How To Give a Talk

Mikkael Sekeres, MD, MS
Director of the Leukemia Program at the Cleveland Clinic in Cleveland, Ohio
Joseph R. Mikhael, MD, MEd
Professor, Applied Cancer Research and Drug Discovery, Translational Genomics Research Institute (TGen), City of Hope Cancer Center and Chief Medical Officer, International Myeloma Foundation

In this special edition of “How We Teach,” Mikkael Sekeres, MD, MS, and Joseph Mikhael, MD, MEd, offer advice to new – and experienced – researchers for giving effective presentations, from respecting the audience to making friends with the AV staff.

What is the first thing you do when planning a presentation?

Dr. Sekeres: First, know your audience and know your context. You may be asked to give a talk on a hematology-specific topic to a general internal medicine audience; in that case, you will need an introduction to the disease that’s forming the basis of your topic. Or you may be asked to give a talk to a specialty society. If it’s a society that specializes in lymphoma, for example, you don’t need to state on your first slide, “Lymphoma is a cancer and it’s bad to have cancer.” If it’s a general internal medicine audience, however, you may need to have that sort of broad scope to your introduction.

Audiences are not necessarily going to comprise just physicians. They may include physicians at different levels of training, nurses, pharmacists, social workers, and students. Figuring out who is going to be in your audience ahead of time also will help you define the level of information you need to provide so that your presentation interests everyone.

Dr. Mikhael: If I ever feel like I’ve been successful in my talks, it’s because I’ve provided a variety of high-hanging and low-hanging fruit. I can give the same talk to a crowd that involves a first-year medical student, an expert in the field, and everybody in between. It’s rare these days that we give a talk to a homogenous audience. Your crowd is heterogenous, and therefore, your talk must have a similar degree of variety. Everybody should leave feeling well-fed.

The horror stories of talks gone wrong usually have to do with people not being appropriately prepared or being so out of touch with their audience, as Mikkael said, that they end up giving a talk that is either so far above the heads or under the feet of their crowd that their message is lost.

How do you define a “successful” presentation?

Dr. Mikhael: When you’re giving a talk, you’re telling a story. This isn’t just a staccato recitation of data. It must be an interwoven story that has an introduction, a body, and a conclusion. You should be able to compress that into a small, abstractlike version of your talk, and you should be able to expand it.

Dr. Sekeres: Any sort of presentation, whether in writing or an oral presentation, should try to accomplish one of two things – and, ideally, two of two things: to educate and to entertain. If you’ve educated and entertained, then the audience will leave, as Joe said, well-fed. They not only haven’t wasted an hour but have actually gained something from the experience.

What are some common mistakes that you see younger researchers or educators – and even more established researchers and educators – making in their presentations?

Dr. Sekeres: Sometimes presenters, particularly when they’re not confident about their material, will try to hide behind their slides. The slides become armor against potential questions they may receive from the audience. In a successful presentation, the slides almost become background noise to the compelling story that you are telling. People should be listening to how you are conveying information, as opposed to what they are reading from the slide. The information is there to support what you’re actually saying, rather than being the point of what you’re saying.

Dr. Mikhael: Your slides are not your talk. If they were, all we would do is email each other slides all the time. It’s fundamental that people create a presentation with that attitude. During a presentation, ask yourself, “Are people looking exclusively at the slide, or are they ever looking at me?” If they’re never looking at you, then you need to course correct.

Dr. Sekeres: And it’s okay to break the fourth wall occasionally. If you look out and you’re getting blank stares or only see the tops of people’s heads because they’re looking at their phones, it’s fine to stop and say, “Hold on. I feel like I’m not connecting with you. Does this make sense? Do I need to reframe it?” Your audience will stop what they’re doing and advise you! Breaking that wall also conveys that you care what your audience thinks of you and that they leave educated and/or entertained – rather than that you are there to present everything you know about some narrow disease topic and what goes on in your individual lab.

The bottom line is to be respectful of your audience – and the time you’ve been allotted to give a talk. An audience that is appreciative of your efforts to educate and entertain will quickly turn hostile if your talk is going beyond the hour you’ve been given. Not only does nobody have any time to ask questions, but now you’ve made them late for seeing a patient in clinic or for their next meeting.

Dr. Mikhael: That is so common. Respect is a fundamental element of any presentation I give. Even philosophically, it irritates me that some people feel that their work is just so important that you want to sit and listen for an additional 10 minutes. Or maybe they think, “You know, normally I give this talk over three hours, but I’m only given 12 minutes today, so let me still use my three-hour slide deck and just speak really quickly.” That is so grossly inappropriate and, as you said, disrespectful to the audience.

Dr. Sekeres: Maintaining credibility is key, as well. People who make the comment in every single presentation, “The research shows that the drug has minimal side effects and is practice-changing,” won’t be believed if what they’re showing is a response rate of 10% and a serious adverse event rate of 85%. When that happens, you can see the audience shaking their heads in disbelief.

One of the best compliments I ever received was from a well-established leukemia doctor who came up to me after I’d presented some results that were okay but had their pluses and minuses. He told me, “That was a very measured presentation.” That meant the world to me, because it indicated that I wasn’t trying to sell something that wasn’t there. I was reflecting the data as they were.

“During a presentation, ask yourself, ‘Are people looking exclusively at the slide, or are they ever looking at me?’ If they’re never looking at you, then you need to course correct.”

—Joseph Mikhael, MD, MEd

What advice do you share with junior faculty who are new to giving presentations?

Dr. Sekeres: There’s the old advice of, “Tell the audience what you’re going to say, say it, then tell them what you’ve said.” That should happen multiple times during your presentation because you have to assume that at least three-quarters of your audience is being tempted to look at their phones, or maybe pace out of the room, or may get a question from a colleague and miss some of your talk. You have to constantly circle back to remind people where you are in your presentation and what are the points that you’ve just made.

Dr. Mikhael: I stress that the first 15 seconds of a presentation are crucial. Think of people flipping through the TV channels at home; they give a channel five to seven seconds before they decide whether they’re going to watch or flip to the next one. If the presenter isn’t ready in those first few seconds – mumbling or adjusting the microphone or asking for help loading his or her PowerPoint presentation – that irritates the crowd and, mentally, they’re changing the channel. The person who goes up crisply, knows what he or she’s going to say, and says it will grab attention. You want to rehearse that first 15 seconds because that’s when you’re getting your buy-in from the crowd.

Dr. Sekeres: I tell trainees, if they are fortunate enough to have an oral presentation at an annual meeting like ASH’s, then take time in the first few seconds of your presentation to recognize the moderators of the session and the abstract selection committee. The same is true if you’re asked to give a talk at an institution. I would suggest spending a little time at that institution before your talk so you can express your appreciation in concrete terms. Something like, “Thank you for inviting me to your beautiful city today. I had the opportunity to walk around the campus and saw this building or that building, and boy, this must be a great place to work.” That goes a long way to letting people know that you appreciate them.

How much should people rehearse their presentations?

Dr. Mikhael: There’s no simple answer to that. As you do more and more talks, you become more comfortable and likely need less formal practice. When you’re relatively new at doing this, absolutely rehearse it. But rehearse it with objective feedback. During the 10 years I was at Mayo Clinic, a close colleague and I had a pact to be ruthless in the honest feedback we gave to each other after talks. No pats on the back, no hollow compliments. Instead, we would say, “These three slides were awful. You’re um-ing too much. You’re spending too much time on your introduction.” Getting objective feedback will improve your talk.

Dr. Sekeres: I would echo what Joe said. There’s no set amount of time to practice your talk, but you should practice it enough that you have your slide transitions down and you’re able to prepare your audience for the slide or set of slides they’re about to see.

Dr. Mikhael: I created what I called a “Communication Consult Service,” where a few of us who were relatively experienced at giving talks would watch junior faculty’s talks and give them formal feedback. The comments we gave were objective because, often, we were watching talks outside of our area of expertise. That kind of personal, directive feedback can be extremely helpful to the speaker.

Dr. Sekeres: If one of our fellows at Cleveland Clinic has the opportunity to present an oral abstract at a large meeting like the ASH annual meeting, we have sessions prior to the meeting where those fellows can give their talks in front of faculty. The faculty give honest feedback about the quality of the talk. You need people who are in your corner, but who also are not constantly offering obsequious feedback.

What recommendations do you have for using slides effectively?

Dr. Mikhael: First of all, you need to know your slides. Nothing is more disturbing than a speaker who stands up, pulls up a slide, and says, “Oh, I didn’t realize I had this in this deck.” Preparation demonstrates that you value your audience’s time. Think of it this way: If a plane is an hour late, it’s not just 60 minutes of wasted time; it’s 60 minutes wasted of each passenger’s time. That’s 200 hours of lost productivity. When I give a talk, it is incumbent on me in advance to prepare appropriately for that talk – to get rid of slides that don’t convey what I want to convey, or what I call “lazy slides.” Many times, people will apologize for a “busy slide,” but, to me, these show a lack of effort.

In our modern day of technology, anyone can put in the effort to appropriately prepare slides. Your slides should be crisp and ready. My presentations may include a few slides that have a lot of words on them, but on those slides, I’ll highlight a certain area. Again, though, that takes time and effort.

Dr. Sekeres: As far as the nuts and bolts of preparing a slide presentation itself, make sure your slides are visually appealing. Dark background with bright red font is irritating, and you don’t want to irritate your audience.

So, a few general rules to follow: Alternate text-heavy slides with slides that have images. One carefully designed study – carefully designed in my brain, but I’m sure it has huge potential – has shown that there is a logarithmic association between the number of slides in a row that have text and the percentage of your audience who slips into a coma.

Dr. Mikhael: For me, slides follow two formats: informative and illustrative. Informative slides provide data, while the illustrative, obviously, illustrate an idea. The latter give small pauses to the audience so that they don’t feel bombarded by one slab of data after another. Inserting quotes, a photo, or any “lighter” content provides a mental break. People don’t come to hear you read your slides.

Many institutions have a one-hour lecture on optimizing your slideshow presentation – take advantage of that. There are so many shortcuts people are unaware of. For example, hitting the ‘W’ on the keyboard makes the whole screen go white. I find that useful for bringing the audience’s attention back to me if I see too many heads turned toward the projector. There are small things that you pick up as you get more practice. So, check if your institution provides a similar workshop because, today, it’s unacceptable not to know how to center a title or circle an important part of your slide when those things can be learned very quickly.

Dr. Sekeres: Also, proofread your slides. Anyone in the audience who has a background in English or is just anal-retentive will notice every single typo or grammatical mistake. (I’m that person, but I’m getting therapy for it.) That person will then jump to the conclusion that “if this presenter isn’t careful about typos and grammatical errors, he or she is probably not very careful about the science either.”

Dr. Mikhael: And that goes for making sure that you appropriately cite references. Don’t just write “Sekeres 2015.” Tell me what journal it was in. That attention to detail influences people’s confidence in a speaker – especially when you’re a more junior person and still building that confidence and trust from your audience.

Another key piece of advice: Never, ever speak disparagingly of the AV staff. They can make your life very difficult. In fact, make an effort to learn the names of the people who are running the AV system. I speak with them in advance to ensure that everything is running smoothly. Or, if I happen to be speaking with an interpreter, I make sure that I spend time with them in advance so that they know key phrases, ideas, and acronyms that I’m going to use during the talk.

I recall a marketing executive from a large company coming to give a talk at our institution and his presentation included several videos, but he didn’t prepare them properly in advance and almost none of them worked. It was hard to believe that someone at that level couldn’t even manage to give a talk. And of course, technology crashes. Frankly, you should be prepared to give your talk even if the AV system fails.

“In a successful presentation, the slides almost become background noise to the compelling story that you are telling.”

—Mikkael Sekeres, MD, MS

Do you have any “horror stories” about a presentation going wrong? How did you get the presentation – and the audience – back on track?

Dr. Mikhael: Well, there was a power failure in the middle of one of my talks and the projector exploded.

Dr. Sekeres: I’ve shown up to a talk with a flash drive at an institution that only took CD-ROMs for presentations, so there was no way to use my presentation. I’ve given talks off of the top of my head when a projector failed or asked for a whiteboard and markers to give the talk that way. And, as Joe said, never insult the AV people when that happens. They are much more mortified than you are, so don’t add insult to injury.

Inherently, the audience is rooting for the person standing up and giving a talk; you only have yourself to blame if they turn against you. There are a few ways that can happen: If you say anything insulting about them, their medical center, or their city, or if you start debating somebody who asks you a rude question. The audience recognizes when that happens and, by engaging in an argument, you’ve just dropped to that person’s level. Things happen, and the more you roll with it, the more you will earn the love of your audience.