Patient Care, Training

Powerful Points: How to develop effective training presentations

Issue 9 and Volume 34.

Microsoft PowerPoint is used 1.25 million times per hour across the world. In EMS, it’s used in almost all the training we do, from instructing EMTs and paramedics on new treatment protocols to demonstrating manipulative skills used on the fire ground. We also see it used pervasively at our conferences.

The trouble is that EMS instructors and speakers usually don’t have formal training in presentation development or delivery. They have the technical knowledge and skills to use the software, but lack the ability to create and deliver a compelling presentation.

Use Visuals to Your Advantage

What makes a presentation “compelling”? We know it’s not crowded slides or speakers who read all the bullets (also known as “death by PowerPoint”). But there’s an obvious need to better understand what makes these presentations effective in the classroom. We compared learning outcomes in EMS training using two styles of PowerPoint in an informal study. This article explains the study and offers advice for EMS instructors and speakers with the goal of improving the overall state of PowerPoint presentations in their classrooms and in the field.

Other, more general PowerPoint studies found it has the potential to increase learning. That’s the good news. The bad news is that not just any type of PowerPoint presentation will lead to better learning. A recent study compared multimedia (text and pictures) presentations to bullet-point (text only) presentations by evaluating the test scores of 170 communication students. After students were given multimedia presentations, scores improved 3% on a knowledge retention (or memory) test and 10% on a knowledge transfer (or application) test. The presentations used in this study were based on specific multimedia principles that had been shown to improve learning.

We used these multimedia principles in our informal study in San Mateo County, Calif. The study compared the knowledge retention test scores of firefighters receiving pandemic flu training. A total of 105 EMT and paramedic/firefighters received the training, 47 with a bullet-point presentation and 58 with a multimedia presentation. Those who received the training with the multimedia presentation scored 4% higher on the test (86% versus 82% correct).

The San Mateo County study showed that slideshow presentations can be designed and delivered in a manner that increases learning. To achieve this result, presentations need to be designed in a simple, consistent manner that leverages multimedia content. More specifically, they need to follow the principles of multimedia learning.

An Eye (and Ear) for Learning

The principles are based on a theory called the Cognitive Theory of Multimedia Learning, developed by Dr. Richard Mayer, a professor of psychology at the University of California, Santa Barbara who has authored 20 books and 250 articles. His theory states that students learn better when presented with both words and pictures because people process information in two channels, visual and auditory. To increase learning, the objective is to maximize the capacity of both channels without overloading either. The specific principles are designed to maximize capacity and minimize cognitive overload. The multimedia principles are coherence, signaling, redundancy, and spatial and temporal contiguity.

The coherence principle asserts that learning is improved when multimedia presentations are free from extraneous information, such as tangential stories, background sounds, fancy slide transitions or text animation. The signaling principle dictates that learning is improved when attention is focused on important parts of the presentation with cues given to highlight key material, such as clear headlines and slides that preview the material to be covered. The redundancy principle explains that learning isreducedwhen information is redundant, such as reading text aloud that is also shown on a slide. The spatial contiguity principle argues that learning improves when words are placed near relevant pictures, and the temporal contiguity principle means learning improves when related (not redundant) narration occurs simultaneously with relevant pictures or text.

Five multimedia principles can make the difference in learning and are worth incorporating into PowerPoints designed by EMS and fire service professionals. The next logical question is how a presenter learns these techniques.

The Complete Package

In Beyond Bullet Points,Cliff Atkinson proposes a new way to create presentations based on Dr. Mayer’s multimedia learning theories. Atkinson outlined three elements for creating PowerPoint based on the multimedia principles: 1) Respect the limits of working memory, 2) Address both the visual and verbal channel, and 3) Guide attention.

The Beyond Bullet Pointsapproach respects the limits of working memory by breaking up the presentation into visually obvious pieces and limiting each slide to one concept with a clear headline and a supporting visual. It addresses both channels by requiring each slide have a text headline and a graphic, with the narration of the slide in the notes section. Finally, it guides attention with declarative headlines and visual “chunking” of the entire presentation. Get more information at

You can get started now on improving your PowerPoint presentations and helping your audience learn more. Here are five quick tips that encapsulate the multimedia learning principles.

When in doubt, leave it out:To adhere to coherence principle, anything that isn’t related to a particular slide shouldn’t be included. A funny but unrelated story about dinner at the firehouse will only reduce learning. The same goes for sexy graphics with moving parts and thrilling music. Unless it’s directly related to the material on the slide, it causes cognitive overload and defeats your purpose as a presenter.

Use a cue:Your audience will follow your presentation if you use a cue or signal at the beginning, end and any time you make a transition during your presentation. A cue is a slide that outlines your presentation and reminds the audience where you’re going and where you’ve been. Preferably, it’s a graphic representation, pictures or an organization tree, and not bullet points. By using the signaling principle, the audience will retain more of the information you’re sharing.

Tell the story:Presentations should be primarily pictures with one complete, declarative sentence on each slide. No bullet points. Bullet points should only be used to help the presenter remember what to say. Put these in the notes section of the presentation and deliver them orally. You’ll avoid redundancy if each slide has one sentence and one to three relevant pictures. Give the audience a few seconds to read the sentence and look at the picture, and then tell the story behind that slide. Your audience will be more likely to remember your key points.

If it’s related, keep it integrated:Labels for graphs should be on top of or very close to the actual graph. If you show a picture of a piece of equipment, put the name of the equipment right next to the picture. Describe a picture or scenario only when the audience can view it–not before or after. This will incorporate the spatial and temporal contiguity principles.

Use the black screen:A helpful and underused function of most projector remote controls is the black screen button. To bring the audience’s attention away from the PowerPoint and back to the speaker midway through a presentation, simply black out the screen. This allows you to use PowerPoint as an adjunct, not as a crutch. Using the “black screen” function also helps you adhere to the redundancy and contiguity principles, allowing you to discuss an item in detail or run a practice drill without the distraction of an unrelated slide in the background.


Using the multimedia learning principles will improve your presentations, starting now with the five quick tips. We live in a visual age where the effective use of visual presentations is expected. But so many presenters fail to effectively use it. We bore our audiences, fail to communicate effectively and reduce learning. Now that research has shown how PowerPoint can help audiences retain and apply the information, every EMS instructor and speaker can create and deliver concise and compelling presentations. Only after doing that can instructors present their knowledge and experience in effective presentations that maximize the learning experience. JEMS

John J. Kammeyeris the EMS division chief of Central County (Calif.) Fire. He’s responsible for the training, safety, and protocols of more than 300 firefighter/paramedics in six cities. He’s an American Heart Association regional faculty member for ACLS, BLS and PALS, and he teaches fire science courses at the College of San Mateo.

Jennifer M. Kammeyeris a communication scholar and consultant. She helps leaders improve communication skills and teaches the fundamentals of communication at San Francisco State University.


This article originally appeared in the September 2009 issue of JEMS.


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