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How to Chair a Good Case Conference and Journal Club
The case conference is useful for the presenter to present a case at examination standard or beyond. The case must be there are sufficiently prepared in detail to cover every angle of assessment, investigation, the aetiology and management. The opportunity to practise presenting skills is vital for any professional. The ability to chair meetings is he key requirement for the executive function of a consultant or specialist registrar hash this used every day in a multi-disciplinary team working. The academic case conference draws on these skills, but he is enhanced to a degree that it promotes teaching as well as promoting the communication of clinical information. This means that the good chairman takes into account his audience and its composition. Does the audience include medical students? Does the audience include trainee doctors? Does the audience include consultant colleagues? Does the audience include members of the multi-disciplinary team, such as social workers, a senior nurses, or psychotherapists. The case conference should ideally be adapted to suit the needs of the entire audience.
Preparation is vital
A barrister would not going to court without having read the depositions for a court case and without having spoken to his instructing solicitor and without having spoken to key witnesses. The TV presenter does not going to studio in front of an audience without having spoken to programme researchers and without having spoken to the guests he is about to interview. Good managers often phone the participants of a meeting beforehand to focus them on issues in the meeting. Similarly it behoves the chair person of a clinical case conference or journal club or evidence based teaching session to speak to the presenters well in advance of the session they are about to chair with a view to finding out what they're about to present and how they aim to present it. The chairperson of a meeting should be intimately familiar with the form and content of the meeting they are about to chair. The TV presenter can expect his researchers to do so much, but could he or she is so unaware of the formal content of the TV programme they will only succeed in looking a fool. Professionals don't wing it in front of audiences. To be successful a case conference should be as interactive as possible. This means that it must engage the audience at every level. Co-ordinating the interaction between the presenter and the audience is absolutely vital and it is an active not passive role. The chairperson must be aware of the content and presentation well in advance so that they can identify the key elements that they wish discussing. At least a week before the case conference the chairperson should contact the key presenters to ensure that they are aware of their functions, that they have their content sorted and that they have decided on appropriate way of communicating this content. The chairman should make every effort to ensure that the speakers are confident enough in the material that they have not to embarrass themselves in front of the audience and so that the proceedings can be beneficial to the presenter and the audience as whole. Any special requirements for the presentation such as hosting the patient for interviewing purposes, or screening the video for patient, or taking into account computers slides or overheads should be discussed. The chairman should be absolutely sure of the contents of the meeting before the meeting is allowed to proceed. As with all meetings the chairperson should make sure that the meeting sticks to time. Your audience often have numerous important commitments that will occur before and after the meeting. Even if the discussion is riveting, if the meeting over-runs then your audience may disappear like melting snow. Let latecomers know that their behaviour is unproductive and discourage people being bleeped out of the meeting by trying to ensure 'protected' time. Perhaps someone else can hold the bleeps for the duration of the meeting. Duties of a chairperson also include:
- Ensuring all attenders make some kind of contribution
- Summarizing views and information
- Being firm - blocking any negative tactics or hostile feedback to the presenter
- Listening to others your body language should show that you are interested in the speakers
- Taking personal responsibility for making the meeting a success consider what makes a successful meeting beforehand
The Task of Chairing a Case Conference
The format of the case conference should be adapted according to the nature of the patient that is being presented. The requirements for the presentation of a child psychiatry case differ from those of an adult psychiatry case for instance. In general the adult psychiatry case conference can be structured into two distinct sections; the presentation of a case and the subsequent discussion. However, this is not the whole matter. In order to keep the audience awake the presentation must be as interactive as possible. Having said this, it's important for the chairman of person to protect the inexperience case presenter by not allowing the audience to bombard them with questions of my hectoring or rhetorical nature during the initial part of the presentation. What is important is not to undermine the confidence of the presenter in this way and a good chairperson will be sensitive to the interaction between the confidence levels of the present and their ability to present.
The chairperson ensures that questions and the ability of the audience to clarify information is restricted to certain episodes during the presentation. For instance some people like to allow the presenter to present the history, then take questions on the history in a discrete episode before moving on to the mental state examination. It is advisable at the start of the case conference, to introduce the presenter and to explain what it is about the presentation why is it being drawn to the audience's attention? For instance is the patient a difficult clinical case that is worth discussing for its diagnosis or for its management?
As mentioned above the chairperson should allow the case presentation to proceed in distinct episodes, with first the presenter working and then the audience working to clarify information in alternation:
- Mental state examination
- Possible interview of patient or alternatively a short video tape of a patient
- Investigations biological, social and psychological
- Differential diagnosis
- Management - biological, social and psychological
- Presentations of evidence base for diagnosis/management i.e. review of relevant interesting issues
The good chairperson of a case conference will take into account that some members of an audience will talk more than others. It appears that some individuals, usually consultants, like to hear their own voice more than others. This is because experience has usury rewarded them for any contribution to the making the past, and the contributions can be interesting. Research of group behaviour has shown however that allowing these individuals to dominate the proceedings merely serves to inhibit the participation of others. The good chairperson will therefore seek to engage other individuals who are traditionally quieter and seek their opinions. Encourage hesitant participants with positive feedback. For these reasons it is usually a good idea to structure the episodes of feedback from the audience by asking for the opinions of relatively junior members first. It may therefore be a wise idea to engage a student doctor before a trainee and a trainee before a consultant. In this way the good chairperson can ask for the investigations that trainees would do before engaging the consultants and seek the ideas on differential diagnosis from medical students before trainees and trainees before their senior peers. All this requires a certain pro-activity on the party of the chairperson that is absolutely vital for a successful case conference.
If discussion flags you can sometimes stimulate the meeting by asking specific questions to individuals you know can speak knowledgeably and well or who like to express their opinions. Learning is best conducted in a warm, accepting and non-threatening group climate and approached as a co-operative rather than a competitive exercise. The chairperson needs to step in when discussion runs through the stages of debate and into conflict or open hostility. If hostility occurs, then this is usually because individuals with previous agendas have allowed these to intrude into a neutral arena. Their apparent need to conflict will jeopardise the case conference and inhibit others from contributing. De-escalating the conflict is the role of the Chairperson. Techniques such as focusing on areas of agreement can defuse matters, but where antagonism prevails the chairperson must signal an end to their conflict and mark a clear switch to other speakers and other topics.
For absolute professionalism the chair and the presenters could meet to rehearse the presentation. Unfortunately time does not allow for this in most clinical centres.
Thank the presenter on behalf of the audience at the end. During the presentation prepare feedback for the presenter. The presenter needs to know what they specifically did well and also what they need to improve. A skilled and tactful chairperson can manage to combine giving mixed feedback to a presenter in the fund of about audience. Her most important part this feedback is the positive points that the chairperson can make for these will reinforce the presenter's likelihood to present again and also promote those behaviours, which are likely to make them a good presenter in the future. Feedback of the specific improvements you have noted down may be postponed until after the meeting. Giving these comments in front of the audience may be (incorrectly) perceived as criticism.
A good chairperson who wishes to improve their future chairing of meetings will want feedback himself or herself. You should nominate someone you trust to participate in the meeting and give you appropriate feedback later.
The Task of Chairing a Journal Club
Make sure that the presenter has got the audience copies of a paper or the papers that they are about to present. Ideally these should have been circulated before the meeting, and there should be a supply of papers available at the meeting. If the chairman has an influence over the content of the journal club they should try and influence the presenter to present relevant and interesting papers. Generally, the soul-destroying and detailed negative criticism of a single paper should be avoided in preference to a balanced overview of several related papers.
Classic papers can be intermingled with up-to-date research in an illuminating and enlightening way. Evidence-based medicine is very much in vogue, but this principle was always the remit of a good journal club.
One of the tasks of the chairperson is to guide the presenter and the audience through a critical appraisal of these papers, and chairpersons should be familiar with the techniques of appraising review papers, meta-analyses, scientific papers, scientific philosophy and scientific method. The presenter should cover the bare bones of the paper the introduction and the relevance of the paper, the method, the results and the discussion, but also focus on the good points of the paper, the limitations and suggestions for improvement how could the research have been more effective?
The presenter should be led through his or her critical appraisal and at appropriate times take questions from the audience. (Ideally the chair person should have gone through the papers with the presenter before the presentation and alerted the presenter to the key issues that the audience could be expected to raise and suggested to the presenter how they might deal with issues for instance by suggesting relevant literature to read up to answer potential questions).
Overheads need to be punchy and legible. Four or five bullet points produced on a computer slide or overhead are better than reams of illegible spidery handwriting on overhead transparencies. Overheads and slides are one of the places where less really is more.
The comments about giving and seeking feedback mentioned above apply to the journal club presentations too.
Finally, remember to thank everybody for attending and all the speakers for contributing.
References and suggestions for future reading
A Handbook for Medical Teachers (3rd Edition) Newble D & Cannon, R. (1994) Lancaster, Kluwer Academic Publishers.
Evidence-based Medicine (1996) Edited by Sackett D L. Edinburgh, Churchill Livingstone; ISBN: 0443056862
Critical Reviews in Psychiatry (1998) Wilkinson, G, Brown T. London, Gaskell (Royal College of Psychiatrists); ISBN: 1901242277
Effective Feedback Skills (The Practical Trainer Series) (1998) Russell T. London, Kogan Page Ltd; ISBN: 0749425695
Constructive Feedback (1998) Bee F, Bee R. London, Institute of Personnel and Development; ISBN: 0852927525.
Research Methods in Psychiatry: a Beginner's Guide (1992) Freeman C and Tyrer P. London, Gaskell (Royal College of Psychiatrists); ISBN: 0902241486
360-degree Feedback (1997) Peter Ward London, Institute of Personnel and Development; ISBN: 0852927053How to Read a Paper (1997) Greenhalgh T & Weatherall, D. London, BMJ Books; ISBN: 0727911392
How to Do It (1995) (3 volumes) (3rd edition) Edited by Deborah Reece. London, BMJ Books ISBN: 0727909061
Managing Meetings (1999) Hindle T. London, Dorling Kindersley, ISBN 0751305294
Learning through Discussion (1982) Hill W F. California, Sage.
Handbook of Clinical Teaching. (1990) Watts, NT. Edinburgh, Churchill Livingstone.
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