One of the bigger aspects of critical care practice, especially for those of us in academics, is giving presentations. These may be very large, such as presenting at conferences and meetings, or small, delivering a quick talk to a group of learners. All of us have the experience of sitting through bad presentations. And we’ve all heard the phrase, “death by powerpoint.” As someone who started in web design and who considers themselves someone with an eye for good design and the importance of visual aesthetics, this is especially painful. But, for a long time, I just did my presentations the same way. I just thought that was how it had to be.

But, then I met Ross Fisher (we can say met when we’ve only met online, right?). Ross is a pediatric surgeon in the UK but he has become well known as “that presentation guy.” He has a great website, p cubed presentations, devoted to helping medical professionals to improve their presentations. And, to be clear, this is not just about better slide design. It’s about better presentation design. I’ve totally changed the way I give presentations based on a lot of Ross’ work and I think for the better.

Critical care professionals, no matter what your role or level of training, should look through the site and try to improve your presentations. We all want people to care about what we’re talking about, and these tips will help with that. The site covers lots of aspects of presentation design and delivery, but also covers different types of presentations. This is especially helpful in addressing the problem of, “well, sure, better presentations would be good, but I’m presenting a bunch of research data, so it won’t work.”

Here is a nice video of Ross discussing his strategies on presentation design and delivery at Queen’s University Pediatric Grand Rounds.

I think one of the hardest things to do in healthcare, and one of the hardest things to teach, is the process of forming a diagnosis. We talk about pertinent positives and pertinent negatives (which in and of themselves can be confusing to students) and about horses and zebras, but overall, we still don’t really do a great job with this. Brandon Oto over at his blog, Critical Concepts, does a great job talking about the importance of making a diagnosis, that is, naming it. Not just saying that the patient has tachycardia, but venturing a guess as to why. And I think that’s a critically important first step. And a scary one. By venturing a guess, we open ourselves up to being wrong. But, that’s how we learn and grow and get better.

But how do we go about making a differential diagnosis list? Do we just take everything that fits the presenting complaint and then start testing? Well, that seems to be what a lot of providers do. We test and test and test some more. But, there is a big downside to testing and in fact, when we test not to confirm a diagnosis but to establish one, we may cause more harm than good (VOMIT).

Dr Andre Mansoor from OHSU is one of the best teachers of diagnostic reasoning and the process of forming a differential diagnosis that I’ve come across. I try to use his techniques and processes not only in my own practice, but in my teaching. I actually teach a course called Diagnostics and Clinical Reasoning at Georgetown University in the Acute Care Nurse Practitioner program. So, I’d like to recommend Dr Mansoor’s website, Physical Diagnosis as well as his book Frameworks for Internal Medicine. This is one of many good talks he gives covering these principles and is a great overview of what you’ll find on his website and in his book.