HealthFebruary 04, 2020

Improving your presentation skills: SOAP and beyond

By: Ogie M. Ezeoke, MD

Your evolution as a medical student can be marked by the achievement of certain milestones, from learning how to be a historian to presenting patients to your clinical team. While not everyone loves public speaking, these presentations are standardized to facilitate student learning and listener clarity, which means they can be mastered—with some knowledge and effort.

If you’re dedicated to improving your presentation skills, here’s what you need to know.

Drill down on SOAP

Some 50 years ago, Dr. Lawrence Weed developed an influential system of approaching patient documentation that would come to be known as the subjective, objective, assessment and plan—or SOAP—note, according to Academic Medicine. Today, getting a grasp on SOAP is one essential way of improving your presentation skills in medicine, as it gives you a structure that helps ensure you don’t miss important information about a patient.

  • Subjective: The subjective aspect of your presentation should focus on the history obtained from the patient as well as any relevant medical history. While you should be concise, be sure to provide pertinent positive information (“chest pain has been ongoing for three hours”) as well as pertinent negative history (“patient has no history of cardiovascular abnormalities”). This is also where you should include your “review of systems,” a reassessment of the patient’s symptoms.
  • Objective: The objective portion should always begin with your patient’s vital signs, and then may include laboratory results and notable physical exam findings. As a medical student, it’s a good habit to describe your physical exam in a head-to-toe system. Not only does this show that you’re an organized presenter, but it also ensures you’re being thorough.
  • Assessment: The assessment of your patient should include a brief summary of your one-liner (as described below) and should comprise your thoughts on the differential diagnosis for your patient. Provide context for your differential, calling on aspects of the history and your physical exam that support one but perhaps not another diagnosis.
  • Plan: The plan is an organized description of the next steps you’re proposing for the patient. Here you may include further diagnostic tests, treatment measures and the need for specialty consultation.

For more detailed resources on SOAP, check out SOAP for the Rotations and SOAP for Family Medicine.


Perfect your one-liner

A great next step toward improving your presentation skills is perfecting your “one-liner.” Think of your one-liner as the gripping title of the bestseller that is your patient’s story.

A solid one-liner shows your understanding of the patient as a whole; it is the mark of a strong medical student to be able to synthesize a patient’s history and prepare the clinical team for the case. A good one-liner will also make it clear to a consulting team why they are being called in—their interest will lie in how your story is relevant to their expertise. Your one-liner helps show that you know your audience.

Pull information from your history gathering into your one-liner to frame your patient as a candidate for the specialized eyes of surgery or obstetrics and gynecology, as may be necessary. You may even alert a senior physician of the need for immediate action.

Focus your history

Medical students are often asked to take a “focused history,” a direction that may be difficult as you’re just starting to understand what parts of the patient’s history are relevant to their present illness. Remember that as a kind of storyteller, you’re hoping to lead the audience to the same conclusion you have made in your assessment of the patient. Don’t bury the lede. In fact, one of the signs of a successful presentation is that by the time you’ve covered the history and physical exam, your audience can anticipate your conclusion.

This is the “subjective” part of your presentation, and you should approach it with a leading diagnosis in mind; consider that each part of the patient’s history could support this diagnosis. Organize your presentation to include the patient’s:

  • History of present illness
  • Past medical history (including past hospitalizations for similar illnesses)
  • Past surgical history, list of medications (as relevant)
  • Allergies to medications and reactions
  • Social history (as relevant, for instance use of intravenous drugs or attendance at daycare)
  • Immunization status

Detail your exam

Make it a habit to begin your physical exam with the vital signs, and describe those rather than listing the numbers. Describing the patient as febrile, tachycardic or tachypneic shows your understanding of the patient’s clinical status and prepares your audience for any interventions that may be needed.

Following vital signs, be sure to highlight the most significant aspects of the physical exam. For example, in a patient presenting with a seizure-like episode, the neurologic exam is the most important to review.

Wrap up your presentation

A key difference between presenting in the preclinical versus the clinical years of medical school is the focus on the plan aspect of SOAP. Your third and fourth years of medical school are when you decide between presenting your plan by system or by problem.

Both methods have their merits, with one approaching the plan by body systems—from cardiac to gastrointestinal, for example—and the other focusing on problems—chest pain to abdominal pain, for instance. Stick to one method of organization for a polished presentation.

Ask for feedback

If you’re a medical student with the goal of improving your presentation skills, getting feedback is a must. At the beginning of a rotation, express what you’d like to improve in your presentations, and always follow up with your team to check your growth.

Ogie M. Ezeoke, MD