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Wednesday, May 18, 2011

PowerPoint bulleted list theorem (Why we should not use long bulleted lists)

Most of us associate PowerPoint with lectures in large darkened halls with many slides of bulleted lists accompanied by a droning voice. So what is wrong with the bulleted lists in PowerPoint? I was preparing to conduct a workshop on PowerPoint and Education and found some theoretical basis for why we should not use bulleted lists when presenting. As you see, I do use them freely in documents.

[Author's Note: This is presented as a theorem just to make it interesting. It is just my very simplistic interpretation of work done by many people and better presented elsewhere. See the references at the bottom. Readers should refer to the Atkinson, Mayer reference below for an excellent and more detailed description of these concepts. My hope here it to get readers interested both the cognitive theories related to this topic and the practical applications of these.]

Some of the biggest advantages of using tools like PowerPoint are:
1) use of multimedia elements,
2) integration with audience response systems,
3) creating branching/non linear presentations based on audience needs,
4) more legible text, clearer images,
5) ability to re-purpose/reuse material from other presentations (can be dangerous), and
6) options for distribution and sharing.

Thus, it is quite obvious, why PowerPoint (and other technology) is used so much in education. It is very important to remember the steps for using technology in learning:
1) understand how people learn,
2) think about how educators can facilitate this learning process, and
3) then think about how technology can help improve this facilitation process.

When we keep these three steps in mind while designing our presentations, it will lead to better use of PowerPoint. When the presentation "fails" it is most likely because we ignored one or both of the first 2 steps and jumped straight into the technology (PowerPoint).

Compare this bulleted list in PowerPoint:


To this:



Statement:
Using bulleted lists while narrating during presentations is detrimental to students' learning.

Axioms:
--Working memory (formerly called short-term memory)
---Processes incoming data/information
---Connects it with existing knowledge/wisdom
---Encodes it into long-term memory

--Working memory has limited capacity to process information
---It has two separate channels
----verbal/auditory input
----visual input
---Each channel has a limited processing capacity
---Text is processed by both visual and verbal channels (you know now where this is going, right?)

--Meaningful learning requires substantial amount of cognitive processing in both channels
---Select and pay attention to incoming data
---Organize the data
---Integrate it with prior knowledge


Argument:
Information presented in a manner that overloads the processing power of the Working Memory makes learning difficult.

Bulleted lists which are multiple concepts presented as text are processed by both the visual and verbal channels.

When you start talking around these lists, the words you speak are processed by the verbal channel.

The audience struggles:
--to correlate the text on the screen with the words you speak
--to grasp which bullet you are talking about
--to decide whether to just read the slide or listen to you talking

This struggle is not germane to getting a deeper understanding of the presented material. It actually takes away from the learning process.

Conclusion:
Presenting (long) bulleted lists while narrating during presentations is detrimental to learning.

Quod erat demonstrandum!

Corollary1:
While narrating in a presentation, showing an appropriate image on the screen is better than showing a bulleted list. This leverages the dual channels to facilitate learning.

Corollary 2:
Putting both an image and a lot of text on a single slide is detrimental to learning. This can overwhelm the visual channel.

References:
Working memory (Baddley and Hitch) [PubMed][Wikipedia]
Dual Coding Theory (Paivio) [PDF article][Wikipedia]
Cognitive Load Theory (Sweller) [EduTech Wiki]
Select Organize Integrate Theory (Mayer)
Cognitive Theory of Multimedia Learning (Mayer and Moreno)
List of learning theories at Learning-theories.com
Richard Mayer's full text article [PDF]
5 ways to reduce PowerPoint overload (Atkinson and Mayer)

Neil Mehta MBBS, MS, FACP, practices internal medicine at a large tertiary care hospital in Ohio. He is also the Director of Education Technology (Academic Computing) for his medical school and in charge of his hospital system's home grown Learning and Content Management System. He is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management. This post originally appeared at Technology in (Medical) Education.

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2 Comments:

Blogger Toni Brayer, MD said...

Wow. I need to revise my ppt that I'm giving to the board tomorrow.The problem is it is easier to make bullet points than to do all of those graphics. I agree with your analysis.

May 18, 2011 at 12:35 PM  
Blogger Neil said...

Toni thanks for the comment. I find that using the Smart art (in PowerPoint 2007 or 2010) and clip art gets me most of the graphics I need. The graphics in the blog post were created using SmartArt. Hope that makes it easier.

May 18, 2011 at 10:16 PM  

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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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