HAIVN Harvard Medical School AIDS Initiative in Vietnam Communicating to Other Health Professionals About Your Patient: Doing Case Presentations HAIVN Harvard Medical School AIDS Initiative in Vietnam M1-20-Case Presentations-EN HAIVN Module 1, Revised April 2012

Learning Objectives By the end of this session, participants should be able to: Outline the key elements of a case presentation about a person living with HIV/AIDS (PLHIV) Explain how to prepare and deliver a case presentation about a PLHIV ASK participants “What is a case presentation?” ALLOW time for them to answer before moving on to the next slide.

What is a Case Presentation? Presentation which gives all the information necessary for a colleague to understand a patient’s situation Patient’s “story”: why patient is being seen in clinic or hospital, what has happened until present time May be long or short, depending upon: where story is being told who it is being told to EMPHASIZE that the case presentation is a summary of the patient’s clinical “story” up through the present time. The presentation can be long or short, depending on the situation in which the presentation is being made. ASK participants “What are some of the elements that go into an effective case presentation?” ALLOW time for them to answer. WRITE down their answers on a flip chart, generating a list. USE discussion to lead into the next slide.

Elements of the Case Presentation Introduction & Chief Complaint History of Present Illness (HPI) Past Medical History medical, surgical, including meds and allergies Social History Review of Systems (ROS) Physical examination Laboratory and diagnostic studies Clinical Assessment Treatment Plan REFER participants to Handout M1S20.1: Elements of a Case Presentation for further detail on what should go into a case presentation.

HIV Case Presentations: Suggestions (1) Mention most recent known CD4 count and ARV status within the first or second sentence “Tuan is a 29 year old HIV+ male who presents with a chief complaint of dyspnea on exertion. He has been on ART for one year and his most recent CD4 cell count was 280 three months ago.” EXPLAIN that the information about the current CD4 count and ARV status helps frame the story for the listener. How the listener thinks about all subsequent information will change based on the CD4 count and ARV status so it is best to provide that information up front.

HIV Case Presentations: Suggestions (2) Make sure to include pertinent negatives as well as positives. “Medications include d4T, 3TC, NVP, and cotrimoxazole. He denies any use of private or traditional medications.” “On examination, there was no thrush, lymphadenopathy, or skin rash.” EXPLAIN that the negatives are often more important to know than the positives. In addition, mentioning the pertinent negatives informs the listener that you have asked that piece of history or performed that part of the physical examination.

HIV Case Presentations: Suggestions (3) When discussing past medical history, include any prior OIs and the most common co-morbidities. “Past medical history includes cerebral toxoplasmosis. There is no prior history of TB, HBV, or HCV infection.” EXPLAIN that mentioning the prior OIs is important since recurrence of a previous OI is always high on the list of possible diagnoses.

HIV Case Presentations: Suggestions (4) Provide a summary statement (s) as part of your clinical assessment “In summary, the patient is a 26 year old man with a CD4 count of 212 who presents with recurrent signs and symptoms of pneumonia despite two weeks of antibiotic therapy.” EXPLAIN that the summary should synthesize all the information and data into a concise statement or statements. REFER participants to Handout M1S20.2: Tips for Giving an Effective Case Presentation for more tips and suggestions.

Pair Activity: Practice Delivering Case Presentations DIVIDE participants into pairs. EXPLAIN that they will practice delivering case presentations to their partner. REFER them to Handout M1S20.3: Case Presentation Scenarios and Worksheet M1S20.4: Observer Checklist. EMPHASIZE the importance of each role: The presenter should present the patient information as listed and then make a fluid case presentation that is logical and organized and in the end summarize the case and make some kind of assessment and treatment plan.  The listener should pay close attention, listen well, make sure that the case makes sense as presented, and take notes about strengths, weaknesses and areas for improvement on the observer checklist.

Key Points Goal of case presentation is to present clinical scenario in a clear, concise manner Case presentations may be used to: consult with a colleague on a difficult case or present a case in a conference or workshop Case presentation should: include all relevant information not include facts or details not pertinent to case After presentation, listener should have a clear understanding of the case and be able to make a treatment plan for the patient SUMMARIZE the usefulness knowing how to do a clear and concise case presentation.

Thank you! Questions?