Presentation Skills on EM Cases with Eric Letovsky and Rick Penciner.

Whether you’re a first year resident or a veteran of EM, you’ve probably given, or will be giving at least one presentation at some point in your career. On the one hand, presentations can be intimidating, time consuming to prepare for and frightening to perform, but on the other hand, if you’re well-prepared and know the tricks of the trade, they can be fun, educational and hugely rewarding. Giving a memorable and educational talk requires skill. It requires serious thoughtful planning, dedicated practice and creativity. The good news is that these skills can be easily taught.

What we know about giving great talks comes from non-medical fields. We can learn about how to use our voices, eyes and body language effectively during a presentation from stage actors. We can learn how to build great slides from experts in design. We can learn how to use stories to help engage an audience and improve their retention of the material from writers, broadcasters and storytellers. We can learn how to inspire people from professional speech writers, and we can employ strategies to help improve retention of the material from cognitive neuroscientists and educators.

As EM providers, we’re much too busy to read dozens of books on effective presenting, so with the help of two EM physicians and master educators, Dr. Eric Letovsky who has studied the art of public speaking and has been giving presentations for more than 30 years, and Dr. Rick Penciner who has been scouring the world’s literature on this topic for 20 years, we’ll distill down for you the key secrets, tips and tricks, theories and approaches, pearls and pitfalls of presentation skills so that the next time you get up in front of your colleagues to give a talk, you’ll blow their minds…

Written Summary and blog post written by Anton Helman, April 2016

Cite this podcast as: Letovsky, E, Penciner, R, Helman, A. Presentation Skills. Emergency Medicine Cases. April, 2016. Accessed [date].


The three key pedagogical principles in presentation skills

There are three important principles that all speakers must understand in order to deliver a memorable and educational presentation:

  1. People cannot listen and think at the same time – so you need to pause for 2 or 3 seconds (which seems like a really long time) after saying something important so that listeners can absorb what you said.
  2. People cannot read and listen at the same time, and their default is reading – so if you have a busy slide that requires a lot of reading, and you talk at the same time as you show the slide, people will naturally tend to read the slide and not listen to what you are saying.
  3. Less is more – the most common pitfall in giving a medical presentation is attempting to pack too much information into the presentation and thereby overwhelming the audience.


There are only two things you need to convey in a presentation

  1. Your message – aim for a high signal to noise ratio; the signal is your message and everything else is clutter.
  2. Your personality – if you speak in a conversational manner, your personality will come through which helps the audience naturally pay attention to what you’re saying and be engaged in your presentation


Preparation presentation skills

5 “W” questions:

Who is the presentation for? Know your audience – your talk is not about you – it’s about your audience.

Consider the kind of relationship you want to have with your audience. Do you want to be their hero? Their mentor? Their cheerleader? Like these characters, good presenters aren’t in it for themselves; they’re in it for others.

Its important to know your audience. So before you start to write down your presentation, speak to your colleagues and people who might be at the talk and ask them what they would want to get out of your talk.

What is the purpose?

Why are you being asked to present as apposed to someone else?

Where are you presenting? Familiarize yourself with the venue before your talk when possible.

When are you presenting? Is your presentation at start of the day, after lunch when the crowd is suffering from post-prandial comas, or at the end of the day when their attention is waning?

A lot of preparation is mandatory for a good talk.  Try storyboarding, using cue-cards, or recording yourself and listening back. Our experts recommend against starting with your slides.  Slides should be the LAST thing you prepare.


9 words to guide your presentation skills

Tell a story.  Keep it simple.  Manage your flow.

Adapted from

Tell a story

We are wired to tell and receive stories from an early age. We have been telling stories for thousands of years, passing the oral tradition from clan to tribe to family. This tradition has fallen to the way side with modern lectures. Stories engage the audience and allow them to activate prior knowledge and prior experience. A presentation, like a good story, should have a strong opening, interesting middle with some conflict, and resolution with a powerful finish.


Keep it simple

Keeping your presentation simple applies to the content of your entire presentation as well as your slides. A rough guide is to deliver no more than three take home points that you state in your introduction, repeat in the body of the talk with sub-points, embellishments, stories, examples and analogies to illustrate your points, and then again repeat your take home points in your closing remarks.

Repetition is vital to learning.

How to make your presentation interactive

Adapted from

The interactivity does not need to be overt. Presenting in a natural conversational manner helps connect with your audience and augment interactivity.

Interactivity between presenter and audience

  • Direct or rhetorical questioning
  • Brainstorming
  • Surveying the audience or using audience response systems

Interactivity between audience and audience

  • Breaking up into smaller groups
  • Think-Pair-Share – a collaborative learning strategy in which learners work together to solve a problem or answer a question. This technique requires learners to think individually about a topic or answer to a question; and share ideas with each other.
  • Buzz groups – a cooperative learning technique consisting in the formation of small discussion groups with the objective of developing a specific task (idea generation, problem solving and so on) or facilitating that a group of people reach a consensus on their ideas about a topic in a specific period of time.
  • Debates or panels

Interactivity between audience and the material

  • Role playing or simulation
  • Use of patients
  • Case presentations
  • Videos
  • Live interviews
  • Writing


The effectiveness of slide presentations vs presentations without slides

Richard Mayer is an educational psychologist who has made significant contributions to theories of cognition and learning, especially as they relate to the design of educational multimedia. He studied retention and transfer of knowledge from slide presentations vs presentations without slides and showed that there is no difference in learning between the two, even though students prefer presentations with slides. If you are going to use slides, visually rich slides (slides primarily with pictures instead of words) are preferred by learners and tend to augment learning compared to slides with lots of words. When used effectively, “a picture is worth 1000 words”.

Slides should reflect the 3 C’s: clear, concise and consistent in colour, font and style.  

Richard Mayer’s ‘Theory of Multimedia Learning‘ states that students learn more effectively from multimedia presentations than verbal presentation alone. The important principles of his theory are the modality principle, the coherence principle and the personalization principle.

Modality Principle – images and narration are used rather than images and text

Coherence Principle – multimedia presentations are interesting rather than basic; people learn better when extraneous words, pictures and sounds are excluded.

Personalization Principle – the presentation is in a conversational style rather than a formal one

If using slides, aim for a high signal to noise ratio. Throw away everything on your slides that does not help to convey your message.


Presentation skills require performance skills

Giving a presentation is a sort of performance.

Be confident. You can be confident by knowing the material inside and out and practicing giving the talk many times in front of a mirror, to your spouse or your colleague; or video your presentation and watch it to critique yourself. For your voice, alter your tone and pitch like you would in an interesting conversation, and don’t forget the long pause after you say something important. Use hand gestures to emphasize important points, like you would in an interesting conversation. Avoid pacing back and forth, but move around a bit on the stage making eye contact with different members of the audience.

Give as many talks as you can, take risks and enjoy yourself!

Tips for settling your nerves before a presentation

  1. Power posing – spend two whole minutes just prior to your presentation standing in a powerful pose that exudes confidence. This has been shown in studies to help relieve performance anxiety, and even improve performance in job interviews.
  2. Visualization – visualize your self in front of the audience on the stage giving the talk, saying the words that you will say and doing a great job at it.
  3. Meditation – spend five minutes doing deep breathing exercises and/or guided imagery before your presentation


The 10 do’s and dont’s of presentation skills and performance

  1. DON’T stand behind a podium (this barrier between you and your audience detracts from connecting with your audience)
  2. DO make eye contact with audience (as in regular conversation, our brains are wired to pay attention when eye contact is made)
  3. DON’T turn your back to the audience to look at the projected slide
  4. DON’T stand on the stage motionless for the entire presentation and DON’T pace back and forth either
  5. For take home messages or for emphasis DO go to the front and centre of the stage and stand still for a few seconds
  6. DON’T say “I’m sorry about this busy slide”; if the slide is busy, get rid of it
  7. DO use a handheld remote to advance your slides so you don’t have to go to your laptop to advance your slides
  8. DON’T point towards your audience
  9. DON’T cross your arms or put your hands in your pockets
  10. DO put your hands in a sort of running position in front of you


Summary of Presentation Skills

Presentation Skills


Dr. Helman, Dr. Letovsky and Dr. Penciner have no conflicts of interest to declare



Mayer RE. Multimedia Learning. Cambridge University Press; 2009.

Reynolds G. Presentation Zen, Simple Ideas on Presentation Design and Delivery. New Riders; 2011.

Duarte N. Slide:ology, The Art and Science of Creating Great Presentations. “O’Reilly Media, Inc.”; 2008.

Gallo C. Talk Like TED: The 9 Public-Speaking Secrets of the World’s Top Minds. St. Martin’s Griffin; 2015

Effective Presenting. Link

Bergman E. The Presenter’s Toolbox: Time-saving tools to build better presentations. Petticoat Creek Press; 2016.


Additional FOAMed Resources on Presentation Skills

Amal Mattu on How to give a great talk on ERCast

How to build a talk with Rob Rogers, Salim Rezaie and Anand Swaminathan on The Teaching Course Podcast

Chris Nickson blogs on How to Give an Unforgettable Talk on Life in the Fast Lane

Jim Colletti on The 10 Commandments for an Effective Presentation on EMBlog Mayo Clinic

Mike Cadogan on The 10/20/30 Rule of Power Point on the LiTFL post Burn Your Power Points