Sunday, March 26, 2017

Sweet dreams are made of this (Musings on conferences and why we attend them)

Updated: 28 July 2020 (Fixed song's link)
March's blog was stimulated by Twitter, specifically a tweet by UK's Sylvia Benjamin (Further Reading) about the value and limitations of lectures (conference presentation) based on a podcast by physicians Rob Orman and Amal Mattu both with 1000s of followers (Further Reading). 

The blog's title comes from a song by Annie Lennox, one I've used before.

Executive version
This blog will highlight Orman and Mattu's excellent podcast and where I differ with them. Pretty nervy but it's no fun to always agree.

I'll be somewhat provocative and facetious about the real reasons many folks attend conferences and why conference presentations often suck. 

Also included will be strategies for how to make conference presentations better. I offer suggestions because, when Powerpoint (PPT) came out in 1990, I was mid-career in MLS and loved PPT (my handwriting is awful). Accordingly, I pretty much made all the mistakes that now jokingly constitute, 'death by PPT.'

Why continue reading the blog? Maybe for insights into giving presentations and listening to them? Or just to see how provocative I can be? Your choice.

The Orman-Mattu podcast has much useful information for presenters and educators but, after a lifetime of attending lectures at scientific and medical conferences and even giving some, I disagree with two of their premises. 

First, they discuss talks at conferences as if their main goal was to train and educate, then strike this aim down because presentation lectures often fail. Perhaps their premise is a logical fallacy that comes close to a straw man argument?

Second, the podsters claim that lectures are an inefficient way to transmit information and knowledge. That their only uses are to inspire or convince/convert.  About inspire, I confess that many conference keynote speakers are inspiring people who give inspiring talks. Yet even with them I seldom can recall what they said of lasting value. 

But lectures can do much more than inspire / convert. They serve other key functions, which include being efficient and effective ways to 
  • Transmit practical information not found in textbooks or published papers;
  • Emphasize and summarize what the crucial information is on a given topic;
  • Model how practitioners approach and think about problems;
  • Explain the evolving nature of technical and clinical practice and incorporate historical developments to show the big picture;
  • Model soft skills such as professional work attitudes, how practitioners approach feedback on performance, interpersonal and professional relationships and ethical dilemmas. 

In fairness, it may be that Orman-Mattu were giving an executive version of what lectures can do well. 

The presumptive purpose of delivering lectures at conferences is to train and educate, i.e., communicate something worth communicating. And often that fails on many levels. I'm reminded of this clip from Cool Hand Luke:

But is training and education really the main purpose of conferences? Allow me to be a bit facetious.


The accepted purposes of presentations (lectures) at medical conferences by researchers, physicians, nurses, medical technologists are to educate others and disseminate knowledge but the real purposes often include these. My Top Ten:
Perhaps, 'alternative facts'?

1. Present research findings, maybe new research or perhaps old research whose data's been massaged to get more published papers (main way academics are judged, despite lip service to teaching and service to the profession);

2. Justify the expense of attending;

3. Have something to put on academic annual reports;

4. Further one's career, essential to young researchers to obtain grant money to keep their positions;

5. Travel to new cities, even better if they're international and somewhat exotic;

6. Fluff egos: "Yes! I'm a 'thought leader' in my field. I can dine off this research talk at hospitality suites and Big Pharma din-dins for the entire conference."

7. Schmooze and spend quality time catching up with colleagues, often in the exhibitor area at vendors with the best free food and booze;  

8. Escape temporarily from family obligations, which can be especially onerous for females with a busy career, a home to run, and children to care for;

9. For pathologists and others who find social interaction and chit chat awkward, presentations give something to talk about, take the pressure off socializing;

10. For some folks, often married ones, conferences provide an annual opportunity to meet up with lovers (who may or may not be colleagues). Over time I've known quite a few people who regularly did this. They never discussed it with those who knew them, but the reality was an open secret among their colleagues. Just the way things are, never to be mentioned.

What can go wrong with presentations and why do they so often suck? 

1.Busy Slides
Think of the slides that many, if not most, physicians often use at conferences. I'm not picking on docs, it's just that they do most presenting at conferences. 

Invariably, they begin by apologizing for a busy first slide using a tiny font size that is unreadable at 10 feet. With slide after similar unintelligible slide, audience eyes gaze over and judgmental folks who know a smidgen about education / communication tend to think, rather uncharitably
  • 'What arrogance! Or is it laziness? Is he really that clued out? And, jaysus! Why didn't I sit at the back for an anonymous exit?'
2. Entire Sentences
Then there's the not-that-rare presenter whose slides consist of sentences presented in bullet format. As if that's not enough, he (yes, it's often a 'he') reads them word for word. Zzzzz....

Once saw presentations like this from a well known, prestigious researcher who held a high position in a blood system. Confess that I felt sorry for the guy because his level of shyness and fear of presenting must be extreme.

Still, it's torture to endure such talks. One of my favorite Dilberts is the guy who wants to be throttled rather than....(2010-02-28)

3. Ringing Bells
You expect  'ringing bells' aka verbal tics in nervous neophytes. Examples: um, you know, er, like, an almost silent 'okay' at the end of sentences, or ending sentences as if they were questions. Other verbal tics in those who should know better because they are experienced speakers include 'actually' and 'absolutely'. 

Trouble is, once you hear a presenter say a few, all you focus on is the repetitive ringing bells.

4. Pissing Contests
Another distractor may occur at the end of  presentations, where someone in the audience aggressively challenges the speaker over research methodology or conclusions, especially if the speaker did not mention them in the talk as limitations. Ex:
  • It's just an observational study, so weak and unreliable;
  • What new findings does your study show;
  • You didn't take into account these confounding variables;
  • Your small sample size lacks statistical power; 
  • The study has little external validity because....
Nothing the matter with peer feedback and constructive criticism except if challengers clearly have an axe to grind or want to get into a pissing contest to show how clever they are. Also, if they attack someone who is less well known than them, all pretense of collegiality ends and the feedback approaches abuse.

We like to think of transfusion medicine as one big happy family but I've seen such combative nonsense and it's not pretty. 

5. Attention Spans
I'll end this section with noting research about attention spans. An often repeated fact is the average attention span of students is 10-15 minutes, but there's no good evidence to support it. 

Research shows that college-aged students (the group most educational research is done on) listening to lectures have attention lapses during the initial minutes, again at 10-18 minutes, and then as frequently as every 3-4 minutes toward the end. 

I used to joke with my students after ~ 15 minutes that I knew they were fantasizing about sex. The mention of sex immediately drew their attention back to me. Indeed, nodding-off heads and glazed eyes would become alert and they'd invariably laugh. If lucky, I'd have them for the next 5 minutes.

Who knows how attention span research applies to adults. Indeed, older adults because we are an aging profession. And while not necessarily sex-obsessed, today's conference attendees cope with many distractions. They may think of the work piling up in their workplace, of the talk they'll give tomorrow, of aging parents or children and spouses at home, etc.

6. Attention-Getting Strategies
1. One way to maximize attention is to introduce your presentation up front and summarize what it will be about, why it's important, and what you hope listeners will get from it. This is akin to being 'above the fold' in newspaper parlance, i.e., stories that editors think will interest readers and sell papers.

2. Also, consider saying as an addendum to the intro, that if the presentation isn't what an audience member anticipated, it's okay to leave. Add something like,  'Seriously, I can take it and would hate to think of you feeling trapped. If it were me, I'd appreciate the same opportunity.' Believe me, you'll have the attention of everyone in the room.

3. Another effective way to get and keep people's attention is well known by reporters, sometimes called the 'Identifiable Victim Effect' or 'one person's story' effect.  The strategy is to focus on one or two individuals because an individual's story is always more compelling than statistics involving masses of anonymous people. 
  • An example from the 1970s Vietnam war is Phan Th Kim PhĂșc.
  • Perhaps the best recent example of this effect is with refugees drowning in the Mediterranean. The numbers who drowned are now into the 1000s. But nothing got the world's attention more than Aylan Kurdi.
Similarly successful authors tell the story of a few people or one family to illustrate larger learning points with more effect. Think of virtually any book you may read.

So how can conference presenters of scientific and medical studies / topics use the 'one person's story' effect to good advantage? Some examples:

1) Research: Audits of how well nurses follow hospital SOPs and policies when administering blood

Begin the talk with a summary of the story of two U.S. ICU nurses who were perhaps fired for not following their hospital's blood administration policies (Why were RNs fired, Further Reading)

2) Topic: Best practice for bedside identity checks prior to transfusion
Begin the talk with a summary of the story of the UK nurse who lost her license and was charged with manslaughter over an identity error that led to a patient's death. (Nurse spared jail over transfusion error, Further Reading)

3) Topic: Challenge of providing clinical training to students in an age of decreasing resources
or: Current issues in handling medical errors in a quality system

Begin the talk with a summary of a real case like TraQ's Case A-8: Severe Hemolytic Transfusion Reaction Involving a Student (Further Reading) or one you know of personally.

Such real-life stories have the added advantage of telling the audience why your research or topic is relevant.

My experience as a lifelong transfusion professional is that conferences invariably are top heavy with physicians and PhD researchers. Guess that's to be expected given that conference goals are to disseminate and advance research. Not that nurses and medical technologists do not engage in research, just much less often, given how hard it is to obtain funding these days and that research is not usually a core part of their job descriptions.

Also, for a long time it's become difficult for medical technologists to get funding to attend conferences, perhaps transfusion nurses too. 

Granted, today most transfusion conferences include a few front-line medical technologists who work in the trenches, often presenting at workshops. Similarly, there may be the odd talk (or workshop) by transfusion nurses.

The most important thing about any talk is its content and why it's worth disseminating to peers. On that point, conferences don't have nearly the reach of press releases and journal publications. If the research seems to a genuine breakthrough (or is made to sound like it is), local science media can be counted on to gladly gobble up the release almost verbatim because writers are always desperate for something to write about.

Podcasters Orman and Mattu spend time on explaining how to deliver a lecture (present at a conference), including offering only a few take-home messages and reinforcing them, plus using pictures / graphics more and text less. 

They also note the problem with handouts (often PPT slides with room for handwritten notes) that invariably get taken home, filed, and never read again. So true. 

A known problem with the ubiquitous PPT handouts is that audience members will read them and not listen to you. The same applies to bulleted slides, even if there's only a few bullets/slide. 

Of course, presenters love PPT because it serves as a handy crib sheet for the talk. To put up a slide with only a picture would require more effort and memorization. Granted, 'grand poohbahs' usually have given the same or a similar talk dozens of times, so are well rehearsed.

Face it. Most transfusion professionals are not 'rock star' presenters who can mesmerize an audience for 15 minutes or longer, especially when more than 50% of listeners have dined out and partied to the wee hours the night before courtesy of a diagnostic sales rep. 

Since most presenters will continue to use PPT software or similar for conference talks, it's at least prudent to know how to use it. Search 'death by Powerpoint' (~1.7 million Google hits, 26 Mar. 2017) and you'll see how many folks tell us how to avoid it.

But this Dilbert Powerpoint collection conveys the pitfalls more effectively. 

One person whose advice for presentations with PPT slides that I find useful is Garr Reynolds (Tips, Further Reading). An example (Source: Slide Share, Further Reading): 

Also Reynolds doesn't ignore the basics, such as what's the purpose of the talk and especially the 'So what?' message you should look for, including in scientific papers. 

For all transfusion professionals it's an honour to be asked to speak at conferences and increasingly a privilege to attend. Hence, Sweet dreams are made of this. Beyond the title, the song is a favorite of mine. 

An upcoming 'sweet dream' to keep in mind is the CSTM joint conference with the ISBT International Congress in Toronto, Canada , June 2 – June 6, 2018.

This blog's origin: Sylvia Benjamin tweet on a podcast  by Rob Orman with Amal Mattu 

Are medical conferences useful? (12 Aug. 2012)

Blog: The way we were (Musings on the benefits of attending conferences) -11 May 2013 

Garr Reynolds Presentation tips

Garr Reynolds Slide Share

UK: Nurse spared jail over transfusion error

USA: Why were RNs fired? 

TraQ: Case A-8: Severe Hemolytic Transfusion Reaction Involving a Student