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

While I am on vacation, I'm reprinting a number of "Classic Insolence" posts to keep the blog active while I'm gone. (It also has the salutory effect of allowing me to move some of my favorite posts from the old blog over to the new blog, and I'm guessing that quite a few of my readers have probably never seen many of these old posts.) These posts will be interspersed with occasional fresh material. This post originally appeared on March 7, 2005 after I arrived home from a meeting.

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!