Pregnancy, parenthood, & catching up

It's been a while since I've been here (March to be exact), and much has happened since then. 

I've been thinking a lot about this blog in the meantime, dutifully logging ideas for posts in an Evernote file. Of course, thinking about writing isn't the same as actually writing. I've been intimidated, though, about trying to catch y'all up on what's been going on, as the context will be important for what I want to discuss in the next few months.

So, how about a 60-second summary? 

(Or maybe even less than that if you're a fast reader!)

Thanks to the incredible generosity of a woman we will never meet, my husband and I became parents earlier this year via egg donation. The adage that pregnancy doesn't cure infertility is definitely true, and I think I didn't blog about my pregnancy because I was afraid to acknowledge it in words in case something went wrong. After infertility, I didn't trust my body's ability to do anything, let alone gestate a human.

I never expected that being a doctor would adequately prepare me for pregnancy and parenthood (and it didn't). But I've learned some things in the last year that I think I should have learned at some point in my training. So, those should be some interesting posts. ;)

Unfortunately, not long after our little one joined us, she entered the healthcare system with difficulities of her own. Interfacing with the healthcare system as a parent - and a family doc - has been a *insert cliche here* experience (possible cliches that apply: "eye-opening," "thought-provoking," "roller coaster"). Thankfully, assuming all goes well with her upcoming surgeries, her prognosis is excellent. 

Whew! I think it's safe to say that this blog will be going in a different direction for a while. I've always endeavored to write about topics that I am passionate about, trusting that those same issues will find some resonance. Perhaps this new direction won't be of interest to you - I won't take that personally, and I'm appreciative that you've been along for the ride thus far. Maybe some new readers will wander over to this corner of the internet who are less interested in medical education and more interested in the intersection of medicine and parenting - that's okay, too.

But to whomever might be reading this post today, thank you. Thank you for being interested in my story, for being curious and empathetic, for celebrating our commonalities and exploring our differences. 

Thank you.

What do high quality PowerPoint slides look like?

It might be easier to ask first, what do low quality PowerPoint slides look like?

You've probably seen hundreds of these over the years: too many words, "death by bullets," not enough visual support, overly complex diagrams, boring or irrelevant backgrounds, etc.

Think for a moment about the last time you saw really great PowerPoint slides. They probably:

• had few words
• had fewer bullets
• used vivid, relevant pictures/visual support
• used simplified, effective diagrams/charts
• reflected the presenter's personality

When I teach presentation skills workshops, I encourage participants to build slides without using stock PowerPoint templates; instead, work from the "blank" template and design each slide without any bullets. This feels uncomfortable for some people at first, but I encourage folks to push through and start playing around with text boxes and images. What universally happens is that each participant's creativity begins to take over - no one's slides look like anyone else's, but they are instantly more compelling.

The purpose of your slides is to support you, the presenter. They should not be able to stand alone (though your handout should), and they should not distract the audience's attention away from you as the presenter. Most of the tips and tricks that follow keep your audience focused on you, not devoting precious brainpower to interpreting your slides or letting that brain wander away on unrelated tangents.

With that in mind, here are my favorite tips and tricks for kick ass presentations:

Keep your font at least as big as 28 point and, ideally, 32 point at a minimum. If your audience is straining to read your words, you've lost their focus on your content. (Besides, larger fonts make cramming too much onto one slide much harder.)

Choose sans serif fonts for better readability. Serif fonts make your audience subconsciously work harder to read your projected words. Every scrap of audience brainpower is precious and should be focused on you and your message!

Make sure there's contrast between your font color and background color, either light font/dark background or vice versa - but please don't use the canned yellow font/blue background from vintage 1990's PowerPoint. There's no surer way to make your presentation look old and dated.

One point per slide...most of the time. Exceptions include overview/agenda slides or slides where you are connecting several ideas together - but be judicious with these.

Keep backgrounds simple. None of those stock PowerPoint slide backgrounds are worth your time; in fact, any repeating backgrounds or info on slides (including your institution's branding) is a distraction to your audience. Remember, one point per slide.

Optimize your visual support with PowerPoint tools. Let's face it, those super-cool images you downloaded from Google are probably not a perfect fit for your objectives or your presentation's aesthetic. Use cropping, remove background, and/or adjust the contrast/coloring to make images truly pop on the slide. ("Remove background" can admittedly be a bit time-consuming, but it is the best way to make your images look like they organically belong on your slide - instead of looking like you just pasted it in from a web search engine. Try it!)

Cartoons, pictures, etc must be relevant to your content. Otherwise, they will distract your audience from your content - and once you've lost your audience's attention, getting it back will be one mighty uphill battle.

Finally, this outstanding 10-minute video summarizes many of these points and, simultaneously, provides an excellent example of what phenomenal PowerPoint slides look like.

Ditch those boring, over-bulleted, word-heavy slides and inject your personality and energy into your presentations with short bullet-free phrases accompanied by striking visuals. Your audience will not only thank you, they may actually walk away learning something as well.

Meaningful goals & objectives should drive every presentation

The idea of incorporating goals and objectives into presentations has percolated fairly deeply into medical teaching tradition. Unfortunately, these goals and objectives are often superficial and meaningless, especially when they are not tied meaningfully to the presentation's content. Frequently in presentations, it's hard to tell the difference between stated goals and objectives, even though they should be quite distinct and serve different purposes.

Before I provide some examples, let's review for a moment what the purpose of educational objectives are:

• Educational objectives describe the skills learners should possess after you finish your presentation.
• Educational objectives also serve as the foundation of evaluating your presentation; you measure the success of your presentation based on how well your learners met your objectives.

High quality objectives are, therefore, precise and measurable. Objectives are not the same as goals; goals can be as pie-in-the-sky and impossible to measure as you like! Goals provide the emotional power to your presentation; typically, you won't share them with your audience, but they are the fuel for your presentation.

Here's an example. I gave an hour-long presentation on asthma to our residents recently, and the objectives were:

1. Classify asthma severity using the EPR-3 guidelines.
2. Calculate a peak flow %.
3. Design appropriate treatment plans for your patients with asthma.

My unspoken goal was:

• Train residents to recognize under-treated or undiagnosed asthma so affected patients don't suffer unnecessarily.

It would be very difficult to quantitatively measure the success of my goal; I would need to know, somehow, which cases of undiagnosed asthma they missed along with the ones they caught. That's completely unrealistic, which is okay - the goal provided me with the passion and energy I needed to get my learners excited and interested in this topic. Your learners can tell when you are not emotionally invested in the material you're teaching, and they won't learn as well without your enthusiasm.

On the other hand, measuring my objectives was easy, and I was able to do so by the end of my presentation. I observed all of our residents who were present work through clinical scenarios where they had to (1) classify asthma severity, (2) calculate peak flow %s, and (3) design treatment plans. Having these clinical scenarios (and the space to write out their answers) incorporated into the handout I provided them was essential to both this measurement and the residents' concrete application of what I taught them.

In summary:

Goal = mega-aspirational, pie-in-the-sky ideal result of your presentation that fuels your passion for the topic.

Objective = precise, measurable criteria that both point learners to your most important teaching points and allow you to measure the success of your presentation.

Bloom's taxonomy provides a great starting point for choosing high-quality verbs for your objectives; "understand" and "review" are fine for goals but have no place in a well-written objective (being neither precise nor measurable). Use Bloom's to connect your objective to the appropriate step of the taxonomy (do you want them to remember? comprehend? apply?) as discussed in my earlier post about interactive presentations.

Now, get out there and write some kick ass goals and objectives!

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. 

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!