How to give a talk

Edward Fathers

Correspondence toDr Edward Fathers, Departmentof Neurology, Musgrove ParkHospital, Taunton TA1 5DA, UK;Edward.Fathers@tst.nhs.uk

Published Online First2 April 2014

To cite: Fathers E. PractNeurol Published Online First:[please include Day MonthYear] doi:10.1136/practneurol-2014-000836

INTRODUCTIONThis is a practical guide to help you standup and deliver talk to a room full ofstrangers.Just as there are no naturally gifted

sportsmen, there is no such thing as anatural public speaker. It is a skill thathas to be acquired by learning the rulesand practising. For a talk to be both edu-cating and entertaining, it needs to havecontent that is appropriate for an oralpresentation. This article explains theimportant differences between conveyingmedical information in written formversus spoken form and provides somespecific practical tips for giving neurologycase presentations and using PowerPoint.If you are not sure whether you need

to bother reading this article, I have pre-pared a screening questionnaire that willhelp guide you.Have you ever given a talk to a group

of people where any of the followinghave occurred:1. Halfway through a talk you have looked

up from the lectern and wondered if youhave accidentally walked into the AGMfor the local sleep apnoea and myastheniagravis association (figure 1)?

2. More than one-third of the room arestaring at their mobile phones beforeyou have even reached your fifth slide(figure 2).

3. Everybody who leaves the room to answertheir phone/pager mysteriously neverreturns.

These could all be signs that your pres-entation skills need a little buffing.I have long thought it unusual that

presentation skills were not formallytaught either at medical student or post-graduate level. This contrasts to theprivate sector (eg, the pharmaceuticalindustry), where media presentation skillsare constantly being taught, appraisedand improved upon.Having sat through hundreds of hours

of medical talks during my two decadesas a doctor, I still find that no more than20% reach the level of very good or

excellent. This seems at odds with thevery high intellectual ability of the speak-ers. The poor quality talks are rarely dueto lack of effort; it is usually because theydon’t know the rules. So here they are.

Understand the important differencesbetween written and oral communicationYou may have noticed that when yourcolleagues praise an outstanding medicaltalk they will often say that the speaker“made me feel as if I really understoodthe subject”.This is because simplicity is the key to a

good oral presentation. Einstein famouslystated, “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 communicatecomplex information. The language used isprecise and direct. There is a high level ofdetail and a logical layout. You can re-readand look at the headings and subheadingsto make sure that you don’t get lost.In my opinion, the commonest mistake

made by doctors giving a poor oral pres-entation is that they use the same amountof complexity and detail that you wouldexpect to find in a scientific paper. Sooften I see the font size shrunken to the6/4 line of a Snellen chart in order tocompress as many facts into a slide withsuch density that it resembles thePowerPoint equivalent of a neutron star.Keep things simple, avoid excessive

detailIn order to illustrate this point and

continue with the cosmic metaphor, Iwould like to use the example of theBBC scientific programme Wonders of theUniverse, hosted by the physicist BrianCox. The first episode in the series lastsone hour; during that time there aresome beautiful illustrations and he gazeswistfully into the distance. However, inthis one episode, he only makes five mainpoints throughout the hour; the sun isvery big, the sun is mostly hydrogen andhelium, the universe is very old, goldcomes from a giant supernova and thereare 92 elements on planet Earth.

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Now that I have pointed this out, you will observethat most scientific presentations will generally makeno more than five or six main points. You must there-fore plan very carefully which points you want tomake and do them with clarity and precision.

Make no more than five or six points per talkThe oral presentation enables you to employ naturallanguage to explain things. You have the advantage ofbeing able to engage with the audience, but you mustremember that they will usually have a 40-minuteattention span and only 50% of what you say will beremembered. This percentage diminishes if you tryand cram in even more facts.It is very easy for the listener to get lost, so there

are several techniques you must employ to preventthis from happening.These techniques are

1. Announcing: You have to tell your audience repeatedlywhat you are doing now and what you are going to donext.

2. Signalling: This is where you explain where you arewithin the context of the talk. For example, show asummary slide at the start of your talk and keep showingit, highlighting where you are currently.

3. Recapping: Tell them what has been said and what isimportant 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 notrepeated, an oral presentation requires a lot of repeti-tion to help to emphasise the areas that are importantand to help people to remember where they are in thenarrative. Humans have communicated for millenniaby telling stories, so it helps to have a narrativerunning through any talk. Many speakers at medicalconferences employ this technique.

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 thisarticle.

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Employ tactics to help prevent your listener from gettinglostChoose the correct number of slides for the length ofyour talkThe next time you go to a medical talk, why don’t

you amuse yourself like I do and try notice how manyPowerPoint slides the speaker is hoping to get throughin the time allotted.It is very similar to going to a summer barbecue in

England. Due to lack of practice, everyone signifi-cantly over caters. In this metaphor, the sausages areslides.If there are 45 slides and a 30-min talk, then you

may want to place a bet with your colleague sittingnext to you for the exact timing of when the slideskipping frenzy begins. My money is usually at the23-min mark.A good general rule is to have no more than one

slide per minute that you hope to talk. I haven’t seenmany exceptions to this rule. If you have been allo-cated a 30-min slot, then it is usually good practice tomake 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 aretalking, approximatelyHave you ever heard anyone complain that a talk wastoo short or that there were not enough slides? If pos-sible, try and see how many of your slides could bereplaced by pictures or diagrams. Often you will beable to replace several written slides with one gooddiagram.

Pictures and diagrams are better than slides with wordsFind out as much as you can before you write yourtalkThis may seem obvious, yet so often I see somebody

who has spent a lot of time and effort on an excellenttalk, but unfortunately it’s been pitched at the wronglevel 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 onlyinterested in common neurological conditions and anyrecent guidelines.

4. Ask if there is a feedback form for the audience. If thereis, ask for a copy yourself in advance. Often the ques-tions relate to whether the talk is relevant to clinicalpractice, will it be of use in the future, where there casestudies, was there audience participation?

5. What ITequipment is available?

Get as much information as possible before you write thetalkRehearse your talk many times before you deliver itI can guarantee you that if you have ever listened to

an outstanding presentation, the speaker will haverehearsed it many times in advance. All the peoplewho you may consider as accomplished speakers willmake sure that they have gone over the talk from startto finish at least six or seven times. Not only is this anexcellent antidote for nerves but also it helps you todeliver the talk more naturally. It also enables you tomake sure that you will keep to time.If you suffer with nerves, I strongly recommend vis-

iting an empty lecture theatre and then deliver yourtalk with a colleague or trainer sitting in the audiencewho will then give you constructive feedback.Anticipate that you will need to repeat the talk severaltimes before you feel more confident.

Aim to rehearse your talk at least five timesRemember that you are delivering a performanceYou may think that the theatrical side to giving an

oral presentation is an optional extra. It isn’t. Whenyou stand at the front of a lecture theatre, your statushas suddenly been elevated to a higher level.Unfortunately, it may not stay like that for long. Thereis an unspoken contract that says that you are going toeducate and entertain, you have thoroughly preparedfor this and you know more about your subject thananyone else in the room. In return, the audience willsit quietly and not distract you. At the end they willpolitely raise their hands if there are any questions.Medical audiences, in general, will not heckle you orthrow soft fruit at you. So the worst thing that canhappen is that most of the audience slip gently in andout of consciousness as you speak in a flat, monoton-ous voice and demonstrate your range of upper bodytics.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 particularlytrue in the medical profession. If you are a gifted actorwith an international scientific reputation, you can getaway with wearing your pyjamas, but for everyone else Iwould stick with the suit.

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

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

4. Control your hands: If you tend to fidget, scratch orface, put your hands in your pockets, then learn to grasp

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your hands behind your back firmly or hold on to thelectern.

5. Avoid laser pointers: Not only does this allow a roomfull of neurologists to diagnose your tremor disorder, italso usually signifies that you haven’t put your slidestogether very well if you need a separate device to tryand highlight something.

6. Don’t read out slides: If you have created a slide that youwant everyone to read, then stand in silence for 30seconds and let them read it at their own speed.A good performance improves the attention of the

audience

ADVICE FOR CREATING YOUR SLIDESPeople who are good at giving talks are usually thesame ones that produce beautiful slides. Creating aslide that is visually interesting takes a lot of work. It’svery hard to describe what makes an excellent slide:generally it is clear, legible and provides a visual repre-sentation of the message you’re trying to deliver. It’smuch easier to write about what constitutes a badslide, probably because I have seen a lot more ofthose. The same errors seem to crop up time andagain.

Here are my tips for creating slides using PowerPointChoose the template carefully. Certain colour schemesare not easy to read. Black letters on a white back-ground give the impression that you haven’t workedout how to use PowerPoint yet. Be cautious withabbreviations: some of your audience may not befamiliar with them, in which case they will becomelost and therefore uninterested. Make sure the fontsize is easy to read. Try to have no more than fivelines of text per slide. If you find yourself wanting toput a list of 30 different causes of dystonia on a slide,think to yourself, is this kind of detail really helpful inan oral presentation, or would it be more suitable fora 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 infor-mation, the font size is too small to be legible and thelevel of detail is too high. Sometimes it is necessary tosummarise comparative data all on one slide.Complex slides can be useful as long as the writing islarge enough to be read, and you spend plenty of timedescribing what the data represent. It would probablytake 3–5 min to go through a detailed slide methodic-ally so that the audience can understand what it isshowing. If you are illustrating data with a graph, thenyou must describe what each axis represents, whatscale 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 toread in a textbook but not on a slide.Presenting radiology images needs to be very care-

fully planned. You must select a small number of

representative images: these need to be enlarged sothat abnormalities can be clearly seen. Use arrows toindicate anatomy and pathology. A comparativenormal scan maybe an additional help. Don’t forgetto announce clearly what the image represents, theimaging modality used, the area being scanned andthe sequences used. It may not be obvious to allmembers of the audience.The latest versions of PowerPoint enable you to

view your current slide and the next slide simultan-eously on your computer screen (during the presenta-tion, when you are connected to a projector). Thiscan help you remember what is coming next. Thescreen also displays notes, which you have written toact as a prompt. There is also a timer function, whichsaves you having to keep looking at your watch. I rec-ommend that you connect your computer to a pro-jector to practise with these features.Using videos in PowerPoint presentations causes

more problems than anything else. If you have embed-ded the videos within the presentation, and it workson your own laptop, the safest thing to do is to bringyour own laptop and plug it into the projector. Don’tforget to bring your adapters (VGA and HDMI) ifyou are using an Apple computer. Not all videoformats will necessarily play on the computer you areusing. There is often nothing you can do about thaton the day.If you want to jump straight to a specific slide, then

type in the slide number and press return. You do ofcourse have to know in advance which numbers touse. It can be very helpful if you are concerned thatyou may be short of time and you want to miss out afew slides without everyone realising. Instead ofrapidly having to press the next slide button—whichsignals to everyone that you haven’t actually rehearsedthe talk to find out how long it takes—you can typein 30 return, and it will jump straight to slide 30.

GENERAL TIPSNever start your talk with an apology. Even if youhave been up all night, the dog ate your laptop or youwere only asked to do the talk the night before, theaudience don’t want to know this. They will immedi-ately assume the talk will be of poor quality and willhave a much lower threshold for drifting off. It ismuch better to deliver the talk—it may be muchbetter than you anticipate—and if there are problems,then the person chairing the meeting can explain tothe audience that there were mitigating circumstances.Do not stop halfway through your talk and ask the

person chairing the meeting, how am I doing fortime? You should know exactly how long you areexpected to talk before you begin. You know howmany slides you have, your rehearsal tells you howlong it takes to deliver the talk, your watch tells youhow much time you’ve got left. Asking the question

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suggests that you’ve made none of these preparations(box 1).

SPECIFIC TIPS FOR NEUROLOGY CASEPRESENTATIONSIf you are a specialist neurology trainee giving a casepresentation at your local neuroscience meeting, thenI 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. Youwill then talk for 10 min using six slides on a subjectrelevant to the case.

3. Tell the person chairing the meeting that you have putin slides to indicate where the pause occurs for discus-sion. You may want to let them know if the casealready 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 usuallythe most important part.

6. Try to be precise and concise when describing examin-ation findings.

7. Consider using a brief summary slide of the case whenyou pause for discussion. This means the other traineesdon’t have to make notes frantically, and consultantsare more likely to be able to offer their thoughts.

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

9. Try and go through the case presentation with yourconsultant in advance. There may be important thingsthat you have missed.

10. Ask for someone to give you feedback immediatelyafter your presentation.

Correction notice This paper has been amended since it waspublished Online First. Our typesetter uploaded an uncorrectedversion rather than the final version. We would like to apologiseto the author for this error.

Competing interests None.

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

Box 1 Tips for inviting speakers

If you are the person inviting someone else to come andgive a talk, you should try and be as clear as possibleabout 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?

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