Noon Conference Best Practices
1. Choose a case! Don’t worry about whether it’s too simple or “not interesting” – part of the goal of conference is to get learning out of any case we see. Talk with the chiefs if you’re uncertain.
2. Condense the meat of the case in a way that will be accessible to you when you present (print H&P, write down labs/vitals/imaging, think about how you want to structure the way you give the residents information)
3. Choose BRIEF teaching points from the case. In particular, at least for the first part of the year we’d like to focus on the concept of illness scripts – if you’re going to make a PowerPoint, one of your slides should be comparing the illness scripts for your case’s diagnosis with the top 1-2 other differential diagnoses. Helpful to highlight similarities and differences.
Key teaching points to address:
* How did this case fit the illness script? How did this case not fit?
* Is there an interesting and relevant piece of media (EKG, imaging, rash photo, etc) that could be shown?
* What was surprising to you about this case (presentation, workup, management)?
* What were some of the cognitive biases that occurred during the management of this case, and/or where are some places with risk of bias?
* Is there a MKSAP question related to this case that could help solidify this script/concept?
Common pitfalls to avoid
* Avoid choosing a PowerPoint template that is difficult to read.
* Choose either a light background with dark/colored text, or a dark background with light text.
* Your text should be legible from the back of the room—dark colored text and a dark background is hard to see.
* Avoid gradient backgrounds as it might be hard to get a uniform text color to be visible.
* When in doubt just use the Virginia Mason template.
Avoid overcrowding your slides.
* Font size should generally be AT LEAST 20-pt or greater, preferably 24-pt or greater.
* If you are having to use smaller fonts you are putting too much text on your slides. While it is ok to use smaller font sizes for tables or lists in which you will highlight the key components for the audience, you should not be using them to deliver most information.
* Focus on the 3-5 key points per slide.
* Remember, your audience cannot both listen to you talk and read a long slide at the same time—they must do one or the other. You don’t need to write EVERYTHING you want to say on your slides, just give yourself a few words as a cue to what you want to say and emphasize the main points.
Avoid a broad overview of a large topic.
* Remember, you only have 5-7 minutes to consolidate key learnings from the case
* Please try to avoid having more than 5-8 slides – we’re more likely to retain information from a narrow talk than a super broad one. For example, rather than having 12 individual slides on the epidemiology, pathophysiology, clinical presentation,
treatment, etc, the broad strokes of those topics could be effectively presented in the context of comparing illness scripts and relating them to your specific case.
* Do NOT reproduce an UpToDate (or other review) article on a topic in slide form—selectively choose key points that relate to YOUR case. You should read and review the topic for your own learning, but your job is to extract the points you think are most helpful and relevant, not to regurgitate the whole article.
* Leave a lecture of a broad topics to our attending presenters who have a half hour to cover more general information
Remember, the goal of these presentations is to synthesize and extract key learnings from a specific case, NOT to provide a full overview of a topic. Focus on the few key points you want the audience to take away from the case.
Our patient:
>50 (62yo)
“pressure” not stabbing/throbbing
woke him up at night
associated with neurologic symptoms
Danger signs of headaches
S = (eg, fever, weight loss, cancer, pregnancy, immunocompromised state, including HIV)
N = (eg, confusion, impaired alertness or consciousness, papilledema, focal neurologic symptoms or signs, meningismus, or seizures)
O = (particularly for age >50 years) or sudden (eg, "thunderclap")
O = (eg, head trauma, illicit drug use, or toxic exposure; headache awakens from sleep, is worse with Valsalva maneuvers, or is precipitated by cough, exertion)
P = or change in attack frequency, severity, or clinical features
Asymptomatic – incidental or autopsy
Visual field defects - parasellar meningiomas
Progressive unilateral visual loss (which may be mistaken for optic neuritis) - optic nerve sheath meningiomas
Mild weakness of extraocular movements - cavernous sinus meningiomas
Hearing or smell – cerebellopontine angle
Mental status – subfrontal/sphenoid ridge
~Optic atrophy in one eye and papilledema in the other, the so-called Foster-Kennedy syndrome, can be produced by parasellar or subfrontal meningiomas
Grade I – 70%, 80-85%, most infratentorial
Grade II – 30%
Grade III - <1%
1. (MRI w/ gad) Dural tail sign, homogenous
2. (CT) Atypical - in general involve bone 20-40% of the time (right parasaggital hy[erdense)
3. (CT) Malignant – parafalcine, entering genu of corpus callosum showing hypervascularity
2. Heterogenous mass, patchy enhancement, L posterior fossa, edema and broad dural attachment
metastatic undifferentiated carcinoma arising from breast
Meningioma:
30% of all primary CNS tumors
One sample: 5,000 adults (mean 65yo), 2.5% had meningioma
Most commonly asymptomatic!
Small ones, incidental and doesn’t always mean the cause of a HA
Dural Metastases
-
Answer: C
Name of this triad? Cushings triad (reflex/response)
Answer: C
Brainstem compression?
Name of this triad? Cushings triad (reflex/response)
Sen Spec Likli P Likli A
BP >=160 37-58 93-94 7.3 0.6
RR
