How to make Medical Presentations: a different perspective.
Edouard Gruwez
Founding Partner @ To The Point at Work : Precision in Communication, Reporting & Decision Making
Medical presentations should break with old traditions.
World-class medical researchers are often locked in an outdated presentation paradigm. A different approach leads to more useful and more effective medical presentations. This article illustrates how this is done with a real-life case in cardiology. In short:
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The Problem: Medical presentations are often inefficient and ineffective.
Having followed the European Society of Cardiology Congress twice, there is no doubt that the research presented at #ESCcongress is second to none. The #ESCcongress also invests heavily to create an attractive experience with world-class digital and visual effects. But some presenters are inefficient and ineffective at transferring valuable knowledge.
Let’s be honest: not a single participant can remain attentive throughout dozens of presentations in which concrete take-away's are needles in a haystack of research data. Many physicians admit that they are “not paying attention during 80% of the time”. If so, then these presentations are wasting time.?
With due respect, even world-leading experts are often mentally locked in an outdated? presentation paradigm. 30 years ago, physicians had less information to digest and more time to do so. They weren't reading messages and emails on their smartphones while following a medical congress, and they couldn't consult the same information online at any given time. During online congresses presentations get even less attention from their multitasking audiences. The world has changed. With a different approach, boring lectures can be turned into concise interest-sparking contributions.
A real-life case: A presentation to cardiologists on photoplethysmography (PPG).
A few weeks ago, a group of cardiologists accepted the challenge to rework a presentation using the "TLSM" approach. (TLSM stands for Thinking-Logic-Story-Media in: Financial Times Publishing, 2014, “Presentation Thinking & Design”) .
"Brilliant and spot-on" said one cardiologist having reworked the presentation.
The presentation discusses a paper on the accuracy of Photoplethysmography (PPG) to detect Atrial Fibrillation (AF): Gruwez, H. et al (2021). "Accuracy of Physicians Interpreting Photoplethysmography and Electrocardiography Tracings to Detect Atrial Fibrillation: INTERPRET-AF". Frontiers in Cardiovascular Medicine.
For laymen: PPG is the technology that uses the camera of a smartphone to detect heart rhythm disorders. Early detection saves lives, and this can now be done at home with no equipment other than a smartphone. Of course, for PPG to be useful the measurements must be interpreted accurately. The paper brings more clarity on the quality of PPG interpretation.
How should medical presentations change?
1. Medical presentations should be created from the audience’s rather than the presenter’s perspective.
Medical researchers have all reasons to be proud of their work. But the objective of medical congresses isn’t one of ego stroking. The objective of most medical presentations is for health care professionals to improve the outcome for their patients. Research presentations traditionally focus on the scientific methodology and discussion. The audience then has to translate that information into practical clinical conclusions. It would be much more efficient if the researcher would directly answer the audience's questions rather than the research questions.
For the presentation on PPG, practicing cardiologists had the following question:
“Should the cardiology team in our hospital consider using PPG to screen for Atrial Fibrillation (AF)?”
This is not the same as the research question:
“What is the sensitivity and specificity of PPG interpretation compared to single-lead and 12-lead ECG interpretation for detecting Atrial Fibrillation (AF), and how does it vary when using a tachogram and Poincaré plot presentation?”
Many experts will argue that a presenter should stick to strictly answering the research question, rather than making further interpretations. This is a very interesting debate (See the paragraph at the end of this article: ‘criticism and comments on the methodology’).?
2. A medical presentation should follow a solution logic rather than a research logic.
?Medical presentations traditionally follow the research logic:?
This logic is useful for a reviewer to assess the quality of a study and its conclusions. Presenters understandably use this logic in a concern for scientific solidity. But for the healthcare professionals who want to improve their medical practice this is not optimal. The audience loses attention long before the presenter reaches his conclusion and useful insights get lost in a mist of less relevant information.?
The introduction created by the cardiologists looked like this (traditional vs TLSM approach). The story becomes shorter, clearer and more useful:
One could claim that this new conclusion is not scientifically robust. The new structure however doesn't reduce the robustness because the 'considerations' will add the necessary nuance to the conclusion.
3. The discussion should be structured in a pyramidal way starting from the conclusion.
Discussions in scientific papers have varying structures. Most frequently this structure is deductive: starting from observations in data leading to new insights and eventually to the conclusions.?Here we used an entirely different structure. The medical presentation now starts with the practical conclusion and gradually goes into the research details:
The value of inductive pyramid structures was first documented by Barbara Minto.?It allows to give a correct and complete answers to complex questions in a concise way. For the case at hand, the cardiologists created the following structure for their medical presentation:
In text format it looks like this :
Should we consider using PPG in the future for screening for Atrial Fibrillation (AF)?
Yes, we should consider using PPG, especially for higher risk patients. But we should take some considerations into account.
A. Why should we consider using PPG?
A1. The sensitivity is as good as a single-lead or 12-lead ECG. (a)
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A2. We will detect more AF early-on that we would have missed otherwise. Because...
A3. PPG interpretation doesn’t require extra training for a cardiologist.
?B. What are the considerations to keep in mind?
B1.?PPG must be interpreted by a cardiologist, using the tachogram and the Poincaré plot. Because...
B2.?A positive PPG should still be followed by a 12-lead ECG. Because...
B3.?We propose to use PPG for high-risk patients only (until further development).
B4.?It is wise to start with a test project.
In this way the study can be presented in 5 to 10 minutes including all relevant details, while the traditional presentation took at least 20 minutes.
4. Medical presentations should have (limited) details and examples to ensure optimal understanding and recollection.
The above pyramid structure helps our mind to grasp the essence in minimal time. But this is not enough. As human beings we need details that speak to our senses in order to interpret, integrate, evaluate, and memorize the key messages. Those details (also called 'story handles') can be:
Relevant details from the study: In the PPG case the cardiologists added relevant graphs on sensitivity (a), specificity (b), and positive predictive value per patient group (c).
Clinical cases: The cardiologists added two patient cases. This makes the subject more tangible and easier for the audience to relate to.
Relevant visuals: Pictures of the devices, a PPG output, a tachogram and Poincaré plot also make it easier for the audience to visualise the usage.
Other story handles: Depending on the time available, other narrative techniques can make the presentation more attractive and memorable such as metaphors, quotes, patient photos, personal stories, quizzes, humour, etc.
Even a little trivia can attract attention and improve recollection. For example when showing the Poincaré plot, tell a short story about the person behind the plot: "Poincaré was a french mathematician in the late 19th and early 20th century. Einstein based some of his theory of relativity on Poincaré's insights. But it wasn't until after Poincaré's death that Einstein admitted doing so."
5. Use simple wording and language.
Many professional presenters (and physicians are no exception) claim that using technical language makes their communication more precise. That is true but one shouldn't underestimate the effort to absorb less well known terms. Most cardiologists have to think twice when they hear “Photoplethysmography”. This detracts their attention from the content of the message. So technical jargon should be used with moderation unless the expression is part of the everyday vocabulary of the entire audience.
Secondly, people tend to understand spoken language much better than literary language. For example, splitting complex sentences into multiple shorter ones creates a better understanding with the same scientific precision.?Ease to understand is more important than grammatical correctness.
Finally, putting full sentences on slides is counterproductive. It reduces the understanding rather than increasing it. Showing just a few keywords or visuals works far better.?R. Mayer gives ample scientific proof of this. (*)
Criticism and comments on the TLSM approach in a research context.
?Presenters should stick strictly to the research conclusions.
Some scientists will have one well-founded criticism to the TLSM approach. It tempts the speaker to go beyond the strict interpretation of the study outcomes.
Rather than telling the audience:
“Here’s the study, here’s how we ran it, and here are the outcomes.”
the presenter now tells them:
“Here’s a study and this is what I think you should do with it and why.”
So, yes, this invites the speaker to put more of his or her interpretation into the presentation, rather than sticking to a pure reproduction of the medical research results.
It is a risk indeed. But isn’t that the added value (and the responsibility) of the speaker? If the presenter doesn’t translate the medical study into conclusions for the practitioners, then each healthcare professional will do so individually. And isn’t the researcher (or the person who studied the research paper in depth) in a better position to interpret the study outcomes correctly??
Edouard Gruwez
January 2022
(*) Readings