Thread by @medrants

1/ Thoughts on presenting on rounds #UncleBob - #5goodminutes

This is how I do rounds - would love questions and critiques.

I explain my expectations the first day on the service.

@WrayCharles @LisaWillett13 @iMedEducation #MedEd @ShreyaTrivediMD @AdamRodmanMD

2/ New patient presentations:

Deliver a succinct HPI - start with chief complaint - insert RELEVANT PMH as desired. Tell the story chronologically if possible. Include related review of systems, social history, health behavior history, medication list as pertinent.

3/ Stop after HPI and we will discuss the HPI. The goal of the discussion is to improve how each learner tells the story. The goal is complete, yet succinct. Don't give too much information. Avoid redundancy. We call this discussion IMMEDIATE FEEDBACK.

4/ Most learners improve their HPI dramatically by their second presentation. They love the constructive feedback and the positive feedback of improvement.
They then provide the physical examination, labs (CBC first, BMP second, then other useful labs). Finally they show images

5/ We then ask them their synthesis and plans. After that we have a team discussion, some teaching (depending on time restrictions). Finally we go to each bedside and take some history again and key physical findings.

6/ Old patients are very different. I particularly want to know what has happened since yesterday - do not need VS on every patient. What is new and what is the current plan? Are we closer to a diagnosis or a treatment plan?
We do not "formally present" on day 2 - X.

7/ The daily focus is to have the learners synthesize the previous days information (new labs, images, consults, change in status). We then critique (in a kind way I hope) their synthesis and their plans. This gives us more time to teach.

I hope I've made this clear & helpful