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Book Review: Bad Blood by John Carreyrou – talking science and the Theranos scandal

girlymicro Book Reviews, Healthcare Science, Leadership, Research/Academia , , , , , ,

It’s the Easter weekend and I haven’t posted a book review in forever, so I thought I would post a review of something that not only I think all scientists should read, as a tale of when science goes wrong, but also because it’s been dramatised and so you could also spend some of your weekend enjoying it in multiple media forms.

I didn’t really know much about the Theranos company before I read this book. I had seen a couple of news articles and video clips of Elizabeth Holmes, but I don’t think it made quite the same coverage in the UK as in the states. I do remember a video of her talking about being able to do several hundred tests from a drop of blood and rolling my eyes and being dismissive as it struck me as scientific nonsense. I didn’t realise this was a system that had been rolled out for actual patient testing and as the basis for clinical decision-making, which to me is incomprehensible. I’m getting ahead of myself however, here is what the book is about.

Bad blood is written by the journalist John Carreyrou, who broke the story at the Wall Street Journal. It is a chronological re-telling of the rise and eventual fall of the Theranos company and its founder, Elizabeth Holmes. It is based on interviews and fact finding that were collected for the articles and runs up until the start of criminal prosecutions.

Elizabeth Holmes is a self-proclaimed Stanford dropout who left university to pursue a bio tech start-up. She claimed to be terrified of needles, so established a company that would enable the avoidance of venopuncture blood draws by using point of care testing using a finger prick to provide the same level of diagnostic information. The end vision sold to investors was that this could all be done by a small microwave sized machine that could, eventually, be sold for home use as a form of self monitoring. The platform was rolled out into patient use at Walgreens chemists, as the first step in a national roll out. Testing patient samples and providing clinical results in Phoenix, Arizona. Interestingly, to me, as this was a private biotech company, there appears to have been little to no oversight of this diagnostic roll out, despite producing a medical device.

The book covers how investment was attracted and rapid growth attained because of the strength of this vision and the charisma of the woman selling it. It also covers how, despite scientists not being able to deliver this vision, it continued to be sold and how the very negative company culture allowed this to happen. All company employees were made to sign non-disclosure agreements, they were prevented from talking outside their teams, their emails were monitored, and threats of legal action appear to have been common. This meant that many of those working on development were unaware of the significant flaws with what was being sold, and those that were and considered or tried to whistle blow were taken down legal routes, where Theranos had considerable more financial capability  to attain a positive outcome.

This was all compounded by a lack of oversight and, as there were no regulatory affairs staff employed, allowed governance processes to be manipulated. The company had two laboratories, one to develop their new technology known as Normandy, and one which was disclosed and Clinical Laboratory Improvement Amendments (CLIA) accredited which containing more standard technology platforms known as Jurassic Park.

Eventually, after the death by suicide of one of the employees and increasing press coverage seen by external scientists who questioned how this was possible, as well as clinical alarm bells, enough momentum was gained to put together a story that shone the light on why this approach was disastrous for the patients who were relying on it.

The story is already available in many different forms, including a TV series that is currently available BBC iPlayer and Disney+

Listening to the audio book of this book whilst I write this blog post it makes me think that are a lot of points that shock me as a English scientist working in such a highly regulated environment, both for NHS services but also for me as a state registered individual.  It has also made me reflect on how crucial support for escalation and whistle blowing is to ensure that scenarios also get flagged when those services are not providing the quality of service required.  I’ve briefly outlined some of my reflections below:

Governance

I spend a lot of time in governance meetings, both local and national. I even sit on a number of grant, research and ethics panels. I don’t think I’ve ever encountered the kind of lack of governance and accountability described in this book. That said, I’ve never worked in private industry or a start up. Just going through this book has made me have a new recognition for how important it is that boards and other oversight structures, ask the difficult questions and undertake constructive challenge in order to identify problems early and reduce risk.

Responding to No

At every stage in this re-telling smart people tried to raise concerns. When concerns were raised those people raising them were either isolated or asked to leave. Those who played the game and did not rock the boat were promoted, ending up in a scenario where the entire of the senior leadership were either the ones who didn’t want to hear or were people that didn’t want to challenge. In other words Elizabeth deliberately surrounded herself with yes men and thus created her own echo chamber. You can see, to an extent, how this can happen in other settings and where unacknowledged risk could therefore be introduced, and so ensuring that challenge is encouraged and not victimised is key to success.

Female leadership

Being a female leader is challenging, being a female leader in the technology and science sectors is both challenging and unusual. I can’t help thinking when reading this book how much of a back lash will occur and impact other female innovators. Elizabeth was heralded as unique and special for being a female in this area, I feel it’s likely that her actions have significantly set back other women in this space trying to make room for themselves. In addition to the patient harm caused, this is one of the things that upsets me the most.

Authentic leadership

To succeed, Elizabeth crafted a new image of herself. She changed the way she dressed to look more like Steve Jobs, whom she admired. She even changed her voice to use a lower octave, as she felt it made her more unique, memorable and aided success. I’m rather struck by the fact that she changed the way she dressed to look and even sound more like her male compatriots. If she changed these external factors, I can’t help but think what else she changed, and how much she went against all the principles of authentic leadership. She shared little of the real her, and I wonder how much that facade enabled her to distance herself from the reality of what she was doing. For me, it’s a reminder of why authentic leadership is so important, to put yourself out there and also to be held to account, rather than introducing a facade which distances you from your actions.

Quality assurance

Quality assurance, ensuring you get the right result on the right patient in the right time frame, seems to have features little if at all in the Theranos story. They utilised out of date reagents, the way they undertook validation testing is like nothing I’ve ever encountered, and they topped it off by actually lying about how and where results were produced. It’s easy to think that we would never act in the same way, and I doubt any of us would to the same extent, but there are aspects of laboratory life which I think would be open to monitoring challenges. The expansion and use of home testing, and even point of care testing (POCT) presents a lot of quality control and assurance challenges. These tests are conducted outside of standard laboratory settings, often by individuals with less knowledge about the processes. How do we increase access whilst maintaining quality in these circumstances? I think it’s something many of us are wrestling with.

Research and innovation

Innovation has risk associated with it, research wouldn’t be research if there were not unknowns. The patient impacts of this work however have given me a chance to reflect on how import ethics and governance reviews are to controlling these risks. As the testing was not rolled out during a trial, there was no consenting of patients to those risks. The people who ran the institutions in which they were rolled out were also not informed that they were effectively partaking in a research experiment. This means that all those involved are less likely to engage in research based processes in the future, as trust has been broken, even if it were to happen with different more established individuals. Thus the behaviour of a few impacts us all, and therefore as scientists we have a responsibility to flag this bad behaviour as and when we see it.

Listening to the scientist in the room

The scientists in the room were not heard. The company was led by people who lacked technical skill. Rather than understanding their limitations, they actively denied any lack of knowledge. They therefore didn’t listen when those best placed tried to flag issues. There was also no route for whistle blowing, either to the board, or to external organisations, partly due to the NDAs and threats of litigation. As a leader, this has made me reflect on both how important it is to listen to those skilled individuals you have working for you, but also how much there needs to be processes in place that bypass me in the case of a need for escalation. No one is perfect, and it is so important that concerns are heard and acted upon.

Silos limit productivity and communication

One reason that Theranos not only manage to hide its failings, but also probably failed in the first place, was that everyone was kept in silos and isolated from each other. There were no multi-disciplinary collaborations, sharing was actively forbidden, and there were no cross department routes of communication. Everything was linear, up and down. This can easily be seen as a failing in other large institutions, not because of an active plan, but because we don’t encourage enough cross organisational working. Collaboration is key to innovation, trouble shooting, but also to fault finding and improvement. It takes effort to do well, but is worth investing the time and energy into for improved results.

Vision alone is not enough

Vision without follow through is always going to fail. Vision without working pragmatically on turning it into reality will not succeed. Once you move from vision into implementation or delivery, it cannot be enough that you alone own the vision. It has to be shared, it can no longer be owned by an individual. By sharing it, you also have to take onboard the input of those others, and if you cling to the original too tightly then you are setting it up to be a disappointment.

People are the ones who suffer

People were actively hurt by this poor use of science and innovation. The scientists themselves suffered when they tried to raise the alarm, emotionally and through litigation. Most of all though, the patients who placed their faith in a diagnostic that could never deliver suffered, either through over or under treatment. Because this tale occurred in the states, those failings also came with a financial burden, as well as a physical one. This book makes me so grateful for the NHS and our regulatory structure for the governance and protection it provides. Nothing is perfect, but an imperfect something is so so much better than the alternatives. I hope you find the book as eye opening as I did.

All opinions in this blog are my own

Stepping Into Leadership: What becoming a senior leader actually means

girlymicro Healthcare Science, Leadership , , , ,

I’ve had some interesting experiences over the last few years as Lead Healthcare Scientist, and inevitably, some of these experiences were things that went well, and some went not so well. As spring arrives, it makes me reflect on these and what they’ve taught me about leadership.

When I mentor, I often get asked about the difference that happens when you step into more senior leadership roles and how you know when you are ready for that next step. I’ve sometimes found it hard to articulate. In light of my reflections, though, I think I’ve made a list of what I believe are probably the biggest shifts. I’m sure there are others, but these are my big hitters.

It’s no longer about you

There is a freedom that I don’t think I recognised or appreciated in just being responsible for yourself. You can choose who to build relationships with. You can make decisions on what is best for you. You have a certain amount of license to be selfish, as you didn’t sign up to be otherwise. The more senior you become however, the less that this is either true or acceptable.

I’ve experienced what it’s like to be in a leadership space with individuals who are still behaving like they have the independence of being more junior leaders, and the impacts can be pretty catastrophic.  They have failed to recognise that they no longer have the freedom to choose not to work with people or to not engage in projects because of personal feelings about who they are being asked to work with, leading to a failure in delivering the collective vision.

When you step up, you no longer have the freedom to judge based on relationships or let that judgement impact the decisions that are being made for the greater whole. You don’t have that kind of freedom anymore as you have moved into a space where the word We, rather than I, should dominate.

You have to get out of your box

We can have pretty small worlds at work, consisting of one department or cluster of departments. This can feel pretty comfortable as you know the people, you understand the rules, and communication is much more straightforward. The thing is, when you step up, that world shifts, and to succeed, that world needs to become a whole lot bigger. At a minimum, you are likely to be working across the Trust, across professional disciplines, and with much larger numbers of people. In reality, your world is likely to be even larger and require you to engage with and understand systems you are less comfortable with in order to maximise your impact.

The expectation will be that you actively engage and independently work to develop the necessary relationships to build your leadership in this area. You will probably get introduced to people, but the follow-up steps need to be owned by you. Now, sometimes, this isn’t a comfortable process. Not everyone is an extrovert after all, but it is necessary for success, and so it is worth investing development time in these relationship building skills.

You need to have and be able to sell a vision

Many of us, as individuals, know where we are going. When stepping into leadership, however, that is no longer enough. You can’t just have a vision for yourself anymore. In fact, the vision that you create is no longer even owned by you. You have to switch mindset. You need a strong, clear vision, but it’s no longer about you and your path. It’s about your team, your workforce, your service, and your patients. You need to develop the vision enough to be able to communicate it, and then you have to share it. Sharing also needs to be bi-directional. Your vision now includes others, and so taking on their input is key so it becomes a co-produced direction of travel that can really land and embed to become a reality.

You will never be ‘in control’

Often, people think that as they step into leadership you have both more control and more freedom. This is both true and false. You have more autonomy, but in some ways less choice about how to use it.  I’m sure some people in leadership positions do feel in control, possibly because they enjoy a more micro management style of leadership than I do, but the honest truth is that I never feel in control. Now, to be clear, this doesn’t mean that I feel like I have lost control either. It’s just I have accepted that leadership is unpredictable.  You can plan all you like but there will be things that come up that mean you have to maintain a flexible approach and the ability to pivot and think on your feet.

I also want to have trust and not control of the staff I lead. I trust them to escalate as needed, I trust them to know their skills and boundaries and where I need to support them in gaining clarity when needed. This is obviously flexible, dependent on level and experience, but for me, development requires supported freedom to make decisions and learn from the process. I always say to my students that I want them to learn all they can so that one day they will become my boss, and I really mean it. It is not my job to be so in control that I clip the wings of those around me. It’s my job to support others to fly.

You can’t play favourites

This one should be obvious, but it is sometimes not as simple as it seems. It takes active effort at every stage to try to ensure that opportunities are openly shared and that individuals feel like they are open to them. One of the reasons for this is that when you advertise or offer up these opportunities you’d be shocked by the number of times no one steps forward. There are lots of reasons for this, personal circumstances, lack of individual confidence, issues with how it was disseminated, and it just not being the right moment. This can lead to you actively needing to identify and encourage individuals who you think might be a good fit. That inevitability introduces bias however, as they are likely to be individuals you are more familiar with. I’m not perfect with this but I am conscious of it and therefore am a work in progress.

I’ve also known some senior leaders who liked to pick and choose who they worked with based on comfort and existing relationships.  I’m not sure that this is the right way, for the reasons I’ve said, so if you only find yourself working with individuals you find comfortable, I think it’s worth reflecting on why, and if that is the fairest and best approach. You are probably doing yourself, your colleagues and your service a disservice without even realising it.

You will have to make the tough calls

The reason this blog post is on a Monday rather than the normal Friday is that last week was tough. It was a week of tough days and tough calls. One of the things I don’t think I’d truly been able to understand, before I was in the position to make them, is quite how hard making some of those calls is. Whether clinical, scientific or leadership, you are likely to either have a) never encountered the situation before or b) not have all the information. The truth of the matter is you make the best decision you can with the amount with the knowledge you have. You have to make that decision confidently and you have to own it. People are looking at you for direction and guidance. You should always feel able to canvas opinion, seek knowledge and input, but at the end of the day the decision, and therefore the consequences, lie with you. It is not possible, nor is it acceptable, to be a leader who cannot make decisions when needed. Vacillating leads those around you to lose confidence in the decision made. It is also not fair to pass that decision making down the chain, so that those who are more junior are made to own the consequences instead. If you make the step up you have to own all of it, the good and the bad, boldly and in a way that enables others to have the confidence needed to do what they need to do. You need to spend every day striving for gumption.

You will need to own your choices, no matter how they turn out

Having said that you need to be confident in your choices, not all of them will turn out the way you hoped. I had a scenario a few years ago where I had to say no. In fact, I have them all the time, but this one sticks with me. I had to say no because otherwise, I was setting the person up to fail in a way that wasn’t wise. There are often times when, as a leader, you have to allow people to fail and grow as it’s a key part of learning.  There are circumstances, however, where the scenario is either too high stakes or risks reputational damage where a no is required. Frankly, this experience did not end well for either of us as it resulted in resentment.  That’s on me as I obviously failed to communicate the rationale in a way that aided processing. I offered, as is key in these circumstances, other options, other routes to attain the same end, but they didn’t lead to resolution. The thing is, I stand by the action, and I own the outcome, as well as the learning. As I said above, you can’t be liked by everyone, you can only try to be consistent and fair.

If you are going to be the person who says no, or make the big calls, you have to own the consequences of that decision. The same is true for when you say yes. If you are a decision maker, you need to understand that you are in a position to make decisions that impact people and patients and that those decisions should not be made lightly. You also can’t absolve yourself of any subsequent events linked to those decisions. You can only challenge yourself to make them for the right reasons and course correct and learn to be better if you get it wrong.

Sometimes, you just have to take it

Last week. again, was a great example of this one. Things went wrong. They were not under my control. I was, however, the face of the corrective actions required. Stress levels were high as well as emotions, and no matter how unpleasant, individuals needed to be able to express some of those emotions. It is much much better that those individuals expressed how the situation made them feel at me than carry them into their next encounter with a patient or different staff member. I understood the context and driver for the response in a way that the next person might not. It was, therefore, better for me to  be the conduit for that emotion. To stand there and hear the concerns and emotions in order to support processing and let them feel heard. Was it pleasant? No. Did it require tea and possibly a quick weep in my office? Yes. Was it the right thing to do? Also, yes. Sometimes, leadership is about allowing others to express unpleasant emotions so they can move past them to a space where they can take the actions needed. I’m not talking about allowing bullying or unacceptable behaviour, but about working with those impacted to move forward in what can be high stakes and very stressful situations. Sometimes being a leader is about doing what is needed to help everyone move forward, both emotionally and in action, so we can all start a new chapter together.

You have to be able to see the jigsaw, not just the pieces

One of the things that can really help with making the hard calls or dealing with the stressful moments is being able to see the whole picture and what that new chapter might look like. This is why having a vision and understanding the wider networks and landscape you are working within is key. You need to be able to take a step back and see the whole jigsaw and know whether the decisions you are making are right across the different levels of context.  That can mean making harder choices, but if you can return back to those wider drivers to sense check, it can make life easier.

One minor example of this is the choice I made to always refer to myself when possible as a Healthcare Scientist, not a Clinical Scientist.  It’s not that I’m not proud of my professional title. On a national and strategic platform, however, using a single name and description gives bigger numbers and a single voice.  It doesn’t require the person trying to navigate that landscape to understand all of the nuances that we experience if we work in the area. So I pivot based on context how I even describe myself, not for my personal benefit but to benefit the profession as a whole. It helps support a single identity and advancement for everyone, rather than any profiling raising I do benefiting just to me as an individual. I strongly advise taking this kind of active reflection across all we do, you never know when a simple change will maximise impact.

You can never be ‘just a passenger’

The final thing, and this can sometimes be hardest for me, is you no longer have the right to disengage. It’s no secret that 2024 has already been quite a challenging year, and I’d be lying if I said that I was in a great head space. My innate reaction to feeling the way I am feeling right now in to hide, to ostrich, to try to protect myself by creating distance. I can not do that. As a leader in challenging times you have to be even more present, even more engaged and involved than you would be otherwise. When circumstances and change are making everyone be unsettled the last thing you can do is become absent or disinterested. You have to step up, you have to be seen, you have to (try to be) the calm at the center of the storm. Personally I can come home and hide in my castle with the safety of Mr Girlymicro for recovery. Once I am out there professionally I need to put all that to one side and throw myself in 100%. You owe too much to your team/s and to your patients to do anything else.

I should say, this posts focuses on the things that can be challenging and the things that may be less obvious from the outside. Being a senior leader though brings so so much joy that all the challenge is more than worth it. Seeing those around you succeed, seeing things become better or change that you envisioned comes to pass, is massively rewarding. There are tough moments but if you are in the right place, with the right people, even the dark times lead to illumination. So take the next step and see what change you can make!

All opinions in this blog are my own

It’s All in the Preparation: My top ten tips to help prepare for your conference presentation

girlymicro Academic Life, Education, Healthcare Science, Leadership, Research/Academia, Science Communication , , , ,

I was presenting at my first conference of the year last week, which is a sign that conference season is soon to well and truly kick off. I know that this often puts many of us in a state of anxiety. We know that conference presentations are important for both getting our work out there and also for personal and career development. Presenting however, can feel like quite a high stakes manoeuvre, especially if you are not comfortable with public speaking. With this in mind I thought it might be useful to share some tips that I have learnt, in the hopes that it might help with your next upcoming session.

1 – Know your audience

The first thing to realise is that we often make presentations about us, when actually they aren’t really about us at all, they are about the audience and what we are trying to achieve on their behalf. We are often given a fairly generic topic to speak on, or have submitted an abstract of what we wish to present. That’s great but actually probably doesn’t have enough clarity to start putting together the session. My first step whenever I’m asked to speak is to think about the learning objectives for the session. What might benefit the audience most? What are they expecting? Learning objectives act as a guidepost, and I will usually include them with the blurb I’m asked to write for the agenda. This means that people selecting their sessions will be able to make an informed decision about whether your session will work for them. Are you pitching an introduction level session or an update on the latest research that assumes pre-existing knowledge? You want to match your pitch to the audience that you are expecting.

It is also worth thinking about what kind of atmosphere is likely to be present? Is it a fairly informal setting where the session will be more discursive or is it a formal conference session where you may need to prepare for possible confrontational questions? Prepare for questions and queries whilst you’re preparing your session, try to think about the rabbit holes that the audience might want to go down and for any potential pitfalls where you will need to have a pre-prepared strategic response. If you’ve been clear about what the session covers and audience pitch this should be less of an issue, but it’s always worth being prepared.

2 – Be prepared to bring your authentic self

One of the things I’ve come to truly believe is that, no matter how formal the session, you should bring your whole self to it. I’ve written previously about how we should feel free to wear clothes that empower us, and conference sessions are no different. This can be something as simple as wearing your favourite colour, but whatever it is, delivering talks is easier when you feel good and empowered so do whatever you need to feel that way. My top tip is that whatever you decide to wear, ensure that it’s comfortable. I used to wear heels to speak but now I always wear flats, as I’ve decided that the pain isn’t worth it for me, especially when you consider how long you will be networking after your session.

The other place were I try to ensure that I also include something that is a little bit me, is within the presentation itself. Again, this can be levelled dependent on setting, sometimes I just choose a colour scheme or icon that speaks to me. Other things you can include are quotes or images that are meaningful to you. Again, it doesn’t have to be something big or in the face of your audience, but something that centres you and makes you feel more like you own the space you are presenting in. Sometimes however going big is the way forward, sometimes making something memorable is the right approach, it all depends on your confidence level and the setting.

3 – Judge your session

I’ve talked up above about thinking about how informal/formal the setting you are presenting in and how this can impact on your content. There are however other things that are beneficial to think about in terms of expectations for your setting. The type of session will dictate a number of things, as will time slot and room allocation. If you know the venue you are going to you may be able to predict numbers of attendees for instance, if you are allocated a room you may be able to find out whether its for 15 people versus 1500. High numbers of attendees will limit your options for interactions, as will being given a 15 minute time slot.

Common types of sessions include:

  • Debates
  • Research presentations
  • Topic presentations
  • Workshop
  • Plenary or keynote
  • Speed presenting
  • Poster presentation
  • Careers presentations
  • Panel sessions

There are obviously others but these are the main ones that spring to mind. Just from looking at the list you’ll be able to see how different ones will attract people with different levels of pre-existing knowledge or interest. There are some key questions that are worth asking to help you support judging your session when the email comes in. First, always confirm length of session and whether or not this will include time for questions. Second, ask about number and types of attendees both for your session and the target audience for the conference/meeting itself. Finally, as this will impact your options for engagement with large audiences, will there be free Wi-Fi available for attendees so they can access voting apps? Don’t feel like this information should confine your creativity and what you want to undertake but build any limitations into your thinking in order find solutions ahead of time. Finally, please please please never be the person that delivers a 40+ minute talk despite being given a 30 minute slot.

4 – Use the agenda to guide you

Once the agenda is released and you’ve starting to build the content of your session you can also use it to help in your preparation. Your timing and position on the agenda can influence the build of your talk. If you are directly after lunch, you might want to think harder about the engagement side to wake everyone up and get them back into the flow. If you are just pre lunch, you might want to stack some of your more exciting parts towards the end and build towards them to ensure you keep the audiences attention. If you are going first or last you probably need to start and finish with a bang. 

The other area where the agenda can really help you is to see what others are covering, especially if they’ve listed any focuses or learning objectives in their descriptions. This may mean you can get valuable slides back if someone is talking on a similar topic ahead of you, and will therefore have given a lot of similar introductory slides, thus giving you more time to build on the subject in your slot. It can also give you ideas of areas to avoid, so that you don’t give too much overlap. One of the things to not do is be intimidated by anyone else on the agenda. If you are speaking/presenting you have earned the right to do so, it doesn’t matter if the person before you is Dame X or Professor Y, acknowledge what that might do to the atmosphere in the room (i.e. may mean you have a larger audience) and then plan as if they were any other speaker.

5 – Have a plan on how to engage attendees

Engagement can start before the event even begins. If you have a poster session for instance, you might want to share a picture of your poster and it’s location on social media. Sometimes I also find running polls can help with working out pitching your session, and also in building engagement so that you are more likely to get an audience. This can be especially important if your session is at an event where there are multiple sessions running at the same time and therefore you almost need to sell why someone should comes to yours when there is so much choice available. Taking some time to raise awareness via social media using the event # can be really beneficial under these circumstances.

Depending on the availability of Wi-Fi and session details you may also want to consider using tools or apps to support interaction with the audience during your session. You can use tools such as Mentimeter and Slido to build voting or other forms of interaction into your session. This approach is especially important if you are asked to do a workshop session. It’s also worth asking additional questions during the prep phase, such as the type of seating, to see whether it would support group discussions.

Even if you are giving a standard presentation without interactive tools you still need to think about how to engage your audience. There obviously many different ways of doing this, starting from basics like pitching correctly so you bring your audience with you. If you can bringing yourself to your session by using framing such as story telling it can really help, alongside the use of humour. You can even think if there are props that would be appropriate to support what you’re talking about, although you also don’t want to make it gimmicky. Whatever tool you feel comfortable with, practice using it as it will make sure your session is more memorable.

6 – Make sure you have a plan B

Things go wrong, they do, despite your very best endeavours. Having a plan B in your pocket never hurts. This can be as simple as having a USB with your slides on it with you in case they haven’t managed to load it before you arrive. If I’ve included videos or anything else ‘fancy’ in my presentation I will always have a plan B and C. Plan B is an extra copy of my talk without the ‘fancy’ bit in it in case it doesn’t work when I test with the AV tech ahead of my talk. Plan C is a script in my head that I can use to describe the video in case it worked on test and suddenly fails during the real thing. If I’m doing a smaller session, I will also sometimes arrive with print outs of my slides so that I can approach it old school if needed.

Having a plan B is especially important if you are using voting or something tech related. If your entire session is going to be based on audience participation you need to have a plan if no one there can get signal or access to Wi-Fi. It’s worth building this flexibility in when you are developing the session so you will not need to entirely wing it if the unexpected happens to you.

7 – Be prepared to push yourself

I’m just throwing this out there. You should be prepared to push yourself into a space where you feel uncomfortable. Growing your skills is a never ending task, even if you feel like you are a pretty good public speaker, there are always things to learn, improve and do better. Sometimes the very act of speaking is a sufficient push because it’s not an area in which you feel comfortable. If you are comfortable talking ‘science’ maybe also stretch yourself by bringing more of yourself into the session. Embrace the creative possibilities and strive to have more impact, build better engagement, be more memorable. Read and research on the topic of how to present better in the same way that you would read and research your content and find inspiration about the next thing you could try.

8 – Facilitate a relaxed state of mind

Having just encouraged you to step out of your comfort zone by planning your presentation I also now want to encourage you to remove the stress that can be present outside of the speaking component itself. I speak from experience. I once agreed to speak at 2 conferences on the same day, on different topics and in different cities. This was beyond foolish. There simply wasn’t enough time to get from point A to point B and I arrived to land on stage for the second session with 1 minute to spare. I’ve also learnt that travelling up on the day of a session doesn’t work for me, it just makes me too stressed. I now will always travel up the night before, even if I arrive really late, because then I can go to sleep knowing that I’m where I need to be rather than lying awake all night stressing about whether an act of god will stop me making it to my session.

I also comfort myself by reading up on the areas that I have identified during my gap analysis that I might get questions linked to, or to reassure myself – even if it’s a topic I know really well – that I have up to date information and references. Feeling like you are walking up to a podium prepared is the best way I have to remove any of my stress linked to presenting.

9 – Plan to do your own timing

This is one I have learnt the hard way. I don’t like clocks present in the corner of a screen when I’m presenting as I want to be looking out at the audience and connecting when I’m speaking not constantly looking down at a monitor, probably slightly influenced by the fact that I don’t use notes as it enables me to feel more organic. I know some of you will feel differently. I’ve learnt to manage this by having a phone with a big clock (on silent) with me when I present so I can see it as I move around. I know that there will often be Chairs or speakers who will signal when you have 5 minutes left. I personally find that I need to pace my session throughout, as otherwise at 5 minutes I could be left with waaaay too much to cover, and so I like to time check myself. The final reason I do this is that I have been caught out. I’ve turned up and started a presentation and realised there was no clock or timing device visible anywhere. The panic, for me, at that point is real people, it’s a real stressor for me. You may have a different thing that triggers you, but once you identify what it is, do your best to have a plan to redress it so it doesn’t distract you from the moment you are in.

10 – Use the opportunity to build your networks

This last one I think is really important, if you are given the opportunity to have a platform use it! No matter how nerve racking it is, no matter how much you may not like presenting. In fact, if this is not your naturally comfort zone all the better, go out and seek opportunities that enable you to do it more. With practice comes familiarity and skill development. Don’t feel alone in your discomfort, but do know that there will be something in you that can inspire and give confidence to others. The world needs to see more people like you, whomever you are, especially if you have the courage to bring some of yourself to the podium. There is not enough diversity present on agendas and that is something that needs to change, and we need to have the courage to do that together as a collective.

The other thing to bear in mind is that so much within health and science is dependent on who you know. It’s probably not fair but it is true. Connections and networks are where you gain invites and opportunities, and presenting and meeting people is a big way to build these relationships. Whether you do this by following the hashtags for the event on social media, by speaking to those presenting or partaking in networking and social events at the meeting, networking is key. For those of you, who like me, find networking challenging I’ve previously written a post which I hope might help, but presenting is often an easy way to do it as people will come to you and you already have a shared interest through the topic. Whatever your level of networking comfort it’s worth putting in some time ahead of the event to think what your strategy might be, and who you might want to catch up with.

I really hope that this post will help support you, no matter how many presentations you’ve done, to bring a little bit more of who you are to the room you are presenting in and to be a little bit braver in some of the choices you make when developing sessions. I also hope that by sharing some of the learning I’ve gained by making mistakes, or making life harder for myself, that you won’t make the same ones. If you have any other top tips that you’ve gained to support presentation preparation then please do add them in the comments. See you at the podium!

All opinions in this blog are my own