American College of Physicians: Internal Medicine — Doctors for Adults ®


Trying to improve your clinical presentations?

Here are some tips for writing better papers—and for avoiding the seven deadly sins of speaking

From the November 1997 ACP Observer, copyright 1997 by the American College of Physicians.

By Christine Wiebe

Whenever chief resident James T. Hardee, ACP Associate, wants a good laugh, he takes out a copy of the first case study he wrote up for publication. "It was rejected four times," he recalled.

Although the case was never published, the editor's comments helped teach Dr. Hardee what goes into a good paper. Today, he has several publications to his name, a distinction he hopes will give him an edge in finding a job when he finishes at the University of New Mexico Health Sciences Center in Albuquerque.

Medical educators wish that more residents would try their hand at publishing. They say that creating presentations, whether written or oral, not only helps expand residents' resumes, but also provides valuable experience in presenting patient cases.

They also note that writing and speaking skills are something of a dying art in medicine, in part because the skills are rarely taught in medical school or residency. "So much emphasis is placed on science that most [residents] feel unskilled in this area," said Barry D. Silverman, FACP, director of medical education at Northside Hospital in Atlanta.

For example, when ACP's New Jersey Chapter holds its annual abstract competition, nearly half the resident submissions are so bad they cannot even be considered, said Richard K. Kasama, FACP, a nephrologist in Stratford, N.J., who helps run the competition. "A lot of the abstracts are so poorly written that you can't believe the program director allowed them to be submitted," he said. Problems range from sentences that run off the entry forms to inappropriate topics. In addition, the chapter's many international graduates face another barrier: the English language.

A solid foundation

The most common flaw in many presentations by housestaff lies with the underlying thought process, said Dr. Kasama. Compared with physician-researchers, he said, clinicians often fail to clearly lay out their goals, procedures and results. He suggests the following steps to organize patient cases:

  • Write a simple outline, starting with "here's the problem," followed by "this is what we did."
  • Create a brief list of the results and discussion points.
  • Look for gaps that need to be addressed. For instance, if the reason for choosing a particular treatment protocol is not clear, the resident may need to do a literature search to substantiate the choice. Or, if the resident discovers that a pertinent clinical test was overlooked, he or she could follow up on a subsequent clinic visit with that patient.

Dr. Kasama added that it is best to begin preparing a case presentation while you're still managing the patient. That means doing literature searches or consulting an attending about the case while still caring for the patient, something essential in more complicated cases and helpful in routine ones as well, he said.

There is another reason to do this type of work with your patients: It's a requirement of your training. According to Daniel M. Goodenberger, FACP, program director in internal medicine at Washington University Medical Center in St. Louis, internal medicine residents are required by the accrediting council to complete a "scholarly activity" during training, and researching patient cases for a paper or oral presentation can fulfill that requirement.

Tips for writing

Besides incorporating solid research and clear thinking into clinical presentations, experts say that many residents need to work on basic writing and speaking skills.

To help physicians improve their writing skills, Deborah St. James, a national workshop organizer, holds free seminars for physicians around the country. At the workshops, she offers seven steps to successful writing:

1. First identify your audience and establish your purpose. She suggested the following sentence to summarize your goal: "I want to (inform/persuade) a group of (practicing physicians/policy-makers) about (your topic)."

2. Research your subject by interviewing colleagues and searching the literature. You should know more about your topic than the average reader.

3. Freewrite, which means disregard grammar and other potential "writer's blocks." This technique will help you produce a collection of ideas for the body of the article.

4. Organize your freewriting, perhaps in outline form. Choose your main points and add supporting details. Look for areas that may require more research or other information.

5. Write in a more formal form, following your outline. Focus on the main ideas, and substantiate each with details.

6. Revise and check for coherence. Make sure each sentence contributes to the idea in the paragraph, and that each paragraph in a section contributes to the main idea. Check transitions from one paragraph to the next, making sure one idea flows to the next.

7. Proofread, or better yet, get someone else to proofread. Try enlarging the type and reading the manuscript out loud to catch mistakes.

The sins of speaking

Preparing an oral presentation requires many of the same skills as good writing, but speakers also have to deal with listeners' attention spans and distractions in the room such as beepers. In her seminars and books on public speaking, Ms. St. James warns participants to avoid the "seven deadly sins of speaking:"

1. Avoid content that is irrelevant.

2. Make your purpose clear. A speaker should be able to say: "This is what I want the audience to take away from my talk."

3. Stay organized. Listeners often tune out if they can't tell where the talk is going. Introduce the topic succinctly: "I am going to give you a five-point approach to this treatment and then discuss its success."

4. Don't give unnecessary information. Audiences can only absorb so much. A good rule of thumb is three ideas for a 30-minute talk.

5. Don't speak in a monotonous tone. Jargon and a lack of enthusiasm can kill the most interesting topic.

6. Keep clear of unnecessary, unclear or inappropriate visual aids. Anything irrelevant to the topic will merely distract the audience.

7. Make eye contact. By definition, reading from a paper manuscript limits eye contact with the audience. At a minimum, become familiar enough with the material to look up from the paper periodically.

Practice, practice, practice

If you're looking for a good place to polish either your speaking or writing skills, try submitting your work to your regional ACP meeting, said Washington University's Dr. Goodenberger.

And remember, while physicians at all levels of practice struggle when making presentations, as a resident you are uniquely situated to learn to do better. "Residency is a good time to do it because you have so many consultants around you," said chief resident Dr. Hardee. In fact, collaborating with an attending is a good way to get started. Residents have the added advantage of encountering interesting cases at teaching hospitals, Dr. Hardee said, which provides good material for publications.

"We present so often in morning report," Dr. Hardee said. "Writing it up is just sort of honing your presentation."

And while Dr. Hardee conceded that finding time is always a big obstacle for residents, presentations can be pieced together a little at a time. The two case reports he prepared each took a year to write. "It's a slow birthing process," Dr. Hardee said. "But once you get your first one done, it's sort of addictive."

Christine Wiebe, of Providence, Utah, writes frequently on issues related to medical residency.

Residents interested in improving their presentation skills have many resources to choose from.

  • For more information about the free workshop series, "Writing and Speaking for Excellence," contact Deborah St. James at 203-812-6357, send an e-mail to or see
  • For more information about making a presentation at your regional ACP chapter meeting, contact your Governor. (A list of ACP chapter meetings is on ACP Online at
  • Residents and medical students are encouraged to enter the competitions held each year at Annual Session. For more information, call Kelly Lott at 800-523-1546, ext. 2697.
  • There are several Internet-based resources. The author instructions of several medical journals, for example, are available at And a "virtual reference desk" with links to dictionaries, encyclopedias and other references can be found at

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