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The Art of a Scientific Presentation: Tips from Steve Jobs

2022; Lippincott Williams & Wilkins; Volume: 149; Issue: 3 Linguagem: Inglês

10.1097/prs.0000000000008849

1529-4242

Sakura Horiuchi, Jacob S. Nasser, Kevin C. Chung,

Health and Medical Research Impacts

Presentations are commonly used to share knowledge in all scientific fields, particularly in medicine, where they play an integral role in medical school and graduate medical education as well as in medical society conferences and continuing medical education activities. Though the use of presentations as learning tools has become universal, how often are they truly effective? Virtually everyone has experienced the jaw-clenching cringe while suffering through a particularly bad presentation, just as everyone has, one hopes, appreciated the vitality, insight, and inspiration that accompany a carefully constructed, well-delivered presentation. Creating effective presentations is a skill, a form of art, and an engineering process that requires time and practice; it is not an intuitive process. Effective presentations begin by establishing a clear objective and a rapport with the audience. To be a physician is to be a teacher, and one must diagnose the audience's needs. It is often helpful to acknowledge the inherent authoritarian structure of presenting, in which the speaker serves as commander and the audience as subordinates receiving the instruction. However, the manner in which the speaker approaches this relationship ultimately impacts the course and effectiveness of the presentation. In and of itself, a presentation simply delivers information; however, an effective presentation goes above and beyond to inspire and empower the audience receiving the message. The late tech titan Steve Jobs, cofounder and former chief executive officer of Apple, Inc., was known for delivering dynamic presentations that ultimately reinforced the success of the company and its products. Though many linked the quality of his presentations to his charisma, Jobs consciously incorporated effective presentation skills throughout his lectures, as described in the book Presentation Secrets of Steve Jobs,1 many of which are translatable to medical education and highlighted in this article. Kosslyn et al. conducted an empirical analysis of the psychological principles that underlie presentation flaws and failures, finding that communication principles were violated to a similar extent across different fields.2 Furthermore, Garner and Alley,3 and others,4,5 have found that how a presentation is designed has the power to inhibit or support its effectiveness. Nonetheless, there is no recent research that examines the quality and effectiveness of presentations used in the field of medicine. Existing studies shed light on single presentation components, such as color themes or fonts,6,7 but this research does not provide comprehensive guidance to help medical researchers and health care providers develop quality medical presentations. A poorly constructed presentation detracts from its value. In this article, our goal is to identify strategies for creating effective scientific presentations for medical school lectures, resident lectures, surgical rounds, and medical conferences. We will provide examples specific to plastic surgery to better guide researchers and medical educators in the specialty in developing presentations. The strategies discussed come from the current literature on effective presentation strategies and the experiences of our research team. We aim to establish a comprehensive list to aid in creating a methodical approach for presenters to evaluate their own presentations to ensure a standard of quality and effectiveness. PREPARATION Constructing a Story Creating an effective presentation is like taking a road trip, thus the first step is to create a clear map to your destination—and identify the landmarks you and your audience will pass along the way. A presenter must give clear instructions to the audience, which can be in the format of an outline or a story. Ultimately, one needs to know why this road trip will be worthwhile; in other words, the purpose and impact of the presentation should be clearly expressed. Simple stories, whether in the form of a metaphor or case presentation, create an organizational framework that makes it easier for the audience to follow along. Creating a narrative—for surgeons, perhaps a story of a challenging case or difficult situation—will help the audience associate new information with preexisting mental representations. Graesser et al. examined whether text genre (i.e., narrative or expository prose) influenced recall of the information presented.8 The authors found that information presented in the context of a narrative improves memory, as stories were remembered better than expository passages. A study by Wolfe and Mienko examined the effect of prior knowledge as a function of memory and learning in a narrative or expository text genre.9 They found that prior knowledge related to greater recall of expository texts but not for narrative genre. Subjects with more prior knowledge had better recall of the expository text information and vice versa.9 In other words, people with a preexisting level of understanding of a topic will remember a presentation better than someone without. Creating associations between a familiar narrative and a complex concept helps the audience learn, independent of their prior level of knowledge. Identify the "So, What?" It is necessary for presenters to build on a persuasive argument. The presenter has a duty to explain why the topic matters and why the learner should care. Adult audiences are more stimulated when the "why" is explicit and pertinent to them. An effective means of accomplishing this is to share a "passion statement." A moment of being vulnerable and sharing the origin of your passion for a topic builds rapport with the audience while striving to inspire them to care about the topic as well. For example, in a presentation focused on global surgical efforts, the presenter may share some of his or her most rewarding and challenging experiences as well as the impact the operations have had on the children treated. Another way to build a persuasive argument is to frame it in a problem-solution model, in which the problem should relate to the audience for the information to be relevant and the presentation should offer a solution. For example, a medical school presentation on carpal tunnel syndrome may focus on teaching students about the pathophysiology and treatment that their parents or grandparents may experience. On the other hand, a presentation at a medical conference may focus on innovative surgical techniques and strategies to improve postoperative outcomes and averting complications. Identifying why the topic is pertinent to the audience early in the talk is one of the first steps in preparing an effective presentation. CHARACTERISTICS OF AN EFFECTIVE PRESENTATION Once preparation for a presentation is complete, the next step is to create it. We will focus on identifying strategies for an effective presentation for an audience; however, the skills mentioned can be translated to many other models of information sharing. Table 1 summarizes the various strategies that can be used to create an effective presentation. Microsoft PowerPoint (Microsoft Corp., Redmond, Wash.) is the most commonly used software to create presentations. Table 1. - Checklist of Strategies for An Effective Presentation Skill Description Example(s) Outline Create an outline or another resource to organize the presentation. Include an outline of the talk within the presentation. A Microsoft Word outline describing the main objectives. Story Construct a fluid, narrative-like structure to the presentation if possible. An analogy or metaphor to the complex topic. Identify the "so, what?" Clearly define the purpose and impact of the presentation. "This presentation is about global hand surgery. It is important because 30% of the global burden of disease is from surgical conditions." Headline Include a headline on each slide that conveys the main message. Each headline should be less than 140 characters and in "subject-verb-object" format when possible. "Sharing the Stage"; "Substantial Benefit for Surgical Interventions." Consistency Use the same font, font size, font color, bullet style, and background color across slides. The font, icons, and diagrams are the same color theme. Four main points Only discuss up to four main points on each slide. Stay within 1 to 4 bullet points per slide. When introducing a study, briefly discuss the author(s), background, methods, and findings. If needed, expand further on the next slide. Word choice Use simple, clear, concise wording. Aim for fewer words per sentence. "Improved quality" (simple) versus "discoverability of the richness" (confusing). Relevancy in numbers Explain the significance and contextualize any numerical value presented within a main point. Cost-benefit analysis of global plastic and reconstructive surgical efforts: approximately 1720 DALYs averted is equal to a $12,957 benefit per patient. 10-Minute rule Add a refreshing element (i.e., new topic, guest speaker, video, demonstration) to maintain the audience's attention every 10 minutes. Ask a knowledge-checking question at the end of a section. Demonstrations/props Incorporate a demonstration or prototype when possible. Three-dimensional virtual models with an augmented reality application. Video clips Imbed <2-minute video clips into the presentation as a tool to explain complex topics (surgical procedure, testimonial, and so on). A video of a new surgical technique. Share the spotlight Introduce, highlight, or show gratitude to others during the presentation (i.e., team members, guest speakers, patient testimonial). Invite a special guest to a virtual meeting presentation. Rehearsal Practice, record, time, and refine the presentation with the script in your pocket. Rehearse with a mock audience without reading off the script and double-check the sound/audio of all the embedded videos. Costume Dress professionally. DALYs, disability-adjusted life years. Outline The presentation should include an outline at the introduction of the presentation. Throughout the presentation, the speaker should reference the outline to remind the audience where they are in the presentation narrative. For example, when presenting on a clinical research study, provide a recurrent slide that presents whether you are discussing the background of the project, methods, results, or conclusions. An outline of the presentation describes the general objectives of the talk while serving as a structure on which to build throughout the presentation. Headline Each presentation slide should have a headline that describes the topic discussed. A headline decreases the cognitive load placed on the audience by identifying the main point. Alley et al. compared the effects of a short phrase headline to a succinct sentence-structured headline on audience retention of a presentation.10 The authors found that the average score for students viewing the succinct sentence-structured headline was significantly higher.10 Specifically, a headline should be in a "subject-verb-object" structure using fewer than 140 characters. When presenting a graph or a table that contains a complex topic, the slide's headline should summarize the take-home point. For example, when presenting a graph on the economic benefit of plastic and reconstructive global surgical trips, the headline could read "Substantial Economic Benefit for Global Surgery Interventions." The actual economics may be a complex topic for the average audience if they are not economists themselves, but the main point resides in the simple headline. Consistency There should be consistency of formatting throughout the presentation and among the different mediums used to present the same information (e.g., slideshow, poster, oral presentation). One simple font should be used throughout the presentation. In addition, the presenter should keep the font size consistent across all headlines, bullet points, diagrams, and tables. Furthermore, background color and design elements, such as the color of the diagrams, should be the same throughout.11 Color palettes found online can be used to create a theme in the design of the presentation. Margins to the slides should also be aesthetically consistent, as demonstrated in Figure 1. If the titles or headlines are of varying sizes, an example of inconsistency, the reader may not recognize that sections are related or exhaust time connecting the key points. Consistency decreases distraction and polishes the delivery of the information.Fig. 1.: Examples of good and bad consistency of margins for presentation slides. The grid lines (gray and green) are present to show the margins and are not part of the presentation. (Above) An example of a template with grid lines (gray) for a slide with consistent margins is shown. The headline is centered and appropriately spaced from the top edge of the presentation. The text is formatted within the center square border created by the margins. (Below, left) The sample slide with green grid lines demonstrates the proper application of the template to a presentation slide. (Below, right) Same slide as shown below, left, without the grid lines. This slide is a visual example of the consistency of margins and overall balance of design.Visual Appeal Aspects that influence a presentation's appeal include font, background color, contrast between color of content and background, symmetry, consistency, and more. Goodhand et al. studied the value of posters at medical meetings and found that audience perception of scientific merit correlates with visual appeal.12 They found that factors increasing visual appeal included their scientific content, pictures/graphs, and limited use of words.12 Visual appeal consists of many different aspects, which makes it difficult to discuss specifically each detail. Complex concepts can be simplified by creating visual representations, flow charts, and vector diagrams. Resources to consider may be graphics available in Microsoft Word (Microsoft Corp.), The Noun Project (The Noun Project, Inc., Los Angeles, Calif.), Lucidchart (Lucid Software, Inc., South Jordan, Utah), or FlatIcon (Freepik Company, Malaga, Spain). Figure 2 demonstrates the use of a SmartArt graphic in Microsoft Word to organize information. However, cartoons or videos could distract the audience from the main purpose of the slide and should be weighed carefully. Spending extra time on aesthetic details such as font, background, symmetry, and consistency will improve the slideshow's visual appeal and professional tone.Fig. 2.: Using SmartArt graphic in Microsoft Word to organize a topic. (Left) This slide demonstrates how to convey information using a graphic representation. (Right) This slide does not use a graphic. The slide with the graphic is more visually engaging and organized with colors and icons. The slide without the graphic uses a simple bullet format to list the same information; it is less engaging, text-heavy, and flat.Four Main Points A presenter should limit each major concept to no more than four main ideas. In 2001, Cowan studied the mental storage capacity for short-term memory and found that humans are able to remember approximately four main points.13 If there are more than four key ideas, the presenter should separate the information, so it is not all included on the same slides. For example, when introducing a research study, the four main points may consist of briefly naming the author(s), methods, findings, and the study's impact on the current topic. Other noteworthy aspects of the study could be expanded upon in the next slide(s). Keeping within four main points aims to maximize the efficiency and overall effectiveness of each slide for the presenter and audience. CONSTRUCTION AND DELIVERY Word Choice Word choice is the specific vocabulary used by the speaker to convey a message. Text in the presentation should be kept simple, using as few words as possible. Using complicated, lofty words increases lexical density and inflicts a strain on the audience to decipher the meaning of the message while requiring additional work to follow along. Sainsbury examined the effect of lexical density and visual clarity of slides on presentation interpretations.14 The study found that the presentations with less lexical density, despite worse visual clarity, led to greater audience fluency.14 Considering word choice and using less dense language is a strategy to improve audience comprehension. In 2007, Todd Bishop, a reporter for the Seattle Post Intelligencer, compared word choice between Apple's Steve Jobs and Microsoft's Bill Gates by running their presentation transcripts through UsingEnglish.com, a language analyzer.15 The tool examines the average number of words per sentence, lexical density, average number of words with more than three syllables, and the level of education theoretically needed to understand the text. It was found that across all four categories, Jobs scored better than Gates.15 He spoke more simply, was less abstract, and used fewer words per sentence. For example, where Jobs would say "improved quality," Gates would say "discoverability of the richness." If a message is confusing, abstract, or convoluted, the presenter will lose an opportunity to share his or her knowledge. Similar language analyzers are offered online and through Microsoft Word. Specifically, Microsoft Word will provide readability statistics, a feature found within its Spelling and Grammar tool. Based on readability statistics, a presenter can adjust his or her language to ensure it resonates better with the audience. Relevancy in Numbers Effective scientific presentations show the topic's relevance to the audience. In surgical and medical education, numbers are often used to describe the efficacy of a treatment or epidemiology of a condition. In breaking down the meaning of data and placing it into a familiar context, greater meaning is provided to the audience. For example, when conducting an economic analysis of plastic and reconstructive surgical efforts in the developing world, Nasser et al. found that the lose of approximately 1720 disability-adjusted life years was averted.16 However, they went further to explain that 1720 disability-adjusted life years were equal to a total economic benefit of $9,795,384, the same as $12,957 per patient.16 As a listener, it may be difficult to comprehend the impact of 1720 disability-adjusted life years without further context, but each audience member can visualize what an extra $13,000 could amount to in their own lives. People are more familiar with the concept of currency than disability-adjusted life years; therefore, placing the numbers in a tangible context enhances understanding and creates a greater impact on the audience. 10-Minute Rule The 10-Minute Rule states that after 10 minutes, the audience will begin to mentally "check out" or naturally lose focus and interest. Thus, every 10 minutes the presenter should change the pace, welcome questions, or add an energizing moment. This can be in the form of sharing a joke or anecdote (these should be relevant, brief, and appropriate), posing a question to the audience, playing a video (which should always be embedded within the presentation to avoid wasting time and creating distractions), or introducing a demonstration. Tanveer et al. studied how narrative trajectories influence audience perception by analyzing the transcripts of more than 2000 TED talks.17 They found that variations in the narratives were important to hold the motivation and attention of the audience, and presentations without variations were more likely to receive lower ratings.17 It is common for a presenter to begin and end a presentation without a break or change in pace, but the 10-minute rule is an objective marker presenters can use to avoid delivering a monologue presentation. Demonstrations/Props Using demonstrations and props, such as sharing a video of an operative technique, using an anatomical model to discuss specific physiology, or bringing a tool or technology relevant to the topic, is a way to increase engagement in a presentation. For example, Atherton et al. described the use of the Aurasma application, formerly available in the iTunes App Store and Google Play Store, which connected anyone with the app to three-dimensional medical models via QR code.18 The presenter could create a demonstration of a surgical technique via Aurasma, and the audience was able to view the demonstration from a presentation on their personal smart devices.18 Demonstrations and props are strategies to keep in mind for the 10-minute rule. Scientific presentations rely heavily on auditory and visual learning, so props offer an alternative way of learning, kinesthetic learning. Although it may be difficult to incorporate props into every presentation, especially as online-based presentations become more popular, apps such as Aurasma may be a useful tool. Video Clips Procedures in surgical education can be described through text and pictures, but utilizing a short video clip to demonstrate a procedure enhances the presentation and further reinforces the prior information. Vara et al. described their experiences using the GoPro HERO systems (GoPro, Inc., San Mateo, Calif.) to record video of hand and upper extremity procedures as a technique to capture, analyze, and share surgical experiences.19 Video clips incorporate motion into a presentation and may help convey complex visual-spatial topics while offering the presenter a moment to share the spotlight and an opportunity to take a break. Nonetheless, it is important to ensure that videos are of reasonable length, as this can influence likability of a video or presentation.20 Embedding the video into your presentation, rather than switching applications, may save time and make the transition more comfortable for the audience. Sharing the Spotlight Sharing the spotlight means incorporating others into a presentation rather than a speaker delivering a monologue. Sharing the spotlight can take the form of simply acknowledging and thanking other team members, or presenters may include guest speakers or specialists in a lecture to share their knowledge. Steve Jobs would often share the spotlight by inviting famous people, such as musician John Mayer, or even a doppelgänger to lead a demonstration.1 A benefit of online meeting platforms, such as Zoom (Zoom Video Communications, San Jose, Calif.) or Webex (Cisco Systems, Inc., Milpitas, Calif.), is that they make it is easier for special guest speakers to join remotely for a portion of the talk. In addition, testimonials from experts or patients are a way of sharing the spotlight in scientific presentations and offer an engaging opportunity to create a memorable moment. REFINING THE PRESENTATION Rehearsal After the presentation has been physically created, rehearsal is critical. As in a theatre rehearsal, there should be a script, costume, and many practices. A script should direct the presenter in how to discuss the information on the slide. Ultimately, with practice, the presenter should not rely on the script during the presentation but should keep a copy in a pocket only to use as a last resort. The comfort of having this security blanket invariably puts the speaker at rest. A presenter should not read every single word on the slide verbatim, but rather explain and verbally bring the information to life. It is essential that the presenter practice the entire presentation, preferably recording the rehearsal to assess body language, verbal fillers, and subconscious nervous habits. Feelings of nervousness and anxiety about public speaking are common. Hansen et al. provide information on techniques for delivering effective lectures to ensure that surgeons speak as well as they operate.21 The authors describe the importance of understanding and acknowledging that everyone experiences a level of anxiety when presenting.21 Physicians are taught to anticipate complications related to a procedure or condition, thus an effective presenter will also learn to anticipate certain traits, such as speaking too fast, anxiety, and nervousness. Acknowledging the humanity in those emotions and practicing using the techniques described will decrease nervousness, boost confidence, and enhance the effectiveness of the presentation. Costume The presenter should dress to match the expected professional role he or she is representing. Some say dress for success, but perhaps a better takeaway is to never be underdressed. This is not to say that every presenter should wear the most formal attire, but rather to consider the conscious and subconscious effect a speaker's outfit may have on the audience's perception of the presenter. As in scientific posters, those who look sharp are taken more seriously. Feeling confident in an outfit may also translate to greater self-assuredness on the stage. Ruetzler et al. performed a conjoint analysis of personal presentation attributes and found that grooming and professional attire were most notable in shaping favorable perceptions.22 Furthermore, Keegan and Bannister studied the effect of color-coordinated attire with poster presentation popularity.23 They found a significantly higher number of visitors for posters of presenters with coordinated rather than clashing attire.23 The two studies suggest that there are benefits to dressing professionally, and that attire does affect how the presentation is received. CONCLUSIONS After the hard work of preparing, constructing, and refining a presentation, the final ingredient for delivering an effective presentation is personality: sprinkle in jokes and anecdotes while demonstrating both confidence and humility throughout to make the presentation representative of the presenter. Creating the presentation should be fun; if the presenter does not enjoy the presentation, there is no way the audience will either. Humor and stories should be kept professional relative to the level of the presentation but should still aim to keep the audience engaged with light and relatable moments. The skills highlighted in this article will help presenters create effective scientific presentations. Furthermore, future research identifying the strengths and weaknesses in plastic surgery presentations can help improve the quality of the presentations in the field.