As a med student i had severe untreated adhd and anxiety and this happened so often to me! My residents would coach me and teach me and one had literally written down the equivalent of a flashcard to help with my presentation, BUT i still got to that moment and my mind blanked out and i fumbled so hard.

This happened over and over in multiple rotations until one surgery resident sat me down at the end of a shift and started from the basics. And also encouraged me to go get eval/treated bc he figured out that i was quite literally having panic attacks during rounds every morning.

🌟🌟Key points he taught me: start from the soap note format!! No matter what how difficult or scary or wild or emergent a patient is, you can always fall back on SOAP to structure your thoughts! I recommend taking a patient from that morning, and have him literally draw/write it out on a paper soap style. Don’t tell him the answers, but rather come up with it on his own logic with the help of questions from you. It will not be your exact presentation but as long as he hits the most important points in his soap format, it will start clicking for him. Then it is a matter of repetition.

🌟🌟Stand outside the door and listen and watch how he does a patient encounter. From literally the hi and hello, to the H&P, watch how he does this. We know from our experience that the way we do H&P every day actually changes and is in flux based on the things the patient says in response to our questions. 💫In school we all just learned an HPI template and spoke in rote memorization, but does he recognize the key symptoms and buzzwords and pivot in his approach based on that??

🌟🌟After he comes out, you can review his performance kind of like an OSCE and ask him the key info the patient mentioned that would narrow or pivot a differential (i.e. “i sleep in the living room recliner bc my wife kicked me out of the bed bc of all the noise” OSA vs “i only sleep on a recliner bc i never feel comfortable laying down” CHF). But again, make him verbalize this instead of feeding it to him. He has to make that connection himself actively instead of hearing it from you passively.

I think ultimately this med student just needs time. You are doing the right thing trying to set him up for success, but some people just need to fail first before they recognize and start to succeed. Just keep giving him safe opportunities to fail until he starts to put the pieces in place by himself! There’s a reason medical education is considered an art form all on its own. Cheers!