American College of Physicians: Internal Medicine — Doctors for Adults ®


Giving a presentation? Try these tips from two experts

Practice makes perfect when it comes to engaging audiences and getting published in prestigious journals

From the June ACP Observer, copyright 2004 by the American College of Physicians.

By Deborah Gesensway

NEW ORLEANS—Residents can easily reel off the common mistakes bad public speakers regularly make: reading the slides, using distracting PowerPoints with hard-to-see colors, droning on in a monotone, taking more time than allotted and mustering feeble attempts at humor.

And given how many presentations residents have to make—whether to a big audience who came to hear about their research or one-on-one to a patient who needs to have his illness explained to him—how many medical trainees can say their instructors have spent any time giving them guidance on how to improve their presentation skills?

"Physicians are leaders in the community, and we have to be good at making presentations,'' explained Scott C. Litin, MACP, a general internist at Mayo Clinic in Rochester, Minn., and Chair of the Scientific Program Subcommittee for this year's Annual Session. At an Annual Session talk, "The Art of Presentation and Getting Published,'' sponsored by the College's Council of Associates, no one raised a hand when Dr. Litin asked if anyone had had any training in public speaking.

"I liken it to when you are learning how to do a lumbar puncture or a sigmoidoscopy,'' he said. "The first time, if it didn't go well, somebody would coach you and help you learn the techniques and skills. Pretty soon, you could do things much more easily.''

Unfortunately, young physicians don't get the same coaching in presentation skills as they do in clinical procedures. As a result, they suffer when poor presentation skills actually hurt their chances for career advancement. "Oftentimes, if their presentations went poorly in the past,'' Dr. Litin added, "they are simply overlooked the next time an invitation to speak is sent out.''

Nonetheless, Dr. Litin told the audience, "Everyone can improve. The key is practice, practice, practice.''

At the session, Dr. Litin was joined by another eminent internist, Annals of Internal Medicine Editor Harold C. Sox, MACP. They shared wisdom gleaned from attending thousands of lectures and reading hundreds of academic papers on how to effectively speak to or write for an audience. Both of them stressed that successful writing and speaking are skills that can be learned—and that accomplishment comes with repeated practice.

Getting published

On the writing side of presentation, Dr. Sox said residents who want to publish a scientific paper should remember that the most prestigious journals accept only a small proportion of original research articles. Annals, for instance, which publishes 120 such articles a year, ends up accepting only 6% to 8% of submitted articles.

Authors can improve those odds, however, by understanding the factors that help push an article into the "accepted'' pile.

To help boost your chances of being published, Dr. Sox advises using a statistician to help design your study and analyze your findings.

It all starts with picking a good topic, Dr. Sox said. It helps if the disease you are researching is "common, important and affects a lot of people'' or is an area where there is "a high level of interest or hot-breaking news.''

Other factors that can boost your chances of being published are unexpected findings (as long as they are believable) and submitting a paper that editors can be confident contains findings that are not a statistical artifact or a chance variation.

"We want to publish results that have a very high probability of being correct,'' he said.

A paper is likely to be rejected by editors, he explained, if it has a fatal flaw—either in study design, execution or both. Even more commonly, he said, a paper gets rejected because the editors identify "a lot of non-fatal problems'' whose cumulative effect adds up to rejection.

"As a result, we lose confidence in the findings because there were so many problems that we can't be sure they're right,'' Dr. Sox said. "A lot of things can go wrong during research, and when they start to add up, your chances of getting published in your favorite journal start to plummet.''

However, residents shouldn't let those odds steer them away from submitting a good article to a top journal. All submissions to Annals, for instance, are read by at least one editor, and nearly half of all submissions are sent for external review. Even if an article is ultimately rejected, Dr. Sox said, the authors get substantive feedback to help them improve it.

And sometimes, the editors invite authors to rewrite and resubmit an article that's been rejected. Annals eventually accepts as many as 85% of such articles.

The way an article is written, he added, also can enhance its chances of acceptance. The following are some tips he offered to improve residents' chances of being published:

  • Don't exaggerate the findings. Self-aggrandizement, he said, is off-putting.

  • State clearly in the introduction what's important about the article and how it advances the field. Answer the first key question that editors ask: "Is it new?''

  • Then answer the next key question: "Is it true?'' You can do this by stating the primary hypothesis and outcome measures early in the text and then describe how you formed your study cohort. Account for any loss of participants. Ask a statistician to assist in designing the study and analyzing the results.

  • Keep the discussion section short and to the point. Identify the major finding, discuss its contribution in the context of previous work, describe the limitations of the research, and suggest how the results might lead to changes in clinical practice.

Don't curb your enthusiasm

Dr. Litin's tips on improving speaking skills came in part from a course he co-directs at the Mayo Clinic, which became a required medical school course a year ago. That course, which targets third-year medical students, includes videotaping students while they are making a presentation, as well as giving presenters feedback via a group critique. Residents and attendings have also been exposed to the course, he said.

When it comes to speaking effectively, Dr. Litin urged residents to be enthusiastic about their topic and to meet the needs of their audience. "It's more important to tell them what they want to know and need to know as opposed to concentrating only on what you find most interesting about the topic,'' he said.

Two of the most common mistakes speakers make, he added, are wasting the opportunity to make a strong impression during the opening and closing part of the talk. At the beginning, he said, "you have less than a minute to hook the audience and keep their attention.''

And at the end, you should have a strong closing to drive home your message. "You shouldn't waste that time with a cartoon or a picture of a sunset and then fumble it, saying something like 'That's my last slide. I guess I'm done.' ''

He gave the audience a number of other tips to make their next presentation go better than their last one:

  • Edit yourself and stick to your allotted time. "It's always OK to finish a little early,'' he said.

  • Avoid "the dreaded monotone."

  • If you use humor, make it self-deprecating. Making a joke at someone else's expense often comes off as sounding mean-spirited, he said. "And if you have to think if someone might be offended by a joke, don't use it.''

  • Assume a comfortable position, and use your hands as props. Avoid the "fig leaf'' (hands clasped in front) or "firing squad'' (hands clasped behind your back) poses.

    "I call it 'edutainment,' " Dr. Litin said. "When people come to listen to a speaker, they come to be educated, but also to be entertained."


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