2. Creativity, Limitations, and Constraints

In Chapter 3, we take a look at the first steps in the preparation stage. Before we do, let’s take a step back and consider something you may not usually think about when preparing a presentation: creativity. You may not think of yourself as being creative, let alone as a creative professional like a designer, writer, artist, and so on. But you should, because developing presentation content—especially content to be delivered with the aid of multimedia—is a creative act.

Most of the students and professionals I meet in classes and seminars around the world say that they are not very creative. Some of this is modesty no doubt, but I think most adults genuinely believe this. They have convinced themselves that creative is just not a term they would use to describe themselves. And yet, these are adults who do well in their jobs and generally have happy and productive lives. How is it that they believe they are not creative or that their jobs do not require high levels of creativity? On the other hand, if you ask a room full of young children if they are creative, you’ll see just about every hand go up.

Pablo Picasso said that “all children are born artists, the problem is to remain an artist as we grow up.” The same can be said for creativity. You were born creative, and you still are that creative being today, no matter what your career path. There are many ways to express your creativity, and designing and delivering an effective presentation is one way to do so.

Creating presentations can be a supremely creative process. The process requires imagination and intuition as much as it necessitates analytical and logical thinking; and design does matter. Who said that business and creativity were mutually exclusive? Is business only about managing numbers and administration? Can’t students become better business leaders tomorrow by learning how to become better design thinkers today? Aren’t design thinking, design mindfulness, and creative thinking valuable aptitudes for all professionals, regardless of their discipline or particular task at hand?

Once you realize that preparing a presentation is an act requiring creativity—not merely the assembling of facts and data in a linear fashion—you’ll see that preparing a presentation is a whole-minded activity requiring as much so-called right-brain thinking as it does left-brain thinking. Although your research and background work may have required much logical analysis, calculation, and careful evidence gathering, the transformation of your content into presentation form will require that you exercise both sides of your brain, so to speak. Presentation is a holistic-thinking activity that requires thinking in pictures as well as words. We need an eye for detail, but we also must never lose sight of the big picture.

Start with the Beginner’s Mind

Zen teachings often speak of the beginner’s mind or child’s mind. Like a child, one who approaches life with a beginner’s mind is fresh, enthusiastic, and open to the vast possibilities of ideas and solutions before them. A child does not know what is not possible and so is open to exploration, discovery, and experimentation. If you approach creative tasks with the beginner’s mind, you can see things more clearly, unburdened by your fixed views, habits, and what conventional wisdom says something is (or should be). One who possesses a beginner’s mind is not burdened by old habits or obsessed about “the way things are done around here” or with the way things could have or should have been done. A beginner is open, receptive, and more inclined to say “Why not?” or “Let’s give it a shot,” rather than something like “It’s never been done” or “What will others think?”

When you approach a new challenge as a true beginner (even if you are a seasoned adult), you need not be saddled with fear of failure or making mistakes. If you approach problems with the expert’s mind, you are often blind to the possibilities. Your expert’s mind is bound by the past; it is not interested in the new, different, and untried. Your expert’s mind will say, “It can’t be done” or “It shouldn’t be done.” Your beginner’s mind will say, “I wonder if this can be done?”

If you approach a task with the beginner’s mind, you are not afraid of being wrong. The fear of making a mistake, risking an error, or being told you are wrong is constantly with us. And that’s a shame. Making mistakes is not the same thing as being creative, but if you are not willing to make mistakes, then it is impossible to be truly creative. If your state of mind is coming from a place of fear and risk avoidance, then you will always settle for the safe solutions—the solutions already applied many times before. Sometimes, the path already taken is the best solution. But you should not follow the path automatically without weighing its merits—and drawbacks—against your alternatives. When you are open to possibilities, you may find that the most common way is the best way for your particular case. However, this will not be a choice made by habit. You will choose based on reflection and in the spirit of a beginner with fresh eyes and a new perspective.

Children are naturally creative, playful, and experimental. If you ask me, we were the most human when we were young kids. We worked on our art, sometimes for hours without a break, because it was in us, although we didn’t intellectualize it. As we got older, fears crept in along with doubts, self-censoring, and overthinking. The creative spirit is in us now; it’s who we are. We just need to look at the kids around us to be reminded of that. Whether you are 18 or 98, it’s never too late, because the child is still in you.

“In the beginner’s mind there are many possibilities, in the expert’s mind there are few.”

—Shunryu Suzuki

Presentation Is a Creative Act

Creative power and creative imagination are not only for the artists of the world—painters, sculptors, and so on. Teachers also need the power of creativity. So do programmers, engineers, scientists, and doctors. You can see the application of creative genius in many professional fields. Remember, it was a group of brilliant and geeky-to-the-core NASA engineers on the ground who were able to jury-rig a solution to the life-threatening buildup of carbon dioxide in the damaged Apollo 13 spacecraft back in 1970. Their heroic fix—literally involving duct tape and spare parts—was ingenious improvisation; it was imaginative and creative.

Being creative does not mean wearing a black turtleneck and hanging out in jazz cafés sipping cappuccinos. It means using your whole mind to find solutions. Creativity means not being paralyzed by your methods and knowledge, but being able to think outside the box (sometimes very quickly) to find solutions to unforeseen problems. This kind of situation requires logic and analysis, but also big-picture thinking. And big-picture thinking is a creative aptitude.

Back down here on earth, the seemingly mundane business of a conference presentation, designed and delivered with the help of slideware, can be a very creative thing. A presentation is an opportunity to differentiate yourself, your organization, or your cause. It’s your chance to tell the story of why your content is important and why it matters. It can be an opportunity to make a difference. So why look or talk like everyone else? Why strive to meet expectations? Why not surpass expectations and surprise people?

You are a creative person—probably far more creative than you think. All people should work toward tapping into their creative abilities and unleashing their imaginations. If You Want to Write by Brenda Ueland (Graywolf Press) is one of the most inspiring and useful books I have ever read. The book was first published in 1938 and probably should have been titled “If You Want to Be Creative.” Her simple yet sage advice is of interest not only to writers but to everyone who yearns to be more creative in their work or to help others get in touch with their creative souls (this goes for programmers and epidemiologists, as well as designers and artists). This book should be required reading for all professionals and especially those aspiring to teach anyone about anything. The following are ideas inspired by Brenda Ueland that we should keep in mind when preparing for a presentation or any other creative endeavor.

Take a Chance

Ah, the big lie we tell ourselves: “I am not creative.” Sure, you might not be the next Picasso in your field. Then again, who knows? But it doesn’t matter. What matters is to not close yourself down too early in the exploration process. Failing is fine; it’s necessary, in fact. But avoiding experimentation or risk—especially out of fear of what others may think—is something that will gnaw at your gut more than any ephemeral failure. A failure is in the past. It’s done and over. But worrying about “what might be if…” or “what might have been if I had…” are pieces of baggage you carry around daily. They’re heavy, and they’ll kill your creative spirit. Take chances and stretch yourself. You’re only here on this planet once, and for a very short time at that. Why not just see how gifted you are? You may surprise someone. Most importantly, you may surprise yourself.

This is a slide from one of my talks on 21st century education. The quote is from Ken Robinson’s TED Talk “Do Schools Kill Creativity?” (2006).

Be a Lion!

Inspiration. Where can you find it? You can find inspiration in a million places, in a million ways—but probably not in your same old routine. Sometimes, you can find inspiration in teaching. When you teach someone something important to you, you are reminded of why it matters, and the enthusiasm of the student—child or adult—is infectious and energizing. Ueland says, “I helped them by trying to make them feel freer, bolder. Let her go! Be careless, reckless! Be a lion. Be a pirate!” You know it’s important to be free, free like children are. You just need to be reminded of that occasionally.

Do Not Force It

Idling—doing nothing—is important. Most of us, myself included, are obsessed with getting things done. We’re afraid to be unproductive. And yet, the big ideas often come during periods of “laziness,” during those episodes when we may feel that we are wasting time. People need more time away from the direct challenges of work, such as taking long walks on the beach, jogging through the forest, going for bike rides, or reading a book for four to five hours in a coffee shop. During these times, your creative spirit is energized. Sometimes you need solitude and a break to slow down so that you can see things differently. Managers who understand this and give their staff the time they need (which they can only do by genuinely trusting them) are the secure managers—and the best managers.

Embrace Your Enthusiasm

Put your love, passion, imagination, and spirit behind your work. Without enthusiasm, there is no creativity. It may be a quiet enthusiasm, or it may be loud. It doesn’t matter, as long as it is real. I remember a co-worker’s comment on a successful long-term project of mine: “Well, you have enthusiasm, I’ll give you that.” He didn’t realize that it was a backhanded compliment. These are the people who get us down. Life is short. Don’t hang out with people who dismiss the idea of enthusiasm, or worse still, with those who try to kill yours. Trying to impress others or worrying about what others may think of your enthusiasm or passion should be the last thing on your mind. In the immortal words of Richard Feynman: What do you care what other people think?

Dr. Ross Fisher

Consultant Pediatric Surgeon,
Sheffield Children’s Hospital, Sheffield, England


In recognition of his contributions to the field of presentation skills and medical education, the College of Surgeons and Physicians of Canada appointed Ross the Harry S. Morton Visiting Professor in Surgery in 2019.

Presentations are fundamental to medical education. Huge volumes of information are “delivered” in lecture halls and medical conferences, but the uncomfortable truth is that little of that information is actually retained. This is not due to a lack of care or effort on the part of the presenter or the audience, but due to the very construct of presentations. Understanding the principles behind effective presentations will significantly improve medical education and, by extension, patient care.

The majority of medical presenters are not taught, they merely copy imperfect, albeit established, approaches. Fueled by a respect for tradition and a desire to conform to expected practices, they perpetuate a flawed presentation style, one which has rendered countless hours of medical education ineffective. This cycle needs to stop; the flaws must be repaired.

To me as a surgeon, researcher, and educator, the discovery of Presentation Zen was eye-opening, leading to fundamental changes in my approach to medical education and the development of the p cubed concept of medical presentations. The changes are simple; the effects are dramatic.

As clinicians we need to construct presentations that facilitate learning, rather than data delivery. An overload of facts does not equate to an abundance of learning.

An effective presentation is made of three component parts: the story (p1), the supportive media (p2), and the delivery (p3) of these. The value of a presentation is the product of these three factors—the p cubed value.

The media used to support such presentations must be illustrative and supportive, but should never be a script, images of the handout, or the source of apology. Text-heavy slides are educationally counterproductive and actively hinder retention of information. If your audience is struggling to read, understand, and record the text on the slides, they can’t fully attend to and absorb what you’re saying. Don’t let your media (p2) get in the way of your delivery (p3). Complex information should be provided as a handout, not on the screen.

Medical presentations highlight many bad presentation habits such as: tiny end-note references, pictures of journal articles, and copying of data tables and graphs directly from articles. Ubiquity is not evidence of efficacy and understanding the differences between printed and performed media is fundamental to improvement of your delivery (p3). Similarly, the presenter that actively engages an audience and displays enthusiasm for a message is an essential factor in the improvement of medical presentations.

Ross Fisher presenting on stage in London in 2019 at the Don’t Forget the Bubbles medical confrence. You can find this talk and many others on the conference website: dftb19.com.

Educational and psychological science hold the keys to improving medical presentations. Rejecting outmoded approaches, constructing presentations for learning, rather than data delivery, and speaking with passion and enthusiasm will facilitate more effective learning and by extension improved patient care and outcomes.

“The presenter that actively engages an audience and displays enthusiasm for a message is an essential factor in the improvement of medical presentations.”

—Dr. Ross Fisher

When forced to work within a strict framework the imagination is taxed to its utmost—and will produce its richest ideas. Given total freedom the work is likely to sprawl.

—T.S. Eliot

The Art of Working with Restrictions

A few years ago, I saw a great presentation in Osaka by my friends Jasper von Meerheimb and Sachiko Kawamura, both experienced designers. They spoke about the issue of restrictive conditions put on creative projects and how these can actually lead to inventive solutions. They talked about how to develop concepts and implement them under such constraints as limited time, space, and budgets. For professional designers, creating great work under a thousand constraints and limitations imposed from the outside is simply the way the world of design works. Whether constraints are good or bad, enabling or crippling, is irrelevant; constraints are the way of the world. Still, as John Maeda points out in The Laws of Simplicity (MIT Press, 2006), “In the field of design there is the belief that with more constraints, better solutions are revealed.” Time, for example, and the sense of urgency that it brings, are almost always constraints, yet “urgency and the creative spirit go hand in hand,” says Maeda.

Using creativity and skill to solve a problem or design a message among a plethora of restrictions from the client, the boss, and so on, is old hat to designers. They live it. Daily. However, for the millions of nondesigners with access to powerful design tools, the importance of constraints and limitations is not well understood. For those not trained in design, the task of creating presentation visuals (or posters, websites, newsletters, etc.) with today’s software tools can make users frustrated by the abundance of options or giddy in anticipation of applying their artistic sensibilities to decorate their work with an ever-increasing array of colors, shapes, and special effects. Either condition can lead to designs and messages that suffer. What you can learn from professional designers is that (1) constraints and limitations are a powerful ally, not an enemy, and (2) creating your own self-imposed constraints, limitations, and parameters is often fundamental to good, creative work.

Self-imposed constraints can help you formulate clearer messages, including visual messages. In the various Zen arts, for example, you’ll find that careful study, practice, and adherence to strict guidelines (constraints) serve to bring out the creative energy of the individual. For example, haiku has a long tradition and strict guidelines, yet with much practice one can create a message (in 17 syllables or less) that captures both the details and the essence of a moment. The form of haiku may have strict rules, but the rules are what can help you express your own “haiku moments” with both subtlety and depth. In Wabi Sabi Simple (Adams Media Corporation, 2004), author Richard Powell comments on wabi sabi, discipline, and simplicity as they relate to such arts as bonsai and haiku:

PechaKucha and the Art of Constraints

PechaKucha is a global presentation phenomenon started in 2003 by Tokyo-based expatriate architects Mark Dytham and Astrid Klein. (PechaKucha is Japanese for “chatter.”) PechaKucha is an example of the changing attitudes toward presentation and a wonderfully creative and unconventional way to make a presentation with the aid of slides. The PechaKucha method of presentation design and delivery is very simple. You must use 20 slides, each shown for 20 seconds, as you tell your story in sync with the visuals. That’s 6 minutes and 40 seconds. Slides advance automatically, and when you’re done you’re done. That’s it. Sit down. The objective of these simple but tight constraints is to keep the presentations brief and focused and to give more people a chance to present in a single night.

PechaKucha Nights are held in more than 1000 cities from Amsterdam and Auckland to Venice and Vienna. The PechaKucha Nights in Tokyo are hosted in a hip multimedia space, and the atmosphere on the night I attended was a cross between a cool user group meeting and a popular night club.

If nothing else, the PechaKucha method is good training and good practice. Everyone should try PechaKucha—it’s a good exercise for getting your story down even if you do not use this exact method for your own live talk. It doesn’t matter whether you can replicate the PechaKucha 20 x 20 6:40 method in your own company or school; the spirit behind it and the concept of “restrictions as liberators” can be applied to almost any presentation situation. This method makes going deep difficult. But if a good discussion arises from a PechaKucha type of presentation, then it may work well even inside an organization. I can envision having college students give this kind of presentation about their research followed by deeper questioning and probing by the instructor and class. Which would be more difficult for a student and a better indication of their knowledge: a 45-minute recycled and typical slide presentation, or a tight 6:40 presentation followed by 30 minutes of probing questions and discussion? On the other hand, if you can’t tell the essence of your story in less than seven minutes, then you probably shouldn’t be presenting anyway.

Check out the PechaKucha website to find a PechaKucha Night near you.


“Do only what is necessary to convey what is essential. [C]arefully eliminate elements that distract from the essential whole, elements that obstruct and obscure…. Clutter, bulk, and erudition confuse perception and stifle comprehension, whereas simplicity allows clear and direct attention.”

Life is about living with limitations of one type or another, but constraints are not necessarily bad. In fact, constraints are helpful, even inspiring as they challenge us to think differently and more creatively about a particular problem. While problems such as a sudden request to give a 20-minute sales pitch or a 45-minute overview of research findings have built-in limitations—such as time, tools, and budget—we can increase our effectiveness by stepping back and thinking long and hard. We can also determine ways to set our own parameters and constraints as we prepare and design our next presentation with greater clarity, focus, balance, and purpose.

As daily life becomes even more complex, and the options and choices continue to mount, crafting messages and making designs that are clear, simple, and concise becomes all the more important. Clarity and simplicity are often all people want or need—yet it’s increasingly rare and all the more appreciated when it’s discovered. You want to surprise people? You want to exceed their expectations? Then consider making it beautiful, simple, clear… and great. The greatness may just be found in what you left out, not in what you left in. It takes creativity and the courage to be different. Your audience is praying that you’ll be both creative and courageous.

In Sum

  • Preparing, designing, and delivering a presentation is a creative act, and you are a creative being.

  • Creativity requires an open mind and a willingness to be wrong. Approach the task with the beginner’s mind.

  • Restrictions, constraints and limitations are not the enemy; they are a great ally and can lead to greater creativity.

  • Consider the PechaKucha method at least as a form of exercise to help you refine your message. You can find a PechaKucha Night event near you at: www.pechakucha.com.

  • As you prepare a presentation, exercise restraint and always keep these three words in mind: simplicity, clarity, brevity.

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