Medicine Science

A field guide to biomedical meeting creatures, part 1: Any questions?

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgOrac is currently away at the ASCO meeting in Chicago. Shockingly, he was so busy that he didn’t bother to write anything last night. Fortunately, he found something from the archives that’s perfect for this occasion. This was originally written in 2005 on the “old’ Respectful Insolence blog and then reposted in 2006. That’ means if you haven’t been reading at least three and a half years, it’s new to you. It’s also related to scientific meetings. Hmmm. This reminds me. I really should update this or do more installations in the saga, even if five years late. If you have any ideas, leave ’em in the comments.

I’m back at home. The meeting went fairly well and my talk was well-received.

Surgical meetings are odd beasts. Although they are similar in some ways to other medical and basic scientific meetings, they tend to be much more formal. For example, all the men wear suits and ties (or at least a tie and a good sportsjacket) and the women all wear business suits. You’d never see that at a basic science meeting, where even many of the speakers don’t dress up all that much. (Heck, I once speculated that, if I were to wear a suit to a basic science meeting, people would probably think I was the concierge or something.) I doubt even internal medicine meetings are so formal, although I’ve never been to a medical meeting that wasn’t surgical, with the exception of the AACR, which is in reality a hybrid medical-basic science meeting. Everything else about surgical meetings tends to be formalized, as well.

In any case, in observing a number of talks and in giving my own, it occurred to me that a little-appreciated art is that of dealing with people who will inevitably ask questions after you’re done with your talk. It’s a tough thing, as the people who come up to the microphone to ask questions sometimes have agendas that aren’t always immediately apparent, agendas that often don’t include simple curiosity about your results. You must also realize that, while you can and should control the content and delivery of your talk, you cannot control what comes after. You can only try to be prepared for it. I’m guessing my observations will not be unique to just surgical or medical meetings (although I suspect the distribution of types of questioners will vary between basic scientific meetings and medical meetings).

In my experience, I have noticed that there are several distinct subspecies of questioners who will come up to the microphone to grille you after you’ve given a scientific or medical talk. I have not experienced them all personally at my talks, but I have observed them all over years of going to such meetings. So, I introduce here part 1 of an occasional series on going to biomedical meetings and the creatures you might encounter here. I’ll probably add another followup (or two) to the series after I go to the AACR meeting in April…

So, without further ado, here they are, the questioners:

  1. Moderator. It’s the Moderator’s job to be sure to come up with a question or two to ask the speaker, to prevent embarrassment if no one from the audience is sufficiently interested to ask questions. As such, the questions that come from the Moderator will be highly variable in quality, ranging from uninterested and ill-informed to nice softball questions that you can hit out of the park to very inciteful. If you only get questions from the Moderator, you have to worry that no one was sufficiently interested in your talk to ask questions. Either that, or you can reassure yourself that your work was so far above the audience that no one understood it. It might even be true–but probably not.
  2. Sycophant. Sometimes a plant (or, at least, I sometimes suspect they’re plants), the Sycophant is someone who will come up to the microphone, and, before asking a softball question, effusively praise the quality of the work just presented. I have actually seen a talk by a colleague of mine in which a Sycophant was so extreme in his praise that it embarrassed the hell out of the speaker. (I need to arrange for one of these for myself someday.)
  3. Pontificator. Whenever you see someone come up to the microphone and say something like, “I have two comments and three questions,” chances are very high that you’re dealing with a Pontificator. The Pontificator will generally blather on about the topic for a long time, sometimes even to the point where the moderator will, in the interests of keeping the session on schedule, sometimes feel compelled to cut him off and ask him what his question is. You see, the Pontificator isn’t really interested in asking a question about the research. He is interested in making his point about this particular topic to the large audience afforded him by the scientific talk. Often he is an opinionated senior scientist or surgeon, but not always. Sometimes he is an opinionated junior faculty looking to become an opinionated senior scientist or surgeon. If the Moderator will not intervene, there’s really nothing you can do about a Pontificator, other than wait for him to blow over and then thank him for his comments. (Try not to let your clenched teeth alter your voice too much.)
  4. Show-Off. Closely related to the Pontificator, the Show-Off is not so much interested in getting his opinion out but rather in showing the audience just how knowledgeable he is about the topic at hand. The Show-Off will therefore quote obscure journal articles (sometimes intentionally making the speaker look foolish for not being familiar with them) and ask very detailed, but often largely irrelevant, questions. The best tactic for dealing with the Show-Off is to thank him for making you aware of that article in the Uzbekistan Journal of Applied Dermatology and promise that you will look it up right away.
  5. Rival. If your talk was about a topic that is hotly debated in the medical world, you’d best be prepared for this species of questioner. The Rival’s goal is not so much to shed light on the topic, but rather heat. Usually, he has done research on the same question you have and quite often he has come up with a very different conclusion. It’s possible that he had another talk at the meeting. It’s also possible that his abstract didn’t get accepted for a talk and he is pissed off about it. The Rival’s goal is to pick your work apart. He will frequently ask confrontational questions and attack any perceived weakness in your study, although sometimes he will take the unctuous route, praising your work before sticking the knife in your back. If you see several Rivals lining up at the microphone after your talk, it’s definitely a badge of honor in that they took your work seriously enough to feel challenged (and therefore the need to respond). However, it’s also a sign that you’ll be in for a rough question-and-answer session. This is the one time when it’s OK to do what it takes to hold your own, even if it occasionally means being a bit bellicose yourself (although the suave, smooth put-down is way more effective, if you are able to pull it off). Just try not to sink to their level.
  6. Conniver. Closely related to the Rival (and in fact, often a Rival using a different tactic or an ally of a Rival), the Conniver is interested in finding out how much further you’ve gotten with your research than what you’ve presented and what you are doing now. He is not interested in this because he is curious, but rather because he or his friend/ally is working on the same thing. The Conniver is looking for an edge. He wants to know your research strategy and if you are on the verge of scooping him. (Either that, or he has a bigger lab than yours and could, with sufficient information, take your results and beat you in publishing the next study.) Consequently, he will often ask highly detailed and technical questions far outside the understanding of the majority of the audience and try to find out what new findings you’ve made since submitting your abstract for consideration. The best way to deal with a Conniver is to be as vague as possible in your answers. Don’t give him too much information.
  7. Me-Too. This beast is probably more common at the more clinical meetings than at basic science meetings, in my experience, mainly because there are often multiple clinical trials and studies going on that examine the same topic. Also closely related to (or the same as) the rival, the Me-Too will get up after the presentation of the results of a clinical trial and ask questions in which he is very obviously trumpeting the results of his own clinical trial on the same or a related question. He will take particular care to try to show how his methodology was superior to yours or how his conclusions more valid. If his results disagree with yours, he will ask you why your results differ from his. If his results largely agree, he will still manage to find flaws in your methodology or question some of your subsidiary findings. He will be very upset if you are not familiar with his work. (He may already be upset that his abstract was not accepted and yours was.) It’s therefore very important to be aware of all the other clinical trials that have been done or are under way in your area and to know why yours is better (if it is better, that is).
  8. Clueless Wonder. I never understand why these people get up and ask questions. The clueless wonder is someone who is very obviously not knowledgeable at all about the topic of the talk. However, Clueless Wonder will still get up and ask either a question so basic that everyone in the audience knows the answer to it or a question that obviously has nothing whatsoever to do with the topic at hand. I remember one example of such a questioner who used to attend Grand Rounds every week when I was a resident. (I realize that Grand Rounds is not really a scientific meeting, but the Clueless Wonder is–alas!–not limited to just national scientific meetings.) He was a very old surgeon (I guessed he was at least in his 80’s) and retired. I suspected that he went to Grand Rounds just to help keep his mind active and to be social, a very laudable thing to do, as far as I’m concerned. (If I make it to my 80’s, I hope to do the same thing someday.) He seemed very sharp mentally if you engaged him one-on-one in conversation. What wasn’t so laudable is that he would almost always stand up after each Grand Rounds and, in a very proper British accent, ask the most inane questions imaginable, often at great length. The goal here is to try to answer the question without looking as though you are making fun of the Clueless Wonder–sometimes a difficult task indeed.
  9. Nonsequitur. Distinguished from the clueless wonder by the fact that he actually appears to understand the material somewhat, Nonsequitur will nonetheless ask questions that have little or nothing to do with the talk just given. The best tactic is to try to answer the question, but there are times when you might be forced to confess (politely, of course) that you don’t see what he’s driving at.
  10. Oh Shit! This is the most dreaded questioner of all, and the reason for his name will become obvious. Oh Shit! will ask a question that unerringly and devastatingly reveals a huge flaw in your experimental or clinical trial methodology (often this flaw is that you forgot what should have been a very obvious control in your experiment or a very obvious control group in your clinical trial), a huge deficiency in your data or statistical analysis, or a gaping hole in your argument. Worse, it’s usually a huge flaw that you never thought of or thought you had papered over successfully. There is no way to deal with Oh Shit! gracefully. Preemption is the only strategy that works, because if Oh Shit! successfully holes your talk below the waterline, there is no recovery. It will sink. You must therefore make sure your study or experiments don’t have any flaws that Oh Shit! can point out, and you must be completely familiar with every weakness in your study design and data, so that you can explain or justify it if necessary.
  11. Appropriate. This is perhaps the most uncommon questioner of all. Appropriate asks an entirely appropriate, interesting question about your data, one that does not insult the intelligence of the audience or speaker and–better yet–one that you can answer well. It may be a challenging (but not too challenging) question, or it may be an interesting take on your data that leads you to think of cool new experiments or studies to do. Be grateful when Appropriate appears.

As you can see, there is more to giving a scientific talk than just giving the talk. As always, hope for the best (the Sycophant or Appropriate) but prepare for the worst (Rival or Oh Shit!), and you will be able to make the most of the opportunity (or at least minimize the damage if you are unfortunate enough to attract the worst).

I wonder how many of my colleagues will recognize these creatures and whether they can suggest more. The floor is open!

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

14 replies on “A field guide to biomedical meeting creatures, part 1: Any questions?”

Hmmm, I think we would all like to be seen as “Appropriate” but I can envision that my colleagues might view me as having some other qualities. Some of the Rivals description, sometimes Pontificator, and occasionally Oh Shit! will fit me. Although I wonder if I don’t also have a little bit of a Show-off in me.

The key to questions (and I say it is the BEAUTY of them) is that they come from each listener’s personal perspective. So when I listen to a talk, I filter it in terms of things I know. As a result, when I come back and ask a question, it is in the context of something I know (hopefully not a non-sequitor). As a result, I tend to ask a question that comes from that perspective, and may not be one that the speaker has thought about. As I said, I hope it is not non-sequitor.

As I said, it is kind of like a Rival, but not really. Consider this part of the description

The Rival’s goal is not so much to shed light on the topic, but rather heat. Usually, he has done research on the same question you have and quite often he has come up with a very different conclusion. It’s possible that he had another talk at the meeting. It’s also possible that his abstract didn’t get accepted for a talk and he is pissed off about it. The Rival’s goal is to pick your work apart. He will frequently ask confrontational questions and attack any perceived weakness in your study, although sometimes he will take the unctuous route, praising your work before sticking the knife in your back.

That is a lot of my approach, I think except for this part

Usually, he has done research on the same question you have and quite often he has come up with a very different conclusion. It’s possible that he had another talk at the meeting. It’s also possible that his abstract didn’t get accepted for a talk and he is pissed off about it.

My motivation is not about rivalry, and it is not about having the same research interests. Yes, sometimes if they are using procedures that I am familiar with and have done them incorrectly, then I will call them out (for example, a colleague gave a talk that included a calculation of a bond dissociation energy curve, and they neglected to allow for diradical character in the product, which blows the energy and the interpretation. Given that I know a lot about that (I’ve made the same mistake myself!) I was quick to point it out during the Q/A session. So in a respect, I “had done the research and come to a different conclusion,” but it was more of “I had done something similar and knew that he was doing it wrong.” I could have waited to do it privately, but I wanted to make sure that it was public so that everyone knew that this was an incorrect approach and that they need to use a correct procedure; does that make me a show-off?)

I think I would add a category – the Reviewer. Because that is more how I like to view a talk – like I am reading a paper that I am reviewing. I am looking mainly to find weaknesses and mistakes to point out to the speaker. I do that because I think it helps them to write a better paper, as it is better to have their weaknesses exposed at a talk than in the paper itself (and has alerted potential referees to things to consider when they get the paper to review).

The actions of the reviewer are going to be very similar to that of the Rival, with the difference being the motivation.

This is a very nice typology, and one that applies to multiple fields. As I reading this, I was easily able to envision all of these types at talks that I’ve given, or attended, at both medical education and psychometric conferences. Thankfully, I’ve not yet gotten an Oh Shit! questioner yet – my one experience with a particularly belligerent and defensive Show-Off was bad enough.

I’d like to suggest the “Don’t Forget Meeeeeee!” questioner. Kind of a cross between “Me-Too” and the “Pontificator”, this is someone who has, in the past (sometimes the very distant past) authored a study similar to yours, or having some tangential relationship to yours. Or, in some cases, having no obvious relationship whatsoever. In any case, they are shocked – SHOCKED – that you have failed to mention their study in your talk and acknowledge its obvious importance in interpreting your own results. Sometimes they are not the original author of the long-ago study, but have some relationship to them – a former student of theirs, for example – and can’t stand to see their dear old mentor’s work forlorn and forgotten (not to mention what that might mean for their OWN career)!

Thanks for the lulz. It’s been far too long since I’ve given a talk at a professional conference and you’ve gotten me feeling nostalgic for some of the abovementioned forms of questioner.

Thanks for the taxonomy of research paper questioners. I’d say you are right on target.

One other category I see frequently is “The Guru”, a close relative of the pontificator.

Gurus are often (but not necessarily) well-published, well-known researchers, who feel the need to remind everyone just how smart and how important they are. The guru is a serial offender, and feels that no presentation is complete unless he/she has graced the the room with a comment or question. The comments may be positive or negative but are usually gratuitous, and of little substance.

I have only been to one professional conference, it was an engineering conference and I was working a slide projector (I was a senior in that particular engineering field, and our department recruited students as helpers, we were paid a lunch). It was a great experience, in that I saw several of those types (and was myself accused of being a plant when I asked a presenter from Rockwell exactly how long before the space shuttle would be in service… one professor of ours spoke lots about its delays).

During one fairly sedate presentation we could hear shouting from the next room. Apparently one guy asked an “Oh, shit!” question, and what followed was lots of contentious and loud discussion.

Two years later I was working for the guy who asked the “Oh, shit!” question. One of the best bosses I ever had, and I learned lots. It also helped that I was willing to learn, and could keep up!

I had the pleasure of being at a recent meeting where the speaker was quite unpleasantly and completely nuked. Let’s call this one “The Unabomber”. Part Guru, part Ponificator, they began as you would expect (my history in the field, my qualifications etc…). Then proceeded to tell the speaker that his talk was completely unintelligible, no one could read the slides and he should not have come here in the first place seeing that he was so woefully unprepared. It was brutal. I think the speaker left the congress immediately after. There is no defense against the Unabomber — any attempt will only make it worse.

Based on a small sample size of geriatrics and palliative medicine conferences, I’d say that I’d stand out a bit in a suit. A long sleeve button shirt is normal. A tie wouldn’t be unusual. However, there were quite a few people in jeans, shorts, t-shirts, and even baseball caps. (None of the presenters were this informal during their sessions, but a good third of the audience at a recent palliative medicine conference were wearing outfits that would be insufficient to meet a standard of “office casual”.)

I need to arrange for one of these for myself someday.

Hey, I offered;)

Actually, the last time I asked what I thought was a Sycophant question it turned out to be an Oh Shit question. Apparently my idea of “easy obvious question” needs a little work.

I’ve started working in basic science research a few months ago, and I know a couple Pontificators and Show-Offs.

Hope you’re enjoying Chicago. We’ve gone a little hockey-crazy at the moment, but we should be back to normal soon.

Booo Blackhawks. Go Flyers! (Sorry, it may be my last gasp after Wednesday night)


The Unabomber response is very good for the “I’m Not Sure How Much You Know…” talks. You know the type, when an often young and cocky speaker believes his field is so specialised and complex that he has to talk down to us plebs…..

“I’m not sure how much you know about small angle neutron scattering, so I’ll keep it brief and simple for you all…”

“You probably don’t know much about thermo-optic imaging so I won’t bother with the details…”

Witnessed one particularly painful takedown of such a speaker, who apparently didn’t realise one of the most respected experts in his field was in the audience. The Q&A session afterwards certainly reminded the young man who knew what and who didn’t.


The Unabomber can come into a variety of sub-species depending on the ratio of Guru/Pontificator. You may have the type as you describe, more Guru than Ponti.

But then you have the opposite, more Ponti than Guru…

The one who while knowledgeable, is a colossal wanker who whines and complains that you didn’t use the correct bullet point format (he would have done it this way), that the coffee was cold (unacceptable for one of his station), and that you didn’t extensivley cover a paper (not even relevant to yours, but he wrote it) which was thrown out/superceeded ten years ago, yet interspersed between the rambling complaining is occasionally some interesting and relevant information.

Very quickly everyone is the room is rolling their eyes and wishing he would STFU, but are afraid to do so as he may actually have a point somewhere.

You nailed it, Orac. Those of us in audience are inwardly groaning when the senior scientist reaches the mic and the first words out of his mouth are “A few questions and an insight…”

I spotted some archetypes that were present at my dissertation defense as well. Rival and Clueless were well-represented, a few Pontificators, but it was that rat bastard “Oh Shit” that still makes me wake up screaming in the middle of the night. Shame he was also on my committee.

Actually, sometimes the highlight of these conferences (for those of us in the cheap seats) are the active debates between presenter and Rival. Darn those moderators for breaking up the only interesting discussion about cancer stem cells or the role of XMRV in prostate cancer.

The surgical meeting also has a special flavour of pontificator.

I call him the “In my experience…”

who seems to think that his personal clinical experience trumps the large muticentered clinical trial that was set up so we didn’t have to reply on shonky clinical experience anecdotes (see slides 2-4 usually)

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