Learning from My Mistakes

So, I was recently asked to give a talk on Accidental Hypothermia. While I was making the talk, I decided to take a short-cut (aka, I got lazy) and put in a clipped portion of a graph from one of the key papers instead of recreating it myself or trying to use my supergraphic correctly.
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Of course, the slide looked great when I was making the lecture, but it projected horribly! I was standing about 1/2 of the way back in the room and I couldn’t read it myself. This got me thinking. How big is the font in graphics like these? Perhaps if I knew how small the font actually was, it would help motivate me from making this mistake again.

So, I cut out a portion of the graphic and decided to use the phrase “impaired consciousness” to test font sizes.

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As you can see, the font in the graphic is only 16 pt. When directly compared to larger fonts, it seems ridiculous to use in any slide or presentation.

Lesson learned.

Deep Thoughts on “Lectures” and the Learning Pyramid

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Ever since I can remember, I have been told that “lectures” are the worst way to for students to learn. I saw a great presentation recently that highlighted the learning pyramid and talked about lectures at the top of that pyramid. For this and many other reasons, lectures have gotten a bad reputation.

The trick is what is meant by “lecture.”

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Essentially, when you look at the pyramid, you see that audio-visuals, demonstrations, and discussions are among the techniques that enhance learning. However, I would argue that great presentations incorporate all of these techniques, and in the right settings, can even get to practice and having students teach other. I think that “lectures” in this setting represent the extreme of purely regurgitating (likely in a monotonous tone) information from a text to the learners. To further emphasize this point, Issa, et. al. has published two papers in the past 2 years showing both short term and long term learning and retention benefits using educational design principles in the presentation.

So, the way I look at it is like this: Presentations can have a range of effectiveness and it is up to us to break the “curse” of the pyramid and make great presentations that optimize learning and retention.


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


When I was growing up, my grandmother would occasionally say, “I’m gonna learn you [insert something I needed to know here].” It’s with that story that I emphasize to my students that learning is not done to others, it is a process that is experienced and leads to a change in behavior, knowledge, or understanding.

Two of my favorite quotes on learning:

“I never teach my pupils; I only attempt to provide the conditions in which they can learn.” -Albert Einstein

Learning results from what the student does and thinks and only from what the student does and thinks. The teacher can advance learning only by influencing what the student does to learn.” – Herbert Simon

Color blindness and presentations

According to estimates from the Howard Hughes Medical Institute, somewhere around 7% of men and 0.4% of women are color blind. The most common is red-green color blindness. I always wondered whether the presentation rule of “never use red” in a presentation was true. So, I spent the a few hours on the website www.vischeck.com to find out.

Vischeck.com lets you upload images to see how they would appear with different types of color blindness.

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So, we can’t tell yellows from reds and greens, but we can still see the BOLD effect in the words clearly.

I decided to try a few of my own slides to see how they project:

These first two are from a lecture I developed before abandoning red altogether. I was very disappointed to find out my orange (2nd pic) suffered the same fate as red.

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Here is the effect in some of my more recent slides.

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So, the morale of the story is that it is likely better to just avoid red altogether, as well as green. However, they can be used with the following caveats:

  1. Do not try to contrast reds, yellows, and greens because they all look the same
  2. Consider using bold, italics, or other effects to give emphasis in addition to the color
  3. Used in isolation, a red or a green will appear yellow to a small portion of your audience. It will still stand out, just not the way you intended
  4. Checking your slides at a site like www.vischeck.com will avoid creating presentations that inadvertently diminish the learning of a portion of your audience


Howard Hughes Medical Institute (2005). Seeing, Hearing, and Smelling the World/Breaking the Code of Color: Color Blindness: More Prevalent Among Males. http://www.hhmi.org/senses/b130.html

Before and After – Headache in the ED

I have been reading and developing this presentation design niche for about 5 years now. Sometimes, I come across some of my old presentations and compare them to the newer presentations. It’s interesting to see some of the development and progression across time.

Here is the “before” of a presentation about headache in the ED:

Here is the “after” version. I consider this an early stage of my development:

Good times…


Themes vs Backgrounds

When starting a new presentation, you have a choice to choose a “theme” in the software presentation. Most of these are actually just backgrounds. They may be stylistic, but don’t carry a consistent idea through the entire presentation.

Some of the best examples of a true theme (and a source of presentation envy for me) are in presentations by one of my colleagues and an up-and-coming star in the world of EM and Ethics, Dr. Nathan Allen. Here is an example of one of his presentations:

You can see that the APPLE serves as his pneumonic and a clever theme running through the presentation.

All About Graphs

One of the first intermediate skills that I cover in any workshop or class I teach on presentation design is the use of graphs. Most presentation software have some easy to use tools to create graphs, but the same educational and design principles still apply and might not be intuitive from using the tools themselves.

Take this graph, for example:

Example Graph 1

Example 1: Focusing on the axis, this is a reasonable ratio to compare the data (there are some other improvements that can be made, but ignore that right now).

However, by changing the axis, you can skew the interpretation of the data.

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Example 2: The graph above has widened the range of the axis, hiding the difference between the two across the four years.

Example Graph 3

Example 3: Here the axis starts at 15 instead of 0. So, the difference between the two is falsely exaggerated.

Here is an example of a great graph from the New England Journal of Medicine. To avoid the problem of ratios, everything is simply labeled for direct comparison.

Example Great Graph 1

What do you mean I can’t use a picture of my dog?


This little guy is Grayson. He is one of two of our Yorkies (total of 10 lbs between the two of them). I call him “Beast” in public, of course. He used to regularly show up in presentations as a way to include images and breaks. It turns out that he was hindering my audience’s learning.

Bartsch and Cobern (2003) found that students actually perform worse in memory and recognition tasks when the images used were non-relevant. This makes sense to me because as we are learning, we are actively trying to form connections and relate our new learning to prior knowledge. As cute as he is, Grayson (or pics of your family, latest travel, etc…) get in the way of processing. So, when presenting ideas and data, make the images relevant to the material being presented.

However, one of the things that has not been studied is whether the placement of the non-relevant image matters. It’s one thing to talk about membrane potential on a beach background, but it may be another to build in a break that incorporates personal “non-relevant” images that help build your connection to the audience.


Bartsch R, Cobern K. (2003) “Effectiveness of Powerpoint presentations in lectures.” Computers and Education. 41(1):77-86