Public speaking for surgeons

Abstract

Our surgical coach gives advice about mastering the skill of public speaking.

Do you dread speaking in front of people? Are you betrayed by a shaky voice or hands, or do you panic that you’ll forget your words? Do you have lots of questions but never put your hand up to ask them at a conference?

Surgeons speak in front of people all the time: informally, in surgical briefs and multidisciplinary meetings; and more formally, at conferences, viva exams and interviews. Whether we can represent ourselves, pass on information and instil confidence1 matters, in delivering our day job as well as to our professional reputation and career progression.2 Nevertheless, 87% of surgeons experience performance anxiety3 and a third of the population experience disabling anxiety when speaking in public.2 This article explores why we struggle to stand up and speak in front of others, and suggests strategies to both help us feel more comfortable in the spotlight and optimise our communication once we’re there.

Part 1: Getting up There and Holding It Together

We are closer to our ancestors than we think. It's a moot point exactly when humans diverged from chimps (let's say 6 million years ago) and yet 85% of us still have the palmaris longus muscle, which we used for forelimb weightbearing and which can be harvested without deficit. Evolution is very slow. We have not yet evolved to live how we do now but rather how we did thousands of years ago, in small, exposed communities, where our social standing really was a matter of life and death. Exile meant vulnerability to predators, enemies and the environment, and less efficient hunter-gathering, cooking and child rearing. Situations involving social evaluation, like public speaking, can therefore feel threatening and elicit a stress response, with all its physical, emotional and cognitive components.4

We can reduce our stress response by starting as regulated as possible, reducing the perceived threat level and managing ourselves in the moment (Figure 1, Table 1).

Figure 1 Manage your stress response by starting as low as possible on the curve, reducing the perceived threat and regulating yourself in the moment. Modified from Cooper L, 2025.4

Situations involving social evaluation, like public speaking, can therefore feel threatening and elicit a stress response, with all its physical, emotional and cognitive components

Part 2: Communicating Information and Helping Your Audience Remember It

The aim of public speaking is to communicate something about a topic and about you, and for that to be remembered. How can you shape what you say (and how you deliver it) to maximise information transfer and retention, and your personal impact? Box 1 contains ideas on how to structure a memorable presentation while Table 2 outlines suggestions to command your audience's attention and optimise learning.

Common Question: I’m Fine Delivering What I’ve Prepared but What if I’m Asked a Question That I Can’t Answer?

Work hard on your topic and presentation to be as informed as possible. Identify the question you are most scared of and answer it in your presentation. Plant the seed for three questions you want the audience to ask. Put your script into an artificial intelligence service and ask it to generate difficult questions from the point of view of your specific audience. Work on potential answers but if you don't know, be humble and honest: “I don't know the answer to that – thank you – I’ll find out and get back to you.” Interrogate the thought behind your anxiety around answering perfectly (e.g. “I must know everything”) and consider an alternative (e.g. “My goal is to optimise learning”). From this point of view, the trickier the questions, the better!

Reflection

Emotions are fuelled by thoughts and beliefs.9 However, we aren't our thoughts and just because these thoughts arise, it doesn't mean they’re real. If you’re anxious about public speaking, what's the thought behind the anxiety? What is true about it and what isn't? What evidence do you have either way? Are there any cognitive distortions like all-or-nothing thinking (“If this doesn't go well, I’m a complete failure!”) or mindreading (guessing what others are thinking)?14 What different thought might be more supportive? For example, what might you tell a good friend? Table 3 gives some examples of cognitive restructuring.