Wednesday, February 3, 2016

Designing learner-centered presentations

As I discussed recently, too many educational sessions in medicine are ineffective. Most of the educational sessions I've seen aren't true presentations, at least not according to my definition:

A "presentation" is a deliberately planned educational activity that incorporates ample opportunity for learners to immediately apply and reinforce new knowledge.

In contrast, a "talk" is nothing more than a speaker or teacher droning on, typically zooming through far more material than any learner could hope to remember afterwards.

Even if delivered by an engaging speaker, talks don't result in any meaningful information gains for learners. Think back to the last talk you attended; even if it was just last week, I bet you can't recall more than 1-2 facts from it (and if you've got 1-2, you're doing better than most).* Adult learners simply aren't wired to memorize reams of facts without context and/or without the opportunity to apply those facts to concrete examples. Even the most motivated of adult learners will struggle to take away something meaningful from observing a talk.

The solution is to incorporate learning activities into educational presentations. Here's one relatively fool-proof presentation formula (warning: this formula will not work if your presentation objectives are weak):
  • Introductions; review presentation objectives
  • Teach content re: objective 1
  • Learning activity re: objective 1
  • Teach content re: objective 2
  • Learning activity re: objective 2
  • Teach content re: objective 3
  • Learning activity re: objective 3
  • Wrap-up; questions; evaluations

The learning activity should directly correlate to its learning objective. So, if one objective is to "List the four types of allergic rhinitis," the learning activity might be to identify which of the four types applies to various patient scenarios, thereby reinforcing what the four types are along with their definitions. If a second objective is to "Describe the classes of medications available to treat allergic rhinitis," then the learning activity might be to match various allergic rhinitis medications with their mechanism of action. 

Each learning activity should fit with the objective's place on the Bloom's taxonomy pyramid. Here are some suggested learning activities for each step of the taxonomy, from top to bottom:

Creating: create a new process or workflow, brainstorm solutions, write/paint/reflect on a recent patient/peer encounter
Evaluating: rate the quality of a group of clinical trials, assess the pros/cons of an office/hospital workflow
Analyzing: categorize disease types by severity, compare and contrast different treatment approaches
Applying: calculate sensitivity/PPV/NNT/etc, diagram the pathophysiology of a disease/condition
Understanding: interpret diagnostic test findings, explain a medication's mechanism of action
Remembering: recall the typical patient history of a disease/condition, list common physical exam findings for a disease/condition

As you can see, it's often appropriate for your objective to precisely reflect the corresponding learning activity.

Most of the time, when we are teaching medical content, we're working within the bottom 3 tiers of Bloom's. But I challenge you to consider how your presentations might incorporate some of the top 3 tiers; especially in curricula on practice management, quality improvement, medical humanities, and evidence-based medicine, where infinite opportunity exists for our learners to analyze, evaluate, and even create.

The exceptions to this fact are those rare individuals with a photographic or eidetic memory

Thursday, January 21, 2016

Giving a presentation? Avoid these common statements

I've listened to a lot of presentations during my time in medicine. Whether as a learner, a teacher, or an observer, I have heard certain statements uttered innumerable times, statements that, frankly, have no place in a thoughtfully designed presentation.

So, here are the Singing Pen's top 3 things never to say in a presentation:

3. "There's a lot of information here, and we'll go quickly, so please interrupt me with questions if you need to."

Unfortunately, the most common mistake I see presenters make is including too much information. At most, learners will remember 3-4 main points after you're done; decide what those 3-4 main points are (hint: your presentation's objectives should reflect them) and spend the time you have emphasizing them. For example, you are not going to be able to cover every single kind of cardiac arrhythmia or every possible type of shoulder injury in 60 minutes. Focus on the key points you want learners to internalize.

FYI: Letting your audience know your preference about interruptions for questions is a great practice, just not when it's said to mitigate your unfocused, bloated presentation.

2. "I got these slides from..." or "I first presented this at..."

It's perfectly fine to adapt others' slides from past presentations into a current presentation as long as you have the creator's permission. But the key word is "adapt." Plopping slides created for one group of learners into a session for another, different, set of learners is fraught with peril. It's highly unlikely that someone else's slides will perfectly fit the needs of your learners, and you risk distracting your audience by skipping unnecessary slides or going off on tangents. Keeping your audience and your educational goals in mind, edit and adjust those slides so that they meet your learners' situation. And, for heaven's sake, put the correct date on the title slide while you're at it.

1. "This slide is hard to read..." or "There's a lot on this slide..."

You have the responsibility as the presenter to create slides that are not hard to read. Yes, many of the concepts we teach in medicine are complex, but an overly complex slide is not going to transmit that information effectively. Don't try to stuff too many words or diagrams on one slide; usually this problem can be fixed by splitting the information into multiple slides and/or thoughtfully using animation to bring in content in a step-wise manner (to avoid looking gimmicky, the only animations you should be using on a regular basis are "appear," "fade," and "disappear").

Unfortunately, the vast majority of medical teachers have never learned how to create an effective educational presentation. Most repeat what they have seen done by others throughout their career: presentations with too much content crammed into them, slides with zero visual appeal (typically stock PowerPoint headings and bullet points on slide after slide after slide, sometimes with the added "bonus" of distracting background graphics), and a dearth of meaningful activities that reinforce key learning points. Building a presentation that negates the need for these 3 statements is a great first step to giving high quality presentations.

Stay tuned for more on creating engaging, effective educational presentations!

Monday, September 14, 2015

This game is frequently used in medical education settings to poor effect.

What is "Jeopardy!"?

Confession time: I despise presentations that involve the use of a PowerPoint Jeopardy! game. To be clear, I get uncomfortable when any game-like activity appears in a medical teaching presentation.

Not that I don't think games can have an important role in education - far from it. Heck, I once worked on a presentation that turned our residency conference room into a giant Game of Life board with the residents as life-sized game pieces. It seems to me, though, that most of the time teachers insert games into their presentations just to do it ("They're games! They're fun!") and not after careful thought about using games as an instructional strategy to further their educational goals. Because, at the end of the day, that's what games should be when we use them to teach - a deliberately chosen instructional activity designed to reinforce knowledge and/or skills.

When we did that Game of Life board, for example, it was part of a longitudinal series we created as faculty development fellows on "The New Health Care System."* In preceding sessions, we had taught the residents about different types of practice models, staffing ratios, and even the debate about whether to invest in an electronic health record.** For the game session, the residents had to make a series of decisions about how they wanted to build their "practice," all the while encountering occasional calamities and successes, just like in the original Game of Life.

We used our modified Game of Life to reinforce previously taught concepts; participants had the opportunity to practice knowledge and skills that they had already received. Most of the time, this sequence - first provide new knowledge, then reinforce new knowledge - is the right way to structure interactive presentations. Provide your audience with new knowledge and/or skills, and then let them practice.

The problem with Jeopardy!, most of the time, is that the audience is not provided with the relevant knowledge being tested beforehand. I would have no quibble with PowerPoint Jeopardy! presentations if they followed other presentations providing the knowledge to be reinforced first, but usually that's not what happens. My observations are that medical teachers, instead, use Jeopardy! as a tool to teach new knowledge. I've been told that "the residents can learn from each other when they're wrong" and this game will "reinforce what they already know." Unfortunately, most learners will not learn effectively in this environment.


1. Most people learn best in low-stress, emotionally safe environments. One emotionally unsafe example is "pimping;" most personality types experience a high level of anxiety related to the potential embarrassment of answering "pimp" questions incorrectly. Medical Jeopardy! presents the same risk; while a few residents and students will thrive in this competitive environment, most will internally cringe at the risk of revealing their perceived ignorance. Anxious, uncomfortable individuals do not retain new knowledge as well as calm individuals.

2. Jeopardy! often involves a vast amount of information that may be only loosely related. Most learners will only walk away from an educational session remembering 3-4 key concepts. A typical Jeopardy! board has 30 squares on it; multiply this by 2 if you've also got "Double Jeopardy!" - and remembering 60 facts after any presentation seems unlikely to me.

3. Most of the time I see Jeopardy! played in teams; that is, with 3-6 residents on a team competing against each other. Having observed several of these sessions over the years, very few audience members get actively engaged in these sessions. It's easy for more anxious, less experienced, and/or more introverted residents and students to take a silent role, and observing instead of participating decreases the educational yield even more.

If the goal of the presentation is to teach (and not just "have fun!"), then games should reinforce new knowledge, not provide it for the first time. Every instructional strategy should intentionally reflect the educational goals of the presentation, and the level of problem-solving inherent in the game should align with the presentation's objectives. The Game of Life, which involves a lot of application and analysis, made sense for teaching about decision-making in new models of office practice. Jeopardy!, which is fundamentally a game of information recall, would work better to reinforce basic knowledge such as antibiotic coverage or musculoskeletal anatomy.

But the key word in that last sentence is "reinforce" - using Jeopardy! to introduce new concepts is a flawed approach that will leave most learners uncomfortable, overwhelmed, and unengaged.

* These concepts preceded the Patient-Centered Medical Home model, so I am definitely dating myself here.
** Again, dating myself. *sigh*