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Creating effective slides.

Long ago, photographers discovered that sliding transparent images in front of projected light created interesting entertainment possibilities. (1) Teachers and communicators began waking their audiences by accompanying lectures with projections of photographed images. (2) Each piece of developed, transparent film went into a frame made of cardboard, metal, or later plastic, allowing the film to slide easily in and out of a still projector. The name "slide" stuck.

Fifty years ago, Kodak developed the Carousel, a round tray that held a collection of films, fit onto a projector, and did the sliding at the touch of a button. The Carousel allowed instructors to keep slide collections and made it possible to view slides in a continuous program while speaking. The "slide" came to be a standard format in the medium of audiovisual communication tools.

Although we no longer use film or film projectors, the purpose of creating slides is still to capture the audience's attention by succinctly presenting a speaker's presentation points. Effective slides help the audience lock information into memory. The guidelines for making effective slides have remained consistent but have not always been practiced and disseminated. Unfortunate practices have taken hold, and what we call "slides" are too often projected versions of a lecture, copies of published data, or visual aids more appropriate for individual study on a computer screen.

Creating effective slides is complicated, even though a successful result appears simple. Writers must understand the information being presented, judge the relative importance of various parts of the information, and organize the information visually in such a way to accompany and enhance the spoken presentation. Slide design requires extracting and translating information into visual images to emphasize the points of the presentation.

Many beginning medical communicators, physicians, and instructors receive no professional training in creating slides, instead learning from others who did not use the slide format well. Visual design and audiovisual perception are rarely included in the training of those who create medical education programs. As a result, the use of ineffective slides is perpetuated. If we do not know what makes a slide presentation effective, we may work very hard at creating ineffective communications.


Although great for some purposes, audiovisual media are not the answer to every presentation need. Before we can plan an effective slide program, we must answer some basic questions:

* Is the slide program introducing a new subject or technique, presenting a point of view, or reviewing information?

* Who will be viewing the slides? What is their level of understanding and familiarity with the subject?

* Will the slides be projected in a large lecture hall, be viewed on computers in a classroom, or be used in another way?

A slide that is effective for one purpose, in one setting, with a particular audience may not work for a different purpose, setting, and audience. If the purpose of a presentation is to give an overview of studies or to introduce important concepts and strategies, a slide format can work well. When the purpose is to review tables of results from studies or compare complicated graphs or charts, printed materials provide a better choice for presenting detailed information.

When a slide is too complicated, the audience loses focus while trying to figure out the slide. Worse, they become distanced, critical, and resentful. Many slide templates are so busy that the audience has difficulty finding the important details. Information presented in slides needs to be much simpler than images (diagrams, tables, graphs) published in textbooks or journal articles. (3)

The purpose of a live presentation is to allow for instruction and interaction, yet most of us have experienced slide presentations in which there was little or none of either. Perhaps the most basic guideline for creating effective slides is that every word on a slide should be readable by every member in an audience.

In too many presentations, the speaker reads every word to the audience. Presenters commonly relate to their slides as if the words on the slide are the presentation. When a speaker puts an entire lecture on slides, the type size is usually too small for the audience to read. In an effort to make it easier for attendees to read the content of slides, presenters provide printed copies. Whether being read to by the presenter or reading along from a printed handout, the audience cannot read, listen, and comprehend at the same time. Rather than enhancing the focus on the presentation and engaging the listener, the handout replaces the presentation. It provides information but no opportunity for interaction. The presentation becomes a reading exercise, and the chance for real learning is lost. It is not surprising when busy audience members grab a copy of the handout and skip the actual presentation. Describing an effective lecture, Copeland et al. advise medical educators not to use slides as speaker's notes. (3)


Michael Alley, a professor of engineering at The Pennsylvania State University, has been on a mission to transform scientific presentations after attending too many that were boring and inadequate. In several books and on a Web site, Alley has attempted to explain and correct ineffective audiovisual teaching practices. (4,5) Alley is one of many who emphasize the problems inherent with using the PowerPoint program to design slides, with its deadly "...default design of a single word or short phrase headline supported by a bullet list." (4) He notes that words and bulleted lists become monotonous and are not effective for enabling information recall. (4)


Most people who write and design slides are less than fond of PowerPoint, but it is the primary slide design software used by the world. Robert Gaskins and Dennis Austin, the inventor-designers of PowerPoint, have said they deplore that the program has replaced rigorous writing and thinking. (6) Designer and information analyst Edward Tufte noted that scientists should know better than to use an inadequate software program for presenting serious data. PowerPoint is too often used for "capturing, editing, and publishing text, tables, data graphics, images, and scientific notation," he says. (7)

Bad slides are not the fault of PowerPoint; bad slides are the result of ineffective efforts to use the slide format inappropriately. When we do not understand the relationship or importance of the information, a bulleted list or any other aspect of design may well end up confusing rather than aiding memory. When we understand the principles of audiovisual perception and know the purpose of a slide program, we can use any software to make effective slides. The medium may contain the message, but the software does not determine the medium.


Alley calls his solution to the problem the assertion-evidence slide. He uses a complete sentence as a headline (the assertion) and then presents visuals to prove the assertion (the evidence). Beginning with a sentence assertion headline brings focus to the presentation and eliminates the common problem of repetitive headers. Providing relevant visual information enhances learning. While some of Alley's slides using the assertion-evidence format are simple enough to accompany a presentation effectively, others are quite complicated. Many of the slide bodies are full of information, illustrations, or photos. The design is really a new format, a self-contained teaching program or visual aid (Figure 1).

Interaction with a presenter or an instructor is often absent when slides are used as part of a computer-based program or as online assignments. Many education programs use the slide format as a substitute for print format, without regard for the rules of timing and perception inherent in the slide format. Alley's assertion-evidence slides require attendees to take time to study the images and discover the information at their own speed. Even a complicated image can be a useful learning aid when used in this setting (Figure 2). When an audio program provides additional information, the audio supplements the visual, a relationship that is opposite that of the traditional audiovisual aid, in which the visual supplements the live audio presentation.



Projected visuals enhance our ability to learn information but only if the images comply with basic rules of human perception. Designing slides requires writers to have proficiency beyond good writing, including an understanding of audio and visual principles, teaching methods, and audience behavior.

Perhaps the main reason writer-designers resort to words and bulleted lists is that they simply do not budget adequate time for creating visual ideas. Any art director can attest that creating visual images takes longer than writing and editing. Before creating the visual concept, you must do the same research and organizing required for writing and editing. Thinking visually means doing it all--first the writing, then the design, and finally the visual presentation of the images.

What is an effective image? Images used in slides are not designed to stand on their own; their purpose is to emphasize and enhance the presentation. Reinforcing is not the same as capturing the audience's attention.


The basic concepts of visual design include the languages of space, size, positioning, and intensity, which psychologist Stephen Kosslyn applied to graphing data and now has developed into a book about creating slides. (8) Educational researchers Clark and Mayer note that learning is enhanced only when visual elements are relevant. Adding irrelevant visuals, sounds, or words distracts the audience and impairs learning. (9)

The audience's perspective is an important consideration when designing slides. Michael K. Gilson, PhD, MD, chair of the newly created Computer-Aided Drug Design program at the Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California, San Diego, gives advice to young scientists about creating slides for seminars based on his experience with the audience's reactions to ineffective slides: (10)

* Use "informative" heads to orient the reader to the content; do not repeat the same head on multiple slides and do not repeat header information in the body of the slide.

* List the main point first; otherwise your audience may lose interest before you get to the main point.

* Use "terse" text; for example, use noun phrases rather than complete sentences.

Arthur Garson, Jr, MD, MPH, Provost of the University of Virginia, Charlottesville, and former Dean of the School of Medicine, has critiqued slide presentations from a seat in the audience and has concluded the following:11

* The most common fault is presenting slides with too much text or with too much data or with a typeface that is too small.

* It is absolutely unacceptable to ask your audience to wade through a slide with too much data.

* Footnotes should be avoided, as reference citations in the body of a slide force the audience to look for the source.

* The use of unnecessary abbreviations is confusing and does not aid memory, particularly for audience members who are not native speakers of the language used in the presentation.

Most of the common problems result when slide creators do not use the basics of psychologic perception in designing slides (Table 1).


Over the years, based on research and experiences preparing and using slides for lectures and teaching presentations, I developed a list of guidelines, which address the basic minimum rules for creating and presenting effective slides. In some circumstances, we may be required to break the rules, but knowing the rules allows us to break them in the least problematic way. Medical writers often write slides for others to present, but we cannot design an effective slide presentation without understanding how design affects content, creates perception, and is the basis for relating to our audience (Table 2).


Will slides survive as a useful teaching tool? Will classroom computers replace instructors, substituting for them with audiovisual lessons that students can study and repeat as often as needed? While we cannot predict what medical communications will look like in the future, we know that to be effective, instructional media must adapt for each purpose, audience, and setting.

If the computer design world develops new software and visual arts engineers create new presentation hardware, the world of education will still need media specialists who can create effective images that convey meaning. No computer program can translate complex concepts into simple visual images, and no design program determines layout. Whatever formats survive in the future, the essential elements for producing effective audiovisual programs will stay the same. Medical communicators who write and design these programs will be, as they are now, in charge of the information and its presentation.

Many resources on slide design are available online, including several new books on slide design for medical and scientific subjects. We may turn this around yet.

Author disclosure: The author notes that she consults for companies that create slides for educational and promotional purposes.


The author thanks Lili Fox Velez and Sheryl Kelly, who contributed information to the AMWA session on which this manuscript is based, and Tom Lang, Ed Heinz, and Lori Alexander, who reviewed the manuscript and provided excellent editing notes. The author gives special thanks to Michael Alley, The Pennsylvania State University, for allowing the use of examples of slides from the extensive collections on his Web site.


(1.) Lantern slides: history & manufacture. Library of Congress: American Memory. Last accessed April 10, 2010.

(2.) Costache, ID. Convergent practices: new approaches to art and visual culture. CHAart (Computers and the History of Art). html. Last accessed April 10, 2010.

(3.) Copeland HL, Longworth D, Hewson MG, Stoller JK. Successful lecturing, a prospective study to validate attributes of the effective medical lecture. J Gen Intern Med. 2000;15(6): 366-371.

(4.) Alley M. Rethinking the design of presentation slides. Available at Last accessed April 10, 2010.

(5.) Alley, M. The Craft of Scientific Presentations. New York: Springer, 2003.

(6.) Gomes L. PowerPoint turns 20, as its creators ponder a dark side to success. The Wall Street Journal Digital Network. Available at http:// SB118228116940840904.html. Last accessed April 10, 2010.

(7.) Tufte E. PowerPoint does rocket science-and better techniques for technical reports. The work of Edward Tufte and Graphics Press (published online September 6, 2005). Available at http:// id=1. Last accessed April 10, 2010.

(8.) Kosslyn SM. Clear and to the Point: 8 Psychological Principles. New York, NY; Oxford University Press, 2007.

(9.) Clark RC, Mayer RE. E-learning & the Science of Instruction, 2nd edition. San Francisco, CA; Pfeiffer, 2008.

(10.) Gilson MK. Designing seminar slides. Available at http://gilsonlab.umbi.; Last accessed April 10, 2010.

(11.) Garson A. Jr. President's page: meeting improvement: a guide to preparation of "slides" for presentation. J Am Coll Cardiol. 1999;34(3):886-889.

Log onto The New York Times Web site ( world/27powerpoint.html) to read a recent article about the love-hate relationship with PowerPoint. You can also view several fun and enlightening videos about PowerPoint on YouTube ( and at www.the

By SL O'Connor, MA, MFA

Medical Writer, Editor, Producer, Palm Coast, FL
Table 1. Basic Concepts of Visual Perception

Perception     concept                Design

Primacy        we see the whole       use the first visual
               before its             impression to create
               components             meaning

Proximity      we see objects near    use spacing to
               each other as a        create meaning

Similarity     we see similar         use visual
               objects as a group     relationships to
                                      give meaning

continuation   we see patterns and    Arrange data and
               groups                 objects to create

closure        we fill in gaps in a   Use breaks
               pattern                intentionally

Table 2. Basic Essentials for Creating Effective Slides

Slide Element    Best Bet               Why

Arrangement      1 point per slide      A slide's purpose is
                                        to make a point

Font Color       Black (or dark) on a   People remember
                 white background       black on white

Color            Don't overdo it!       People are
                                        interested by color

Testing of       Project slides in a    Is everything
Size & Colors    room of the            readable? Are the
                 appropriate size and   colors right?

Images           Simple and relevant    Design and color
                                        should enhance

Software         Allow sufficient       Thinking visually
                 time to design and     takes longer than
                 refine ideas           writing words

Hardware         Plan for problems      Problems happen

Audiovisual      Never use words on a   People cannot hear
Principles       slide that are also    and remember what is
                 spoken by the          said when they are
                 presenter              trying to read the
                                        exact same words at
                                        the same time

Coherent Whole   Each slide is a        Each slide creates
                 whole within the       its own moment of
                 whole of the slide     focus and meaning

Slide Element    Tricks

Arrangement      Sometimes one word or one
                 image is sufficient

Font Color       Use subtle backgrounds to
                 create tone

Color            Use color to add meaning

Testing of       If you skip this step, prepare
Size & Colors    to be surprised!

Images           If it is not working, take it out!

Software         Test the images on others
                 before using them with an

Hardware         Take your own equipment

Audiovisual      Don't use "spoken
Principles       language" or text on a slide

Coherent Whole   It is not just about the number
                 of words, bullets, or images
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Author:O'Connor, S.L.
Publication:American Medical Writers Association Journal
Date:Jun 1, 2010
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