The Dr. Fox Lecture

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The phenomenon in which the style of a lecture masks its poor content is known as the “Dr. Fox Effect.”

In the 1970’s, three researchers hired an actor, Michael Fox, to “teach charistmatically and nonsubstantively on a topic about which he knew nothing.” The lecture, titled “Mathematical Game Theory as Applied to Physician Education,” was attended or rewatched via video by a total of 55 participants (physicians, educators, and administrators).

This is a video of the lecture:


This is a video of an edited version with clips added:


Table 1 from the paper shows the responses that the participants had to the survey.

  • Group 1 – 11 psychiatrists, psychologists, and social-worker educators
  • Group 2 – 11 psychiatrists, psychologists, and psychiatric social workers
  • Group 3 – 33 educators and administrators with 21 of these holding master’s degrees, 8 with bachelor’s degrees, and 4 with other degrees not specified

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The authors concluded that “style was more influential than content in providing learner satisfaction” for those participants in the study. They were specifically aiming to address the idea that student ratings of educators had more to do with personality than with educational content.

What implications does this have for us as medical educators? There are many different theories that can come from this study. The authors themselves write “there is much more to teaching than making students happy.” This is very true, but much like attention, there is an undeniable effect of “performance” on gaining interest and motivating learners. The authors note that “despite having been misinformed, the motivation of some respondents to learn more about the subject matter persisted.”

Although much more research has to be done in this area to answer the question effectively, my own answer is summarized in a quote I use frequently in my presentations:

“Successful teaching is a performance, and the sooner we make peace with that, the better.” – Tauber, et. al.


Naftulin D, Ware J, and Donnelly F. “The Doctor Fox Lecture: A Paradigm of Educational Seduction.” Journal of Medical Education. 1973;43:630-5

Tauber R, Mester C. Acting Lessons for Teachers: Using Performance Skills in the Classroom. Praeger, 2007. 2nd edition.

Book Review – Slide:ology


This is one of the books that started it all! Well, at least for me…

When I first became interested in presentation design, this was one of the first books that my mentors had me read. This is a must read for anyone interested in presentation design (and that should be all of us).

This book, written by Nancy Duarte, was my first introduction into the process of thinking visually, and also “how” to create slides that fit design principles. In it, she gives a brief history of visual aids, and makes a compelling argument for presenters to raise the “stakes” on their presentations. The majority of the book outlines the process of creating presentations and actually gets into the key ideas of creating slides with sections like “creating diagrams,” “displaying data,” and “using visual elements.” The book also uses case studies of various people, projects, and presentations to highlight the key ideas.

One of the few weaknesses of this book is that it doesn’t cover design for medical education. This book is more geared towards marketing and selling ideas. In it’s defense, there are very few that are geared towards design for medical education. Our needs in medical education are obviously different. Selling and idea versus promoting learning are much different goals. The same principles apply, but must be tailored to the audience and goals. 

With that said, this is still a must read for anyone serious about presentation design in any field. I find myself referring to it often. Below are some excerpts from the book. Enjoy!

Manifesto: The Five Theses of the Power of a Presentation

  1. Treat Your Audience as King
  2. Spread Ideas and Move People
  3. Help Them See What You Are Saying
  4. Practice Design, Not Decoration
  5. Cultivate Healthy Relationships

Quotes from the book:

“Presentation software is the first application broadly adopted by professionals that requires people to think visually. Unfortunately, most people never make the jump from verbal expression…”

“Simplicity is the essence of clear communication.”

“To communicate your data effectively, you first must articulate the conclusions you want your audience to adopt.”

“Effective slide design hinges on mastery of 3 things: Arrangement, Visual Elements, and Movement.”


Duarte, N. 2008. Slideology: The Art and Science of Creating Great Presentations. O’Reilly Media.

Key Articles in Presentation Design – Applying Multimedia Design Principles

Two key articles give us some of the first evidence in medical education that applying multimedia design principles affect learning.

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The first article is a prospective study where “traditional” powerpoint slides were compared to “modified” powerpoint slides in a 50-minute lecture on shock given to third year medical students during their surgery clerkship. The modifications were based on Mayer’s multimedia design principles. A pre-test/post-test control group was used and took a convenience sample of students (39 in the control group, 91 in the modified slide group).

The author, Dr. Nabil Issa, was gracious enough to send me the slides he used in his study. I have included the ones that appear in the two articles for comparison.





Results: Both groups showed improvements in retention , transfer, and total scores between pre- and post-tests. However, further analysis showed statistically greater improvements in retention (F=10.2, p=0.0016) and total scores (F=7.13, p=0.0081) for those students in the modified slide group. Interestingly, there was not a significant difference between the groups ability to apply the new knowledge to clinical vignettes.

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The second article is a follow-up study based on the first.

Results: The modified slide group significantly outscored the traditional slide group on delayed tests of transfer and retention given at 1 week (d=0.83, 0.83 respectively) and 4 weeks (d=1.17, 0.83 respectively) after initial instruction. The modified slide group also significantly outperformed the traditional slide group on immediate tests of retention and transfer. (see below)

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So, what does this mean for us. Well, a few things. First, we have evidence that the way we design our materials affects learning. It also means we have a lot of work to do. There are many more questions to answer to fully understand the effect of incorporating multimedia design principles. Are certain concepts taught better in certain ways? Does the length of the presentation affect retention (yes on this one, but just thought I would throw it out there)? How do we best teach others to design with multimedia principles?

Hopefully, this is the first of many studies on optimizing the delivery of content to our learners. I even hope to contribute to this body of literature myself in the coming years.

I have written previously on Mayer’s work in this blog if you are looking for more information about multimedia design principles. Click here to see the page.

Below is a diagram of the cognitive theory of multimedia learning: Screen Shot 2013-03-28 at 10.31.05 PM(Click to enlarge)


Issa, et. al. “Applying Multimedia Design Principles Enhances Learning in Medical Education.” Medical Education. 2011;45:818-26

Issa, et. al. “Teaching for Understanding in Medical Classrooms Using Multimedia Design Principles.” Medical Education. 2013;47:388-96