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DUCATION

he Basics of PowerPoint and Publicpeaking in Medical Education

argaret J. Tarpley, MLS, and John L. Tarpley, MD

epartment of Surgery, Vanderbilt University, Nashville, Tennessee

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OMPETENCY: Medical Knowledge, Professionalism, Inter-ersonal and Communication Skills

ffective medical education presentations require a workingnowledge of computer software such as Microsoft PowerPointMicrosoft Corporation, Redmond, Washington) and skills inublic speaking. Electronic presentations require readability asell as worthwhile content; projection before the scheduledresentation is necessary for evaluating layout and color. Theften overwhelming amount of data tempts the educator torowd slides with graphs, illustrations, or tiny print and then tonnounce, “I know you can’t read this, but . . . .” Constructingffective slides entails close attention to the number of text lines,ont size, and font style as well as templates and backgrounds toaximize visibility and readability. The medical educator can

enefit from discovering and using features of PowerPoint suchs the Master Slide for personalized templates, Custom Anima-ion, Compress, and the spelling and grammar checking soft-are. Preparation for oral and electronic presentations requiresnowledge of the audience, careful choice of words, and timedractice for clarity and appropriate volume.Medical educators depend on electronic and oral presenta-

ions for didactic teaching, formal lectures, and research fo-ums. Accusations such as “death by PowerPoint,”1 might bevoided if educators, residents, and students acquire basic skillsn public speaking as well as PowerPoint. After a discussion ofelected features of Microsoft PowerPoint, the general princi-les of public speaking will be addressed.

AKING THE MOST OF POWERPOINT

riginally developed for business and marketing purposes, Mi-rosoft PowerPoint can enhance teaching and informationharing when used properly. The following pointers are notntended to be exhaustive but are an introduction to the basics.

orrespondence: Inquiries to Margaret Tarpley, Associate in Surgery, Vanderbilt Univer-ity, D-4314 Medical Center North, Nashville, TN 37232-2730; fax (615) 322-0689;-mail: Margaret.tarpley@vanderbilt.edu

vPresented, in part, at Surgical Education Week, APDS Section, in Washington, DC,

pril 13, 2007.

ournal of Surgical Education • © 2008 Published by Elsevier Inc. onAssociation of Program Directors in Su

ecause successful and effective use of PowerPoint requireskillful manipulation rather than a casual approach, designingppropriate and understandable presentations requires atten-ion to every detail. Font style and size, layout, backgrounds,nd color must be chosen carefully with the subject matter,udience, and—above all—legibility and readability in mind.

ONT STYLE AND SIZE

ont is the technical term for the style of type face. A type fonts either serif or sans serif. Serif means stroke or line in Germannd refers to the little extra stroke at the edge of letters. Sans serifwithout a stroke) is preferred for projection clarity. SometimesowerPoint supplies Times New Roman, a serif style, as theefault font; therefore, the user must learn to change to a sanserif font such as Arial. Font size (measured in points) and theumber of text lines on a page must be considered. Provideargins that keep the text away from the edges of the slide,

articularly at the bottom. Stay at 20 points or larger, and avoidhe use of all capital letters. Avoid overuse of italics if used at all.even to 8 lines of text per page is ideal—if you have more thanlines, project the slides and observe how readable they are.hen outlining main points and subpoints, 1 item only undertopic does not warrant a bullet or a number according to

roper outlining rules.

ACKGROUNDS—TEMPLATES ANDASTER SLIDE

hen creating the presentation, many users uncritically choosene of the numerous default templates available in PowerPoint,hich negates any layout decisions. These default templatesften distract, obscure, or compete, thus proving dangerous toour presentation. The default font may not be sans serif, andhe font color and size may not always be read easily. Red typen a blue background or vice versa is often difficult to read anday not be visible at all to those with some color-blindness.hy use a template if you must override defaults? Backgrounds

eg, clouds in a sky) may have an uneven hue or distractingesign, which causes words to have varying contrast and poor

isibility. Numerous backgrounds are unattractive and inap-

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ropriate for scientific or academic subject matter. Designingour own template is encouraged.

Personalized templates may be created by using the Slideaster feature. Plain white backgrounds with a sans serif black

ont are acceptable but potentially boring for a presentationasting longer than a few minutes. Here are the steps for editinghe Master Slide (PowerPoint 2003):

Click View on Toolbar.On the View drop-down menu, click Master.On the Master drop-down menu, click Slide Master.Slide Master View appears.Working in the slide, edit the Master Slide by going to For-mat on the Toolbar and working on Font and Background.Insert graphics if desired (on the Toolbar, click Insert, thenclick Picture, and select source of graphic).Return to Normal View by going to View and clicking onNormal or by clicking on Close Master View on the dialogbox that often appears in Slide Master view.

With the Master Slide on the screen, the background can beesigned with color, copyright information, logos, or other graph-

cs. A sans serif font such as Arial can be selected. Customizedemplates created with Slide Masters are personal and distinctive.he institutional colors are always a good starting point as is the

pproved logo (consulting the institution is advised because somechools insist on use of approved images). White or light font on aark background can be as readable as a dark or black font on ahite or light background. Do not rely solely on the computer

creen for design and clarity. Continually view each slide in Slidehow projection by going to the Toolbar, clicking on Slide Shownd choosing View Slide or by clicking on the small screen icon inhe lower left corner of the screen. To return to edit mode, press thescape key in the upper left corner of the keyboard. Projection will

eveal color and layout difficulties as well as readability of your textnd graphics.

When editing the Master Slide, keep in mind that any itemsdded to the Master Slide will appear on every slide in the show.ny individual slide can be customized and graphics can be re-oved if a graphic interferes with layout by following these steps:To remove Master Slide graphics from an individual slide:

Place cursor on the slide (but not in a text box) and right-click.In the dialog box that appears choose Background.Background dialog box appears.Click “Omit background graphics from master.”Click Apply button not “Apply to all” if only the one slide isinvolved.

To change individual slide background:

Place cursor on the slide and right-click.In the Dialog box that appears choose Background.Under “Background Fill” is a button for color selection.Click on the button and choose a color or effect.Click Apply button not “Apply to all” if only the one slide is

involved. q

30 Journal of S

RAPHICS AND ANIMATION

raphics provide interest and visual appeal. Learn to use theormat Picture feature that offers size, color, position, and res-lution adjustments for graphics. Consider taking some train-ng in a graphics software program such as Adobe PhotoshopAdobe Systems Incorporated, San Jose, California). High res-lution and excessive numbers of graphics may increase file sizeo the point of unwieldiness and add difficulty to storage and-mail transfer. Keep size and resolution to a minimum. Beware that a resolution of 72 to 100 dpi (dots per inch) is all thatost projected presentations require. Large images may be

ompressed within PowerPoint by inserting a graphic in thelide and then compressing it. The Compress feature is foundithin the Format Picture dialog box. Format Picture may be

ccessed two ways:

. Select the graphic and right-click to produce the FormatPicture dialog box; then click Picture tab and access theCompress button.

. Select the graphic, click Format on the Toolbar, and thenclick Picture; in the dialog box, click the Picture tab toaccess the Compress button.

When the Compress button is clicked, options appear thatelate to which graphics need compression. Choices are as fol-ows: “Apply to” and “Change resolution.” Under “Apply to,”hoose “all pictures in document” if the entire file needs reduc-ion in size and quality will not be compromised. Choose “se-ected pictures” if compression causes the visual quality of sometems to deteriorate. Under “Change resolution,” choose “Web/creen (96 dpi)’” to reduce the size of those graphics. Clipart isseful, but clipart file sizes can vary widely. Avoid clipart withxcessive actions; if on the screen too long, animations are te-ious, not to mention distracting.The Custom Animation allows text and graphics to enter or

xit the slide in a lively manner. This feature is found withinlide Show on the Toolbar. To access:

Select text or graphic to animate (ie, appear, disappear, orchange).Click on Slide Show.Then click on Custom Animation from the drop-downmenu.Click the Add Effect button.Choose Entrance, Emphasis, Exit, or Motion Path.

All graphics should be large and sharp enough to be rec-gnizable, and all charts and graphs should be readable.ever say, “I know you can’t read it, but this chart (or graph

r illustration) proves my hypothesis.” Other factors relatedo readability include font selection, room size, and lightontrol as well as vision and location of the viewers and

uality of projection.

urgical Education • Volume 65/Number 2 • March/April 2008

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REPARATION, PRACTICE, AND SET-UP

hat About the Room?

he best view is found in front, not to the side. If you do yourwn setup, project parallel to the long axis of the room whenossible. Learn how the microphone works, whether lavaliere ortationary. Test the volume level. Know how to adjust the lightsr ask the host if someone will handle the light level. Neverssume your local host is computer-literate—ask about com-uter technology support if your presentation is complex orncludes video or DVD.

ractice

ever view your presentation on a screen for the first time at theenue. Project it first, and find the bugs. Avoid placing text toolose to any slide margin. Use the spell-checking and grammar-hecking features found on the Toolbar under Tools. Someresentations convince viewers that the presenter was unawaref those useful features. A visual edit is mandatory because theseheckers are not fool-proof and do miss some errors such asord use as in “wit” versus “with.”As soon as one arrives at the speaking venue, one must always

est out the laptop connection or the disk or flash drive to makeertain the file will appear for projection. Quickly run throughhe show to be certain all graphics are compatible. Deleting (onoolbar under Edit) or hiding (on toolbar under Slide Show) a

lide with an invisible graphic is preferable to projecting anmpty slide. Load the presentation file to the desktop if possi-le; the PowerPoint program runs faster from the hard drive.emove your USB flash drive or disk. If left in place on theomputer, flash drives can be bent by speaker or host movementnd disks might be forgotten. Especially if you have video com-onents, try them out as well. Resolution incompatibilities canause the video portions to fail.

Canned talks are proven and time-saving but must be ad-usted to the occasion, time, and audience. PowerPoint is veryexible; therefore no excuses are permitted for failure to adapthe prepared talk. If you have too much material, hide slidesather than race through and perhaps skip something vital andhen be forced to rerun the presentation and hunt. Wheneverossible, go ahead of time to the room where you will speak.ake certain the microphone and all other electronics are

orking. If you need a laser pointer, take your own or check onvailability. The mouse arrow also works as a pointer. Try outhe projector, whether LCD or 35 mm. Do your slides and/orresentation work with their equipment?Patient privacy and copyright issues must be considered.

ood manners as well as regulations such as HIPPA make itecessary to disguise patient information. Give credit or pro-ide the sources for copyrighted materials. If your talk containsopyrighted materials and patient information, ascertain that itill be password protected if it might be uploaded on the insti-

ution’s web site. Audiences enjoy handouts. Consider provid-

ng a hard copy of key references and perhaps the key points as t

ournal of Surgical Education • Volume 65/Number 2 • March/April

ell. Avoid last-minute preparation; some hosts request or evenequire the speaker to submit the talk beforehand for publicelations or educational purposes (Fig. 1).

UBLIC-SPEAKING PRINCIPLES

ublic-speaking essentials date back to the Greek orator Demo-thenes in the 4th century BCE: know your audience, be pre-ared, be understandable, and hold their attention. Even 2500ears later, these 4 broad guidelines continue to underpin pub-ic presentations, both oral and electronic. Although speakingn public raises anxiety levels for many, including experiencedrofessional speakers, this fear is normal. Being thoroughly pre-ared and practiced proves the best remedy.. Know Your Audience. The first principle might seem obviousor the teacher of medical students or residents but more com-lex for someone invited to give a talk in a different city or eveno a nonmedical audience on the home campus. Even medicalroups are not homogeneous; primary care physicians, basicesearchers, and academic surgeons are distinct. The presenterhould ask several questions of the host: To whom will I ad-ress? Is everyone a professional? Will spouses or guests beresent? Are ages mixed? (Gory operating room shots or naked

FIGURE 1. PowerPoint “pointer’s” checklist.

orsos might need hiding in some venues).

2008 131

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. Be Prepared. Acquire information about the circumstancesf presentation. Make a note of the host, occasion, and institu-ion, and use this information in the introduction—audiencesppreciate a personal touch (eg, copy an institution’s logo fromheir website and use it on the introductory slide). Before leav-ng home, ask the host exactly how much time is allotted for thealk and inquire about computer compatibility (ie, Mac vs PC).

Take to heart the old saw, “Practice makes perfect.” Projectour talk: practice it out loud at home and time it. Fit theaterial to the time given—too much is worse than too little—

ount on a late start and build in a few minutes for questions.Pay attention to your clothing. A business suit for either

ender is usually correct for any geographic area, but sometimeshe occasion may be casual. Cultural distinctions exist betweenedical specialties as well as for grand rounds, retreats, and

ducational conferences. If any uncertainty exists, ask.. Be Understandable. If you know your audience, you will adjusthe content and vocabulary accordingly. A certain amount of ner-ousness is normal, but to know that one has prepared, practiced,nd timed the talk increases confidence. Speak loudly enough to beeard with or without the microphone. Look at the audience andot just at your notes, especially if you do have a microphone. Thebility to project your voice outward and to engage in eye contactesults from being prepared (ie, practicing the presentation outoud several times). Try not to rush the words. If one has too much

aterial for the time allotted, one probably is not “prepared.” Pro-ounce words clearly and distinctly, and even practice your pauses.aying the talk aloud will reveal those tongue-twisting word com-inations and other potential stumbles and allow you to workhrough them.. Hold Their Attention. Be certain you can be heard—remembero check your sound equipment and the room. Vary yourone of voice; monotones are soporific. Project interest andxcitement in your own topic—it’s contagious! Make eyeontact—it’s engaging. Tailoring material appropriate to yourudience increases the likelihood for maintaining attention.umor can be effective, but use it carefully—avoid politically

ncorrect and insensitive remarks. Ad libbing is dangerous; therudent course is to clear questionable humor with the host.pologies and self-denigration contribute to attention loss. Doot apologize for coughing, throat clearing, stumbles over wordnunciation, or a dropped pen or pointer; these actions inter-upt the flow and serve only to draw attention to something that

ight well otherwise go unnoticed. No speaker should ever

32 Journal of S

egin a talk—for the sake of humility or any other reason—ith an apology for the forthcoming presentation or a declara-

ion of unworthiness to stand before the group. Those personsesponsible for the invitation considered the speaker worthynd would not wish to be proven wrong and that might happenfter a convincing self-denigrating introductory declaration.

Although “thank you” has become a standard concluding re-ark, it may detract from a strong ending. Offer thanks in the

eginning if you feel that it is necessary. Effective talks should endith a strong concluding remark—then project a black or white

lide and use body language to signify you are finished. The audi-nce owes you thanks. A dramatic pause is effective; calling foruestions is OK, or look over to your host or sit down (Fig. 2).

Acquiring basic public-speaking skills as well as learning toanipulate basic features of PowerPoint will provide the tools

or the medical educator to improve the effectiveness of teach-ng and communication.

EFERENCES

. Taylor D. Death by PowerPoint. Dev Med Child Neurol.

FIGURE 2. Ten suggestions for effective public speaking.

2007;49:395.

urgical Education • Volume 65/Number 2 • March/April 2008