We spend a good part of our lives trying desperately to convince ourselves as well as everybody else that we know more than we really do.
There are only two types of speakers in the world, the nervous and the liar.
As a former television reporter and a current medical educator and practicing medical internist, I have taught many sessions and seminars on public speaking and presentation skills. I have met physicians, clinical researchers, executives, and other health professionals who know that their skills and training in this area are deficient and are very interested in learning how to improve. The good news is that most people are much better at public speaking than they think they are. However, no matter what your current competence level is, you can always do better. After you learn how to identify and tap into your natural personality, attributes, and communication style, you will begin to feel more comfortable.
At some point during your professional life, someone will ask you to give a presentation. You may be honored and elated. But like many people, including many physicians, you may also be nervous and even terrified. There are few activities other than skydiving, rock climbing, and public speaking that can squeeze your adrenal glands, raise your blood pressure, and cause more of an overwhelming sense of doom than public speaking. In fact, many people will go to great lengths to avoid speaking in front of an audience altogether.
Physicians, throughout their training and careers, are often asked to do a variety of different types of public speaking—from addressing large academic settings and videotaped seminars to speaking in informal informational settings or leading impromptu discussions. Doctors are asked to speak on important clinical topics at hospital grand rounds; discuss preventative health with patients in the community; lecture about their research at a professional conference; talk to medical students or residents at a noon conference; speak to a television reporter about a timely topic; respond at a press conference about a controversial issue; conduct a job interview through video broadcast; Skype with a team of academic researchers from around the world; or conduct themselves on camera for a telemedicine interaction with patients and colleagues.
On September 14, 2018, Dr. Allan Tunkel, Senior Associate Dean for Medical Education at the Warren Alpert Medical School of Brown University, gave the White Coat Address at Cooper Medical School of Rowan University. It was one of the highlights of his professional career. He told the personal story of his near-death experience while suffering from septic shock and pneumonia in the intensive care unit (ICU). He shared important take-home lessons about healthcare for the medical students present that day. The twenty-minute talk was brilliant and well-received by the audience despite the fact that Dean Tunkel committed several errors in public speaking that day. Specifically, he read most of his talk word for word, was hidden behind a podium, and only looked up at the audience occasionally. But Dean Tunkel is a natural storyteller, and what made his talk so effective were his honesty, humor, and true emotion. He tapped into his personal communication style to tell a thoughtful message about his experience.1
Examples of Public Speaking Opportunities for Physicians
• Grand rounds lecture
• Community talk to patients
• Professional medical conference presentation
• Noon conference lecture for students or residents
• Television interview
• Press conference appearance
• Video or Skype job interview
• Skype with research team members
• Telemedicine interaction with patients and colleagues
Whether you are asked to speak in one of these varied venues with different media platforms, to different audiences about different topics, or in another type of setting, many of the essential communication skills are the same. Fortunately, they are skills and can be learned, practiced and even perfected. Whatever presentation you give, your communication skills, or lack thereof, will be readily evident to your audience. But you will reduce your anxiety and heighten your performance if you have an increased awareness of your natural skills, knowledge of the mission of your talk, and thorough preparation and practice. I have heard many common misgivings about public speaking.
• “If I could improve one thing about my public speaking, it would be to engage more with my audience. I tend to get very nervous and stick to what I need to say, and I want to get the process over with as quickly as possible. This comes at the cost of not reading the audience or being able to make adjustments and tweaks as needed.”
• “Something negative about my public speaking is that if I make one mistake, I struggle to let it go and come back from it. I focus on the mistake that likely nobody else noticed, and it becomes a positive feedback loop of continuing mistakes.”
• “Something positive that people have told me is that my pace is good and I seem confident in what I’m saying, which I think is pretty funny because I tend to be nervous in public speaking contexts and not feel confident at all.”
Individuals are usually filled with apprehension about speaking in front of a group because they do not realize how good they can be by making minor adjustments and how easy it really is. More often than not, many people will avoid talking in front of a live audience or a video camera if they possibly can. But opportunities to speak are important to take advantage of, whether self-directed or prompted by a request from a superior or an organization. Professional careers and personal connections can be enhanced by giving an outstanding presentation with excellent skills.
I have heard many stories from individuals about avoiding public speaking, from turning down invitations to talk to audiences of patients, to turning down media interviews and even professional opportunities to speak at important conferences. One therapist whom I know declined to be listed on a popular physician referral site simply because she did not want to talk about herself and her work in front of a video camera.
She wrote to me in an email, “I don’t like the idea of having to do the video, but that’s just me. I am shy.”
Unfortunately, medical school, residency, fellowship, and other medical and science graduate trainings offer little if any specific instruction or formal guidance about the topic of presentation skills. Studying science courses, doing well on multiple-choice exams, and memorizing mountains of basic science data may produce knowledgeable doctors and successful researchers but not individuals who are excellent communicators. Although training in this area is changing and more education is becoming available, on the whole there is still little instruction or guidance for healthcare professionals who want to present themselves and their work in the most optimal way.
Whether your goal is to slightly improve your presentation and communication skills or to perfect your performance so that you can become an engaging or even motivational speaker, the rules are the same. Yes, you can become a top-notch communicator and effective speaker. Yes, you should care because if you cannot communicate to an audience about your work, then your knowledge, advice, insight, and opinions will not be heard. And unfortunately, your work may be lost, and your experience and wisdom may never be acknowledged or remembered. Your mission may never get off the ground. The spotlight will shine on others with excellent speaking skills and their work. Those with better presentation skills are often more likely to be promoted, funded and rewarded.
Communication and presentation skills are critical for a successful career. Today, many careers in medicine and throughout the healthcare profession require not only that you give presentations in person to large and small live audiences but also that you are camera-ready and know how to successfully perform in a video presentation or broadcast interview.
Ninety percent of how well the talk will go is determined before the speaker steps on the platform.
Analyze Your Communication Style
So where should you begin? Unfortunately, the first problem comes with thinking about yourself and your individual communication style. It seems that just thinking about how we speak in front of another person or in front of a group of people, camera, or microphone can cause anxiety. Thinking about our communication is a little like thinking about breathing: all of a sudden something so natural that you have done all of your life becomes awkward and foreign when you focus attention on it or try to analyze it. All of your negative self-damning thoughts, your inner and outer critics, and the memory of individuals in your life who may have put you down, or even your own baseline nervousness, can come back to haunt you and limit your performance.
You may envision yourself as a poor speaker with all of your weaknesses present instead of beginning to see yourself as an articulate and compelling presenter. Knowing your material and the reason you are presenting it and recognizing your skills as a natural communicator are the first steps to helping your performance. Realizing that you have many talents and assets from different aspects of your life and applying those experiences and confidence to your presentations can also be helpful. Just like you have done in other areas of your life, you can apply these inherent human communication and life skills to improving your presentations. Remember that your work and your knowledge are both important. Your audience needs to be informed about your work and what you need to say.
Think about the traits and skills you appreciate in a speaker. Do you like when the person is passionate, clear, understandable, succinct, and comfortable? Would you prefer a presenter who connects with the audience, stays on message, and is able to successfully tell a story or use humor?
Do you appreciate a lecturer who appears to be in charge of the lecture from beginning to end? Are you impressed when the lecturer remains calm and in control no matter what comes up, such as a technical problem with the microphone or a difficult question or comment from the audience?
One truism that may help boost your confidence is the following: remember that, the vast majority of the time, when you are presenting, you will know more about the information than anyone else in the room. There may be some very smart people in the audience, who may ask you some tough questions, but no one knows your presentation and all the information it contains as well as you do. While your audience doesn’t know as much as you know about the topic, unfortunately they also may not care as much as you do. Your job is to make them understand the information and make them care about it as much as you do. That is why clear, articulate, engaging, and passionate talks are the most effective and memorable. Make your listeners learn and share your concern and interests. Ensure that the audience hears your message and becomes as passionate and articulate as you are about it.
If you don’t know what you want to achieve in your presentation your audience never will.
Try to imagine your audience in a positive light. Instead of fearing your audience and imagining a group of enemies, envision the audience as open, accepting, and encouraging. Instead of thinking about the worst-case scenario, imagine yourself giving a great presentation and successfully completing your mission to a group of friends and colleagues. Remember, when you are an audience member, you just want to listen and learn from an informative and accessible presentation. You assume it will go well. Your audience expects you to win, and they are planning for you to give an effective and informative talk.
Another lesson to remember is that practice improves performance. Start accepting opportunities to speak. When asked to do a presentation, don’t say no and avoid it. Force yourself to say yes to invitations to give talks. Also, create your own opportunities and talk to your boss or colleagues who might help make these types of opportunities happen for you. The more public speaking you do, to small intimate groups or to large audiences, the better you will become at it. Do not shy away from speaking engagements. Speak more. Each time you present to an audience, it will become easier and you will enjoy it more.
After you have secured a speaking engagement, you will want to do three things: First, remind yourself why you want to speak and create a mission statement for yourself about the goal of your talk. Remember and articulate why you are the best person to give this talk. Second, become an expert about the topic you are speaking on and know your information well. Third, know who your audience is and what they need from you. Realize your inherent worth and, most important, the inherent worth of the knowledge you need to impart in giving an excellent presentation. Transfer your nervousness into productivity; start researching and writing your talk. Also, try to attend a few live lectures or watch some presentations online. Take notes on things you like and don’t like. Figure out what kind of presentation skills you want to emulate, then you can begin to gain the knowledge you need to begin to practice and prepare.
It usually takes me more than three weeks to prepare a good impromptu speech.
Even though it is not easy, it is only by focusing on our own communication skills and dissecting them in an objective manner that we can analyze our specific and unique assets and deficits. Then we can begin to learn the important tools to improve. First impressions are key—and that includes first impressions by our audiences about our presentations. Most people make up their minds about us in the first few seconds of meeting us or in the first moments of our lecture; that is why our skills from beginning to end are critical to our success.
There are many common problems people have concerning public speaking. For most of them, there are some easy solutions.
1. “I’ve been told I speak too quickly, so I would like to improve this and find a comfortable pace.”
When most people are nervous, they speak too quickly. Remind yourself that it is almost impossible to speak too slowly. Take a breath. Look out at the audience. Utilize pauses effectively. You should know that while it is hard to speak too slowly, it is possible (and a common error) to speak without enough energy or enough passion. One of the most common errors is speaking too quickly—the other common error is speaking without enthusiasm. Don’t commit either of these errors. Try to connect and convince your audience that what you are saying is important. Try to be natural, clear, succinct and make a good impression. Look up at your audience after important points. Have a conversation with them.
2. “Sometimes I get so nervous when I am speaking that I sort of black out and really lose my self-awareness. I feel like when I am finished, I have no idea how long I have been talking or if I have even effectively gotten my point across.”
Remember it is not about you. It is about the information you are presenting. If what you have to say is important, then think about how important it is to inform and engage your audience with the content of your presentation. Be organized and engaging. Look out at the audience and build a bridge to them. Make sure they are hearing and understanding your important presentation.
3. “I don’t know about my body language when I am speaking. I try not to fidget, but I hear mixed things about using hands versus not or walking around on stage or not—this is something that I know I do.”
The more you can focus on your information and the importance of your talk, the more you will be confident and comfortable with your own body language. The more comfortable you are, the more your body language will follow and display confidence. You won’t worry about your hands, your feet, or your body movements; you will use your posture and gestures like you do when you are calm and in control in other situations. (See section on Nonverbal Communication: Our Body Language in Chapter 1.)
4. “I have been given generally good feedback about my public speaking, but I would say that regardless of external feedback, I tend to feel horrendous while doing it. Some strategies for managing nerves during public speaking would be fabulous. The old ‘picture everyone in their underwear’ trick doesn’t quite do it for me.”
Instead of thinking of people in their underwear (which I don’t recommend), imagine yourself sitting in the audience. What are you expecting from the speaker? You are expecting an informative presentation. You may also be thinking about your next meeting, your daughter’s birthday, and maybe even lunch. In other words, the people in the audience are just like you, they have busy lives and just want to hear an interesting and relevant talk—so give them one.
5. “I feel like I can do okay with thoroughly rehearsed material, but I can stumble a bit if I have to come up with the words as I go.”
Some people do need to read a script, but instead try to write down bulleted points and know the structure and flow of your talk. You will be able to have a dialogue with your audience instead of reading a script. Just like when you have a conversation with one person, you are not reading a script—think about having a conversation with your audience, only it’s one in which you get to do most of the talking. When we “read a script” we tend to lose all of our natural voice qualities and become monotone and emotionless. You will want to give a presentation that is directed to real people in your audience—tell them a story and talk to them as individuals. If you must use a script, mark it up with notes and highlights so you can remember to ad lib, pause and emphasize where necessary. Try to make it more conversational and you will have more success.
6. “I would love to be able to stand in front of others and speak more clearly. I often lose my train of thought and then become roundabout with my word choice.”
Having notes of exact figures or important percentages or other bulleted points in front of you can help you if you lose your train of thought. If you do use a script, you can mark it up so you have notes for yourself. Make your presentation come to life in any way you can. Also, be confident enough that you can easily say, “I think I just got off-track or misspoke; let me back up.” Or, “Is that clear to everyone?” or “Are there any questions?”
7. “I wish I could be more succinct and conclude my ideas better rather than trailing off.”
Just like you do when you are speaking to someone else one to one, make your point and then move on to the next point. Put a period at the end of each sentence. Be confident, clear and concise. Each talk should contain between three and six take home lessons. Write these down beforehand. Make sure you discuss all of them and reiterate them before you finish.
8. “I would like to eliminate space-filler words during public speaking. I want to deliver a short speech effectively.”
We all use excess words as crutches or filler words such as “uh,” or “yeah” or “do you know what I mean?” and one way to help reduce these is to audio record or video tape yourself. If you hear yourself using unnecessary phrases or filler words as crutches, it will be easier to eliminate them. Catch yourself saying these words in any way you can and work on stopping the use of them.
9. “I would like to have more confidence and focus.”
Think of an activity or hobby you are good at and enjoy, such as golf, tennis, playing an instrument, or another hobby. Transfer your confidence, including body language, tone of voice and other confident mannerisms into your public speaking skills. When you walk onto the tennis court, how confident is your posture? When you play the piano, how peaceful and focused are you? When you are talking to your best friend, how happy and engaged are you? When you are talking to your children, how clear and encouraging are you? Try to emulate these gestures and feelings while speaking to your audience.
10. “I would like to know how to make eye contact without making it look like I’m intentionally and deliberately trying to make eye contact with people.”
Look at one face at a time in your audience. Smile and look into people’s eyes while you are talking until you see a nod or smile. Pretend the person you see is the only person in the room, then move on to someone else until you gradually build the number of friendly faces you have connected with to as many people as possible in the room. Their facial expressions should calm you down and give you immediate feedback on how you are doing.
11. “People tell me my voice doesn’t sound like it’s shaking, but to me it definitely sounds like it’s shaking.”
Take a few slow deep breaths before you begin speaking. This can help calm your nerves and reduce the shaking. You can try to yawn a few times before you walk on stage. Slow yourself, heart rate and ultimately the speed of your talk down. Think of a person, a situation, a geographic location or an activity you love. Close your eyes for a minute and imagine you are in a serene, confident and happy state. Smiling and stretching your body can help as well. Try not to focus on your voice or yourself. Instead focus on the information and how best you are going to engage and teach your audience.
How to Assess Your Public Speaking
1. Make a list. Be honest with yourself about your strengths and weaknesses as a communicator and presenter of information, but do not be hypercritical. Write down a list of your perceived strengths in all areas of communication, not just presentation skills and not just when speaking to an audience. Think about your strengths when speaking to a friend or family member or to students, residents, or employees and write these strengths down. Now think about what you would like to improve in your presentation style. You can write down just one word or make a list. Write down any weaknesses you have when communicating or as a presenter. Try to make your strengths a longer list than the list of weaknesses. Next to any weakness, write down the correction you need to make.
• I mumble. I will learn how to improve my articulation and enunciation with specific knowledge, exercises, and practice. (See exercises in this chapter.)
• I speak too quickly. I will learn how to slow down by focusing on serene thoughts and my breathing. I will use pauses and look out at the audience when I speak.
• I speak too softly. I will learn how to breathe properly using a full diaphragm and speak with enough volume, passion, and energy to be heard.
• I am afraid to look at the audience. I will think of other situations where I am confident and can easily make eye contact with others. I will use this tactic as immediate feedback on how I am doing. Reading the facial expressions of my audience is as important as reading the facial expressions while sitting across from someone while having a face-to-face discussion. There is no better and immediate way to realize your audience is confused, bored, or happily engaged, then looking at specific faces in the audience.
• I am worried about my accent. There are excellent, dynamic presenters who speak in every language and have many different types of accents and different types of voices. I will embrace myself and my beautiful unique voice and use it to my advantage. If I need professional evaluation or help, I will consult a voice coach or speech therapist. There is usually no reason to eliminate accents that may be different from the native language of your audience.
2. Ask others. If you need help making a list of your present communication style, talk to a supportive friend or colleague or even a professional voice coach, speech therapist, boss, or superior to help evaluate how you are at communicating and how you can improve. Ask for your reviews after you give a presentation—and ask your colleagues to tell you honestly how you can improve. You can also ask family members and peers about your communication and presentation skills. Compare this list with the one you created for yourself.
3. Video yourself. Finally, record yourself doing a one- to two-minute presentation about your work or topic of interest to you with your computer or your phone. You can use some notes but try not to read a script verbatim if you can help it. Just talk to the camera like you are talking to a friend or a student about your topic. When you are alone, just open your laptop or smart phone, push record, and look into the camera and talk about something you know and are passionate about such as your work, sports, a hobby, or a recent vacation you took. Watch and listen to the presentation. Be kind to yourself. Give yourself an honest assessment. Write down what you like and what you would like to do better. Most people can smile and soften their features at the very least—which, believe it or not, helps their voice sound more natural. Another method to evaluate your voice is to record yourself talking on the phone to a friend or your mother. Listen and evaluate your natural tone, inflections, speed, and clarity. Most people have wonderful voices when they are talking naturally to friends or family members.
4. Read your reviews. When you do give a presentation to a live audience or a videotaped performance for others to watch, welcome any feedback. Look closely at the audience reviews to see where and how you might improve.
5. Watch the experts. Watch people you think are good, whether they are professors, politicians, actors, journalists, or even your colleagues. What makes them so good? Try to figure out what it is they are doing that you like. Are they earnest, confident, and making eye-contact? Are they prepared and knowledgeable but also able to handle spontaneous comments or difficult questions? Are their words and their voice clear, pleasant, and understandable?
Best way to conquer stage fright is to know what you’re talking about.
—Michael H. Mescon
Improve Your Voice (Your Instrument)
Your voice is literally your instrument. When you give a presentation, how people feel about your voice will be integral to how they perceive your presentation.
Think about how you react to various types of voices when you hear others presenting. Whether their voices are high and screechy or low and mellow may determine how long you can listen before leaving the lecture or before falling asleep. What about when someone talks too softly? Is that frustrating for you? Or what about when someone speaks indistinctly or incoherently or speaks too quickly or talks too loudly? Is that irritating to you? Besides our body language, our voice quality may have more influence on people’s perception of us and understanding of our presentation than any other aspect of our communication skills.
Mistakes People Make with Their Voices
• Pitch too high (screechy)
• Volume too soft (inaudible)
• Energy too low (too mellow or monotone and without passion)
• Poor articulation (mumbling, chewing gum, or fingers in front of mouth)
• Speaking too quickly (it is hard to speak too slowly)
• No pauses (pauses are important and natural)
Do you remember how annoying it can be during a phone conversation with a bad connection or listening to the radio when the signal keeps cutting out? How does it make you feel when the presenter’s microphone volume is too loud or too soft? Often, when you give a presentation, you will be speaking through a microphone. It is okay to ask the audience if everyone can hear you—ask specifically whether the volume is too high or too low. You may be speaking perfectly, but if the volume of the microphone is off, or worse yet, if the audio transmission is scratchy or a speaker is broken, your audience may become upset with the sound of your voice and it has nothing to do with you. If the sound system is broken, take off the microphone and speak in a volume that is audible (and pleasant) for the entire audience. You may have to increase your volume.
Always look to your audience for feedback. If even one audience member is wincing or cupping an ear, you know something is wrong. Your audience members will let you know how you are doing. You just need to look at them to see their facial expressions and body language to measure their comfort and understanding of your presentation.
What type of voice is most easily heard and understood? In an article published in Science Magazine in 2012, Sabine Louet wrote: “A growing body of evidence from multidisciplinary research in acoustics, engineering, linguistics, phonetics, and psychology suggests that an authoritative, expressive voice really can make a big difference.”2 Someone who speaks slowly with a low voice and a pleasant intonation can be perceived as someone with a commanding influence. According to Louet’s article, a good example of an authoritative voice is the voice on the New York subway that says, “stand clear of the closing doors.” If you listen closely to professional actors and broadcasters, male and female, as well as different speakers during presentations you attend, you will begin to identify voices you like. Try to figure out what type of voice the person has and what is pleasing, or not pleasing, about it. There are many different voices with different pitches and tones as well as speeds and inflections. The common trait that all successful voices have is that they are authentic and true to the personality of the person speaking. That said, the voice still needs to be supported with a full breath, coming from a confident posture. You need to articulate your important message with the correct volume and energy by properly opening and utilizing your vocal instrument.
Of course, perception of a voice is very subjective. Our culture, geography, gender, age, ethnicity, professional norms, and other biases can influence our perceptions about another person’s voice quality. Overall, it seems that low and slow voices from confident male and female speakers using good volume, inflection, and enunciation are often perceived as the most pleasing and commanding.
However, speaking with your natural pitch is just that—it is YOUR pitch produced by not stressing or straining your vocal instrument or trying to imitate someone else. The phrase “speak low” may make some women, and maybe even some men, try to speak lower than their natural pitch. This is a mistake. You should never try to speak higher or lower than your natural pitch. This will strain your body and make your voice sound unnatural, and it can be harmful to your vocal folds. To find your true speaking pitch, say “ho-hummm,” and the pitch of the “humming” sound is usually your natural pitch.
Similar to the way a singer determines whether they are a soprano, alto, tenor, or base, you can find and speak in your proper range and comfortable pitch. If you are a soprano, your voice can sound wonderful and melodic unless you try to pretend you are a tenor. Many women in the early years of news broadcasting used to speak with an artificially low pitch, and some still do. But speaking with your natural voice and with your natural pitch will help your voice sound the best. If your throat hurts after giving a speech or at the end of a long day of talking, you may not be speaking at your natural pitch, or you may have other vocal problems that a speech therapist or vocal coach could easily identify.
Listening to a badly tuned voice is like a badly tuned radio.
—Alan Mars, Voice coach
The production of voice, while complex, is still a product of our neuromuscular bodies and can be improved with good instruction and practice. Pitch, volume, timbre, speech rate, and articulation are all essential aspects of our voices and all amenable to training. A speech therapist or vocal coach can help you work on any major problems you may have, such as poor pronunciation, lack of breath control or volume, using the wrong pitch or stuttering. For many people, just practicing a few simple daily exercises and following some specific guidelines when speaking can help improve the quality of their voices. You may also consider taking an acting class, signing up for speech therapy or voice instruction, singing in a chorus, joining a debate club, teaching, coaching, leading groups while hiking or exercise, or engaging in any other pursuits that require you to use your voice regularly, publicly, and effectively.
Almost a decade ago, I joined a chorus. I love music, and I have always wanted to sing. But I also hoped that singing regularly at weekly rehearsals and performing concerts throughout the year would improve my vocal quality and speaking voice so it would remain strong, full, and healthy as I aged. It has worked.
I can prove that regular singing in a group has improved my speaking voice quality by simply watching myself on television or on video. Singing has indeed improved my voice by improving my breathing and use of my diaphragm. The pitch, volume, and modulation of my voice are all more natural now. Just like when you are singing correctly, if you are speaking correctly then your throat should not get tired or sore after giving a talk. When I appear in television presentations now, my voice sounds better at midlife than it did during my twenties when I was reporting regularly on television. Back then, the problems with my voice were numerous. I would run out of air at the end of long sentences. When I was tired, my voice sounded weak, hoarse or artificial. Sometimes my throat would be sore after speaking for long periods of time. But I have learned that relaxing my throat, neck, shoulders, and face and opening my jaw and using my full diaphragm and breath to support my voice (as well as speaking with my natural pitch) have helped eliminate vocal problems.
You may be able to think of many other activities or hobbies, including singing or reciting poetry or storytelling, that require good posture and use of full breaths and vocal muscles to help you regularly produce a pleasant and understandable projection of your best vocal speaking voice. Try to engage in these activities as much as possible. Your voice muscles are like other muscles in your body—you need to use them to keep them in shape. Here are some tips and exercises that can help you improve your voice:
1. Speak up and project.
2. Smile when you speak.
3. Slow down and enunciate.
4. Practice deep breathing and controlling your breath on the exhale.
5. Speak naturally and avoid being monotone.
6. Do vocal exercises (listed next).
7. Read aloud in front of a mirror.
8. Record yourself reading and listen to it.
9. Hire a voice coach or see a speech therapist.
Exercises to Improve Your Voice
1. Good posture. Stand on two feet in a confident and comfortable manner. Make sure your weight is evenly distributed over both feet. Make sure your feet are hip-width apart. Do not lock your knees. Make sure your feet do not appear nailed into the ground or that you are frozen in position. You can take a few steps one way or the other if you want. Arms at your side. Your posture will affect your voice, and your body language will reinforce your image of confidence. Before we sing, we always stand and spend a few minutes making sure our posture is good. Our hips are over our knees. Our chests are lifted, ribs are in, and abdomen is soft. Move your head from side to side and drop one ear to one shoulder and the other ear to the other shoulder to loosen your neck. Do not stand on your heels or lean on one hip. You should be upright, strong, and supple like a dancer. Do not fidget or be rigid or appear frozen. Stand, breathe, and move with confidence.
2. Breathe. Yawn a few times to open the jaw. Now take a deep full breath in on three counts and exhale out on three counts. Now again on five counts in and five counts out. Do this a few times. Diaphragmatic breathing is easy for some and counterintuitive for others. It took years for it to feel natural to me. Singing helped me the most. Put your hand on your belly. When you expand your belly as you breathe in, fill up slowly until you cannot take any more air in; then as you exhale, contract the belly and slowly but steadily breathe out. You will eventually feel the diaphragm literally pulling down and out to fill your lungs with air and then pushing up and inward as you exhale. The expansion as you inhale can be felt around the circumference of the mid-body including the back and the sides. A strong diaphragm and good breath control will give your voice more power and projection.
3. Relax. Try to remove any tension from your body, especially from your face, jaw, and neck to your shoulders, back, and legs. Just as tension affects our bodies, it certainly affects our voices. The more at ease you are, the better your voice will sound. You should be alert, engaged, and ready to sing (or give your talk). Do a few shoulder rolls forward and backward. Twist your body gently from side to side. Breathe in and sigh out.
4. Warm up and strengthen your instrument. Do some lip trills. This is what you may have called “motor boat” when you were young or playing with young children. Use air to vibrate your lips. You can hum notes or hum a song you know (e.g., “Oh, Say Can You See” or “Happy Birthday”). If you have trouble doing this, gently push or pull the sides of your lips together. You can also try to do a few enunciation exercises as outlined later.
My mother was a professional broadcaster and theater actress. As a little girl, I would ride in the car with her and listen as she practiced elocution and breathing exercises on the way to the broadcast station or theater. She would literally be warming up her vocal instrument so that she would be ready to perform. Try a few of these exercises to help warm up and keep your vocal skills sharp:
Exercises to Improve Enunciation and Elocution
Say these slowly at first and then increase your speed:
• She sells seashells by the seashore.
• How now brown cow.
• Peter piper picked a peck of pickled peppers.
• Red leather, yellow leather.
• Unique New York. Unique New York.
• Betty Botter bought a bit of butter. But the bit of butter Betty Botter bought was bitter. So, Betty Botter bought a better bit of butter.
Read one or two of the exercises daily for at least several days before your presentation. Try to increase your speed. Record yourself. If you memorize a few of these, you will be able to use them as part of your warm-up exercises before you give a presentation.
There are many other exercises to help you awaken and strengthen all of the muscles of the face, tongue, throat, and diaphragm that produce your voice. You can certainly find many of these exercises on YouTube and elsewhere. You can also consider scheduling an appointment with a speech therapist and see if you need any professional help. You can hire a voice or singing coach to help you improve your voice or join a community theater or chorus.
1. Yawn five times. Soft palate lifts, brings down the lower jaw, and opens and stretches your instrument from the lips to the throat to the diaphragm. Some problems with voice, including a “nasal” quality or even mumbling, can be due to our tongues not being engaged and our soft palates not being lifted. When the back of our throat is opened (like during a yawn), the voice can sound better.
2. Lip trills. Awakens and strengthens the muscles around the lips.
3. Tongue trills. Engage the tongue, say “butter”; then bend tip of tongue up to roof of mouth and vibrate while making a sound. This awakens and strengthens the tongue.
4. Say “Ho-hummmmmm” then hum a song or a scale. With the lips closed and the jaw, mouth, and back of the throat wide as possible. This will open and soften the throat—as well as help you find your natural pitch.
5. Stifle a laugh. Keep your lips firmly pressed together. This will activate your jaw, lips, and other face and throat muscles.
6. Tongue circling in the front of upper and lower teeth. Both directions. Count 4 right, then 4 left, then 3-3, 2-2, and 1-1. This will help strengthen and improve the agility of the tongue for clearer enunciation.
7. Say or sing a vowel for as long as you can. (A) “ah” (E) “eh” (I) “eye” (O) “oh” (U) “oo.” Use a full breath. Sing or say one vowel at a time. Open your mouth as wide as you can (look in the mirror) and deepen the back of your mouth and expand your diaphragm.
How can we improve the projection of our voice? When we give a presentation, it is very important that we project to an audience with a full and resonant tone. We need a full breath and the ability to control it to produce this sound. According to Jayne Latz, speech pathologist, our power source is our diaphragm and there are many exercises we can learn to strengthen and engage it.3,4
Here are her exercises as well as some I do in singing workshops: Stand or sit up in your chair with your feet firmly planted. (Do not do anything that makes you dizzy or feel sick. If you do feel faint, stop right away.) Make sure you are comfortable. Breathe in and then count loudly as far as you can. “One, two, three, four. . . .” Try it again and see if you can increase the number each time. Make sure during the last few numbers you say that you are still using a strong and full voice. Again, breathe in and then count aloud. Keep adding on to the numbers if you can. Fill your back muscles with air. Count outloud on the outbreath to ten, then to fifteen, and then try to count to twenty loudly and clearly if you can. You can also make a “hissing” sound on the exhale or sing or say a vowel sound (“ah” or “eh”). Look at your watch and time it, and continue to try to make it longer each time. Again, if you feel dizzy or out of breath, stop immediately and sit down.
You can improve your voice by doing these types of exercises daily. After becoming familiar with these types of exercises, you may begin to feel your diaphragm as you take much fuller breaths. Our breath is what produces our voice. The fuller our breath is, and the more we learn to utilize and control it, the better our voices will be. Speaking coaches will work with the specific characteristics of your voice, improving in areas where you may need it the most, from your volume and resonance to enunciation and clarity. There are many tools and techniques that can improve the quality of your voice. But the bottom line is that the better your voice is, the better your presentation will be.
The best thing most speakers can do is optimize their ordinary speaking voice for public performance. Audiences will like you better for it—and you will feel both more natural and more relaxed as a result.
—Tina Blake, Voice coach5
Four Common Mistakes in Presentations
Common Mistakes in Presentations
• Letting your nerves get the best of you
• Reading every word of a script
• Speaking too quickly
• Not engaging the audience
After years of leading communication skills training workshops and programs, I have witnessed many different types of problems, but there are some common mistakes I see most people make. Fortunately, there are many relatively quick and easy solutions.
Letting Your Nerves Get the Best of You
There is no doubt that if you let your mind create a stressful environment, then a shower of negative thoughts and anxiety often carried by your stress hormones will cascade over you during the classic fight, flight, or flee response. Once that physiologic mayhem begins to happen, it is hard to give a calm, clear, and concise presentation. Trust me, even the best public speakers get nervous, but they stay in charge of their nerves and emotions by doing the following:
1. Realize it is normal to be nervous. Expert speakers realize that being nervous is a normal response. In other words, if you are not nervous, something is wrong. But the level of nervousness and how you handle those nerves will determine your success.
2. Channeling nervous energy. You can channel nervous energy into a good performance with tools such as positive thinking, remembering why you wanted to give this talk and how important the information is for the audience. Remember to use your breathing and visualization techniques. If you are in charge of your emotions, you will be in charge of your presentation.
3. Think of activities you are good at. What are you really good at? Think of the professional activities (e.g., operating as a surgeon, speaking with patients or medical students, diagnosing illnesses, talking to employees) or personal hobbies or activities (e.g., golf, tennis, skiing, painting, playing a musical instrument, talking to your children). Now, think about the confidence of your speech and your body language when you are doing those activities. Try to emulate your body language and voice from those activities when you give your presentation. Remember how nervous you were when you were a medical student and you interviewed your first patient? Think of how comfortable and confident you are now when you interview patients and know that you can be the same way in your presentations.
4. It is not about you. One way I have calmed down many medical students and residents and improved their presentations of patients’ histories and physical exams is to remind them why they are doing the presentation. Presentations on rounds or while handing over care to another doctor are done to ensure that the next doctor or other doctors can take great care of your patient. The presentation is about the patient and not about the student or resident giving the presentation. The same is true for you. Remember, your presentation, regardless of the topic, is about the information you are teaching and message you are imparting. It is about your ultimate goal and overall mission in doing the presentation; it is not about you.
5. Visualization and imagery. I often tell people to imagine that the presentation is over and visualize it playing out in the best possible way. Ask yourself a few important positive questions. How did it go? How great was it? How did you want your presentation to go? How did you want your audience to think about you and remember your information? Now, go out and make your presentation that way, just as great as you imagined it.
No one ever complains about a speech being too short.
—Ira Hayes, US Marine
There is another strategy called a “premortem” (hypothetical opposite of a postmortem) or “prospective hindsight” that business people often use before a project is launched. A project team imagines that a project or organization has failed and then works backward to determine what potentially could lead to the failure of the project or organization. You could certainly do this before giving your presentation. Think about all that you are worried about. Play out each scenario or even write them down. When you review them one by one, they will not look so bad, and you can think of ways to prevent your worst fears from coming true during your presentation.
According to an article in the Harvard Business Review written by Gary Klein, “unlike a typical critiquing session, in which project team members are asked what might go wrong, the pre-mortem operates on the assumption that the ‘patient’ has died, and so asks what did go wrong. . . . The pre-mortem analysis seeks to identify threats and weaknesses via the hypothetical presumption of near-future failure. But if that presumption is incorrect, then the analysis may be identifying threats/weaknesses that are not in fact real.6
Ask yourself why are you so nervous to give this presentation. Articulate your specific reasons and fears out loud or write them down. Many of your fears may seem ridiculous and somewhat irrational. But you can also begin to create an emergency toolbox if any of your fears begin to come true during the presentation.
• Are you afraid you are going to freeze and forget what to say? Bring your cheat sheet of bulleted points and engaging quotes or phrases and, yes, even a script if you must. Prepare and practice beforehand. Take a deep breath. Look out and find a friendly face and smile. Calm down. Go with the flow. Be kind and supportive of yourself before, during, and after the presentation.
• Are you worried your throat will get dry and you will lose your voice? Bring water and some throat lozenges and keep them handy. Taking periodic sips of water (not a caffeinated beverage) will keep you hydrated and, most important, will give you and your audience a nice break.
• Do you fear you will make a mistake or lose your train of thought? Remember you are human. You might make a mistake. It is okay. Often, your audience will not notice, and even if they do, just apologize and get back on track. Again, bring your specific notes to glance at. Prepare and practice beforehand. Learn to react on your feet. “I am sorry, I think I just misspoke or stated that the wrong way. This is what I meant to say.”
• Are you afraid your audience won’t like you or you will look like a fool in front of your peers? Most audiences want you to succeed, they want to hear and be rewarded with your great presentation. Don’t imagine them in any other way. Look out while you are speaking to get immediate feedback from their expressions (and comments or questions) and then adjust as needed.
• Are you worried you will speak too quickly or in a monotone voice or not be understandable or look too stern? Videotape yourself practicing the talk. Watch and listen to it, and you will immediately see what you need to fix. Do you need to slow down or smile more or take a few pauses at important points? You may be your worst critic, so you may want to ask a friend to look at the video with you. Once you see yourself, you will likely know how to sound and look better.
• Think you may faint? Remember to sit down immediately if you are feeling faint or ill in any way. Tell your audience or others on the panel if you think this very rare event might be occurring.
• What will you do if you are asked tough questions? You should always try to predict the questions and comments you might receive from your audience and write down the answers beforehand. Prepare a list of responses such as, “that is a very good question but it is outside of the scope of my talk” or, “that is an interesting and important comment, I am happy to talk to you afterward.” Or you can always repeat the question back to them. Ask them to clarify the question and give you more specifics. “That is a good question—why do you ask or what do you think the right answer is?” Answer the question the best you can or simply say, “I am not sure of the answer to that.” Many people who ask tough questions just want to be heard and are not attacking you or your work. Even if they are challenging you, it is always best not to react emotionally or become defensive. Remain calm, confident, logical, in charge, and credible. The audience knows you have just received a tough question and, many times, they are just watching to see how you handle yourself and whether you can give an answer. Remember that your audience is not your enemy—they are your students and they are there to learn from you. But you are also there to learn from them, and like any conversation, it is okay to have a good give and take session. Ask them questions. Learn from them and what they have to say. Maybe someone in the audience knows the answer to the tough question someone else asked—listen to the answer, congratulate them and move on. Create and keep a collegial and supportive environment during your presentation.
• Could the computer or audio/video equipment fail? Think about all the possibilities of how technical equipment might fail, assume that it will, and have a backup thumb drive or alternative source of power or microphone or other important backup equipment. Know who and how you can call for assistance and how you might finish your presentation even if the equipment fails.
• Might the audience boo you or throw tomatoes at you? Keep a hooded rain jacket handy.
While you should consider the possibility of some of your worst fears happening, generally they will never occur. After you have examined your worst fears about public speaking, begin to focus on the positive aspects of yourself and imagine your presentation being a success. Just like in sports or in theater, visualizing a positive performance while you are preparing your presentation and before you begin are key to an optimal performance.
It takes one hour of preparation for each minute of presentation time.
—Wayne Burgraff, American philosopher
One major reason that we become so nervous speaking in front of an audience is our fear of being evaluated, assessed, and rejected. Trust me, people are already evaluating, assessing, and, yes, even rejecting you at times, and there is very little you can do about any of it. So, during your talk just be who you are every day. Just prepare and know what you want to say, then practice your presentation, smile, be calm and confident, and remember to imagine and rehearse giving a great talk beforehand.
Visualization versus Premortem
Personally, I like to imagine myself giving a great talk in the exact setting I will be speaking in. I like to close my eyes for a few minutes and actually watch a movie of my performance, similar to what athletes do before they compete. I may even try to visit the location or simulate it in my office. I may record myself with audio or video so that I can watch myself and see if I sound and look okay. The minute I hear and see my recording, I can see things I can improve on. Am I speaking clearly and with enthusiasm? Or am I speaking too slowly or sternly? Am I smiling? Am I pausing and using natural infections? Am I sounding hesitant or unknowing? Am I slowing down and using important pauses when I say something really important? Do I sound natural? Are there any words, names, or data that I am worried about stumbling over? I focus and rehearse and sometimes record these beforehand just to make sure I reduce the risk for error.
Athletes and actors use visualization all of the time. Writing more than two thousand years ago, the famous philosopher and scientist, Aristotle, described the process this way:
First, have a definite, clear, practical ideal; a goal, an objective. Second, have the necessary means to achieve your ends: wisdom, money, materials, and methods. Third, adjust all your means to that end.
Creating the mental image of how you want your presentation to go can help you achieve your desired outcome. If you can see it before you perform it, then you can lower the chances of your nervous energy getting the best of you before you speak—and improve your odds of giving a great talk. We must see it before we can believe it. Before we can believe in a goal, our brains and our bodies have to know what it is going to look and feel like.
Reading Every Word of a Script
There are very few people who can read a speech word for word and make it engaging and effective. Usually, it will sound flat, perfunctory, and unnatural. Most of the people who can read a scripted presentation and sound engaging are actors or professional broadcasters.
But instead of using a script, you should have an outline with prepared bulleted points, data, and conclusions. If you are using slides, this can always help you stay focused and organized. But you still want to include your own impromptu comments, personal stories, or maybe even some light humor. You want to have a conversation with your audience about your key points. If you have a conversation (and don’t read a script), you will use natural pauses, modulation, and inflections; you will speak in your normal voice. You will use natural body language and facial expressions. You want to interact and react with your audience. You will not be frozen in a monotone voice or appear like a “deer in the headlights” in front of your audience. The key is to sound like you are having a discussion with your audience. Each audience is different so each time you give your talk it should be slightly different.
If You Must Read a Script
If you must read a script, and sometimes you will, then you need a well-written (and well rehearsed) script in a conversational tone. Use shorter sentences. Write creative, engaging and memorable phrases. Think about cadence and word choice and even poetry or free verse. Mark up your script while rehearsing it. Find the areas where you need to slow down or to pause. Your words need to be powerful, unforgettable, and well-selected. Think about political speeches and remember there is a reason that speech writing is a professional career. When you have a well-written script, you will need plenty of practice to use your natural speaking voice and make your message indelible. Remember to look up and out to your audience as often as possible. You can use your finger or a pen to keep track of where you are so when you look back down you know where to begin again. Professional broadcasters and actors are very good at this because they literally make physical or mental notes about when to look up at the audience and when to pause. (And they rehearse!) It takes practice reading from your notes or a teleprompter to appear natural. If you are using a teleprompter, ask for help beforehand and try to rehearse with the device as many times as you can. If you must read a script, you will have to practice looking relaxed, acknowledging individual faces in your audience, and speaking with varied tone, pitch, and breathing to emphasize important points. You need to allow your audience to listen and enjoy your words. Making notes in the margins of your script to remember to smile, breathe, and make eye contact can be helpful and important. Underlining or highlighting statistics or important phrases can be critical.
Speaking Too Quickly
Many people speak too fast. Most people do not speak too slowly. Again, in reality, for most people it is almost impossible to speak too slowly. The biggest problem with reading or memorizing a script (or being nervous) is that you may tend to speak even more quickly. Reading a script (or memorizing a script) may make you speak too quickly, but even when not reading a script, many people will speak with too much speed. Unfortunately, if you do speak too fast, people will not be able to understand you. Imagine if you spoke a foreign language to your audience. They would not understand, much less remember a thing you said, right? If you speak too quickly, you might as well speak in a foreign language because your audience will not understand you.
By slowing down a speeded-up presentation and using passion and natural inflections and rhythms of your own voice (and making eye contact with your audience), you will be seen, heard, and remembered. Speaking in a flat monotone voice without any energy is not the same as speaking too slowly. In all my years of teaching communication skills, I have seen very few people speak too slowly.
Not Engaging Your Audience
One of the most common problems for many speakers is not smiling, making eye contact, or using natural facial expressions. You need to make eye contact with the audience as much as possible, and avoid a “deer in the headlights” appearance. Smile more and use natural expressions. If you are speaking about a very serious subject, and smiling would be inappropriate, you can soften your facial features and avoid looking stern or nervous by appearing earnest, solemn, calm and encouraging or using other emotional expressions suitable to your topic. Before you begin speaking, take a full breath and look out to your audience. Find at least one friendly face and connect with them. Throughout your presentation, continue to find another friendly face to connect with. If you do this, you will receive three major benefits: First, you will appear calm and confident. People will trust you and look right back in your eyes. Second, you will receive immediate feedback on how you are doing. If your audience is looking perplexed, you are not being clear or believable. If your audience is looking bored or distracted, you are not being conversational, enthusiastic, or engaging. Third, in looking up and out, you will pause, and your speed and delivery will be more natural.
As I mentioned earlier, I developed a lesson to help people improve their public speaking presentations and other communication endeavors. I call it, “MACY” for mission, audience, content, and you. These are the four important aspects to think about before and during your presentation. Before you begin to plan and practice your presentation, try to answer these questions:
• M—Mission: What is my mission? Why am I speaking? What is the purpose of this talk? What is my ultimate goal? If I could accomplish one goal with this talk what would it be? State your mission in one sentence.
• A—Audience: Who are they? What do they need from me? What do they already know? (You may need to ask them directly.) What do the members of the audience want to know? What will they learn from my talk? How can I be most responsive to their needs?
• C—Content: Make sure it is organized and informative. Use words and phrases that make your message concise, relevant, and engaging. Tell a story if you can. Overall, make sure your talk has a beginning, a middle, and an end. Be prepared with specific points you want to make but also be prepared to improvise. Have a conversation with your audience about your important points. Do not read every word from a prepared lecture.
• Y—You: Be prepared, organized, and rested. Be calm, clear, and confident. Rehearse the entire talk at least twice in the week leading up to the talk. Know why you are the best person to give this talk on this day. And remember, it is not about you—it is about the information you are presenting.
I am convinced that most people have all the tools they need to be a great communicator. To help you improve, it usually requires identifying and tapping into your natural communication skills and then using them in an unnatural setting. It also requires identifying and eliminating obstacles or habits that may be getting in your way of giving a great presentation.
How can you identify and tap into your natural communication style and skills? Think about when you are with friends, trusted colleagues, or beloved family members. Stop and listen to yourself when you are talking to a friend or doing an activity that you are good at. Most likely you are clear and confident. You know you have something to say and something to do, and you go about doing just that in a natural way. Your body language and posture, as well as your facial expressions and your voice, tell everyone you know what you are doing. That character and persona is what you need to tap into to transfer these attributes to your presentation skills. But how do you translate being poised, eloquent, fluent, effective, persuasive, lucid, expressive, intelligible, comprehensible, and understandable into another setting—particularly at a podium in front of a large audience or in front of a video camera in a television studio?
First, we need to tap into the basics of what makes a good communicator. Again we can turn to Aristotle and the 3 critical elements of a great communicator he identified. Ethos is our character, credibility, reputation, trustworthiness, tone and style. Pathos is our emotional imaginative impact—the stories we tell to make a personal connection. Logos is the reasoning, arguments, facts, figures and case studies we use—the logic and the actual words we speak.
We do all of these naturally when we are engaging in an activity we are good at. Do you remember the first time you played the piano, examined a patient, performed surgery, or followed a recipe? My guess is that you were not as confident and capable as you are now doing those activities, right? How did you gain that confidence?
Yes, with knowledge, expertise and practice, but also focusing not on yourself but on the task at hand. You need to play the music on the piano keys, not think about yourself playing each note. You need to examine that patient and present your findings to your team and not focus on your words or pauses or posture. You need to swing that golf club or tennis racquet for a successful game and not think about how nervous you are trying to perfectly connect with the ball.
You need to focus on the task at hand. You need to play the concerto and win the point. You need to give a great presentation. The information you are presenting needs to be communicated. The audience wants to hear your message and learn from you. Communicate with confidence and by using your natural abilities and talents.
Observe Natural Communicators—including Yourself
Try to study people who are natural communicators. When you are listening to a live lecture or watching a TED talk or a news broadcaster on television, think about what qualities you appreciate in a speaker. What makes them effective at communicating? What is their body language? What are their facial expressions? How lively and interesting is their voice? How are they connecting with the audience or the camera? How do they make you feel as if they are talking directly to you? Do you think they are nervous? Trust me, they are, but they are letting their message be more important than their nerves.
Most important, you need to observe and study yourself. Again, what do you sound and look like when you are with your best friends or family? When you are talking to your children or sailing your boat or riding your bike? When you are engaging in familiar activities in familiar settings, what does your voice sound like? You can transfer this confidence, conversational speaking style, calmness, and clarity to your public speaking.
Imagine that Your Audience (or the Camera) Is Your Best Friend
Think of someone who makes you feel both calm and confident—someone who believes in you. Bring that person to mind and really see and hear them. They are looking and listening to you, and they want not only to hear what you have to say but also for you to do a good job. Whether this is your best friend, a trusted colleague, or a family member, imagine this person is in the audience (or in the camera) and then speak directly to him or her.
One Skill You Would Like to Improve
If you could improve one aspect of your presentation skills, what would it be? Most people usually know where they need to improve their communication capabilities.
Do you speak too quickly? Do you try to memorize and end up sounding like a machine speaking in a monotone voice? Are you too nervous to make eye contact with the audience? Are you so uptight that you do not blink or smile or use your natural facial expressions? Do you forget to take a big breath and calm yourself beforehand? Can you be calm and focused and just have a conversation so that you incorporate pauses and natural inflections in your speech? Can you improvise or react when you get a tough question or something goes wrong with the equipment? Write down your important points and answers to tough questions you may be asked before you begin.
Again, the most important tip I can give is to be yourself and have a conversation with your audience.
Many medical talks, like published abstracts, academic writing, research articles, and patient notes (e.g., histories and physical exams) often follow a standard format. Most medical presentations use or misuse slide programs such as PowerPoint. But that doesn’t mean you have to—especially when speaking to a nonacademic audience. Even in an academic setting, think about ways to break the mold and be more effective and informative, and your audience will thank you.
How can you improve your clinical talk, academic research, or other important presentation to your peers?
Why should you avoid jargon even when speaking to your peers? In every profession, including medicine, we use jargon and acronyms assuming everyone in the audience understands us. The problem is that it is not always true. Often, using professional jargon, buzz words or acronyms becomes a bad habit and a crutch that limits the discussion instead of broadening it. Many times, you and your peers have either never known or have forgotten what the real meaning is. And even if that is not true, there is nothing that makes a talk flat and uninspiring as one that is riddled with idioms and professional vernacular. Challenge yourself, with your writing and your speaking, to avoid the use of jargon, abstruse professional terminology, and acronyms. Try to stop using words like “stakeholders” “big data” “population health management” and “innovative care strategies” and just use words to explain exactly what you are talking about. Pretend you are talking to someone outside of health care. Use plain English. If you must use acronyms (and medicine is filled with them), at least say the whole phrase or name—at least once say endoscopic retrograde cholangiopancratography instead of ERCP or lateral collateral ligament instead of LCL. You will not only broaden your audience (not everyone always knows the professional jargon you may use), but your audience will listen more closely and maybe even learn and or remember something they had forgotten.
Do you and your audience really know the meaning of all the acronyms you use? Even if you and they do, what is the harm in saying the full meaning once in your talk? Words are powerful and informative. Acronyms are slang crutches and shortcuts that can become outdated or misleading. They can clutter our presentations, preventing us from fully engaging our brains. I challenge you to avoid any use of acronyms the next time you give a presentation.
Slide Presentations: PowerPoint and Others
The vast majority of presentations today still utilize Microsoft PowerPoint, but there are certainly other slide presentation programs now available, including Google Slides, Prezi, Visme, Haiku Deck, Emaze, Keynote, Projeqt, Slidedog, Slidebean, and Zoho Show. Slide-building software programs are invaluable tools to help illustrate and illuminate your information. Unfortunately, many people make major errors in using the programs. First, most people use too many words on each slide. Many speakers fill each slide with text or even write out their entire talk on each slide. Then they proceed to read whole paragraphs and even sections of chapters or expect their audience to read large sections of text from each slide. This is not only inefficient but also boring and frustrating.
You want to use PowerPoint or another slide program to elucidate and augment your talk not as a crutch or a distraction. Illustrations, graphs, photographs, formulas, data points, life cycles, and other simple but efficacious graphics should bring your presentation to life. They should be simple and easily understood. You should use as little text as possible. You also should not overwhelm your audience with moving graphics or too many bells and whistles. You are giving a lecture, not putting on a circus of multimedia examples. Think of yourself as an audience member. You want to be informed and enlightened, not befuddled and bombarded with special effects.
The slides should speak for themselves. You should not have to “read” your slides to your audience. You can refer to them or let them illustrate what you are saying but do not read them outloud. You want to make eye contact as much as possible while talking to your audience. You are having a conversation with your audience and making important points. Slides should illustrate information clearly and memorably than your spoken words. Again, do not write out your talk on your slides to use as a crutch. Know your talk well from your rehearsals and then illustrate the important points with graphic slides.
[S]cientists look toward the projected slides a lot when they present. As a result, they fail to maintain eye contact with the audience, which is a very important part of a good presentation. In my study I found that, during a 20-minute presentation, speakers turn toward the projection an average of 3 times per minute.
—Brigitte Hertz, PhD, Wageningen University, Netherlands7
Best Practices for Slide Presentations
• Write the outline of your talk before making any slides.
• Limit the number of words on each slide.
• Slides should augment your information (not distract).
• Use graphs, illustrations, formulas, and pictures.
• Important visual message on each slide should speak for itself.
• Use 10 relevant slides for twenty-minute talk (or 20 slides for forty-minute talk).
• Slides should communicate something you cannot say in words.
Informal Audiences: Patients and the Public
If you have the opportunity to speak to a group of patients or members of the public or others in a community or academic setting, by all means do it. Some physicians are more intimidated talking to a group of nonphysicians than they are speaking to peers, but they shouldn’t be.
Talking to a group of patients or members of the public is no different than talking to patients one to one or members of the public one to one. True, these are not medical colleagues, and you may need to speak in simpler terms and explain technical points or complex medical information, but you should be doing that regardless of your audience. With a nonmedical audience, you should think about talking to individual members of the audience, not a large group of faceless audience members. Think about talking to specific family members and friends who are do not work in medicine. You can still be informative and engaging even without using scientific, academic or professional words or jargon.
Fred Sullivan Jr. is a professional actor who teaches public speaking. He teaches his students to imagine they are throwing a ball to the audience when they are speaking, and the audience has to catch it and throw it back. This image illustrates the dialogue you have to have with your audience—you need to make sure they are hearing and understanding you. Take your cues from their facial expressions, ask them questions, and encourage their questions to make sure you are throwing the ball (your information and message) and they are catching it (understanding your message and responding to your information).
Tips for Excellent Presentations
• Make eye contact with specific audience members.
• Relax—be comfortable and confident.
• Tell a story (beginning, middle, and end).
• Ask the audience questions.
• Poll your audience by asking for a “show of hands.”
• Encourage the audience to ask you questions.
The most precious things in speech are the pauses.
—Sir Ralph Richardson, actor
In 1986, I read The Man Who Mistook His Wife for a Hat by the brilliant Dr. Oliver Sacks. I learned that he was speaking at the Harvard Graduate School of Education that fall and I could not wait to attend. I arrived early and noticed Dr. Sacks in the hallway outside the classroom by himself. I approached him with my pen and my copy of his book in hand. But when he noticed me, he snapped at me with a menacing look. I don’t remember exactly what he said, but I quickly went into the classroom and took my seat near the front. Throughout his lecture, I noticed he was sweating profusely. Many of his slides (shown through an old carousel slide projector) were out of order. He seemed frustrated. Even though his lecture was not as smooth as I thought it could be, it was still interesting. But I was embarrassed and nervous myself about approaching him again. The minute Dr. Sacks finished, and once the applause and cordial exchanges ended, he came directly over to me and apologized. He explained how nervous he was about public speaking. He asked to sign my book. I still have the book and cherish his autograph to this day. But it was an early lesson that even some of the finest minds (and writers) among us are not always naturally great lecturers.
Of course, in the decades that followed, Dr. Sacks became a public figure and gave many interviews and talks and often appeared on television. He clearly became more comfortable speaking to groups, and perhaps he received some professional communications training along the way. But he certainly improved his skills and hopefully reduced his anxiety.
Don’t Be Afraid to Ask the Audience Questions
Peggy Noonan, author and political speech writer for President Ronald Reagan, spoke at Harvard Kennedy School in the late 1980s. I squeezed into the standing-room-only auditorium packed with students, faculty, and others. After being introduced, the accomplished and brilliant Noonan went up to the microphone and looked out over the audience. The room was silent. No one could wait to hear from the person who wrote some of the best political speeches of our time, including President Reagan’s “Boys of Pointe du Hoc” speech on the 40th anniversary of D-Day and his address to the nation after the Challenger explosion, and Vice President George H. W. Bush’s famous phrases “a kinder, gentler nation” and “a thousand points of light.”
She stood at the microphone, looked out over the audience, and said, “tell me what questions you have.” My heart sank, when I realized this phenomenal speech writer had not prepared her own speech for us. I was a little taken aback. But then Noonan proceeded to take an hour of questions from the audience and gave the most eloquent, thorough, and informative answers you can imagine. She gave the audience exactly what they had come for—a chance to ask their specific questions. There was a standing ovation from the audience at the end of her talk.
While I don’t recommend you doing what Noonan did for your presentations, I do think the take-home lesson is to try to give the audience what they want and need from you. Know your audience. Know what they already know and what they need from you. Keep looking directly at their faces during your talk to see how you are doing. Encourage comments and feedback. Leave time for questions either throughout the talk or at the end.
What is difficult about speaking to a group of nonpeers is that you may not know what they already know and what they hope to learn from you. Whether you are speaking to a group of patients at the community library or legislators at the state capitol, here are some tips that can help you “read” your audience:
1. Ask the audience questions. Start out by asking a few questions that would help you understand their level of understanding. “Does anyone know the year AIDS was first described?” “Can anyone tell me what country has higher overall vaccination rates—Cuba or the United States?” Asking a question is a great way to begin your talk—and your conversation with your audience. Of course, you should also try to figure out what burning questions your audience hopes you will answer in your talk. Go ahead and ask them a few open-end questions before you start. You can answer their questions right then or better yet write them down and tell them you will make sure you address those questions in your talk. Some audience members will just want to make a comment and not have a specific question. You can always respond to comments and expand on them. “That is a very good point and here is some more information about that topic” or “I will talk more about that later in my talk” or simply “That is interesting” and then move on.
2. Introductions. Ask for a few volunteers from the audience to introduce themselves and tell you what they are hoping to learn from your talk. If there is time, and it is a small audience, you can certainly have everyone introduce themselves.
3. Encourage comments. Before you begin, tell your audience that you welcome questions and comments either throughout your talk or at the end. It will help you and your audience warm up and get to know each other if you take questions early on. After you begin your presentation, you can decide whether you want to be interrupted during your talk. I usually prefer to be interrupted throughout my talk because then my presentation becomes more of a conversation with the audience. But you can also tell your audience that you will leave enough time for questions, answers, and discussion at the end of your talk, which may help you keep from getting off point or running out of time. If you do this, then encourage your audience to write down any questions and make sure to ask them when you are finished with your talk.
But what if your audience is a camera? Here are some lessons about giving a presentation on a television broadcast or via a recorded video.
Video Skills: On-Camera Presentations
If you are speaking to a camera, first of all you need to do two things: (1) forget the camera is a camera, and (2) imagine the lens is your best friend. Again, imagine that someone who helps you feel calm and confident (a family member, colleague, or a friend) is literally sitting inside the lens. Talk to that person.
If you can actually imagine that your best friend, beloved family member, or trusted colleague is inside that lens, then you will lean into the camera and talk to them directly. Your body and your voice will be more natural. Of course, there is no one looking back at you giving you immediate feedback, as with a live audience, but imaging that someone you admire is listening to you will help you look into the lens and be a sincere, effectual and natural communicator. Your eyes should not be reading a script or darting around the room. You should be smiling and pausing and using your natural compelling and useful facial expressions. Everyone looks better when they smile, breathe, and let their body and their breath follow their thoughts and the mission of communicating important information.
Like an actor, if your mind can think of a person you trust and like (or even love) and who helps make you feel comfortable and confident, then your body, face, and voice will ease, and you will be on your way to using your own best style to communicate authentically.
If you are speaking to a camera, you need to make “natural” eye contact with the lens. This can be intimidating at first. But if you can imagine that the lens is the actual face of your best friend or trusted colleague, you will look and speak naturally. If you can imagine that a family member or friend is literally inside the lens, you won’t appear stone faced or have a “deer in the headlights” look. You don’t want to grimace, squint, or think about how much or how little you blink or if your smile is okay. You don’t want your eyes to look like they are reading a script or darting around the room and making you look shifty. If you can look straight into the camera and just truly imagine talking to the friendly person you have identified, then you will loosen up and appear less formal. You will be on your way to using your own best style to communicate authentically, even when speaking to a camera.
Writing for Video
When you write down the actual message and information you would like to say to the audience (through the camera), the information needs to be clear, concise, and conversational. Usually, you will want to state your name and your title first. Just like you would in person, introduce yourself and tell the audience the title of your talk. You should tell them what they are about to hear and why they should listen. Introduce yourself and grab their attention. You will want to tell a story to keep your audience engaged. Use short sentences. Use meaningful memorable phrases. Do not use jargon or professional buzzwords. Make sure you have written down five important points you want to make. Write down any statistics or data you need to cite, but present all of this information as a story and in a conversational style. Make the words sound as if you are talking to your best friend. Make it passionate and informative.
Name It and Give It a Title
You will also want to give your talk a brief, memorable, and descriptive title. After the audience hears a title, they are ready to grasp the details and explanation. When we give something a name or a title, we give it meaning so that we can make it tangible and memorable. We help our audience know what to expect with a title.
Be yourself. It is not about you. It is about the information. Breathe. Smile. Look the person (or the camera) directly in the eye. Watch others and see what works—but more important, watch yourself when you are talking to your friend or family member about something you are excited about. Slow down in important sections. Pause after an important point. Don’t speed up or throw away lines (your name, title, project). Sit up or stand. Be enthusiastic and passionate. Make them care about what you are saying.
Camera and Technical Skills
Framing. Try to make sure that your head, shoulders, and upper torso fill two thirds of the video screen. Try to make sure there are no windows or mirrors or ceilings in the picture. Sometimes you will see a very nice interview done in front of a window—but usually the lighting is perfect, and there are trees, sunshine, and a pretty landscape seen through the window. This is difficult to make look professional and usually requires professional photographers and lighting specialists.
Lighting. Most video cameras, even those in our computer screens or phones, make automatic adjustments as needed for lighting. You usually do not have to worry about doing any special lighting yourself. Usually the best lighting is natural lighting from windows nearby (but the windows should not be seen in the frame). If you must use the lights in the room (or on the camera), make sure that when you take a sample video, your face is not too dark and the overall lighting of the room is pleasing and not distracting by being too bright or too dark.
Clean office and neat background. Make sure your office, desk, bookshelves, and room seen in the video are clean and neat. You do not want a distracted or cluttered background. You want the exam room, office, or desk area to appear organized and professional. It should not be obtrusive. You can first take a still frame shot of yourself as you will appear in the video and then look at it and make sure it looks as good as it can before you begin videotaping. Make sure there is not an overflowing trash can or several piles of paper or clutter nearby.
Your appearance. Dressing in professional business attire is usually recommended. You want to be comfortable but make sure that what you wear is conveying the image you want to project. You should wear whatever you would wear in person to speak to the audience for whom you are videotaping. Follow whatever is the professional norm in your environment. Remember that it is usually better to be slightly overdressed than underdressed. Your clothes and your appearance are your image.
Clothes for On-Camera Appearance
• Professional business attire is usually best.
• Wear something that fits and is comfortable while standing or sitting.
• Avoid wearing black or very dark clothing.
• Avoid busy, loud, or small prints.
• Avoid large jewelry because it can cause noise.
• Have a suit, shirt, or dress lapel or collar to clip a microphone on.
• Do not wear hats or large earrings.
• Wear dress shoes (assume your legs and feet will be seen).
• For men, navy blue suits with light shirt and tie look best on camera.
• Women can usually wear pastels or bright solid colors.
• Bring a backup suit or dress in another color in case you need to change.
In preparation for your presentation, think about the following: Your words. Your voice. Your body language. Your authenticity. Remember to just try to have a conversation with your audience. Do not read your speech or use a teleprompter. Smile. Breathe. Focus. Educate and engage your audience and they will remember you and the information you taught them.
Tips to Improve Vocal Skills and Presentations
• Do more presentations and public speaking (not fewer).
• Watch and study the experts, TED talks, lectures, political speeches, and other presentations.
• Practice and record yourself giving a talk (find others to join you).
• Listen (or watch) your recording and see what you need to change. Do you need to speak slower or pick up the pace? Be more animated? Smile more? Be more relaxed?
• Take an acting class or public speaking seminar.
• Find a voice coach or public speaking teacher.
• Join a chorus (singing can improve breathing and voice quality).
Practice, Practice, Practice
Always practice. Do a run through with another person if possible. But at the very least, read it out loud at least once. Time yourself. Try to videotape yourself. This can be very helpful.
Advice for Video Presentations
• Your head, shoulders, and upper torso should fill up two thirds of the video screen. You should be the largest object in the picture.
• The background should not be distracting. It should be clean and professional. Take a still picture first with you in it just the way you will be sitting when you talk to the camera, before you start. Make sure you and your background look the way you want them to.
• Make sure you are eye to eye with the lens. You do not want to be looking down at or up into the lens.
• Do not sit in front of a window or a mirror when videotaping yourself.
• Make sure a lamp, plant, or other object does not appear to be growing out of your head. Background objects should be to the side of you generally.
• You should be well-lit and well-framed.
• Have a conversation with the lens as if your best friend were sitting inside the camera.
• If you sit, sit up comfortably with good posture.
• Do not look frozen or assume a “deer in the headlights” look.
• Soften your features and smile more.
• Be confident that you know the information you are presenting.
• Don’t think it has to be perfect. Speak naturally. Just talk and have a conversation with the lens. Talk like you do in your everyday life. It is okay to have a few filler words and not speak in complete sentences.
• Make it a great video presentation!
Advice for Live Presentations
• Relax, lean into the microphone or podium, and first say hello and introduce yourself.
• Make sure you have water nearby.
• Remember to ask the audience questions about their background and their experiences, including whether they are comfortable with the room audio, visuals, lighting, and temperature.
• Talk to the audience like it is an audience of close colleagues and friends.
• Speak in your natural voice with inflections and enthusiasm.
• Wear professional attire that you are comfortable wearing while sitting or standing—and that projects your desired image.
• Make sure there is a place on your clothing to attach a microphone if necessary (suit jacket or collar lapel).
• Create a catchy and memorable title for your project.
• Know your opening and closing lines and make them memorable.
• Use pauses effectively before or after you state important points.
• Uses pauses to look out at your audience.
• Speak slowly and clearly but with good energy and passion.
• Do not look frozen or fearful.
• Soften your features and smile more.
• Think about standing because it will give your voice and body more energy.
• If you sit, sit up comfortably with good posture.
• Have a great presentation!
Matt Abrahams, “A Big Data Approach to Public Speaking,” Stanford Business, April 4, 2016. Retrieved from: https://www.gsb.stanford.edu/insights/big-data-approach-public-speaking.
Dorie Clark, “A Checklist for More Persuasive Presentations,” Harvard Business Review, October 11, 2016. Retrieved from: https://hbr.org/2016/10/a-checklist-for-more-persuasive-presentations.
Peggy Noonan, On Speaking Well: How to Give a Speech with Style, Substance and Clarity (New York: Regan Books, 1999).Find this resource:
Steve Olenski, “Five Communications Skills that Make Good Leaders Great,” Forbes, March 29, 2016. Retrieved from: https://www.forbes.com/sites/steveolenski/2016/03/29/five-communication-skills-that-make-good-leaders-great/#48bbe0457ae9.
Charles Osgood, Osgood on Speaking: How to Think on Your Feet without Falling on Your Face (New York: William Morrow, 1988).Find this resource:
William Safire, Lend Me Your Ears: Great Speeches in History, Updated and expanded edition (New York: W. W. Norton, 2004).Find this resource:
Rebecca Shambaugh, “To Sound Like a Leader, Think about What You Say and How and When You Say It,” Harvard Business Review, October 31, 2017. Retrieved from: https://hbr.org/2017/10/to-sound-like-a-leader-think-about-what-you-say-and-how-and-when-you-say-it.
Allison Shapira, “Breathing Is the Key to Persuasive Public Speaking,” Harvard Business Review, June 30, 2015. Retrieved from: https://hbr.org/2015/06/breathing-is-the-key-to-persuasive-public-speaking.
1. A. Tunkel, “White Coat Address at Cooper Medical School of Rowan University,” September 14, 2018. Retrieved from: http://cmsru.rowan.edu/students/whitecoat/.
2. S. Louet, “Your Voice: Your Passport to Authority,” Science, January 27, 2012. Retrieved from: https://www.sciencemag.org/careers/2012/01/your-voice-your-passport-authority.
3. J. Latz, Communicating Up the Corporate Ladder (Oceanside, CA: Indie Books International, 2016).Find this resource:
4. J. Latz, “Be Clear, Concise and Confident with Corporate Speech Solutions,” YouTube, January 30, 2017. Retrieved from: https://www.youtube.com/watch?v=8rQiqC6q5gUJayneLatz; https://www.corporatespeechsolutions.com.
5. T. Blake. Retrieved from: http://www.tinablake.com/category/voice/.
6. G. Klein, “Performing a Project Premortem,” Harvard Business Review, September 2007. Retrieved from: https://hbr.org/2007/09/performing-a-project-premortem.
7. Hertz, B., Kerkhof, P., and van Woerkum, C. “PowerPoint Slides as Speaking Notes: The Influence of Speaking Anxiety on the Use of Text on Slides,” Business and Professional Communication Quarterly, 2016;79(3):348–359, doi: 10.1177/2329490615620416.Find this resource: