraduate and postgraduate level.

Medical students are taught how to take histories, examine, and communicate effectively with patients. However, we are expected to learn how to present effectively by observation, trial, and error.

Principles of presentation

Remember that the purpose of the case presentation is to convey your diagnostic reasoning to the listener. By the end of your presentation the examiner should have a clear view of the patient’s condition. Your presentation should include all the facts required to formulate a management plan.

There are no hard and fast rules for a perfect presentation, rather the content of each presentation should be determined by the case, the context, and the audience. For example, presenting a newly admitted patient with complex social issues on a medical ward round will be very different from presenting a patient with a perforated duodenal ulcer who is in need of an emergency laparotomy.

Whether you’re presenting on a busy ward round or during an objective structured clinical examination (OSCE), it is important that you are concise yet get across all the important points. Start by introducing patients with identifiers such as age, sex, and occupation, and move on to the complaint that they presented with or the reason that they are in hospital. The presenting complaint is an important signpost and should always be clearly stated at the start of the presentation.

Presenting a history

After you’ve introduced the patient and stated the presenting complaint, you can proceed in a chronological approach—for example, “Mr X came in yesterday with worsening shortness of breath, which he first noticed four days ago.” Alternatively you can discuss each of the problems, starting with the most pertinent and then going through each symptom in turn. This method is especially useful in patients who have several important comorbidities.

The rest of the history can then be presented in the standard format of presenting complaint, history of presenting complaint, medical history, drug history, family history, and social history. Strictly speaking there is no right or wrong place to insert any piece of information. However, in some instances it may be more appropriate to present some information as part of the history of presenting complaints rather than sticking rigidly to the standard format. For example, in a patient who presents with haemoptysis, a mention of relevant risk factors such as smoking or contacts with tuberculosis guides the listener down a specific diagnostic pathway.

Apart from deciding at what point to present particular pieces of information, it is also important to know what is relevant and should be included, and what is not. Although there is some variation in what your seniors might view as important features of the history, there are some aspects which are universally agreed to be essential. These include identifying the chief complaint, accurately describing the patient’s symptoms, a logical sequence of events, and an assessment of the most important problems. In addition, senior medical students will be expected to devise a management plan. 1

The detail in the family and social history should be adapted to the situation. So, having 12 cats is irrelevant in a patient who presents with acute appendicitis but can be relevant in a patient who presents with an acute asthma attack. Discerning the irrelevant from the relevant is not always easy, but it comes with experience. 2 In the meantime, learning about the diseases and their associated features can help to guide you in the things you need to ask about in your history. Indeed, it is impossible to present a good clinical history if you haven’t taken a good history from the patient.

Presenting examination findings

When presenting examination findings remember that the aim is to paint a clear picture of the patient’s clinical status. Help the listener to decide firstly whether the patient is acutely unwell by describing basics such as whether the patient is comfortable at rest, respiratory rate, pulse, and blood pressure. Is the patient pyrexial? Is the patient in pain? Is the patient alert and orientated? These descriptions allow the listener to quickly form a mental picture of the patient’s clinical status. After giving an overall picture of the patient you can move on to present specific findings about the systems in question. It is important to include particular negative findings because they can influence the patient’s management. For example, in a patient with heart failure it is helpful to state whether the patient has a raised jugular venous pressure, or if someone has a large thyroid swelling it is useful to comment on whether the trachea is displaced. Initially, students may find it difficult to know which details are relevant to the case presentation; however, this skill becomes honed with increasing knowledge and clinical experience.

Presenting in an exam

Although the same principles as presenting in other situations also apply in an exam setting, the exam situation differs in the sense that its purpose is for you to show your clinical competence to the examiner.

It’s all about making a good impression. Walk into the room confidently and with a smile. After taking the history or examining the patient, turn to the examiner and look at him or her before starting to present your findings. Avoid looking back at the patient while presenting. A good way to avoid appearing fiddly is to hold your stethoscope behind your back. You can then wring to your heart’s content without the examiner sensing your imminent nervous breakdown.

Start with an opening statement as you would in any other situation, before moving on to the main body of the presentation. When presenting the main body of your history or examination make sure that you show the examiner how your findings are linked to each other and how they come together to support your conclusion.

Finally, a good summary is just as important as a good introduction. Always end your presentation with two or three sentences that summarise the patient’s main problem. It can go something like this: “In summary, this is Mrs X, a lifelong smoker with a strong family history of cardiovascular disease, who has intermittent episodes of chest pain suggestive of stable angina.”

Improving your skills

The RIME model (reporter, interpreter, manager, and educator) gives the natural progression of the clinical skills of a medical student. 3 Early on in clinical practice students are simply reporters of information. As the student progresses and is able to link together symptoms, signs, and investigation results to come up with a differential diagnosis, he or she becomes an interpreter of information. With further development of clinical skills and increasing knowledge students are actively able to suggest management plans. Finally, managers progress to become educators. The development from reporter to manager is reflected in the student’s case presentations.

The key to improving presentation skills is to practise, practise, and then practise some more. So seize every opportunity to present to your colleagues and seniors, and reflect on the feedback you receive. 4 Additionally, by observing colleagues and doctors you can see how to and how not to present.

Remember the purpose of the presentation

Be flexible; the context should dictate the content of the presentation

Always include a presenting complaint

Present your findings in a way that shows understanding

Have a system

Use appropriate terminology

Additional tips for exams

Start with a clear introductory statement and close with a brief summary

After your summary suggest a working diagnosis and a management plan

Practise, practise, practise, and get feedback

Present with confidence, and don’t be put off by an examiner’s poker face

Be honest; do not make up signs to fit in with your diagnosis

Originally published as: Student BMJ 2010;18:c1539

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

See “Medical ward rounds” ( Student BMJ 2009;17:98-9, http://archive.student.bmj.com/issues/09/03/life/98.php ).

• ↵ Green EH, Durning SJ, DeCherrie L, Fagan MJ, Sharpe B, Hershman W. Expectations for oral case presentations for clinical clerks: Opinions of internal medicine clerkship directors. J Gen Intern Med 2009 ; 24 : 370 -3. OpenUrl CrossRef PubMed Web of Science
• ↵ Lingard LA, Haber RJ. What do we mean by “relevance”? A clinical and rhetorical definition with implications for teaching and learning the case-presentation format. Acad Med 1999 ; 74 : S124 -7. OpenUrl CrossRef PubMed Web of Science
• ↵ Pangaro L. A new vocabulary and other innovations for improving descriptive in-training evaluations. Acad Med 1999 ; 74 : 1203 -7. OpenUrl CrossRef PubMed Web of Science
• ↵ Haber RJ, Lingard LA. Learning oral presentation skills: a rhetorical analysis with pedagogical and professional implications. J Gen Intern Med 2001 ; 16 : 308 -14. OpenUrl CrossRef PubMed Web of Science

Oral Presentations: Tips, Significance, Design, Guidelines & Presentation

1) Know your audience

It is always a good idea to structure your talk so that anyone in the audience can understand  what you are presenting. A good scientist should be able to present complex, scientific ideas,  no matter how technical, in a simple, easy to follow manner. Complexity is not a necessity, it is an annoyance.

Understand your purpose. This way you can get the point of your talk across appropriately and affectively by  catering to your specific audience. 

2) Be organized

• Whether you are giving a 15 minute talk or a 45 minute talk, make sure you give yourself  enough time to deliver all the information you want in a calm manner. Allocate time for questions/answers.
• Be able to summarize your presentation in five minutes.
• Be concise. Use your space wisely. Use illustrations. Check grammar, spelling, and lay out of each slide.
• Keep an outline with you during the presentation; it will help you stay on track.
• Prepare back up slides. These will come in handy if a question comes up about a topic that needs  further explanation.

3) Presentation

Practice your talk enough so that you have flow, but no so much that you have the entire talk memorized.  Memorizing your talk will bore you and your audience, as it will be monotonous.

4) Be professional

• Know what you are presenting and be ready to answer question during and after the presentation.  Do not answer questions vaguely. A knowledgeable scientist is specific and accurate with his/her information.
• Dress up to present with confidence and respect for the audience and the science involved.
• Be enthusiastic. Scientific talks can be boring, as often they are full of technical jargon. Be clear and talk simplistically.
• Make sure the presentation is visually pleasing. Add pertinent graphics and use fewer words.

5) Be aware of technical problems.

Make sure the format you choose for your presentation is compatible with your style of speech.  Also, be prepared for technical disasters just before your talk. Be able to give your talk in another format  just in case your first choice (ex: PowerPoint presentation) fails to load.

Significance

Oral presentations are an excellent means of communicating basic science or clinical research.  Unlike a poster presentation or a written manuscript, the audience during an oral presentation is more  attentive as they are focused on the presenter. For the researcher, this is a rare opportunity to shine!  In as few as five minutes, the researcher can convey scientific information and give a years worth work  some meaning that can be useful to thousands of people. Of course, this also means that in as little as  five minutes, the researcher can cause a great deal of confusion by giving a bad presentation.

Just as is the case with written manuscripts and poster presentations, oral presentations must also  communicate research to include all aspects of the scientific method. There are, however, no rules as to  what order and which format this should be done in. In order to deliver a successful talk, the presenter  should be organized, prepared, and enthusiastic about the research being presented.

Design: A General Guideline

Regardless of whether you choose a PowerPoint presentation or transparencies to deliver your talk,  here are some general guidelines to keep in mind when designing your presentation.

1) Title (include authors and affiliations)

2) Introduction (Background, Purpose, Hypothesis)

3) Method (A brief introduction to the methodology without too much technical Jargon)

4) Results (Use graphs/charts/table, Provide an extra slide/transparency with a summary of the results, Explain the results)

5) Conclusions/Discussion (Clear explanation of the results, Clinical implications)

6) Future work (Provide information on where the project is headed)

7) Acknowledgment

Presentation

There some people for whom public speaking is as natural as having a conversation with their friends.  Conveniently, however, public speaking is an art that can be perfected with enough practice.  Here some things to consider before and during the presentation:

• Do not go over the time limit.
• Speak clearly and concisely. Be coherent. Do not ramble, play with the pointer, or move around in circles.
• Dress appropriately.
• Make eye contact.
• Make sure that each slide/transparency is not cluttered with too many points and ideas. Graphs, tables,  and charts should be clearly labeled and easy to interpret.
• Practice your talk, but do not memorize a script.
• Be visually and orally interesting.
• Answer questions in a calm, non-condescending manner; do not argue with or interrupt the questioner.
• Be polite and graceful.
• Give a presentation that is focused with one underlying message.

• Health Science

Definition of a Clinical Presentation

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Affiliation.

• 1 Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, USA.
• PMID: 9431639
• DOI: 10.1097/00007632-199712151-00003

Osteoporosis is a skeletal condition characterized by decreased density (mass/volume) of normally mineralized bone. The reduced bone density leads to decreased mechanical strength, thus making the skeleton more likely to fracture. Postmenopausal osteoporosis (Type I) and age-related osteoporosis (Type II) are the most common primary forms of bone loss seen in clinical practice. Secondary causes of osteoporosis include hypercortisolism, hyperthyroidism, hyperparathyroidism, alcohol abuse, and immobilization. In the development of osteoporosis, there is often a long latent period before the appearance of the main clinical manifestation, pathologic fractures. The earliest symptom of osteoporosis is often an episode of acute back pain caused by a pathologic vertebral compression fracture, or an episode of groin or thigh pain caused by a pathologic hip fracture. In the diagnostic process, the extent and severity of bone loss are evaluated and secondary forms of bone loss are excluded. A careful diagnostic work-up that includes clinical history, physical examination, laboratory evaluation, bone densitometry, and radiographic imaging will allow the clinician to determine the cause of osteoporosis and to institute medical interventions that will stabilize and even reverse this frequently preventable condition.

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Preeclampsia: Pathophysiology and Clinical Presentations

The following are key points to remember from this JACC state-of-the-art review on preeclampsia—pathophysiology and clinical presentations:

• Preeclampsia is a hypertensive disorder of pregnancy that occurs in 2-8% of pregnancies and causes substantial morbidity and mortality.
• Preeclampsia is defined as new-onset hypertension and new-onset end-organ damage after 20 weeks’ gestation. Proteinuria is no longer required for the diagnosis.
• The complex pathophysiology of preeclampsia begins with abnormal placental development, endothelial dysfunction, and immunologic aberrations, possibly related to genetic susceptibility. Clinical features of preeclampsia include hypertension, proteinuria, renal dysfunction, neurological abnormalities, eclampsia, cardiac dysfunction, pulmonary edema, hepatic dysfunction, hematologic dysfunction, and fetal growth restriction.
• Hypertension is necessary for the diagnosis of preeclampsia, defined as systolic blood pressure (SBP) ≥140 mm Hg or diastolic BP (DBP) ≥90 mm Hg on two occasions ≥4 hours apart after 20 weeks’ gestation in a woman with previously normal BP; or SBP ≥160 mm Hg or DBP ≥110 mm Hg on one occasion.
• Proteinuria: The imbalance between proangiogenic and antiangiogenic factors likely causes podocyte injury leading to increased risk of hypertension and chronic kidney disease. Proteinuria can take up to 2 years to resolve after preeclampsia.
• Renal dysfunction in preeclampsia is defined as serum creatinine >1.1 mg/dl or a doubling of baseline creatinine. Inflammatory cytokines lead to endothelial dysfunction and thrombotic microangiopathy of the kidneys, and decreased intravascular volumes in preeclampsia increases sodium and free-water retention.
• Neurologic dysfunction includes headaches, visual disturbances, seizure, posterior reversible encephalopathy syndrome, and hemorrhagic stroke. The classic preeclampsia headache is progressive, bilateral, pulsating/throbbing, associated with visual changes, worse with higher BP, worsened by physical activity, and not relieved by over-the-counter medications.
• Eclampsia is defined as new-onset tonic-clonic, focal or multifocal seizures in the setting of pregnancy-related hypertension. Magnesium reduces the risk of eclampsia by 59%.
• Cardiac dysfunction: Impaired placentation in preeclampsia causes increased vascular resistance and higher afterload, resulting in mild-to-moderate left ventricular diastolic dysfunction with concentric left ventricular hypertrophy. Preeclampsia is also a risk factor for peripartum cardiomyopathy (defined as left ventricular systolic function <45%).
• Pulmonary edema is rare in preeclampsia and is related to: 1) increased vascular permeability, 2) cardiac dysfunction, 3) corticosteroids/tocolytics, and 4) iatrogenic volume overload.
• Hepatic dysfunction is defined as transaminases ≥2x the upper limit of normal (AST typically < ALT) with right upper quadrant or epigastric tenderness.
• Hematologic disturbances in preeclampsia include thrombocytopenia (due to increased platelet activation, aggregation, and consumption) and disseminated intravascular coagulopathy (due to consumption coagulopathy, hepatic injury and decreased clotting factors, and/or inflammatory response).
• Fetal growth restriction (defined as an estimated fetal weight <10th percentile for gestational age) occurs commonly in pregnancies complicated by preeclampsia. Several mechanisms of uterine and placental dysfunction contribute to intrauterine growth restriction.
• Low-dose aspirin is recommended for prevention of preeclampsia in high-risk women. Possible benefits of exercise, pravastatin, and metformin are being investigated. The definitive treatment for preeclampsia is delivery.
• Further research to understand the link between preeclampsia and subsequent short- and long-term cardiovascular disease is needed.

Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Vascular Medicine, Acute Heart Failure, Hypertension

Keywords: Aspirin, Cardiomyopathies, Eclampsia, Fetal Growth Retardation, Headache, Hypertension, Hypertension, Pregnancy-Induced, Hypertrophy, Left Ventricular, Pre-Eclampsia, Kidney Diseases, Pregnancy, Primary Prevention, Proteinuria, Pulmonary Edema, Renal Insufficiency, Seizures, Stroke, Thrombocytopenia, Vascular Diseases

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