David Oliver: The view from the conference lectern

Preparing a talk for a medical conference is an arduous and often thankless task. Let’s give speakers a break, says David Oliver

Earlier this year, Matt Morgan and Peter Brindley wrote a lively BMJ Opinion piece on the need to shift medical conferences towards more modern, interactive multimedia experiences that are more likely to engage, inform, and stimulate 21st century delegates. They highlighted examples of newer methods—like podcasts, “TED style” talks and presentations, and experts they called “people’s champions”—which are steering conference content to a brighter future. Their article sits alongside many other recent resources and campaigns, ushering us to a brave new conference future and away from more traditional approaches from invited speakers.

I sympathised with some of their arguments, but as a veteran conference speaker, serial delegate, and consumer of content, I also found myself muttering “But steady on!” Why my desire to push back in defence of us speakers and give the view from behind the lectern?

I realise that some researchers, campaigners, or healthcare leaders deliberately target conferences to launch key reports or messages, or even bid for invites. I know that others happily take speakers’ fees and sponsorship to speak for money. In that case it’s a reciprocal bargain that they deliver professional, interesting content for paying delegates.

Yet in my experience, most speakers aren’t in that category. For starters, we have young, up and coming clinicians and researchers who are gaining their first, nervous experience of presenting to a large, live audience of strangers. Of course, learning to speak well, prepare well, and make good visual materials is a vital career skill for many. But it’s a learning curve and frightening enough without the pressure to deliver a talk with the smooth confidence of a seasoned speaker, let alone the slick format of a TED talk delivered by a broadcast media professional. We want speakers to come back and get better, not deter them. 

Then we have a whole group of speakers (and this was me for many years before I started turning down most invitations) who never asked for a platform, had nothing they had been pushing to sell or tell, but were invited by the organisers for the expertise or profile they might add. This group is unlikely to be paid anything beyond expenses. That’s fine by me as we don’t need to ramp up costs for delegates. Speakers may find themselves still having to pay registration fees, without which conference business models might suffer. 

Yet preparing a talk is a lot of work. If I have been asked to deliver a talk of anything from 20 to 45 minutes⁠, then preparation time for all the materials will run into at least four to eight hours of work⁠—generally at evenings and weekends. This multiplies when it’s two or three different talks on the same speaking trip or event. (I try hard to update and tailor talks for specific audiences.) Then, you also have to factor in the time spent travelling and away from patients, trainees, and the clinical day job you are paid for. This is why I mostly refuse invitations these days. I’ve had my fill. Besides, there are newer, fresher voices.

Not everyone with a fantastic grasp of their subject is a natural speaker, nor a wizard with graphics and software. And many have no assistants or assistance. Speakers already get anonymised summary feedback as standard and may not be invited back if they’re no good. A general air of grumbling if they don’t measure up is deflating. Do we really want to encourage more less “constructive” remarks on presentation and delivery as well? It’s bad enough having every slide photographed on iPads till you wonder if anyone is listening. 

Into that mix, I’ve experienced treatment by conference organisers over the years that ranges from brilliant to awful. This includes being asked for a full synopsis, biography, and even slides many months in advance⁠—a big ask when you might have 30 or 40 talks to write in a year. I know that they are only doing their jobs but it’s big pressure. I have experienced worse though: adverts putting speakers’ names or the bullet points they’ll cover on the programme when they haven’t yet agreed to speak; organisers telling me very directly what I will be covering in my talk; and edicts on how not to bore or offend the delegates⁠—in one case “like speakers usually do.” 

I have had people tell me I had 30 minutes, prepared to fill that time slot, and then on the day been asked, “Can you make it 15 instead?” I’ve had chairs who let sessions start too late but still need it to finish on time; technical staff who assured me that the presentation or clip was working or compatible, or that a comfort screen would be visible, only to find out the hard way, in front of several hundred people, that it wasn’t; and organisers deciding to “lose a few of your slides” or “tidy them up” so on stage I didn’t recognise my own materials. 

I’ve also heard of conferences where whatever you prepare and submit, it gets turned into a TED format whether you like it or not. 

Beyond all this, I just don’t buy the notion that there is one “best” way of delivering conference presentations. If people are well informed, passionate about their subject, and can connect with an audience and speak human that’s what counts. 

I have seen brilliant talks from people with no visual materials, even no notes, fairly standard PowerPoint formats, multimedia resources, electronic audience interaction and polls, or with what would technically count as “too many” slides with “too much” content. I am suspicious of self-appointed “how to” gurus, often monetising their resources. 

Let’s support the people behind the lectern. They are mostly doing their best and successful conferences still need them.

David Oliver is a consultant physician in Berkshire and writes the weekly BMJ “Acute perspective” column. He makes terrible slides and uses too many of them but some people still like his talks. Twitter @mancunianmedic 

Competing interests: None declared