What I’ve learned from giving bad talks

At the end of our Swedish emergency medicine conference in March 2015 I decided to give a short closing talk. The idea came up in the lunch break before it was about to happen. I put some photos from the conference together and gave a ten minute talk about the future of EM in Sweden, in English. It was one of my better talks ever. I was so sleep deprived and stressed out after organizing the conference, I could barely stand on my feet, yet the talk was passionate and more coherent than most sentences I had spoken during the days of the conference.

I drew the wrong conclusion from this experience: That I could deliver talks in English as well as I can in Swedish, and that improvising only gives it a better touch.

What I should’ve learned is that passion is my strength and that when the topic is close to my heart and I speak to an audience that is friendly and willing to accept my message, speaking English is no obstacle.

In October 2015 I gave a talk on EM education in Sweden at the EuSEM meeting. It was in one of the smaller rooms and the microphone was stuck to the podium. It made it more difficult to connect to the audience, but gave the security of having the presenter’s view on the computer in front of me. It was an ok talk.

What I learned: Speaking about ”How it is in my context” is the most difficult type of topic. There can be no take home message and there is no learning objective. You have to go for a storytelling approach, but it is easy to get caught up with explaining the context and the background. It also made me realize that speakers from the US and the UK never get invited to speak about how it is in their countries, but how it is in a universal perspective (and often also how it should be everywhere else).

Shortly after the EuSEM conference I gave a talk about ethical issues in Emergency medicine for the Swedish Society of medicine. I had received the invitation to speak only two weeks in advance and was quite busy preparing my other talks, but could easily put together some rather good looking slides and delivered a passionate talk that was very well received.

What I learned: People like to hear talks that confirm their beliefs, even if it doesn’t add any new information. Once again, passion is the most important ingredient in a motivational talk.

In November 2015 I had been invited to give a talk at the first meeting of the Serbian EM society. I travelled there on the day before the conference and had the opportunity to meet and get to know the wonderful people who are struggling to introduce the inhospital specialty of emergency medicine into their system. Meeting them and watching some of the talks at the conference made me change my talk quite a lot. I managed to speak about how we have worked on developing EM in Sweden with clear references to what was going on in Serbia. Since the other talks had very conventional slides, I was a bit worried mine wouldn’t go down well, but they did and my talk was a success.

What I learned: The feeling that you are talking to and encouraging your friends is very comforting. And when you feel comfortable it isn’t that difficult to make last minute changes to rearrange your talk.

Only a week later I went to Leeds, UK, to give a talk at their Leadership meeting. The topic was about Leading change in Sweden. I could have given the same talk as in Serbia and gotten away with it. And I used many of the same slides. But I wanted to convey a completely different message. I believe that we as emergency physician are part of an imperfect health care and welfare system, where all failures of other parts of the system will end up in the ED. I truly don’t support the idea that spending more money on emergency medicine is the solution to that problem. Judging from all other talks at the conference I was the only one with this opinion. And I tried to include that message in my talk. I thought I had learned from the conference in Serbia that last minute changes wouldn’t be a big problem.

The conditions for my talk were terrible. I was up too late the evening before, but still woke up early and couldn’t go back to sleep. I had come down with a cold and had a running nose and a heavy head. I wanted to upload my presentation during the coffee break, but the lectures didn’t finish on time and I started to worry that there wouldn’t be a coffee break before my talk. Just as we were about to start I was told that the last speaker wasn’t coming, so I needn’t worry about time, which made me speak more freely and add things I had taken out. The speaker before me said some things that upset me. I always feel uncomfortable when management people start to talk about their leadership and now the whole audience was full of them. So I gave my talk and it was the worst delivery of a talk I had done since grade 8 in primary school. It came as a total surprise and quite a disappointment to me that I could be that bad at public speaking.

What I learned: Don’t try to include a controversial message in your talk if that isn’t the main purpose of your talk and you have built your talk around it. Stick to the topic that people expect you to talk about and if you think that there is a risk that you can’t give a high class delivery – go for a safe delivery of good enough.

Then came the invitation to be a backup speaker at ICEM. Some speakers had cancelled and I was offered to choose between ortho or surgery. I thought I could talk about hip fractures, since we have special fast tracks for them in Sweden. ICEM was only a few weeks after our national conference which is a cognitive melt down for me. And since I had not at all studied the literature on hip fractures I had quite a lot of reading to do. Since I knew I was going to present at SMACC I took this as an opportunity to practice and decided to speak without any slides. We arrived in Cape Town a few days early and I assumed that I would have some time to go through my talk, but the wifi was so slow that I spent most of my time trying to get online. I still had a fairly good manuscript and decided to take a written version as back up. But I had the feeling that I hadn’t prepared properly. And just as I was supposed to get up, my mouth got all dry. That had never happened to me before. I didn’t feel very nervous, I don’t even think I had palpitations, it’s just that it suddenly got very difficult to speak. And there was nothing I could do about it. I managed to get through my talk. It wasn’t great, but it was ok.

What I learned: Confidence is key. The feeling of not knowing your material well enough will mess up your talk. Expect the unexpected and plan for disaster. Control the environment. What if the projector shuts down? What if the speaker before you puts everyone to tears through their amazing talk.

Wise from the experience, I thought, my conclusion was that I would have to know exactly what to say for my SMACC talk. This was the talk where you had to get everything right. I was going to prepare so well. My topic was Biomarkers and I wanted to make it about how we as clinicians deal with uncertainty and how lab values affect our decision making. I started reading books about the psychology behind decision making and I searched for literature on biomarkers. I realized there were several angles to this topic and when I found that many studies on biomarkers are authored by scientists who own the patents, my talk took another turn. After hours of research I had a content that I was very happy with and a presentation that would tell the story, but which contained many quotes and facts that had to be presented correctly and in the right order. To make sure I got everything right I wrote down the manuscript word for word, which I usually don’t do. Every time I went through it I thought about changes, but decided to not make any last minute additions, an urge that was quite difficult to resist.

So came the time to deliver my presentation. Scott Weingart went before me and during his talk it occurred to me that I had forgotten most of what I was going to say. I got started anyway, but suddenly realized that I wasn’t able to see the upcoming slide on the projector, which I always do when I use my own computer. It made me lose myself totally and I had to start over. All of a sudden there was nothing fun about presenting at SMACC, but I managed to get through my talk. Great content delivered with total lack of confidence and finesse.

What I learned: I hadn’t learned the previous lessons well enough. When delivering under high stress conditions the story that sounds great when you practice on your own is not going to come out that way. For a talk that doesn’t follow a timeline you can squeeze in important parts anywhere, but if things need to be said in a certain order, it is better to set up the slides so they give you the important cues. It doesn’t mean you have to write bullet points, but a certain picture or symbol can give your overloaded brain the signals to keep you on track. Passion will not get you out of the situation where you have forgotten what to say, neither is it an important part of a talk that is more factual than motivational.

I also learned that speaking in English is an important obstacle to me. From my previous experiences of speaking English in Sweden or Serbia, I thought it wasn’t, but looking back at my other international talks I understand it is. My speaking skills in English are what my Swedish skills were several years ago. In Swedish I can cover up the mishaps. In English they knock me off my feet. I think that means that I need different strategies for preparing talks in English and Swedish. So I thank SMACC for letting me learn that lesson. That embarrassment is temporary and failing is the best way to learn, I learned already in grade 8, as anyone who read my lesson learned based CV knows.