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SCCM Pod-511: LEAD: Crafting Captivating Presentations

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Unlock the key to captivating your audience with SCCM's Leadership, Empowerment, and Development (LEAD) Program. Have you ever left a presentation wondering if anyone was really paying attention? In this episode, Kyle B. Enfield, MD, FCCM is joined by Amanda R. Emke, MD, MHPE, to discuss the essential skills needed to create presentations that leave a lasting impression. From weaving compelling narratives to incorporating interactive elements, learn how to command the stage with confidence and ensure your audience walks away truly moved.

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Dr. Enfield: Hello and welcome to the Society of Critical Care Medicine Podcast. I’m your host, Kyle Enfield. Have you ever finished rounds only to wonder if anyone learned anything that day or left a presentation wondering if anyone was actually paying attention?

Today I’m speaking with Dr. Amanda Emke, MD, MHPE, from our Leadership, Empowerment, and Development Program to discuss how to create engaging presentations and maximize the impact of your teaching. Dr. Emke is an associate professor of pediatrics and associate fellowship director, pediatric critical care medicine, at St. Louis Children’s Hospital. She is also assistant dean for assessment for Washington University and the St. Louis School of Medicine. Knowing that research tells us that we can only hold your attention for 15 to 30 minutes, we’re going to jump right in. But before we do, Amanda, do you have anything you wish to disclose?

Dr. Emke: No, I do not.

Dr. Enfield: Currently, empowering better medical education has become really the zeitgeist of our times. People are talking about how to engage learners and making sure that our presentations are great. But for you, what really grabbed your interest in understanding adult learning?

Dr. Emke: There were a few things that really grabbed my interest around this. From a personal standpoint, I have two kids, both who have ADD, but it presents very differently, so thinking about how I could help them leverage their successes to better learn in the classroom was really important to me.

Then, from a professional standpoint, I knew that I was on this trajectory to increase my involvement at the medical school. When I was first asked to take over this pre-clerkship pediatrics course that was taught as a random conglomerate of lectures, it just didn’t feel like that was actually going to get anybody’s attention or capture anybody’s interest. We know that a small percentage of medical students are going to go into pediatrics in the first place, and yet they were supposed to learn this material, hold on to it for a various number of months until they got to their pediatric clerkships, and then somehow try to remember it.

That’s when I really started thinking about, how do people learn? Then I got an extra kick in the pants, I’ll say, because both of my sisters have degrees in education. As we were sitting around the family dinner table, let’s just say I got chastised a little bit for being outside my lane, so to speak, when I was talking about all these things I wanted to do for the course.

One of my sisters looked at me and said, I spent a lot of time at the doctor’s office. You have been taught a lot and suddenly seem to think that that makes you an expert in how to do this. Does that mean I’m now an expert and can become a doctor? I said, good point. That’s when I decided to formalize my training a little bit and where I was first introduced to the concept of cognitive load theory.

Dr. Enfield: I will start by saying I think I’m a little chastised by your sisters now too, because I probably fall into that same bucket of thinking I’ve been in a lot of classes so I should be able to teach. But before we dig into that psychological trauma now, maybe let’s talk about cognitive load theory and what that means.

Dr. Emke: Yeah, absolutely. Cognitive load theory was described by Dylan Wiliam. It is for some educators felt to be the single most important thing that teachers should know. It really talks about how the human brain is designed to take in information, encode it, transfer it to long-term memory, and it goes further to talk about the things that we do as teachers that make that process easier or harder.

Dr. Enfield: Can you give us some examples of things that we already are doing in medical education?

Dr. Emke: Yeah, absolutely. Let’s think about running a code with a brand-new learner. The first thing they do is they pull out their BLS or their PALS card. That’s actually an important piece of cognitive load theory that we should allow because it helps them to decrease the burden of trying to remember things that would distract from the other focuses that their attention should have.

Or another great example is thinking about a telephone number. There’s actually a reason that telephone numbers are seven digits. That’s about how much we can store in working memory and retrieve easily. So we want to really think about what are those things that we are doing that create unnecessary information that we’re trying to convey, especially to those novice or new learners versus what are the memory guides or tools that we’re helping to put in place that will help people code and store that so they can retrieve it easier the next time.

Dr. Enfield: Thinking about that, are there some fundamental things that educators can do as we think about how we approach teaching on rounds or the chalk talks that many of us give to medical students, residents, and fellows?

Dr. Emke: Absolutely. There are a couple of things we really want to think about when we’re teaching on rounds or doing those chalk talks. The first is time. How much time do you have to devote to this teaching session? How much time does the medical student, resident, fellow have to be 100% focused on this teaching? Not worrying about their pager going off or the nurses coming up and asking questions, 100% devotion to this teaching opportunity.

Likely, it’s pretty short. We’re probably talking five minutes or even less than that. The chalk talk might be five minutes. If we’re trying to give a teaching pearl on rounds, it’s much less than that. So we want to really hone to that one specific, most important take-home message. We want to prime the learner for what that’s going to be. We want to give our succinct teaching point.

Then we want to do something that forces the learner, the medical student, resident, or fellow, to immediately reengage with that information so that they do that extra coding to try to put it into long-term memory. For example, if you are going to teach about asthma on rounds, you probably don’t want to go through the pathophysiology, the clinical history, the management, when should you cannulate for ECMO. You’re going to have to pick one specific thing that you want to focus on.

You’re going to want to prime the learner, for example, saying, that patient in bed six presented with severe asthma, let’s talk about what I saw that made me know they needed to be intubated. We’ve now primed them for the specific thing we’re going to talk about. Then we give our very brief description of what we saw, what we did, maybe even what somebody else might’ve done. Then we have to ask them a question. What are you going to look for the next time you’re seeing a patient on the inpatient team or in the emergency department based off of what we talked about today?

Dr. Enfield: What you described is probably very different than what 99.9% of listeners experienced on rounds when they were training. Tell us how it’s an improvement over the way we were trained, which usually was through a series of questions until the point where we didn’t know something.

Dr. Emke: Yeah, the old-fashioned Socratic method, so to speak. The reason that it’s different, and I’ll offer has some advantages, is that, one, the series of questions may or may not relate to each other. Or more importantly, as a learner, I may or may not understand how they relate to each other. Also, by the time you get to the point where I am mentally exhausted at being able to answer your questions, I now am no longer in a space where my brain is ready and primed to pick up on that nugget that you’re going to offer me.

I’m also not sure what it’s anchored to. You’ve created no scaffolding around the key learning point. If you think about the example I gave, I tied it directly to a patient we were taking care of. So I already prompted or started that encoding process by anchoring it to that patient. As we all can remember, when we went through the series of questions, it usually started, sometimes, from a patient, but by the time we got to the end of it, we no longer knew which road we were on anymore.

Dr. Enfield: Okay, I think so far you’ve convinced me that this method is better. Clearly there are probably people who learn differently. You spoke about your ADHD kids. I have three kids with ADHD and we know that they all learn differently. Are there things that we need to be looking out for as teachers, and how we can adapt to those different learning styles?

Dr. Emke: Yes, it’s a little bit harder when we’re in the clinical space and we’re on rounds and we’re trying to give a teaching point. I think that, in those situations, it’s just important for us to remember that not everybody may learn just by listening to us. We may want to offer the medical students, residents, or fellows an opportunity after rounds to come back and talk about the same topic where they might be able to take some notes or do some drawings about it. Many of us like to provide diagrams or drawings while we’re doing our teaching, which I think are really helpful. We just need to think about, do we have enough time to do that and bring the whole cycle to completion?

I think it’s a little bit different when we’re doing a planned talk. When we’re doing a planned teaching session, I think that’s when we really need to think about how we can present material through multiple modalities at the same time. That may mean talking to medical students, residents, and fellows while we’re also drawing things on the board or having them draw it on the board, even better. That way we’re engaging both our auditory and our visual learners at the same time.

Dr. Enfield: That works great when you’re thinking about the chalk talks or on rounds, but how do you approach this when you think about moving that to the grand rounds format where it’s a lot more formal and we’re anchored toward slides often?

Dr. Emke: I think that’s actually where I have found cognitive load theory comes into play and helps us think through things even more so. When we’re thinking about our slide design and how we as a presenter engage with our slides and the audience, this is where we can really start to think about, what are we adding or using within those slides that’s going to augment and help people remember what we’re talking about or engage with what we’re talking about versus what are those things that are just going to be distractions and then they’re going to miss those important points we’re trying to make.

For example, we can do that priming piece even when we’re giving grand rounds or, let’s say, an SCCM five-minute platform talk, right? We can prime the audience with what we’re going to talk about today. We can also give an anecdote that really helps to capture the audience. For those of you writers out there, that was the hook that we learned about when we first started to learn how to write. Now we’ve got our audience captured and engaged. Then we have to think about how we’re going to deliver that middle section of what we’re trying to talk about.

When we think about creating our slides, again, this comes back to not putting unnecessary information on our slides, not using unnecessary colors or animations. Colors and animations should be used sparingly and to really drive home important key points that you want people to recognize. You also don’t want to have to force people to go back and forth between two slides in a PowerPoint when you’re trying to describe something. You want to figure out how to put all of it on the same slide.

An example that we talk about in some of our workshops here is if you’re trying to teach people about the embryologic development and congenital diseases in the pulmonary system, you want to actually have all of that on one slide, which is, again, where we come back to really thinking about, how do we decrease extraneous information on the slides? How do we intentionally use animations to have points come to the forefront and then maybe fade to the back?

The other thing is trying to avoid unnecessary redundancy. The way that I see this come out most often is when somebody has a quote on their slide and they stand and they read the whole quote, and now the audience isn’t sure, am I supposed to be listening to you? Am I supposed to be trying to read the slide? Is the whole quote important? Is it really certain parts of it? Those are some things to think about how we can optimize the way that we use our slides and the part that we’re talking about to really keep that audience engaged.

Dr. Enfield: Having listened to you for a little bit here, I know that I’m getting ready for a talk for our medical students. It’s an epidemiology review. If you were in my shoes and you were sitting down to think about how to put those slides together, what would be some of the intentional steps that you would take to really help them master some of the core concepts in an area that most medical students sort of dismiss as not important to their lives?

Dr. Emke: The first thing I would do is I would tell them up front why it is important to their lives. That’s the hook, grounding it in something that is important to them. The other thing I would do is I would try to think in advance of, how many key points do I want to make and have them take away? Usually we talk about that being only three to five key points if you’re doing a 50- to 60-minute talk. You’re going to clearly and succinctly put those at the front of your session and then you’re going to come back to them at the end.

In between there, the other thing I would do to help prime my audience is I would tell them how I’m going to use things on my slides to signal importance. For example, I talked about decreasing unnecessary colors. I would start by telling the students, if I bold something and it is in orange, that means that this is a really key point to remember from this slide.

Dr. Enfield: I can imagine the students really liking all of those points and that’s going to help me and hopefully a lot of the other listeners as we move forward. But we also know that we lose people’s attention. What do we know about the adult learner and attention span and how do we keep them engaged through a 50-minute or 45-minute conversation or learning period?

Dr. Emke: Yeah, absolutely. We know that it’s only about a 15-minute span before the brain starts to fade and we no longer can hold things in working memory, and anything that isn’t held in working memory isn’t going to get encoded and sent to long-term memory. When I’m thinking about a 60-minute teaching session, I break it up into three major chunks. The first five minutes are that anchoring, introduction, priming piece. The last five minutes is for summarizing the key take-home points.

Everything else in the middle then gets split into about 15-minute chunks, and after 15 minutes, I do something that forces the audience to engage or to completely disengage. If I’m going to do something that forces the audience to engage, that would be a great time to have a Poll Everywhere question or some sort of check-in question that asks them about what you’ve just been discussing in those previous 15 minutes. We do hear from learners that they don’t want to be, quote, put on the spot. That’s where things like Poll Everywhere or other anonymous question approaches can be helpful because it allows people to engage but they’re less worried about being wrong in front of their peers.

If I want to do something that forces them to totally disengage, that’s where you might have some brief icebreaker-type conversation or question that you pose. Something that just forces the group to stop for a second and, believe it or not, gives space for that cognitive processing. And I just keep that cycle going. You get about three cycles of that before you have to go to your wrap-up and your summary.

Dr. Enfield: That’s perfect. If we’ve done our job halfway decently on this podcast, people who’ve listened to it should have learned by now that they should hook their listener in with an engaging story, just like we were taught in writing. Make sure that the learner knows what they’re going to learn, and then come back to them and give them an opportunity to ask questions. Have I summarized that pretty well?

Dr. Emke: Yeah, that sounds perfect.

Dr. Enfield: I can imagine that the cognitive load for most of us listening to this is going to be pretty intense because this is definitely not what we normally think about. If they want to learn more or have additional questions, are there resources that they can look to to help them get better as educators?

Dr. Emke: Absolutely. For most of us, we have some version of an academy of educators in our own institution. I would really strongly encourage people to look into that as a resource. There are a couple of reasons around that. One, you’re going to probably identify a whole host of local people who are experts in different areas of education, whether that’s feedback, how to give a chalk talk, the one-minute preceptor. By finding your local experts, not only do you start to know who you can turn to for really short faculty development or longer workshops, you can start to see the wealth of experience that’s at your own institution.

Dr. Enfield: That’s a great example. I just want to also point our listeners to the LEAD resources on the Society of Critical Care Medicine’s website, which can be found in the Member Center. In addition to forthcoming webcasts, there are several resources that people can look toward to develop leadership skills, educational skills, and other skills to progress their career.

I know that I’m going to take a lot away from this conversation because, right after I hang up with Amanda, I’m going to be going back to my slides to rewrite them. This will conclude another episode of the Society of Critical Care Medicine Podcast. If you’re listening on your favorite podcast app and liked what you heard, consider rating and leaving a review. For the Society of Critical Care Medicine Podcast, I am Kyle Enfield.

Announcer: The information discussed in this podcast was provided by the Society of Critical Care Medicine’s Leadership, Empowerment, and Development Lead Committee. Find other professional development topics and more in the SCCM Resource Library.

Kyle B. Enfield, MD, FCCM, is an associate professor of medicine in the Division of Pulmonary and Critical Care at the University of Virginia. He received his undergraduate degree from the University of Oklahoma.

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Knowledge Area: Professional Development and Education