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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Beyond Bullet Points
- Paul Davies (30 May 2008)
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my most memriable real lecture was the one based on the speaker's extensive personal experience
- oscar,m jolobe (31 May 2008)
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Chalk and blackboard
- Andrew J Heeps (1 June 2008)
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Take the zen approach
- Ben Braithwaite (1 June 2008)
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Let's hear it for PowerPoint!
- Patricia M M Fowlie (3 June 2008)
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The “Power” and the “Point” in the PowerPoint presentation: Continuing the real lectures campaign
- Joyce A. Owino (4 June 2008)
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Flying Chalk
- John F Pickup (4 June 2008)
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Do text and spoken word compete rather than re-inforce?
- Ian L Millar (5 June 2008)
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Peripatetic power points and cutting the bull out of bullet points.
- Roger K.A. Allen (5 June 2008)
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A poor worker always blames his/her tools
- Richard Bartley (5 June 2008)
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Accessibility
- Karen A Atkinson (16 July 2008)
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Paul Davies, Pharmacist Mental Health Partnerships NHSGG&C St Vincent Street Glasgow G3 8YZ
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Of interest may be a book and supporting website called Beyond Bullet Points (BBP) by Cliff Atkinson. He promotes a no-bullet-point approach to presentations and further, suggests a film-script type approach to the contruction of the message or story to be delivered. This style is more time consuming to put together and the greatest hurdle I've had to face is not having the bullet points as a reminder of what I have to say. I have however, had much better feedback from my BBP presentations than from my 'standard' powerpoint slidesets. This approach still uses Microsoft Powerpoint to deliver the material, so the tools of change are at your disposal. Competing interests: None declared |
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oscar,m jolobe, retired geriatrician manchester medical society, c/o john rylands university library, oxford road, manchester M13 9PP
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A cardiologist from a teaching hospital had been invited to lecture on heart failure at our district general hospital postgraduate medical centre. Instead of blinding us with science, statistics, and power point, his starting point was to invite members of the audience to volunteer their personal misgivings and uncertainties about any aspect of heart failure they had always wondered about but had been too afraid to ask. The suggestions came thick and fast and he wrote each one of them down on a "flip" chart. After consultation with the audience, he then grouped the topics under a few clinically relevant subheadings so as to avoid unnecessary repetition. Using those headings as the basis of his lecture and , without the benefit of notes, slides, transparencies, or powerpoint, he then proceeded to deliver, straight from the heart, the most compelling account of heart failure I have ever heard, using a synthesis of references to the medical literature and his own extensive personal experience so as to reach out to each and every member of that audience. That was way back in the 1990's but that style of delivery, like an inspirational speech,has enduring value. That is the kind of delivery, I would like to imagine, where the speaker with extensive personal experience would not be self-righteously dismissive of misgivings about the relevance of evaluation of jugular venous pressure(JVP) in ordinary clinical practice(1). Instead, he might, for instance, be the first one to admit that, in his experience, the classic technique of estimating JVP, with variable inclination of the upper body and the sternal angle as the reference point, is fraught with difficulty and inaccuracy. However, rather than discard the use of JVP out of hand, he might suggest that a reasonable compromise would be to sit the patient bolt upright and evaluate whether or not pulsatile jugular venous distension was visible above the right clavicle. In one study, this rule of thumb proved to have 65% sensitivity and 85% specificity for identifying authentic elevation of central venous pressure when the gold standard was right atrial pressure obtained invasively by right heart catheterisation(2). For the sake of completeness, in my anecdote, the speaker was Dr D Rowlands from Manchester Royal Infirmary, but I'm not sure I am allowed to mention this in a rapid response. The question of JVP did not arise during his lecture but I feel confident that he would have handled it in the way I suggested. To this day I have enduring respect for his mastery of his subject and the way he managed to make it both interesting and relevant to his audience without haveing to rely on gimmickry. Like Dr Greenhalgh(3),that is the kind of "real lecture" I would like to attend. After all, in the "google" era we can always look up the bare impersonal facts for ourselves at the click of a mouse, but those facts do not tell us anything about the real world where the most inspirational characters are the ones who can convey in an "ex tempore" lecture how they have acheived the magical synthesis of their extensive personal experience and their interpretation of the published evidence. References (1) Spence D The world is round British Medical Journal 2008:336:1134 (2) Sinisalo J., Rapola J., Rossinen J., Kupari M Simplifying the estimation of jugular venous pressure American Journalm of Cardiology 2007:100:1779-81 (3) Greenhalgh T Campaign for real lectures British Medical Journal 2008:336:1252 Competing interests: None declared |
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Andrew J Heeps, ST2, Obstetrics and Gynaecology Chelsea and Westminster Hospital, London SW10 9NH
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The best lecture I had at medical school was given by the retired professor of respiratory medicine at Charing Cross, Emeritus Prof Stephen Semple, given a good ten years ago. He shuffled down to the front of the lecture hall, took a (semi-)disgusted look at the overhead projector (remember those?) and cranked the antiquated blackboards into life. He then spoke, without notes, for ninety minutes on respiratory physiology, only using a crumbly piece of yellow chalk to illustrate his points. The diagrams, both cellular and those of gross anatomy, were beautifully clear, and I remember the principles he taught to this day. He demonstrated that the key to being a good teacher, and a good lecturer, is knowing your stuff - the rest just falls into place. Competing interests: None declared |
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Ben Braithwaite, General Practitioner Richford Gate Medical Practice, London W6 7HY
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Another excellent resource for engaging, image-based presentations is the Presentation Zen blog (www.presentationzen.com) and associated book. As well as denigrating the use of bullet-pointed, text heavy slides (which seem often to be designed with automatically-generated handouts in mind, rather than as visual aids) its author Garr Reynolds urges presenters to focus on the story that their presentation is trying to tell, rather than getting caught up in the minutiae of font sizes and sound effects.
Competing interests: None declared |
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Patricia M M Fowlie, Associate Specialist Community Paediatrician West Kent PCT TN1 1JU
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OK, some of you can live without PowerPoint; those of you who have razor-sharp focus, and, more importantly, a good short-term auditory memory. Not those of us, who as very junior psychiatrists would be sent to the geriatric ward to check out if some senior citizen was dementing or not. The humiliation of discovering that the frail octogenarian before you could rattle of strings of numbers, forward and back, twice as long as your twentysomething brain could manage. Not to mention "serial 7s" - I had to learn them by rote to keep up with the oldies. What this means in practice is that some people just do need to see things written down. I don't think I ever learned very much either at school or since that wasn't in print, even if I'd enjoyed the talk. Doing Membership, I was aware attending courses was a waste of time; much more effective to read a few books. I still passed MRCPsych parts 1 and 2 at a single sitting, from a standing start a few months before. It would have been so different if PowerPoint had been developed then. No frantic taking the speaker's words down as dictation, no panics about losing focus briefly and losing the plot, no worries about whether you're going to be able to feedback to colleagues - and the PCT - what you've learned. So, please have mercy on those of us with the mind of a Pentium and the memory of a 286 - keep the PowerPoint, or relegate us to a "slow listeners" group. Competing interests: None declared |
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Joyce A. Owino, Nurse Educator Great Lakes University of Kisumu, 40100, Kenya
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I do not know if the person who named it PowerPoint was referring to electric energy or other that can enable presentation projection onto a point on a screen, but in looking up the definition of power, I found that it is the “ability to do or act; capability of doing or accomplishing something; great or marked ability to do or act” (1). In my experience with power point, as a recipient and giver of lectures, I have sometimes been left to wonder whether or not the PowerPoint presentation em‘power’s the user to do a better delivery than when using traditional methods of giving lectures. PowerPoint presentation is not that new either. Abraham Lincoln used it in 1863 at the Gettysburg Cemetery Dedication. This is how his opening words went: “Good morning. Just a second while I get this connection to work. Do I press this button here? Function-F7? No, that's not right. Hmmm. Maybe I'll have to reboot. Hold on a minute. Um, my name is Abe Lincoln and I'm your president. While we're waiting, I want to thank Judge David Wills, chairman of the committee supervising the dedication of the Gettysburg cemetery. It's great to be here, Dave, and you and the committee are doing a great job. Gee, sometimes this new technology does have glitches, but we couldn't live without it, could we? Oh - is it ready? OK, here we go:” (2) Sound familiar? Not a very ‘power’ful start. I wonder whether he would have competently continued with the planned ‘points’ of that speech had the technology completely failed that morning. Talking of ‘points’ in the PowerPoint presentations, the whole point is to write in point form to remind the presenter and also to give the listener direction and key words. But like Greenlaugh (2008) (3), I’m also still a novice at lectures, and the presentations I have been subjected to (and have probably subjected others to) seem to range from bullet points of one or two words to whole paragraphs or stories. I agree with Heeps A. (4) & Jolobe O (4) that it is best to know your subject matter. You can then deliver your subject with power, technology or no technology, and be able to accomplish with great ability. I also identify with Fowlie P (4). Some of us are just not endowed with the same inherent power as others, to be able to soak up and then disseminate huge amounts of subject matter, however passionate one might be about the subject, and especially when new to a field. Could it be that we need to explore, through research, whether or not we are better off as a result of the use of PowerPoint presentation? Reference: 1. Dictionary.com, http://dictionary.reference.com/browse/power, accessed on 3/6/08 2. The Gettysburg Powerpoint Presentation 11/19/1863, http://norvig.com/Gettysburg/index.htm accessed on 3/6/08 3. Greenlaugh T. (2008) Campaign for real lectures, British Medical Journal;336:1252 (31 May) 4. Rapid Responses to: VIEWS & REVIEWS: Trisha Greenhalgh Campaign for real lectures, BMJ 2008; 336: 1252 Competing interests: None declared |
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John F Pickup, Pharmacist Royal Cornwall Hospital, Treliske, TR1 3LJ
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The title touched a nerve with me. Last week I delivered a telematic plenary to year four students in our medical school. (I had to ask too - it turns out it's a lecture disguised with a trendy name). I stood fixed to the focal point of a television camera in a large lecture theatre faced with a single, rather bored looking, student sitting in the gloom near the back. One small screen in front of me showed me my slides and another a view of a theatre 100 miles away with a dozen students - who may not have been listening at all, I could't tell at that distance. What was wrong with being able to walk around in front of the whole year, fixing the occasional listener in one's sights and trying to make them smile? What was wrong with throwing a piece of chalk at the group near the back who weren't listening? I must be too old, it's time to give up... Competing interests: I think I'll get a fee for the "lecture" mentioned! |
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Ian L Millar, Hyperbaric Physician Melbourne 3004, Australia
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Before Powerpoint, I lectured with a background of 35mm slide photos. I think people usually listened to me. After adopting Powerpoint, I had the feeling they were reading the slides and not listening. I have reverted to speaking with mainly photos and no words on my Powerpoint slides and have received lots of positive feedback from students. I have a strong impression that taking in the written word on the screen competes with absorbing the spoken word as if the language centres of the brain can only properly process one incoming stream at a time. Is this neurophysiologically correct? I know my multi-media focussed, multi- tasking 22 year old son would disagree but talking +/- images and not talking whenever text has to be displayed does seem to work much better than the standard "Powerpointlessness" of bullet points summarising the spoken word. The only problem is if the lecture organisers insist on hand- outs. One strategy that seems to work is preparing the lecture in bullet point form as a personal speakers guide and handout, then making a copy and replacing every slide possible with pictures or data. Competing interests: None declared |
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Roger K.A. Allen, Senior Consultant Thoracic and Sleep Physician Wesley Medical Centre, Auchenflower, Brisbane, Australia
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Modern Homo sapiens has become used to instant entertainment with TV, Internet and Power Point with lots of razzle-dazzle. Audiences are shocked if you don't arrive with myriad of images and bullet points for a talk. We have become “visual” junkies and are losing the “auditory” retentive bit in our nuts from lack of practice. Most people under 30 are incapable of being conscious without an ear-piece pumping one-way low frequency sound waves from an Ipod into their grey matter. What few lecturers seem to realise is that most of us are “kinaesthetic” and that simple folk like me learn best from this method. Try teaching knot tying by visual bullet points versus using a piece of rope and using the "kineasthetic" method. A great example of an effective teacher, Jesus Christ, taught by the kinaesthetic method involving all the senses including touch, smell and taste e.g. the loaves and the fishes parable, Palm Sunday, bla, bla, bla. He didn’t use bullet points or a black board. The Last Supper and the Crucifixion were great examples of this. He also used the peripatetic style of the Greeks in the classroom of life. He used real power points. The Greek philosophers managed to engage students and produce the goods. Socrates would occasionally doodle in the dirt with a stick. They used to narrate Homer over a glass of wine and a fireplace without any trouble for quite a while and manage to keep the audience enthralled. The narrator did it by heart. I note that psychiatrists can sit in a group and talk about patients for a few hours with not even a black board. My wife does this as a psychiatrist and can recall a whole interview verbatim. Most of us have the attention span of newts. We can't even remember someone's name when introduced or on the phone. I believe a good teacher can impart ideas very effectively by engaging the audience when the subject is something he or she knows from experience and has a passion for. I think that there is little imagination used in imparting ideas. My high school chemistry teacher's attempt to teach the periodic table spings to mind...not a mention of the birth of stars, nuclear fusion or the beginnings of the cosmos and where the damned table all started....just valences and dry as dust stuff about halogens and rare earths, bla,bla, bla, Zzzz, Zzzz. He had the imagination of a spleen-wort. Many lectures are too narcissistic to realise that they are boring. The worst lectures I have experienced were in the army when they were done by numbers and assumed that everyone listening was an imbecile. The second worse are those where the lecturer blithely vomits facts on the audience. Give me the Greek peripatetic tradition with lots of the kinaesthetic any day with students who thirst to be engaged and teachers who seek to slake their thirst. Competing interests: None declared |
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Richard Bartley, Physiotherapist Denbigh, Wales
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I am pretty sure that PowerPoint presentations are employed for the teacher rather than the listener. The slides act as convenient memory pointers for the speaker. They can also provide a comfort zone for an insecure speaker, who may fear that the essential teaching points won't come across verbally as well as something written. In other words, Power Point can become a crutch rather than an enhancing tool. Numerous international agencies recognise that public pictorial warning symbols are more effective than written ones. People can relate to pictures and images better than text. I always enjoy lectures were the Powerpoint slides exclusively consist of pictures, graphs and amusing cartoons. Well, especially cartoons. Competing interests: None declared |
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Karen A Atkinson, Manager RNIB Resource Centre/Senior Lecturer University of East London
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Whilst agreeing with many of the points made in the original article and other responses re: overuse/overreliance on PowerPoint and bullet points etc., can I just remind you about accessibility. Not everyone in your lectures will be able to access your fantastic images. If you turn down the lights so they show better, your hearing impaired students will not be able to lip read you and none of your students will be able to take notes; people with dyslexia, visual impairments or mental health difficulties will find it almost impossible to take in and/or note down your key pearls of wisdom without the information being provided in other accessible formats. You may all do this anyway - but in my experience over the last 18 years, accessibility is not usually at the top of peoples' lists when they are preparing lectures. Competing interests: None declared |
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