Bradley Sharpe, MD, FACP, didn't get off to a very good start in his lecture to Hospital Medicine 2015 attendees. He hid behind the podium, read from his slides, said “um” a lot, and warned listeners that “I haven't given this talk before, so it might not be very good.”
But his performance was quickly revealed as an act, because Dr. Sharpe, a professor of medicine at the University of California, San Francisco, was actually leading a session on how to give a great medical talk that ensures the audience will pay attention and increases the chance that they will learn something.
“When we stand up and start teaching in this setting, we're fighting a hard-to-win battle, a war, against the fallibility of human memory,” said Dr. Sharpe. Research has shown that students typically remember only 39% of the information conveyed in a lecture immediately afterward and just 3% a month later, he reported.
But speakers can impact retention, as well as control, to at least some degree, which part of a talk stays with listeners. “How we organize content is going to help us do that,” said Dr. Sharpe.
The first step in preparing a lecture's content is to know your audience, not just whether they're hospitalists, residents, or medical students, but their current state of mind, which may differ by time of day or previous activities. For example, if you're speaking to a group of students, “Did they just come from a pathology small group, or have they been sitting in lecture for 3 hours? The battles you're fighting are different depending on that context,” said Dr. Sharpe.
Next, determine the session's goals, which are the knowledge, skills, or attitudes you want learners to take home. They should be measurable and specific. “The turn of phrase I use is, ‘By the end of this lecture, you should be able to ...’,” said Dr. Sharpe.
The goals will shape the talk's agenda. “What we talk about in a lecture should be guided, not by what I think I should talk about, but what I think the learner should be able to do right after the lecture, and what the 3% they might remember in a month is,” he said.
Both the agenda and the goals should be explained during the lecture's introduction. “When speakers just start talking without an agenda, all of the audience has a subtle sense of unease, this anxiety about where are we going, what are we going to talk about?” Dr. Sharpe said.
A powerful and engaging introduction to a talk is essential because listeners take only a couple of minutes to judge a speaker. “At about 5 minutes, the medical students in the audience have already made a judgment and, if is not engaging, they will think, ‘It's not going to be that good,’ and out comes the laptop or their cell phone,” said Dr. Sharpe.
Even before you start to speak, the audience will make a judgment about you. So, keep it simple, and “stand up straight and smile,” advised Dr. Sharpe. He also offered some clothing advice: Women should remember to wear a top that will allow a lavalier microphone to be attached directly below their mouths (men will likely naturally wear a button-down shirt), and anyone with pants pockets should take everything out of them. “If you have something in your pocket, you have a tendency to put your hands in your pocket, and that's weird,” said Dr. Sharpe. As an added bonus, emptying your pockets is a reminder to turn your phone off.
Capturing listeners' attention as soon as you begin to talk is crucial. It helps to be enthusiastic about the topic, something many speakers fail to do. “Who's ever heard, ‘I'm here today to talk about readmissions. It's not that sexy or interesting of a topic’ ... Don't say that!” said Dr. Sharpe. “It's interesting all the time, or you shouldn't be talking about it. Don't throw yourself under the bus.”
Cases and controversies are effective ways to grab attention with an intro. “Or if nothing else, just say, ‘You're here because you're going to see a lot of this disease.’ ... Make it relevant,” he said.
On the move
In addition to words, speakers need to use their bodies to get listeners' attention. Dr. Sharpe recommends staying away from the podium, and if possible, walking around in the audience. “When I'm giving lectures to med students, I'm spending about 15% of my time in the back row,” he said. Moving away from the podium and into the audience is stimulating to them.
While moving around, make eye contact. “But the eye contact should not be random ... Ideally, you are intentionally looking at people in different quadrants of the room,” Dr. Sharpe said.
Speakers who stand in place without making eye contact are going to be subconsciously compared to the kinds of entertainment that their audience usually watches through a screen. “You create this big glass screen around me and compare me to those other people. [A speaker] cannot beat YouTube,” said Dr. Sharpe.
Move your arms, too, using gestures to support your words (for example, reaching to the left, middle, and right when describing 3 categories of patients), and vary your voice quality and speed. “It is remarkable how slowing down can cause an impact,” said Dr. Sharpe. Speak clearly and loudly (but not too loudly), and, of course, avoid “ums” and “ahs.”
The speaker should not be the only one speaking and moving during the session, if the audience is to remain alert. “If there's no activity, meaning you just sit there and the information is conveyed to you, the first 10 or 15 minutes, the attention level is pretty good. But if there is not exercise or activity, attention plummets and, along with it, ability to retain information,” said Dr. Sharpe.
Inserting an activity partway through a lecture restores the audience's ability to concentrate and learn to its original level, he explained. The activity can be something as small as making everyone in the audience raise their hands and then lower them in response to a question. “Some people will say, ‘Everyone stand up for 30 seconds. Just stand up and introduce yourself to the person next to you,’” said Dr. Sharpe.
More formal options include asking the audience to discuss a topic with a person or 2 near them or brainstorming as a group.
A speaker could ask for questions from the audience or ask them questions, for example, with an audience response system. “I'll often use it as a pretest, and then teach the content. You can also flip it. If you just talked about the prevention of delirium, at the end of that section, say, ‘Here's a multiple-choice question: Which of these is not an evidence-based way to prevent delirium?’” said Dr. Sharpe.
Activities should be scattered throughout the talk. “If you have an hour, at least twice they should be doing something to get their attention back up,” Dr. Sharpe said.
While activities are a good way to gain the audience's attention, slides full of text are an effective way to accomplish the opposite. “The slides are not a regurgitation of all that you want to talk about. It should be a visual aid that helps make your presentation better,” he said.
A good rule of thumb is no more than 7 lines per slide and no more than 7 words per line, and information should be conveyed in bullet points, not paragraphs, Dr. Sharpe advised. “When you see what looks like a paragraph up on the screen, you don't want to read it,” he said.
No speaker should ever find themselves apologizing for a “really busy slide,” he added. “No, it's not a ‘really busy slide,’ it's a crappy slide. ... What you're saying is I didn't want to take the time to actually make my own graph or take the time to copy just that part of the table and expand it in PowerPoint.”
Slides should be highly readable, but not highly decorated with wacky backgrounds or graphics. “Animation was cool in 1995,” joked Dr. Sharpe. However, animating text, so that it appears 1 line at a time, can be helpful. “You can read a lot faster than I can talk. Animating the text means the information comes out in the way I want it to come out,” he said.
The best colors for backgrounds are blue, black, and white. For text, white and yellow are good with dark backgrounds, and black or blue text can be used with a white background. Avoid red and green, because they are difficult for the colorblind. Choose a single sans serif font for your presentation, and never use smaller than the 28-point size, advised Dr. Sharpe.
Speakers should arrive early to get a sense of the room as well as practice showing their slides. “Slide advancers are all very different. They have different triggers so you may want to practice ahead of time,” said Dr. Sharpe.
During the session, don't watch your own slides. “If you look at the screen, so will the entire audience. Then, it is like they are reading off a computer screen back at home ... and then they realize they could be doing this in a coffee shop or in their pajamas at home,” Dr. Sharpe said.
Not looking at the screen requires practicing your talk until you're comfortable. “I probably practiced each section 3 times out loud,” said Dr. Sharpe. Transitions are particularly important to have down, he noted.
Finally, there's the conclusion of the talk, in which you should repeat the goals, or things you want the listeners to learn. “In an hour talk, 3 is probably enough—maximum of 5-take-home points,” said Dr. Sharpe.
Or you can let the audience members choose their own. “Say, ‘Turn to the person next to you, and tell them one thing that you learned.’ They say it out loud, and the other person hears that, and they're activated as they walk out the door,” Dr. Sharpe said.
It's possible for everyone to be an effective lecturer, he reassured the audience, as long as they follow his advice, and practice, practice, practice.