236 2021 u6 present a case SNAPPS LIS

UNIT – LISTENING & SPEAKING (2 hours) ENGLISH IN MEDICINE – GENERAL PRACTITIONER Y2 ORAL CASE PRESENTATION: THE SNAPPS METHOD Editor: Nguyen Hoang Quynh Mai Email: nguyenhquynhmai@duytan.edu.vn PRONUNCIATION EXERCISES LISTENING EXERCISES SPEAKING ACTIVITIES PRONUNCIATION EXERCISES daily presentation ward round admitted patient inpatient outpatient various structures individual supervisors clinical knowledge clinical reasoning patient care identify information chief complaint treatment plan foundational approach preceptor clinical uncertainty differential diagnosis most likely diagnosis PRONUNCIATION EXERCISES Communicating patient care information to colleagues and other health professionals is an essential skill regardless of specialty Internists have traditionally given special attention to case presentation skills because of the comprehensive nature of patient evaluations and the various settings in which internal medicine is practiced Students should develop facility with different types of case presentation: written and oral, new patient and follow-up, inpatient and outpatient 1 PRONUNCIATION EXERCISES When done correctly, oral case presentation is a powerful clinical skill A fluent case presentation allows for efficient and effective transitions between providers Such communication is essential within and between provider teams and between physicians and supporting staff The oral case presentation also serves as a useful proxy for assessing student competency in clinical reasoning and patient care Despite its clear importance, oral case presentation has not been consistently and effectively taught in medical school Student and faculty perceptions of the oral case presentation vary widely Evaluations of the oral case have also varied, and the variation has been attributed to interrater variability despite attempts to standardize the process 2 LISTENING EXERCISES SNAPPS in action: https://www.youtube.com/watch?v=Y6J3dL7hZfk Listen to the video twice and try to fill in the blanks 2 LISTENING EXERCISES P: So tell me about Donna S: Donna’s a (1) patient who presents with a 4-month history of intermenstrual bleeding She’s saying she’s bleeding in between periods for (2) and needing about one panty liner per day; no particular associated pain with these bleeds but she does admit to deep pain occasionally during intercourse for the last months as well She otherwise has (3) every weeks with bleeding for about days Bleeding at this time is not particularly heavy but it has become more painful over the last few years 2 LISTENING EXERCISES She’s been (4) since she was twenty with very few partners Her current partner’s been the same one for the last years and she has no histories of (5) They’re currently using condoms and not watching a family at this point, and she’s never taken any contraception in the past She’s never been pregnant, never had an ectopic or any miscarriage in the past She’s had regular pap smears throughout her life, she’s never had abnormal result and her last one was about over a year ago She’s a nonsmoker, otherwise healthy and no significant past medical history On examination, her abdominal exam was entirely normal On bimanual exam, her uterus was a little bit tender (6) , but otherwise normal Speculating examination was normal and at the same time I did a pap smear and swabs 2 LISTENING EXERCISES Great! So (7) at this time would be DUB (dysfunctional uterine bleeding), would be endometriosis and maybe the presence of a uterine fibroid, a polyp So going through the differentials, a DUB would be quite common but it’s kind of a (8) so I have to rule out other causes first Endometriosis can occur at this age, she has the intermenstrual spotting as well as (9) Painful intercourse I think that’s about it for any pain during a period A polyp or fibroid can also have deep dyspareunia as well as the bleeding during periods Great 2 LISTENING EXERCISES Do you think there’s any other diagnoses? I guess my only other one would be adenomyosis Have you thought about that? Okay, I don’t know that much about it It wasn’t (10) anyway Okay So as far as management, we had discussed her symptoms and her problems together and we thought we would send her for a (11) We’ll a CBC just to see how much blood has been lost We’ll wait for the results of the pap smear that we did and we’ll (12) some NSAIDs for her pain I’m not entirely sure what NSAID to use and how much 2 LISTENING EXERCISES Okay well we can discuss that with her when (13) Okay As far as the case to read up, further about I was thinking if it had adenomyosis as I’m not that (14) Great Alright, let’s go in and see her Okay 2 LISTENING EXERCISES S P: So tell me about Donna S: Donna’s a 40-year-old female patient who presents with a 4month history of intermenstrual bleeding She’s saying she’s bleeding in between periods for or days and needing about one panty liner per day; no particular associated pain with these bleeds but she does admit to deep pain occasionally during intercourse for the last months as well She otherwise has regular periods every weeks with bleeding for about days Bleeding at this time is not particularly heavy but it has become more painful over the last few years 2 LISTENING EXERCISES S She’s been sexually active since she was twenty with very few partners Her current partner’s been the same one for the last years and she has no histories of sexually transmitted disease They’re currently using condoms and not watching a family at this point, and she’s never taken any contraception in the past She’s never been pregnant, never had an ectopic or any miscarriage in the past She’s had regular pap smears throughout her life, she’s never had abnormal result and her last one was about over a year ago She’s a nonsmoker, otherwise healthy and no significant past medical history On examination, her abdominal exam was entirely normal On bimanual exam, her uterus was a little bit tender on palpation, but otherwise normal Speculating examination was normal and at the same time I did a pap smear and swabs 2 LISTENING EXERCISES Great! N A So my differential at this time would be DUB (dysfunctional uterine bleeding), would be endometriosis and maybe the presence of a uterine fibroid, a polyp So going through the differentials, a DUB would be quite common but it’s kind of a diagnosis of exclusion so I have to rule out other causes first Endometriosis can occur at this age, she has the intermenstrual spotting as well as the bleeding Painful intercourse I think that’s about it for any pain during a period A polyp or fibroid can also have deep dyspareunia as well as the bleeding during periods Great 2 LISTENING EXERCISES P P Do you think there’s any other diagnoses? I guess my only other one would be adenomyosis Have you thought about that? Okay, I don’t know that much about it It wasn’t on my list anyway Okay So as far as management, we had discussed her symptoms and her problems together and we thought we would send her for a pelvic ultrasound We’ll a CBC just to see how much blood has been lost We’ll wait for the results of the pap smear that we did and we’ll probably prescribe some NSAIDs for her pain I’m not entirely sure what NSAID to use and how much 2 LISTENING EXERCISES S Okay well we can discuss that with her when we go back in Okay As far as the case to read up, further about I was thinking about adenomyosis as I’m not that familiar with it Great Alright, let’s go in and see her Okay 3 SPEAKING ACTIVITIES DESCRIBE THE PICTURE SPEAKING ACTIVITIES DESCRIBE THE PICTURE SPEAKING ACTIVITIES CONVERSATION WITH A PATIENT Introduce yourself - name & role Confirm patient details - name & DoB Explain the need to take history Gain consent Present complaint Ask for details Other symptoms Previous health Summary & next step SPEAKING ACTIVITIES CONVERSATION WITH A PATIENT Work in pairs to make your own story, start with a common symptom that you’ve learned QUESTIONS & ANSWERS ... consistently and effectively taught in medical school Student and faculty perceptions of the oral case presentation vary widely Evaluations of the oral case have also varied, and the variation has been attributed... staff The oral case presentation also serves as a useful proxy for assessing student competency in clinical reasoning and patient care Despite its clear importance, oral case presentation has not... she’s never had abnormal result and her last one was about over a year ago She’s a nonsmoker, otherwise healthy and no significant past medical history On examination, her abdominal exam was entirely