‘Presentation top tips LSA Trainees Prize’

Feedback from LSA Trainees Prize events

Dr P Mullen (LSA Committee)

v. Nov2012

Background

• In 2011, for the first time the audience voted the winner and runner up at the annual ‘LSA Trainees Prize’ event.

• Free text feedback from the audience formed part of the process

• This presentation is (mostly) based on feedback from the 2011 & 2012 Trainees Prize events, and may inform trainees generally about pointers towards a quality presentation

LMI founded in what year?

LMI current building opened?

Historical trivia

LMI 1739

LMI building 1837

Lecture theatre

• Last refurbished?

• Seating capacity?

Lecture theatre

• Last refurbished 1998

• Seating capacity (~120 max)

When was LSA founded?

LSA & Trainees Prize

Jackson Rees Medal

LSA Trainees Prize

• Most recent winner/runner-up?

• Past winners?

• What sort of projects?

• Prize £ ?

2012 Dr Clint Chevannes (1st Prize)Dr Christine Bell (President LSA) 2011

L to R: Dr Will Lo (2nd Prize)Dr Christine Bell (President LSA)

Dr Adie Morrison (1st Prize)

L to R: Prof. J Hunter (President LSA), Dr C Mollitt (2nd), Dr C Hammell (1st), Prof R Jones (Judge)

20092010

L to R: Dr A McDonald (1st), Prof. Jennie Hunter (President LSA), Dr H Neary (2nd)

Previous LSA winning projects

• Fast ROTEM evaluation in major obstetric hemorrhage (2012)

• Intra-thecal magnesium meta-analysis (2011)• Spinal vs iv diamorphine for spinal surgery• Intra-thecal diamorphine for THR• Survey of patient satisfaction with GA• Evaluation of new airway device for L’oscopy

2011 Entries submitted

= Presentation ‘top tips’!

Free-text comments

(= ‘top tips’ for presentations)

from LSA Prize 2010 (prelims), 2011 & 2012 (Prize meetings)

(plus some example slides)

Introduction/Methods/Results

Interpretation/Skills

Feedback/Tips – ‘Introduction’

INTRODUCTION(background/clinical

importance/aims/objectives)• No background slides• Too long introduction.• Very relevant to current practice and well

presented• What is the incidence of e.g. pre-op hypothermia

and post –op hypothermia? How big are these problems?

• Literature overview slide would have been better at the start in Introduction section rather than later on

• Excellent overview & background, lacking only in references

INTRODUCTION(background/clinical

importance/aims/objectives)

• Good clinical relevance and good to see critical care network guidelines developed as a result. Excellent background knowledge

• No relationship (relevance) to (my) practice• Too many assumptions that assembled

audience familiar with subject (e.g.CPX testing) (many retired members of LSA probably not)

• We didn’t need an explanation of how to do a meta-analysis but would have liked to see more results, e.g. how long the block was delayed etc.

Feedback/Tips – ‘METHODS’

Introduction/Methods/Results

Interpretation/Skills

METHODS (Quality of the design, effort required by the

individual e.g. in data collection)• Need to tell us how much of the work he/she did• Effort required in data collection by the individual was

low because it was a survey• Data quality likely to be very subjective• Ethically very very shaky – should have sought ethics

committee advice at least.• Very serious concerns over ethics.• I disagree about the ‘No need for ethical approval’• Ethical approval? Was consent sought? Was any

(informal) advice sought from ethics committee members even?

METHODS (Quality of the design, effort required by the

individual e.g. in data collection)• I have not got a clear idea what the study aims were• Survey, not audit • A lot of work, ?usefulness • Small sample size, appears large amount of effort

• How valid is Parklands formula? – reference? - the audit ‘standard’ hinged around this validity. How valid is the ‘rule of thumb’ regarding mortality prediction (in burns patients)? Supporting references?

• Data quality poor • How was weight estimated? – potentially large errors• Too much data, in search of a missing link

METHODS (Quality of the design, effort required by the

individual e.g. in data collection)• Large study although unclear how much done by presenter

• How much analysis did presenter do himself?

• Why no data on elective/urgent surgery? Surely surgical experience is of relevance? Did those with a previous LSCS need more blood transfusion than primips?

• Project (a meta-analysis) results hinged mainly on data pick-up from e-search – what steps were taken to check validity - that some papers were not missed (3 key words were used for searching – was any attempt made to use different but similar key words, e.g. ‘patient’ instead of ‘human’?)

METHODS (Quality of the design, effort required by the

individual e.g. in data collection)• Choice of statistic analyses not correct

• Good explanation of stats

• I didn’t understand ‘propensity scoring’ (despite long explanation; did I really need to understand it?)

• If you use a statistical method that a substantial part of your audience is likely to be unfamiliar with then explain briefly (1 minute rather than 3-4 minutes of a 10 minute presentation); e.g. propensity scoring

• Use of integers for LOS data not explained, otherwise excellent.

Feedback/Tips – ‘RESULTS’

Introduction/Methods/Results

Interpretation/Skills

Total cases found N = 299

n = 191

n = 158

Meditech n=199

Extras from booking forms

n=100

No booking date/time (104),

Operation cancelled (4)

No operation date/time (30),

Booking date/time error likely (3)

+

(Often very useful to have a flow chart, outlining how arrived at population)

This example = audit of time between booking of case for urgent/emergency surgery and actual arrival into anaesthetic room, 1 month period)

RESULTS (Data quality – e.g. validation – and data

analysis; + effort, correct stats)Presentation of numerical data

Use appropriate number of decimal places e.g. 2.1 days not 2.12 days, Hb 12.1 not 10.92; be consistent with number of decimal places within data domains (e.g. avoid LOS Control Group = 2.1 days, Treatment Group = 2.15 days)

Avoid expressing continuous data as discrete data (e.g. 2 days) unless obvious difference between the results (2 days versus 13 days)

Indicate which ‘average’ was used (mean, median, mode, are all ‘averages’)

Indicate which statistical tests were used (‘I used Excel’ doesn’t cut it!);

RESULTS (Data quality – e.g. validation – and data

analysis; + effort, correct stats)Presentation of tabular data If using busy tables then colour fill the rows that you wish

to draw attention to (using a side arrow partly does this but it can be difficult to follow the row of data across in the table that is quite busy);

Avoid moving rapidly thro busy tables, without using the above device;

Comparing data from 2 groups, don’t just use mean of each group and the difference between the means - include spread of data (IQR, SD) as well as central location (median, mean)

Fair bit of data here, but essentially one main difference between the 2 results columns – can you spot it?

D

D

?Good pie diagram or not? How would you improve it?

Too many categories, difficult to compare

Comparison now easy. Note that if countries were listed on the X-axis then problems reading, except for circus acts!

RESULTS Data quality (validation), data analysis, effort,

correct stats

Presentation of graphical data• Quite busy graphs• Results too condensed• Exploded pi-diagram: avoid white segmnt on white b/ground• Use the pointer to draw attention to key point(s)• Busy not easy intelligible graphs• Percentages on Y axis may be better than absolute numbers• Too many groups for a pie chart (try horizonthal bar chart)

?

?

In a 3D Pie diagram the 3-6pm slice is often falsely perceived as larger than actually is.

RESULTS Data quality (validation), data analysis, effort,

correct statsPresentation of graphical data• No graphs regarding range/spread presented (e.g. IQR, SD)• Was mean the correct average to use? Some box and whisker plots

would have been nice

• Displaying some of the results in a table would have been better.• The vertical bar charts didn’t quite work – using horizontal bar chart

would have made it easier to read the text.• Avoid using 28.00% on X-axis

• Pie charts not clear (light blue vs grey!) - very difficult to interpret/separate out groups

• Best to avoid blue against blue bar chart comparisons (use a different contrasting colour)

• Avoid graphs with same coloured lines

RESULTS Data quality (validation), data analysis, effort,

correct stats

• Lean on statistics (e.g. mean used a lot, no indication of spread of data so this may have been the wrong average to use)

• Don’t bother mentioning non significant trends (time)

• (If there are ‘outliers’ then offer an explanation)

100

90

80

70

60

50

40

30

20

10

0

Ste

p 2

Hrs

Time from booking to start of anaesthetic/intervention

Mean 14.4 hrs

n = 107/158

Can you spot any problems or errors here? What would be a simple summary statement?

100

90

80

70

60

50

40

30

20

10

0

Ste

p 2

Hrs

Time from booking to start of anaesthetic/intervention

Median 6.2 (IQR 2.8 – 20.4) hours

(Mean 14.4 hrs)

‘Most interventions began within 24 hours’

n = 107/158

The wrong ‘average’ to use here!

Skewed data. In this e.g. the * symbol = outliers, i.e. beyond Q3 + 1.5(IQR); the mean is not resistant to outliers whilst the median is.

Comparative boxplots are often an excellent way of getting summary data across quickly and effectively, comparing 2 or more groups.

321

70

60

50

40

30

20

10

0

Speciality

Ho

urs

Time from booking to start of anaesthetic/intervention

GenSurg Ortho Plastics

(*p = 0.0006)

* Mann-Whitney, 2 sided, alpha = 0.05

e.g.

RESULTS Data quality (validation), data analysis, effort,

correct stats

• Colour scheme for slides could be  better

• Not sure of the matching/confounding factors

• (Limitations)

What do you think of this graph? Good and bad points = ?

Fantastic graph! Text a little small perhaps, but colours, trends, absolute numbers, etc have all been combined into 1 results slide. This is clearly a slide to dwell on in a presentation. (Note: in this instance part of the reason for the small text is that it is a ‘screenshot’, obtainable from the ‘prt sc’ of your laptop, which has been then pasted).

Feedback/Tips – ‘Interpretation’

Introduction/Methods/Results

Interpretation/Skills

In theatre ….

Median: 0.7 hours

IQR: 0.5 - 1.3

Range: [0.1 - 5.5]

Step 5: Surgical Time

0

1

2

3

4

5

6

Hours

A scatterplot, showing raw data points can be a useful graph. But what is a simple summary/interpretation of this data? Summaries should not repeat data %’s etc. Lead on to conclusions.

In theatre ….

Median: 0.7 hours

IQR: 0.5 - 1.3

Range: [0.1 - 5.5]

Step 5: Surgical Time

0

1

2

3

4

5

6

Hours

Majority of surgical interventions were

completed quickly in theatre

INTERPRETATION(Conclusions, Recommendations, action plan)

• Interesting subject but didn’t seem to come to any conclusions

• Slides (as presenter actually alluded to) were ‘cluttered and unclear’ with no conclusions or recommendations. No definite conclusion to study

• Good presentation and plenty of material and information, but need to tell us: how much LA used in each technique, need to highlight difference between statistical significance vs clinical importance; these results could provide basis for number needed to treat to aid statistical significance in future prospective study

• More diagrams and focusing on the main messages in results would have been better

INTERPRETATION(Conclusions, Recommendations, action plan)

• Good subject …good material, I think one of the main messages he did not bring forward was to stress the fact that "Rehearsal" of the Guideline is essential for future adherence to it

• Less introduction, more results and conclusion please

• Avoid ‘1 patient ruined my data’ comments

• If the study data showed a reduced LOS in the study group then it is not reasonable to say that ‘this was due to earlier mobilisation’ (unless the mobilisation variable was also assessed and correlated accordingly with the LOS data). ‘It may have been due to earlier mobilisation, but we have no data on this’ would be more accurate

• When making summary comments, make sure your they accurately reflect the project results; if based on previous publication, then reference this

INTERPRETATION(Conclusions, Recommendations, action plan)

• Interesting topic but struggled to find relevance to my practiceDid not adequately explain relevance to most anaesthetists

• Some of the recommendations were not directly as a result of the audit

• Many recommendations at end – not clear on what these were based, many seemed not based on the data presented; a slide re limitations of the audit would have been useful

• Composite end points have their limitations so draw attention to these (i.e. show insight)

INTERPRETATION(Conclusions, Recommendations, action plan)

• More diagrams and focusing on the main messages in results would have been better

• Unclear conclusions with too much information

Feedback/Tips – ‘SKILLS’

Introduction/Methods/Results

Interpretation/Skills

Know your venue

Features

Know your venue/audience

• Moderate size• Unfamiliar • Formal• Colours iffy• Font size >/=20• PA system• No roving mike• Many retired• Much experience

of research

• Features of this venue?

Features

• Features of this venue?

• Small/cozy• Intimate• Familiar• Smaller font ok• Hot/sleepy• Interactive• Just after

Wednesday Chester cake club!

SKILLS(quality of the presentation oral/visual,

handling of Q/A from audience)

• Pre-event advice from a previous adjudicator: (General)

‘Speak up, steady pace not too slow or too fast, acquaint yourself to all tools you are going to use on the night, use pointers, look at audience and your slides, if using busy slides apologise about but only point out the salient information in the slide, if co-authored paper try to point to the audience how much work you have done yourself’

SKILLS(quality of the presentation oral/visual,

handling of Q/A from audience)

Voice• Good presentation but was hurried, …• Too quiet Project your voice• Good subject, plenty of material but very slow, low voice,

slides are too busy• Good punchy presentation.• Good manner of speech, not rushed.

SKILLS(quality of the presentation oral/visual,

handling of Q/A from audience)

Slides• Slides a bit too busy in places and needs to look at

audience more than the screen.• Avoid looking back at the screen too much, but

rather address the audience• Clear delineation of Method, Result, Discussion not

done• Nice tables and stats; a little quick through the slides

(too many of these)• Nice LWH logo slides!

SKILLS(quality of the presentation oral/visual,

handling of Q/A from audience)

Props• Great speaker. Good use of audiovisual props• Having a video running at the same time (on a different

screen) is very distracting and not a good idea• Need to point to slides for areas of interest• Use the pointer!

SKILLS(quality of the presentation oral/visual,

handling of Q/A from audience)

• Great presentation, clear not rushed. Covered aims, methods results and conclusions.

• Confident presentation• Handled quite well, good time keeping but

seemed a bit rushed. • Liked the extra slides at the end to cover

(potential) questions• Too fast

SKILLS(quality of the presentation oral/visual,

handling of Q/A from audience)

• Poor time keeping - STICK TO TIME!• The content of the slide on view should

reflect/coincide with the content of what the speaker is saying

• Too many slides; too many crowded busy slides; pushed to stay within time limit

• Heading of slides is difficult to read - improved by better choice of colour scheme [not faint blue text against white background!]

SKILLS(quality of the presentation oral/visual,

handling of Q/A from audience)

Q&A• Sufficient time to any individual slide – if going to run

over then exclude some slides for oral presentation and keep them in reserve slides for Q&A use

• Avoid talking over the person asking the question. Allow him/her to finish the Q.

• Good knowledge of subject ; answered questions well• Some answers plainly incorrect • Excellent handling of audience questions. Clear concise

PowerPoint slides• Didn’t deal with questions very well; unconvincing

SKILLS(quality of the presentation oral/visual,

handling of Q/A from audience)Q&A• Nicely presented. Not a lot of data. Did not cope that well

with questions

• Slides too fast. Muddled answers to some questions.

• Not prepared for the questions being asked. Needs to be a little more anticipating of issues likely to be raised

• Clear introduction of meta-analysis and explanation of results; didn’t do so well with question of why (Mg) not licensed; good knowledge of all papers

LSA Prize Feedback

Main points/Summary

Summary

• Clinical relevance

• Know your subject

• Know your venue and props

• Know the score-sheet/system

• Concise and clear slides/presentation

• Q/A tricks & tips

The gold standard?

What needs changing on this, if anything?

?This presentation will be made available to the members of the Mersey Post FRCA group, and will be also available on the LSA site www.lsoa.org.uk

Next LSA trainees prize event = Friday 22nd February 2013

Comments/questions to patrickmullen@nhs.net