During residency, you must choose a case to present to your colleagues or faculty in a formal setting. Many of you will be flying by the seat of your pants without instruction on how to do so. So, how do you select which case from the past week, month, or year? What features make up an excellent case for discussion at a case conference? And what exactly should you discuss during the presentation? These questions and more I will answer as we discuss how to present a great case conference.
Which Case Should I Choose?
On any given day, you will encounter multiple cases that have the potential to become excellent cases for a conference. Some studies may have confounded you or your faculty. Other times, your attending may love a case for some reason. Then, your attending may want a classic case of a particular disease entity. In these situations, how do you pick among all the possibilities?
Typically, I look for cases on a particular theme I want to address. Even better, the study may have addressed several points that created interesting discussions or controversies. Then, I check to see if the case runs through multiple imaging modalities. What do I mean by that? The best cases show a particular diagnosis in many different ways. For instance, say you are interested in showing lung cancers at this specific time. So, a perfect case would be a lung nodule on plain film that the hilum may partially hide. Then in the same study, you have a CT scan showing the mass abutting the hilum with subtle adenopathy within the mediastinum. And perhaps you also have a PET-CT scan demonstrating additional hypermetabolic nodes present on the scan and a hidden osseous hypermetabolic lesion in a vertebral body. Cases that show a finding or related findings in multiple modalities reinforce the subject matter well.
How To Prepare For The Discussion
So, you’ve found this extraordinary case. First, make sure that you can describe the findings appropriately. If you have less experience, you may want to run it by a faculty member or senior resident to confirm that you are conveying the description correctly.
Next, like any good physician, you should read on the topics extensively. In the case I described above, you need to read about lung cancer diagnosis, staging, and treatment basics. Additionally, you should learn how the radiological diagnosis affects the management of the patient. For instance, how does the presence of hypermetabolic nodes and a vertebral body lesion affect the outcome of the patient? Ultimately, you want the listeners to perceive you as the expert on this topic for the presentation.
Moreover, you want to be able to answer almost any question thrown at you. In other words, go to town! By reviewing the topic extensively, in essence, you are not only going to improve the discussion and your ability to answer questions, but also you are studying for the boards at the same time.
What Should You Discuss At The Case Conference?
The lung nodule example above lends itself well to discussing the findings on each of the modalities, the differential diagnosis, the final diagnoses, and the pathophysiology behind the final diagnoses. Furthermore, the topic will lead to basic management principles like how vertebral lesions change treatment.
I would first review the findings similar to the standard logical approach of taking cases. And then, I would discuss the differential diagnosis and the management in that order, just as if you were taking a case during a faculty presentation. If you want to make the case conference a bit more spicy and controversial, you can discuss whether the case met the ACR appropriateness criteria for the symptoms given. Usually, you will get multiple opinions from different attendings if the ordering physician approaches the workup correctly. It would help if you strived to guide the discussion to ensure it follows an appropriate path. With a case like this, the debate can ensue for a while!
Case Conference As A Tool For Learning
You primarily need to remember the end goal whenever you create a conference. In a typical case conference setting, the presenter should want the audience to learn a few essential points by the end of the discussion. Too much information will overload the learner. Likewise, too little information may not reinforce the concepts. So, try to strike a balance after discussing the specific case.
In the end, you should view case conferences as a tool for learning, not as a burden. They are opportunities to learn a topic in great detail and the art of presenting. Moreover, each presentation you perform builds upon the knowledge that you have. I still remember the case conferences I created when I was a resident. Just like I did, if you prepared appropriately, you will use the strategies and information you learned from your case conferences when you become a faculty member yourself many years from now!
