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How to give a talk
  1. Edward Fathers
  1. Correspondence to Dr Edward Fathers, Department of Neurology, Musgrove Park Hospital, Taunton TA1 5DA, UK; Edward.Fathers{at}tst.nhs.uk

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Introduction

This is a practical guide to help you stand up and deliver talk to a room full of strangers.

Just as there are no naturally gifted sportsmen, there is no such thing as a natural public speaker. It is a skill that has to be acquired by learning the rules and practising. For a talk to be both educating and entertaining, it needs to have content that is appropriate for an oral presentation. This article explains the important differences between conveying medical information in written form versus spoken form and provides some specific practical tips for giving neurology case presentations and using PowerPoint.

If you are not sure whether you need to bother reading this article, I have prepared a screening questionnaire that will help guide you.

Have you ever given a talk to a group of people where any of the following have occurred:

  1. Halfway through a talk you have looked up from the lectern and wondered if you have accidentally walked into the AGM for the local sleep apnoea and myasthenia gravis association (figure 1)?

  2. More than one-third of the room are staring at their mobile phones before you have even reached your fifth slide (figure 2).

  3. Everybody who leaves the room to answer their phone/pager mysteriously never returns.

Figure 1

Subtle body language from the audience may hint that they are not enjoying your presentation.

Figure 2

If this scene looks familiar you had better read this article.

These could all be signs that your presentation skills need a little buffing.

I have long thought it unusual that presentation skills were not formally taught either at medical student or postgraduate level. This contrasts to the private sector (eg, the pharmaceutical industry), where media presentation skills are constantly being taught, appraised and improved upon.

Having sat through hundreds of hours of medical talks during my two decades as a doctor, I still find that no more than 20% reach the level of very good or excellent. This seems at odds with the very high intellectual ability of the speakers. The poor quality talks are rarely due to lack of effort; it is usually because they don’t know the rules. So here they are.

Understand the important differences between written and oral communication

You may have noticed that when your colleagues praise an outstanding medical talk they will often say that the speaker “made me feel as if I really understood the subject”.

This is because simplicity is the key to a good oral presentation. Einstein famously stated, “if you can’t explain it to a 6-year-old, you don’t understand it yourself”.

The medical profession use scientific papers and textbooks to communicate complex information. The language used is precise and direct. There is a high level of detail and a logical layout. You can re-read and look at the headings and subheadings to make sure that you don’t get lost.

In my opinion, the commonest mistake made by doctors giving a poor oral presentation is that they use the same amount of complexity and detail that you would expect to find in a scientific paper. So often I see the font size shrunken to the 6/4 line of a Snellen chart in order to compress as many facts into a slide with such density that it resembles the PowerPoint equivalent of a neutron star.

Keep things simple, avoid excessive detail

In order to illustrate this point and continue with the cosmic metaphor, I would like to use the example of the BBC scientific programme Wonders of the Universe, hosted by the physicist Brian Cox. The first episode in the series lasts one hour; during that time there are some beautiful illustrations and he gazes wistfully into the distance. However, in this one episode, he only makes five main points throughout the hour; the sun is very big, the sun is mostly hydrogen and helium, the universe is very old, gold comes from a giant supernova and there are 92 elements on planet Earth.

Now that I have pointed this out, you will observe that most scientific presentations will generally make no more than five or six main points. You must therefore plan very carefully which points you want to make and do them with clarity and precision.

Make no more than five or six points per talk

The oral presentation enables you to employ natural language to explain things. You have the advantage of being able to engage with the audience, but you must remember that they will usually have a 40-minute attention span and only 50% of what you say will be remembered. This percentage diminishes if you try and cram in even more facts.

It is very easy for the listener to get lost, so there are several techniques you must employ to prevent this from happening.

These techniques are

  1. Announcing: You have to tell your audience repeatedly what you are doing now and what you are going to do next.

  2. Signalling: This is where you explain where you are within the context of the talk. For example, show a summary slide at the start of your talk and keep showing it, highlighting where you are currently.

  3. Recapping: Tell them what has been said and what is important as you move on.

If the audience gets lost during your talk, they won’t understand it and therefore they won’t enjoy it. Unlike a scientific paper where information is not repeated, an oral presentation requires a lot of repetition to help to emphasise the areas that are important and to help people to remember where they are in the narrative. Humans have communicated for millennia by telling stories, so it helps to have a narrative running through any talk. Many speakers at medical conferences employ this technique.

Employ tactics to help prevent your listener from getting lost

Choose the correct number of slides for the length of your talk

The next time you go to a medical talk, why don’t you amuse yourself like I do and try notice how many PowerPoint slides the speaker is hoping to get through in the time allotted.

It is very similar to going to a summer barbecue in England. Due to lack of practice, everyone significantly over caters. In this metaphor, the sausages are slides.

If there are 45 slides and a 30-min talk, then you may want to place a bet with your colleague sitting next to you for the exact timing of when the slide skipping frenzy begins. My money is usually at the 23-min mark.

A good general rule is to have no more than one slide per minute that you hope to talk. I haven’t seen many exceptions to this rule. If you have been allocated a 30-min slot, then it is usually good practice to make sure that you speak for no more than 25 min, which means no more than 25 slides.

You should have one slide for every minute you are talking, approximately

Have you ever heard anyone complain that a talk was too short or that there were not enough slides? If possible, try and see how many of your slides could be replaced by pictures or diagrams. Often you will be able to replace several written slides with one good diagram.

Pictures and diagrams are better than slides with words

Find out as much as you can before you write your talk

This may seem obvious, yet so often I see somebody who has spent a lot of time and effort on an excellent talk, but unfortunately it’s been pitched at the wrong level for that particular audience.

When somebody invites you to give a talk, go through the following checklist:

  1. Who will be in the audience, you need to pitch it at the right level.

  2. Time. How long will you talk for, will there be time for questions after, how long will that be?

  3. Are there any particular topics you should cover? If you are talking to general practitioners, they are usually only interested in common neurological conditions and any recent guidelines.

  4. Ask if there is a feedback form for the audience. If there is, ask for a copy yourself in advance. Often the questions relate to whether the talk is relevant to clinical practice, will it be of use in the future, where there case studies, was there audience participation?

  5. What IT equipment is available?

Get as much information as possible before you write the talk

Rehearse your talk many times before you deliver it

I can guarantee you that if you have ever listened to an outstanding presentation, the speaker will have rehearsed it many times in advance. All the people who you may consider as accomplished speakers will make sure that they have gone over the talk from start to finish at least six or seven times. Not only is this an excellent antidote for nerves but also it helps you to deliver the talk more naturally. It also enables you to make sure that you will keep to time.

If you suffer with nerves, I strongly recommend visiting an empty lecture theatre and then deliver your talk with a colleague or trainer sitting in the audience who will then give you constructive feedback. Anticipate that you will need to repeat the talk several times before you feel more confident.

Aim to rehearse your talk at least five times

Remember that you are delivering a performance

You may think that the theatrical side to giving an oral presentation is an optional extra. It isn’t. When you stand at the front of a lecture theatre, your status has suddenly been elevated to a higher level. Unfortunately, it may not stay like that for long. There is an unspoken contract that says that you are going to educate and entertain, you have thoroughly prepared for this and you know more about your subject than anyone else in the room. In return, the audience will sit quietly and not distract you. At the end they will politely raise their hands if there are any questions. Medical audiences, in general, will not heckle you or throw soft fruit at you. So the worst thing that can happen is that most of the audience slip gently in and out of consciousness as you speak in a flat, monotonous voice and demonstrate your range of upper body tics.

So how do you avoid a performance disaster? Here come some more numbered points:

  1. Dress smartly: The performer status thing works much more effectively if you dress formally. It is particularly true in the medical profession. If you are a gifted actor with an international scientific reputation, you can get away with wearing your pyjamas, but for everyone else I would stick with the suit.

  2. Be positive: Introduce yourself, remembering to say your name slowly and clearly. The audience genuinely want you to do well and if they see that you are a positive person they will be much more forgiving.

  3. Eye contact: It is very difficult to make a connection with the audience if you never look at them. Try to pretend you are looking at different people directly. Staring at a screen or your notes for the whole talk signals lack of confidence and under preparation.

  4. Control your hands: If you tend to fidget, scratch or face, put your hands in your pockets, then learn to grasp your hands behind your back firmly or hold on to the lectern.

  5. Avoid laser pointers: Not only does this allow a room full of neurologists to diagnose your tremor disorder, it also usually signifies that you haven’t put your slides together very well if you need a separate device to try and highlight something.

  6. Don’t read out slides: If you have created a slide that you want everyone to read, then stand in silence for 30 seconds and let them read it at their own speed.

A good performance improves the attention of the audience

Advice for creating your slides

People who are good at giving talks are usually the same ones that produce beautiful slides. Creating a slide that is visually interesting takes a lot of work. It’s very hard to describe what makes an excellent slide: generally it is clear, legible and provides a visual representation of the message you’re trying to deliver. It’s much easier to write about what constitutes a bad slide, probably because I have seen a lot more of those. The same errors seem to crop up time and again.

Here are my tips for creating slides using PowerPoint

Choose the template carefully. Certain colour schemes are not easy to read. Black letters on a white background give the impression that you haven’t worked out how to use PowerPoint yet. Be cautious with abbreviations: some of your audience may not be familiar with them, in which case they will become lost and therefore uninterested. Make sure the font size is easy to read. Try to have no more than five lines of text per slide. If you find yourself wanting to put a list of 30 different causes of dystonia on a slide, think to yourself, is this kind of detail really helpful in an oral presentation, or would it be more suitable for a textbook?

Any slide that needs to be excused with the phrase “please forgive this busy slide” is best avoided. Usually, this implies that there is far too much information, the font size is too small to be legible and the level of detail is too high. Sometimes it is necessary to summarise comparative data all on one slide. Complex slides can be useful as long as the writing is large enough to be read, and you spend plenty of time describing what the data represent. It would probably take 3–5 min to go through a detailed slide methodically so that the audience can understand what it is showing. If you are illustrating data with a graph, then you must describe what each axis represents, what scale is used and what information it tells us.

Too often I see a scientist using a graph, which was cut and pasted from another source that was easy to read in a textbook but not on a slide.

Presenting radiology images needs to be very carefully planned. You must select a small number of representative images: these need to be enlarged so that abnormalities can be clearly seen. Use arrows to indicate anatomy and pathology. A comparative normal scan maybe an additional help. Don’t forget to announce clearly what the image represents, the imaging modality used, the area being scanned and the sequences used. It may not be obvious to all members of the audience.

The latest versions of PowerPoint enable you to view your current slide and the next slide simultaneously on your computer screen (during the presentation, when you are connected to a projector). This can help you remember what is coming next. The screen also displays notes, which you have written to act as a prompt. There is also a timer function, which saves you having to keep looking at your watch. I recommend that you connect your computer to a projector to practise with these features.

Using videos in PowerPoint presentations causes more problems than anything else. If you have embedded the videos within the presentation, and it works on your own laptop, the safest thing to do is to bring your own laptop and plug it into the projector. Don’t forget to bring your adapters (VGA and HDMI) if you are using an Apple computer. Not all video formats will necessarily play on the computer you are using. There is often nothing you can do about that on the day.

If you want to jump straight to a specific slide, then type in the slide number and press return. You do of course have to know in advance which numbers to use. It can be very helpful if you are concerned that you may be short of time and you want to miss out a few slides without everyone realising. Instead of rapidly having to press the next slide button—which signals to everyone that you haven’t actually rehearsed the talk to find out how long it takes—you can type in 30 return, and it will jump straight to slide 30.

General tips

Never start your talk with an apology. Even if you have been up all night, the dog ate your laptop or you were only asked to do the talk the night before, the audience don’t want to know this. They will immediately assume the talk will be of poor quality and will have a much lower threshold for drifting off. It is much better to deliver the talk—it may be much better than you anticipate—and if there are problems, then the person chairing the meeting can explain to the audience that there were mitigating circumstances.

Do not stop halfway through your talk and ask the person chairing the meeting, how am I doing for time? You should know exactly how long you are expected to talk before you begin. You know how many slides you have, your rehearsal tells you how long it takes to deliver the talk, your watch tells you how much time you’ve got left. Asking the question suggests that you’ve made none of these preparations (box 1).

Box 1

Tips for inviting speakers

If you are the person inviting someone else to come and give a talk, you should try and be as clear as possible about your request.

  1. Try to establish the title of the talk as soon as possible.

  2. Who will be in the audience, and how many?

  3. Start time, expected duration of the talk, time for questions.

  4. Will there be speakers afterwards? Therefore please do not overrun.

  5. What topics the audience would find helpful.

  6. Will there be feedback? If so, send them a copy of the feedback form in advance.

  7. If they are bringing a laptop, what connections and power supplies are available?

Specific tips for neurology case presentations

If you are a specialist neurology trainee giving a case presentation at your local neuroscience meeting, then I offer you these tips:

  1. Introduce yourself clearly and slowly, not everyone knows who you are.

  2. Tell everyone how long your talk will be: for example, if you plan to spend 15 min on a case presentation, indicate that you will pause twice for discussion. You will then talk for 10 min using six slides on a subject relevant to the case.

  3. Tell the person chairing the meeting that you have put in slides to indicate where the pause occurs for discussion. You may want to let them know if the case already has a diagnosis or if this is still being evaluated.

  4. Indicate which consultant is responsible for the case; have you also seen the patient yourself?

  5. Speak slowly when delivering the history; this is usually the most important part.

  6. Try to be precise and concise when describing examination findings.

  7. Consider using a brief summary slide of the case when you pause for discussion. This means the other trainees don’t have to make notes frantically, and consultants are more likely to be able to offer their thoughts.

  8. If you are going to talk briefly after the presentation on a related matter, try to limit yourself to 10 min. Do not attempt to summarise the current world knowledge on the topic; instead try to think of three interesting and relevant points and illustrate this with a few slides. Don’t cut and paste the abstract from a recent paper and put it on a slide. It is dull to look at and is usually too small to read.

  9. Try and go through the case presentation with your consultant in advance. There may be important things that you have missed.

  10. Ask for someone to give you feedback immediately after your presentation.

Footnotes

  • Correction notice This paper has been amended since it was published Online First. Our typesetter uploaded an uncorrected version rather than the final version. We would like to apologise to the author for this error.

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed. This paper was reviewed by Chris Allen, Cambridge, UK.

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