My last day of rotation, I just failed my clinical rotation preceptor evaluation

[indigo5486]

I'm currently in my clerkship year, 2nd rotation, and on my last day my preceptor told me that I will have to retake my clerkship. It will be replace one of my electives at the end of the year after my core elective, and I'm feeling especially down, but I have accepted the decision. Their reasons were that I had difficulty with presentations, and knowledge content. During my mid-rotation evaluation, I acknowledged that I had difficulty with presentations, and I relied on my notes to make the presentation. I have severe anxiety with making presentations, and having my notes readily available really helped me, my lead preceptor even said I was able to use my notes for the later presentations, which definitely improved my presentations, but now it seems that they are going against their word. I wished that they had told me mid-week, and checked in or given me ways to improve throughout and not thrown it at me all at the end. Regarding my knowledge content, as a student, my job here was to learn, and I feel as if I'm being penalized for asking questions that I did not know to. 

Essentially, I just want some advice on how to cope with improving my presentations and anxiety, along with any input on any further steps I should take. 

[Carolina]

I'm so sorry to hear about your experience. It's difficult to memorize all the medical content, almost everyone needs some kind of outline or notes to follow when presenting. I have yet to do my rotations but I learned the following from my presenting in my Chemistry Thesis Defense:
-OneNote - Helped me to outline my ideas. I placed pictures that represented some thoughts I had, that helped me to remember pictures instead of memorizing paragraphs.
-Practice as much as you can and much before your presentation, it'll help you be confident and remember the material better
-Find people that encourage and motivate you. In my case was different because my family is in another country so I found motivation from YouTube speakers.
I pray for the best in your upcoming tasks!

[greenmood]

It sounds like there was an attempt made to bring this up during the rotation at your midway review, but it perhaps was not direct enough since you left that discussion not thinking their concerns were especially serious.

Presentations are hard, and there is an art to them. It's very challenging to master, and made more so when you don't have control over your anxiety. @Carolina is right, practice often helps. I find many students try to cram too much information into the presentation, which makes everything worse. They don't remember the important parts and I have difficulty helping navigate the clutter. You didn't mention what specialty this was, but if it was primary care (or internal medicine) consider a more minimalist approach. That will allow you to sound firm and concise, and you can then add information or answer questions.

Regarding the knowledge content, that's a tough one. You're so early in your clinical year and again I don't know the specialty. I remember my pediatrics preceptor was outraged I couldn't do metric dose conversions by memory, which I thought was especially unfair since everything was weight based and I didn't want to OD some tiny infant on ibuprofen. But in his mind that was a basic ability I needed in order to be efficient and effective in his office. There may be things that they felt really strongly you needed to understand - think back. Did you make an extra effort to look for the information yourself before you asked the question? Did you demonstrate that you had read and considered the topic? If so, maybe their expectations were a little off. If not, it's something to work on. Preceptors want to see independent learning and effort.

In any case, you're getting a second crack at it. After you've had a minute to lick your wounds, please make sure to go back to these people or your clinical coordinator and get a really firm, concrete understanding of where they felt you went wrong. You need to know if there were specific content areas where they found deficiencies so that you can study and correct them. And start practicing your presentations, on video, with a partner. And watch the video. It will be excruciating, but you will learn so much.

[indigo5486]

@greenmoodThis was extremely helpful, and I will definitely take your advice with practicing presentations on video. Thank you. 

[UGoLong]

I've seen some overcome this problem by using a template. Rather than ad-libbing everything, the first sentence or two could always be of the same general format so that you can relax while you say it and get ready for the rest of your talk. ("Mrs. Smith is a 41 yo female with a history of x, y, and z who presents today after 48 hours of a diffuse mid-abdominal pain..."  

You only have 30-60 seconds and trying to get in too much can be a problem. I see med students use one 3x5 card listing what they want to get across. Your job is to organize your thoughts to help the listener, not to regurgitate lots of detail in random order. When you finish, they may have questions that you can answer.

Edited June 9, 2021 by UGoLong

[greenmood]

On 6/9/2021 at 9:50 AM, UGoLong said:

"Mrs. Smith is a 41 yo female with a history of x, y, and z who presents today after 48 hours of a diffuse mid-abdominal pain..."  

 

I just want to add, OP be careful with the x, y, z part here or you may lose your listener. I don't want to hear about my 41 year old female's broken bone from 5th grade unless the leg was amputated and she's here with an infection in the residual limb.

Consider.

You: Mrs. Smith is a 41 year old female here with right pyelonephritis. She has medical comorbidities significant for poorly controlled type 2 diabetes and morbid obesity. Medical history is notable for recently treated chlamydia and childhood history of VUR. She noticed dysuria and gross hematuria about 3 days ago, and developed fever and flank pain last night.

Me: What else is going on with her?

You: Well, her hypertension is well controlled on lisinopril, and she's been on a stable dose of zoloft for the last 10 years for depression.

Me: Great, keep going.

You: [ED findings, pertinent labs, PE, plan of attack]

Me: Wow you're the best student ever. You even identified that she's high risk for atypical organisms due to her recent chlamydia and antibiotic therapy, and because you have great bedside manner she felt comfortable enough to share personal details with you and we can check her for other STIs. Good job you.

[st3ppingstoneinlife]

I just want to say that the anxiety may never actually go away. You may learn to cope with it a little better though. What has always helped me is to plan any presentation as meticulously as I can, being prepared and knowing the material will help calm the nerves a bit. I would also suggest to join a public speaking group where you can practice. The more you practice the easier it will get, like anything else in life. 

Good luck! 

[mmtaylor]

I just wanted to thank everyone for their advice on this topic. I'm a naturally shy person who struggles with debilitating anxiety and am very nervous for my clinical rotations for the exact same reason as the author -- I have struggled with knowledge recall during OSCEs and with presentations. The advice about using a template is incredibly helpful.

Any other advice to overcome this anxiety and stuttering when being "pimped" is much appreciated.

Thanks!

[PAschoolisfun]

I'm about to start my clerkship year here soon. Some advice I got from one of my faculty was to have a complete physical (with all findings you could find) memorized. I know that sounds like a lot, but it just takes practice. He told us to just repeat it over and over, in the car, in the shower, to your pet, etc. So that you have all of that in the back of your head for when you need to pick it out. I also agree with all of the other comments about the history portion as well. I hope this helps. I will be following this thread because I too, need to sharpen up my oral presentations before I start in June.

[ohiovolffemtp]

A very important thing to think about is that PA school tends to teach physical exam and even OSCE's as exhaustive lists to be passed by regurgitating everything.  In the actual medical world, the physical exam is actually a decision tree.  There are some things, such as mental status, lungs, and cardiac that are always present, but many other things vary significantly in depth of exam or even being examined at all based on the patient's complaints and presentation.

When you present a patient to a preceptor who's actually working in the field they're interested in hearing only what's relevant for the patient and don't want to have to find the wheat in the chaff.

Greenmod gave a good example of the targeted presentation vs the laundry list.

So, your faculty's advice needs to be tempered.  The complete physical exam that you're memorizing is the big version that you will always prune to what's relevant when you're doing your rotations.

[LT_Oneal_PAC]

all good advice here. I’ll agree with keeping presentations limited to pertinent information. What’s pertinent? Well, that takes experience and practice.
 

I’ll just say this, failing a second rotation student for presentation seems pretty….severe. Knowledge content maybe, but it would have to lack of pretty basic knowledge for me to fail a second rotation student. Personally, I take failing a student as a personal failure as a teacher, unless they are just lazy or an A-hole. Rarely does one make it this far and is unteachable for lack of intelligence.