A guide to successful poster patient selection and presentation

Patient Selection

Final year looming, exams stress starting to rise, revision is taking its toll, but there's one little itty bit more you need to prepare: the dreaded poster presentation!

The thought of standing and giving a presentation lasting ten minutes, plus an extra five minutes of brain picking may send a shiver of fear running down your spine. It's not all that bad! This is actually the fun part of finals -a chance for the tutors to be educated by you on a topic of YOUR choice.

My first piece of advice, is to be wise. Choose something you have a real interest in, or if in doubt, choose something that is a common exam question. This way you can combine your research for your project into revision to pass the last hurdles: the written and unseen cases.

I chose Amelogenesis Imperfecta. Nice. Simple. One of the most common subject areas covered by the Paeds Department in written papers. And it came up in mine! Make sure to take clinical photographs of a few choice interests to keep your options open. Keep your eyes peeled on your consultant clinics for cases to use. Here are some specialty areas to consider with examples to whet your appetite:

• Oral Surgery - third molar removal with nerve damage, Oro-Antral Communications and their management
• Oral Medicine - Lichen Planus, Pemphigoid, Recurrent Apthous Ulceration
• Paediatrics - Hypodontia, Gross caries, Dentinogenesis Imperfecta, Fluorosis, Trauma cases
• Orthodontics - Missing upper laterals, Poor Prognosis 6s, Impacted Canines, Class two and three cases possibly requiring orthognathic surgery
• Oral & Maxillofacial surgery - Trauma cases, Cancer, Trigeminal Neuralgia

Poster Design

Once your subject has been selected, the design of the poster needs to be carefully considered. It needs to be colourful and catchy, as well as professional. It needs to appeal to your examiners and win them over in one glance! A suggested example is the template I created for my presentation (see below).

The design was aimed at drawing attention to the pictures whilst not giving the poster a jumbled and overcomplicated look. Choose an appropriate background which gives your poster a professional look.

It's important to understand that you can't put everything into the poster. You need to be selective with your information and use the poster to prompt your speaking parts. Cue cards are essential to help guide you with your presentation. Ideally, these need to be written alongside the poster development.

Written information on the poster should be minimal and concise, allowing you the opportunity to expand whilst talking. Avoid large chunks of text as this is difficult for the examiner to read, takes up lots of space and doesn't look attractive.

Poster Layout

By separating the poster into three boxes I was able to give myself three sections to concentrate on, which makes the flow of a verbal presentation easier to follow.

The first box was aimed at relating the information about the patient to examiners. This included:

• Initial Referral - state who the referral was from and what was written in the referral
• Patient's age - at time of referral, presentation to you and current age.
• Medical History (MH) - relate this back to the condition you are discussing or to considerations for risk management in relation to medical emergencies.
• Previous Medical History (PMH) - this is extremely important when discussing paediatric patients as we all know that for developmental abnormalities pre-natal, neo-natal and post-natal causes can be contributory factors and need to be identified and documented. Examiners will often ask the timing of these abnormalities in relation to tooth development.
• Patient Complaining of (PO) - in the patient's own words. For example, "feeling numb ever since the wisdom tooth was removed". History of presenting Complaint (HPC) - The history of the condition. Write key words. Remember to use "SOCRATES".
• Family History (FH) - for conditions where this is appropriate. In my case, I explained that FH is important to attain when diagnosing enamel deficiencies. However, as the patient had no positive FH of Amelogensis Imperfecta, I spoke about this rather than writing about it.
• Previous Dental History (PDH)H - for patients in oral medicine it is important to state if they have a heavily restored dentition and the type of materials used with respect to allergies/Lichen Planus. For paediatric patients it is good to state if they have previous dental treatment and what their attendance is like.

The middle box concentrates on your assessment and investigations and discussion of the findings:

• Examination - discuss your clinical assessment including extra oral and intra oral examination and make clear points about what your findings were.
• Investigations and appropriate special tests which are required. These can include radiographs, scans, pain stimulus test, blood tests, biopsies, oral rinses and other specialist referrals. Remember you may be asked to justify why you carried these out.
• Results - what they showed and how they lead to the differential and definitive diagnosis.
• Differential and Definitive Diagnosis - using all the information you have gathered you must now demonstrate your ability to create and explain your differential diagnosis list. It doesn't have to include a million things, but a list of three or four relevant conditions and your rationale for including these. You should be able to discuss this and demonstrate how you have arrived at a definitive diagnosis by a process of elimination. This allows the examiners to see you are putting information together and making an informed decision about your patient's diagnosis, prognosis and thus management. It also reassures the examiners that you understand and are going through a tried and tested process that is expected of you to show that you are safe.

The end box is centered on explaining how the treatment plan was devised and how you carried it out. When writing your treatment plan, use key words, for example; in paediatric dental development abnormalities, there are four buzz words that treatments aim to cover:

• Prevention
• Aesthetics
• Function
• Long-term management

For Oral Medicine think about:

• Prevention/elimination of possible causes
• Pharmacological/psychological management
• Review

This is also a chance to discuss what your treatment appointments consisted of and to show off your beautiful composites or your exceptionally placed sutures.

The Discussion

Highlight in bullet points what you have learnt from your experience. This can include subjects you weren't aware of and how these have influenced your future management of patients. Discuss how your patient felt with the outcome, and how you felt. Talk about an investigation you've never performed before and how this has provided useful insight into that specialty. Most importantly explain that you understand the need for a multidisciplinary team (MDT) approach for these complicated cases.

Choosing references can take time. They can be from text books or journals. It's best to find recent good quality evidence to use. Remember your hierarchy of evidence: from expert opinion to systematic review. Once you've collected a few papers, print them off, read them and quote them where appropriate in your presentation. This shows you've taken an evidence-based approach to your patient management. Make sure the layout of your references follows the dental school's guidelines.

Getting help

When you have nearly finished your poster design and preparation, take advantage of the help your tutors are willing to offer. They want you to pass, so take your poster to them and show them! Discuss any problems you have encountered and request advice on how to tackle these.

It is a good idea to practice in front of friends and time it and also to create an introduction to your poster before jumping straight in. I used this opportunity to include some information about the facts and stats associated with Amelogenesis Imperfecta. It can be easily applied to all topics. By saying the epidemiology: the prevalence, incidence and causes, you're demonstrating that you have read around your subject area.

Take time to become familiar with your photos and to point at areas of interest to guide your examiners attention. Go through your radiographs meticulously. If your patient is a child, make sure they have the correct number of teeth and the correct development for their age. When discussing enamel deficiencies talk about enamel thickness and root formation - don't forget those Taurodont molars.

The Presentation

The tutors examining you may not have a great depth of knowledge about your topic area, but they will ask you questions regarding management in a general dental practice setting, such as what restorative materials are best to use for child patients? How has the dental anomaly affected bond strength of the restorative materials used? What's the most recent evidence? If GA is considered, demonstrate informed consent. Examiners want to know you have the ability to apply your knowledge and understanding and to know that you are safe.

Simple questions were the ones that threw me! After chatting heartily about stainless steel crowns, I was asked what other crowns I could provide for a child. Having been told that to drill a child's tooth was a mortal sin by the Paediatric Department I did not talk about conventional crowns. It's not going to lose you vital points, but make sure you don't forget to talk about all available options (...even the bad ones you wouldn't necessarily choose).

Be aware that you could be interrupted at any point for a bit of Q&A. Don't let this throw you. Take time to brainstorm any questions you think could be asked regarding all aspects of your treatment. For example what materials did you use? The specific clinical handling characteristics with regard to moisture control in young patients (Fuji Triage)? How would you handle this situation in general practice? Presentation and management of patients with similar conditions. What's the long term management of your patient? Think outside the box. You won't cover every question but by familiarising yourself with the process of drawing comparisons with other treatment modalities you'll be able to handle difficult questions.

The more information you can give, the more you cover, the more searching the questions become the better mark you will score. So go out there, prepare and tell them about your special interest with confidence. Good luck.

Emilie Abraham qualified with BDS Honours from The University of Sheffield in 2012. She is currently employed as a Core Trainee in Oral & Maxillofacial Surgery at York Teaching Hospital.
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