Here’s a comprehensive, actionable guide to presenting a clinical case effectively, whether you’re a medical student on rounds, a resident at morning report, or presenting at grand rounds.

The Standard Clinical Case Framework

Use the **SOAP+ structure (adapted for presentation flow):

1. The Hook (30 seconds)

• Chief Complaint: "This is a 58-year-old male presenting with 3 days of crushing substernal chest pain"
• One-liner: Age, sex, relevant history, presenting problem, and key severity indicator
• Why this matters: Give the audience the "punchline" upfront so they can think along with you

2. History of Present Illness (HPI) (2-3 minutes)

Present chronologically, not by ROS:

• Onset: When did it start? Sudden vs. gradual?
• Character: Quality, severity (1-10), radiation, associated symptoms
• Context: What was patient doing? What makes it better/worse?
• Relevant negatives: Key symptoms that don't exist (e.g., "No fevers, no hemoptysis")
• Prior episodes/interventions: What has been tried?

Pro tip: Use the patient's own words in quotes at least once ("It feels like an elephant sitting on my chest").

3. Pertinent History (1 minute)

• Past Medical/Surgical History: Only relevant positives and critical negatives
• Medications: Include adherence and recent changes
• Allergies: Especially to contrast, medications relevant to current case
• Social History: Smoking, alcohol, drugs, occupation, living situation (if relevant to management)
• Family History: Only genetically relevant conditions

4. Physical Exam (1 minute)

• Vitals: Include trends if available ("Temp 38.2→39.1 over 4 hours")
• General appearance: Cachectic, distressed, alert/oriented?
• Focused exam: Only systems relevant to the differential
• Key findings: Abnormalities first, then pertinent negatives

5. Diagnostic Data (1-2 minutes)

• Labs: Trend critical values (Creatinine 1.2→2.1), don't laundry-list every CBC result
• Imaging: Describe key images yourself rather than reading the radiology report
• Other: EKG findings, microbiology, pathology
• Preliminary vs. Final: Flag pending results

6. Assessment (2 minutes)

• Problem list: 3-5 active problems, prioritized by acuity
• Summary statement: One paragraph synthesizing the case
• Differential diagnosis: 3-5 possibilities, ranked by likelihood with supporting/refuting evidence for each
• Working diagnosis: Your leading hypothesis and confidence level

7. Plan & Next Steps (2-3 minutes)

Organize by problem:

• Diagnostic: What tests to order and why? Risks?
• Therapeutic: Specific medications (dose/route), procedures, consults
• Disposition: ICU vs. ward vs. discharge? Code status discussion needed?

8. Teaching Points/Discussion (2-5 minutes)

• Learning objective: One clear take-home message
• Evidence: One key paper or guideline supporting your plan
• Clinical pearl: Something memorable about this specific case

Step-by-Step Preparation Checklist

24-48 Hours Before:

• Verify all facts in the chart (med rec, last vitals, pending labs)
• Choose 1-2 representative images (CXR, EKG, rash photo) with patient identifiers removed
• Anticipate 3 questions your audience will ask and prepare answers

2-4 Hours Before:

• Time yourself: Target 5-7 minutes for daily rounds, 15-20 for case conferences
• Synthesize, don't summarize: Cut any lab value that doesn't change management
• Prepare the "pivot": Know exactly where in your note to jump if interrupted

15 Minutes Before:

• Check your technology (clicker, screen mirroring, microphone)
• Bring a physical copy of your one-pager/outline
• Review the first 60 seconds verbatim (this is when nerves are highest)

Visual Aid Template

Create a one-slide summary (even for verbal presentations):

Rules for slides:

• Max 5-6 bullet points per slide
• Font size ≥24pt
• One image per slide, clearly labeled
• No complete sentences (except direct quotes)

Audience-Specific Adaptations

Morning Rounds (Attending + Team):

• Focus on overnight events and today's to-do list
• Skip detailed remote history unless new information
• Be ready to present alternatives if attending challenges your plan

Case Conference/Grand Rounds:

• Include epidemiology and literature review
• Show imaging progression (serial CXRs, EKG evolution)
• Discuss health systems issues (cost, discharge barriers, social determinants)

Morbidity & Mortality (M&M):

• Lead with what happened and what was done
• Focus on systems issues rather than individual blame
• Present change ideas (new protocols, checklists)

Common Pitfalls to Avoid

1. The Data Dump: Reading every lab value from the past week. Instead: "Renal function has been deteriorating since admission, with creatinine rising from 0.9 to 2.1."
2. The Mystery Novel: Hoarding the diagnosis until the end. Give the chief complaint immediately.
3. Jargon without translation: If you say "patient is tachypneic," follow with "respiratory rate of 28."
4. Ignoring the nurse/RT: Acknowledge bedside team input: "The nurse noted new confusion at 0200, prompting the rapid response."
5. Weak differential: Never say "could be anything." Show your reasoning by weighing evidence for/against each possibility.

Sample Opening Script

"Good morning. I'm presenting Mr. Johnson, a 58-year-old male with coronary artery disease and diabetes who presented last night with crushing chest pain. In brief, this appears to be an NSTEMI complicated by contrast-induced nephropathy. The key decision point this morning is whether to proceed with cath given his rising creatinine.

History: He was playing basketball when he developed substernal pressure rated 8/10, radiating to his left arm, associated with nausea but no vomiting... [Continue with framework above]"

To tailor this further for your specific situation, could you tell me:

1. What is your training level (student, resident, attending, NP/PA)?
2. What is the venue (daily rounds, case conference, M&M, or external presentation)?
3. What specialty/format are you working in, and do you have any specific challenges (difficult diagnosis, complex social situation, or teaching case)?

I can then provide specialty-specific templates (ICU handoff vs. outpatient clinic vs. psychiatry formulation) or help you workshop a specific case you're preparing.

Presenting a clinical case effectively is a core skill in medicine. Whether you are on rounds, in a morning report, or presenting at a conference, the goal is to tell a concise, logical story that leads your audience to a specific diagnosis and treatment plan.

Follow this step-by-step template to structure and deliver your case.

Phase 1: The "One-Liner" (Introduction)

This sets the stage. It should be a single sentence that captures the essence of the patient.

• Template: "Mr./Ms. [Last Name] is a [Age]-year-old [Gender] with a history of [Relevant Chronic Conditions] who presents today with [Chief Complaint]."
• Example: "Mr. Smith is a 65-year-old male with a history of COPD and heart failure who presents with a three-day history of worsening shortness of breath."

Phase 2: History of Present Illness (HPI)

Focus on the chronology of the current issue. Use the OLD CARTS acronym to ensure you cover all bases:

• Onset, Location, Duration.
• Character, Aggravating/Alleviating factors, Radiation, Temporal pattern, Severity.

Actionable Tip: Include "pertinent negatives." If the patient has chest pain but no nausea or diaphoresis, say so. It helps narrow the differential diagnosis.

Phase 3: Relevant Past History

Do not list every surgery or medication the patient has ever had. Only include what is relevant to the current presentation.

• Medical/Surgical History: Relevant chronic illnesses.
• Medications: List doses and compliance.
• Social History: Smoking, alcohol, drug use, or living situation if relevant.
• Allergies: Specifically mention drug allergies.

Phase 4: Physical Exam (Focus on Pertinent Findings)

Start with Vitals (Temperature, HR, BP, RR, SpO2).

• General Appearance: "The patient appears in acute distress" or "The patient is resting comfortably."
• Organ Systems: Focus on the system related to the complaint (e.g., if it's shortness of breath, focus on Lungs and Heart).
• Negative Findings: Mention what you didn't find if it rules out a serious condition.

Phase 5: Labs and Imaging

Summarize the data rather than reading a list of numbers.

• Labs: "CBC was notable for a leukocytosis of 15,000; electrolytes were within normal limits."
• Imaging: "Chest X-ray showed a right lower lobe infiltrate consistent with pneumonia."
• EKG/Special Tests: Only mention the findings that change your management.

Phase 6: Assessment and Plan (The "Synthesis")

This is the most important part. It shows your clinical reasoning.

1. Summary Statement: Briefly restate the case (The "Problem Representation").
2. Differential Diagnosis: List 3-5 possibilities, starting with the most likely or the most dangerous.
3. Plan: Organize by problem.
   • Problem 1 (e.g., Pneumonia): Start IV Ceftriaxone, supplement oxygen to maintain Sat >92%.
   • Problem 2 (e.g., History of Hypertension): Continue home Lisinopril.

Delivery Tips for Success

• Don't read your notes: Use them as a guide, but maintain eye contact with your audience.
• Be concise: A standard ward presentation should take 3 to 5 minutes.
• The "Rule of Relevant": If a piece of information doesn't help you reach the diagnosis or affect the treatment, consider cutting it.
• Commit to a diagnosis: Even if you aren't sure, state what you think is most likely. It shows you are thinking critically.

Ready to refine your presentation?

To provide more specific guidance, tell me:

1. What is your role? (Medical student, Resident, Nurse, etc.)
2. What is the setting? (Daily bedside rounds, a formal Grand Rounds presentation, or an ER handoff?)
3. Do you have a specific case in mind that you would like me to help you format right now?