Public Speaking and Presentation Skills - Book and Article
Public Speaking and Presentation Skills - Book and Article
Terry L. Schraeder
https://doi.org/10.1093/med/9780190882440.001.0001
Published: 2019 Online ISBN: 9780190882471 Print ISBN: 9780190882440
CHAPTER
Abstract
Physicians, throughout their training and careers, are often asked to do a variety of di erent types of
public speaking—from large academic settings and videotaped seminars to informal informational
settings or impromptu discussions. Doctors are asked to speak on important clinical topics at hospital
grand rounds; discuss preventative health with patients in the community; lecture about their research
at a professional conference; respond at a press conference about a controversial issue; conduct a job
interview through video broadcast; Skype with a team of academic researchers from around the world;
or conduct themselves on camera for a telemedicine interaction with patients and colleagues.
Individuals are usually lled with apprehension about speaking in front of a group. More often than
not, many people will avoid talking in front of a live audience or a video camera if they possibly can.
But opportunities to speak are important to take advantage of, whether self-directed or prompted by a
request from a superior or an organization. Professional careers and personal connections can be
enhanced by giving an outstanding presentation with excellent skills. Whether the goal is to slightly
improve physicians’ presentation and communication skills or to perfect their public speaking
performances, this chapter will help them. Today, many careers in medicine and throughout the
healthcare profession require not only that physicians make presentations in person to large and small
live audiences but also that they are camera-ready and know how to successfully perform in a video
presentation or broadcast interview.
Keywords: presentation skills, PowerPoint, video, podium, microphone, public speaking, vocal exercises
Subject: Professional Development in Medicine, Clinical Skills
Collection: Oxford Medicine Online
We spend a good part of our lives trying desperately to convince ourselves as well as everybody else
that we know more than we really do.
—Charles Osgood
There are only two types of speakers in the world, the nervous and the liar.
—Mark Twain
Introduction
As a former television reporter and a current medical educator and practicing medical internist, I have
taught many sessions and seminars on public speaking and presentation skills. I have met physicians,
clinical researchers, executives, and other health professionals who know that their skills and training in
this area are de cient and are very interested in learning how to improve. The good news is that most people
are much better at public speaking than they think they are. However, no matter what your current
competence level is, you can always do better. After you learn how to identify and tap into your natural
personality, attributes, and communication style, you will begin to feel more comfortable.
p. 114 At some point during your professional life, someone will ask you to give a presentation. You may be
honored and elated. But like many people, including many physicians, you may also be nervous and even
Physicians, throughout their training and careers, are often asked to do a variety of di erent types of public
speaking—from addressing large academic settings and videotaped seminars to speaking in informal
informational settings or leading impromptu discussions. Doctors are asked to speak on important clinical
topics at hospital grand rounds; discuss preventative health with patients in the community; lecture about
their research at a professional conference; talk to medical students or residents at a noon conference;
speak to a television reporter about a timely topic; respond at a press conference about a controversial issue;
conduct a job interview through video broadcast; Skype with a team of academic researchers from around
the world; or conduct themselves on camera for a telemedicine interaction with patients and colleagues.
On September 14, 2018, Dr. Allan Tunkel, Senior Associate Dean for Medical Education at the Warren Alpert
Medical School of Brown University, gave the White Coat Address at Cooper Medical School of Rowan
University. It was one of the highlights of his professional career. He told the personal story of his near-
death experience while su ering from septic shock and pneumonia in the intensive care unit (ICU). He
shared important take-home lessons about healthcare for the medical students present that day. The
twenty-minute talk was brilliant and well-received by the audience despite the fact that Dean Tunkel
committed several errors in public speaking that day. Speci cally, he read most of his talk word for word,
p. 115 was hidden behind a podium, and only looked up at the audience occasionally. But Dean Tunkel is a
natural storyteller, and what made his talk so e ective were his honesty, humor, and true emotion. He
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tapped into his personal communication style to tell a thoughtful message about his experience.
• Television interview
Whether you are asked to speak in one of these varied venues with di erent media platforms, to di erent
audiences about di erent topics, or in another type of setting, many of the essential communication skills
are the same. Fortunately, they are skills and can be learned, practiced and even perfected. Whatever
presentation you give, your communication skills, or lack thereof, will be readily evident to your audience.
But you will reduce your anxiety and heighten your performance if you have an increased awareness of your
natural skills, knowledge of the mission of your talk, and thorough preparation and practice. I have heard
many common misgivings about public speaking.
• “If I could improve one thing about my public speaking, it would be to engage more with my audience. I
• “Something negative about my public speaking is that if I make one mistake, I struggle to let it go and
come back from it. I focus on the mistake that likely nobody else noticed, and it becomes a positive
feedback loop of continuing mistakes.”
• “Something positive that people have told me is that my pace is good and I seem con dent in what I’m
saying, which I think is pretty funny because I tend to be nervous in public speaking contexts and not
feel con dent at all.”
Individuals are usually lled with apprehension about speaking in front of a group because they do not
realize how good they can be by making minor adjustments and how easy it really is. More often than not,
many people will avoid talking in front of a live audience or a video camera if they possibly can. But
opportunities to speak are important to take advantage of, whether self-directed or prompted by a request
from a superior or an organization. Professional careers and personal connections can be enhanced by
giving an outstanding presentation with excellent skills.
I have heard many stories from individuals about avoiding public speaking, from turning down invitations
to talk to audiences of patients, to turning down media interviews and even professional opportunities to
speak at important conferences. One therapist whom I know declined to be listed on a popular physician
referral site simply because she did not want to talk about herself and her work in front of a video camera.
She wrote to me in an email, “I don’t like the idea of having to do the video, but that’s just me. I am shy.”
Unfortunately, medical school, residency, fellowship, and other medical and science graduate trainings
o er little if any speci c instruction or formal guidance about the topic of presentation skills. Studying
science courses, doing well on multiple-choice exams, and memorizing mountains of basic science data
p. 117 may produce knowledgeable doctors and successful researchers but not individuals who are excellent
communicators. Although training in this area is changing and more education is becoming available, on
the whole there is still little instruction or guidance for healthcare professionals who want to present
themselves and their work in the most optimal way.
Whether your goal is to slightly improve your presentation and communication skills or to perfect your
performance so that you can become an engaging or even motivational speaker, the rules are the same. Yes,
you can become a top-notch communicator and e ective speaker. Yes, you should care because if you
cannot communicate to an audience about your work, then your knowledge, advice, insight, and opinions
will not be heard. And unfortunately, your work may be lost, and your experience and wisdom may never be
acknowledged or remembered. Your mission may never get o the ground. The spotlight will shine on
others with excellent speaking skills and their work. Those with better presentation skills are often more
likely to be promoted, funded and rewarded.
Communication and presentation skills are critical for a successful career. Today, many careers in medicine
and throughout the healthcare profession require not only that you give presentations in person to large
and small live audiences but also that you are camera-ready and know how to successfully perform in a
video presentation or broadcast interview.
Ninety percent of how well the talk will go is determined before the speaker steps on the platform.
—Somers White
You may envision yourself as a poor speaker with all of your weaknesses present instead of beginning to see
yourself as an articulate and compelling presenter. Knowing your material and the reason you are
presenting it and recognizing your skills as a natural communicator are the rst steps to helping your
performance. Realizing that you have many talents and assets from di erent aspects of your life and
applying those experiences and con dence to your presentations can also be helpful. Just like you have done
in other areas of your life, you can apply these inherent human communication and life skills to improving
your presentations. Remember that your work and your knowledge are both important. Your audience needs
to be informed about your work and what you need to say.
Think about the traits and skills you appreciate in a speaker. Do you like when the person is passionate,
clear, understandable, succinct, and comfortable? Would you prefer a presenter who connects with the
audience, stays on message, and is able to successfully tell a story or use humor?
Do you appreciate a lecturer who appears to be in charge of the lecture from beginning to end? Are you
impressed when the lecturer remains calm and in control no matter what comes up, such as a technical
problem with the microphone or a di cult question or comment from the audience?
One truism that may help boost your con dence is the following: remember that, the vast majority of the
p. 119 time, when you are presenting, you will know more about the information than anyone else in the room.
There may be some very smart people in the audience, who may ask you some tough questions, but no one
knows your presentation and all the information it contains as well as you do. While your audience doesn’t
know as much as you know about the topic, unfortunately they also may not care as much as you do. Your
job is to make them understand the information and make them care about it as much as you do. That is why
clear, articulate, engaging, and passionate talks are the most e ective and memorable. Make your listeners
learn and share your concern and interests. Ensure that the audience hears your message and becomes as
passionate and articulate as you are about it.
If you don’t know what you want to achieve in your presentation your audience never will.
—Harvey Diamond
Try to imagine your audience in a positive light. Instead of fearing your audience and imagining a group of
enemies, envision the audience as open, accepting, and encouraging. Instead of thinking about the worst-
case scenario, imagine yourself giving a great presentation and successfully completing your mission to a
group of friends and colleagues. Remember, when you are an audience member, you just want to listen and
learn from an informative and accessible presentation. You assume it will go well. Your audience expects
you to win, and they are planning for you to give an e ective and informative talk.
Another lesson to remember is that practice improves performance. Start accepting opportunities to speak.
When asked to do a presentation, don’t say no and avoid it. Force yourself to say yes to invitations to give
talks. Also, create your own opportunities and talk to your boss or colleagues who might help make these
types of opportunities happen for you. The more public speaking you do, to small intimate groups or to large
After you have secured a speaking engagement, you will want to do three things: First, remind yourself why
you want to speak and create a mission statement for yourself about the goal of your talk. Remember and
articulate why you are the best person to give this talk. Second, become an expert about the topic you are
speaking on and know your information well. Third, know who your audience is and what they need from
you. Realize your inherent worth and, most important, the inherent worth of the knowledge you need to
impart in giving an excellent presentation. Transfer your nervousness into productivity; start researching
and writing your talk. Also, try to attend a few live lectures or watch some presentations online. Take notes
on things you like and don’t like. Figure out what kind of presentation skills you want to emulate, then you
can begin to gain the knowledge you need to begin to practice and prepare.
It usually takes me more than three weeks to prepare a good impromptu speech.
—Mark Twain
Even though it is not easy, it is only by focusing on our own communication skills and dissecting them in an
objective manner that we can analyze our speci c and unique assets and de cits. Then we can begin to learn
the important tools to improve. First impressions are key—and that includes rst impressions by our
audiences about our presentations. Most people make up their minds about us in the rst few seconds of
meeting us or in the rst moments of our lecture; that is why our skills from beginning to end are critical to
our success.
There are many common problems people have concerning public speaking. For most of them, there are
some easy solutions.
p. 121 1. “I’ve been told I speak too quickly, so I would like to improve this and nd a comfortable pace.”
When most people are nervous, they speak too quickly. Remind yourself that it is almost impossible
to speak too slowly. Take a breath. Look out at the audience. Utilize pauses e ectively. You should
know that while it is hard to speak too slowly, it is possible (and a common error) to speak without
enough energy or enough passion. One of the most common errors is speaking too quickly—the
other common error is speaking without enthusiasm. Don’t commit either of these errors. Try to
connect and convince your audience that what you are saying is important. Try to be natural, clear,
succinct and make a good impression. Look up at your audience after important points. Have a
conversation with them.
2. “Sometimes I get so nervous when I am speaking that I sort of black out and really lose my self-
awareness. I feel like when I am nished, I have no idea how long I have been talking or if I have
even e ectively gotten my point across.”
Remember it is not about you. It is about the information you are presenting. If what you have to say
is important, then think about how important it is to inform and engage your audience with the
content of your presentation. Be organized and engaging. Look out at the audience and build a bridge
to them. Make sure they are hearing and understanding your important presentation.
3. “I don’t know about my body language when I am speaking. I try not to dget, but I hear mixed
things about using hands versus not or walking around on stage or not—this is something that I
know I do.”
The more you can focus on your information and the importance of your talk, the more you will be
con dent and comfortable with your own body language. The more comfortable you are, the more
p. 122 your body language will follow and display con dence. You won’t worry about your hands, your
feet, or your body movements; you will use your posture and gestures like you do when you are calm
4. “I have been given generally good feedback about my public speaking, but I would say that
regardless of external feedback, I tend to feel horrendous while doing it. Some strategies for
managing nerves during public speaking would be fabulous. The old ‘picture everyone in their
underwear’ trick doesn’t quite do it for me.”
Instead of thinking of people in their underwear (which I don’t recommend), imagine yourself sitting
in the audience. What are you expecting from the speaker? You are expecting an informative
presentation. You may also be thinking about your next meeting, your daughter’s birthday, and
maybe even lunch. In other words, the people in the audience are just like you, they have busy lives
and just want to hear an interesting and relevant talk—so give them one.
5. “I feel like I can do okay with thoroughly rehearsed material, but I can stumble a bit if I have to
come up with the words as I go.”
Some people do need to read a script, but instead try to write down bulleted points and know the
structure and ow of your talk. You will be able to have a dialogue with your audience instead of
reading a script. Just like when you have a conversation with one person, you are not reading a script
—think about having a conversation with your audience, only it’s one in which you get to do most of
the talking. When we “read a script” we tend to lose all of our natural voice qualities and become
monotone and emotionless. You will want to give a presentation that is directed to real people in your
audience—tell them a story and talk to them as individuals. If you must use a script, mark it up with
notes and highlights so you can remember to ad lib, pause and emphasize where necessary. Try to
p. 123 make it more conversational and you will have more success.
6. “I would love to be able to stand in front of others and speak more clearly. I often lose my train of
thought and then become roundabout with my word choice.”
Having notes of exact gures or important percentages or other bulleted points in front of you can
help you if you lose your train of thought. If you do use a script, you can mark it up so you have notes
for yourself. Make your presentation come to life in any way you can. Also, be con dent enough that
you can easily say, “I think I just got o -track or misspoke; let me back up.” Or, “Is that clear to
everyone?” or “Are there any questions?”
7. “I wish I could be more succinct and conclude my ideas better rather than trailing o .”
Just like you do when you are speaking to someone else one to one, make your point and then move
on to the next point. Put a period at the end of each sentence. Be con dent, clear and concise. Each
talk should contain between three and six take home lessons. Write these down beforehand. Make
sure you discuss all of them and reiterate them before you nish.
8. “I would like to eliminate space- ller words during public speaking. I want to deliver a short
speech e ectively.”
We all use excess words as crutches or ller words such as “uh,” or “yeah” or “do you know what I
mean?” and one way to help reduce these is to audio record or video tape yourself. If you hear
yourself using unnecessary phrases or ller words as crutches, it will be easier to eliminate them.
Catch yourself saying these words in any way you can and work on stopping the use of them.
10. “I would like to know how to make eye contact without making it look like I’m intentionally and
deliberately trying to make eye contact with people.”
Look at one face at a time in your audience. Smile and look into people’s eyes while you are talking
until you see a nod or smile. Pretend the person you see is the only person in the room, then move on
to someone else until you gradually build the number of friendly faces you have connected with to as
many people as possible in the room. Their facial expressions should calm you down and give you
immediate feedback on how you are doing.
11. “People tell me my voice doesn’t sound like it’s shaking, but to me it de nitely sounds like it’s
shaking.”
Take a few slow deep breaths before you begin speaking. This can help calm your nerves and reduce
the shaking. You can try to yawn a few times before you walk on stage. Slow yourself, heart rate and
ultimately the speed of your talk down. Think of a person, a situation, a geographic location or an
activity you love. Close your eyes for a minute and imagine you are in a serene, con dent and happy
state. Smiling and stretching your body can help as well. Try not to focus on your voice or yourself.
Instead focus on the information and how best you are going to engage and teach your audience.
If you want to try to assess your own public speaking and presentations, you will need to be open to
p. 125 acknowledging the areas you need to work on. You will also want to listen and learn from others.
1. Make a list. Be honest with yourself about your strengths and weaknesses as a communicator and
presenter of information, but do not be hypercritical. Write down a list of your perceived strengths in
all areas of communication, not just presentation skills and not just when speaking to an audience.
Think about your strengths when speaking to a friend or family member or to students, residents, or
employees and write these strengths down. Now think about what you would like to improve in your
presentation style. You can write down just one word or make a list. Write down any weaknesses you
have when communicating or as a presenter. Try to make your strengths a longer list than the list of
weaknesses. Next to any weakness, write down the correction you need to make.
• I mumble. I will learn how to improve my articulation and enunciation with speci c knowledge,
exercises, and practice. (See exercises in this chapter.)
• I speak too quickly. I will learn how to slow down by focusing on serene thoughts and my breathing.
I will use pauses and look out at the audience when I speak.
• I speak too softly. I will learn how to breathe properly using a full diaphragm and speak with enough
volume, passion, and energy to be heard.
• I am afraid to look at the audience. I will think of other situations where I am con dent and can
easily make eye contact with others. I will use this tactic as immediate feedback on how I am doing.
Reading the facial expressions of my audience is as important as reading the facial expressions
while sitting across from someone while having a face-to-face discussion. There is no better and
immediate way to realize your audience is confused, bored, or happily engaged, then looking at
speci c faces in the audience.
2. Ask others. If you need help making a list of your present communication style, talk to a supportive
friend or colleague or even a professional voice coach, speech therapist, boss, or superior to help
evaluate how you are at communicating and how you can improve. Ask for your reviews after you give
a presentation—and ask your colleagues to tell you honestly how you can improve. You can also ask
family members and peers about your communication and presentation skills. Compare this list with
the one you created for yourself.
3. Video yourself. Finally, record yourself doing a one- to two-minute presentation about your work or
topic of interest to you with your computer or your phone. You can use some notes but try not to read a
script verbatim if you can help it. Just talk to the camera like you are talking to a friend or a student
about your topic. When you are alone, just open your laptop or smart phone, push record, and look
into the camera and talk about something you know and are passionate about such as your work,
sports, a hobby, or a recent vacation you took. Watch and listen to the presentation. Be kind to
yourself. Give yourself an honest assessment. Write down what you like and what you would like to do
better. Most people can smile and soften their features at the very least—which, believe it or not,
helps their voice sound more natural. Another method to evaluate your voice is to record yourself
p. 127 talking on the phone to a friend or your mother. Listen and evaluate your natural tone, in ections,
speed, and clarity. Most people have wonderful voices when they are talking naturally to friends or
family members.
4. Read your reviews. When you do give a presentation to a live audience or a videotaped performance for
others to watch, welcome any feedback. Look closely at the audience reviews to see where and how
you might improve.
5. Watch the experts. Watch people you think are good, whether they are professors, politicians, actors,
journalists, or even your colleagues. What makes them so good? Try to gure out what it is they are
doing that you like. Are they earnest, con dent, and making eye-contact? Are they prepared and
knowledgeable but also able to handle spontaneous comments or di cult questions? Are their words
and their voice clear, pleasant, and understandable?
Best way to conquer stage fright is to know what you’re talking about.
—Michael H. Mescon
Improve Your Voice (Your Instrument)
Your voice is literally your instrument. When you give a presentation, how people feel about your voice will
be integral to how they perceive your presentation.
Think about how you react to various types of voices when you hear others presenting. Whether their voices
are high and screechy or low and mellow may determine how long you can listen before leaving the lecture
or before falling asleep. What about when someone talks too softly? Is that frustrating for you? Or what
about when someone speaks indistinctly or incoherently or speaks too quickly or talks too loudly? Is that
p. 128 irritating to you? Besides our body language, our voice quality may have more in uence on people’s
perception of us and understanding of our presentation than any other aspect of our communication skills.
Do you remember how annoying it can be during a phone conversation with a bad connection or listening to
the radio when the signal keeps cutting out? How does it make you feel when the presenter’s microphone
volume is too loud or too soft? Often, when you give a presentation, you will be speaking through a
microphone. It is okay to ask the audience if everyone can hear you—ask speci cally whether the volume is
too high or too low. You may be speaking perfectly, but if the volume of the microphone is o , or worse yet,
if the audio transmission is scratchy or a speaker is broken, your audience may become upset with the sound
of your voice and it has nothing to do with you. If the sound system is broken, take o the microphone and
speak in a volume that is audible (and pleasant) for the entire audience. You may have to increase your
volume.
Always look to your audience for feedback. If even one audience member is wincing or cupping an ear, you
know something is wrong. Your audience members will let you know how you are doing. You just need to
look at them to see their facial expressions and body language to measure their comfort and understanding
of your presentation.
p. 129 What type of voice is most easily heard and understood? In an article published in Science Magazine in 2012,
Sabine Louet wrote: “A growing body of evidence from multidisciplinary research in acoustics, engineering,
linguistics, phonetics, and psychology suggests that an authoritative, expressive voice really can make a big
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di erence.” Someone who speaks slowly with a low voice and a pleasant intonation can be perceived as
someone with a commanding in uence. According to Louet’s article, a good example of an authoritative
voice is the voice on the New York subway that says, “stand clear of the closing doors.” If you listen closely
to professional actors and broadcasters, male and female, as well as di erent speakers during presentations
you attend, you will begin to identify voices you like. Try to gure out what type of voice the person has and
what is pleasing, or not pleasing, about it. There are many di erent voices with di erent pitches and tones
as well as speeds and in ections. The common trait that all successful voices have is that they are authentic
and true to the personality of the person speaking. That said, the voice still needs to be supported with a full
breath, coming from a con dent posture. You need to articulate your important message with the correct
volume and energy by properly opening and utilizing your vocal instrument.
Of course, perception of a voice is very subjective. Our culture, geography, gender, age, ethnicity,
professional norms, and other biases can in uence our perceptions about another person’s voice quality.
Overall, it seems that low and slow voices from con dent male and female speakers using good volume,
in ection, and enunciation are often perceived as the most pleasing and commanding.
However, speaking with your natural pitch is just that—it is YOUR pitch produced by not stressing or
straining your vocal instrument or trying to imitate someone else. The phrase “speak low” may make some
women, and maybe even some men, try to speak lower than their natural pitch. This is a mistake. You
p. 130 should never try to speak higher or lower than your natural pitch. This will strain your body and make
your voice sound unnatural, and it can be harmful to your vocal folds. To nd your true speaking pitch, say
Similar to the way a singer determines whether they are a soprano, alto, tenor, or base, you can nd and
speak in your proper range and comfortable pitch. If you are a soprano, your voice can sound wonderful and
melodic unless you try to pretend you are a tenor. Many women in the early years of news broadcasting used
to speak with an arti cially low pitch, and some still do. But speaking with your natural voice and with your
natural pitch will help your voice sound the best. If your throat hurts after giving a speech or at the end of a
long day of talking, you may not be speaking at your natural pitch, or you may have other vocal problems
that a speech therapist or vocal coach could easily identify.
The production of voice, while complex, is still a product of our neuromuscular bodies and can be improved
with good instruction and practice. Pitch, volume, timbre, speech rate, and articulation are all essential
aspects of our voices and all amenable to training. A speech therapist or vocal coach can help you work on
any major problems you may have, such as poor pronunciation, lack of breath control or volume, using the
wrong pitch or stuttering. For many people, just practicing a few simple daily exercises and following some
speci c guidelines when speaking can help improve the quality of their voices. You may also consider taking
an acting class, signing up for speech therapy or voice instruction, singing in a chorus, joining a debate club,
p. 131 teaching, coaching, leading groups while hiking or exercise, or engaging in any other pursuits that
require you to use your voice regularly, publicly, and e ectively.
Almost a decade ago, I joined a chorus. I love music, and I have always wanted to sing. But I also hoped that
singing regularly at weekly rehearsals and performing concerts throughout the year would improve my
vocal quality and speaking voice so it would remain strong, full, and healthy as I aged. It has worked.
I can prove that regular singing in a group has improved my speaking voice quality by simply watching
myself on television or on video. Singing has indeed improved my voice by improving my breathing and use
of my diaphragm. The pitch, volume, and modulation of my voice are all more natural now. Just like when
you are singing correctly, if you are speaking correctly then your throat should not get tired or sore after
giving a talk. When I appear in television presentations now, my voice sounds better at midlife than it did
during my twenties when I was reporting regularly on television. Back then, the problems with my voice
were numerous. I would run out of air at the end of long sentences. When I was tired, my voice sounded
weak, hoarse or arti cial. Sometimes my throat would be sore after speaking for long periods of time. But I
have learned that relaxing my throat, neck, shoulders, and face and opening my jaw and using my full
diaphragm and breath to support my voice (as well as speaking with my natural pitch) have helped
eliminate vocal problems.
You may be able to think of many other activities or hobbies, including singing or reciting poetry or
storytelling, that require good posture and use of full breaths and vocal muscles to help you regularly
produce a pleasant and understandable projection of your best vocal speaking voice. Try to engage in these
activities as much as possible. Your voice muscles are like other muscles in your body—you need to use
them to keep them in shape. Here are some tips and exercises that can help you improve your voice:
1. Good posture. Stand on two feet in a con dent and comfortable manner. Make sure your
weight is evenly distributed over both feet. Make sure your feet are hip-width apart. Do not
lock your knees. Make sure your feet do not appear nailed into the ground or that you are
frozen in position. You can take a few steps one way or the other if you want. Arms at your
side. Your posture will a ect your voice, and your body language will reinforce your image of
con dence. Before we sing, we always stand and spend a few minutes making sure our
posture is good. Our hips are over our knees. Our chests are lifted, ribs are in, and abdomen is
soft. Move your head from side to side and drop one ear to one shoulder and the other ear to
the other shoulder to loosen your neck. Do not stand on your heels or lean on one hip. You
should be upright, strong, and supple like a dancer. Do not dget or be rigid or appear frozen.
Stand, breathe, and move with con dence.
p. 133 2. Breathe. Yawn a few times to open the jaw. Now take a deep full breath in on three counts
and exhale out on three counts. Now again on ve counts in and ve counts out. Do this a few
times. Diaphragmatic breathing is easy for some and counterintuitive for others. It took
years for it to feel natural to me. Singing helped me the most. Put your hand on your belly.
When you expand your belly as you breathe in, ll up slowly until you cannot take any more
air in; then as you exhale, contract the belly and slowly but steadily breathe out. You will
eventually feel the diaphragm literally pulling down and out to ll your lungs with air and
then pushing up and inward as you exhale. The expansion as you inhale can be felt around
the circumference of the mid-body including the back and the sides. A strong diaphragm and
good breath control will give your voice more power and projection.
3. Relax. Try to remove any tension from your body, especially from your face, jaw, and neck to
your shoulders, back, and legs. Just as tension a ects our bodies, it certainly a ects our
voices. The more at ease you are, the better your voice will sound. You should be alert,
engaged, and ready to sing (or give your talk). Do a few shoulder rolls forward and backward.
Twist your body gently from side to side. Breathe in and sigh out.
4. Warm up and strengthen your instrument. Do some lip trills. This is what you may have
called “motor boat” when you were young or playing with young children. Use air to vibrate
your lips. You can hum notes or hum a song you know (e.g., “Oh, Say Can You See” or “Happy
Birthday”). If you have trouble doing this, gently push or pull the sides of your lips together.
You can also try to do a few enunciation exercises as outlined later.
My mother was a professional broadcaster and theater actress. As a little girl, I would ride in the car with her
p. 134 and listen as she practiced elocution and breathing exercises on the way to the broadcast station or
theater. She would literally be warming up her vocal instrument so that she would be ready to perform. Try a
few of these exercises to help warm up and keep your vocal skills sharp:
• Betty Botter bought a bit of butter. But the bit of butter Betty Botter bought was bitter. So,
Betty Botter bought a better bit of butter.
Read one or two of the exercises daily for at least several days before your presentation. Try to increase your
speed. Record yourself. If you memorize a few of these, you will be able to use them as part of your warm-up
exercises before you give a presentation.
There are many other exercises to help you awaken and strengthen all of the muscles of the face, tongue,
throat, and diaphragm that produce your voice. You can certainly nd many of these exercises on YouTube
and elsewhere. You can also consider scheduling an appointment with a speech therapist and see if you need
any professional help. You can hire a voice or singing coach to help you improve your voice or join a
community theater or chorus.
1. Yawn ve times. Soft palate lifts, brings down the lower jaw, and opens and stretches your
instrument from the lips to the throat to the diaphragm. Some problems with voice,
including a “nasal” quality or even mumbling, can be due to our tongues not being engaged
and our soft palates not being lifted. When the back of our throat is opened (like during a
yawn), the voice can sound better.
2. Lip trills. Awakens and strengthens the muscles around the lips.
3. Tongue trills. Engage the tongue, say “butter”; then bend tip of tongue up to roof of mouth
and vibrate while making a sound. This awakens and strengthens the tongue.
4. Say “Ho-hummmmmm” then hum a song or a scale. With the lips closed and the jaw,
mouth, and back of the throat wide as possible. This will open and soften the throat—as well
as help you nd your natural pitch.
5. Sti e a laugh. Keep your lips rmly pressed together. This will activate your jaw, lips, and
other face and throat muscles.
6. Tongue circling in the front of upper and lower teeth. Both directions. Count 4 right, then 4
left, then 3-3, 2-2, and 1-1. This will help strengthen and improve the agility of the tongue
for clearer enunciation.
7. Say or sing a vowel for as long as you can. (A) “ah” (E) “eh” (I) “eye” (O) “oh” (U) “oo.”
Use a full breath. Sing or say one vowel at a time. Open your mouth as wide as you can (look
in the mirror) and deepen the back of your mouth and expand your diaphragm.
Here are her exercises as well as some I do in singing workshops: Stand or sit up in your chair with your feet
rmly planted. (Do not do anything that makes you dizzy or feel sick. If you do feel faint, stop right away.)
Make sure you are comfortable. Breathe in and then count loudly as far as you can. “One, two, three, four. . .
.” Try it again and see if you can increase the number each time. Make sure during the last few numbers you
say that you are still using a strong and full voice. Again, breathe in and then count aloud. Keep adding on to
the numbers if you can. Fill your back muscles with air. Count outloud on the outbreath to ten, then to
fteen, and then try to count to twenty loudly and clearly if you can. You can also make a “hissing” sound
on the exhale or sing or say a vowel sound (“ah” or “eh”). Look at your watch and time it, and continue to
try to make it longer each time. Again, if you feel dizzy or out of breath, stop immediately and sit down.
You can improve your voice by doing these types of exercises daily. After becoming familiar with these types
of exercises, you may begin to feel your diaphragm as you take much fuller breaths. Our breath is what
produces our voice. The fuller our breath is, and the more we learn to utilize and control it, the better our
voices will be. Speaking coaches will work with the speci c characteristics of your voice, improving in areas
where you may need it the most, from your volume and resonance to enunciation and clarity. There are
many tools and techniques that can improve the quality of your voice. But the bottom line is that the better
your voice is, the better your presentation will be.
The best thing most speakers can do is optimize their ordinary speaking voice for public
p. 137 performance. Audiences will like you better for it—and you will feel both more natural and more
relaxed as a result.
5
—Tina Blake, Voice coach
Four Common Mistakes in Presentations
After years of leading communication skills training workshops and programs, I have witnessed many
1. Realize it is normal to be nervous. Expert speakers realize that being nervous is a normal response. In
p. 138 other words, if you are not nervous, something is wrong. But the level of nervousness and how you
handle those nerves will determine your success.
2. Channeling nervous energy. You can channel nervous energy into a good performance with tools
such as positive thinking, remembering why you wanted to give this talk and how important the
information is for the audience. Remember to use your breathing and visualization techniques. If you
are in charge of your emotions, you will be in charge of your presentation.
3. Think of activities you are good at. What are you really good at? Think of the professional activities
(e.g., operating as a surgeon, speaking with patients or medical students, diagnosing illnesses, talking
to employees) or personal hobbies or activities (e.g., golf, tennis, skiing, painting, playing a musical
instrument, talking to your children). Now, think about the con dence of your speech and your body
language when you are doing those activities. Try to emulate your body language and voice from those
activities when you give your presentation. Remember how nervous you were when you were a
medical student and you interviewed your rst patient? Think of how comfortable and con dent you
are now when you interview patients and know that you can be the same way in your presentations.
4. It is not about you. One way I have calmed down many medical students and residents and improved
their presentations of patients’ histories and physical exams is to remind them why they are doing the
presentation. Presentations on rounds or while handing over care to another doctor are done to ensure
that the next doctor or other doctors can take great care of your patient. The presentation is about the
patient and not about the student or resident giving the presentation. The same is true for you.
p. 139 Remember, your presentation, regardless of the topic, is about the information you are teaching and
message you are imparting. It is about your ultimate goal and overall mission in doing the
presentation; it is not about you.
5. Visualization and imagery. I often tell people to imagine that the presentation is over and visualize it
playing out in the best possible way. Ask yourself a few important positive questions. How did it go?
How great was it? How did you want your presentation to go? How did you want your audience to
think about you and remember your information? Now, go out and make your presentation that way,
just as great as you imagined it.
According to an article in the Harvard Business Review written by Gary Klein, “unlike a typical
critiquing session, in which project team members are asked what might go wrong, the pre-
mortem operates on the assumption that the ‘patient’ has died, and so asks what did go wrong. . . .
The pre-mortem analysis seeks to identify threats and weaknesses via the hypothetical
presumption of near-future failure. But if that presumption is incorrect, then the analysis may be
6
identifying threats/weaknesses that are not in fact real.
Ask yourself why are you so nervous to give this presentation. Articulate your speci c reasons and fears out
loud or write them down. Many of your fears may seem ridiculous and somewhat irrational. But you can also
begin to create an emergency toolbox if any of your fears begin to come true during the presentation.
• Are you afraid you are going to freeze and forget what to say? Bring your cheat sheet of bulleted
points and engaging quotes or phrases and, yes, even a script if you must. Prepare and practice
beforehand. Take a deep breath. Look out and nd a friendly face and smile. Calm down. Go with the
ow. Be kind and supportive of yourself before, during, and after the presentation.
• Are you worried your throat will get dry and you will lose your voice? Bring water and some throat
lozenges and keep them handy. Taking periodic sips of water (not a ca einated beverage) will keep you
hydrated and, most important, will give you and your audience a nice break.
• Do you fear you will make a mistake or lose your train of thought? Remember you are human. You
might make a mistake. It is okay. Often, your audience will not notice, and even if they do, just
apologize and get back on track. Again, bring your speci c notes to glance at. Prepare and practice
beforehand. Learn to react on your feet. “I am sorry, I think I just misspoke or stated that the wrong
way. This is what I meant to say.”
• Are you afraid your audience won’t like you or you will look like a fool in front of your peers? Most
audiences want you to succeed, they want to hear and be rewarded with your great presentation. Don’t
imagine them in any other way. Look out while you are speaking to get immediate feedback from their
expressions (and comments or questions) and then adjust as needed.
p. 141 • Are you worried you will speak too quickly or in a monotone voice or not be understandable or
look too stern? Videotape yourself practicing the talk. Watch and listen to it, and you will immediately
see what you need to x. Do you need to slow down or smile more or take a few pauses at important
points? You may be your worst critic, so you may want to ask a friend to look at the video with you.
Once you see yourself, you will likely know how to sound and look better.
• Think you may faint? Remember to sit down immediately if you are feeling faint or ill in any way. Tell
your audience or others on the panel if you think this very rare event might be occurring.
• What will you do if you are asked tough questions? You should always try to predict the questions and
comments you might receive from your audience and write down the answers beforehand. Prepare a
list of responses such as, “that is a very good question but it is outside of the scope of my talk” or,
“that is an interesting and important comment, I am happy to talk to you afterward.” Or you can
always repeat the question back to them. Ask them to clarify the question and give you more speci cs.
“That is a good question—why do you ask or what do you think the right answer is?” Answer the
question the best you can or simply say, “I am not sure of the answer to that.” Many people who ask
• Could the computer or audio/video equipment fail? Think about all the possibilities of how technical
equipment might fail, assume that it will, and have a backup thumb drive or alternative source of
power or microphone or other important backup equipment. Know who and how you can call for
assistance and how you might nish your presentation even if the equipment fails.
• Might the audience boo you or throw tomatoes at you? Keep a hooded rain jacket handy.
While you should consider the possibility of some of your worst fears happening, generally they will never
occur. After you have examined your worst fears about public speaking, begin to focus on the positive
aspects of yourself and imagine your presentation being a success. Just like in sports or in theater,
visualizing a positive performance while you are preparing your presentation and before you begin are key
to an optimal performance.
One major reason that we become so nervous speaking in front of an audience is our fear of being evaluated,
assessed, and rejected. Trust me, people are already evaluating, assessing, and, yes, even rejecting you at
times, and there is very little you can do about any of it. So, during your talk just be who you are every day.
p. 143 Just prepare and know what you want to say, then practice your presentation, smile, be calm and
con dent, and remember to imagine and rehearse giving a great talk beforehand.
Visualization versus Premortem
Personally, I like to imagine myself giving a great talk in the exact setting I will be speaking in. I like to close
my eyes for a few minutes and actually watch a movie of my performance, similar to what athletes do before
they compete. I may even try to visit the location or simulate it in my o ce. I may record myself with audio
or video so that I can watch myself and see if I sound and look okay. The minute I hear and see my recording,
I can see things I can improve on. Am I speaking clearly and with enthusiasm? Or am I speaking too slowly
or sternly? Am I smiling? Am I pausing and using natural infections? Am I sounding hesitant or unknowing?
Am I slowing down and using important pauses when I say something really important? Do I sound natural?
Are there any words, names, or data that I am worried about stumbling over? I focus and rehearse and
sometimes record these beforehand just to make sure I reduce the risk for error.
Athletes and actors use visualization all of the time. Writing more than two thousand years ago, the famous
First, have a de nite, clear, practical ideal; a goal, an objective. Second, have the necessary means
to achieve your ends: wisdom, money, materials, and methods. Third, adjust all your means to that
end.
—Aristotle
Creating the mental image of how you want your presentation to go can help you achieve your desired
outcome. If you can see it before you perform it, then you can lower the chances of your nervous energy
getting the best of you before you speak—and improve your odds of giving a great talk. We must see it
p. 144 before we can believe it. Before we can believe in a goal, our brains and our bodies have to know what it is
going to look and feel like.
But instead of using a script, you should have an outline with prepared bulleted points, data, and
conclusions. If you are using slides, this can always help you stay focused and organized. But you still want
to include your own impromptu comments, personal stories, or maybe even some light humor. You want to
have a conversation with your audience about your key points. If you have a conversation (and don’t read a
script), you will use natural pauses, modulation, and in ections; you will speak in your normal voice. You
will use natural body language and facial expressions. You want to interact and react with your audience.
You will not be frozen in a monotone voice or appear like a “deer in the headlights” in front of your
audience. The key is to sound like you are having a discussion with your audience. Each audience is di erent
so each time you give your talk it should be slightly di erent.
If You Must Read a Script
If you must read a script, and sometimes you will, then you need a well-written (and well rehearsed) script
in a conversational tone. Use shorter sentences. Write creative, engaging and memorable phrases. Think
about cadence and word choice and even poetry or free verse. Mark up your script while rehearsing it. Find
the areas where you need to slow down or to pause. Your words need to be powerful, unforgettable, and
p. 145 well-selected. Think about political speeches and remember there is a reason that speech writing is a
professional career. When you have a well-written script, you will need plenty of practice to use your natural
speaking voice and make your message indelible. Remember to look up and out to your audience as often as
possible. You can use your nger or a pen to keep track of where you are so when you look back down you
know where to begin again. Professional broadcasters and actors are very good at this because they literally
make physical or mental notes about when to look up at the audience and when to pause. (And they
rehearse!) It takes practice reading from your notes or a teleprompter to appear natural. If you are using a
By slowing down a speeded-up presentation and using passion and natural in ections and rhythms of your
own voice (and making eye contact with your audience), you will be seen, heard, and remembered. Speaking
in a at monotone voice without any energy is not the same as speaking too slowly. In all my years of
teaching communication skills, I have seen very few people speak too slowly.
As I mentioned earlier, I developed a lesson to help people improve their public speaking presentations and
other communication endeavors. I call it, “MACY” for mission, audience, content, and you. These are the
four important aspects to think about before and during your presentation. Before you begin to plan and
practice your presentation, try to answer these questions:
• M—Mission: What is my mission? Why am I speaking? What is the purpose of this talk? What is my
ultimate goal? If I could accomplish one goal with this talk what would it be? State your mission in one
sentence.
• A—Audience: Who are they? What do they need from me? What do they already know? (You may need
to ask them directly.) What do the members of the audience want to know? What will they learn from
• C—Content: Make sure it is organized and informative. Use words and phrases that make your
message concise, relevant, and engaging. Tell a story if you can. Overall, make sure your talk has a
beginning, a middle, and an end. Be prepared with speci c points you want to make but also be
prepared to improvise. Have a conversation with your audience about your important points. Do not
read every word from a prepared lecture.
• Y—You: Be prepared, organized, and rested. Be calm, clear, and con dent. Rehearse the entire talk at
least twice in the week leading up to the talk. Know why you are the best person to give this talk on this
day. And remember, it is not about you—it is about the information you are presenting.
p. 148 I am convinced that most people have all the tools they need to be a great communicator. To help you
improve, it usually requires identifying and tapping into your natural communication skills and then using
them in an unnatural setting. It also requires identifying and eliminating obstacles or habits that may be
getting in your way of giving a great presentation.
How can you identify and tap into your natural communication style and skills? Think about when you are
with friends, trusted colleagues, or beloved family members. Stop and listen to yourself when you are
talking to a friend or doing an activity that you are good at. Most likely you are clear and con dent. You
know you have something to say and something to do, and you go about doing just that in a natural way.
Your body language and posture, as well as your facial expressions and your voice, tell everyone you know
what you are doing. That character and persona is what you need to tap into to transfer these attributes to
your presentation skills. But how do you translate being poised, eloquent, uent, e ective, persuasive,
lucid, expressive, intelligible, comprehensible, and understandable into another setting—particularly at a
podium in front of a large audience or in front of a video camera in a television studio?
First, we need to tap into the basics of what makes a good communicator. Again we can turn to Aristotle and
the 3 critical elements of a great communicator he identi ed. Ethos is our character, credibility, reputation,
trustworthiness, tone and style. Pathos is our emotional imaginative impact—the stories we tell to make a
personal connection. Logos is the reasoning, arguments, facts, gures and case studies we use—the logic
and the actual words we speak.
We do all of these naturally when we are engaging in an activity we are good at. Do you remember the rst
time you played the piano, examined a patient, performed surgery, or followed a recipe? My guess is that
you were not as con dent and capable as you are now doing those activities, right? How did you gain that
con dence?
p. 149 Yes, with knowledge, expertise and practice, but also focusing not on yourself but on the task at hand. You
need to play the music on the piano keys, not think about yourself playing each note. You need to examine
that patient and present your ndings to your team and not focus on your words or pauses or posture. You
need to swing that golf club or tennis racquet for a successful game and not think about how nervous you are
trying to perfectly connect with the ball.
You need to focus on the task at hand. You need to play the concerto and win the point. You need to give a
great presentation. The information you are presenting needs to be communicated. The audience wants to
hear your message and learn from you. Communicate with con dence and by using your natural abilities
and talents.
Most important, you need to observe and study yourself. Again, what do you sound and look like when you
are with your best friends or family? When you are talking to your children or sailing your boat or riding
your bike? When you are engaging in familiar activities in familiar settings, what does your voice sound
p. 150 like? You can transfer this con dence, conversational speaking style, calmness, and clarity to your public
speaking.
Imagine that Your Audience (or the Camera) Is Your Best Friend
Think of someone who makes you feel both calm and con dent—someone who believes in you. Bring that
person to mind and really see and hear them. They are looking and listening to you, and they want not only
to hear what you have to say but also for you to do a good job. Whether this is your best friend, a trusted
colleague, or a family member, imagine this person is in the audience (or in the camera) and then speak
directly to him or her.
Do you speak too quickly? Do you try to memorize and end up sounding like a machine speaking in a
monotone voice? Are you too nervous to make eye contact with the audience? Are you so uptight that you do
not blink or smile or use your natural facial expressions? Do you forget to take a big breath and calm
yourself beforehand? Can you be calm and focused and just have a conversation so that you incorporate
pauses and natural in ections in your speech? Can you improvise or react when you get a tough question or
something goes wrong with the equipment? Write down your important points and answers to tough
questions you may be asked before you begin.
Again, the most important tip I can give is to be yourself and have a conversation with your audience.
p. 151 Avoid the Standard Format if You Can
Many medical talks, like published abstracts, academic writing, research articles, and patient notes (e.g.,
histories and physical exams) often follow a standard format. Most medical presentations use or misuse
slide programs such as PowerPoint. But that doesn’t mean you have to—especially when speaking to a
nonacademic audience. Even in an academic setting, think about ways to break the mold and be more
e ective and informative, and your audience will thank you.
How can you improve your clinical talk, academic research, or other important presentation to your peers?
Why should you avoid jargon even when speaking to your peers? In every profession, including medicine, we
use jargon and acronyms assuming everyone in the audience understands us. The problem is that it is not
always true. Often, using professional jargon, buzz words or acronyms becomes a bad habit and a crutch
Do you and your audience really know the meaning of all the acronyms you use? Even if you and they do,
what is the harm in saying the full meaning once in your talk? Words are powerful and informative.
Acronyms are slang crutches and shortcuts that can become outdated or misleading. They can clutter our
presentations, preventing us from fully engaging our brains. I challenge you to avoid any use of acronyms
the next time you give a presentation.
The vast majority of presentations today still utilize Microsoft PowerPoint, but there are certainly other
slide presentation programs now available, including Google Slides, Prezi, Visme, Haiku Deck, Emaze,
Keynote, Projeqt, Slidedog, Slidebean, and Zoho Show. Slide-building software programs are invaluable
tools to help illustrate and illuminate your information. Unfortunately, many people make major errors in
using the programs. First, most people use too many words on each slide. Many speakers ll each slide with
text or even write out their entire talk on each slide. Then they proceed to read whole paragraphs and even
sections of chapters or expect their audience to read large sections of text from each slide. This is not only
ine cient but also boring and frustrating.
You want to use PowerPoint or another slide program to elucidate and augment your talk not as a crutch or a
distraction. Illustrations, graphs, photographs, formulas, data points, life cycles, and other simple but
e cacious graphics should bring your presentation to life. They should be simple and easily understood.
You should use as little text as possible. You also should not overwhelm your audience with moving graphics
or too many bells and whistles. You are giving a lecture, not putting on a circus of multimedia examples.
p. 153 Think of yourself as an audience member. You want to be informed and enlightened, not befuddled and
bombarded with special e ects.
The slides should speak for themselves. You should not have to “read” your slides to your audience. You can
refer to them or let them illustrate what you are saying but do not read them outloud. You want to make eye
contact as much as possible while talking to your audience. You are having a conversation with your
audience and making important points. Slides should illustrate information clearly and memorably than
your spoken words. Again, do not write out your talk on your slides to use as a crutch. Know your talk well
from your rehearsals and then illustrate the important points with graphic slides.
[S]cientists look toward the projected slides a lot when they present. As a result, they fail to
maintain eye contact with the audience, which is a very important part of a good presentation. In
my study I found that, during a 20-minute presentation, speakers turn toward the projection an
average of 3 times per minute.
7
—Brigitte Hertz, PhD, Wageningen University, Netherlands
• Use 10 relevant slides for twenty-minute talk (or 20 slides for forty-minute talk).
If you have the opportunity to speak to a group of patients or members of the public or others in a
community or academic setting, by all means do it. Some physicians are more intimidated talking to a group
of nonphysicians than they are speaking to peers, but they shouldn’t be.
Talking to a group of patients or members of the public is no di erent than talking to patients one to one or
members of the public one to one. True, these are not medical colleagues, and you may need to speak in
simpler terms and explain technical points or complex medical information, but you should be doing that
regardless of your audience. With a nonmedical audience, you should think about talking to individual
members of the audience, not a large group of faceless audience members. Think about talking to speci c
family members and friends who are do not work in medicine. You can still be informative and engaging
even without using scienti c, academic or professional words or jargon.
Fred Sullivan Jr. is a professional actor who teaches public speaking. He teaches his students to imagine they
are throwing a ball to the audience when they are speaking, and the audience has to catch it and throw it
back. This image illustrates the dialogue you have to have with your audience—you need to make sure they
are hearing and understanding you. Take your cues from their facial expressions, ask them questions, and
encourage their questions to make sure you are throwing the ball (your information and message) and they
are catching it (understanding your message and responding to your information).
In 1986, I read The Man Who Mistook His Wife for a Hat by the brilliant Dr. Oliver Sacks. I learned that he was
speaking at the Harvard Graduate School of Education that fall and I could not wait to attend. I arrived early
and noticed Dr. Sacks in the hallway outside the classroom by himself. I approached him with my pen and
my copy of his book in hand. But when he noticed me, he snapped at me with a menacing look. I don’t
remember exactly what he said, but I quickly went into the classroom and took my seat near the front.
Throughout his lecture, I noticed he was sweating profusely. Many of his slides (shown through an old
carousel slide projector) were out of order. He seemed frustrated. Even though his lecture was not as smooth
as I thought it could be, it was still interesting. But I was embarrassed and nervous myself about
approaching him again. The minute Dr. Sacks nished, and once the applause and cordial exchanges ended,
he came directly over to me and apologized. He explained how nervous he was about public speaking. He
asked to sign my book. I still have the book and cherish his autograph to this day. But it was an early lesson
that even some of the nest minds (and writers) among us are not always naturally great lecturers.
Of course, in the decades that followed, Dr. Sacks became a public gure and gave many interviews and talks
and often appeared on television. He clearly became more comfortable speaking to groups, and perhaps he
p. 156 received some professional communications training along the way. But he certainly improved his skills
and hopefully reduced his anxiety.
Peggy Noonan, author and political speech writer for President Ronald Reagan, spoke at Harvard Kennedy
School in the late 1980s. I squeezed into the standing-room-only auditorium packed with students, faculty,
and others. After being introduced, the accomplished and brilliant Noonan went up to the microphone and
looked out over the audience. The room was silent. No one could wait to hear from the person who wrote
some of the best political speeches of our time, including President Reagan’s “Boys of Pointe du Hoc”
speech on the 40th anniversary of D-Day and his address to the nation after the Challenger explosion, and
Vice President George H. W. Bush’s famous phrases “a kinder, gentler nation” and “a thousand points of
light.”
She stood at the microphone, looked out over the audience, and said, “tell me what questions you have.” My
heart sank, when I realized this phenomenal speech writer had not prepared her own speech for us. I was a
little taken aback. But then Noonan proceeded to take an hour of questions from the audience and gave the
most eloquent, thorough, and informative answers you can imagine. She gave the audience exactly what
they had come for—a chance to ask their speci c questions. There was a standing ovation from the audience
at the end of her talk.
While I don’t recommend you doing what Noonan did for your presentations, I do think the take-home
lesson is to try to give the audience what they want and need from you. Know your audience. Know what
they already know and what they need from you. Keep looking directly at their faces during your talk to see
how you are doing. Encourage comments and feedback. Leave time for questions either throughout the talk
or at the end.
p. 157 What is di cult about speaking to a group of nonpeers is that you may not know what they already know
and what they hope to learn from you. Whether you are speaking to a group of patients at the community
library or legislators at the state capitol, here are some tips that can help you “read” your audience:
2. Introductions. Ask for a few volunteers from the audience to introduce themselves and tell you what
they are hoping to learn from your talk. If there is time, and it is a small audience, you can certainly
have everyone introduce themselves.
3. Encourage comments. Before you begin, tell your audience that you welcome questions and
comments either throughout your talk or at the end. It will help you and your audience warm up and
get to know each other if you take questions early on. After you begin your presentation, you can
p. 158 decide whether you want to be interrupted during your talk. I usually prefer to be interrupted
throughout my talk because then my presentation becomes more of a conversation with the audience.
But you can also tell your audience that you will leave enough time for questions, answers, and
discussion at the end of your talk, which may help you keep from getting o point or running out of
time. If you do this, then encourage your audience to write down any questions and make sure to ask
them when you are nished with your talk.
But what if your audience is a camera? Here are some lessons about giving a presentation on a television
broadcast or via a recorded video.
If you are speaking to a camera, rst of all you need to do two things: (1) forget the camera is a camera, and
(2) imagine the lens is your best friend. Again, imagine that someone who helps you feel calm and con dent
(a family member, colleague, or a friend) is literally sitting inside the lens. Talk to that person.
If you can actually imagine that your best friend, beloved family member, or trusted colleague is inside that
lens, then you will lean into the camera and talk to them directly. Your body and your voice will be more
natural. Of course, there is no one looking back at you giving you immediate feedback, as with a live
audience, but imaging that someone you admire is listening to you will help you look into the lens and be a
sincere, e ectual and natural communicator. Your eyes should not be reading a script or darting around the
room. You should be smiling and pausing and using your natural compelling and useful facial expressions.
Everyone looks better when they smile, breathe, and let their body and their breath follow their thoughts
and the mission of communicating important information.
p. 159 Like an actor, if your mind can think of a person you trust and like (or even love) and who helps make you
feel comfortable and con dent, then your body, face, and voice will ease, and you will be on your way to
using your own best style to communicate authentically.
If you are speaking to a camera, you need to make “natural” eye contact with the lens. This can be
intimidating at rst. But if you can imagine that the lens is the actual face of your best friend or trusted
colleague, you will look and speak naturally. If you can imagine that a family member or friend is literally
Delivery
Be yourself. It is not about you. It is about the information. Breathe. Smile. Look the person (or the camera)
directly in the eye. Watch others and see what works—but more important, watch yourself when you are
talking to your friend or family member about something you are excited about. Slow down in important
sections. Pause after an important point. Don’t speed up or throw away lines (your name, title, project). Sit
up or stand. Be enthusiastic and passionate. Make them care about what you are saying.
p. 161 Lighting. Most video cameras, even those in our computer screens or phones, make automatic
adjustments as needed for lighting. You usually do not have to worry about doing any special lighting
yourself. Usually the best lighting is natural lighting from windows nearby (but the windows should not
be seen in the frame). If you must use the lights in the room (or on the camera), make sure that when you
take a sample video, your face is not too dark and the overall lighting of the room is pleasing and not
distracting by being too bright or too dark.
Clean o ce and neat background. Make sure your o ce, desk, bookshelves, and room seen in the video
are clean and neat. You do not want a distracted or cluttered background. You want the exam room, o ce,
Your appearance. Dressing in professional business attire is usually recommended. You want to be
comfortable but make sure that what you wear is conveying the image you want to project. You should
wear whatever you would wear in person to speak to the audience for whom you are videotaping. Follow
whatever is the professional norm in your environment. Remember that it is usually better to be slightly
overdressed than underdressed. Your clothes and your appearance are your image.
p. 162 • Avoid all white (usually includes a doctor’s white coat); white doesn’t look good on
camera.
• Wear dress shoes (assume your legs and feet will be seen).
• For men, navy blue suits with light shirt and tie look best on camera.
• Bring a backup suit or dress in another color in case you need to change.
In preparation for your presentation, think about the following: Your words. Your voice. Your body
language. Your authenticity. Remember to just try to have a conversation with your audience. Do not read
your speech or use a teleprompter. Smile. Breathe. Focus. Educate and engage your audience and they will
remember you and the information you taught them.
Tips to Improve Vocal Skills and Presentations
• Watch and study the experts, TED talks, lectures, political speeches, and other presentations.
• Listen (or watch) your recording and see what you need to change. Do you need to speak
slower or pick up the pace? Be more animated? Smile more? Be more relaxed?
• Your head, shoulders, and upper torso should ll up two thirds of the video screen. You should
be the largest object in the picture.
• The background should not be distracting. It should be clean and professional. Take a still
picture rst with you in it just the way you will be sitting when you talk to the camera, before
you start. Make sure you and your background look the way you want them to.
• Make sure you are eye to eye with the lens. You do not want to be looking down at or up into
the lens.
• Make sure a lamp, plant, or other object does not appear to be growing out of your head.
Background objects should be to the side of you generally.
• Have a conversation with the lens as if your best friend were sitting inside the camera.
p. 164 • Think about standing because it will give your voice and body more energy.
• Be con dent that you know the information you are presenting.
• Don’t think it has to be perfect. Speak naturally. Just talk and have a conversation with the
lens. Talk like you do in your everyday life. It is okay to have a few ller words and not speak
in complete sentences.
• Relax, lean into the microphone or podium, and rst say hello and introduce yourself.
• Remember to ask the audience questions about their background and their experiences,
including whether they are comfortable with the room audio, visuals, lighting, and
temperature.
• Wear professional attire that you are comfortable wearing while sitting or standing—and that
projects your desired image.
• Make sure there is a place on your clothing to attach a microphone if necessary (suit jacket or
collar lapel).
p. 165 • Do not read a script. Memorize or write down the important points you want to make and
the ow of your talk, then just have a conversation about your topic.
• Know your opening and closing lines and make them memorable.
• Speak slowly and clearly but with good energy and passion.
• Think about standing because it will give your voice and body more energy.
Dorie Clark, “A Checklist for More Persuasive Presentations,” Harvard Business Review, October 11, 2016. Retrieved from:
https://hbr.org/2016/10/a-checklist-for-more-persuasive-presentations.
WorldCat
Peggy Noonan, On Speaking Well: How to Give a Speech with Style, Substance and Clarity (New York: Regan Books, 1999).
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Charles Osgood, Osgood on Speaking: How to Think on Your Feet without Falling on Your Face (New York: William Morrow, 1988).
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William Safire, Lend Me Your Ears: Great Speeches in History, Updated and expanded edition (New York: W. W. Norton, 2004).
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Rebecca Shambaugh, “To Sound Like a Leader, Think about What You Say and How and When You Say It,” Harvard Business
p. 166 Review, October 31, 2017. Retrieved from: https://hbr.org/2017/10/to-sound-like-a-leader-think-about-what-you-say-and-
how-and-when-you-say-it.
WorldCat
Allison Shapira, “Breathing Is the Key to Persuasive Public Speaking,” Harvard Business Review, June 30, 2015. Retrieved from:
https://hbr.org/2015/06/breathing-is-the-key-to-persuasive-public-speaking.
WorldCat
References
1. A. Tunkel, “White Coat Address at Cooper Medical School of Rowan University,” September 14, 2018. Retrieved from:
http://cmsru.rowan.edu/students/whitecoat/.
WorldCat
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6. G. Klein, “Performing a Project Premortem,” Harvard Business Review, September 2007. Retrieved from:
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© Terry L. Schraeder