This presentation was delivered to medical students who were about to undertake their audit presentation. I have included the handout notes given to them

1. How to make your
presentation not suck!
@nickharveysmith

2. PRESENTATION
CRIMES?
What should be
Reading from slides?
Too many words/busy slides?
Clashing colours?
Animations?
Speaking too quietly?
Speaking too quickly?
Everyones presentation hates are the same so why do people keep doing it?

3. DELIVERYSLIDESMESSAGE+ +
A presentation is made up of 3 parts. Most of us spend too long on the slides and not enough time thinking about the message they are trying to deliver. They also
neglect practicing the delivery

4. MESSAGE

5. 11 weeks
5 minuets
So how do we fit 11 weeks work in to 5 minutes

6. WHAT do they know already?
WHEN am I delivering it?
DO I have a backup plan?
WHERE am I delivering it?
HOW am I going to deliver it?
Ask yourself these question

7. Most people start by opening the laptop and then PowerPoint. This means you tend to produce a presentation dictated by the software.
We are going to look at why this is a bad thing.
WARNING - You will never look at anyones presentation the same way again.

8. POST-IT!
POST-IT!
POST-IT!
I start all my presentation off with Post-It notes
Just scribbling down everything I can think about on the subject matter

9. TOPIC
HOW? WHEN?WHERE?WHO?
CONCLUSION
ESSENTIAL ESSENTIAL ESSENTIALESSENTIAL ESSENTIALESSENTIAL
NICE NICE NICE NICE NICE NICE
WHY?WHAT?
QUESTIONS?
Then organise them in to an order and decide what are the most important bits that you need to get across to your audience - cut the unnecessary, cut the nice to know
and leave only the essential to know. Remember you are condensing 11wks in to 5min and you can’t do that by simply taking fast and whizzing through your slides - cut -
cut - cut
Also think about what questions they might ask you - prepare for everything!

10. What is your ESSENTIAL
MESSAGE
CUT the NICE to know

11. SLIDE SET

12. space for
UNDERSTANDING
METHOD
of delivery
complexity of
INFORMATION
Cognitive
load
WORKINGMEMORYCAPACITY
People who are watching you presentation have a working memory capacity (short term memory) and your presentation will start to fill that working memory (its called
the cognitive load).
It will be filled by processing the information it is receiving and the method by which it is being delivered. Any remaining space is then free for understanding the
information.

13. space for
UNDERSTANDING
METHOD
of delivery
complexity of
INFORMATION
Cognitive
load
WORKINGMEMORYCAPACITY
So if you have a poor method of delivery there is less space for understanding.

14. METHOD
of delivery
complexity of
INFORMATION
Cognitive
load
WORKINGMEMORYCAPACITY
If you have complex information AND a poor delivery then there is NO space for understanding (I am certain we have all experienced those lectures at some time)

15. METHOD
of delivery
complexity of
INFORMATION
Cognitive
load
WORKINGMEMORYCAPACITY
OVER
Any further increase in either the complexity of the method of delivery or the complexity of the information will cause overload

16. ??
Have you ever been at a party talking to someone and also trying to listen in on another conversation behind you? You can’t do it can you…? you zone out from the
person who is talking to you, and whilst you can hear that they are talking you are really taking it in whilst you listen to the conversation behind (this does have something
to do with presentations so bare with me).

17. Person 1
Person 2
Broca/Wernicke network
Auditorycortex
Auditorycortex
Inferior frontal gyrus
HEARING UNDERSTANDING
Inside our brain we have 2 auditory cortex’s (which is why we can hear sounds around us whilst we listen to speech) but we only have one route in to the processing part
of our brain, so we get a bottle neck of sound at what is known as the Broca/Wernicke network.
This bottle neck is controlled by the inferior frontal gyrus which acts as a gatekeeper, only allowing the sound from one auditory cortex at a time. This mens that whistle
we are processing the speech of person one, whilst we can hear that person 2 is speaking, we are no processing what they are saying, so anything they say is lost.

18. Person 1
Person 2
Broca/Wernicke network
Auditorycortex
Auditorycortex
Inferior frontal gyrus
HEARING UNDERSTANDING
The only way we can understand what person 2 is saying is by flipping our inferior frontal gyrus from person 1 to person 2. This means we are not understanding person
1 now.
The best we can do to try to understand 2 conversations is to flip our inferior frontal gyrus between the 2 conversations, missing bits of both.

19. We CANT process
2 AUDITORY
things TOGETHER

20. “Combining words and images
effectively facilitates learning; their
impact is additive. This insight is the
result of dual-coding theory (Paivio
1970), which assumes that we have
two specific yet connected cognitive
subsystems…”
Picture by @olicav
Read this to yourself
What did you hear inside your head?
Your own voice reading it?

21. “It’s one small
step for man… …one giant
leap for
mankind”
Who’s ‘voice’ did you hear inside your head?
Neil Armstrong?

22. VISUAL CORTEX
AUDITORY CORTEX
This is because we process text and speech in the same way. Whilst reading, the visual cortex lights up but almost immediately after so does the auditory cortex. So
processing reading is done in the same place as processing hearing (now perhaps you can see where I am heading with this)

23. Speech
Text
Broca/Wernicke network
Auditorycortex
Auditorycortex
Inferior frontal gyrus
‘HEARING’ UNDERSTANDING
When we are reading a slide our inferior frontal gyrus blocks out the processing of the presenters speech

24. 240 wpm 120 wpm
We read around twice as fast (if not more) than most people speak which means even if we flick back and forth between text and speech, they are arriving at different
points

25. Internal
voice
Speech
Text
So when presented with a slide like this the auditory channel of the brain (more on that later) is receiving the text faster than it’s receiving the speech. As the brain tries to flick between the two, it is receiving
different bits of information at different times, in the same way as trying to listen to 2 different conversations at the same time, and struggles to cope due to the high cognitive load. We then tend to prefer to
process the text in preference which leads to the question “what is the point in having the presenter there if we are not going to listen to them?”

26. Internal
voice
Speech
Text
So when presented with a slide like this the auditory channel of the brain (more on that later) is receiving the text faster than it’s receiving the speech. As the brain tries to flick between the two, it is receiving
different bits of information at different times, in the same way as trying to listen to 2 different conversations at the same time, and struggles to cope due to the high cognitive load. We then tend to prefer to
process the text in preference which leads to the question “what is the point in having the presenter there if we are not going to listen to them?”

27. We CANT
LISTEN & READ
at the SAME TIME

28. VISUALS

29. LONG-TERM MEMORY
Image
Speech
WORKING MEMORYSTIMULOUS
Visual
channel
Auditory
channel
Information from images and speech are taken in through the separate visual & auditory channels in to working memory to be processing.

30. LONG-TERM MEMORY
Auditory schema
Visual schema
WORKING MEMORYSTIMULOUS
Image
Speech
Visual
channel
Auditory
channel
These channels create 2 separate mental models, a visual channel and an auditory channel

31. LONG-TERM MEMORYWORKING MEMORYSTIMULOUS
Phonological loop
Visio-spacial
sketchpad
Image
Speech
Prior
knowledge
Visual
channel
Auditory
channel
This information is combined with previous knowledge in what Alan Baddeley described as the visospacial sketchpad and phonological loop to create a visual model and
an auditory model.

32. LONG-TERM MEMORY
cross
referencing
WORKING MEMORYSTIMULOUS
Auditory schema
Visual schema
Image
Speech
Visual
channel
Auditory
channel
Prior
knowledge
and a little bit of cross referencing takes place (just to check everything is ok)

33. LONG-TERM MEMORYWORKING MEMORYSTIMULOUS
Auditory model
Visual model
Visual
model
Auditory
model
Image
Speech
Visual
channel
Auditory
channel
Prior
knowledge
cross
referencing
NEW
SCHEMA
A bit of cross referencing occurs between the two models before processing to the long-term memory for storage as a new schema.
Because they are stored as separate but connected models this gives an increased chance of recalling the information.

34. Who is the highest
ranking person on the
ACS project?
Who department has
the most people
working on the ACS
project?
Which people are not
involved on the ACS
project?
READ THIS OUT VERBALLY
“Jenny is Medical Director of Acute Care. Fatima is Clinical Director of Emergency Medicine.
Tom, Joe and Sue work for Fatima.
Harry is Clinical Director of Cardiology.
Joanne, Chaz and Tanya report to Harry.
Sue, Joanne, Chaz and Harry are working together on the joint Acute Coronary Syndrome Care Pathway project.

35. Who is the highest
ranking person on the
ACS project?
Who department has
the most people
working on the ACS
project?
Which people are not
involved on the ACS
project?
So even though I used simple words and short sentences I am certain you found that hard to do… Why?
Speech is only transient. If we have to hold verbal information in our working memory in order to answer questions later we find it very difficult

36. Who is the highest
ranking person on the
ACS project?
Who department has
the most people
working on the ACS
project?
Which people are not
involved on the ACS
project?
Jenny is Medical Director of Acute Care.
Fatima is Clinical Director of Emergency
Medicine. Tom, Joe and Sue work for Fatima.
Harry is Clinical Director of Cardiology. Jo,
Chaz and Tanya report to Harry. Sue, Jo, Chaz
and Harry are working together on the joint
Acute Coronary Syndrome Care Pathway
project.
So lets try with text instead…
Easier?
It still creates quite a high cognitive load whilst you work things out doesn’t it although it is doable

37. ACUTE CARE
CARDIOLOGYEMERGENCY MEDICINE
Who is the highest
ranking person on the
ACS project?
Who department has
the most people
working on the ACS
project?
Which people are not
involved on the ACS
project?
Fatima
Jenny
Harry
Joanne Chaz TanyaJoe SueTom
ACS CARE
PATHWAY
Is that easier to answer the questions now?
Diagrams mean we need to use less words - our audience don’t have to use valuable cognitive space creating their own mental diagrams - we do it for them
Can you use diagrams in your presentation?

38. space for
UNDERSTANDING
METHOD
of delivery
complexity of
INFORMATION
WORKINGMEMORYCAPACITY
Diagrams
understanding
by cognitive
load

39. Lets look back at the example we used earlier

40. ?VTE
DVT WARFARIN
PE
<1
<4
DISCUSS with
SENIOR
RISK OF
BLEEDING?
?UNFRACTIONATED
HEPARIN
LMWH
Is this easier?

41. Opening
Epidemiology
Think about the age , the gender
and the initial problem. What are
the common causes/conditions in
this context? How does this help
you think about risk factors for
different problems?
Can you explain the patients
symptoms and signs by linking
your knowledge of pathology and
physiology, onset , duration and
sequence of events?
Can you put the information
together to develop evidence
based relationships that might
suggest diagnoses?
Are there any red flags? Why?
How are you going to explore
this?
Evidence-
Based
Associations
RED FLAGS
Differential
Diagnoses
From the opening statement what
are you thinking? What systems
or anatomical structures could it
be? Ask the patient to describe
the problem not their diagnosis.
Check for
your Errors
Can you differentiate the relevant
from the irrelevant information?
Narrow down the information to
what is most important.
Are there any gaps? Do you need
to go back and clarify?
Can you explain information that
doesn’t fit with your ideas?
HOW?
Are you ignoring things that don’t
fit with your hypotheses?
Are you giving something too
much weight?
Do you need to go back and ask
more questions?
Discriminate
Pathophysiolog
y
CLARIFY,CLARIFY,CLARIFY
Can you suggest three most
likely differential diagnoses and
state why you think these are
appropriate.
What conditions do you need to
exclude?
ASK yourself : What did I learn that I can use next time? What else do I need to learn now?
To make accurate and safe decisions it is essential to think about WHY you are asking the
questions, not just what you are asking
Deciding the next step….
What investigations do you want to order and WHY?
What else needs to be done? Justify , Justify, Justify
PATIENT ASSESSMENT GUIDE
With thanks to Drs. ………………………………
There is a caveat to diagrams though - they must be simple and easily understood.
“Sorry for this busy slide’ just means sorry I couldn’t be bothered to make this simpler for you

42. Looking at a diagram shouldn’t be like playing Where’s Wally

43. “I’m sorry for
this busy
slide…”
“I couldn’t be
bothered
making it
easier”
=

44. We process SIMPLE
DIAGRAMS
EASIER than WORDS

45. DATA

46. Some Data
Data 1 Data 2 Data 3 Data 4 Data 5 Data 6 Data 7 Data 8
Pie charts suck! The viewers attention is split between the key and the chart - You can’t see whether data 3, 4 or 5 is larger so cognitive load is high working it out.

47. Some Data
Data 1 Data 2 Data 3 Data 4 Data 5 Data 6 Data 7 Data 8
Exploding the chart out doesn’t make it any clearer…

48. Data 1 Data 2 Data 3 Data 4 Data 5 Data 6 Data 7 Data 8
Neither does making it 3D - it just means the presenter found the 3D button on PowerPoint

49. Some Data
0
25
50
75
100
Data 1 Data 2 Data 3 Data 4 Data 5 Data 6 Data 7 Data 8
Bar charts are far clearer but the viewer still might struggle to see at a glance if Data 3 or Data 5 is bigger

50. Some Data
0
25
50
75
100
Data 2 Data 1 Data 4 Data 3 Data 5 Data 6 Data 7 Data 8
So if necessary re-order to make things clearer (clearer reduces cognitive load!)
Also remember that if everything is bright then nothing stands out

51. Some Data
0
25
50
75
100
Data 2 Data 1 Data 4 Data 3 Data 5 Data 6 Data 7 Data 8
DATA1
DATA2
DATA3
DATA4
So think about highlighting the area you are discussing - which one to you think I am discussing here?

52. “Let me
explain this
chart for
you…”
“I couldn’t be
bothered
making it
easier”
=

53. Keep
CHARTS
‘at a glance’ SIMPLE

54. LAYOUT

55. If you must use text on a
slide, with the possible
exception of a title, centre
justifying your text makes it
harder to read than left justify

56. If you must use text on a
slide, with the possible
exception of a title, centre
justifying your text makes it
harder to read than left justify

57. The relative risk of radiation from
CT scans
Nick Smith
Year 3 Medical Student
Manchester Royal Informary
MBChB University of Manchester
Whats wrong with this - Who’s trying to work out what’s on the CT scan?
Comic Sans is for comics - if your project is comical by all means use it but if you want to be taken seriously then don’t. Look at the way the logo is squashed, how many
fonts are used, is it pleasing on the eye?
People eyes will wander around this still, trying to work out what to look at, what to read. Is there anyone sitting in an APEP presentation who doesn’t know its being
presented by a Year 3 student from the University of Manchester CUT

58. The Relative Risk of Radiation from CT Scans
Nick Smith
Year 3 Medical Student
Better? - still too much on the slide? It still suffers from the split attention affect
Guess who found the REFLECTION button?

59. Nick Smith
The relative risk of radiation from CT scans
Better? Bit boring?

60. The relative RISK
of RADIATION
from CT SCANS
Nick Smith
Better still? This took less time to make than the original

61. YOU WILL READ
THIS FIRST
And then you will read this
Then this one
Finally this one
The size of words create the hierarchy

62. I
love
Paris in the
the springtime
What’s wrong with this? Keep trying - now you’ve got it! Why does this happen? Because the brain is a predication machine. It predicts what’s going to happen next.

63. The reaosn yuo can raed tihs esaliy
is bceasue yuor barin is a precditoin
mcahnie

64. keep fonts
clear and
simple.Use a large size.
Don’t mix fonts
Use contrasting colours
Keep your fonts simple - if you have downloaded fronts from the internet or have the latest version of PowerPoint then the computer you present on my not have the
same fonts and therefore may change everything.
When you use text on screen think about the person at the back… can they see it?
In this presentation for my main slides I used 3 colours - Green, White, Black/Grey and one typeface(font) (Helvetica Neue) and varied it only by weighing of the typeface
(condensed bold and ultra thin)
Think about the choice of colours. What might look fine on a HD screen of your computer may well be lost when it’s projected on to the screen in a lecture theatre.
Keep it simple! Use a colour wheel to see what colours compliment each other

65. Be careful with your animation
Animation if used at all should be subtle.
What runs really quickly and smoothly on your MacBook might not run so well on the hospital computers

66. The brain likes simple
CONSISTENT
content

67. DELIVERY
Use the microphone
Dont hide behind the lectern
Dont read off your slides (if you are worried you are likely to forget then have some flash cards - but try not to read off them unless you do have a mental block)
Speak slowly and clearly
Practice, get feedback, practice, and practice again.

68. Finally when you think you are
FINISHED… CUT
1 thing from your slide

69. FINISHED?
1
THING
CUT

70. What
QUESTIONS
do you have?

71. Whats your MESSAGE?
CUT things
MINISE text
use DIAGRAMS
SIMPLE charts
PRACTICE more
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