Internal Medicine Grand Rounds

Lecture Title: What's Pneu in Pneumonia

Course: UAMS College of Medicine Internal Medicine Grand Rounds

Date: January 18, 2018

Evaluator: Kelsey McCain

Material/Content: A review updated recommendations for pneumonia treatments and laboratory markers to help delineate a differential diagnosis. The presenter performed his presentation via power point in a large auditorium with a projector, microphone, and large screen. No handouts or teaching materials were provided. A copy of the lecture is available online to view the presentation again if needed.

Pace: I felt the speaker was talking quickly but stayed on each slide for an appropriate amount of time. At times the speaker was out of breath. It appeared he wasn't rushing through his presentation, he had a lot to elaborate on during the presentation.

Objectives:

  • Review recently published IDSA/ATS management guidelines of HAP and VAP
  • Utility of MRSA nare PCR screen for vancomycin de-escalation
  • Procalcitonin: The right answer but to which question?

Explanations: My favorite explanation the speaker used was introducing "HCAP's Obituary." It was a humorous effort to describe why the new guidelines were created. He specified who HCAP was "survived by" and who HCAP "knew well" which helped me understand how many patients were included in HCAP criteria. The presenter consistently had clean, concise, and clear slides, but spoke for a while on each slide. For example, to identify the length of therapy has been changed to seven days for HAP/CAP, he put a large "7" on the slide and spoke about the changes. Additionally he related empiric antibiotic choices to local studies at the Central Arkansas Veterans Health Systems Infectious Disease department where Pseudomonas susceptibility was regained by Pipercillin/Tazobactam. He also broke down how to use the antibiogram UAMS Antimicriobial Stewardship provides yearly.

Organization: The presenter transitioned from one objective to the other by showing a photo and providing a short description of each of his children. This helped break up the presentation, and allowed the presenter to be more relatable to his audience. For his procalcitonin objective he broke down literature regarding high yielding utility of the laboratory test. He transitioned between each study by summarizing the results and asking a leading question into the next article. As he introduced new figures or visuals (especially for the procalcitonin objective) he continued to orient the audience back to the procalitonin algorithm each article used throughout their study.

Summaries: The presentation was summarized at the end with an overarching message to utilize the tools provided (anitbiogram, IDSA guidelines) when triaging pneumonia as a differential diagnosis. He urged the importance of understanding how the results will impact practice once a Nasal MRSA PCR and Procalcitonin are obtained.

Class Participation: There was not an opportunity for class participation during the lecture, but there was an opportunity for questions to be asked at the end of the presentation. Another technique I enjoyed during the presentation was that the presenter provided photos of the different residents and faculty that have worked on some of the pneumonia management research at UAMS. This was not direct audience participation, but it likely eluded interest from the audience.

Questions:

  1. In the Sepsis 2017 guidelines they give procalcitonin use a 2C recommendation, how do you recommend use in sepsis patients?
  2. Should patients with a positive Nasal MRSA PCR be on contact isolation?
  3. What are your conflicts of interest or royalties in Nasal MRSA PCR?
  4. What other disease states or agents will give a high level of Procalcitonin?

Audiovisual Aids: None.

Handout: None.

Slides: Slides were simple in design and formatting. Figures were large and words on the slides were kept at a minimum. He spent plenty of time on large tables, diagrams, or results sections of articles which provided the audience enough time to listen and visually digest the information.

Overall Impression: This presenter is very knowledgeable in the area of infectious disease. He was effective in providing an evidence based review and pulling out applicable recommendations. He was relatable, easy to listen to, and passionate about his presentation. He was invested in learning and set out to make an impact on pneumonia management and practice. I admire the intangible skills of the presenter but would recommend to him to slow his speaking pace, as mentioned earlier at times he seemed out of breath.

How this observation will impact my teaching: In the future I would like to incorporate some of this presenter's techniques regarding slide formatting, transitions between objectives, and honesty during the question and answer session. I was engaged during this presentation because the presenter made it easy for me as the learner to understand the why behind his objectives and recommendations.