SPEAKING AT MEETINGS

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Special

Articles

SPEAKING AT MEETINGS CLIFFORD F. HAWKINS M.D. Lond., F.R.C.P. CONSULTANT PHYSICIAN TO THE UNITED BIRMINGHAM HOSPITALS AND LECTURER IN CLINICAL MEDICINE IN THE UNIVERSITY OF BIRMINGHAM

As the number of medical meetings increases, the communications delivered become harder to understand. There are several reasons for this. The papers of a decade or more ago were often brief descriptions of clinical or pathological conditions, whereas the scientific

paper of today may occupy an entire session. It demands greater care from the speaker and sometimes more intelligence from his hearers. Priority is rightly given to research. Also, the trend towards specialisation (each specialty with its own jargon and terminology) creates ptoblems in intercommunication; so that one sometimes wonders whether general meetings will not soon become impracticable. Nevertheless, none of these developments should prevent a communication being understood, provided it is properly delivered. Simple faults in technique spoil many good papers. Sometimes in a meeting lasting many hours, there may be only one communication conspicuous for its clarity and fine slides-its presentation so concise and easy that few appreciate the work which went into its construction. TWO COMMON ERRORS

Reading Instead of Speaking Most societies have a rule that communications must be spoken and not read. Reading, unless by an expert, is impersonal; and a paper read rapidly in a monotone becomes almost meaningless. The natural rhythm of telling a story, with its pauses and its contact with the audience, is lost. Perhaps the only exception to this rule should be at an international meeting when a speaker has to give his paper in another language.

Incomprehensible Slides as the first requirement in a speaker is audibility, the first requirement in a slide is legibility. Yet at nearly every meeting slides are shown which are unreadable unless the audience is equipped with field-glasses. Slides seem often to be a mere formality which confuse rather than illuminate. In the ten or fifteen seconds given to showing the slide, only three or four short lines can be read. Yet, the slides may be packed with ten or twenty lines of detail which the speaker has spent months in preparing. There is only one thing worse than the dull, overcrowded slide and that is a series of such slides.

Just

so

PLANNING A COMMUNICATION

speakers seem to have a natural ability to make interesting subject dull or a simple one complicated; others can imbue a complicated subject with an interest and clarity which captivates their audience. It is generally true that the clearer the delivery the harder the work that has been put into its preparation. The person who boasts that he has put his talk together in the train on the way to the meeting may sometimes be brilliant; but more often the listener may wish that the journey had been longer, or not undertaken at all. The temptation to use an article, perhaps already in the press, as the text for a talk should be resisted. Speaking is an art by itself and it is better to plan the communication afresh. Some

an

Form

The usual pattern should be followed. A minute or so given to an introduction is not only desirable but also a

natural courtesy to those unfamiliar with the subject; and there is seldom an audience so specialised as not to appreciate this. An opening such as " May I have the lights out ? First slide please " should always be avoided. The material may consist of work that has taken one or more years; and the purpose of the paper-to bring out the three or more points that can be made in ten or fifteen minutes-should be clearly in mind. Strict pruning of unnecessary or complex data is essential. Details, such as tables and lists of figures, can be circulated afterwards to anyone interested. The conclusion should be as clear as the introduction-perhaps a final thought, or a repetition of the main points, or a brief speculation about future developments in the subject discussed. The

Language

.

Short words of Anglo-Saxon origin have a force and clarity often lacking in polysyllabic words from Greek or Latin. The golden rule of writing, said Gowers, lies in the choice of words, and this applies as much to speaking. Even when the address is fully prepared and rehearsed, it is a pleasant and useful exercise to look through it with a dictionary or reference book at hand, finding better words, and eliminating cliches and words which through constant use have ceased to convey anything to the hearer. Abbreviations without explanation are frustrating Even though symbols to those unfamiliar with them. such as c.c.F., B.R.R., I.U.G.T., and P.P.L.O. may be obvious to most, there may be some who stumble over them.

Timing the Communication A speaker who exceeds his allotted time without permission from the chair may upset the entire plan of the meeting. Reputations have been spoiled by speaking for too long; and it is better to aim at one or two minutes less than the full time allotted-generally ten or fifteen minutes. An audience always appreciates a firm chairman. Methods of stopping a speaker vary. The usual method is by a light, often a green warning light, followed by a red one. This is best placed on the speaker’s desk out of sight of the audience. The speaker who continues in spite of a warning is uncommon, though at one international meeting a speaker had to be removed forcibly while he was still talking. In some hospital or university departments, rehearsals are routine practice, when verbiage is omitted and incomprehensible slides are eliminated. Otherwise, the dictaphone is a valuable aid. For the speaker to hear his own talk may come as a shock, but it is better that he should hear it first than that the audience should. The best speakers are usually those who have given much time to practice and rehearsal. SLIDESs Slides must be projected beforehand, for they may look different on the screen-which accounts for the speaker who gazes at his slide in some perplexity, trying to recognise it. Slides may make or mar a communication. Though it is possible to use them as notes for talking, their real purpose is to illustrate and emphasise points. They should fit in logically with the talk. If the slide contains reading matter, the speaker should keep silent and allow the audience time to read it. Above all, he should not talk about something else while it is being read. Each slide should speak for itself, simply and clearly.

Preparation of Slides Few are fortunate enough to have access to a departof medical illustration which can prepare slides. Most speakers have to manage without professional aid.

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has made the film; for his efforts may blind him to its real value. A film must be edited ruthlessly. Less important detail may be speeded up while it is being projected. THE PROJECTIONIST The speaker depends upon the projectionist, who can wreck his talk by inexperience. Common faults are that slides are put in the wrong way round (though this is unlikely with proper labelling) or that they are put in too soon or not changed at the right moment. Incorrect focusing is perhaps the most frustrating fault of all, for fine slides can then be spoilt. Focusing on to lettering should be easy, but many slides are of pathological speci. mens, chromatograms, or other subjects which are a complete enigma to a technician. The only person who But help may be obtained from A Practical Outlme for can focus properly is the person who made the slide, or Preparing Medical Talks and Papers,’ or from Illustrating someone who knows the subject. It is quite unreasonable Medicine and Surgery,2 as well as from various articles.3-5 to expect a projectionist to know what to focus upon; the Every aspect of legibility is covered admirably by remedy is for someone of experience to sit by the projector Ollerenshaw6 in his Renwick lecture. to help when necessary, or for a special mark to be No more than three or four lines of reading should be inserted in the corner of certain slides for the purpose of put on each slide, and line graphs should be used only focusing. On one unforgettable occasion a lecture by a when there are no more than two, or possibly three, lines distinguished American visitor was ruined by bad focusto be compared. The design should be simple and open, . ing. Slide after slide was shown, and brave efforts were with plenty of space. Radiographs should be shown only made by the projectionist to focus on to obscure forms or when there is enough contrast to permit projection on a patterns. Nobody got up to help; the audience just sat in slide, and an explanatory line-drawing in one corner will a frustrated and embarrassed silence. help those who are seeing it for the first time. Legibility An efficient automatic type of projector will solve the of lettering is more likely if the capital letters only of a problem of focusing. The magazine is loaded with slides typewriter-if possible an electric typewriter-are used. in correct order and proper position. A long cable runs Print is preferable, because it is better spaced. Each from projector to lecturer with a switch containing two letter on a typewriter has to fill the same area; hence the buttons, one for changing the slide and the other for m’s are compressed, though the i’s have plenty of space focusing. The lecturer is then in complete control, and around them.Standardgraph’ or ’Uno ’ stencils are there is no distracting sound of a buzzer or a banging of particularly useful for lettering, and this is easier on grey a pointer as each slide is shown. graph paper, the lines of which do not appear on the slides. MICROPHONES Arguments still continue as to whether slides prepared A microphone, though indispensable in any large hall, as negatives, white lettering on black, are preferable to the may add to the difficulties of a speaker; for the machine usual method of black on white (see figure). White letteritself may develop extraneous noises which may compete ing on black is certainly attractive, and it is an easy matter for the listener’s attention. The fixed microphone needs to colour in the white spaces (letters or lines) by brushing care to avoid fluctuations in noise as the speaker’s distance over with coloured ink. A bright white screen with black it changes; even a mere turn of the head to look at lettering, which causes the iris to contract, may improve from a slide will lower the volume by several decibels. The the ability of the presbyopic eye to focus.6 mobile microphone, hung around the neck, is better. The Slides should be numbered as well as marked for worst type is the portable one on a long flex. Anything correct insertion; for this not only helps to prevent the anticlimax of the last slide being shown first but may be may happen with this. It may be put down on the desk useful also in discussion at the end, if a speaker wishes to and accidentally covered by the notes; or an absentrefer back to one of them. (The slide numbering should minded speaker may inadvertently put it in his pocket. NOTES also be recorded in the notes.) Notes should be simple, well spaced, and in large There are limitless possibilities of catastrophes with slides. Simple matters such as the slide not fitting the lettering, and must be easy to read from a distance. The machine should be eliminated beforehand, but other sudden silence of a lecturer while he peers at his notes hazards remain. Fortunately, the use of modern trans- through a monocle, or hunts through pages of typescript parencies (5 x5 cm.;2 x 2 in.) avoids the disaster of the to find the place, is always rather an anticlimax, particuold glass slides (8 x 8 cm.; 31/J’/31/4 in.) being dropped larly if his delivery has been faultless until then. just before the lecture, though the risk of melting from POINTS TO CHECK JUST BEFORE THE MEETING an overheated projector still exists. Technology, while improving efficiency, has made the Films modern lecture more complex. In particular, the two The objection to showing films during an address is not actors, the lecturer and his projectionist, may be comonly the risk of a technical fault, but also that much may pletely separated, the only means of communication being be redundant. This is more likely if the speaker himself by signal; the greater the distance between the two the 1. Zollinger, R. M., Pace, W. G., Kienzle, G. J. Medical Talks and greater the possibility of error. It is therefore essential to Papers. New York, 1961. see the lecture hall beforehand. The slides should be 2. McLarty, M. C. Illustrating Medicine and Surgery. Edinburgh and London, 1960. to the with about lighting. instructions projectionist given 3. Treadgold, S. Lancet, 1949, i, 701. should 4. Treadgold, S. Guy’s Hosp. Gaz. 1956, 70, 283. method of be The agreed upon, and the signalling 5. Turnbull, P. Brit. J. Photogr. 1958, 105, 508. position of the rod or hand-torch for pointing to the slide 6. Ollerenshaw, R. Photogr. J. 1962, 102, 41.

263 should be checked, as well as the position of chalk if it is necessary to draw on a blackboard. It is important to have a light on the reading desk, and the position of the switch for this must be noted. Instructions, preferably written, should be given to the projectionist as to which slides should be shown with the light half-dimmed (print) and which should be shown with the lecture hall completely darkened (colour slides, histological material, and

radiographs). PERSONALITY AND MANNER

One has only to think of a great teacher whose lectures stand out for their brilliance, clarity, and wit, and are delivered with a showmanship which fixes them in the memory. By contrast, there is the other type of renowned figure, who has talked on the same theme so many times before that the inspiration has gone; his manner has become tedious, and his slides too well worn. The audience depart, pleased to have seen the celebrity, but disappointed with the lecture. He should have delegated it to one of his subordinates. Another example of a defective manner is the bright young man who paces up and down (how irritating are the repetitive movements of a speaker) talking condescendingly-treating a distinguished audience as if it were a final-year class of students. To speak to those who know little, yet to do so with humility, may not be easy. It has been said that the research-worker-the backroom boy who has no opportunity to teach-will naturally be unable to express his thoughts in public. Yet serious thinkers can usually express their thoughts simply and

Personality

is

important.

analytically. Most bad communications are due to defects of techbe readily remedied. Perfection in an acquired characteristic. I am grateful to Dr. T. L. Hardy for his valuable criticism of this article. My thanks are also due to Miss Sylvia Treadgold of the department of medical illustration at Guy’s Hospital, London, and to Mr. T. F. Dee, of the photographic department at the Queen Elizabeth Hospital, Birmingham, for their helpful advice.

nique which can speaking is mainly

Symposium EVALUATION OF DRUGS &mid ot;

FROM A CORRESPONDENT

A SYMPOSIUM on this subject was arranged in London Jan. 23 by the Association of Medical Advisers in the Pharmaceutical Industry. The difficulty of securing clinical trials of new drugs, and the possibility that the new Committee of Drug Safety might cause the loss of valuable new drugs, were two of the problems discussed. on

Testing of New Drugs particular difficulties over the initial stages of drug testing, involving in-vitro and then animal experiments. At the next stage, healthy human volunteers were needed. In the U.S.A. paid volunteers were often used. In this country employees of drug firms, medical students, and nurses were the groups usually asked. The Committee on Drug Safety stated categorically that no patient could be a volunteer, though he might of course take part in a clinical trial, or refuse to, once the stage of trial in healthy humans was passed. It was questioned whether digitalis would ever have become available for heartThere

were no

disease under the present regime: it would depend on how the committee interpreted their ruling on the danger of its deleterious effects. There was a possibility that other useful drugs might be lost through strictness of screening. Perhaps standards could not be too severe for a drug likely to be widely used for minor complaints such as headache or insomnia; but

had sometimes justified desperate remedies. A sufferer from so-called incurable cancer, for instance, might well be the most suitable subject for trial of some of the anticancerous drugs, which are of necessity highly toxic to normal

desperate straits

people. Clinical Trials for New Products The medical profession had a moral responsibility to further the discovery of new therapeutic benefits. At present, red tape and new regulations, legal considerations, and the difficulties of publishing results were making this more difficult; but perhaps the greatest need today was for more clinical trials. Clinical trials, it was stated, were easy to criticise, difficult to do, and never wholly satisfactory. Nevertheless they must be done on every new product offered to the profession. Speed was vital, not only because of the ethics of withholding a possible cure from the public, but also because industry might founder if there was too long a delay between spending vast sums on research on a new product and beginning to cover these losses with sales. In the past, clinical trials had been nobody’s job, but the hobby of a dedicated few. Less than 5% of doctors, it was thought, were ready to experiment. Teaching in therapeutics had been very patchy, and for too long confined to preclinical students who knew nothing of disease. Moreover, the rationale of therapeutic research had not been sufficiently explained to the ancillary staff (nurses, almoners, social workers) even when they were actually engaged in clinical trials. The British Tuberculosis Association was quoted as an outstanding body for its activities in drug research. It had a subcommittee on clinical trials, and its constitution included a pledge to further the discovery of new therapeutic means. It had been very active in the trial and use of new drugs, and clearly the tuberculosis patient has benefited. Tentative schemes were suggested for furthering clinical trials. One recommended a central fund for clinical trials, or more academic chairs in clinical therapeutics; under either arrangement, junior and senior research fellowships would be

offered, reciprocal

to

medical-registrar appointments. This

out in some detail and would cost of the Drug Bill. It was suggested E120.000 year-or 0.16% that there would be offers of financial help from industry. Another suggestion would cost Elmillion, but this included the expense of the hospital beds and ancillary services. Five academic units were called for, plus fifty research fellows to carry out clinical trials. They would work with patients already in the existing hospital service, probably dividing their time between a teaching hospital and adjoining group hospitals. The patients would remain under the care of their own physi-

particular plan

was

worked

a

cians, who would at all times have complete powers of veto over anything suggested in the form of clinical trial. In some cases the trials would be conducted or continued among outpatients, and here the social workers and psychologists would play a greater part. Five years ago similar recommendations were made in the Hinchliffe report, but there seems to have been no move to implement them. Role of the Clinical Pharmacologist Prof. A. G. MACGREGOR spoke of clinical pharmacology as an emergent science. It was already an exact science in some areas of medicine, but when the cause of the illness remained obscure, as in mental disease and atherosclerosis, it was still very much an empirical one. Benefit to the patient must remain the keystone of the science. A greater number of appointed clinical pharmacologists was called for by Dr. K. G. GREEN (I.C.I.). Clinical trials of drugs must be part of the ordinary discipline of medicine. Anyone

conducting them must have patients, and must therefore be a physician. Though there might be room for academic appointments, the great need was for consultant pharmacologists in the hospital service, to work beside the physician, who would remain in charge of the case. Physicians should call in consultant pharmacologists more often rather than leaving it to their registrars

individual cases, keep them up to date

over

to