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• Presentation top tips LSA Trainees Prize
• Feedback from LSA Trainees Prize events
• Dr P Mullen (LSA Committee)
• v. Nov2012

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Background

• In 2011, for the first time the audience voted
  the winner and runner up at the annual LSA
  Trainees Prize event.
• Free text feedback from the audience formed part
  of the process
• This presentation is (mostly) based on feedback
  from the 2011 2012 Trainees Prize events, and
  may inform trainees generally about pointers
  towards a quality presentation

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LMI founded in what year?
LMI current building opened?
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Historical trivia

• LMI 1739
• LMI building 1837

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Lecture theatre

• Last refurbished?
• Seating capacity?

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Lecture theatre

• Last refurbished 1998
• Seating capacity (120 max)

When was LSA founded?
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LSA Trainees Prize
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Jackson Rees Medal
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LSA Trainees Prize

• Most recent winner/runner-up?
• Past winners?
• What sort of projects?
• Prize ?

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Dr Clint Chevannes (1st Prize) Dr Christine Bell
(President LSA)
2012
2011
L to R Dr Will Lo (2nd Prize) Dr Christine
Bell (President LSA) Dr Adie Morrison (1st Prize)
2009
2010
L to R Dr A McDonald (1st), Prof. Jennie Hunter
(President LSA), Dr H Neary (2nd)
L to R Prof. J Hunter (President LSA), Dr C
Mollitt (2nd), Dr C Hammell (1st), Prof R Jones
(Judge)
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Previous LSA winning projects

• Fast ROTEM evaluation in major obstetric
  hemorrhage (2012)
• Intra-thecal magnesium meta-analysis (2011)
• Spinal vs iv diamorphine for spinal surgery
• Intra-thecal diamorphine for THR
• Survey of patient satisfaction with GA
• Evaluation of new airway device for Loscopy

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2011 Entries submitted
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Presentation top tips!
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Free-text comments( top tips for
presentations)

• from LSA Prize 2010 (prelims), 2011 2012 (Prize
  meetings)
• (plus some example slides)

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Feedback/Tips Introduction

• Introduction/Methods/Results
• Interpretation/Skills

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INTRODUCTION(background/clinical
importance/aims/objectives)

• No background slides
• Too long introduction.
• Very relevant to current practice and well
  presented
• What is the incidence of e.g. pre-op hypothermia
  and post op hypothermia? How big are these
  problems?
• Literature overview slide would have been better
  at the start in Introduction section rather than
  later on
• Excellent overview background, lacking only in
  references

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INTRODUCTION(background/clinical
importance/aims/objectives)

• Good clinical relevance and good to see critical
  care network guidelines developed as a result.
  Excellent background knowledge
• No relationship (relevance) to (my) practice
• Too many assumptions that assembled audience
  familiar with subject (e.g.CPX testing) (many
  retired members of LSA probably not)
• We didnt need an explanation of how to do a
  meta-analysis but would have liked to see more
  results, e.g. how long the block was delayed etc.

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Feedback/Tips METHODS
Introduction/Methods/Results Interpretation/Skills
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METHODS (Quality of the design, effort required
by the individual e.g. in data collection)

• Need to tell us how much of the work he/she did
• Effort required in data collection by the
  individual was low because it was a survey
• Data quality likely to be very subjective
• Ethically very very shaky should have sought
  ethics committee advice at least.
• Very serious concerns over ethics.
• I disagree about the No need for ethical
  approval
• Ethical approval? Was consent sought? Was any
  (informal) advice sought from ethics committee
  members even?

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METHODS (Quality of the design, effort required
by the individual e.g. in data collection)

• I have not got a clear idea what the study aims
  were
• Survey, not audit
• A lot of work, ?usefulness
• Small sample size, appears large amount of effort
• How valid is Parklands formula? reference? -
  the audit standard hinged around this validity.
  How valid is the rule of thumb regarding
  mortality prediction (in burns patients)?
  Supporting references?
• Data quality poor
• How was weight estimated? potentially large
  errors
• Too much data, in search of a missing link

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METHODS (Quality of the design, effort required
by the individual e.g. in data collection)

• Large study although unclear how much done by
  presenter
• How much analysis did presenter do himself?
• Why no data on elective/urgent surgery? Surely
  surgical experience is of relevance? Did those
  with a previous LSCS need more blood transfusion
  than primips?
• Project (a meta-analysis) results hinged mainly
  on data pick-up from e-search what steps were
  taken to check validity - that some papers were
  not missed (3 key words were used for searching
  was any attempt made to use different but similar
  key words, e.g. patient instead of human?)

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METHODS (Quality of the design, effort required
by the individual e.g. in data collection)

• Choice of statistic analyses not correct
• Good explanation of stats
• I didnt understand propensity scoring (despite
  long explanation did I really need to understand
  it?)
• If you use a statistical method that a
  substantial part of your audience is likely to be
  unfamiliar with then explain briefly (1 minute
  rather than 3-4 minutes of a 10 minute
  presentation) e.g. propensity scoring
• Use of integers for LOS data not explained,
  otherwise excellent.

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Feedback/Tips RESULTS

• Introduction/Methods/Results
• Interpretation/Skills

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(Often very useful to have a flow chart,
outlining how arrived at population)

Total cases found N 299
n 191
n 158
This example audit of time between booking of
case for urgent/emergency surgery and actual
arrival into anaesthetic room, 1 month period)
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RESULTS (Data quality e.g. validation and
data analysis effort, correct stats)

• Presentation of numerical data
• Use appropriate number of decimal places e.g.
  2.1 days not 2.12 days, Hb 12.1 not 10.92 be
  consistent with number of decimal places within
  data domains (e.g. avoid LOS Control Group 2.1
  days, Treatment Group 2.15 days)
• Avoid expressing continuous data as discrete data
  (e.g. 2 days) unless obvious difference between
  the results (2 days versus 13 days)
• Indicate which average was used (mean, median,
  mode, are all averages)
• Indicate which statistical tests were used (I
  used Excel doesnt cut it!)

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RESULTS (Data quality e.g. validation and
data analysis effort, correct stats)

• Presentation of tabular data
• If using busy tables then colour fill the rows
  that you wish to draw attention to (using a side
  arrow partly does this but it can be difficult to
  follow the row of data across in the table that
  is quite busy)
• Avoid moving rapidly thro busy tables, without
  using the above device
• Comparing data from 2 groups, dont just use mean
  of each group and the difference between the
  means - include spread of data (IQR, SD) as well
  as central location (median, mean)

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D
Fair bit of data here, but essentially one main
difference between the 2 results columns can
you spot it?
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D
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?
Good pie diagram or not? How would you improve it?
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Too many categories, difficult to compare
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Comparison now easy. Note that if countries were
listed on the X-axis then problems reading,
except for circus acts!
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RESULTS Data quality (validation), data
analysis, effort, correct stats

• Presentation of graphical data
• Quite busy graphs
• Results too condensed
• Exploded pi-diagram avoid white segmnt on white
  b/ground
• Use the pointer to draw attention to key point(s)
• Busy not easy intelligible graphs
• Percentages on Y axis may be better than absolute
  numbers
• Too many groups for a pie chart (try horizonthal
  bar chart)

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?
?
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In a 3D Pie diagram the 3-6pm slice is often
falsely perceived as larger than actually is.
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RESULTS Data quality (validation), data
analysis, effort, correct stats

• Presentation of graphical data
• No graphs regarding range/spread presented (e.g.
  IQR, SD)
• Was mean the correct average to use? Some box and
  whisker plots would have been nice
• Displaying some of the results in a table would
  have been better.
• The vertical bar charts didnt quite work using
  horizontal bar chart would have made it easier to
  read the text.
• Avoid using 28.00 on X-axis
• Pie charts not clear (light blue vs grey!) - very
  difficult to interpret/separate out groups
• Best to avoid blue against blue bar chart
  comparisons (use a different contrasting colour)
• Avoid graphs with same coloured lines

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RESULTS Data quality (validation), data
analysis, effort, correct stats

• Lean on statistics (e.g. mean used a lot, no
  indication of spread of data so this may have
  been the wrong average to use)
• Dont bother mentioning non significant trends
  (time)
• (If there are outliers then offer an
  explanation)

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Mean 14.4 hrs
n 107/158
Can you spot any problems or errors here? What
would be a simple summary statement?
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(Mean 14.4 hrs)
n 107/158
The wrong average to use here!
Skewed data. In this e.g. the symbol
outliers, i.e. beyond Q3 1.5(IQR) the mean is
not resistant to outliers whilst the median is.
?
Median 6.2 (IQR 2.8 20.4) hours
Most interventions began within 24 hours
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Comparative boxplots are often an excellent way
of getting summary data across quickly and
effectively, comparing 2 or more groups.
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e.g.
(p 0.0006)
Plastics
GenSurg
Ortho
Mann-Whitney, 2 sided, alpha 0.05
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RESULTS Data quality (validation), data
analysis, effort, correct stats

• Colour scheme for slides could be  better
• Not sure of the matching/confounding factors
• (Limitations)

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What do you think of this graph? Good and bad
points ?
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Fantastic graph! Text a little small perhaps, but
colours, trends, absolute numbers, etc have all
been combined into 1 results slide. This is
clearly a slide to dwell on in a presentation.
(Note in this instance part of the reason for
the small text is that it is a screenshot,
obtainable from the prt sc of your laptop,
which has been then pasted).
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Feedback/Tips Interpretation

• Introduction/Methods/Results
• Interpretation/Skills

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In theatre .
A scatterplot, showing raw data points can be a
useful graph. But what is a simple
summary/interpretation of this data? Summaries
should not repeat data s etc. Lead on to
conclusions.

• Median 0.7 hours
• IQR 0.5 - 1.3
• Range 0.1 - 5.5

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In theatre .

• Median 0.7 hours
• IQR 0.5 - 1.3
• Range 0.1 - 5.5

Majority of surgical interventions were completed
quickly in theatre
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INTERPRETATION(Conclusions, Recommendations,
action plan)

• Interesting subject but didnt seem to come to
  any conclusions
• Slides (as presenter actually alluded to) were
  cluttered and unclear with no conclusions or
  recommendations. No definite conclusion to study
• Good presentation and plenty of material and
  information, but need to tell us how much LA
  used in each technique, need to highlight
  difference between statistical significance vs
  clinical importance these results could provide
  basis for number needed to treat to aid
  statistical significance in future prospective
  study
• More diagrams and focusing on the main messages
  in results would have been better

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INTERPRETATION(Conclusions, Recommendations,
action plan)

• Good subject good material, I think one of the
  main messages he did not bring forward was to
  stress the fact that "Rehearsal" of the Guideline
  is essential for future adherence to it
• Less introduction, more results and conclusion
  please
• Avoid 1 patient ruined my data comments
• If the study data showed a reduced LOS in the
  study group then it is not reasonable to say that
  this was due to earlier mobilisation (unless
  the mobilisation variable was also assessed and
  correlated accordingly with the LOS data). It
  may have been due to earlier mobilisation, but we
  have no data on this would be more accurate
• When making summary comments, make sure your they
  accurately reflect the project results if based
  on previous publication, then reference this

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INTERPRETATION(Conclusions, Recommendations,
action plan)

• Interesting topic but struggled to find relevance
  to my practiceDid not adequately explain
  relevance to most anaesthetists
• Some of the recommendations were not directly as
  a result of the audit
• Many recommendations at end not clear on what
  these were based, many seemed not based on the
  data presented a slide re limitations of the
  audit would have been useful
• Composite end points have their limitations so
  draw attention to these (i.e. show insight)

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INTERPRETATION(Conclusions, Recommendations,
action plan)

• More diagrams and focusing on the main messages
  in results would have been better
• Unclear conclusions with too much information

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Feedback/Tips SKILLS

• Introduction/Methods/Results
• Interpretation/Skills

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Know your venue
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Features

• Know your venue/audience

• Moderate size
• Unfamiliar
• Formal
• Colours iffy
• Font size gt/20
• PA system
• No roving mike
• Many retired
• Much experience of research

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• Features of this venue?

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Features

• Features of this venue?

• Small/cozy
• Intimate
• Familiar
• Smaller font ok
• Hot/sleepy
• Interactive
• Just after Wednesday Chester cake club!

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SKILLS(quality of the presentation oral/visual,
handling of Q/A from audience)

• Pre-event advice from a previous adjudicator
• (General)
• Speak up, steady pace not too slow or too fast,
  acquaint yourself to all tools you are going to
  use on the night, use pointers, look at audience
  and your slides, if using busy slides apologise
  about but only point out the salient information
  in the slide, if co-authored paper try to point
  to the audience how much work you have done
  yourself

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SKILLS(quality of the presentation oral/visual,
handling of Q/A from audience)

• Voice
• Good presentation but was hurried,
• Too quiet Project your voice
• Good subject, plenty of material but very slow,
  low voice, slides are too busy
• Good punchy presentation.
• Good manner of speech, not rushed.

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SKILLS(quality of the presentation oral/visual,
handling of Q/A from audience)

• Slides
• Slides a bit too busy in places and needs to look
  at audience more than the screen.
• Avoid looking back at the screen too much, but
  rather address the audience
• Clear delineation of Method, Result, Discussion
  not done
• Nice tables and stats a little quick through the
  slides (too many of these)
• Nice LWH logo slides!

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SKILLS(quality of the presentation oral/visual,
handling of Q/A from audience)

• Props
• Great speaker. Good use of audiovisual props
• Having a video running at the same time (on a
  different screen) is very distracting and not a
  good idea
• Need to point to slides for areas of interest
• Use the pointer!

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SKILLS(quality of the presentation oral/visual,
handling of Q/A from audience)

• Great presentation, clear not rushed. Covered
  aims, methods results and conclusions.
• Confident presentation
• Handled quite well, good time keeping but seemed
  a bit rushed.
• Liked the extra slides at the end to cover
  (potential) questions
• Too fast

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SKILLS(quality of the presentation oral/visual,
handling of Q/A from audience)

• Poor time keeping - STICK TO TIME!
• The content of the slide on view should
  reflect/coincide with the content of what the
  speaker is saying
• Too many slides too many crowded busy slides
  pushed to stay within time limit
• Heading of slides is difficult to read - improved
  by better choice of colour scheme not faint blue
  text against white background!

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SKILLS(quality of the presentation oral/visual,
handling of Q/A from audience)

• QA
• Sufficient time to any individual slide if
  going to run over then exclude some slides for
  oral presentation and keep them in reserve slides
  for QA use
• Avoid talking over the person asking the
  question. Allow him/her to finish the Q.
• Good knowledge of subject answered questions
  well
• Some answers plainly incorrect
• Excellent handling of audience questions. Clear
  concise PowerPoint slides
• Didnt deal with questions very well
  unconvincing

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SKILLS(quality of the presentation oral/visual,
handling of Q/A from audience)

• QA
• Nicely presented. Not a lot of data. Did not cope
  that well with questions
• Slides too fast. Muddled answers to some
  questions.
• Not prepared for the questions being asked. Needs
  to be a little more anticipating of issues likely
  to be raised
• Clear introduction of meta-analysis and
  explanation of results didnt do so well with
  question of why (Mg) not licensed good knowledge
  of all papers

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LSA Prize Feedback

• Main points/Summary

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Summary

• Clinical relevance
• Know your subject
• Know your venue and props
• Know the score-sheet/system
• Concise and clear slides/presentation
• Q/A tricks tips

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The gold standard?
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What needs changing on this, if anything?
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• ?

Comments/questions to patrickmullen_at_nhs.net
This presentation will be made available to the
members of the Mersey Post FRCA group, and will
be also available on the LSA site
www.lsoa.org.uk
Next LSA trainees prize event Friday 22nd
February 2013