Giving Presentations in Clinical Medical Education:  The Basics

By:  Helen H. Baker, Ph.D., MBA,  Associate Dean, Assessment and Educational Development and Professor, West Virginia School of Osteopathic Medicine; section on Case Presentations by Gail Swarm, DO, Assistant Professor of Family Medicine, West Virginia School of Osteopathic Medicine

Content:

I.         Basic principles (apply to any presentation type)

II.        Computer-Based Slide Presentation  (“PowerPoint®” or similar)

III.         Blackboard/Whiteboard/Flip Chart

IV.      Overhead Projector

V.       Case Presentations

I.  Principles that apply to any presentation

1. Be prepared.  At every presentation, you represent yourself and your profession. Do so with excellence.
2. Know and state your objectives.  Be clear in your own mind what you wish for the participants to be able to do at the end of the session.  The best way to do this is to complete the statement, “At the end of this session, participants will be able to….”  Also, help learners understand why they need to know this, and build on their previous learning.  Ask questions:  “Remember the patient we had last week?  Here's why this is important....”
3. Provide the outline for your presentation – help learners follow your organization.
4. Know your time limits, and start and end on time.
5. Make presentation as participatory as possible (people learn more if they participate).
6. In a clinical setting, expect participants to be beeped out or arrive late – have continuing visual aids that deal with partial absence (more about this below).
7. Resist the urge to apologize for your presentation or handout.  (Plan so you don’t feel you have to apologize!) If you say your work is flawed, everyone will believe you, and give low ratings of your work.  Never say, “I needed more time to prepare.”
8. Seek feedback, either formally from the group and/or from one trusted colleague.
9. Presenter must generate energy and enthusiasm – particularly for sessions at 7 am after many participants have had a long night on call.   Be up-beat;  call on people;  make learning fun!

II.  Computer-Based Slide Presentations (“Powerpoint®” or similar)

1. Be prepared for the system not to work; at least have one paper copy of the presentation for yourself, to serve as notes. (In high-stakes situation, also have overheads and/or handouts for all participants.)
2. Check set-up in advance:  do trial run with the computer and disk you plan to use, and know location of light switch and/or ask for a volunteer to handle lights.
3. Advantages to Computer-Based Slide Presentations:
   1. makes organization apparent to learners
   2. may decrease speaker nervousness
   3. “makes sure topics are covered”  (doesn’t insure that they are learned)
   4. traditionally the mark of a prepared, professional presenter (don’t attempt anything less for formal CME presentations)
   5. perfect for large rooms, when flip charts/chalk boards cannot be read
4. Disadvantages:
   1. may inhibit interaction and therefore inhibit learning
   2. can be deadly boring
   3. when the speaker has too much content, it’s very obvious  (more so than other presentations) – so speaker MUST rehearse (with a stopwatch) regarding time constraints
   4. many clinical rotation sites will not accommodate computer-based presentations unless you bring your own computer and projecter, which is cumbersome
   5. a few people are biased against presentations using this format, and will transfer that distaste to the speaker and his/her subject matter
5. Slide presentation should include:
   1. introduction
   2. objectives (usually one slide)
   3. outline (usually one slide)
   4. content
   5. summary and conclusions
6. Keep classroom lights moderately bright EXCEPT when high resolution is absolutely necessary (radiology, pathology slides) – and if high resolution is necessary, dim lights only for those specific slides.
7. Don’t read slides verbatim;  elaborate and explain concepts. Consider adding slides that just say "Questions?", to reminder yourself to stop. (But include such stops when you're planning the amount of material, and keep on schedule.)
8. Use key words, not sentences, on each slide:  attempt for each slide to have not more than 7 lines, 7 words per line.
9. Don’t use all capitals (doing so makes text hard to read).
10. Use essential graphics. 
11. Provide a paper handout of complex tables or graphs.
12. Cite your references (looks more professional, and if you include page numbers, allows easy access of resources in case you’re challenged)
13. Use colors and font that are successful in that room with that system (usually successful: light grey Ariel font 34-point or larger, on dark blue or dark green.

14. Decide whether to give related handout in advance;  for case disclosure, full handout will spoil the surprise.

 III.   Chalkboard, Dry Erase White Board, or Flip Chart

       1.      Advantages:

a.       particularly useful in a clinical learning situation in which participants “on call” may be beeped from the room  

b.      few technology breakdowns (particularly if you bring your own Dry-Ease markers in all needed colors)

c.       if used properly, allows/encourages group interaction

2.      Disadvantages:

a.       less effective than slides in a large room because board may be difficult to read

b.      can be more challenging for the presenter than using computer slides

3.      Students must be able to see and read what is written:

a.       consider using a colleague to serve as “scribe”

b.      handwriting must be legible

c.       must be big enough to be seen

d.      occasionally ask participants whether writing can be read

4.      Consider placing some material on the board before the session starts, possibly concealed (on a flip chart, you may start with the second or third page;  with chalkboard/marker boards, sometimes can conceal by lowering a projector screen)

a.       objectives

b.      outline of session

c.       content headings:  for example, columns for “patient history”, “physical exam”, “labs”, “differential dx”, etc.

d.      key information or a complex drawing

5.      Use color/underline/arrows to:

a.       highlight key findings

b.      indicate changes over time (for a clinical case, perhaps you’d use black for initial presentation, red for “2^nd hospital day”, etc.)

c.       alter information previously recorded (for example, delete items from the differential diagnosis by putting a red line through them, rather than by erasing, so those beeped out will realize what was considered earlier)

6.      Talk while you’re writing to teach in both visual and auditory modes

7.      Avoid damaging the room:

a.    for dry-erase board, as you begin, remove from your reach any permanent markers that are not designed for dry erase:  the moderate-size board being installed for PBL class notes cost $425 – large ones cost more

b.    for flip charts, ask permission before affixing pages to the wall – tape often removes wallpaper or paint

c.     for flip charts, take care in marking on pages which are already affixed to wall or furniture, since markers may bleed through and destroy the wallpaper underneath the paper
 

IV.    Overhead Projector

 1.   Advantages:

a.    overheads are available most places

b.    few technology breakdowns (bring your own transparency sheets and color pens) – however, we recommend you verify that there’s a spare bulb, in case it burns out

c.    if used properly, allows/encourages group interaction

d.      timing is less critical, because audience probably won’t know if there are overheads you decided not to use

e.      if presenter writes group responses on overhead, overhead allows presenter to keep a copy of group responses for later summary (also true with Flip Chart, but overheads are easier to store)

2.   Disadvantages:

a.   less effective than slides in a large room because board may be difficult to read

b.   the presenter is more likely to mix up order of slides (don’t drop ‘em!)  Many experienced presenters use 3-ring binders to organize, and cardboard frames with numbers on the sides to guide organization.

3.   Check size of display area – make sure what you prepared will fit the projector

             -  if not certain about size,  8” x 8” will almost always work.

4.   Keep text simple: 

a.    limit each overhead to one point or comparison

b.    use key words, not complete sentences: aim for no more than 7 lines, of no more than 7 words per line.

c.    as a general rule, keep lettering to at least 18 point (1/4^th inch high)

d.   don’t use all capitals – research shows all caps are harder to read

e.   don’t just make a transparency of a typical typewritten page (yes, we know some people do that, but you also know how hard it is to read!)

f.        if hand-writing, be legible (consider asking a colleague to do the writing)

5.   Presenting overheads:

a.    after checking that audience can see the overheads, face your audience and don’t block the projector or line of sight

b.    use color pens to add details

c.    use masks to cover parts of the transparency until you want to show them

d.    switch off machine when changing transparencies or to shift students’ attention

e.    use a pen to point to the projector stage, rather than the screen.

 V.   Presenting a Clinical Case in the Classroom

(Summary of principles prepared by Gail Swarm, DO, Assistant Professor of Family Medicine, WVSOM)

1. Subject:  Try to pick cases that demonstrate one interesting or critical point
   1. tend to be the usual rather than zebra cases
   2. something colleagues are likely to run across
2. Consider the goal of the presentation
   1. what will be the topic of discussion ?
   2. adverse reactions
   3. patient is a “classic case of…”
   4. therapy
   5. disease state
3. Presentation:  Follow the SOAP note format
   1. audience participation
   2. disclosure format
   3. assign someone to be a scribe
4. Presentation of the Patient
   1. present the demographics and Chief complaint
   2. allow the audience to discover the history of the patient (history of present illness, past medical history, family history, social history)
   3. audience then requests pertinent physical exam information
   4. review problem list
   5. audience asks for labs, x-rays, and any other tests
   6. review problem list
   7. develop differential diagnosis
5. Visuals:  Consider what works for the room and for your audience
   1. can be labs, actual x-rays:  depends on the goal of the case – if you plan to use radiographs, be sure there’s capacity for viewing them
6. Summary of the patient
   1. may add additional information that was not discovered by the audience
7. Topics Discussion (this can be almost any entity as it relates to the case)
   1. disease state
   2. therapeutic principles
   3. major outcomes.

 References/resources:

Parts of this resource were adapted to apply to clinical medical education, from Indiana University’s the excellent resource, “Technology for Teaching”, available on-line at http://www.indiana.edu/~teaching/handbook_2.html