My Road to Conquering Public Speaking

As a medical student and resident you will most certainly be required to present cases, morning reports, journal clubs, and other academic conferences. If you are an average guy like me (or woman) the thought of public speaking is anxiety provoking. Well, it used to be for me. Here’s how I overcame that paralyzing fear, diaphoretic, clammy hands, blinders on the eyes, and a shaky voice (borderline vasovagal / syncopal).

One of my first jobs out of grad school was for a small not-for-profit organization in NYC. I was responsible for building a program for youth who were one step away from incarceration. It was a tough crowd but, frankly, that was the easy part. At my first job performance review my supervisor was very pleased with the infrastructure that I built and the relationships that I had developed throughout the company, including the Depts. of Probation, Education, and the Juvenile Courts. She then asked a question I was not prepared for: “How many group speaking engagements have you completed to educate the community and my new contacts about the services?” I was floored! I could recall everyone I spoke to, all the policy and procedures I created, the staff I began hiring and training. I built a team that was mobilized in less than 90 days. I did not remember that public presentations were part of my review (at least I thought I could hide it with all the other wonderful things I accomplished).

While overall my performance was impressive there was a need to have public speaking engagements. It was not enough to meet with the heads of each departments and judges but there was a need to educate their people. WOW! I had a great evaluation with one major area in need of improvement: Public Speaking.

In the coming days I spoke with my supervisor and expressed my fears in the hopes of getting some guidance (or an exemption was more like it). No such luck and it was now my responsibility to figure it out. After a little research I found a program that was pretty well known. A week later I was registered for a 4 - hour workshop on public speaking.

I made it to the seminar. So here was my choice: Take my normal spot in the back of this enormous room or get engaged by taking this one head on in the front of the room. Well, I decided to sit up front not to mention the back of the room was already full. The room was packed with about 200 people and I really wanted to hear this guy. Plus, I wasn’t sure what was on the agenda.

As the seminar progressed we were divided into small groups of 10-15 people. A spokesperson was needed for each group. I ended up raising my hand partly because everyone at the table was looking for someone other than themselves and partly because I had to figure this thing out. So I volunteered to lead a group at a table exercise. Besides, group activities and table top exercises were no big deal. Much to my surprise, I quickly learned that the group leaders responsibility included a very public and “really” videotaped (yes this was some time ago with VHS) presentation. Well, I survived, barely. But what was amazing was we were given an added benefit of reviewing our recordings with one of the trainers, in private, and came away with some really amazing tips. I’ll share some of my favorites:

  • Lead in Statement – This is the attention grabber. Should be a fact, statistic, or a joke. Whichever it is make it yours and sound natural.
  • Hold something – in the beginning I used to hold a pen and pretended it was like a pointer. As I became more comfortable I used my hands in an expressive manner. This helped control the nervous energy that I had. By channeling it to the pen and then my hands I was no longer rocking back and forth
  • If you are wearing a suit keep your jacket buttoned. Essentially it conveys an image of professionalism and authority. Since you’re in charge of the presentation you have control of the room.
  • Body movement – it’s OK to walk around but do not rock back and forth. That’s a sure sign of nerves and usually indicative of a psychiatric patients’ self-stimulating. See my comment about holding a pen until you orient yourself to the stage.
  • Eye contact – look around take it all in because the room is actually listening to you. This lets you connect with people and you will begin to see them nod in agreement.
  • Rehearse – yes you should review your presentation until it feels right. But I have found that also preparing answers to a few anticipated questions will help you gain some confidence. There is nothing more anxiety provoking when a member of the audience asks a question and you stare at them like a “deer in headlights.” Questions are good because it shows people were actually listening. Give your presentation a trial run (or 2 or 3 times) to a colleague. This will help with any holes in the presentation, get comfortable with the information and understand what some questions might arise. Obviously, it helps to know what you’re talking about. Very few talented/gifted folks can get up in front of a room “cold” and start speaking.
  • Video – OK this is a little corny. But truthfully if you want to see what you look like before getting in front of an audience record yourself practicing. This is the best way to see your non-verbal movements (in some folk’s manic gesticulations) and the sound of your voice. Pay attention to these tips when you review it. It wasn’t until I saw myself on video that I really appreciated how I appeared. You don’t need any fancy equipment. Use your phone to record. The video doesn’t lie but your friends, family, and colleagues might to spare your feelings. Once you see it, then can you correct it.

Remember nerves are normal and everyone gets anxious. Public speaking is one of the tougher ones to overcome because of “performance anxiety.” The fear of public embarrassment and that you may not know what you’re talking about or that the group is smarter than you. True you might be challenged, but your audience is there because they want the information in your head. Just have a conversation with them and it will start to flow.

Over the years I was expected to lecture and present in front of groups of 100s. Many of these groups were physicians and for me that was intimidating. But at the end of the day they are in the audience to hear you and learn something. It was these tips that helped me overcome this fear. Although I must admit that I still get a little nervous energy: Except now I use it to feed my performance.

So whether you’re a medical student, medical resident, business person or seasoned veteran of your field, I hope that this helps you be better prepared for that next presentation. Remember, a little work upfront pays dividends in return. So get out and present. I’d love to have feedback. Please share your story.


As always, comments and suggestions are welcomed.  If you have an idea for future topics please share and we can collaborate.

Michael Farca served as a residency program coordinator for the Department of Medicine at one of the largest training programs in the country.  He became the Department Administrator with continued oversight of the residency program, 2 primary site fellowships and 3 rotating fellowships.  Michael has dedicated over a decade to graduate medical education and is board certified in Teaching Administrators for Graduate Medical Education (C-TAGME).