Slides From the Talk
Presentations in medical education fail to inspire, engage, and inform. Not for lack of effort or experience, but because we as educators focus too much on the what of the data rather than the so what of the story.1
We approach presentations as if the purpose is to deliver as much information as humanly possible, when the real purpose is to deliver a persuasive and memorable story – or message – relevant to our audience (yes, even for dense, science-heavy topics like biochemistry or the renin-angiotensin-aldosterone system).
We as educators focus too much on the what of the data rather than the so what of the story.
Here is an example of a classic data dump slide, one that I would be tempted to read to my audience (and apologize that the text is too small).
What’s my story? Is my slide supporting that story? How’s my delivery if I just read it to you? And most importantly – who in the audience is feeling inspired, with a renewed passion to care for patients with sepsis?
What we see in my sepsis talk above is what Ross Fisher – pediatric surgeon, presentation guru, and author of p cubed presentations blog2 – would call a presentation fail, something that is all too common in medical education (and likely all of academia in general). The cognitive psychology literature supports this claim – in 2012, researchers reviewed hundreds of PowerPoint presentations in academia and found that every single presentation violated multiple psychological principles and were therefore more difficult to learn from.3
Fisher argues that presentations are the product of the story, the supportive media, and the delivery.
My sepsis talk above has:
- No story or central message; it fails to connect with the audience.
- Story fail
- Slides that are busy, distracting, and unsupportive of my message.
- Supportive media fail
- An unmemorable, unpassionate, ‘read verbatim’ delivery.
- Delivery fail
How many of you have given a talk like that? I have (and sometimes still do). But I hate it, you hate it, and our audience hates it too. So why do we do that? And why don’t we fix it?
A way out: the p-cubed presentation strategy
To build further on Fisher’s presentation-cubed or p3 paradigm:
The idea here is that even minor improvements in any of these domains can make our presentations exponentially better. And when we do – the evidence shows that our learners enjoy our lectures more,4 do better on exams,5 and retain more information over the long term.5-6
When preparing a talk, the first thing that many people in my professional circle do is open PowerPoint and start putting data on their slides.
NEVER DO THIS!
The strategy of dumping facts onto slides comes from the assumption that the purpose of a lecture is to deliver data – as if each learner is a USB drive onto which we need to download information. But the true process of learning is far less efficient than that, and is unfortunately dependent on a short attention span, finite working memory, and limited encoding into long-term memory.7
Thinking Through Stories
The human brain organizes the world through stories, narratives, and messages – not data.8-9 Data won’t get you a standing ovation.10
Anyone working in medicine knows this; we don’t present a patient or call a consult by providing endless data points: “Age 70. Creatinine 3.5. BUN 63. Thank you.” This information is not memorable, and the message is not clear.
When we present patients, we tell stories: “This is Mr. Jones, he is a 70-year-old male who was found confused at home by his family and was ultimately discovered to have acute kidney injury with a creatinine of 3.5 and a BUN of 63. I’m calling for you to consider placing him on dialysis…” This is memorable, and the message is clear.
Stories are just data with a soul.
Much of the information delivered in any given lecture is lost and forgotten.11 In fact, most audience members will only remember a single core message and three take home points. It is up to us to determine what that core message – or story – will be; otherwise the audience will do it themselves at random.
It’s also helpful to consider your elevator pitch – the 60 second summary of your talk that you want the audience to walk away with.
Researchers who study human cognition say that stories are “psychologically privileged” — that is, our minds treat them differently than other kinds of information. We understand them better, remember them more accurately, and we find them more engaging to listen to in the first place.
P1 Story: Take Home Points
- The first thing you should do when you write a talk is close your laptop and consider what your story is. Perhaps it’s a story about your personal experience with the topic, or a patient case, or an anthropomorphic tale of a membrane protein. Whatever you choose, be sure that it is memorable and relevant to your audience.
- If stories are uncomfortable to you – change the word story to message. What’s the one core message and three take home points you want your audience to walk away with?
- Write your elevator pitch – the 60 second summary of your talk. If you can’t summarize your talk in 60 seconds, you certainly can’t do it in 60 minutes.
P2: Supportive Media
Slides exist to support your story. They should be simple, illustrative, and not burdened with text, busy data, or bullet points. Documents exist for reading, studying, and depth of understanding. Many of us combine these two media into what Dr. Fisher considers a slideument,12 something that neither supports our story nor allows for adequate depth of understanding. Slideuments are good for nothing.
Consider the below slideument (this was an actual slide that I created for one of my past presentations):
The facts are accurate and organized into bullets with sub-bullets, but there is too much text. There is also a picture of a wave that serves little purpose in illustrating my point. But the biggest problem is that I have two choices when presenting this slide.
- I can discuss each component and let the audience read the slide as I speak. The issue with this strategy is that it’s impossible to read and listen at the same time. The audience will rapid task switch between reading, listening, reading, listening – and end up doing both worse.13
- I can read the slide word for word. The issue with this strategy is that it’s not interesting at best or, worse, it’s actually frustrating for the audience (who could easily read these slides to themselves in the comfort of their own home).
Slideuments like this burden the audience and overload the senses.3,14
Instead of that slideument, I should use an image like this to illustrate my point:
This slide clearly highlights how wavelength and frequency are related. It allows the audience to quickly glance at the slide and then listen to my explanation. Simplified slides actually help students perform better on the exam and retain more information long term.⁵
Simple, illustrative slides capitalize on the picture superiority effect, a phenomenon where the human brain can remember much more information when it is presented through images as opposed to text.15
The problem with going rogue and deleting all of your bullet points
The downside of the simple slides strategy is that
- Many students have come to expect a slideument that they will be able to use as a study tool over the long term. Having only simplified slides can be frustrating when they need to revisit the material.
- Sometimes you must present more complex material that simply cannot be factored down into a simple picture or a few words.
The way around both problems is to make your simple slides but also provide the audience with the document (the one you would have made anyway for your busy slides!). You can print it, email it, upload it, or make it available on a website (like this one!).
P2 Supportive Media: Take home points
- Separate slides (which are meant to support our talk) from documents (which are meant to be taken home, poured over, and studied).
- Simplify, simplify, simplify – and limit how much text you use. Remember that your audience cannot listen and read at the same time.
- Prioritize images wherever possible – this capitalizes on the picture superiority effect that allows us to remember images far better than we can remember text alone.
There are so many ways that we can improve our presentation delivery (and all of these are worthwhile, albeit difficult to master, skills to pursue):
But two simple (not necessarily easy) ways that we can improve our delivery today center around passion and practice.
TED talks are so powerful because, not only is the speaker sharing a story, but they are also sharing their passion. Teacher enthusiasm during a lecture motivates learners to better understand lecture content.16 Speakers on the TED stage share a special connection with their topic – a connection that makes their heart sing. What makes your heart sing about your topic? What is the special connection that you share with the material?
Practice doesn’t make perfect. Only perfect practice makes perfect. If we want to deliver better presentations, we must engage in deliberate practice.17 Deliberate practice is a cycle of practice, performance, feedback, reflection, and more practice. This cycle repeats over and over as we drill down on the nuances of our presentations.
Functionally speaking, practicing our presentations does NOT mean flipping through the slides prior to the talk. Practicing our presentations means clicking ‘presenter mode,’ standing up, and giving the talk. Out loud. Initially to ourselves, and then to any willing audience that we can find (family, friends, students, colleagues). We then need to seek out feedback, sit down, revise, and do it all over again. Perfect practice is what will make our delivery better.
P3 Delivery: Take home points
- Passion is powerful. Ask yourself – what makes your heart sing? What is the special connection that you share with your topic?
- Deliberate practice is also powerful. We need to practice, perform, seek out feedback, reflect, and then do it again.
Presentations in medical education fail to inspire, engage, and inform. Not for lack of effort or experience, but because we as educators focus too much on the what of the data rather than the so what of the story.
TED talks are so powerful and memorable because many of them (knowingly or unknowingly) follow a p-cubed strategy, where the quality of a presentation is the product of the story (p1), the supportive media (p2), and the delivery (p3).
If we want to improve our presentations, we need:
- P1: Stories that are deliberate and memorable.
- P2: Supportive media with separate slides and documents but no slideuments.
- P3: Delivery that is passionate and practiced.
All of us can give TED-worthy presentations. I’m not there yet, and maybe you aren’t either – but please remember:
- It’s not about how smart or how great of a speaker we are.
- It’s not about how terrible our presentations used to be.
- It’s not a race.
- There is no end point.
It’s about our learners.
It’s about being better.
It’s about inspiring our learners to be better, too.
- Fisher, Ross. “So what.” P Cubed Presentations, 18 June 2014, ffolliet.com/2014/06/18/so-what/
- Kosslyn SM, Kievit RA, Russell AG, Shephard JM. PowerPoint(®) Presentation Flaws and Failures: A Psychological Analysis. Front Psychol. 2012;3:230.
- Ferguson I, Phillips AW, Lin M. Continuing Medical Education Speakers with High Evaluation Scores Use more Image-based Slides. West J Emerg Med. 2017;18(1):152-158.
- Issa N, Schuller M, Santacaterina S, et al. Applying multimedia design principles enhances learning in medical education. Med Educ. 2011;45(8):818-26.
- Savoy, April, et al. Information retention from PowerPoint™ and traditional lectures. Computers & Education. 2009;52(4):858-867
- Cooper, Graham. Research into Cognitive Load Theory and Instructional Design and UNSW. The University of New South Wales, School of Educational Studies. 1998.
- Anderson, Tory. Goal Reasoning and Narrative Cognition. 2015 Annual Conference on Advances in Cognitive Systems: Workshop on Goal Reasoning. 2015.
- Szurmak, Joanna, Thuna, Mindy. Tell Me a Story: The Use of Narrative as a Tool for Instruction. Ala.org ACRL. 2013.
- Gallo, Carmine. Data Alone Won’t Get You a Standing Ovation. Harvard Business Review. 2014.
- Wolff, Florence I., and Nadine C. Marsnik. Perceptive Listening. Harcourt College Pub, 1993.
- Fisher, Ross. “A typical useless slideument.” P Cubed Presentations, 2017. http://ffolliet.com/2017/12/01/lists-of-facts/
- Meyer DE, Kieras DE. A computational theory of executive cognitive processes and multiple-task performance: Part 1. Basic mechanisms. Psychol Rev. 1997;104(1):3-65.
- Mayer, Richard, Moreno, Roxana. Nine Ways to Reduce Cognitive Load in Multimedia Learning. Educational Psychologist. 2003; 38(1):43-52
- Defeyter, Margaret, et al. The picture superiority effect in recognition memory: A developmental study using the response signal procedure. 2009;Cognitive Development 24(3):265-273
- Full text can be found here (need to request a download)
- Patrick, B. C., Hisley, J., & Kempler, T. What’s everybody so excited about?”: The effects of teacher enthusiasm on student intrinsic motivation and vitality. The Journal of Experimental Education, 2000;68(3), 217– 236
- Ericsson, Anders K. et al., The Role of Deliberate Practice in the Acquisition of Expert Performance, 1993;100(3), 363-406
Other Must-Browse Websites:
Where to find free high resolution images:
- Google Advanced Image Search (Select ‘Large’ for size and ‘Free to use’ for usage rights)
- Morgue File
- Free Images
- Everystockphoto Engine