a presentation method

15 Essential Presentation Techniques for Winning Over Any Audience

• The Speaker Lab
• April 13, 2024

Table of Contents

Ever found yourself standing before an audience, your heart racing? That’s the moment when knowing effective presentation techniques can prove to be your unwavering ally. But what are presentation techniques? And what makes them so powerful? In this article, we’re going to answer those questions.

Before we can talk about presentation techniques, though, we first have to talk about good communication. The power of effective communication isn’t just in what you say. It’s how you say it; it’s in those deep breaths that steady nerves, and in maintaining eye contact. It’s about turning a room full of strangers into an engaged audience hanging onto your every word. When it comes to public speaking, real success comes from mastering non-verbal cues to punctuate our words and using visual aids not as crutches but as tools for engagement.

As you hone your communication skills, you will begin to form effective presentation techniques. Expect rough patches as you get the hang of things, but view them as mere footholds propelling you towards your ultimate triumph. Keep pushing forward.

Mastering Presentation Techniques for Impactful Delivery

Presentation techniques are more than just standing in front of a crowd and talking. They’re about making connections, telling stories that resonate, and leaving your audience with something to remember you by.

Elements of an Effective Presentation

For your presentation to resonate, ensure the visuals are straightforward and supportive, rather than distracting. Your message should be concise yet powerful enough to stick. And let’s not forget engagement; keeping your audience on their toes is key.

• Visuals: Keep them simple but impactful.
• Message: Make every word count.
• Engagement: Interact with your audience, ask questions, make them think.

We’ve all seen those slides crammed with text or charts. When you make your slides, don’t cram information, because nobody wants to squint at tiny fonts or decipher complex graphs while trying to listen to you speak. This resource suggests focusing on clarity and simplicity when designing slides—advice worth taking.

Strategies for Delivering a Successful Presentation

To deliver a knockout presentation, start strong. Grab attention from the get-go with an intriguing fact or story related directly back into the topic at hand. Maintain eye contact across the room so everyone feels included in the conversation. Finally, end on a memorable note, either with a call to action or insight gained during the time together. Leave them wanting more information and eager to learn about the subject matter discussed today.

• The opener: Hook your audience with a relevant fact or anecdote.
• Maintain connection: Eyes up, engage everyone around.
• Closing remarks : Last chance for impact–what’s your mic drop?

As author Lilly Walters once said, “The success of your presentation will be judged not by the knowledge you send but by what the listener receives.” This quote reminds us that the true goal of any speech is the understanding achieved between the speaker and the listeners.

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Engaging Your Audience with Nonverbal Communication

As the name implies, nonverbal communication denotes all of the ways you communicate without using words. This includes eye contact, body language, and facial expressions. Although nonverbal communication might not be the first presentation technique that comes to mind, it’s nevertheless a very powerful tool to have in your arsenal. Let’s take a look.

The Power of Eye Contact, Body Language, and Facial Expressions

Making eye contact isn’t just about looking someone in the eye; it’s about forging a connection. Aim for brief moments of eye contact across different sections of your audience throughout your presentation. Establishing fleeting eye connections across diverse audience segments fosters a sense of trust and keeps them hooked, all while ensuring no one feels on edge.

Body language is similarly important. Stand tall with good posture; it exudes confidence even when you feel nervous. As you grow more confident, mix up standing still with moving around subtly. This dynamic shift holds attention better than being rooted to one spot or nervous pacing. Use your hands to gesture naturally as you speak—it adds emphasis and keeps things lively.

If there’s one thing people can spot from miles away, it’s insincerity. So let those facial expressions match your words. Smile when you share something amusing, and furrow your brow when diving into serious stuff. After all, it’s not just what you say but how visually engaged and passionate you appear while saying it that counts.

Tying these elements together helps you deliver impactful, memorable talks. When done right, folks will leave feeling more connected, understood, and fired up by your presentation, all thanks to your techniques.

Designing Compelling Presentation Materials

Knowing how to design engaging presentation materials is one technique you can’t do without. Far from mere embellishments, these implements are crafted to hammer your message home. Hence, it’s vital to select these aids with great care and discernment.

Tips for Creating Effective Slides

When it comes to crafting slides, think of each as a billboard advertisement for your idea. You want it clear, impactful, and memorable.

• Keep it simple : One idea per slide keeps confusion at bay and attention locked in.
• Use bullet points : Break down your points so your audience can track.
• Pick a font size : Generally speaking, bigger is better.
• Use color : Harness colors that pop without blinding anyone; contrast is key.
• Use images with purpose : A good picture or chart can help illustrate your point, but keep it relevant and don’t overdo it.

With a few helpful visuals, your presentation can go from good to great. For more on creating slides, check out this link here .

Handling Questions and Interactions Professionally

For some speakers, it’s not the presentation itself that makes them nervous—it’s the Q&A session that follows. This is the moment where you get to shine or stumble based on how well you handle those curveballs from your audience. If you want to round off your presentation well, you’re going to want to learn a few techniques for fielding these questions. Let’s look at a few ways of doing this.

Preparing for Audience Questions and How to Address Them Effectively

Below are six techniques that will help you address audience questions effectively.

• Listen Up : The first rule of thumb is to listen like it’s a superpower. When someone throws a question at you, don’t just hear them out—really listen. Demonstrating this level of attentiveness not only conveys your respect but also affords you a brief moment to collect your ideas.
• Stay Calm : You’ve got this. Even if a question catches you off guard, take a deep breath before diving into your answer. No one expects perfection, but showing confidence matters.
• Practice Beforehand : Before presentation day arrives, think about potential questions folks might ask and prep some responses in advance. Practice makes perfect, after all.
• Vary Your Techniques : Not every question needs an essay as an answer; sometimes short and sweet does the trick. Mix up how detailed or brief your answers are depending on what’s asked.
• Show You Care : If you ever get a question that leaves you stumped, say so honestly—but add that magical line: “Let me find out more and I’ll get back to you.” Then actually do it.
• Appreciate Audience Curiosity : Remember that the reason you audience is asking questions is because they’re interested. So no matter what questions you get, keep engaging with enthusiasm.

Go forth with confidence, knowing not only can these moments boost credibility—they make connections too. So next time when facing down those queries remember to listen hard, stay calm & always engage warmly. With these techniques under your belt, answering audience questions after your presentation will feel much less daunting.

Techniques for a Memorable and Effective Presentation

No matter what topic you cover in your presentation, you can easily add in a story, and more likely than not you can add a little humor too. Together, these two presentation techniques are perfect for making your speech memorable.

Incorporating Storytelling into Your Presentation

One great technique for making your presentation stick is telling stories. Stories have the power to touch people profoundly, especially when they depict relatable experiences. So, when you’re up there presenting, kick things off with a story that ties into your main message. It could be personal, something from history, or even an anecdote that gets your point across. Stories are not just fluff; they’re the glue of your presentation. They make complex ideas digestible and memorable.

Using Humor to Connect with the Audience

Another great way of engaging your audience is by using humor. But here’s the deal—use humor wisely. Keep it tasteful and tied closely to the content at hand so it enhances rather than detracts from your message.

• Pick universal themes everyone can relate to.
• Avoid anything potentially offensive.
• Tie jokes back to your key points to make them relevant.

If humor isn’t your thing, or you’re worried about your comedic timing, it’s perfectly okay to skip the jokes. Especially if you’re new to public speaking, humor can be hard to nail immediately. But as you grow and hone your presentation techniques, consider stretching yourself a bit. By starting small, you can practice using humor to connect with your audience. That is your goal, after all—to leave a positive, memorable impression on your audience.

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Overcoming Public Speaking Anxiety

For some speakers, stepping in front of a crowd to speak causes immediate anxiety. But fear not! Conquering public speaking anxiety is entirely within your grasp.

Techniques to Manage Stage Fright and Boost Confidence

First off, feeling nervous before taking the stage is completely normal. Even Mark Twain admitted, “There are two types of speakers. Those who get nervous and those who are liars.” So take that flutter in your stomach as a sign you care deeply about delivering value to your audience. In addition, consider the following tips as you prepare to hit the stage.

• Breathe Deep: Before stepping up, take some deep breaths. In through the nose, out through the mouth. Feel every muscle relax with each exhale.
• Mind Over Matter: Visualization is key. Picture yourself nailing that presentation, because if you can see it, you can achieve it.
• Keep It Simple: Stick to what you know best; this isn’t the time for surprises or untested waters.
• Pace Yourself: Speak slowly but surely—there’s no rush here.

Believe it or not, acting relaxed often leads to actually being relaxed. Remember when we said mind over matter? Well, it applies here big time. The power pose backstage might just be what turns those nerves into excitement.

So next time you feel stage fright coming on, fight back with these techniques. With these tricks up your sleeve, you’re more than ready. So go ahead, breathe deep, and step onto that stage. You’ve got this.

Using Different Presentation Methods to Engage Your Audience

While learning styles is “ little more than urban myth ,” presenting your material in a variety of ways is a great technique for engaging your audience. By switching it up, you increase your chances of explaining something in a way that clicks with individual audience members. This is especially helpful for more complex topics that might be hard to grasp.

There are three main ways of presenting your material to your audience: through visuals, audio, and hands-on activities.

• Visuals: Use slides packed with images, graphs, and bullet points.
• Audio: Tell stories, play audio clips or engage in discussions.
• Hands-on Activities: Include activities or demonstrations that allow audience members to participate physically.

Making sure everyone gets something from your presentation means considering these techniques when planning content. Not only can incorporating various methods increase audience engagement, but it can also elevate your presentation from decent to memorable.

Essential Tips for First-Time Presenters

Stepping onto the stage or logging into that webinar platform as a first-time presenter can feel nerve-wracking. But fear not! With these tips on how to dress appropriately, arrive early, and make your presentation shine, you’ll be ready to confidently nail that presentation.

Dress Appropriately

Your outfit is your armor. Choose something professional yet comfortable. Whether it’s in-person or online, dressing one notch above what you expect your audience to wear usually hits the sweet spot. Aim for solid colors that won’t distract your audience.

Arriving Early

If possible, arrive at the venue before your audience does. This gives you time to settle in, test any tech gear like microphones or projectors, and take those deep breaths. This extra time also lets you chat with early birds. By connecting with people before taking center stage, you can ease nerves significantly.

Making Presentation Time Count

You only have the audience’s attention for so long. Keep an eye on the clock as you present, but avoid rushing through content. It especially helps to pause after key points, letting information sink in. Your end goal? Leave you’re audience wanting more. You’ll know if you succeeded based on the number of questions you get during the Q&A.

So there you have it—the techniques you need to deliver an engaging presentation. By honing nonverbal communication, like eye contact and posture, you can captivate your audience with your energy. And visual aids? They’re not just ornamental; they help bolster your point and drive it home.

We also learned that tackling audience questions is not an art reserved for the eloquent few but a skill sharpened by preparation and presence. While it takes a little work to nail good storytelling and well-timed humor, the ultimate outcome is worth it.

So while standing before an audience may set your heart racing, know that arming yourself with knowledge and technique can transform not just your presentation, but you yourself. So don’t be afraid to try your hand at these skills; in doing so, you build your own confidence and become a better speaker in the process.

• Last Updated: April 11, 2024

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6 Things To Consider Before Choosing A Presentation Method

Your presentation method—that is, how you deliver a presentation—is just as important as organizing your material ahead of your presentation. How you deliver your message is a vital component of the message itself. Your goal is to engage your audience and compel them to listen and act on what you’re saying. For that reason, you do need to invest some time into selecting the best presentation method.

Presentation Methods Matter

We talk a lot about connecting with your listeners. That’s because there’s little value in giving a presentation if no one pays attention to what you’re saying. When you connect with your audience , you command their attention. They can’t help but listen to you, because you’ve sparked something within them that makes them want to hear what you have to say. And sometimes, what grabs their attention is not the words you’re speaking but how you deliver them.

What exactly do we mean by a “presentation method”? Well, consider the presentations you’ve given or the ones you’ve been witness to. And remember a presentation comes in many shapes in sizes: a business pitch; a church sermon; a stand-up comedy act—basically, just about any transfer of information between two or more people can be considered a presentation. And certainly, your pastor’s presentation method differs quite a bit from that of a corporate CEO.

Think Ahead

Assuming you’ve already plotted and organized your presentation, now is the time to consider how to deliver it. You may have aspirations of pumping the air full of rocking tunes before wowing your audience with show-stopping visuals, but wait a minute: Does the venue have the equipment for all that?

And so, as you begin to map out your presentation method, you’ll need to consider these:

• What’s the Occasion? —Every presentation is unique. Even if you’ve given the same talk a dozen times before, remember that while your message may be relevant in more than one situation, the occasion dictates your presentation method. A sales pitch to a familiar group of colleagues will have a different approach than a sales pitch to a board of directors. Match your presentation method accordingly.
• Who’s in The Audience —Again, it doesn’t matter how many times you’ve presented on the same topic, you have to tailor your presentation to the audience of the day. Are you familiar with the people in the group? What’s their knowledge on the subject? While a formal event to an audience with little knowledge of the topic may warrant slides, a small, informal group who has extensive knowledge of the subject may only require an infographic.
• Where Will I Be Presenting? Imagine preparing your presentation with the expectation of giving it in a small 12×12 office, only to show up and find out you’re giving it in a lecture hall. The delivery method you choose is relative to the room in which you will be presenting. Acoustics, range of view, and even the ambiance is different. Know ahead of time where exactly you’ll be presenting and plan accordingly.
• What Sound Equipment is Available? — A good presenter always tests his equipment before launching a presentation. Whether you’re just using a mic or require more sophisticated sound equipment, make sure you know what is available to you before choosing your presentation method and how to operate it.
• Will I Be Set Up for Visual Aids? You would expect most conference rooms in America are now equipped with audio-video equipment, but do a double-check on that before putting together a presentation that relies on Powerpoint slides.
• Is This an Interactive Presentation? — If you expect to involve your audience through audience participation, your presentation method needs to be selected accordingly. If you will be inviting audience members to share their own experiences or participate in role-playing games, you may want to go out into the audience or at least not remain on stage the entire time. Consider how you will be interacting with your audience before choosing an appropriate presentation method.

Leave Nothing to Chance

An effective presentation is carefully prepared based on where it’s happening, who’s in the audience, and your objectives. Your goal is to deliver a speech or presentation that will leave a favorable lasting impression, so be strategic in choosing a presentation method and do some investigation before you make your choice.

There are so many different methods to deliver an amazing presentation, do you have any tips that could help our audience? Comment down below with your favorite method, and if these methods have helped you – Share them with those that could benefit from them too!

I used to only use PowerPoint but now I’m trying other methods in my presentation.  I feel it’s harder to connect with the audience when useing PPT. Thanks!

Thanks for the info there is a lot to think about.

I once spoke to a man who was a key speaker at many events in his life. He was 72 at the time. He said the key to really presenting what you have to offer is being yourself and knowing how to speak to who you are presenting to. You don’t want to show a group of older adults tech heavy presentations that are fast just as you don’t want to use nothing but pictures to a younger audience. 

Would love to hear more on this topic. Not much out there on “presentation methods.” Great blog.

Nice article.

Very helpful. Thanks!

Great article. It is important that all these questions are fully addressed before the presentation to get the best results.

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Presenting is a craft that requires a thoughtful approach. There’s a lot of stuff to include in the good presentation. From quality visuals to a compelling speech, everything matters. Doing a presentation on your own may be quite a challenge especially if it’s your first time experience with the presentations. What can really help though, are the effective presentation techniques. In essence, they are the blueprint for your presentation, that helps you to hit all the right spots. Let’s look into some of those techniques.

Presentation Methods

Before you start thinking of a technique, let’s first understand the presentation methods and how they relate to the audience and the content of your presentation. Among the different presentation methods, the main ones are formal and formal. Their difference is mainly in the style of your delivery and the data presentation methods. The formal presentation is best suited for the business meetings or college level, scientific presentations. The informal methods of presentation can best be used during the smaller meetings with your team to discuss business subjects or, for example, at a Ted-like speech event.

Method 1: Keeping Everything Simple

This is a rather basic technique. Just strip your presentation of all the unnecessary information, leaving only the core statements that you want to address. Simplicity not only helps your audience to understand your points better but even more, this data presentation method lowers the risk of making a mistake, forgetting — and saves you and your audience quite a lot of time! There are different definitions of simplicity — sometimes just a few words are enough, while in other cases several bullet points on the slide may be sufficient. Choose what suits your topic best.

Method 2: Good Start 

This method of presentation is all about attention-grabbing. Starting your presentation with a powerful statement, unusual fact or an interesting question will make the audience engage in your presentation instantly. Another great way to start is a joke, though humor can be quite a landmine, especially when you’re presenting in front of strangers, and you are not sure whether your joke would be fun or actually offensive.  So, try to think of something neutral, yet funny.

Method 3: Use  Visuals in your Presentation

Visuals are a must for any presentation and are able not only to support your speech but also to tell and contribute to the stuff you’re telling about. The pictures, graphs, infographics, and even short videos especially when done by presentation design services are what truly make the presentation, and help you to connect with your audience. A carefully selected visual connects both with your speech and the slide content, making your presentation methods work in complete harmony. What is more, visuals can serve as a great way to help you recall your speech in case you suddenly forgot some of it during the presentation.

Method 4:   Rehearse

Don’t rush to tell your presentation just once you’ve made it. Instead, try to first rehearse your presentation in front of a mirror. This presentation technique allows you to spot the mistakes and downfalls in your speech and visual part and improve powerpoint presentation . What is more, it can also make you more confident, as with each time you rehearse you’ll memorize your stuff better and better. Bonus points for starting rehearsing from the random spots in your presentation — using this presentation technique will allow you to become completely familiar with your information.

Method 5:   10/20/30 Presentation Rule

While it may not be applied to all of the presentations, the ones that you are usually dealing with can really benefit from it. 10 20 30 rule is about the time and size of your presentation: 

• Your presentation should have no more than 10 slides
• The time needed for the presentation should be no more than 20 minutes
• The font you are using for presentation text (if there is any on slides) is no less than 30 point

Method 6:  Storytelling

Telling a story is a powerful presentation technique for keeping the audience interested. In general, people get bored from being fed just straight-up facts and numbers for a long time. However, an interesting story, connected to the subject of your presentation gives that personal touch to it, engaging the audience into what you are talking about. What is more, a good story in the context of the presentation will actually resonate with the audience, causing more approval to you as an expert.

• Tell a personal  story .
• Create suspense.
• Bring characters to life.
• Build up to S.T.A.R moment.

Method 7:   Presentate with your Voice

Speech is the most common method of presentation . When you are presenting, it’s important not only WHAT you say, but also HOW do you say it. Creating a proper voice for presentations is actually one of the things you need rehearsal for. Your goal is to sound confident and interested in the subject you are telling about. What is more, it is important to not make unnecessary pauses and avoid the “ummm”, “oh” and other similar stuff that slows down your presentation and may put off the audience.

Method 8:   Know your Audience

Make sure that the data presentation methods you are using make your data  relevant to your audience. The research of your audience is needed to craft a relatable story, as well as to understand what approach in presenting you may want to take. After you’ve done the research, you can just tell the audience what it wants and expects to hear. Such an approach would result in the satisfied and interested audience enjoying your presentation. And in this case your presentation would surely and up being a huge success!

Method 9:   Back up plan

Even though you may plan everything in advance, something can always go wrong. The strange ability of the hardware to malfunction right in the middle of your presentation is probably one of the most known presentation-related memes. So, plan at least some of the bad scenarios. For example, have a printed set of slides with you during your presentation. Check everything right before you’ll start presenting. A good idea also is to have your script written out so that in case you have completely forgotten some of its parts, you can easily and quickly look into it and goon with the presentation.

Method 10:   Relax

This one is not only a presentation technique , but a great life technique as well. Actually, the most common reason for the mistakes during presentations are the nerves and fear a lot of people feel while presenting. It’s absolutely normal to be a little worried about the presentation, but you have to instill confidence in your knowledge and expertise with the subject among the audience, and it’s hard to do if you feel fear. Try to reason with yourself — you have rehearsed, prepared great visuals, learned about the audience and even have a plan B in case the situation gets worse. There’s nothing to worry about — you have all the right presentation techniques !

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How to Deliver Great Presentations

Presenting like a pro.

By the Mind Tools Content Team

Key takeaways:

• Connect with and understand your audience . Who is attending and why? What are their needs and expectaions?
• Prepare your content . How to start and finish strong. Tips to keep your audience engaged.
• Deliver confidently . Get comfortable with your visual aids. How to use body language effectively.
• Control the environment . Practice, practice, practice! Handling equipment failures. Have a back up plan.

Ever been to a really bad presentation? You know, the kind where the speaker stands behind the podium, uses slides that mirror what he is saying directly, and includes lots of data tables to validate his position.

But. "What's so bad about that?" you ask. "Isn't that how most presentations are given?" Yes. That is how most presentations are delivered, but that doesn't mean that's the most effective way to deliver them. This kind of presentation risks boring your audience to the point where they start wishing for a fire alarm to go off so they can escape. And once you lose someone, it is next to impossible to bring her attention back.

If the information you are presenting is important enough for you to deliver orally, then it demands an appropriate amount of planning and preparation so that the information you present is memorable – for the right reasons. Give a bad presentation and you'll be remembered all right: it just won't be the type of impression you want to leave in anyone's mind.

When someone presents well, it sends the message that the person is capable, confident, intelligent, and competent. These people get noticed and that type of attention bodes well for your career. Even if you don't make formal presentations in your current position, think about the future and keep in mind that you do have to present your ideas and opinions on a daily basis. The same basic principles of effective delivery apply.

Four Principles of Great Presentations

• Connect With and Understand Your Audience.
• Prepare Your Content.
• Deliver Confidently.
• Control the Environment.

1. Connect With and Understand Your Audience

To deliver a great presentation you have to consider the following audience characteristics:

• Profile – Who are they? What is the common element that brings them together?
• Needs – Why are they attending the presentation? What do they need to know after you've finished?
• Wants – What do they want from the presentation? Do they want to increase knowledge, learn something or be entertained? How can you connect their interests with your message?
• Expectations – What do they expect in terms of content and length?
• Current Knowledge – How much explanation do you need to provide? What assumptions can you make?

When you know your audience, you can prepare content that appeals to them specifically. If you pass over this first crucial step you risk delivering a presentation that is content rich and relevance poor.

2. Prepare Your Content

Now that you know who you are presenting to and why they are there, you can determine what to present. Here are some tips for content preparation:

• Don't try to cover everything. As Voltaire said, "The secret of being a bore is to tell all." Great presentations stimulate thoughts, questions, and discussion. Develop your content so that it covers the main points but leaves room for the audience to apply the information to their own circumstances.
• Start off well with a great hook – you only have a few minutes right at the start to fully engage the audience. Don't use this time to present background information. Get your audience charged up and eager to listen. Make the relevance immediately obvious.
• Also, start by telling your audience where you are heading. Don't make them wait for your conclusion, tell them up front what your premise or purpose is. This helps your audience stay focused. They may or may not agree with you at the start, but they will be able to quickly spot all of your supporting arguments.
• Your presentation should have five to seven take-away points. This follows the chunking principle , which you can learn more about here .
• Tell a story, make comparisons, and use lots of examples. Be sure to mix up the type of content to stimulate audience interest.
• Present your ideas logically using supporting evidence as necessary.
• Provide only as much background information as needed.
• Outline actions or next steps that are required.
• Develop a strong close, including a summary. Bring your conclusions back around to audience need and the hook you created. Consider ending with a question designed to stimulate further discussion.

For a similar but a subtly different approach, see our article on the Rhetorical Triangle .

3. Deliver Confidently

There are two main aspects of your delivery: your visual aids and your style. We'll look at them separately.

Unless your presentation is very short, you will need some sort of visual aid to keep the attention of your audience. There is a fine line, though, between drawing attention to your points, and distracting the audience from what you are saying. Here are some key factors to consider when designing slides:

• Keep slides simple and easy to understand.
• When explaining, start with the overall concept and then move to the details.
• The information on the slide should add value to your presentation or summarize it – it is not meant to be your presentation.
• Ensure that any charts, graphs or tables you include are very simple and easy to read. Use them sparingly.
• Use images (clip art and photos) sparingly and make sure the image means something and isn't just there to fill up space.
• Use pleasant color schemes, high contrast, simple fonts, and bold and italic to add meaning to words.
• Don't use fly-ins, fade-ins or outs or other animations unless absolutely necessary to really emphasize a point. How many times have you been put into a hypnotic state watching words or lines fly into a presentation?

Delivery Style

The way you deliver the content is often what makes or breaks a presentation. Here are some pointers to remember:

• Use gestures for meaning, not for comfort. Try not to talk with your hands or move about carelessly. Everything you do should have purpose i.e. gesture to the visual aid to draw the audience's attention.
• Pause for effect after main points or after you present a visual aid.
• Step out from behind the podium and connect with your audience – make sure you have a remote control device to change slides or cue other types of visuals.
• Talk loudly enough for people at the back to hear, or use a microphone.
• Make eye contact and hold it for three to five seconds. Any less and it looks like you are merely scanning the crowd.
• Be passionate – show your audience that you care about what you are saying.
• Consider putting up a blank or low-content screen between slides – this puts the attention where it should be: on you!
• Change your pace and style from time to time.
• Be natural – don't try to be a comedian if you're not.
• Finish early rather than late.

When you present with confidence and authority, your audience will pay attention and react to you as someone who is worth listening to. Fake it if you need to, by turning your nervousness into creative and enthusiastic energy.

4. Control the Environment

You won't ever eliminate all sources of problems, but through diligent planning and preparation, you can mitigate your risks.

• Practice, practice, practice: The ultimate goal is to deliver your presentation note-free. Short of that, you want to be sure you are comfortable with the material and that nothing comes as a surprise. Consider practicing in front of a video camera and reviewing your delivery. Don't take short-cuts here because it shows! The point is for the presentation to look effortless – when you struggle, the audience focuses on you, and not on what you are saying.
• Keep the lights on: when you darken the room, the screen stands out, not you. And it also encourages sleep, which you want to avoid at all costs!
• Always have back-ups and a backup plan. What if you forget your material? What will you do if the CD won't load? What if the equipment doesn't arrive on time? Plan for as many contingencies as possible.
• Dress appropriately for the situation – find out in advance what the dress code will be.
• Have a policy for answering questions – let your audience know when they can ask questions so you aren't inappropriately interrupted.
• Finish on time, every time. Last impressions are just as important as first ones.

Presenting is not a natural activity and to do it well requires careful thought and lots of practice.

You can choose to be average, or even below average, by simply emulating what most other presenters do. Or, you can take your presentations to the next level and leave your audiences with a powerful message that they remember, while keeping them interested and connected from start to finish.

To do this you need to pay strict attention to your audience analysis, content preparation, delivery style, and the external environment. When you control these for optimum audience relevance, interest, and engagement you are ready to deliver a great presentation.

The final element you must add is lots and lots of practice. Make your next presentation great by planning and preparing well in advance and making it look like it does come naturally to you.

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Complete Guide for Effective Presentations, with Examples

July 9, 2018 - Dom Barnard

During a presentation you aim to look confident, enthusiastic and natural. You’ll need more than good words and content to achieve this – your delivery plays a significant part. In this article, we discuss various techniques that can be used to deliver an effective presentation.

Effective presentations

Think about if you were in the audience, what would:

• Get you to focus and listen
• Make you understand
• Activate your imagination
• Persuade you

Providing the audience with interesting information is not enough to achieve these aims – you need to ensure that the way you present is stimulating and engaging. If it’s not, you’ll lose the audience’s interest and they’ll stop listening.

Tips for an Effective Presentation

Professional public speakers spend hours creating and practicing presentations. These are the delivery techniques they consider:

Keep it simple

You shouldn’t overwhelm your audience with information – ensure that you’re clear, concise and that you get to the point so they can understand your message.

Have a maximum of  three main points  and state them at the beginning, before you explain them in more depth, and then state them at the end so the audience will at least remember these points.

If some of your content doesn’t contribute to your key message then cut it out. Also avoid using too many statistics and technical terminology.

Connect with your audience

One of the greatest difficulties when delivering a presentation is connecting with the audience. If you don’t  connect with them  it will seem as though you’re talking to an empty room.

Trying to make contact with the audience makes them feel like they’re part of the presentation which encourages them to listen and it shows that you want to speak to them.

Eye contact and smile

Avoiding eye contact is uncomfortable because it make you look insecure. When you  maintain eye contact  the audience feels like you’re speaking to them personally. If this is something you struggle with, try looking at people’s foreheads as it gives the impression of making eye contact.

Try to cover all sections of the audience and don’t move on to the next person too quickly as you will look nervous.

Smiling also helps with rapport and it reduces your nerves because you’ll feel less like you’re talking to group of faceless people. Make sure you don’t turn the lights down too much before your presentation so you can all clearly see each other.

Body language

Be aware of your body language and use it to connect:

• Keep your arms uncrossed so your  body language is more open .
• Match your facial expressions with what you’re saying.
• Avoid fidgeting and displaying nervous habits, such as, rocking on your feet.
• You may need to glance at the computer slide or a visual aid but make sure you predominantly face the audience.
• Emphasise points by using hand gestures but use them sparingly – too little and they’ll awkwardly sit at your side, too much and you’ll be distracting and look nervous.
• Vary your gestures so you don’t look robotic.
• Maintain a straight posture.
• Be aware of  cultural differences .

Move around

Avoid standing behind the lectern or computer because you need to reduce the distance and barriers between yourself and the audience.  Use movement  to increase the audience’s interest and make it easier to follow your presentation.

A common technique for incorporating movement into your presentation is to:

• Start your introduction by standing in the centre of the stage.
• For your first point you stand on the left side of the stage.
• You discuss your second point from the centre again.
• You stand on the right side of the stage for your third point.
• The conclusion occurs in the centre.

Watch 3 examples of good and bad movement while presenting

Example: Movement while presenting

Your movement at the front of the class and amongst the listeners can help with engagement. Think about which of these three speakers maintains the attention of their audience for longer, and what they are doing differently to each other.

Speak with the audience

You can conduct polls using your audience or ask questions to make them think and feel invested in your presentation. There are three different types of questions:

Direct questions require an answer: “What would you do in this situation?” These are mentally stimulating for the audience. You can pass a microphone around and let the audience come to your desired solution.

Rhetorical questions  do not require answers, they are often used to emphasises an idea or point: “Is the Pope catholic?

Loaded questions contain an unjustified assumption made to prompt the audience into providing a particular answer which you can then correct to support your point: You may ask “Why does your wonderful company have such a low incidence of mental health problems?” The audience will generally answer that they’re happy.

After receiving the answers you could then say “Actually it’s because people are still unwilling and too embarrassed to seek help for mental health issues at work etc.”

Be specific with your language

Make the audience feel as though you are speaking to each member individually by using “you” and “your.”

For example: asking “Do you want to lose weight without feeling hungry?” would be more effective than asking “Does anyone here want to lost weight without feeling hungry?” when delivering your presentation. You can also increase solidarity by using “we”, “us” etc – it makes the audience think “we’re in this together”.

Be flexible

Be prepared to adapt to the situation at the time, for example, if the audience seems bored you can omit details and go through the material faster, if they are confused then you will need to come up with more examples on the spot for clarification. This doesn’t mean that you weren’t prepared because you can’t predict everything.

Vocal variety

How you say something is just as is important as the content of your speech – arguably, more so.

For example, if an individual presented on a topic very enthusiastically the audience would probably enjoy this compared to someone who covered more points but mumbled into their notes.

• Adapt your voice  depending on what are you’re saying – if you want to highlight something then raise your voice or lower it for intensity. Communicate emotion by using your voice.
• Avoid speaking in monotone as you will look uninterested and the audience will lose interest.
• Take time to pronounce every word carefully.
• Raise your pitch when asking questions and lower it when you want to sound severe.
• Sound enthusiastic – the more you sound like you care about the topic, the more the audience will listen. Smiling and pace can help with this.
• Speak loudly and clearly – think about projecting your voice to the back of the room.
• Speak at a  pace that’s easy to follow . If you’re too fast or too slow it will be difficult for the audience to understand what you’re saying and it’s also frustrating. Subtly fasten the pace to show enthusiasm and slow down for emphasis, thoughtfulness or caution.

Prior to the presentation, ensure that you  prepare your vocal chords :

• You could read aloud a book that requires vocal variety, such as, a children’s book.
• Avoid dairy and eating or drinking anything too sugary beforehand as mucus can build-up leading to frequent throat clearing.
• Don’t drink anything too cold before you present as this can constrict your throat which affects vocal quality.
• Some people suggest a warm cup of tea beforehand to relax the throat.

Practice Presentation Skills

Improve your public speaking and presentation skills by practicing them in realistic environments, with automated feedback on performance. Learn More

Pause to breathe

When you’re anxious your breathing will become quick and shallow which will affect the control you have on your voice. This can consequently make you feel more nervous. You want to breathe steadily and deeply so before you start speaking take some deep breaths or implement controlled breathing.

Controlled breathing is a common technique that helps slow down your breathing to normal thus reducing your anxiety. If you think this may be useful practice with these steps:

• Sit down in an upright position as it easier for your lungs to fill with air
• Breathe in through your nose and into your abdomen for four seconds
• Hold this breathe for two seconds
• Breathe out through your nose for six seconds
• Wait a few seconds before inhaling and repeating the cycle

It takes practice to master this technique but once you get used to it you may want to implement it directly before your presentation.

Completely filling your lungs during a pause will ensure you reach a greater vocal range.

During the presentation delivery, if you notice that you’re speaking too quickly then pause and breathe. This won’t look strange – it will appear as though you’re giving thought to what you’re saying. You can also strategically plan some of your pauses, such as after questions and at the end of sections, because this will give you a chance to calm down and it will also give the audience an opportunity to think and reflect.

Pausing will also help you  avoid filler words , such as, “um” as well which can make you sound unsure.

• 10 Effective Ways to use Pauses in your Speech

Strong opening

The first five minutes are  vital to engage the audience  and get them listening to you. You could start with a story to highlight why your topic is significant.

For example, if the topic is on the benefits of pets on physical and psychological health, you could present a story or a study about an individual whose quality of life significantly improved after being given a dog. The audience is more likely to respond better to this and remember this story than a list of facts.

Example: Which presentation intro keeps you engaged?

Watch 5 different presentation introductions, from both virtual and in-person events. Notice how it can only take a few seconds to decide if you want to keep listening or switch off. For the good introductions, what about them keeps you engaged?

More experienced and confident public speakers use humour in their presentations. The audience will be incredibly engaged if you make them laugh but caution must be exercised when using humour because a joke can be misinterpreted and even offend the audience.

Only use jokes if you’re confident with this technique, it has been successful in the past and it’s suitable for the situation.

Stories and anecdotes

Use stories whenever you can and judge whether you can tell a story about yourself because the audience are even more interested in seeing the human side of you.

Consider telling a story about a mistake you made, for example, perhaps you froze up during an important presentation when you were 25, or maybe life wasn’t going well for you in the past – if relevant to your presentation’s aim. People will relate to this as we have all experienced mistakes and failures. The more the audience relates to you, the more likely they will remain engaged.

These stories can also be  told in a humorous way  if it makes you feel more comfortable and because you’re disclosing a personal story there is less chance of misinterpretation compared to telling a joke.

Anecdotes are especially valuable for your introduction and between different sections of the presentation because they engage the audience. Ensure that you plan the stories thoroughly beforehand and that they are not too long.

Focus on the audience’s needs

Even though your aim is to persuade the audience, they must also get something helpful from the presentation. Provide the audience with value by giving them useful information, tactics, tips etc. They’re more likely to warm to you and trust you if you’re sharing valuable information with them.

You could also highlight their pain point. For example, you might ask “Have you found it difficult to stick to a healthy diet?” The audience will now want to remain engaged because they want to know the solution and the opportunities that you’re offering.

Use visual aids

Visual aids are items of a visual manner, such as graphs, photographs, video clips etc used in addition to spoken information. Visual aids are chosen depending on their purpose, for example, you may want to:

• Summarise information.
• Reduce the amount of spoken words, for example, you may show a graph of your results rather than reading them out.
• Clarify and show examples.
• Create more of an impact. You must consider what type of impact you want to make beforehand – do you want the audience to be sad, happy, angry etc?
• Emphasise what you’re saying.
• Make a point memorable.
• Enhance your credibility.
• Engage the audience and maintain their interest.
• Make something easier for the audience to understand.

Some general tips for  using visual aids :

• Think about how can a visual aid can support your message. What do you want the audience to do?
• Ensure that your visual aid follows what you’re saying or this will confuse the audience.
• Avoid cluttering the image as it may look messy and unclear.
• Visual aids must be clear, concise and of a high quality.
• Keep the style consistent, such as, the same font, colours, positions etc
• Use graphs and charts to present data.
• The audience should not be trying to read and listen at the same time – use visual aids to highlight your points.
• One message per visual aid, for example, on a slide there should only be one key point.
• Use visual aids in moderation – they are additions meant to emphasise and support main points.
• Ensure that your presentation still works without your visual aids in case of technical problems.

10-20-30 slideshow rule

Slideshows are widely used for presentations because it’s easy to create attractive and professional presentations using them. Guy Kawasaki, an entrepreneur and author, suggests that slideshows should  follow a 10-20-30 rule :

• There should be a maximum of 10 slides – people rarely remember more than one concept afterwards so there’s no point overwhelming them with unnecessary information.
• The presentation should last no longer than 20 minutes as this will leave time for questions and discussion.
• The font size should be a minimum of 30pt because the audience reads faster than you talk so less information on the slides means that there is less chance of the audience being distracted.

If you want to give the audience more information you can provide them with partially completed handouts or give them the handouts after you’ve delivered the presentation.

Keep a drink nearby

Have something to drink when you’re on stage, preferably water at room temperature. This will help maintain your vocal quality and having a sip is a subtle way of introducing pauses.

Practice, practice, practice

If you are very familiar with the content of your presentation, your audience will perceive you as confident and you’ll be more persuasive.

• Don’t just read the presentation through – practice everything,  including your transitions  and using your visual aids.
• Stand up and speak it aloud, in an engaging manner, as though you were presenting to an audience.
• Ensure that you practice your body language and gesturing.
• Use VR to  practice in a realistic environment .
• Practice in front of others and get their feedback.
• Freely improvise so you’ll sound more natural on the day. Don’t learn your presentation verbatim because you will sound uninterested and if you lose focus then you may forget everything.
• Create cards to use as cues – one card should be used for one key idea. Write down brief notes or key words and ensure that the cards are physically connected so the order cannot be lost. Visual prompts can also be used as cues.

This video shows how you can practice presentations in virtual reality. See our  VR training courses .

Two courses where you can practice your presentations in interactive exercises:

• Essential Public Speaking
• How to Present over Video

Try these different presentation delivery methods to see which ones you prefer and which need to be improved. The most important factor is to feel comfortable during the presentation as the delivery is likely to be better.

Remember that the audience are generally on your side – they want you to do well so present with confidence.

• PRESENTATION SKILLS

What is a Presentation?

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The formal presentation of information is divided into two broad categories: Presentation Skills and Personal Presentation .

These two aspects are interwoven and can be described as the preparation, presentation and practice of verbal and non-verbal communication. 

This article describes what a presentation is and defines some of the key terms associated with presentation skills.

Many people feel terrified when asked to make their first public talk.  Some of these initial fears can be reduced by good preparation that also lays the groundwork for making an effective presentation.

A Presentation Is...

A presentation is a means of communication that can be adapted to various speaking situations, such as talking to a group, addressing a meeting or briefing a team.

A presentation can also be used as a broad term that encompasses other ‘speaking engagements’ such as making a speech at a wedding, or getting a point across in a video conference.

To be effective, step-by-step preparation and the method and means of presenting the information should be carefully considered. 

A presentation requires you to get a message across to the listeners and will often contain a ' persuasive ' element. It may, for example, be a talk about the positive work of your organisation, what you could offer an employer, or why you should receive additional funding for a project.

The Key Elements of a Presentation

Making a presentation is a way of communicating your thoughts and ideas to an audience and many of our articles on communication are also relevant here, see: What is Communication? for more.

Consider the following key components of a presentation:

Ask yourself the following questions to develop a full understanding of the context of the presentation.

When and where will you deliver your presentation?

There is a world of difference between a small room with natural light and an informal setting, and a huge lecture room, lit with stage lights. The two require quite different presentations, and different techniques.

Will it be in a setting you are familiar with, or somewhere new?

If somewhere new, it would be worth trying to visit it in advance, or at least arriving early, to familiarise yourself with the room.

Will the presentation be within a formal or less formal setting?

A work setting will, more or less by definition, be more formal, but there are also various degrees of formality within that.

Will the presentation be to a small group or a large crowd?

Are you already familiar with the audience?

With a new audience, you will have to build rapport quickly and effectively, to get them on your side.

What equipment and technology will be available to you, and what will you be expected to use?

In particular, you will need to ask about microphones and whether you will be expected to stand in one place, or move around.

What is the audience expecting to learn from you and your presentation?

Check how you will be ‘billed’ to give you clues as to what information needs to be included in your presentation.

All these aspects will change the presentation. For more on this, see our page on Deciding the Presentation Method .

The role of the presenter is to communicate with the audience and control the presentation.

Remember, though, that this may also include handing over the control to your audience, especially if you want some kind of interaction.

You may wish to have a look at our page on Facilitation Skills for more.

The audience receives the presenter’s message(s).

However, this reception will be filtered through and affected by such things as the listener’s own experience, knowledge and personal sense of values.

See our page: Barriers to Effective Communication to learn why communication can fail.

The message or messages are delivered by the presenter to the audience.

The message is delivered not just by the spoken word ( verbal communication ) but can be augmented by techniques such as voice projection, body language, gestures, eye contact ( non-verbal communication ), and visual aids.

The message will also be affected by the audience’s expectations. For example, if you have been billed as speaking on one particular topic, and you choose to speak on another, the audience is unlikely to take your message on board even if you present very well . They will judge your presentation a failure, because you have not met their expectations.

The audience’s reaction and therefore the success of the presentation will largely depend upon whether you, as presenter, effectively communicated your message, and whether it met their expectations.

As a presenter, you don’t control the audience’s expectations. What you can do is find out what they have been told about you by the conference organisers, and what they are expecting to hear. Only if you know that can you be confident of delivering something that will meet expectations.

See our page: Effective Speaking for more information.

How will the presentation be delivered?

Presentations are usually delivered direct to an audience.  However, there may be occasions where they are delivered from a distance over the Internet using video conferencing systems, such as Skype.

It is also important to remember that if your talk is recorded and posted on the internet, then people may be able to access it for several years. This will mean that your contemporaneous references should be kept to a minimum.

Impediments

Many factors can influence the effectiveness of how your message is communicated to the audience.

For example background noise or other distractions, an overly warm or cool room, or the time of day and state of audience alertness can all influence your audience’s level of concentration.

As presenter, you have to be prepared to cope with any such problems and try to keep your audience focussed on your message.   

Our page: Barriers to Communication explains these factors in more depth.

Continue to read through our Presentation Skills articles for an overview of how to prepare and structure a presentation, and how to manage notes and/or illustrations at any speaking event.

Continue to: Preparing for a Presentation Deciding the Presentation Method

See also: Writing Your Presentation | Working with Visual Aids Coping with Presentation Nerves | Dealing with Questions Learn Better Presentation Skills with TED Talks

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Blog Graphic Design 15 Effective Visual Presentation Tips To Wow Your Audience

15 Effective Visual Presentation Tips To Wow Your Audience

Written by: Krystle Wong Sep 28, 2023

So, you’re gearing up for that big presentation and you want it to be more than just another snooze-fest with slides. You want it to be engaging, memorable and downright impressive. 

Well, you’ve come to the right place — I’ve got some slick tips on how to create a visual presentation that’ll take your presentation game up a notch. 

Packed with presentation templates that are easily customizable, keep reading this blog post to learn the secret sauce behind crafting presentations that captivate, inform and remain etched in the memory of your audience.

Click to jump ahead:

What is a visual presentation & why is it important?

15 effective tips to make your visual presentations more engaging, 6 major types of visual presentation you should know , what are some common mistakes to avoid in visual presentations, visual presentation faqs, 5 steps to create a visual presentation with venngage.

A visual presentation is a communication method that utilizes visual elements such as images, graphics, charts, slides and other visual aids to convey information, ideas or messages to an audience. 

Visual presentations aim to enhance comprehension engagement and the overall impact of the message through the strategic use of visuals. People remember what they see, making your point last longer in their heads. 

Without further ado, let’s jump right into some great visual presentation examples that would do a great job in keeping your audience interested and getting your point across.

In today’s fast-paced world, where information is constantly bombarding our senses, creating engaging visual presentations has never been more crucial. To help you design a presentation that’ll leave a lasting impression, I’ve compiled these examples of visual presentations that will elevate your game.

1. Use the rule of thirds for layout

Ever heard of the rule of thirds? It’s a presentation layout trick that can instantly up your slide game. Imagine dividing your slide into a 3×3 grid and then placing your text and visuals at the intersection points or along the lines. This simple tweak creates a balanced and seriously pleasing layout that’ll draw everyone’s eyes.

2. Get creative with visual metaphors

Got a complex idea to explain? Skip the jargon and use visual metaphors. Throw in images that symbolize your point – for example, using a road map to show your journey towards a goal or using metaphors to represent answer choices or progress indicators in an interactive quiz or poll.

3. Visualize your data with charts and graphs

The right data visualization tools not only make content more appealing but also aid comprehension and retention. Choosing the right visual presentation for your data is all about finding a good match. 

For ordinal data, where things have a clear order, consider using ordered bar charts or dot plots. When it comes to nominal data, where categories are on an equal footing, stick with the classics like bar charts, pie charts or simple frequency tables. And for interval-ratio data, where there’s a meaningful order, go for histograms, line graphs, scatterplots or box plots to help your data shine.

In an increasingly visual world, effective visual communication is a valuable skill for conveying messages. Here’s a guide on how to use visual communication to engage your audience while avoiding information overload.

4. Employ the power of contrast

Want your important stuff to pop? That’s where contrast comes in. Mix things up with contrasting colors, fonts or shapes. It’s like highlighting your key points with a neon marker – an instant attention grabber.

5. Tell a visual story

Structure your slides like a storybook and create a visual narrative by arranging your slides in a way that tells a story. Each slide should flow into the next, creating a visual narrative that keeps your audience hooked till the very end.

Icons and images are essential for adding visual appeal and clarity to your presentation. Venngage provides a vast library of icons and images, allowing you to choose visuals that resonate with your audience and complement your message. 

6. Show the “before and after” magic

Want to drive home the impact of your message or solution? Whip out the “before and after” technique. Show the current state (before) and the desired state (after) in a visual way. It’s like showing a makeover transformation, but for your ideas.

7. Add fun with visual quizzes and polls

To break the monotony and see if your audience is still with you, throw in some quick quizzes or polls. It’s like a mini-game break in your presentation — your audience gets involved and it makes your presentation way more dynamic and memorable.

8. End with a powerful visual punch

Your presentation closing should be a showstopper. Think a stunning clip art that wraps up your message with a visual bow, a killer quote that lingers in minds or a call to action that gets hearts racing.

9. Engage with storytelling through data

Use storytelling magic to bring your data to life. Don’t just throw numbers at your audience—explain what they mean, why they matter and add a bit of human touch. Turn those stats into relatable tales and watch your audience’s eyes light up with understanding.

10. Use visuals wisely

Your visuals are the secret sauce of a great presentation. Cherry-pick high-quality images, graphics, charts and videos that not only look good but also align with your message’s vibe. Each visual should have a purpose – they’re not just there for decoration. 

11. Utilize visual hierarchy

Employ design principles like contrast, alignment and proximity to make your key info stand out. Play around with fonts, colors and placement to make sure your audience can’t miss the important stuff.

12. Engage with multimedia

Static slides are so last year. Give your presentation some sizzle by tossing in multimedia elements. Think short video clips, animations, or a touch of sound when it makes sense, including an animated logo . But remember, these are sidekicks, not the main act, so use them smartly.

13. Interact with your audience

Turn your presentation into a two-way street. Start your presentation by encouraging your audience to join in with thought-provoking questions, quick polls or using interactive tools. Get them chatting and watch your presentation come alive.

When it comes to delivering a group presentation, it’s important to have everyone on the team on the same page. Venngage’s real-time collaboration tools enable you and your team to work together seamlessly, regardless of geographical locations. Collaborators can provide input, make edits and offer suggestions in real time. 

14. Incorporate stories and examples

Weave in relatable stories, personal anecdotes or real-life examples to illustrate your points. It’s like adding a dash of spice to your content – it becomes more memorable and relatable.

15. Nail that delivery

Don’t just stand there and recite facts like a robot — be a confident and engaging presenter. Lock eyes with your audience, mix up your tone and pace and use some gestures to drive your points home. Practice and brush up your presentation skills until you’ve got it down pat for a persuasive presentation that flows like a pro.

Venngage offers a wide selection of professionally designed presentation templates, each tailored for different purposes and styles. By choosing a template that aligns with your content and goals, you can create a visually cohesive and polished presentation that captivates your audience.

Looking for more presentation ideas ? Why not try using a presentation software that will take your presentations to the next level with a combination of user-friendly interfaces, stunning visuals, collaboration features and innovative functionalities that will take your presentations to the next level. 

Visual presentations come in various formats, each uniquely suited to convey information and engage audiences effectively. Here are six major types of visual presentations that you should be familiar with:

1. Slideshows or PowerPoint presentations

Slideshows are one of the most common forms of visual presentations. They typically consist of a series of slides containing text, images, charts, graphs and other visual elements. Slideshows are used for various purposes, including business presentations, educational lectures and conference talks.

2. Infographics

Infographics are visual representations of information, data or knowledge. They combine text, images and graphics to convey complex concepts or data in a concise and visually appealing manner. Infographics are often used in marketing, reporting and educational materials.

Don’t worry, they are also super easy to create thanks to Venngage’s fully customizable infographics templates that are professionally designed to bring your information to life. Be sure to try it out for your next visual presentation!

3. Video presentation

Videos are your dynamic storytellers. Whether it’s pre-recorded or happening in real-time, videos are the showstoppers. You can have interviews, demos, animations or even your own mini-documentary. Video presentations are highly engaging and can be shared in both in-person and virtual presentations .

4. Charts and graphs

Charts and graphs are visual representations of data that make it easier to understand and analyze numerical information. Common types include bar charts, line graphs, pie charts and scatterplots. They are commonly used in scientific research, business reports and academic presentations.

Effective data visualizations are crucial for simplifying complex information and Venngage has got you covered. Venngage’s tools enable you to create engaging charts, graphs,and infographics that enhance audience understanding and retention, leaving a lasting impression in your presentation.

5. Interactive presentations

Interactive presentations involve audience participation and engagement. These can include interactive polls, quizzes, games and multimedia elements that allow the audience to actively participate in the presentation. Interactive presentations are often used in workshops, training sessions and webinars.

Venngage’s interactive presentation tools enable you to create immersive experiences that leave a lasting impact and enhance audience retention. By incorporating features like clickable elements, quizzes and embedded multimedia, you can captivate your audience’s attention and encourage active participation.

6. Poster presentations

Poster presentations are the stars of the academic and research scene. They consist of a large poster that includes text, images and graphics to communicate research findings or project details and are usually used at conferences and exhibitions. For more poster ideas, browse through Venngage’s gallery of poster templates to inspire your next presentation.

Different visual presentations aside, different presentation methods also serve a unique purpose, tailored to specific objectives and audiences. Find out which type of presentation works best for the message you are sending across to better capture attention, maintain interest and leave a lasting impression. 

To make a good presentation , it’s crucial to be aware of common mistakes and how to avoid them. Without further ado, let’s explore some of these pitfalls along with valuable insights on how to sidestep them.

Overloading slides with text

Text heavy slides can be like trying to swallow a whole sandwich in one bite – overwhelming and unappetizing. Instead, opt for concise sentences and bullet points to keep your slides simple. Visuals can help convey your message in a more engaging way.

Using low-quality visuals

Grainy images and pixelated charts are the equivalent of a scratchy vinyl record at a DJ party. High-resolution visuals are your ticket to professionalism. Ensure that the images, charts and graphics you use are clear, relevant and sharp.

Choosing the right visuals for presentations is important. To find great visuals for your visual presentation, Browse Venngage’s extensive library of high-quality stock photos. These images can help you convey your message effectively, evoke emotions and create a visually pleasing narrative. 

Ignoring design consistency

Imagine a book with every chapter in a different font and color – it’s a visual mess. Consistency in fonts, colors and formatting throughout your presentation is key to a polished and professional look.

Reading directly from slides

Reading your slides word-for-word is like inviting your audience to a one-person audiobook session. Slides should complement your speech, not replace it. Use them as visual aids, offering key points and visuals to support your narrative.

Lack of visual hierarchy

Neglecting visual hierarchy is like trying to find Waldo in a crowd of clones. Use size, color and positioning to emphasize what’s most important. Guide your audience’s attention to key points so they don’t miss the forest for the trees.

Ignoring accessibility

Accessibility isn’t an option these days; it’s a must. Forgetting alt text for images, color contrast and closed captions for videos can exclude individuals with disabilities from understanding your presentation. 

Relying too heavily on animation

While animations can add pizzazz and draw attention, overdoing it can overshadow your message. Use animations sparingly and with purpose to enhance, not detract from your content.

Using jargon and complex language

Keep it simple. Use plain language and explain terms when needed. You want your message to resonate, not leave people scratching their heads.

Not testing interactive elements

Interactive elements can be the life of your whole presentation, but not testing them beforehand is like jumping into a pool without checking if there’s water. Ensure that all interactive features, from live polls to multimedia content, work seamlessly. A smooth experience keeps your audience engaged and avoids those awkward technical hiccups.

Presenting complex data and information in a clear and visually appealing way has never been easier with Venngage. Build professional-looking designs with our free visual chart slide templates for your next presentation.

What software or tools can I use to create visual presentations?

You can use various software and tools to create visual presentations, including Microsoft PowerPoint, Google Slides, Adobe Illustrator, Canva, Prezi and Venngage, among others.

What is the difference between a visual presentation and a written report?

The main difference between a visual presentation and a written report is the medium of communication. Visual presentations rely on visuals, such as slides, charts and images to convey information quickly, while written reports use text to provide detailed information in a linear format.

How do I effectively communicate data through visual presentations?

To effectively communicate data through visual presentations, simplify complex data into easily digestible charts and graphs, use clear labels and titles and ensure that your visuals support the key messages you want to convey.

Are there any accessibility considerations for visual presentations?

Accessibility considerations for visual presentations include providing alt text for images, ensuring good color contrast, using readable fonts and providing transcripts or captions for multimedia content to make the presentation inclusive.

Most design tools today make accessibility hard but Venngage’s Accessibility Design Tool comes with accessibility features baked in, including accessible-friendly and inclusive icons.

How do I choose the right visuals for my presentation?

Choose visuals that align with your content and message. Use charts for data, images for illustrating concepts, icons for emphasis and color to evoke emotions or convey themes.

What is the role of storytelling in visual presentations?

Storytelling plays a crucial role in visual presentations by providing a narrative structure that engages the audience, helps them relate to the content and makes the information more memorable.

How can I adapt my visual presentations for online or virtual audiences?

To adapt visual presentations for online or virtual audiences, focus on concise content, use engaging visuals, ensure clear audio, encourage audience interaction through chat or polls and rehearse for a smooth online delivery.

What is the role of data visualization in visual presentations?

Data visualization in visual presentations simplifies complex data by using charts, graphs and diagrams, making it easier for the audience to understand and interpret information.

How do I choose the right color scheme and fonts for my visual presentation?

Choose a color scheme that aligns with your content and brand and select fonts that are readable and appropriate for the message you want to convey.

How can I measure the effectiveness of my visual presentation?

Measure the effectiveness of your visual presentation by collecting feedback from the audience, tracking engagement metrics (e.g., click-through rates for online presentations) and evaluating whether the presentation achieved its intended objectives.

Ultimately, creating a memorable visual presentation isn’t just about throwing together pretty slides. It’s about mastering the art of making your message stick, captivating your audience and leaving a mark.

Lucky for you, Venngage simplifies the process of creating great presentations, empowering you to concentrate on delivering a compelling message. Follow the 5 simple steps below to make your entire presentation visually appealing and impactful:

1. Sign up and log In: Log in to your Venngage account or sign up for free and gain access to Venngage’s templates and design tools.

2. Choose a template: Browse through Venngage’s presentation template library and select one that best suits your presentation’s purpose and style. Venngage offers a variety of pre-designed templates for different types of visual presentations, including infographics, reports, posters and more.

3. Edit and customize your template: Replace the placeholder text, image and graphics with your own content and customize the colors, fonts and visual elements to align with your presentation’s theme or your organization’s branding.

4. Add visual elements: Venngage offers a wide range of visual elements, such as icons, illustrations, charts, graphs and images, that you can easily add to your presentation with the user-friendly drag-and-drop editor.

5. Save and export your presentation: Export your presentation in a format that suits your needs and then share it with your audience via email, social media or by embedding it on your website or blog .

So, as you gear up for your next presentation, whether it’s for business, education or pure creative expression, don’t forget to keep these visual presentation ideas in your back pocket.

Feel free to experiment and fine-tune your approach and let your passion and expertise shine through in your presentation. With practice, you’ll not only build presentations but also leave a lasting impact on your audience – one slide at a time.

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Present Your Data Like a Pro

• Joel Schwartzberg

Demystify the numbers. Your audience will thank you.

While a good presentation has data, data alone doesn’t guarantee a good presentation. It’s all about how that data is presented. The quickest way to confuse your audience is by sharing too many details at once. The only data points you should share are those that significantly support your point — and ideally, one point per chart. To avoid the debacle of sheepishly translating hard-to-see numbers and labels, rehearse your presentation with colleagues sitting as far away as the actual audience would. While you’ve been working with the same chart for weeks or months, your audience will be exposed to it for mere seconds. Give them the best chance of comprehending your data by using simple, clear, and complete language to identify X and Y axes, pie pieces, bars, and other diagrammatic elements. Try to avoid abbreviations that aren’t obvious, and don’t assume labeled components on one slide will be remembered on subsequent slides. Every valuable chart or pie graph has an “Aha!” zone — a number or range of data that reveals something crucial to your point. Make sure you visually highlight the “Aha!” zone, reinforcing the moment by explaining it to your audience.

With so many ways to spin and distort information these days, a presentation needs to do more than simply share great ideas — it needs to support those ideas with credible data. That’s true whether you’re an executive pitching new business clients, a vendor selling her services, or a CEO making a case for change.

• JS Joel Schwartzberg oversees executive communications for a major national nonprofit, is a professional presentation coach, and is the author of Get to the Point! Sharpen Your Message and Make Your Words Matter and The Language of Leadership: How to Engage and Inspire Your Team . You can find him on LinkedIn and X. TheJoelTruth

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Chapter 6: Developing Presentations

39 Methods of Presentation Delivery

The importance of delivery.

Delivery is what you are probably most concerned about when it comes to giving presentations. This chapter is designed to help you give the best delivery possible and eliminate some of the nervousness you might be feeling. To do that, you should first dismiss the myth that public speaking is just reading and talking at the same time. Speaking in public has more formality than talking. During a speech, you should present yourself professionally. This doesn’t necessarily mean you must wear a suit or “dress up”, but it does mean making yourself presentable by being well groomed and wearing clean, appropriate clothes. It also means being prepared to use language correctly and appropriately for the audience and the topic, to make eye contact with your audience, and to look like you know your topic very well.

While speaking has more formality than talking, it has less formality than reading. Speaking allows for flexibility, meaningful pauses, eye contact, small changes in word order, and vocal emphasis. Reading is a more or less exact replication of words on paper without the use of any nonverbal interpretation. Speaking, as you will realize if you think about excellent speakers you have seen and heard, provides a more animated message.

Methods of Presentation Delivery

There are four methods of delivery that can help you balance between too much and too little formality when giving a presentation.

Impromptu Speaking

Impromptu speaking is the presentation of a short message without advance preparation. You have probably done impromptu speaking many times in informal, conversational settings. Self-introductions in group settings are examples of impromptu speaking: “Hi, my name is Steve, and I’m an account manager.” Another example of impromptu presenting occurs when you answer a question such as, “What did you think of the report?” Your response has not been preplanned, and you are constructing your arguments and points as you speak. Even worse, you might find yourself going into a meeting and your boss says, “I want you to talk about the last stage of the project. . . “ and you had no warning.

The advantage of this kind of speaking is that it’s spontaneous and responsive in an animated group context. The disadvantage is that the speaker is given little or no time to contemplate the central theme of his or her message. As a result, the message may be disorganized and difficult for listeners to follow.

Here is a step-by-step guide that may be useful if you are called upon to give an impromptu presentation in public:

• Take a moment to collect your thoughts and plan the main point you want to make.
• Thank the person for inviting you to speak. Avoid making comments about being unprepared, called upon at the last moment, on the spot, or feeling uneasy.
• Deliver your message, making your main point as briefly as you can while still covering it adequately and at a pace your listeners can follow.
• If you can use a structure, using numbers if possible: “Two main reasons . . .” or “Three parts of our plan. . .” or “Two side effects of this drug. . .” Timeline structures are also effective, such as “past, present, and future or East Coast, Midwest, and West Coast”.
• Thank the person again for the opportunity to speak.
• Stop talking (it is easy to “ramble on” when you don’t have something prepared). If in front of an audience, don’t keep talking as you move back to your seat.

Impromptu presentations:  the presentation of a short message without advance preparation . Impromptu presentations are generally most successful when they are brief and focus on a single point.

For additional advice on impromptu speaking, watch the following 4 minute video from Toastmasters: Impromptu Speaking

Manuscript Presentations

Manuscript presentations  are the word-for-word iteration of a written message . In a manuscript presentation, the speaker maintains their attention on the printed page except when using visual aids. The advantage of reading from a manuscript is the exact repetition of original words. In some circumstances this can be extremely important. For example, reading a statement about your organization’s legal responsibilities to customers may require that the original words be exact.

A manuscript presentation may be appropriate at a more formal affair (like a report to shareholders), when your presentation must be said exactly as written in order to convey the proper emotion or decorum the situation deserves.

However, there are costs involved in manuscript presentations. First, it’s typically an uninteresting way to present. Unless the presenter has rehearsed the reading as a complete performance animated with vocal expression and gestures, the presentation tends to be dull. Keeping one’s eyes glued to the script prevents eye contact with the audience. For this kind of “straight” manuscript presentation to hold audience attention, the audience must be already interested in the message and presenter before the delivery begins.

It is worth noting that professional speakers, actors, news reporters, and politicians often read from an autocue device, commonly called a teleprompter, especially when appearing on television, where eye contact with the camera is crucial. With practice, a presenter can achieve a conversational tone and give the impression of speaking extemporaneously and maintaining eye contact while using an autocue device. However, success in this medium depends on two factors: (1) the presenter is already an accomplished public speaker who has learned to use a conversational tone while delivering a prepared script, and (2) the presentation is written in a style that sounds conversational and in spoken rather than written, edited English.

Extemporaneous Presentations

Extemporaneous presentations  are carefully planned and rehearsed presentations, delivered in a conversational manner using brief notes . By using notes rather than a full manuscript, the extemporaneous presenter can establish and maintain eye contact with the audience and assess how well they are understanding the presentation as it progresses. Without all the words on the page to read, you have little choice but to look up and make eye contact with your audience.

Watch the following 10 minute video of a champion speaker presenting his extemporaneous speech: 2017 International Extemporaneous Speaking National Champion — Connor Rothschild Speech

Presenting extemporaneously has some advantages. It promotes the likelihood that you, the speaker, will be perceived as knowledgeable and credible since you know the speech well  enough that you don’t need to read it. In addition, your audience is likely to pay better attention to the message because it is engaging both verbally and nonverbally. It also allows flexibility; you are working from the strong foundation of an outline, but if you need to delete, add, or rephrase something at the last minute or to adapt to your audience, you can do so.

The disadvantage of extemporaneous presentations is that it in some cases it does not allow for the verbal and the nonverbal preparation that are almost always required for a good speech.

Adequate preparation cannot be achieved the day before you’re scheduled to present, so be aware that if you want to present a credibly delivered speech, you will need to practice many times. Because extemporaneous presenting is the style used in the great majority of business presentation situations, most of the information in the subsequent sections of this chapter is targeted toward this kind of speaking.

Memorized Speaking

Memorized speakin g is the recitation of a written message that the speaker has committed to memory. Actors , of course, recite from memory whenever they perform from a script in a stage play, television program, or movie scene. When it comes to speeches, memorization can be useful when the message needs to be exact and the speaker doesn’t want to be confined by notes.

The advantage to memorization is that it enables the speaker to maintain eye contact with the audience throughout the speech. Being free of notes means that you can move freely around the stage and use your hands to make gestures. If your speech uses visual aids, this freedom is even more of an advantage. However, there are some real and potential costs.

First, unless you also plan and memorize every vocal cue (the subtle but meaningful variations in speech delivery, which can include the use of pitch, tone, volume, and pace), gesture, and facial expression, your presentation will be flat and uninteresting, and even the most fascinating topic will suffer. Second, if you lose your place and start trying to ad lib, the contrast in your style of delivery will alert your audience that something is wrong. More frighteningly, if you go completely blank during the presentation, it will be extremely difficult to find your place and keep going. Obviously, memorizing a typical seven-minute presentation takes a great deal of time and effort, and if you aren’t used to memorizing, it is very difficult to pull off. Realistically, you probably will not have the time necessary to give a completely memorized speech. However, if you practice adequately, your approach will still feel like you are being extemporaneous.

Communication for Business Professionals Copyright © 2018 by eCampusOntario is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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15 Sales Presentation Techniques That Will Help You Close More Deals Today

Updated: June 01, 2022

Published: May 31, 2022

Hate the thought of doing sales presentations ? You’re not alone. But the best reps have sales presentations down pat, even if it’s not their favorite activity.

The best sales reps know that, when done right , sales presentations are a high-earning skill.

So, let’s hone that skill with simple sales presentation techniques that communicate an irresistible narrative and get buyers to close.

Sales Presentation

An effective sales presentation tells a compelling story, highlights your value proposition, and aligns with your audience's needs and desires. It ends with a strong call-to-action and leads prospects to your differentiators instead of leading with them.

As it can sometimes mean the difference between closing a deal or losing a customer, you definitely want to get your sales presentation right. There are strategies and tips you can follow to ensure your sales presentations are effective, memorable, and engaging. Let’s go over them below.

Sales Presentation Methods

1. structure your presentation. .

Guiding your prospects down a clear path is key to a successful sales presentation. You’ll follow a logical structure, and listeners will understand how each element of your presentation relates to one another, rather than them having to piece together disjointed information on their own. 

There are times when flipping the structure can add unique elements to your presentation, though, and we’ll discuss this further below. 

2. Use data visualizations. 

Using visuals, like charts and graphics, to supplement your message is a valuable way to showcase your content in an easy-to-understand format as they make your words more impactful. 

For example, if you’re selling SaaS that helps users organize their sales process for a shorter cycle, you can create a visual that displays the average length of your clients’ sales cycle vs. those using other tools. 

By doing this, you’re adding extra emphasis to your words with a visual picture, and a bonus is that visuals are more likely to stick with your audience and get them thinking versus just hearing you talk. 

3. Rely on spoken words — not text.

If your presentation slides are text-heavy, prospects may get caught up reading the words you’ve written instead of listening, causing them to miss out on the value you’re sharing. Aim to include less text by calling attention to the most significant elements with short bursts of text that you supplement with your words. 

In addition, when you have less text on your slides, you may be less inclined to just read from them, which can be a bad part of presentations. You’ll have to speak instead of relying on written content. 

Let’s go over some sales presentation techniques that, when paired with the three methods above, will help you nail it every time.

Sales Presentation Techniques

1. send your buyer the presentation deck before your call..

You might assume that sending a buyer a deck before a call is like revealing whodunnit on the cover of a murder mystery. No one will pay attention to the rest of the book, right? 

When the Gong.io team started sharing our deck before opening sales calls, we learned it was a winning move. 

If your deck is compelling, prospects will want to get into it with you, even if they know the main point. Together, you can dive in, dissect the good bits, and talk through questions. It’s going to be a juicy conversation, and they know it.

Then, you can begin the conversation during your presentation with a statement like, “Based on the information in the deck I sent, where should we start?”

2. Invoke self-discovery.

It’s tempting to stick to a positive linear story during your sales presentation. That usually invokes talking about benefits, outcomes, and desired results. But, that approach isn’t always the best. 

Before discussing solutions and results, you must understand your prospect's problem. More importantly, you have to be sure your prospects understand the problem. 

Self-discovery is the ticket that gets you there. Instead of telling the buyer what the problem is and how you’ll address it, get your buyer to connect with the problem on their own. 

3. Talk about Point A. Don’t skip to point B.

This is 100% linked to the tip above. There’s a problem (point A) and desired outcome (point B). Point A is the status quo. It’s a problem your buyer will continue to face if they don’t make a change. 

You can stand out by focusing on point A, as talking about a pain point is shockingly more effective than talking about positive outcomes. 

Make your buyer feel the pain that results from the status quo. Convince them the pain will only worsen without your solution — because you know that to be true.

You should only talk about benefits once they’re on board with that line of thinking. Urgency is what allows benefits to land. Without urgency, benefits are just happy points that hold no real meaning.

4. Insight is your #1 lead story.

Buyers are experts on their circumstances, but they want insights into their situation from you. 

You’re most likely to impress a buyer by telling them something new about themselves, as your offering is a unique insight into their problems and opportunities.

Check out this TaylorMade video. It’s a bang-on example of how to lead a presentation with insight, and then move on to your product’s strengths:

You learned how to get more distance from your golf swing (an insight into what you’re doing). Then you learned how that’s supported by the product’s particular strength.

Insight comes first. It changes how your buyers think about the problem your product solves. Only then benefits can land effectively.

5. Don’t lead with differentiators, lead to them.

At Gong.io, we’ve taught our sales reps to speak with buyers about a critical problem only we can solve. It’s the delta between top producers and the rest of the team.

• "The numbers from your top reps are fantastic."
• "The downside is they’re annulled by everyone else who’s missing their quota."
• "Your team goes from outstanding numbers to breaking even or missing quota. Both of those options are unsustainable."

We only introduce our key differentiator once the backstory is clear and the buyer gets it. Then, our reps say something like this:

"Gong is the only platform that can tell you what your top reps do differently from the rest of your team. We can tell you which questions they ask, which topics they discuss, when they talk about each one, and more."

See why we lead to our differentiator, and not with it? It just wouldn’t land the same way if we started with the differentiator. In fact, it might not land at all.

6. Focus on value, not features.

Gong.io research found that focusing on features over value is not impactful. Prospects, especially decision-makers, want value propositions about how you’ll help them solve their problems rather than an overview of the features they’ll get. 

7. Flip your presentation.

he next, eventually achieving a shiny, final outcome. This isn’t always the best strategy. 

Instead of building up to the most significant and impactful part of your demo for your prospect, begin with the most valuable part, which is how you’ll help them, and let the conversation flow from there. 

There’s one other tactic underlying it all: The best product demos start with topics the buyers highlighted on the discovery call . For example, if the buyer spends 4 minutes talking about X and 10 minutes talking about Y, you want to begin with Y, as the buyer has demonstrated that they’re heavily interested in Y. In the opening section of your presentation, address the biggest issue from discovery. Address the second biggest issue second, etc.

It’s called solution mapping, and it’s going to change your sales presentation process forever. Stop saving the big reveal for last. Stop building anticipation. Start with the good stuff. Let it rip right out of the gate.

8. Turn your presentation into a conversation.

If you sensed we were looking for a two-way dialogue during your pitch, you’re right. That’s a relief to most salespeople, especially the ones who hate delivering traditional presentations.

A two-way dialogue is going to make your pitch feel more natural. To do this, Gong.io says to get buyers to ask questions by giving them just enough info to inspire them to ask more questions and keep the conversation going. In fact, top performers ask fewer questions because they don’t bombard prospects with too much information but instead give buyers just enough information to have them ask questions. 

Long monologues won’t help you have real conversations with your buyers. Instead, aim for a great two-way conversation. 

9. Mind the 9-minute period.

This tip is crisp and clear: Don’t present for more than nine minutes. Gong.io data supports this. 

Presentations for lost deals last an average of 11.4 minutes. Why do they go so poorly? Because it’s hard to retain attention. If you do go longer than nine minutes, switch it up. 

Vary something that re-captures attention and keeps people engaged. Change channels by doing something like switching up who’s speaking in real life or on video. This can rest your clock to zero, and you’ve got nine more minutes for the next portion of the show. 

10. Be strategic with social proof. 

Social proof. Best friend or worst nightmare? It can be either one, so use it carefully. For example, generic social proof (i.e., naming impressive clients for brand power alone) is a disaster. Buyers might not identify with them. Sure, they’re dazzled, but they may not see how they relate to your current client.

An effective strategy is to reference clients similar to your buyer, with the same pain points, challenges and needs that they can relate to. You can tell an accompanying story about the client and their pain points, helping the buyer see themselves in the story you’re telling.

11. Talk price after you establish value.

Would it surprise you to know it matters when you talk about certain topics? It can actually affect whether you win or lose a deal. Pricing is a great example of this principle.

The top salespeople wait to talk about pricing. They know it’s important to demonstrate their product’s value first.

Set an agenda at the start of your call so your buyer knows when to expect a pricing discussion. They’ll be less likely to raise it early, and if they do, you can refer back to the agenda.

Open with something like, " I’d like to talk about A, B, and C on our call today. Then we can go over pricing at the end and -- if it makes sense for you -- talk about next steps. Does that work for you?"

You’re all set.

12. Reference your competitors.

Our data shows that you’re more likely to win a deal if you talk about the competition early in the sales process instead of ignoring them completely.

For best results, practice this during your first sales presentation. Waiting until the end of your sales process puts you into a dangerous red zone. Your buyers will already have formed opinions, and they’ll be harder to change.

In other words, at the end of the day, buyers will justify a decision they made early in the process, which is why it’s critical to set yourself up as the winner early on. Talk about the competition in your presentation. Put the conversation out there. Get your buyer to see you through that lens, and you’re golden.

Over To You

You now have 15 new tips and techniques to throw down this quarter. Many of these data-backed moves come from Gong.io’s own findings and have proven to be effective for us. Implement them, and I know you’ll boost your numbers.

Don't forget to share this post!

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How To Get Free Access To Microsoft PowerPoint

E very time you need to present an overview of a plan or a report to a whole room of people, chances are you turn to Microsoft PowerPoint. And who doesn't? It's popular for its wide array of features that make creating effective presentations a walk in the park. PowerPoint comes with a host of keyboard shortcuts for easy navigation, subtitles and video recordings for your audience's benefit, and a variety of transitions, animations, and designs for better engagement.

But with these nifty features comes a hefty price tag. At the moment, the personal plan — which includes other Office apps — is at $69.99 a year. This might be the most budget-friendly option, especially if you plan to use the other Microsoft Office apps, too. Unfortunately, you can't buy PowerPoint alone, but there are a few workarounds you can use to get access to PowerPoint at no cost to you at all.

Read more: The 20 Best Mac Apps That Will Improve Your Apple Experience

Method #1: Sign Up For A Free Microsoft Account On The Office Website

Microsoft offers a web-based version of PowerPoint completely free of charge to all users. Here's how you can access it:

• Visit the Microsoft 365 page .
• If you already have a free account with Microsoft, click Sign in. Otherwise, press "Sign up for the free version of Microsoft 365" to create a new account at no cost.
• On the Office home page, select PowerPoint from the side panel on the left.
• Click on "Blank presentation" to create your presentation from scratch, or pick your preferred free PowerPoint template from the options at the top (there's also a host of editable templates you can find on the Microsoft 365 Create site ).
• Create your presentation as normal. Your edits will be saved automatically to your Microsoft OneDrive as long as you're connected to the internet.

It's important to keep in mind, though, that while you're free to use this web version of PowerPoint to create your slides and edit templates, there are certain features it doesn't have that you can find on the paid version. For instance, you can access only a handful of font styles and stock elements like images, videos, icons, and stickers. Designer is also available for use on up to three presentations per month only (it's unlimited for premium subscribers). When presenting, you won't find the Present Live and Always Use Subtitles options present in the paid plans. The biggest caveat of the free version is that it won't get any newly released features, unlike its premium counterparts.

Method #2: Install Microsoft 365 (Office) To Your Windows

Don't fancy working on your presentation in a browser? If you have a Windows computer with the Office 365 apps pre-installed or downloaded from a previous Office 365 trial, you can use the Microsoft 365 (Office) app instead. Unlike the individual Microsoft apps that you need to buy from the Microsoft Store, this one is free to download and use. Here's how to get free PowerPoint on the Microsoft 365 (Office) app:

• Search for Microsoft 365 (Office) on the Microsoft Store app.
• Install and open it.
• Sign in with your Microsoft account. Alternatively, press "Create free account" if you don't have one yet.
• Click on Create on the left side panel.
• Select Presentation.
• In the PowerPoint window that opens, log in using your account.
• Press Accept on the "Free 5-day pass" section. This lets you use PowerPoint (and Word and Excel) for five days — free of charge and without having to input any payment information.
• Create your presentation as usual. As you're using the desktop version, you can access the full features of PowerPoint, including the ability to present in Teams, export the presentation as a video file, translate the slides' content to a different language, and even work offline.

The only downside of this method is the time limit. Once the five days are up, you can no longer open the PowerPoint desktop app. However, all your files will still be accessible to you. If you saved them to OneDrive, you can continue editing them on the web app. If you saved them to your computer, you can upload them to OneDrive and edit them from there.

Method #3: Download The Microsoft PowerPoint App On Your Android Or iOS Device

If you're always on the move and need the flexibility of creating and editing presentations on your Android or iOS device, you'll be glad to know that PowerPoint is free and available for offline use on your mobile phones. But — of course, there's a but — you can only access the free version if your device is under 10.1 inches. Anything bigger than that requires a premium subscription. If your phone fits the bill, then follow these steps to get free PowerPoint on your device:

• Install Microsoft PowerPoint from the App Store or Google Play Store .
• Log in using your existing Microsoft email or enter a new email address to create one if you don't already have an account.
• On the "Get Microsoft 365 Personal Plan" screen, press Skip For Now.
• If you're offered a free trial, select Try later (or enjoy the free 30-day trial if you're interested).
• To make a new presentation, tap the plus sign in the upper right corner.
• Change the "Create in" option from OneDrive - Personal to a folder on your device. This allows you to save the presentation to your local storage and make offline edits.
• Press "Set as default" to set your local folder as the default file storage location.
• Choose your template from the selection or use a blank presentation.
• Edit your presentation as needed.

Do note that PowerPoint mobile comes with some restrictions. There's no option to insert stock elements, change the slide size to a custom size, use the Designer feature, or display the presentation in Immersive Reader mode. However, you can use font styles considered premium on the web app.

Method #4: Use Your School Email Address

Office 365 Education is free for students and teachers, provided they have an email address from an eligible school. To check for your eligibility, here's what you need to do:

• Go to the Office 365 Education page .
• Type in your school email address in the empty text field.
• Press "Get Started."
• On the next screen, verify your eligibility. If you're eligible, you'll be asked to select whether you're a student or a teacher. If your school isn't recognized, however, you'll get a message telling you so.
• For those who are eligible, proceed with creating your Office 365 Education account. Make sure your school email can receive external mail, as Microsoft will send you a verification code for your account.
• Once you're done filling out the form, press "Start." This will open your Office 365 account page.

You can then start making your PowerPoint presentation using the web app. If your school's plan supports it, you can also install the Office 365 apps to your computer by clicking the "Install Office" button on your Office 365 account page and running the downloaded installation file. What sets the Office 365 Education account apart from the regular free account is that you have unlimited personal cloud storage and access to other Office apps like Word, Excel, and Outlook.

Read the original article on SlashGear .

Case Study Research Method in Psychology

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

On This Page:

Case studies are in-depth investigations of a person, group, event, or community. Typically, data is gathered from various sources using several methods (e.g., observations & interviews).

The case study research method originated in clinical medicine (the case history, i.e., the patient’s personal history). In psychology, case studies are often confined to the study of a particular individual.

The information is mainly biographical and relates to events in the individual’s past (i.e., retrospective), as well as to significant events that are currently occurring in his or her everyday life.

The case study is not a research method, but researchers select methods of data collection and analysis that will generate material suitable for case studies.

Freud (1909a, 1909b) conducted very detailed investigations into the private lives of his patients in an attempt to both understand and help them overcome their illnesses.

This makes it clear that the case study is a method that should only be used by a psychologist, therapist, or psychiatrist, i.e., someone with a professional qualification.

There is an ethical issue of competence. Only someone qualified to diagnose and treat a person can conduct a formal case study relating to atypical (i.e., abnormal) behavior or atypical development.

 Famous Case Studies

• Anna O – One of the most famous case studies, documenting psychoanalyst Josef Breuer’s treatment of “Anna O” (real name Bertha Pappenheim) for hysteria in the late 1800s using early psychoanalytic theory.
• Little Hans – A child psychoanalysis case study published by Sigmund Freud in 1909 analyzing his five-year-old patient Herbert Graf’s house phobia as related to the Oedipus complex.
• Bruce/Brenda – Gender identity case of the boy (Bruce) whose botched circumcision led psychologist John Money to advise gender reassignment and raise him as a girl (Brenda) in the 1960s.
• Genie Wiley – Linguistics/psychological development case of the victim of extreme isolation abuse who was studied in 1970s California for effects of early language deprivation on acquiring speech later in life.
• Phineas Gage – One of the most famous neuropsychology case studies analyzes personality changes in railroad worker Phineas Gage after an 1848 brain injury involving a tamping iron piercing his skull.

Clinical Case Studies

• Studying the effectiveness of psychotherapy approaches with an individual patient
• Assessing and treating mental illnesses like depression, anxiety disorders, PTSD
• Neuropsychological cases investigating brain injuries or disorders

Child Psychology Case Studies

• Studying psychological development from birth through adolescence
• Cases of learning disabilities, autism spectrum disorders, ADHD
• Effects of trauma, abuse, deprivation on development

Types of Case Studies

• Explanatory case studies : Used to explore causation in order to find underlying principles. Helpful for doing qualitative analysis to explain presumed causal links.
• Exploratory case studies : Used to explore situations where an intervention being evaluated has no clear set of outcomes. It helps define questions and hypotheses for future research.
• Descriptive case studies : Describe an intervention or phenomenon and the real-life context in which it occurred. It is helpful for illustrating certain topics within an evaluation.
• Multiple-case studies : Used to explore differences between cases and replicate findings across cases. Helpful for comparing and contrasting specific cases.
• Intrinsic : Used to gain a better understanding of a particular case. Helpful for capturing the complexity of a single case.
• Collective : Used to explore a general phenomenon using multiple case studies. Helpful for jointly studying a group of cases in order to inquire into the phenomenon.

Where Do You Find Data for a Case Study?

There are several places to find data for a case study. The key is to gather data from multiple sources to get a complete picture of the case and corroborate facts or findings through triangulation of evidence. Most of this information is likely qualitative (i.e., verbal description rather than measurement), but the psychologist might also collect numerical data.

1. Primary sources

• Interviews – Interviewing key people related to the case to get their perspectives and insights. The interview is an extremely effective procedure for obtaining information about an individual, and it may be used to collect comments from the person’s friends, parents, employer, workmates, and others who have a good knowledge of the person, as well as to obtain facts from the person him or herself.
• Observations – Observing behaviors, interactions, processes, etc., related to the case as they unfold in real-time.
• Documents & Records – Reviewing private documents, diaries, public records, correspondence, meeting minutes, etc., relevant to the case.

2. Secondary sources

• News/Media – News coverage of events related to the case study.
• Academic articles – Journal articles, dissertations etc. that discuss the case.
• Government reports – Official data and records related to the case context.
• Books/films – Books, documentaries or films discussing the case.

3. Archival records

Searching historical archives, museum collections and databases to find relevant documents, visual/audio records related to the case history and context.

Public archives like newspapers, organizational records, photographic collections could all include potentially relevant pieces of information to shed light on attitudes, cultural perspectives, common practices and historical contexts related to psychology.

4. Organizational records

Organizational records offer the advantage of often having large datasets collected over time that can reveal or confirm psychological insights.

Of course, privacy and ethical concerns regarding confidential data must be navigated carefully.

However, with proper protocols, organizational records can provide invaluable context and empirical depth to qualitative case studies exploring the intersection of psychology and organizations.

• Organizational/industrial psychology research : Organizational records like employee surveys, turnover/retention data, policies, incident reports etc. may provide insight into topics like job satisfaction, workplace culture and dynamics, leadership issues, employee behaviors etc.
• Clinical psychology : Therapists/hospitals may grant access to anonymized medical records to study aspects like assessments, diagnoses, treatment plans etc. This could shed light on clinical practices.
• School psychology : Studies could utilize anonymized student records like test scores, grades, disciplinary issues, and counseling referrals to study child development, learning barriers, effectiveness of support programs, and more.

How do I Write a Case Study in Psychology?

Follow specified case study guidelines provided by a journal or your psychology tutor. General components of clinical case studies include: background, symptoms, assessments, diagnosis, treatment, and outcomes. Interpreting the information means the researcher decides what to include or leave out. A good case study should always clarify which information is the factual description and which is an inference or the researcher’s opinion.

1. Introduction

• Provide background on the case context and why it is of interest, presenting background information like demographics, relevant history, and presenting problem.
• Compare briefly to similar published cases if applicable. Clearly state the focus/importance of the case.

2. Case Presentation

• Describe the presenting problem in detail, including symptoms, duration,and impact on daily life.
• Include client demographics like age and gender, information about social relationships, and mental health history.
• Describe all physical, emotional, and/or sensory symptoms reported by the client.
• Use patient quotes to describe the initial complaint verbatim. Follow with full-sentence summaries of relevant history details gathered, including key components that led to a working diagnosis.
• Summarize clinical exam results, namely orthopedic/neurological tests, imaging, lab tests, etc. Note actual results rather than subjective conclusions. Provide images if clearly reproducible/anonymized.
• Clearly state the working diagnosis or clinical impression before transitioning to management.

3. Management and Outcome

• Indicate the total duration of care and number of treatments given over what timeframe. Use specific names/descriptions for any therapies/interventions applied.
• Present the results of the intervention,including any quantitative or qualitative data collected.
• For outcomes, utilize visual analog scales for pain, medication usage logs, etc., if possible. Include patient self-reports of improvement/worsening of symptoms. Note the reason for discharge/end of care.

4. Discussion

• Analyze the case, exploring contributing factors, limitations of the study, and connections to existing research.
• Analyze the effectiveness of the intervention,considering factors like participant adherence, limitations of the study, and potential alternative explanations for the results.
• Identify any questions raised in the case analysis and relate insights to established theories and current research if applicable. Avoid definitive claims about physiological explanations.
• Offer clinical implications, and suggest future research directions.

5. Additional Items

• Thank specific assistants for writing support only. No patient acknowledgments.
• References should directly support any key claims or quotes included.
• Use tables/figures/images only if substantially informative. Include permissions and legends/explanatory notes.
• Provides detailed (rich qualitative) information.
• Provides insight for further research.
• Permitting investigation of otherwise impractical (or unethical) situations.

Case studies allow a researcher to investigate a topic in far more detail than might be possible if they were trying to deal with a large number of research participants (nomothetic approach) with the aim of ‘averaging’.

Because of their in-depth, multi-sided approach, case studies often shed light on aspects of human thinking and behavior that would be unethical or impractical to study in other ways.

Research that only looks into the measurable aspects of human behavior is not likely to give us insights into the subjective dimension of experience, which is important to psychoanalytic and humanistic psychologists.

Case studies are often used in exploratory research. They can help us generate new ideas (that might be tested by other methods). They are an important way of illustrating theories and can help show how different aspects of a person’s life are related to each other.

The method is, therefore, important for psychologists who adopt a holistic point of view (i.e., humanistic psychologists ).

Limitations

• Lacking scientific rigor and providing little basis for generalization of results to the wider population.
• Researchers’ own subjective feelings may influence the case study (researcher bias).
• Difficult to replicate.
• Time-consuming and expensive.
• The volume of data, together with the time restrictions in place, impacted the depth of analysis that was possible within the available resources.

Because a case study deals with only one person/event/group, we can never be sure if the case study investigated is representative of the wider body of “similar” instances. This means the conclusions drawn from a particular case may not be transferable to other settings.

Because case studies are based on the analysis of qualitative (i.e., descriptive) data , a lot depends on the psychologist’s interpretation of the information she has acquired.

This means that there is a lot of scope for Anna O , and it could be that the subjective opinions of the psychologist intrude in the assessment of what the data means.

For example, Freud has been criticized for producing case studies in which the information was sometimes distorted to fit particular behavioral theories (e.g., Little Hans ).

This is also true of Money’s interpretation of the Bruce/Brenda case study (Diamond, 1997) when he ignored evidence that went against his theory.

Breuer, J., & Freud, S. (1895).  Studies on hysteria . Standard Edition 2: London.

Curtiss, S. (1981). Genie: The case of a modern wild child .

Diamond, M., & Sigmundson, K. (1997). Sex Reassignment at Birth: Long-term Review and Clinical Implications. Archives of Pediatrics & Adolescent Medicine , 151(3), 298-304

Freud, S. (1909a). Analysis of a phobia of a five year old boy. In The Pelican Freud Library (1977), Vol 8, Case Histories 1, pages 169-306

Freud, S. (1909b). Bemerkungen über einen Fall von Zwangsneurose (Der “Rattenmann”). Jb. psychoanal. psychopathol. Forsch ., I, p. 357-421; GW, VII, p. 379-463; Notes upon a case of obsessional neurosis, SE , 10: 151-318.

Harlow J. M. (1848). Passage of an iron rod through the head.  Boston Medical and Surgical Journal, 39 , 389–393.

Harlow, J. M. (1868).  Recovery from the Passage of an Iron Bar through the Head .  Publications of the Massachusetts Medical Society. 2  (3), 327-347.

Money, J., & Ehrhardt, A. A. (1972).  Man & Woman, Boy & Girl : The Differentiation and Dimorphism of Gender Identity from Conception to Maturity. Baltimore, Maryland: Johns Hopkins University Press.

Money, J., & Tucker, P. (1975). Sexual signatures: On being a man or a woman.

Further Information

• Case Study Approach
• Case Study Method
• Enhancing the Quality of Case Studies in Health Services Research
• “We do things together” A case study of “couplehood” in dementia
• Using mixed methods for evaluating an integrative approach to cancer care: a case study

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• Open access
• Published: 21 May 2024

Effectively teaching cultural competence in a pre-professional healthcare curriculum

• Karen R. Bottenfield 1 ,
• Maura A. Kelley 2 ,
• Shelby Ferebee 3 ,
• Andrew N. Best 1 ,
• David Flynn 2 &
• Theresa A. Davies 1 , 2  

BMC Medical Education volume  24 , Article number:  553 ( 2024 ) Cite this article

Metrics details

There has been research documenting the rising numbers of racial and ethnic minority groups in the United States. With this rise, there is increasing concern over the health disparities that often affect these populations. Attention has turned to how clinicians can improve health outcomes and how the need exists to educate healthcare professionals on the practice of cultural competence. Here we present one successful approach for teaching cultural competence in the healthcare curriculum with the development of an educational session on cultural competence consisting of case-based, role-play exercises, class group discussions, online discussion boards, and a lecture PowerPoint presentation.

Cultural competence sessions were delivered in a pre-dental master’s program to 178 students between 2017 and 2020. From 2017 to 2019, the sessions were implemented as in-person, case-based, role-play exercises. In 2020, due to in-person limitations caused by the COVID-19 pandemic, students were asked to read the role-play cases and provide a reflection response using the online Blackboard Learn discussion board platform. Evaluation of each session was performed using post-session survey data.

Self-reported results from 2017 to 2020 revealed that the role-play exercises improved participant’s understanding of components of cultural competence such as communication in patient encounters (95%), building rapport with patients (94%), improving patient interview skills (95%), and recognition of students own cultural biases when working with patients (93%).

Conclusions

Students were able to expand their cultural awareness and humility after completion of both iterations of the course session from 2017 to 2019 and 2020. This session can be an effective method for training healthcare professionals on cultural competence.

Peer Review reports

It is projected that by the year 2050, racial and ethnic minority groups will make up over 50% of the United States population [ 1 ]. With a more multicultural society, growing concern has emerged over how to address the health disparities that effect these populations and the ways in which healthcare professionals can increase positive health outcomes. Continuing evidence suggests that many patients from racial and ethnic minority groups are not satisfied with the current state of healthcare which has been attributed to implicit bias on the part of physicians and current challenges faced by practitioners who feel underprepared to address these issues due to differences in language, financial status, and healthcare practice [ 2 , 3 , 4 ].

To contend with health disparities and the challenges faced by practitioners working with a more diverse population, healthcare educators have begun to emphasize the importance of educating healthcare workforce on the practice of cultural competence and developing a skilled-based set of behaviors, attitudes and policies that effectively provides care in the wake of cross-cultural situations and differences [ 4 , 5 , 6 ]. There are several curricular mandates from both medical and dental accreditation bodies to address this issue [ 7 , 8 , 9 ], and large amounts of resources, ideas, and frameworks that exist for implementing and training future and current healthcare providers on the inadequacies of the healthcare system and cultural competence [ 10 , 11 , 12 ]. These current institutional guidelines for accreditation and the numerous amounts of resources for training cultural competence, continue to evolve with work documenting the need for blended curriculum that is continuous throughout student education, starting early as we have done here with pre-dental students, including in-person didactic or online sessions, a service learning component, community engagement and a reflective component [ 4 , 5 , 13 , 14 ].

This study investigates teaching cultural competence in a healthcare curriculum. We hypothesized that early educational exposure to cultural competence through role playing case studies, can serve as an effective mechanism for training early pre-doctoral students the practice of cultural competence. Utilizing student self-reported survey data conducted in a predental master’s curriculum, in which two iterations of role-playing case studies were used to teach components of cultural competence, this study aims to evaluate and support research that suggests role-playing case studies as effective means for educating future clinical professionals on the practice of cultural competence.

This study was determined to be exempt by the Institutional Review Board of Boston University Medical Campus, Protocol # H-37,232. Informed consent was received from all subjects.

Data collection

The role-playing, case-based simulated patient encounter exercises were developed and administered at Boston University Chobanian & Avedisian School of Medicine to predental students in the Master of Science in Oral Health Sciences Program (see Table  1 ). From 2017 to 2020, we administered patient encounter cases [see Additional File 1 ] to students ( n  = 178) in the program as a portion of a case-based, role-playing exercise to teach the importance of cultural competence and cultural awareness during patient encounters. During years 2017–2019, real actors portrayed the patient and physician. In 2020, the session was conducted online via a discussion board through a Blackboard Course Site. The original case was published as part of a master’s students thesis work in 2021 [ 15 ].

Description of patient encounter cases 1 and 2

Patient Encounter Case 1 [see Additional file 1 ] is composed of two subsections, scenario 1 A and scenario 1B, and is centered around a patient/physician interaction in which a patient who is pregnant presents with pain upon urination. The physician in 1 A is short and terse with the patient, immediately looking at a urine sample, prescribing medication for a urinary tract infection, and telling the patient to return for a follow-up in 2 weeks. In scenario 1B, a similar situation ensues; however, in this scenario the physician takes more time with the patient providing similar care as the physician in 1 A, but asking for more information about the patients personal and medical history. At the conclusion of the scenario, the patient is offered resources for an obstetrician and a dentist based on the information that is provided about the patient’s background. The patient is then sent on their way and asked to follow-up in 2 weeks. The patient does not return.

Patient Encounter Case 2 [see Additional file 1 ] follows a similar format to the Patient Encounter Case 1. In scenario 2 A, the same patient from Case 1 returns with tooth pain after giving birth. The physician in 2 A, like 1 A, is short with the patient and quickly refers the patient to a dentist. In 2B, the physician again takes more time with the patient to receive background information on the patient, make a connection, and provides an antibiotic and dental referral.

Each Patient Encounter Case explored topics such as the importance of building a trusting physician/patient relationship, the importance of asking a patient for patient history, making a connection, and the importance of a physician taking all facets of a patient’s circumstances into consideration [ 15 ].

Session outline

The sessions conducted between 2017 and 2019 were composed of three parts: (1) enactment of an abridged patient encounter facilitated by session administrators, (2) group discussion and reflection during which time students were asked to critically reflect and discuss the theme and key take-aways from the role play exercise, and (3) a PowerPoint presentation emphasizing take-away points from the role-play exercise. At the conclusion of the cultural competence training sessions, students participated in a post-session Qualtrics generated survey administered electronically to assess each student’s feelings about the session [see Additional file 3 ].

Role-play enactment

Facilitators dressed-up in clothing to mimic both the physician and patient for all case scenarios in Patient Encounter Case 1 and Case 2. At the conclusion of the role play portion of each of the cases, the facilitators paused to lead students in a real-time class group discussion. After Case 1, students were asked questions such as: What did you think ? Were the patient’s needs met? Did you expect the patient to return? Following Case 2, similar questions were asked by the facilitators, including: What did you think ? Were the patient’s needs met? Did you expect the patient to accept help?

At the conclusion of this portion of the session, the facilitators led a larger general discussion about both cases and how they related to one another. Finally, the course session concluded with a PowerPoint presentation that reinforced the take-home points from the session [see Additional file 2 ] [ 15 ].

Change in session modality due to COVID-19 pandemic

In Fall 2020, due to the COVID-19 pandemic, the course modality moved to an online platform and consisted of three parts on a Blackboard Discussion Board (Blackboard, Inc.). Students were required to: (1) read each of the Patient Encounter Cases and add a brief reflection comparing the scenarios, (2) then comment on at least two peer’s posts in the discussion forum and (3) attend class to hear a PowerPoint presentation by a course session facilitator on the key take-aways from each scenario [ 15 ].

Student surveys

At the conclusion of the cultural competence training sessions, students participated in a post-session Qualtrics ( https://www.qualtrics.com ) generated survey administered electronically to assess each student’s feelings about the sessions [see Additional file 3 ]. The format of the survey included 5 questions with the following Likert scale response options: strongly agree, agree, disagree, strongly disagree. These post-session surveys were not required but rather optional [ 15 ].

A total of 178 students completed the cultural competence sessions between 2017 and 2020. Of these participants, 112 voluntarily completed a post-session survey on the effectiveness of the course in teaching cultural competence and cultural awareness during patient encounters. Between 2017 and 2019, 99 students completed post-session surveys following sessions with role play exercises. In 2020, 13 students completed post-session surveys following discussion board sessions.

Role-play exercises enhanced cultural competence

In responding to post-session survey questions following cultural competence sessions that included role-play exercises (2017–2019), 71% of students surveyed strongly agreed and 24% agreed that the role-play exercises helped them to identify the importance of communication in patient encounters. In asking participants if the role-play exercises made them more aware of different strategies to improve their patient interview skills, 72% strongly agreed and 23% agreed. Also, 68% of the students strongly agreed and 26% agreed that the exercises helped them to better identify the importance of building rapport and trust during patient encounters. When asked if the exercises helped the students to better understand their own bias and/or cultural awareness when working with patients, the results of the survey showed that 62% of students strongly agreed and 31% agreed with this statement. In addition, most students found the role-play exercises to be enjoyable (72% strongly agreed and 22% agreed). See results shown in Fig.  1 .

Cultural Competence Session Survey Data from the Year 2017–2019. Survey data from students at Boston University’s Oral Health Sciences Program for the years 2017–2019. Data is presented as percent of respondents ( n  = 99)

Discussion boards and reflections enhanced cultural competence

Cultural competence sessions held during 2020 did not include role-play exercises due to the Covid-19 pandemic. Instead, students participated in discussion boards and reflections on Blackboard. In response to the post-session survey question asking if the discussion board exercises were helpful in identifying the importance of communication during patient encounters, 67% of students strongly agreed and 25% agreed with this statement. Also, 75% of students strongly agreed and 17% agreed that the discussion board exercises helped them identify the importance of building rapport and trust during patient contact. When asked if the exercises helped the students to better understand their own bias and/or cultural awareness when working with patients, the results of the survey showed that 67% of students strongly agreed and 25% agreed with this statement. In addition, most students found the discussion board exercises to be enjoyable (67% strongly agreed and 22% agreed). See results shown in Fig.  2 .

Cultural competence session survey data from the Year 2020. Survey data from students at Boston University’s Oral Health Sciences Program for the year 2020. Data is presented as percent of respondents ( n  = 13)

Student responses to the reflection portion of the online cultural competency sessions were recorded and categorized. Five themes were selected and 441 reflection responses were coded using NVivo (Version 12). The results showed that 29% of reflections demonstrated student’s ability to understand a holistic approach to clinical care, 24.3% understood the importance of collecting a patient history, 6.8% recognized the socioeconomic factors during a patient encounter, 27.9% reflected on the importance of the patient clinical relationship, and 12% on the effects on improving health outcomes (Table  1 ). Representative student responses to these themes are shown in Table  1 .

There exists a need to develop novel and effective means for teaching and training the next generation of healthcare professionals the practice of cultural competence. Thus, two iterations of a course session using case-based patient centered encounters were developed to teach these skills to pre-professional dentals students. Overall, the results of this study demonstrated that participation in the course, subsequent group discussion sessions, and take-away PowerPoint sessions significantly improved the participant’s understanding of the importance of communication skills and understanding of socioeconomic, environmental, and cultural disparities that can affect a patient’s health outcome.

According to results from the course session implemented in-person from 2017 to 2019, the role-playing exercise significantly improved participants understanding of important components that can be used to improve health outcomes that may be affected due to health disparities. Students were strongly able to identify the importance of communication in patient encounters, to understand strategies such as communication and compassionate care in patient encounters, identify the importance of building a patient-physician relationship with patients, and were able to recognize their own cultural biases. Similarly, in 2020, even with a change in course modality to on-line learning due to COVID-19, students were able to understand the same key take-aways from the course session as demonstrated by reflections using the discussion board regarding the need for a holistic approach to care, importance of the patient clinician relationship, and importance of taking a patient history. Despite promising implications of both iterations of the session, students completing the session online did not find the same success in “understanding my own bias/and or cultural awareness when working with patients.” This decrease may be attributed to change in course modality and the strengths of the role-play enactment of the patient encounter. It is important to recognize that additional learning components, including video recordings of the role-play enactment, may be necessary if the discussion board is used as the primary learning method in the future.

In contrast to previous studies that attempted to determine the effectiveness of cultural competence training methods, this session had many unique characteristics. The simulated role-playing exercise enabled student participants to see first-hand an interactive patient scenario that could be used as an example for when students begin working with patients or communicating with patients who are culturally diverse. Additionally, the nature of the cases created for the course session which were divided into a part A in which the patient physician was more straightforward when diagnosing and treating the patient and a part B with a more comprehensive and nurturing approach to care, allowed the students to compare the scenarios and make their own assumptions and comments on the effectiveness of each portion of the case. Another strength of this training, was the faculty with cultural competence training were uniquely involved in case creation and facilitation of the course session. According to previous studies with similar aims, it was noted that direct observation and feedback from a faculty member who had cultural competence training and direct contact with patients can provide students with a more memorable and useful experience when educating students [ 12 ]. The facilitators of this session were able to emphasize from their own personal experiences how to work with culturally diverse populations.

An important aspect of the 2020 iteration of the course session in which a discussion board format was used, was that it allowed students who may feel uncomfortable with sharing their thoughts on a case and their own biases, the opportunity to share in a space that may feel safer than in person [ 4 ]. Previous studies have mentioned challenges with online discussion boards [ 4 ] but here we had robust participation, albeit required. Students often contributed more than the required number of comments and they were often lengthy and engaging when responding to peers. Finally, in contrast to previous studies, this course session took place in a pre-professional master’s program, the M.S. in Oral Health Sciences Program at Boston University Chobanian & Avedisian School of Medicine. This program, in which students are given the opportunity to enhance their credentials for professional school, provided students with early exposure to cultural competence training. Students that completed this session in their early pre-professional curriculum should be better prepared than peers who did not receive any cultural competence training until they entered their designated professional school. This session is part of an Evidence Based Dentistry course, which incorporates a larger component of personal reflection that serves to engage students in critical thinking as they begin to develop the skills to be future clinicians. Students that understand different cultures, society and themselves through self-assessments will grow and be best suited in time to treat future patients [ 4 , 16 , 17 ].

One limitation of the present study was the number of survey participants that competed the post-session surveys, as survey completion was not required. Thus, the number of student participants declined over the years, reaching its lowest number of participants in 2020 when the discussion board course session was implemented, and students may have been over surveyed due to the pandemic. Another limitation to this study, was the lack of both a pre and post survey that could be used to determine how student’s understanding of cultural competence had evolved from their entry into the course to the conclusion of the course as well as individual bias and self-reporting measures.

In the future, the course should implement both a role-playing format and subsequent discussion board reflections within the same course session. Studies have shown that alternatives ways of drawing students to reflect whether role play, personal narratives, etc. can be extremely advantageous in developing personal reflection and awareness building competency [ 4 , 16 , 17 , 18 ]. It is noted that role-playing exercises that allow students to provide feedback with student colleagues can provide students with more insight into their own behaviors. It has also been shown in previous studies that student writing and reflection activities can also facilitate student’s reflections on their own beliefs and biases [ 4 , 11 ]. Reflective writing skills are an important and effective means for students to continue to gauge their cultural competence throughout the remainder of their academic training and as future clinicians [ 4 , 17 , 19 ]. Further, students may experience emotional responses through the process of reflective writing as they recognize personal bias or stereotypes, creating a profound and impactful response resulting in enhanced understanding of cultural differences and beliefs [ 4 ]. By combining both learning techniques, students would be able to understand their own bias and their classmates and create a dialogue that could be more beneficial than just one learning method alone. Furthermore, by implementing the discussion board into the role-playing session, as stated previously, students that are more cautious about sharing their point of view or about their own implicit bias in a traditional classroom setting would be able to express their opinions and facilitate a more comprehensive discussion more thoroughly.

Here we show an effective means to utilize role-play of a multi-scenario case-based patient encounter to teach pre-professional healthcare student’s components of cultural competence, emphasizing the importance of provider-patient interactions, holistic patient care, and patient history and socioeconomic factors in provider care. This study contributes to the larger body of work that seeks to address this important aspect of education as it relates to enhancing patient health care outcomes.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to acknowledge Boston University’s Chobanian & Avedisian School of Medicine’s Graduate Medical Science students and study participants.

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Contributions

TAD designed the original study concept, taught the classes (roleplay), conducted the surveys, and collected data; MAK designed the original case and PowerPoint, and performed roleplay; DBF and SF evaluated data and drafted original figures; ANB assisted in drafting the manuscript; KRB finalized figures and the manuscript.

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Bottenfield, K.R., Kelley, M.A., Ferebee, S. et al. Effectively teaching cultural competence in a pre-professional healthcare curriculum. BMC Med Educ 24 , 553 (2024). https://doi.org/10.1186/s12909-024-05507-x

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• Foveal atrophy in patients with active central serous chorioretinopathy at first presentation: characteristics and treatment outcomes
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• Ki Young Son 1 ,
• Seul Gi Lim 2 ,
• Sungsoon Hwang 2 ,
• Jaehwan Choi 3 ,
• http://orcid.org/0000-0002-1502-3155 Sang Jin Kim 2 ,
• http://orcid.org/0000-0003-2125-1231 Se Woong Kang 2
• 1 Department of Ophthalmology , Chungnam National University Sejong Hospital , Sejong , Korea (the Republic of)
• 2 Department of Ophthalmology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Korea (the Republic of)
• 3 Department of Ophthalmology , Kyung Hee University Medical Center, Kyung Hee University , Seoul , Korea (the Republic of)
• Correspondence to Dr Se Woong Kang, Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, Korea (the Republic of); kangsewoong{at}gmail.com

Background/aims This study aimed to investigate the clinical characteristics and treatment outcomes of patients with active central serous chorioretinopathy (CSC) and foveal atrophy.

Methods Patients diagnosed with active idiopathic CSC using multimodal imaging and followed up for at least 6 months were included. They were divided into two groups (foveal atrophy group vs foveal non-atrophy group) according to a cut-off central foveal thickness of 120 µm on baseline optical coherence tomography (OCT). Baseline characteristics, angiographic and tomographic features and treatment outcomes were compared between the two groups.

Results Of the 463 patients, 92 eyes of 92 patients (19.9%) were in the foveal atrophy group and 371 eyes of 371 patients (80.1%) were in the foveal non-atrophy group. The baseline subretinal fluid (SRF) height was 111.3±76.8 µm in the foveal atrophy group and 205.0±104.4 µm in the foveal non-atrophy group on OCT images (p<0.001). Complete resolution of SRF after treatment was noted in 60.4% and 93.5% of patients in the foveal atrophy and foveal non-atrophy groups at the final visit, respectively (p<0.001). The foveal atrophy group showed worse visual acuity at baseline (logarithm of the minimum angle of resolution, 0.43±0.33 vs 0.13±0.18, p<0.001) and final visit (0.41±0.32 vs 0.05±0.15, p=0.035).

Conclusions CSC with foveal atrophy was associated with a shallow SRF height, low treatment efficacy and poor vision before and after treatment. We suggest that early active treatment should be considered for eyes with CSC accompanied by a persistent shallow SRF and foveal atrophy.

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

https://doi.org/10.1136/bjo-2023-324147

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WHAT IS ALREADY KNOWN ON THIS TOPIC

Foveal atrophy has been known as one of the sight-threatening complications in chronic central serous chorioretinopathy (CSC). However, the incidence and clinical significance of foveal atrophy at first presentation in patients with CSC have not been documented yet.

WHAT THIS STUDY ADDS

CSC with foveal atrophy accounted for 20% of active CSC and was closely related to persistent shallow subretinal fluid. In these eyes, the treatment outcomes and visual prognosis were poor.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

In the clinical setting, the prompt and active treatment would be required for preventing visual loss in patients with CSC with prolonged symptom duration, which may indicate persistent shallow subretinal fluid, and foveal attenuation.

Introduction

Central serous chorioretinopathy (CSC) is a chorioretinal disease with complex aetiology characterised by serous elevation of the neurosensory retina and focal detachment of the sub-retinal pigment epithelium (RPE). 1 Although there is evidence that the disease is strongly associated with dysfunction of the RPE and choroidal complex, the pathogenesis of CSC remains unclear. 2 3 Furthermore, there is no consensus regarding the classification of CSC. 4 The two most widely known entities are acute and chronic forms of the disease. Acute CSC is characterised by serous retinal detachment with limited focal or multifocal RPE alterations, leakage through the RPE on fluorescein angiography and resolution within 3–4 months. Chronic CSC is characterised by persistent serous retinal detachment after 4–6 months and is accompanied by widespread tracks of RPE atrophy and irregular RPE detachment. There is no consensus regarding the specific duration distinguishing chronic CSC from acute CSC, with the threshold typically set between 4 and 6 months in most published reports. 1 These temporal criteria have made it difficult for clinicians to determine the appropriate timing for intervention. Even in the chronic form of CSC, the natural course and phenotype are heterogeneous and vary significantly between individuals.

Foveal atrophy is a potential sight-threatening macular complication in patients with CSC. 5 6 Prolonged symptom duration, which represents persistent subretinal fluid (SRF), is associated with foveal attenuation in patients with CSC. 6 Furthermore, previous studies have reported that attenuation of foveal thickness, including the outer nuclear layer and foveal photoreceptor layer thickness, is associated with poor visual outcomes after resolution of SRF. 5–8 However, the incidence of foveal atrophy at first presentation of active CSC and its distinct clinical features have not been elucidated by large-scale studies.

In this study, we investigated the incidence of foveal atrophy at the initial visit of patients with active CSC, identified its clinical features and treatment outcomes and elucidated its pathogenesis.

Study design and settings

This retrospective comparative study included patients with active CSC at their initial visit to the Department of Samsung Medical Center, Seoul, Korea between January 2012 and June 2021. The study followed all guidelines for experimental investigation in human subjects.

Subjects aged 18 years or older who were diagnosed with active CSC in at least one eye were identified from the medical records. Subjects were included in the study if neurosensory detachment, including the presence of subfoveal fluid, was documented by optical coherence tomography (OCT), and one or more sites of leakage at the level of the RPE were confirmed by fluorescein angiography at the first clinic visit. All participants were treatment naïve and completed a questionnaire during their first visit to the clinic. The questionnaire comprised seven short questions covering age, sex, duration of symptoms before an initial clinic visit, subjective visual symptoms, ophthalmic treatment history, systemic illness and sociobehavioural information. Eyes with other macular abnormalities, including idiopathic choroidal neovascularisation (CNV), high myopia, epiretinal membrane, neovascular age-related macular degeneration, severe glaucoma, or history of intraocular surgery, prior argon laser photocoagulation, photodynamic therapy, or intravitreal anti-vascular endothelial growth factor (VEGF) injection were excluded. Patients with intraretinal fluid in the fovea that interfered with foveal thickness measurements were also excluded. The subjects were divided into two groups: the foveal atrophy and foveal non-atrophy groups based on a central foveal thickness of 120 µm on spectral-domain OCT. The cut-off value of 120 µm was determined by a distribution < the mean −2 SD of the central foveal thickness (119 µm) in healthy volunteers reported in a previous study. 6 To confirm the cut-off value in this study, reference data were obtained from 57 eyes of 57 age-matched healthy volunteers aged 49.6±13.7 years (mean±SD; range: 23–78 years) with no history of eye disease and refractive errors less than ±6 dioptres. The central foveal thickness in healthy subjects was 180.7±18.7 µm (mean±SD; range: −2 SD to +2 SD=143.2–218.2), which did not exceed the established criterion of 120 µm for foveal atrophy. If both eyes were eligible as per the inclusion and exclusion criteria, the right eye was selected as the study eye.

Multimodal imaging and imaging analysis

All subjects underwent ocular examinations, including best corrected visual acuity (BCVA), manifest refraction, axial length measurement, applanation tonometry and slit-lamp biomicroscopy with a non-contact fundus lens (SuperField lens; Volk Optical, Mentor, Ohio, USA). Structural OCT imaging was performed using a spectral-domain OCT (Spectralis; Heidelberg Engineering, Heidelberg, Germany). The OCT images were obtained through horizontal and vertical crosshair scans and 6 mm radial scans at 30° intervals centred on the fovea. In addition, horizontal and vertical cross-sectional enhanced depth imaging OCT scans were obtained to evaluate choroidal features. A quality score greater than 25 was required for the OCT images to be included. Colour fundus photographs and autofluorescence images were obtained using a Topcon fundus camera (TRC-50Dx; Topcon Medical System, Oakland, New Jersey, USA). Confocal scanning laser ophthalmoscopy, fluorescein angiography and indocyanine green angiography images were obtained using an eye-tracked Spectralis Heidelberg retina angiograph plus OCT (Heidelberg Engineering), according to a standard imaging protocol. All OCT images were analysed by two independent and experienced graders (KYS and SGL), who were blinded to the patients’ information, using a computer-based calliper measurement tool in the spectral-domain OCT system. When the clinical data were ambiguous or when there were disagreements between the graders, a senior retinal specialist (SWK) confirmed the interpretation by further discussion.

Central foveal thickness was defined as the average distance between the internal limiting membrane and the outermost layer of the detached central fovea on the horizontal and vertical OCT images, with the steepest foveal excavation from the raster scans obtained at the first visit. We measured the distance between the internal limiting membrane and the tip of the outer segment at the fovea on OCT images with a uniform outer segment type. If there was an apical projection or a protruding outer segment among the uniform outer segments, we subtracted the distance between the layer of uniform outer segments and the tip of the protruded outer segments. The SRF height was measured as the maximum distance between the outer margin of the photoreceptor layer and the inner surface of the RPE layer on OCT obtained during the initial visit. The subfoveal choroidal thickness, diameter of the largest choroidal vessel, presence of flat irregular pigment epithelial detachment, serous pigment epithelial detachment, turbid SRF, intraretinal and subretinal hyper-reflective foci, presence of extrafoveal cystoid macular degeneration, disruption of the ellipsoid zone, presence of RPE atrophy and inner choroidal attenuation were evaluated on initial OCT images. The presence of RPE atrophy was defined as evidence of choroidal hypertransmission (at least 250 µm in diameter) associated with an RPE defect and thinning of the outer retina on OCT images at baseline. 9–11 In addition, initial multimodal imaging findings were collected, including depigmentation of the RPE, gravitational tract, pachydrusen, soft drusen, acquired vitelliform-like lesions on colour fundus photography and autofluorescence, choroidal hyperpermeability, the presence of hyperfluorescent spots and locations in the mid-late phase of indocyanine green angiography, delayed choroidal arterial filling in the early phase of indocyanine green angiography (one disc diameter to larger areas with a geographical pattern) 12 and the pattern of RPE leaks on fluorescein angiography. Choroidal hyperpermeability was classified into patch (one or two disc diameters) and diffuse (larger than three disc diameters) types based on the size of the hyperfluorescence with blurred contours observed during the mid-phase of indocyanine green angiography.

Treatments and outcomes

All patients were observed for 3 months if there was serous neurosensory detachment of less than one disc diameter in size without RPE atrophy. In other cases, active treatments such as half-fluence photodynamic therapy or argon laser photocoagulation were considered.

Half-fluence photodynamic therapy with verteporfin (Visudyne, Charleston, South Carolina, USA) was applied to the area of choroidal hyperpermeability demonstrated by indocyanine green angiography. If discrete focal leakage points were located at more than one disc diameter away from the foveal centre, argon laser photocoagulation (MC-500 multicolour Argon Laser Photocoagulator; Nidek, Tokyo, Japan) was applied to the leakage point on fluorescein angiography. The endpoint of laser photocoagulation was to create a greyish burn by laser parameters of 0.1 s exposure time, spot size of 100–200 µm and 100–200 mW power.

Adjuvant treatment, such as an oral carbonic anhydrase inhibitor (acetazolamide, 100 mg/day), was administered at the discretion of the physician. Anti-VEGF therapy (a single intravitreal injection of 1.25 mg bevacizumab) has been used off-label in limited cases who met the following criteria: (1) lack of response to initial treatments such as photodynamic therapy, argon laser photocoagulation or adjuvant treatment including oral carbonic anhydrase inhibitors; (2) in cases where exudative pachychoroid neovasculopathy was not completely ruled out; and (3) occurrence of CNV subsequent to photodynamic therapy or argon laser photocoagulation.

Treatment outcomes were evaluated in three categories based on vertical and horizontal OCT images obtained 3 months after treatment. Complete resolution was defined as the complete absence of SRF (anatomical success), partial resolution as a reduction of >30% in baseline SRF height and no response as a reduction of less than 30% or an increase in baseline SRF height.

Statistical analysis

All statistical analyses were performed using SPSS software (V.23.0; SPSS). Categorical variables were analysed using Fisher’s exact test, the χ 2 test or linear-by-linear association for proportions. All continuous variables are reported as mean±SD and were compared using the t-test or Mann-Whitney test. Statistical significance was set at p<0.05.

Data from 525 eyes of 525 patients with active CSC at initial visit were collected. A total of 62 eyes were excluded due to a follow-up period of less than 6 months (32 eyes), the presence of CNV (2 eyes), 13 high myopia (13 eyes) and an epiretinal membrane (15 eyes). A total of 463 eyes of 463 patients (74.1% males, 25.9% females) were included in the primary analysis. Among them, 92 eyes (19.9%) were in the foveal atrophy group and 371 eyes (80.1%) were in the foveal non-atrophy group ( figure 1 ).

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Flow chart of the study design. CNV, choroidal neovascularisation; CSC, central serous chorioretinopathy.

The baseline characteristics of the two groups are presented in table 1 . The mean ages of the foveal atrophy and foveal non-atrophy groups were 53.2±8.3 years (range=32–68) and 48.7±9.3 years (range=23–84), respectively (p<0.001). Male predominance was more pronounced in the foveal atrophy group. The foveal atrophy group included 79 men (85.9%) and the foveal non-atrophy group included 264 men (71.2%) (p=0.005). The prevalence and distribution of symptoms differed significantly between the groups. 79 patients (85.9%) in the foveal atrophy group had decreased visual acuity at baseline, followed by metamorphopsia or micropsia in five patients (5.4%) and relative central scotoma in five patients (5.4%). In the foveal non-atrophy group, on the other hand, 136 patients (36.9%) had decreased visual acuity, followed by 89 patients (24.1%) with relative central scotoma, 74 patients (20.1%) with metamorphopsia or micropsia and 59 patients (16.0%) with blurred vision (p<0.001). The symptom duration, defined as the interval between symptom onset and first visit to any ophthalmology clinic, was 39.8±55.4 months in the foveal atrophy group and 4.9±8.1 months in the foveal non-atrophy group (p<0.001). The baseline and final BCVA was worse in the foveal atrophy group than in the foveal non-atrophy group (logarithm of the minimum angle of resolution, 0.43±0.33 vs 0.13±0.18, p<0.001; 0.41±0.32 vs 0.05±0.15, p<0.001, respectively).

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Baseline characteristics of patients with active central serous chorioretinopathy according to presence of foveal atrophy

Baseline tomographic characteristics are presented in table 2 . The central foveal thickness was thinner in the foveal atrophy group (89.9±20.5 µm) than in the foveal non-atrophy group (162.3±24.8 µm) (p<0.001). The baseline SRF height at the central fovea was 111.3±76.8 µm (range: 10–432) in the foveal atrophy group and 205.0±104.4 µm (range: 41–498) in the foveal non-atrophy group (p<0.001). The prevalence of disrupted ellipsoid zones (86.8% vs 13.6%, p<0.001), RPE atrophy (80.4% vs 17.3%, p<0.001), flat irregular pigment epithelial detachment (40.7% vs 18.7%, p<0.001), turbid SRF (33.0% vs 11.7%, p<0.001) and cystoid macular degeneration (7.7% vs 1.1%, p=0.002) was higher in the foveal atrophy group (representative cases, figures 2 and 3 ).

Baseline spectral-domain optical coherence tomographic characteristics of patients with active central serous chorioretinopathy according to presence of foveal atrophy

Representative case of a male patient in mid-50s with central serous chorioretinopathy with foveal atrophy. (A) colour fundus photography image showing pigmentary abnormalities. (B) The late phase of a fluorescein angiography image showing diffuse and vague leakage. (C) The late phase of an indocyanine green angiography image showing scattered punctate hyperfluorescent spots. (D) The shallow subretinal fluid (SRF) and foveal attenuation are observed in an initial optical coherence tomography image (SRF height=68 µm, foveal thickness=63 µm).

Representative case of a male patient in mid-40s with central serous chorioretinopathy in the foveal non-atrophy group. (A) colour fundus photography image showing serous detachment. (B, C) The late phase of fluorescein angiography and indocyanine green angiography images showing a smokestack leakage pattern without punctate hyperfluorescent spots. (D) The serous elevation is observed in an initial optical coherence tomography image (subretinal fluid (SRF) height=359 µm, foveal thickness=183 µm).

Baseline fundoscopic and angiographic characteristics are presented in table 3 . On the baseline fluorescein angiographic images, a diffuse or vague pattern (57 eyes, 65.5%) was the most frequent pattern of RPE leakage in the foveal atrophy group. In contrast, the most frequent pattern of RPE leakage in the foveal non-atrophy group was the inkblot pattern (68.5%, p<0.001). On indocyanine green angiography, choroidal hyperpermeability was present in 56 eyes (65.1%) in the foveal atrophy group and in 176 eyes (48.3%) in the foveal non-atrophy group (p=0.006). The number of clusters of the hyperfluorescent spot was 2.59±2.05 in the foveal atrophy group and 2.12±1.88 in the foveal non-atrophy group (p=0.033). The total area of clusters of hyperfluorescent spots was wider in the foveal atrophy group (13.31±13.49 mm 2 ) than in the foveal non-atrophy group (5.91±7.91 mm 2 ) (p<0.001).

Baseline fundoscopic and angiographic characteristics of patients with active central serous chorioretinopathy according to presence of foveal atrophy

Treatment modalities and outcomes are presented in table 4 . There were no significant differences in the initial and secondary treatment modalities between the two groups. However, the responses to the initial and second treatments differed between the two groups. In the foveal non-atrophy group, 338 eyes (91.4%) showed complete resolution after the initial treatment, followed by 26 eyes (7.0%) with partial resolution, and 6 eyes (1.6%) with no response. In the foveal atrophy group, only 50 eyes (57.5%) showed complete resolution after the initial treatment, followed by 29 eyes (33.3%) with partial resolution, and 8 eyes (9.2%) with no response (p<0.001). Complete resolution of SRF was achieved in 60.4% of eyes with foveal atrophy and 93.5% of eyes without foveal atrophy (p<0.001) at the final visit. In the eyes treated with photodynamic therapy, the consecutive decline in the average SRF height after photodynamic therapy between the two groups is shown in figure 4 . The average SRF height before photodynamic therapy was 117.4±74.5 µm in the foveal atrophy group and 197.9±100.4 µm in the foveal non-atrophy group (Mann-Whitney test, p<0.001). After photodynamic therapy, the average SRF height initially declined, but it had plateaued with a shallow height in the foveal atrophy group (28.2±34.2 µm in 1 month, 23.8±36.4 µm in 3 months and 29.3±40.1 µm in 6 months). On the other hand, it continuously declined during 6 months in the foveal non-atrophy group (15.7±37.2 µm in 1 month, 7.6±32.0 µm in 3 months and 4.8±22.8 µm in 6 months).

Treatment and response of patients with active central serous chorioretinopathy according to presence of foveal atrophy

(A) The average subretinal fluid (SRF) height at baseline and 1, 3 and 6 months after photodynamic therapy (PDT) between the foveal atrophy (69 eyes) and foveal non-atrophy (289 eyes) groups. At baseline, the average SRF height in the foveal atrophy group was significantly lower than in the foveal non-atrophy group (117.4 µm vs 197.9 µm). After PDT, the average SRF height continuously declined over 6 months in the foveal non-atrophy group (15.7, 7.6 and 4.8 µm at 1, 3 and 6 months, respectively) with 219, 241 and 275 eyes showing complete resolution of SRF at the corresponding time points. However, the average SRF height initially declined and then plateaued in the foveal atrophy group (28.2, 23.8 and 29.3 µm in 29, 33 and 38 eyes showing complete resolution of SRF at 1, 3 and 6 months, respectively). (B) Changes in best corrected visual acuity (BCVA) at baseline and 6 months after PDT between two groups. Compared with foveal non-atrophy group, the eyes in the foveal atrophy group show less improvement in vision after PDT.

Because the shallow SRF height noted in the foveal atrophy group could be related to longer symptom duration, a subgroup analysis in the foveal atrophy group was performed for the SRF height according to symptom duration. In 17 eyes with a symptom duration of less than 10 months, the SRF height was 95.59±48.66 µm. In 13 eyes with a symptom duration of less than 5 months, the SRF height was 88.08±28.88 µm. Regardless of symptom duration, the SRF height in the foveal atrophy group was consistently shallow.

The 463 eyes of the 463 patients included in this study had clinical, tomographic and angiographic findings consistent with active CSC as well as varying foveal thickness and SRF height. Approximately 20% of eyes with active CSC had foveal atrophy at presentation. Piccolino et al reported that the incidence of an atrophic outer photoreceptor layer in patients with CSC was 50% (14/28 patients) at presentation. 5 In Wang et al ’s study, 37.5% of foveal atrophy was observed after resolution of SRF. 6 There is no consensus on the OCT definition of foveal atrophy among studies. Furthermore, the definition of foveal atrophy in this study (central foveal thickness less than 120 µm) is quite conservative compared with previous studies, and the incidence of foveal atrophy was apparently lower than those in previous reports. The current study, with a relatively large study population, indicated that one-fifth of the eyes with active CSC already had foveal atrophy at presentation, which was not an infrequent occurrence.

Remarkably, the foveal atrophy group had a shallower SRF than the foveal non-atrophy group at presentation. Reduced anterior displacement of the neurosensory retina may cause the eye to become less hyperopic and minimise symptoms such as blurred vision, relative central scotoma and metamorphopsia. In this study, the foveal atrophy group had a longer symptom duration (mean: 39.8 months vs 4.9 months) and a higher rate of non-specific visual symptoms like decreased visual acuity compared with the foveal non-atrophy group before the first visit to any ophthalmological clinic. We suppose that persistent shallow SRF might leave active CSC undetected for a long duration, resulting in foveal atrophy. Thus, persistent shallow SRF is the most important and distinct characteristic of CSC with foveal atrophy, and this clinical feature influences the visual prognosis of these patients. Additionally, a high frequency of hyper-reflective dots, diffuse RPE atrophy, subretinal turbid SRF and cystoid macular degeneration are associated with SRF chronicity. 1 14–16

We suppose that persistent shallow SRF may be the cause of longer symptom duration and the resultant poor visual outcomes in the foveal atrophy group. However, one may raise question whether longer symptom duration itself could be a cause of shallow SRF in the foveal atrophy group. This does not seem to be the case because the shallow SRF height was also noted in the subgroup of eyes with short symptom duration among the foveal atrophy group.

Angiographic features between the two groups revealed that the foveal atrophy group showed a higher proportion of choroidal hyperpermeability and delayed choroidal arterial filling than the foveal non-atrophy group. Foveal atrophy in CSC is closely related to the ischaemic condition of the choroidal inner layer leading to RPE damage, and underlying choroidal hyperpermeability is thought to be a functional consequence of choriocapillaris attenuation. 3 The area of hyperfluorescent spots, which is considered a characteristic of choroidal vascular hyperpermeability in CSC, 17 was widely distributed in the foveal atrophy group. This might represent chronically increased intrachoroidal hydrostatic pressure and diffuse extensive RPE damage. 18 On the other hand, the presence of these findings may provide clues to clinicians for the management of patients with CSC at high risk of developing foveal atrophy.

Interestingly, CSC with foveal atrophy showed low treatment efficacy, although there was no difference in the therapeutic strategy between the two groups. In particular, alterations in the SRF height following photodynamic therapy differed between the two groups. The SRF height was lower in the foveal atrophy group before photodynamic therapy. However, residual shallow SRF was more likely to persist in the foveal atrophy group 3 and 6 months after photodynamic therapy. Poor baseline BCVA, disruption of the ellipsoid zone, cystoid macular degeneration, absence of intense hyperfluorescent areas on indocyanine green angiography and diffuse hyperfluorescent patterns on indocyanine green angiography are factors associated with ineffective photodynamic therapy. 14 19–23 It is worth noting that these factors are also characteristic of CSC with foveal atrophy. Because of the self-limiting nature of CSC, 24 25 clinicians might overlook the significance of persistent shallow SRF in active CSC with foveal atrophy. This study suggests that CSC with shallow SRF and foveal atrophy may necessitate active treatment rather than conservative treatment or observation, considering the poor visual and treatment outcomes.

Furthermore, the current study suggests that active intervention should be considered in CSC with non-fluctuating persistent shallow SRF, even before the incidence of foveal atrophy, especially if there are multimodal imaging findings of chronic CSC, such as diffuse leakage and pigmented atrophy. Many of the cases in our study involved patients initially observed without specific intervention and were later referred to tertiary hospitals after deterioration. Therefore, the potential significance of this study lies in promoting vigilance in managing patients with CSC who present with persistent thin SRF, with or without foveal atrophy. To reiterate the main conclusion of the study, treatment should be initiated in the case of active CSC diagnosed on multimodal imaging and the presence of shallow subfoveal neurosensory detachment. In contrast, in the case of a diagnosis of active (or inactive) CSC based on multimodal imaging and the presence of ‘high’ neurosensory detachment, a wait-and-see policy may be considered. Future studies are required to ascertain the value of early active treatment for CSC with persistent shallow SRF.

This study had several limitations. First, it was retrospective and conducted at a single centre with a predominantly Asian population. Additionally, treatment strategies were not standardised in the present study. Therefore, despite the rarity of chronic CSC with shallow SRF and foveal atrophy, further longitudinal and large-scale studies are warranted. Second, because most patients were referred from primary clinics, the results do not represent the overall cases of this disease. Third, there is a possibility that the SRF height on OCT may not reflect the peak SRF amount during the episode of CSC. Fourth, we were unable to collect OCT angiography images in all cases because of the recent introduction of this imaging modality. Thus, the presence of pachychoroid neovasculopathy with SRF could not be ruled out in those cases. Fifth, because many variables were analysed between the two groups in this study, the probability of a type 1 error in the statistical results might have increased. However, by applying conservative adjustments for multiple testing and assuming 45 comparisons, the significant p values were <0.0011, as determined using the Bonferroni method for multiple testing (0.05 divided by 45). Despite these stringent adjustments, most variables retained statistical significance, thereby validating the conclusions of the study.

Nevertheless, we have demonstrated the incidence of foveal atrophy in a relatively large number of patients with CSC. This study confirmed a close relationship between persistent shallow SRF in CSC and the incidence of foveal atrophy. Furthermore, CSC and foveal atrophy at first presentation were associated with poor visual and treatment outcomes.

In conclusion, CSC with foveal atrophy accounted for 20% of the active CSC cases at first presentation and was closely associated with persistent shallow SRF. In these eyes, treatment outcomes and visual prognosis were poor. Prompt and active treatment is required to prevent visual loss in patients with CSC with persistent shallow SRF and foveal atrophy.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

This study involves human participants and was approved by the Samsung Medical Center Ethics Committee (IRB file number: 2022-07-133) and adhered to the tenets of the Declaration of Helsinki (1964) and its later amendments. The board waived the requirement for informed consent due to the retrospective design of the study.

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Contributors KYS drafted and revised the manuscript and acquired and analysed the data. SH and JC revised the manuscript and analysed the data. SGL acquired and analysed the data. SWK designed, drafted, conceptualised, critically revised the manuscript and supervised the study. SJK designed and conceptualised the manuscript and critically revised it. SWK is the guarantor.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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InfoQ Homepage Presentations From Mainframes to Microservices - the Journey of Building and Running Software

From Mainframes to Microservices - the Journey of Building and Running Software

Suhail Patel discusses the platforms and software patterns that made microservices popular, and how virtual machines and containers have influenced how software is built and run at scale today.

Suhail Patel is a Staff Engineer at Monzo focused on building the Core Platform. His role involves building and maintaining Monzo's infrastructure which spans nearly two thousand microservices and leverages key infrastructure components like Kubernetes, Cassandra, Etcd and more. He focuses specifically in investigating deviant behaviour and ensuring services continue to work reliably.

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Patel: I want to spend a bit of time reflecting on this blissful era of computing we've had for running software and deploying software on the internet, and also maybe reflect together on whether that level playing field will continue. I'm going to start my talk with my conclusion. In the era of mainframes, we had a couple big players that offered all the hardware, and all the APIs, and the operating system, and all the software that came behind the scenes. The software that you developed on top of those mainframes was pretty much baked into their core. You might have used COBOL, or IBM assembly, or whatever, but the vendor tentacles were dug deep into your organization and into your practices, which effectively locked you in, and effectively, every couple years, you'd have to go to someone like IBM with a whole pile of money, and they had the upper hand. Over the last couple decades, we've had a massive explosion in the era of commodity computing. You can hop from provider to provider, choose to run your own servers, go with the cloud. Thanks to the magic of things like open source and portability. We've had a massive breadth of knowledge as well in the industry. We have this utopia where we have a lot of choice, and a lot of competition in the market. As our needs have gotten a lot more complex in how we develop software, there's really only a few big players that can power all the infrastructure to power all of our consumer needs. Effectively, our software is becoming a little bit less portable. Let's dissect that.

This isn't an old man yells at cloud talk. I earn my living on a day-to-day basis, thanks to the immense power and also the complexity of AWS. I'm employed because I get to break down that complexity so that others don't have to. I'm legitimately amazed at some of the scale that these systems operate at, and some of the systems we'll be talking about, we'll be diving a little bit deep into that scale. I grew up in the era of the LAMP stack, in the big PHP explosion. You could get a relatively cheap VPS or like a dedicated server, and run really popular websites and communities from very little bits of hardware. I like to think that that was the heyday of the internet. Our applications weren't as rich as they are now, but we still serve the masses on commodity hardware. The things I learned about building applications in that particular era have served me well in today's modern era, going deep into systems like MySQL and Postgres.

My name is Suhail. I'm a Senior Staff Engineer at Monzo. We're based in the UK. I work on the platform group at Monzo, where we focus on the underlying infrastructure. We want to make that infrastructure transparent to the engineers that build on top of it. I like to say, I really want our engineers to be focused on building a bank, and not have to worry about whether their platform is up and running. If you remember the magic of Heroku, that's the kind of experience that we aim to emulate, but more suited for a highly regulated environment. Monzo is a consumer facing retail bank in the UK, and also here in the U.S. We don't have any physical branches. All of our branches are on GitHub, as we like to remark. We power all of our banking features through a mobile app. If you've heard of Chime here in the U.S., we operate on a very similar model, but I think we have much nicer looking cards. The coral one specifically is really nice. In the UK, we have over 8 million customers. We are fully licensed and regulated.

Monzo - A Modern Banking Stack

You'll typically find me on the architectures or the microservices track here at QCon. Our whole philosophy at Monzo is to build infrastructure and also all the components that sit within our banking ecosystem using composable microservices. We are a consumer facing retail bank, so we got to have integrations with payment networks, and things like MasterCard and Swift. For example, on the screen are all the different services that we've built, that are involved in just handling a card payment, to do with checking your balance, checking whether your account is valid, doing financial crime control, and everything in between to actually make a decision. All these microservices that we build need to talk to external parties and databases and queues and a whole heap of other systems in order to make that decision. We need them to be quick and mega reliable, because we don't want you standing at Whole Foods waiting for a spinner to see if your card is being processed. We only have a very small-time window to make that decision. We've been going for about 8 years now. The intention right from the get-go was to build a modern banking stack. Naturally, when we were making that decision, we decided to go into the cloud. Many of the early engineers that founded Monzo, had worked in companies or even founded companies that were built on top of vendors like AWS and GCP, for all of their compute needs. That was a natural choice. Today, we take that for granted, especially in the financial space, at least in the UK. I'm pretty sure you have similar challenges here in the U.S. When we were getting started, it was unheard of. We were the first to go to the UK regulator and say we want to run a consumer facing retail bank on top of the cloud. The regulators were really focused on, where is your data center going to be located? Do you have physical access? Because they wanted the ability, if it was necessary, to come in and see the blinking lights on the servers, and probably hard disks spinning away. We had to make a really concrete use case that the physical access controls of AWS and GCP and all these other vendors were going to be much more reliable than what we could build internally. Things like CloudTrail and being able to do audit logging would be far more than the capabilities we'd be able to build, it'd be much more rigorous.

Many of us have seen the difficulties of maintaining old software. This is especially true, for example, for old mainframe software. Many of the engineers that developed these systems have retired and left the market. That expertise has reduced at a really fast rate, and is now a mega niche market. Then we have all of these critical systems that are depending on mainframes on a day-to-day basis. For example, the oldest mainframe system, according to the Guinness Book of Records, affects probably many people. It is the IRS tax filing system. It began life in the '60s as a mixture of COBOL and IBM assembly, and spans over 20 million lines in today's day and age, encoding all of the complexities of which there are, I'm sure many, of your wonderful tax code. There's a bit of a dispute on whether this is the oldest continuous running system that is only beat by the airline reservation system. Every time you see funky characters or the lack of Unicode, you can probably blame the fact that it's running on top of a mainframe.

Today's mainframes are pretty slick looking, with a ton of hardware and capabilities to boot. On the screen is an IBM z16, which is one of their most recent models. These are really powerful machines. You can have over 240 CPUs in one of these within one rack, 16 terabytes of RAM, many petabytes of storage. If you're working in, for example, my industry within financial services, you can do all of your card processing and financial transactions all within the one unit. I showcased a little bit earlier, all the different microservices involved, you can run all of that on this spectacular looking hardware. Arguably, it is a valid and legitimate approach, which is to handle all of that within one mainframe. You don't have things like network spanning multiple geographies to contend with. If you were choosing a software stack for today's day and age, would you choose to run one of these as a primary contender? Probably for the vast majority of folks, the answer is going to be no. At least within the financial services industry, the answer has been a universal no. As an industry, though, we've leveraged commodity computing for a number of decades. Here's a picture from the Computer History Museum here in San Francisco, and is one of the first Google server racks with 80 off-the-shelf PCs. It allowed Google to get started serving hundreds of thousands of queries just on this hardware. When you have a hard constraint on, for example, the number of servers and capacity, you build your software to take full advantage of the hardware. Right now, though, when we write software, you have the ability to spin up a virtual machine, a server that you don't see, in seconds, and pay a couple dollars, and spin that machine down. It's a billing model that allows for a lot of flexibility in today's modern day and age, unlike when the Google folks were getting started. There's no upfront procurement. There's no complex negotiations. There's no planning out your hardware if you need to get a mainframe. There's no racking you need to do. Has anyone ever racked a server? They are really heavy nowadays.

Warehouse Scale Computing

In 2009, a book was released called, "The Datacenter as a Computer," written by some Google fellows. It outlined a principle that we take for granted in today's world, especially when you look at a lot of the modern software that it's empowered, but is really important. Hardware and software needs to work in concert, treating the data center as one massive warehouse scale computer. This warehouse scale computing model really allows you to unlock some unbelievable amounts of scale. One of my favorite blog series is to see how AWS powers their Prime Day, and how Amazon powers their Prime Day. It perfectly illustrates multiple warehouses of computers working in concert, to run one of the biggest e-commerce events of the year. In the recent 2023 edition, they were processing 126 million DynamoDB queries per second, and over 500 million HTTP requests to CloudFront every minute. These are astronomical numbers. There's probably someone like, I can run this on a shoestring with a bunch of Cassandra servers. You still run into foundational limits on how far you can scale before you need to get into the guts of these particular open source systems, if you're going to run them, and optimize those to run best for your particular hardware. Most open source software can't assume a particular set of topology. They're built in a very generic manner.

These warehouse scale computing units have also unlocked new models of running systems beyond just running existing bits of software on our behalf. I am a databases nerd. I like to go deep into the world of databases. I showcase a little bit about the DynamoDB scale. There's another system that continues to blow my mind every time I use it, and it's Google BigQuery. BigQuery is like a data warehouse. It's been around for quite some time. You ingest your data into it or you supply a location of your data on like S3, or Google Cloud Storage, and it does analytics processing. It's like an OLAP style datastore. What is really remarkable to me is that you can run queries that are querying over petabytes of data, and they execute in minutes. If you are running a database system, even an OLAP based system off the shelf, can you query petabytes in minutes? I don't think so. Data storage is pretty much local to a lot of these systems. Whereas Google has built a model where they've been able to leverage their warehouse scale cloud or whatever they want to call it, and they've got a petabit network in between, so that they can make access between storage and compute really cheap. They're able to abstract the two things away. The key selling points of systems like BigQuery, and Dynamo, or you look at Lambda, or Cloud Functions, is that behind the scenes, there's no server for the consumer to manage. There's no fooling anyone, it is running on servers behind the scenes, but that's all massively abstracted away from you. There's this new model of compute. You pay for the computing on a unit of consumption basis. This model has worked extremely well. You look at companies like the BBC or Liberty Mutual. There's a really good book, "The Value Flywheel Effect," where they talk about being able to adopt cloud technologies, and having that accelerated through compute platforms like serverless. These services have been around long enough and are mature enough. There's a strong incentive from providers. For example, if you speak to your account manager at one of these vendors, they will give you a very financially lucrative deal with free data transfer between services, and they'll frame all of these buzzwords, reducing total cost of ownership, and taking away the undifferentiated heavy lifting.

I run our platform teams at Monzo, and we run and operate all the funky technology, so we've got Kubernetes, we've got Kafka. While I think that they are fantastic systems, admittedly, there is a massive opportunity cost in operating all of that complexity ourselves. I tell each and every one of our team members that joins especially within the platform group, that our goal is not to be experts in the latest detail within Kubernetes or Kafka. We operate those systems to serve our business needs. A core mission related to that is to abstract that all away from engineers and keep it really boring, so that they can really focus on empowering the business need. We're all in on AWS for all of our infrastructure, and they've been a really incredible partner. A question that I often get asked is, why do you not leverage managed services from vendors like AWS and GCP, like managed Kafka or managed Kubernetes, or what have you, especially given what I've just described around opportunity cost. In the financial world, at least within the UK, there was a significant focus right now from regulators on concentration risk. They're worried that there's a few players, where everyone has concentrated and that's going to harm the UK economy if one of those vendors goes down. For example, if eu-west-1 goes down, then it could take a large chunk of the UK financial economy with it, which wouldn't be great for the UK. They're worried that there's a concentration on a handful of providers. For us, it was really easy to comply with this regulation that is coming out, because we've invested in running open technologies.

Debuggability

Beyond data and vendor lock-in, I personally have two other core reasons why I like working with open technologies and tried to stay away from managed solutions as much as I can, especially for our core competencies, for me is debuggability and performance. I'll talk about debuggability first, because I want to go a little bit deeper into the performance realm. When you have control over your stack, you get to deeply investigate and influence the murder mystery. You have control over the outcome. When the interface boundary crosses over to a service that is not within your control, that becomes significantly harder, because the best you can do is submit a support ticket, and hope you get a reasonable response on the other end, and just chalk it off as the cost of doing business. Again, I am not anti-managed services or solutions or whatever, but this is a strong consideration that is often not part of the conversation. At scale, your skill set with the shifts from operating the service yourself, to becoming really intimate with the managed service, to try and decipher and almost reverse engineer its inner workings. There was a really good article about 15 years ago from the ACM, called the tail at scale. It goes deep into the factors that influence, for example, tail latency variability. There are some really interesting things in the article talking about hardware component variability, and hedged requests, when you send a request again, as a form of speculative execution. A key highlight for me is this concept that they admit, which is the scale and complexity of modern apps is quite significant. Services make it infeasible to eliminate all latency variability. If you need that really tight latency guarantee, that's something that they can't really provide. You probably see this in practice. Try and get your provider to give you a latency SLA, where they will give you a financial payout if they're not able to meet that SLA. It's going to be next to impossible. That's not unreasonable to any degree. These systems are running on tens of thousands of machines spread across multiple geographies, hundreds of thousands, maybe in the millions, nowadays, when you total it all up. If you look at software yourself, these things are running multi-tenanted systems, that's the only way that they are financially viable. They're running at massive scale. For them, an individual server or something going down that is hosting you as a tenant, is just a minor blip on their radar, because they're looking at the service in aggregate.

Performance

Let's talk a little bit about performance. A core thing that I'm interested in, and actually probably a lot of vendors are interested in, is extracting more compute out of your existing infrastructure, or even reducing your infrastructure footprint. There was a really fantastic Intel report that I read a couple months back, which stated that 50% of greenhouse gases are due to infrastructure and software inefficiency in the data center. It's rather ironic coming from Intel because that inefficiency effectively makes them money because they sell more chips. That figure on the outset seems really high. Think about the software that you run at your organization. When you think about runtime overheads and virtualization overheads and compute overheads, that inefficiency does accumulate, and you get a sense of how that 50% might come about. In 2005, there was an article that was written, titled, "The Free Lunch Is Over," by a folk called Herb Sutter. The article talked about the slowing down of Moore's Law, and how drastic increases in clock speed couldn't paper over our software inefficiency. Reading it in retrospect is like a crystal ball into the present. No matter how fast processors get, software consistently finds a new way to eat up that extra speed. If you make a CPU 10 times as fast, software will find 10 times more things to do. We've become accustomed to the world of infinite compute. I was talking a little bit earlier about being able to provision hundreds if not thousands of instances and being able to scale them down. That's a luxury that we're in right now. Most of our software has been designed to just scale ever upwards and outwards, without a ton of regard for performance per unit of compute that we're utilizing.

A lot of us have this perception, either through lived experience, or from literature or something that we read or our peers, that running systems at scale involves lots of hardware, especially in the modern day and age, which can be a massive pain to manage. With modern hardware paired with modern software, that doesn't necessarily need to be the case. Take, for example, solid state drives. This technology became a commodity and it gave a massive speed injection to our software. I remember putting an SSD into my laptop probably about 10 years ago, and just seeing Photoshop boot up within a couple seconds. It was remarkable. When a lot of the modern systems that we run nowadays, like your Postgres's, and your Kafka's, and things that were designed, they were designed for the world of hard drives: spinning platter, spinning rust. It was a completely different set of tradeoffs. To read an item from disk we talk about milliseconds, for the read-write head to get into the right place, and to get your data. With SSDs, that reduced by an order of magnitude, and even with the NVMe drive nowadays, that is now in the nanoseconds realm. Again, with throughput, we'd have a hard drive that would saturate its throughput by about 200-ish megabytes per second. Now with NVMe drives, you can blaze past that, multiple gigabytes a second. I think I saw an NVMe drive a couple months back, that was over 7 gigabytes a second, which is ludicrous speed. Even in the world of CPUs, we still see 10% to 15% gains on clock speed. While we're not living the beauty of Moore's Law, cumulatively we're still able to extract significant performance on a per core basis. It's not just about adding more cores and more threads. Even if we go deep into CPUs, if you're looking at cache sizes, like L1 and L2 caches. I've plotted a graph of some of these increases over time, especially if you're running instances on the cloud, these are machines that are on AWS, the probability of a cache hit can have a massive influence on the speed and the reliability of the application, reducing the amount of CPU cycles that you're spending. As a quick refresher, an L1 cache hit is 200 times more faster than going to main memory.

In 2012, there was a publication on latency numbers that every programmer should know. Many pieces of core software that we have run on a regular basis reminds us of the fact that these latency numbers exist. They need to be firmly in the back of your mind. It's interesting to see how just in the last decade, these numbers have come dramatically down, and this trend continues to go downwards. We've seen CPU caches get larger, networks get significantly faster, and arguably much more reliable, and hard disk get both much larger and much faster. In the world of software, for a long amount of time, many of these hardware improvements have been free upgrades. You stuck an SSD into it, your application got remarkably faster. An NVMe drive, it got even more faster. We've also now gotten new APIs that we should be looking at and leveraging, which vastly take advantage of modern hardware. Take, for example, io_uring. Historically, in the world of Linux, async I/O has been pretty complicated. You can get into a world where, for example, buffers were full, or the I/O wasn't quite matching what your file system was expecting. Or you'd filled your disk request queue, which meant that that fire and forget asynchronous call that you'd made, had become synchronous and blocking. There's a lot of memory overhead too with using async I/O APIs, especially if you're doing lots of small requests, if you're writing lots of small bits of data, there was a lot of overhead. io_uring provides a new interface, a new set of APIs at the kernel level with Linux based systems, which addresses a lot of these problems. This is merged into the mainline, it's ready to use. Just to show the difference in performance in effect, here's a chart of random reads and writes at a 4-kilobyte block size. If we're using the standard Linux I/O operations, there's really a cap on the number of operations that we can handle before all of our resources are starved. The chart on the bottom there, shows a massive delta in reads and writes. It questions this notion that disks and hardware is the constraint. It begs the question whether our software is actually taking advantage of the hardware that it's provisioned on. These benchmarks, for example, were all done on the same system, the only difference was the API that was being used.

The Rapid Development of Programming Languages

The world of programming languages, if we take, for example, has seen rapid development. You've got new languages that are coming into the fray. You got Rust. I think there's going to be a couple talks on Zig as well. Previously where you'd have to resort to writing C or C++ to get close to the metal, which is difficult and error prone, and if you're working in certain industries, undesirable, now you've got all of these memory safe and easy to write languages. You've got all of these system programming languages. It's becoming safer and much more delightful. The barrier to entry arguably is much lower as well. Even languages that a lot of us use on a daily basis are getting remarkably better. Java 21 recently got released, and it was a long-term support release. There's been big support on language features, for example. Things like virtual threads, which are very similar to coroutines, or fibers, or goroutines. Something I got really excited about a couple months back is the ZGC garbage collector, that has been in Java for quite some time. Its goal is to give sub-millisecond pause times for your heap. I enabled this for our Kafka clusters in production, and I saw the pause time just drop off a cliff and tail latency drop off a cliff. This isn't a distant reality, this is production ready, today, and folks are using it in production. For those of us who are programming, or writing Java applications, these pause times have a dramatic effect on the experience that we're able to serve. We're able to unlock all of these new capabilities by leveraging all of these features. What I find when I speak to a lot of people is that they're reluctant to do so, there's a level of inertia on making these changes.

Here's a little bit of a hot take. Most of the systems that me and you and everyone build are just glorified data processers. We take some data on one end, we do some processing, and we put it somewhere else on another end, and we do that repeatedly, ad infinitum. There's a lot of low-hanging fruit in that layer as well. For example, I imagine if you take a profile of your systems, you're going to find JSON parsing as a significant contributor, deserialization and serialization. There are things happening within the software world. There's a project here that I've put on the screen called simdjson which takes advantage of CPU instructions that have been there for decades, and leverages those to make JSON parsing significantly faster. This is a drop-in for many programming languages, and you could switch over really quickly.

Rearchitecting

A core inspiration for this particular talk, in general, was this particular blog post from some engineers who work on Amazon Prime Video. Just to give a little bit of a backstory, they had a particular tool that they wrote to detect Prime Video serves, like very similar to Netflix. Serves a bunch of video content, some popular shows. They had a tool which would analyze video to find audio sync issues, and to flag them for analysis. This service, when they originally architected it, as you will do probably within Amazon, was using things like Lambda and AWS Step Functions, and things like that. Which meant that they didn't have to worry about the infrastructure behind the scenes, they were able to be very elastic with their infrastructure. These services were built to run small units of lag and are massively parallelized by running lots of them simultaneously. This meant in the Prime Video example, they were running multiple transitions within the Step Function for every single second of the video stream. Every single second was being analyzed individually, and they had a metadata coordinator to stitch it all together. They had written a bunch of microservices that orchestrated and corralled everything and made sure that it all fit together. What they found is that this proved to be really costly for them. Because, for example, they were doing a lot of back and forth on S3 using as intermediate storage since these machines didn't have any local storage. The Prime Video team rearchitected the application, and they moved away from serverless Step Functions and onto a fleet of, in this particular instance, containers that would listen to jobs and run the same work. They migrated to a monolith-based architecture. All in all, they managed to save 90% in cost and compute time. Through the rewrite the system is also more scalable. When this blog post was released, the internet went haywire. I think it was one of the most popular posts on the orange website, and had a lot of comments. Many decried the demise of serverless and managed platforms, it was all a lie. They probably chanted on the streets of SF, "Bring back the monolith." What I saw here is a really healthy decision to rearchitect, and they had the ability to do so. They weren't getting the benefits of serverless platforms when they look at it in retrospect, so decided to change their architecture to better suit their needs. I think this is a perfect example of the ability to still retain control. They leveraged these managed technologies to get started and to provide the initial value. When they decided that the tradeoff wasn't quite worth it, they were able to rearchitect pretty swiftly.

There are some more extreme examples of this. There are articles where companies are like, we're completely abandoning the cloud. Those things always generate a whole bunch of noise. There was this article by 37signals, which are the folks that run Basecamp and HEY. They're undertaking a massive migration away from AWS for cost and performance reasons, into their own self-managed data centers. There's always two divisive groups when these sorts of articles come out. There's a group that decries all the complexities of the cloud. There's another group that stands and thinks, how are you going to recreate all this functionality that you get within the cloud? Why would you self-host? That's all undifferentiated heavy lifting. What about all these servers that you need to provision? It's a really interesting discussion every time one of these articles come out, because as software engineers and practitioners, we'll probably all agree when we say that stuffing in software architecture isn't a binary option. The beauty with what we have with writing and building and operating software is that we have this control, this level of portability, to be able to make these decisions and go back and forth, assuming that time and cost and complexity allows for.

Coupling of Open Source Frameworks

One interesting phenomenon I've seen is the coupling, for example, of popular open source frameworks, with the owing organization. It's making it really easy to be able to deploy onto their own bespoke platforms. This practice isn't really new. If you are an open source maintainer, it's not a very financially lucrative position. You typically need to be backed by some company or organization that is supporting you, from a financial perspective. Many would argue that the frameworks being open source is a net positive for the community, regardless of the intertwining of the platform features into the open source framework. I'm presenting this because I recently spoke to a bunch of young engineers that are dipping their toes into the world of web development, and things like React.js, and Next.js. For them, they were talking about the developer experience of deploying onto the Vercel platform. Nothing else was in consideration because they could run a couple commands, it was all integrated within their toolkit, and they were able to get up and running in a very small amount of time. I mention this, because it's pretty typical, especially in our industry, to learn your production operation chops, while on the job. It's not something that you really get taught at college or at university. If we're building this generation of engineers that are able to just offload it to another provider, they're not learning that skill.

On the flip side, the world of open core and open source system continues to grow significantly. This screen, which is the cloud native landscape gets ever larger, you can't fit it onto one slide in any legibility, which is nice. It encapsulates a lot of really cool projects. It's setting precedence in the industry at pace. Many of these are mature projects that you can drop into your systems and gain significant leverage. I think the key thing is that by leveraging technologies like these, your software remains portable. Being the owner of infrastructure and application runtimes can be a really hard and sometimes a thankless job. I'm sure, collectively, we've got some war stories that we tell in hushed tones about how production went down. Wouldn't it be nice if we never ever had to deal with that? The key consideration here is the feature set and cost capacity. We aren't really imposed on any particular platform or we don't want to be imposed on any particular platform. We could choose to move our software with minimal effort by continuing to run it ourselves.

Advances in GPUs and TPUs

That trend might be rapidly changing. Unless you've been living under a rock, I'm sure many of you folks have heard about the advances in large language models. The entire space is massively fascinating. I am not smart enough to talk about what is going on behind the scenes. I'm massively curious about what's happening in the industry, especially from a hardware perspective. Let's start with the painful bit first. These cards that you need to have in order to run the training and inference in any reasonable amount of time, are really expensive. They're tens of thousands of dollars each. That's if you can get your hands on one in the first place. NVIDIA is pretty much the only vendor who will sell you one, because they only have the suitable product in the market. There was some research that was published a couple years back about GPT-3. It mentioned that it took nearly 10 compute years to train the 175 billion parameter model. Microsoft built an entire supercomputer cluster just for OpenAI, the folks behind ChatGPT, with 285,000 CPU cores and 10,000 of those NVIDIA graphics cards just for OpenAI to train for GPT-3. There's a lot of compute that is needed, and that number only continues to go one way, which is up. Since 2017, Google have been working on their equivalent of the NVIDIA graphics cards. They've got their own Tensor Processing Unit, which is also built for the AI acceleration platform that they provide. They're on their fourth iteration, which is reportedly up to 1.7 times faster and up to two times using less power than the NVIDIA alternative. Even AWS has their own AI acceleration platform called Trainium. On the one hand, it's really awesome to see these advances in hardware, and the integration between Tensor hardware and being able to leverage platforms like AWS and Google Cloud. These have direct connectivity, and you can run them as a super cluster. They have really fast interconnects. For us, as consumers, very crucially, you can rent these by the second. You can spin them up, run a whole bunch of inference and then spin them down, and you aren't out of pocket by tens of thousands of dollars. So far, these chips are playing really nicely with frameworks like PyTorch, and TensorFlow, but naturally, there will be purpose-built capabilities that are only inherent in these particular pieces of hardware, that are not available in hardware in the open market. That's going to either be implicitly or explicitly surface, which will affect the efficiency and the functionality of the software that you write on top.

It's not like you can go to your favorite auction website and actually buy a TPU to deconstruct it. This is custom silicon. It's purpose-built. Once it is retired, it's probably shredded, or sat in some server farm somewhere. You can rent it by the hour on GCP or AWS. If you want to run these within your own data centers, or clusters, you're pretty much out of luck. Let's put some of the scale that these systems are being run at into perspective. I found this truly remarkable. AWS recently just announced that they've got 20,000 of these really advanced NVIDIA GPUs that they've clustered all together. The downside is that if you want to rent one of these GPUs, a cluster of 8 is going to cost you a pretty $70,000 a month. If you want to train your own foundational models, you're going to need a couple hundreds of these instances unless you want to wait 10 compute years. This is a huge area of innovation. Every day, you hear about new companies building new ideas, and building stuff with AI and LLMs, is AI everything nowadays. The vast majority of them are built on top of the same set of foundational models. If you have really deep pockets and you know your account manager extremely well, you might have a fighting chance of being able to join the building your own foundational model space. For the rest of us, unfortunately, there's just too much compute that is required, and there are other priorities for a lot of these other vendors. They are building their own custom silicon.

AWS recently announced that they're partnering with Anthropic, the folks who make Claude, to give them access to AWS hardware. What this surfaces is that all the big providers have partnered with an AI company, effectively. Google are working on Bard, and Microsoft have partnered with OpenAI, Amazon with Anthropic. Part of these partnerships is access to specialized compute hardware. This is where the battleground is. It stands to reason that they would get preferential pricing or preferential access to these hardware, which makes it an increased barrier to entry for the common people, for me and you. It's not all doom and gloom. For example, you've got Llama, which is a model that is open, built by the folks at Meta. There's a really popular C++ implementation, which you can actually run on a MacBook. It's not going to have nearly as many parameters as you do within GPT, but it at least gives us a fighting chance of understanding the space and innovating, continuing to contribute to the ecosystem. As engineers, if you're familiar with building software, we can contribute too. There was an excellent pull request not too long ago, which, for example, tweaked the file format to use Nmap which led to a huge 100 times improvement and a reduction in memory, which is usually the big bottleneck, by half. This was a relatively small change, it wasn't a trivial change, but they were able to make the change. It led to a massive speedup. Old tricks that a lot of us are probably familiar with, with Nmap and memory alignment can still yield massive benefits.

I showed at the beginning of the talk that the portability of our software is diminishing, as it's becoming interlinked with the platforms that they are running on. These platforms are increasingly becoming singular to a specific vendor and relying on specific bits of hardware. Any hope of running it yourself is diminishing really rapidly. This can have really drastic consequences for cost and performance and price leverage in the market. It's not all doom and gloom, though. Every day, it has become easier, especially both through managed services and self-hosted services, as well, to deploy production ready systems that can serve the masses at scale. Where historically our systems were portable between providers and services, we're in a world where our computing needs are becoming ever vast. There's really only a handful of providers with bespoke hardware and software and the capacity and the scale to serve our needs. It's really easy to start relying on these systems, even by accident. When you realize, for example, a system like BigQuery can handle petabytes of data, what are you going to do? You're going to generate petabytes of data, you're not going to reduce your data consumption. It's really easy to get into that world accidentally, without understanding the implications, and especially lose the ability to move away. Don't let the identity of your system be tied into a particular service. There's a fine line between leveraging all of these managed services in order to build and serve your customers, versus locking yourself into a particular vendor. As I showcased a little bit earlier, there is, if you have an underperforming system, a lot of really cool tricks that you can pick up and deploy probably within one business day, that will mean that your application that is running currently will get a massive speedup.

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Recorded at:

May 22, 2024

Suhail Patel

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