If you are scheduled to make a presentation of a clinical vignette, reading this article will improve your performance. We describe a set of practical, proven steps that will guide your preparation of the presentation. The process of putting together a stellar presentation takes time and effort, and we assume that you will be willing to put forth the effort to make your presentation successful. This and subsequent articles will focus on planning, preparation, creating visual aids (slides), and presentation skills. The intent of this series of articles is to help you make a favorable impression and reap the rewards, personal and professional, of a job well done.
The process begins with the creation of an outline of the topics that might be presented at the meeting. Your outline should follow the typical format and sequence for this type of communication: history, physical examination, investigations, patient course, and discussion. This format is chosen because your audience understands it and uses it every day. If you have already prepared a paper for publication, it can be a rich source of content for the topic outline.
To get you started, we have prepared a generic outline to serve as an example. Look over the generic outline to get a sense of what might be addressed in your presentation. We realize that the generic outline will not precisely fit all of the types of cases; nevertheless, think about the larger principle and ask yourself, "How can I adapt this to my situation?" In order to help you visualize the type of content you might include in the outline, an example of a topic outline for a clinical vignette is presented.
The main purpose of the introduction is to place the case in a clinical context and explain the importance or relevance of the case. Some case reports begin immediately with the description of the case, and this is perfectly acceptable.
1. Describing the clinical context and relevance
i. Ergotism is characterized by intense, generalized vasoconstriction of small and large blood vessels.
ii. Ergotism is rare and therefore difficult to diagnose.
iii. Failure to diagnose can lead to significant morbidity.
The case report should be chronological and detail the history, physical findings, and investigations followed by the patient's course. At this point, you may wish to include more details than you might have time to present, prioritizing the content later.
i. A 34-year-old female smoker has chronic headaches, dyspnea, and burning leg pain.
ii. Clinical diagnosis of mitral valve stenosis is made.
iii. She returns in one week because of burning pain in the legs.
iv. One month after presentation, cardiac catheterization demonstrates severe mitral valve stenosis.
v. Elective mitral valve commisurotomy is scheduled, but the patient is admitted to hospital early because of increased burning pain in her feet and a painful right leg.
2. Physical Examination
i. Normal vital signs.
ii. No skin findings.
iii. Typical findings of mitral stenosis, no evidence of heart failure.
iv. Cool, pulseless right leg.
v. Normal neurological examination.
i. Normal laboratory studies.
ii. ECG shows left atrial enlargement.
iii. Arteriogram of right femoral artery shows subtotal stenosis, collateral filling of the popliteal artery, and pseudoaneurysm formation.
4. Hospital Course
i. Mitral valve commisurotomy is performed, as well as femoral artery thombectomy, balloon dilation, and a patch graft repair.
ii. On the fifth postoperative day, the patient experienced a return of burning pain in the right leg. The leg was pale, cool, mottled, and pulseless.
iii. The arteriogram of femoral arteries showed smooth segmental narrowing and bilateral vasospasm suggesting large-vessel arteritis complicated by thrombosis.
iv. Treatment was initiated with corticosteroids, anticoagulants, antiplatelet drugs, and oral vasodilators.
v. The patient continued to deteriorate with both legs becoming cool and pulseless.
vi. Additional history revealed that the patient abused ergotamine preparations for years (headaches). She used 12 tables daily for the past year and continued to receive ergotamine in hospital on days 2, 6, and 7.
vii. Ergotamine preparations were stopped, intravenous nitroprusside was begun, and she showed clinical improvement within 2 hours. Nitroprusside was stopped after 24 hours, and the symptoms did not return.
viii. The remainder of hospitalization was uneventful.
The main purpose of the discussion section is to articulate the lessons learned from the case. It should describe how a similar case should be approached in the future. It is sometimes appropriate to provide background information to understand the pathophysiological mechanisms associated with the patient's presentation, findings, investigations, course, or therapy.
i. The most common cause of ergotism is chronic poisoning found in young females with chronic headaches.
ii. Manifestations can include neurological, gastrointestinal, and vascular (list each in a table).
iii. Ergotamine poisoning induces intense vasospasm, and venous thrombosis may occur from direct damage to the endothelium.
iv. Vasospasm is due primarily to the direct vasoconstrictor effects on the vascular smooth muscle.
v. Habitual use of ergotamine can lead to withdrawal headaches leading to a cycle of greater levels of ingestion.
vi. In addition to stopping ergotamine, a direct vasodilator is usually prescribed.
vii. Lesson 1: Physicians should be alert to the potential of ergotamine toxicity in young women with chronic headaches that present with neurological, gastrointestinal, or ischemic symptoms.
viii. Lesson 2: The value of a complete history and checking the medication list.
Creating a topic outline will provide a list of all the topics you might possibly present at the meeting. Since you will have only ten minutes, you will prioritize the topics to determine what to keep and what to cut.
How do you decide what to cut? First, identify the basic information in the three major categories that you simply must present. This represents the "must-say" category. If you have done your job well, the content you have retained will answer the following questions:
What happened to the patient?
What was the time course of these events?
Why did management follow the lines that it did?
What was learned?
After you have identified the "must-say" content, identify information that will help the audience better understand the case. Call this the "elaboration" category. Finally, identify the content that you think the audience would like to know, provided there is enough time, and identify this as the "nice-to-know" category.
Preparing a presentation is an iterative process. As you begin to "fit" your talk into the allotted time, certain content you originally thought of as "elaboration" may be dropped to the "nice-to-know" category due to time constraints. Use the following organizational scheme to efficiently prioritize your outline.
Prioritizing Topics in the Topic Outline
1. Use your completed topic outline.
2. Next to each entry in your outline, prioritize the importance of content.
3. Use the following code system to track your prioritization decisions:
A = Must-Say
B = Elaboration
C = Nice-to-Know
4. Remember, this is an iterative process; your decisions are not final.
5. Review the outline with your mentor or interested colleagues, and listen to their decisions.
Use the Preparing the Clinical Vignette Presentation Checklist to assist you in preparing the topic outline.
Candidates are responsible for choosing the Management Case Study topic.
Where appropriate, Candidates should discuss their proposed topic with the appropriate parties within their own organisation for any consideration toward confidentiality or privacy.
The Candidates should identify a topic related to their workplace and a process/event that they have actively been involved in and one that has provided the opportunity for them to demonstrate their leadership skills.
Examples of topics include but are not limited to:
- the development of aspects of improved communication in their workplace
- the introduction of aspects of an improved financial management system
- a change in committee structure
- the development of a new clinical program or service
- a change management process
- introduction of new technology
- an audit
- management of a complex incident e.g. Coroners case, Emergency Response, significant clinical incident, significant concern regarding a clinician
- service development, implementation and evaluation
- development of a Workforce or Strategic Plan.
- ability to identify an important health service management issue
- ability to assess and research the issue
- capacity to relate this appropriately to theory, knowledge and best practice
- ability to take management action
- ability to document the Case Study in a clear and professional manner.
The study is intended to extend the knowledge and skills of the Candidate. Both the preparation and the examination of the Case Study should be a learning experience. The study is not intended to be original research, but nevertheless, it should not have been submitted previously for other course work or another degree.
Undertaking the Study
Management Case Study Proposal
The Management Case Study Proposal will incorporate an outline of the proposed Case Study: the rationale for undertaking it, the specific objectives, the proposed methodology and expected outcome.
In determining an appropriate subject for study, Candidates must discuss their Proposals with their Preceptors. The Proposal must be signed off by the Preceptor or Executive Coach before being sent to the Censor for Research and Case Studies for endorsement. Any Proposal not signed off by the Preceptor or Executive Coach will not be considered.
The Management Case Study Proposal should be a maximum of 1,000 words.
The Management Case Study should demonstrate that the Candidate has developed further knowledge and practical skills in the subject area. It should describe a health service management activity and analyse it in terms of relevant management literature and practice. Any lessons for health service management practice should be identified.
The usual format for the Proposal is as follows:
Title – The title of your project
This should be a succinct but defining statement of the overall nature of your study.
Background – A description of the problem being addressed
The 'problem' is a description of what precisely the event or process improvement is and how it will be identified. This may include reference to key relevant literature or needs analyse.
If the problem is too broad for this Management Case Study, it is important to define the scope of the part of the problem you will be addressing.
Methodology – An outline of the actual course of action taken.
This is a statement of the overall approach, strategies or method you used.
Outline the specific competencies from the RACMA Curriculum you will be discussing in your Case Study.
Please submit your Management Case Study Proposal with the Cover Sheet to your Preceptor.
Written Management Case Study
The written submission should consider the following:
- Why the topic is being presented?
- What was the problem/issue/challenge? Contextualise this and convey meaning about the importance of resolving the problem. Why was it a priority?
- What did you do to understand, determine a course of action, communicate, get agreement to and implement the course of action/response to the problem, and how effective was the outcome?
- What did you learn from this problem solving action - about organisation, management, people, systems, managing change, etc.?
- What research did you do to find a solution?
- How it was managed to conclusion/resolution?
- What was your role in the process?
- How did the Candidate’s development of the RACMA Core Competencies apply in the management of this situation?
- What skills and knowledge have you developed as a result of this activity?
The final Management Case Study will be:
- Between 2,500 and 3,000 words (excluding references, title, footnotes, appendices).WORD COUNT MUST BE STRICTLY APPLIED, IN CASE OF EXCESSIVE WORD COUNT THE MANAGEMENT CASE STUDY WILL NOT BE FORWARDED TO THE MARKERS FOR ASSESSMENT.
- Appropriately referenced to relevant literature. Please note: Candidates may choose the Harvard or Vancouver referencing system.
- Appropriately related to the RACMA Core Competencies to demonstrate how the Candidate has attained and enhanced these as part of a learning process during Candidacy.
A signed statement (as below) that the work submitted is your own and has not been submitted for any previous assessment.
"I hereby declare that the intellectual content of this Case Study is the product of my own work even though I may have received assistance from others in style, presentation and linguistic expression.
I also declare that I have addressed all ethical and legal considerations prior to submission.
This written Case Study has not been previously submitted in this form, for assessment at any time.
My Preceptor has read this case study and concurs that it is ready for submission.”
You should sign and date this declaration.
The written Management Case Study must be submitted in a WORD document to RACMA National Office via the eETP with the Management Case Study Cover Sheet (available on the web). The cover sheet must be signed by the Preceptor. The Preceptor should acknowledge on the cover sheet that the work is ready for submission and assessment by Censors.