“So there’s a patient, and umm…  they are in the hallway, they came to the ED today for breathing problems, I mean dyspnea.  They also don’t speak any English.  So, uh the respiratory rate is normal, and they had a blood clot, er… I mean PE, in the past, but not on coumadin anymore.  Shoot, I forgot to tell you my exam…they had pitting edema for 3 months.  By the way, the labs came back on that other anemic patient in the other hallway, and they are really anemic…” – Anonymous medical student

Sounds familiar? Imagine working in a hectic ED while listening to this chaotic presentation. 

What’s the secret to presenting patients?

We, as attendings or senior residents, often assume that increasing knowledge will lead to improved presentations, and so focus on broadening their medical knowledge. That’s only part of the solution.

What’s the other part?

Polishing the trainee’s public speaking skills 

This is just like recommending to a lecturer that to improve their lectures, they should develop public speaking skills. In this case, the lecturer (trainee) is lecturing to an audience of one (attending).

Think of presentations as mini-impromptu speeches.  

Important qualities in public speaking:

  • Lack of fillers (um, so, uh, really, like)
  • Knowledge of content
  • Brevity
  • Organized structure
  • Eye contact
  • Subject matter of pertinence to the audience
  • Practice (go over the presentation in your head once before giving it)

As a senior resident or attending taking patient presentations, imagine a presentation that is succinct (less than 1-2 minutes), where the trainee avoids filler words, with an organized history, physical, assessment, and plan.  Imagine a presentation that does not deviate but remains true to the topic and tells a coherent story.  This type of presentation would almost be like a gentle relief in an over-stimulated ED environment.

Just as how you probably would not interrupt a good public speaker in the middle of his/her speech,  you should hold your questions until the end of their presentation. Remember this, and try to allow the trainees to finish speaking.  It may help them to keep their train of thought and structure.

For the senior resident or attending

  • I challenge you to consider these aspects of public speaking the next time you listen to a patient presentation from a student or resident. See if you can make recommendations to improve his/her presentation style as well as the content.

For the trainee

  • Work on being a better public speaker. 
  • As a side note, I was a part of Toastmasters International which is a nonprofit public speaking organization while in college.  Although I am no longer with the organization, I credit them with significantly improving my confidence and public speaking skills in both prepared and impromptu styles. Plus it was a lot of fun!  This is definitely something to consider if you are looking for a way to improve your public speaking skills.


Nikita Joshi, MD

Nikita Joshi, MD

ALiEM Chief People Officer and Associate Editor
Clinical Instructor
Department of Emergency Medicine
Stanford University
Nikita Joshi, MD


Emergency Medicine Doctor Associate Editor of ALiEM Gun Sense Advocate #FOAMed #Docs4GunSense #MomsDemandAction Tweets represent my own views and opinions