Erik Reinertsen     Blog     Research     Tech     Teaching     Talks

How to give a great chalk talk


On the medicine sub-internship (“sub-I”) at Emory, we give an 8-15 minute chalk talk on one topic from our curriculum:

  • Acute kidney injury
  • Edema
  • Acute respiratory complaints
  • GI bleeding
  • Acute diarrhea
  • Abdominal pain
  • Chest pain
  • HIV + HA or cough
  • Dyspnea
  • Anemia
  • Bleeding
  • Syncope

These topics comprise the “Approaches” curriculum designed by the sub-I director Dr. Richard Pittman and are drawn from the textbook “Symptom to Diagnosis: An Evidence-Based Guide”. Topics are organized by a patient’s presenting problem or complaint, rather than diagnosis or organ system. This better reflects diagnostic reasoning.

Here I share thoughts on how to prepare and deliver a great chalk talk, especially in the context of the medicine sub-I.

To do: insert photo of example Approaches chalk talk.

To do: add short paragraph to emphasize that an incentive to doing this is to develop a repertoire of short teaching scripts to retain through residency, fellowship and beyond.

To do: emphasize the point of Approaches is to build a mental map of how to work through diagnosis.

To do: Pipes & Water; emphasize branch points that help separate.

_To do: reduce number of bullet points below.__

Prepare

Read your chapter. Spend quality time with the material, outline key points with pen and paper, and reflect on one of your patients with said complaint cements the knowledge. This sounds obvious but you really need to know your chapter better than everyone in the room.

Define the scope of the talk. This means a subtopic within the chapter. I suggest aiming for 10 minutes because 15 minutes feels long. Your goal is to deliver a “tight” talk which is defined by a stimulating but not overwhelming density of information. Do not underwhelm by oversimplifying or covering too few topics at a slow pace. Typically restraint beats excess, but if your goal is excellence you must hit the sweet spot.

Plan how to use your canvas. You will be using the whiteboard, not slides and a projector. Sketch it out on paper. Or even better, use a real whiteboard to develop the talk. Avoid crowding or empty spaces. Keep content density balanced. Decide which colors to use for what content, e.g. red for topic names, black for details, and blue for lab values or specific examples.

Organize the information. The only way to effectively map complex information from your brain to theirs is to be very organized. As a general rule, one main topic can be branched into 3-5 subtopics, but going broader or deeper in 10 minutes is not recommended. Use diagrams, drawings, mnemonics, or some visualization to give the audience a scaffold upon which to organize what you teach.

Create an accompanying handout. I like handouts that complement the chalk talk. Information on the handout should not be redundant with the whiteboard. Add “fill in the blanks” for key information, e.g. physical exam findings with high positive likelihood ratios in acute MI. Think how you can use the handout to let your audience participate.

Keep it clinically relevant. Open with why everyone should know what you are about to teach. Effective openers remind us how common or serious the presenting problem is. For example, ask the M4s to imagine being fresh interns and getting paged for acute GI bleeding while on night float. They will now pay extra attention to your neat diagram of management. Bonus points if you incorporate a score on MDCalc that is actually useful, e.g. CURB-65 for your talk on pneumonia.

Practice. Teaching is like everything else in life. Improvement is the result of arduous preparation done intentionally and often. There is no way to skip it. If you practice, especially in front of colleagues or record a video of yourself, you will improve.

Deliver

Don’t preview too much or obsess over learning objectives. For a short talk you should be extremely brief with your outline, e.g.

“Today we will talk about the initial evaluation of a patient with AKI. We’ll focus on the must-not-miss diagnoses of hypovolemia and obstruction, what to focus on in the physical exam, and how to interpret relevant lab tests.”

Write legibly, ahead of time, and with good whiteboard markers. Take time to add some content to the whiteboard before you begin. It is very hard to write as fast as you speak, and you will feel slow and start writing too fast, and your handwriting will become illegible.

Pace should be energetic, yet in control, and never rushed. Calibrate your sense of pace by practicing (see above). Don’t bore everyone by speaking too slowly. Don’t run out of time and rush at the end.

Be aware of body language. Some people pace, wring their hands, or look at the floor. Everyone has a different style and you can make yours work for you. Just be self-aware and adjust PRN.

Engage the audience. Even if you did not architect questions into the talk, you can interact as you go. Make eye contact instead of facing the board the entire time. Assess understanding as you go, acknowledge if a colleague had a relevant patient situation to the topic, etc.

Finish by summarizing the main ~3 learning points. Reinforce what you want people to remember. If you opened with a clinical scenario or case, circle back and close the loop.