numero rivista e pagine: HSR Proceedings in Intensive Care and Cardiovascular Anesthesia 2010; 2(4): 303-305
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Message in a body: controlling your nerves during an oral presentation

Authors: M. John*1

Professor of Applied English, Faculty of Medicine, UniversitÓ Vita-Salute San Raffaele Milan, Italy

Corresponding author: * Corresponding author:
Prof. Michael John
UniversitÓ Vita-Salute San Raffaele, Milan, Italy
Via Olgettina, 48 - 20132 Milan, Italy

E-mail: michael.john@hsr.it

According to 'The Book of Lists', which, as you might be able to understand from its title, is not exactly the type of publication you will find on Pubmed, the fear of speaking in public is second only to being burnt alive! Statistically speaking, this means that a certain number of people might even seriously consider being burnt alive rather than have to face the torment and ordeal of speaking before an audience. A peer audience at that. Yet, it has to be said that nervousness before a presentation is more than normal. Unfortunately, it is a problem that causes not only suffering for the speaker, but can also destroy even a well-prepared presentation. A good rush of adrenalin can, of course, be used to your advantage and give you a push in the right direction. The secret is knowing how to conceal and control your nervousness.
Most congress speakers worry about being judged negatively by others. People don’t want to look stupid and, moreover, don’t wish to fail to deliver the correct answers during ‘question time’ (which we spoke about in detail last time). Other reasons why people are nervous during oral presentations involve such things as fear of failure and fear of the unknown, forgetting what you have to say, not having enough to say in the allotted time, having too much to say in the allotted time, feeling inadequate (especially linguistically inadequate) and a general dislike of being 'put under the microscope'.
Body language is a very important part of a presentation. A good way to study body language is by turning down the volume of your TV to watch newsreaders, actors and talk-show hosts who are able to use facial expressions, head nodding, smiles and frowns to convey a million emotions.


People often ask me what they should do with their hands during a presentation. Well, what you shouldn’t do is probably easier to describe:

  • do not play with things in your pockets, such as coins or keys
  • never put both hands into your pockets
    - this is just too casual
  • do not fold your arms across your chest
  • do not wave your arms around so you seem like a windmill
  • avoid playing excessively with your hair and your spectacles


You can move your hands around a bit to add some kind of dramatic and theatrical effect to what you are saying. You do not need to keep your arms vertical and rigid, as if you are a soldier standing to attention. In any case, your hands will be necessary to hold your laser pointer, or eventually change slides on your computer, so it will be impossible to keep them in the same position throughout your talk.
Then we have the so-called ‘pause noises’, such as ums and ers, which should never become too noticeable (a teacher at school was so boring that we students would prefer to count his ums and ers rather than listen to his excruciatingly tedious lessons).
Don’t speak too quickly or too quietly, drink water if your throat goes dry and try to control your breathing. Taking one or two deep breaths before speaking will generally make you feel more relaxed. Correct breathing patterns will also enhance voice volume and projection, which will no doubt be appreciated by your audience.
Eye contact is fundamental. Scan the audience and involve everyone present in your presentation, whether they are ten or a thousand. Never stare at people for too long as you might intimidate them, and also avoid private conversations with friends or members of the audience that look nice because they are nodding at everything you say and seem to agree with you all the time. Of course, the main thing to remember when you are speaking in public is that you have to at least give the impression, even when it might not be absolutely true, that you are enjoying yourself and wish for nothing more than to communicate your fascinating data to the gathered peer audience. When speakers are too worried about not being able to tell their story they sometimes disengage and don’t seem interested in communicating at all. This is, of course, a defence mechanism, but flat uninteresting and, what is more serious, uninterested voices are the sad result. The overall impression is that they couldn’t care less about speaking to the audience: not a good tactic to use.
Remember that successful communication is always a two-way matter. Even though you are talking to the audience, you should still sense their reaction to what you are saying. Work on all these things, and not only on your PowerPoint slides and data, if you want your presentation to be memorable.


Questions from the readers

1. How long should you spend on each slide so as not to bore the audience?

This depends on the type of slide you are describing. Simple slides can be presented in 30 seconds, while more complex ones can take up a minute or more. In any case, as a rule you should never spend more than two minutes on any slide.

2. Considering the fluctuating attention of the audience, and the importance to transmit certain fundamental data, should we aim to transmit our key points when the audience is fully concentrated? Can we use intermediate-conclusion terms such as ‘to summarise’ or ‘in conclusion’ to focus drifting audience attention, and how often might we do so without losing the audience’s respect and trust? Is it absolutely wrong to transmit important data when the audience is not 100% concentrated and can this type of phrase help regain audience attention?

If you are a dynamic speaker and give the impression that what you are speaking about is fundamental for the audience’s professional future, then there is no reason they will not listen to you, with or without intermediate conclusions, as long as your data are valid.

3. How should a case report be set out?

A case description is generally told in chronological order:

  • patient’s presenting signs and symptoms and chief complaint(s)
  • medical history e.g. family diseases such as heart disease or diabetes
  • social history such as alcohol, drugs, tobacco
  • medications being used
  • results from physical examination and laboratory tests
  • differential diagnosis
  • final diagnosis (es)
  • treatment and follow-up

Different journals have different styles. Each journal will make it clear if they want or not a brief introduction, a presentation of the case report and a discussion/conclusion. The above described order/check list applies to the case report paragraph.

4. While presenting a poster, should we follow the standard IMRAD (Introduction, Methods, Results And Discussion) scheme?

A poster generally follows the standard IMRAD format, although there is usually no abstract, methods are kept to a minimum and, most importantly, there is no long Discussion section. A poster should focus mainly on the principal results of the study being presented and should use as many images (graphs, tables, photographs) as possible to stimulate interest and attract viewers. You can change the order around to make things ‘more interesting’ if you think this will do the job.

5. Which is the best way to use a microphone during public speaking?

A microphone needs to be held close to your mouth so that it actually picks up your voice. Cable microphones can be annoying (due to the cable); radio frequency microphones give you more freedom to move around. Be sure to give a microphone to questioners so the rest of the audience can actually hear the question before you answer.

6. How can you effectively communicate orally during a slide presentation when your audience is divided into two different categories (e.g. nurses and doctors or surgeons and anesthesists)?

Who is in the audience will determine the type of presentation you give. Find out beforehand.


'This is the eighth of a series of articles on this topic. Send any questions to michael.john@hsr.it who will answer them as part of this column'