Abstract Attack Journal Article Presentation Format

 

I recently participated in an Addiction Medicine Journal Club where the presenter used a novel presentation technique called Abstract Attack. The result in terms of group process was so good – I thought I would present it here for further exposure and comment.  As a qualifier I would add that I have not spoken directly to the creators and base this post on my direct participation in the format and the PowerPoint from the creators (1) and the presentation I attended (2).

Standard presentations in medicine and other academic fields typically consist of a single presenter charged with presenting data or techniques for information and some discussion.  The expertise of the presenter and role of the audience varies considerably.  For example, in my Biochemistry course in medical school the seminars were focused on techniques and concepts. The course instructor would typically choose a paper or two on a clear topic like diphtheria or cholera toxin.  The presenter was responsible for presenting those two papers at the minimum with additional papers as necessary. That was in 1978 – well before the Internet and online resources. All papers had to be obtained as hard copies from the medical library.  We would have two or three biochem seminars per week – so there were always a number of presentations to prepare for and the information content was variable.  My pharmacology course used a similar format but slide presentations were allowed. Since there was no digital presentation software – the slides had to all be shot on 35 mm film and projected.  That was the standard until well after I completed residency and started working. Eventually presentation software was developed making the job much easier.

Microsoft PowerPoint eventually evolved into the standard presentation format but it is not without controversy.  In the past 15 years there have been numerous presentations and papers written about everything that people consider to be wrong with PowerPoint.  That criticism is highly variable such as too little to too much information, being more boring that an extemporaneous lecture, problematic graphics and format on the slides, reading the slides, and competing software that claims to produce a better presentation.  The competition angle is an interesting one because in the beginning I bet on (and paid for) two competing products before it became apparent that PowerPoint would be the winner. It is difficult to win against a product that is installed on most business computers in the country.

My person bias is that I like the PowerPoint format.  The product is greatly improved in the past decade and can also be used to produce graphics for other applications.  I have attended seminars and courses on this to improve the approach with PowerPoint from a graphical standpoint and my slide making has improved considerably. I think it is very useful to put up graphics and texts that provide more information to the audience while I am free associating to the slides. To me the main difference between a verbal only lecture and a PowerPoint presentation is the greater informational content.  Consider that TED Talks are supposed to present a great idea in 18 minutes.  I am supposed to be presenting many ideas and facts in 50-50 minutes. That is what a PowerPoint presentation is for.

The doesn’t mean that all high information PowerPoints are successful. The speaker still has to be fairly good in both presentation style and engaging the audience. The audience has to be well behaved and focused on the content. I was giving a fairly detailed lecture on alcohol use and the latest World Health Organization (WHO) report on the scope of the problem.  There was a student in the audience checking the data on my slides (taken directly from the report) about what he could find on his phone and arguing about it. There are always unexplained emotional reactions in the crowd and in some cases, people get up and leave – even when nothing presented is really controversial. We have all attended presentations when the discussion starts with the dreaded: “I don’t have a question but I would like to comment……” followed by a 10 minute long irrelevant digression.  

When you experience all of those occurrences at conferences and lectures, you can’t help thinking: “Is there a better way to keep all of this on track?” Limiting the discussion, not taking questions, or having all of the questions submitted and moderated are certainly possibilities that I have seen used successfully. But I was recently exposed to a presentation format that structured the responses right in PowerPoint and that led to a focused high-quality discussion.  I will explain the format and hopefully provide a good example of how to approach the problem.

The method is called Abstract Attack and it was apparently devised by members of the University of Minnesota North Memorial Family Medicine Program.  Rene Crichlow, MD, FAAFP is credited with the concept and in the PowerPoint I acquired her co-presenters were Tanner Nissly, DO, and Jason Ricco, MD, MPH (1).  I first experienced this approach in a journal club teleconference (2) that was presented by Ian Latham, MD a resident from the UMN program on an article about lorazepam versus phenobarbital for alcohol detoxification based on a 2021 paper (3).

The overall goals for this presentation format are from family practice curriculum.  In the initial presentation the authors use the Accreditation Council for Graduate Medical Education (ACGME) requirements for scholarship to develop the Abstract Attack approach.  Those scholarship requirements can be found in the document on common requirements for all residency programs. Interested readers can find the specifics in a box graphic on page 26 of this document.  It is an elaboration of the way all physicians are trained to critique scientific and clinical studies and the application of the studies to clinical work.  The primary goals of Abstract Attack (1) are cited as:

1.  "Abstract Attack", a method to provide uniform acquisition of skills and knowledge

2.  Sufficient for a practicing clinician to confidently, participate in efficient and effective Evidence Based critique of the medical literature at the point of care

 The secondary goal is “Eschew Obfuscation”.

The overall process is described as patient rather than disease oriented and adhering to a critical appraisal pathway that answers the questions:   Pertinent to your patients’ care?  Consistent or Inconsistent?  Valid or Invalid?  The structured order of presentation is given in the slide below:

  

In the session I attended (2) the author discussed the overall goal of being able to present journal articles with the assumption that nobody else has read it.  He proceeded to illustrate how the presented information could be discussed at the level of every slide by the following prompts (that he incorporated in every slide):

What is interesting about this?

What is concerning about this?

What do I need to know more about?

I will illustrate with a few slides from a recent JAMA paper (5).  The slides cueing the discussion might look something like this.

   

Additional slides are provided on the methods and results.  That is followed by a slide with questions exploring how the study potentially impacts clinical practice and what additional information or studies may be needed.  Supplemental slides can contain information on the scientific and statistical concepts used in the paper.  The emphasis is clearly proceeding from the clinical trials to clinical practice.

My direct experience with this format is that there was timely discussion every step of the way.  Senior clinicians and physicians can add commentary early in the process about what they see are being important about the study.  The audience is clearly engaged without every reading the paper. The presenter can add critical information in supplementary slides at the end after the discussion on how impactful the information is on clinical practice and what else might be needed.

Overall, I thought this was a breakthrough in how to make these presentations efficiently when everyone’s time is at a premium. Dr. Crichlow and her colleagues are to be congratulated.  I have made a comparison slide below.

 

George Dawson, MD, DFAPA

 

References:

1:  Crichlow R, Nissly T, Ricco J.  Trans-formative Journal Club Experience as a Basis for a Longitudinal EBM Curriculum.  PowerPoint Presentation.  Accessed on October 16, 2022.

2:  Latham I. Phenobarbital Versus Lorazepam for Management of Alcohol Withdrawal Syndrome: A Retrospective Cohort Study Addiction Medicine Journal Club.  PowerPoint Presentation. August 2, 2022.

3:  Hawa F, Gilbert L, Gilbert B, Hereford V, Hawa A, Al Hillan A, Weiner M, Albright J, Scheidel C, Al-Sous O. Phenobarbital Versus Lorazepam for Management of Alcohol Withdrawal Syndrome: A Retrospective Cohort Study. Cureus. 2021 Feb 11;13(2):e13282. doi: 10.7759/cureus.13282. PMID: 33728215; PMCID: PMC7949711.

4:  Accreditation Council for Graduate Medical Education (ACGME).  Common Requirements Currently In Effect.  7/1/2022:  https://www.acgme.org/what-we-do/accreditation/common-program-requirements/  Accessed on 10/19/2022.

5:  Florian J, van der Schrier R, Gershuny V, Davis MC, Wang C, Han X, Burkhart K, Prentice K, Shah A, Racz R, Patel V, Matta M, Ismaiel OA, Weaver J, Boughner R, Ford K, Rouse R, Stone M, Sanabria C, Dahan A, Strauss DG. Effect of Paroxetine or Quetiapine Combined With Oxycodone vs Oxycodone Alone on Ventilation During Hypercapnia: A Randomized Clinical Trial. JAMA. 2022 Oct 11;328(14):1405-1414. doi: 10.1001/jama.2022.17735. PMID: 36219407.

Supplementary Info:

Any slide above can be enlarged by clicking on it.

 

Associative Memory During A Formal Presentation - Keeping It Real

I just completed a formal presentation this morning at about 9:15 AM.  It was in a big conference room at a plush hotel near the Mall of America.  There was a little pressure because I was the lead off man in terms of the scheduled presentations.  I walked into the venue early and got up on the stage.  It was a black elevated platform about 25 feet square.  It looked like it was built to be portable.  There was a lectern with a fixed microphone.  The platform was positioned between two large 20 x 25 foot screens.  In order to see the screens or use a laser pointer, I had to walk out from behind the lectern to bring me about 12 feet away from the back wall.  I looked out over the audience filing into to 4 sections of tables and thought: "Not the most convenient set up - but I have done this before."

My experience with presentations like this is mixed over the years.  A lot of that has to do with neurotic behavior.  I have given many presentations that I became disgusted with and was glad they were over.  They were probably the ones that I did not think were good enough or up to my often unrealistic standards.  In the old days before everything was standardized as PowerPoints, the formatting and graphics would often throw me off.  For 5 dark years I was using a presentation program called Aldus Presentation followed by Harvard Graphics and there was always a lot of luck involved in what that final presentation looked like.  Those were also the days of 35 mm slide sets and projecting from carousel projectors.  There were also services that would charge significant fees to convert your presentation images to 35 mm slides.  Nowadays I can obsess about the presentation right up until the last moment and walk in with presentation, several modified versions, and several alternative graphics on a USB drive and make a last minute change.  Technically about the only thing I have to complain about is getting copyright permissions but all of the hardware and software is good.

Getting mentally prepared is much harder.  I received instructions that I had to make sure that the presentation was exactly 45 minutes long.  Right before I started I was told about 5, 2, and 1 minutes cards that would let me know how the time was running out.  I was supposed to rehearse it and I did.  I digitally recorded it and it ran 45 minutes exactly.  I went back and recorded as many key concepts as I could.  I thought about my self acknowledged deficiencies as a presenter.  I can suddenly start to isolate affect and drone on in a rapid and obsessive manner.  I can remember giving a presentation about medications to a large crowd and at one point I made eye contact with a fellow staff member in the audience as he mouthed the words: "Slow down!" - rather emphatically.  I am fairly humorless.  At least that is the general audience experience.  My humor is dry - often bone dry.  It is the humor that only introverts get at times.  When I hear more than a muffled response, I wonder: "What just happened?"  There is also the fear that I will choke in the same way I choked in a pharmacology seminar in medical school.  My seminars generally consisted of the same group of people.  They were all friendly and not threatening in any manner.  The same thing was true of the professor.  I knew the material on the cardiovascular pharmacology of calcium channel blockers cold.  There was no good explanation for me just blanking out at the ten minute mark.  I remember I was thinking about hiking through Glacier National Park.  I had the image of a photo I took of the moon high in the sky over Nebraska.  Everything seemed right with the world until my reverie was interrupted by the Professor saying: "Hello?  Mr. Dawson?  Are you going to get on with it?"  I don't know how long I was staring blankly in front of my fellow students.  I snapped out of it and completed my presentation.

I have given thousands of presentations since that pharmacology seminar incident and no similar episodes have occurred.  Even at the time, I don't  remember being embarrassed about it.  Also unusual.  That does not mean that I am any less neurotic.  Since reading Yalom as an intern, I have always seen the truth in existentialism,  so I was not surprised about this spontaneous thought on my drive to the hotel: "What do you care what people think about this?  You are going to be dead soon anyway and nobody is going to talk about it at the funeral."  .... Okay - focus George - you can only die after the presentation.  Don't work yourself up into a lather of death anxiety in addition to the fairly well controlled performance anxiety.

After surveying the venue, I decided to forgo the conference coffee and go to one of my favorite chain of coffee shops.  The conference rooms were set up so that they intersected a main skyway into the mall.  The coffee shop was about 100 yards away.  I had about 15 minutes until I started, so I headed down the hallway.  At about the 50 yard mark, there was a set of three steps followed by a landing and then another set of four steps.  I failed to notice it at the time but the height of the steps was unusually low and I was headed down these steps.  This is a major thoroughfare and the hallway was about 20 feet wide.  I made it to the third step tripped and went crashing onto my right knee and hands.  That's right - I fell almost flat on my face shortly before my presentation was scheduled to start.  The same thing happened to me in O'Hare one day as I was waiting to catch a flight to Boston.  I was balancing with a brief case against a guard railing in one of those large central areas that everybody seems to stream through headed to the other side of the airport at O'Hare.  I slipped sideways and hit the floor, the metal edge of my brief case making a loud cracking sound.  No fewer than a hundred people came sprinting over to me as if I had been shot.  It took a good ten minutes for the crowd to clear after they confirmed that I was apparently unscathed.

This morning I immediately pushed myself up off the floor and braced for the onslaught.  There were at least a hundred people in the area.  To my amazement, nobody seemed to have noticed the old man hitting the deck. I moved quickly to the coffee shop, placed my order and moved to a back corner where I could pull up my baggy trouser leg and inspect the knee damage.  Ten minutes later I was at the podium.  One of my colleagues commented on the way up that I never looked nervous.  He didn't see me just hit the floor like a bag of dirt.

This is it.  I am finally ready for the show.  I always have a number of jokes ready that I never use.  Instead I go to a few controversial remarks about the topic.  I am actually a student of PowerPoints.  I have attended the Tufte seminars and have his books.  I try to apply principles of good design to the slides and to use as many graphics as possible.  Tufte doesn't like PowerPoint.  He thinks it doesn't contain enough information.  I attended one of his seminars and he was using large sweeping graphics with no text.  It was visually interesting but content?  It reminded me of a TED talk - a lot of affect and minimal content.  TED talks are useful for that mode of communication, but the crowds I talk to deal in facts and a lot of them.

I know it is not going to be the Dave Chapelle show, but I know there is some important information I need to convey.  I want the slides to contain the information and where to get more information, but I never want to read them.  I also don't want to focus on talking points or read a script.  I just realized today that what I have is free association points on the slides, and I need to say whatever comes to mind when the slide pops up.  While the audience is reading the slide or looking at a graphic, I need to come up with the best illustration from my personal experience.  It went something like this:

And that is pretty much how it went.  Matching my associations to the lecture content.  It is only slightly more to obsess about.

And nobody had to die.

Oh well - on to the next presentation........


George Dawson, MD, DFAPA