Incidence of and risk factors for nodding off at scientific sessions

The Canadian Medical Association Journal must be applauded for her incessant efforts of educating her readers about the meaning of scientific meetings for the medical profession. Rockwood et al.'s eye-opening study of nod-off episodes at lecture (NOELs) [1] is perhaps the other side of the coin when coupled with Ian Rose's article published 35 years ago in the same journal [2].

Rose has rightly prophesied that lectures have become a necessity for the survival of any specialist. For the budding lecturer, the followings are Rose's advice: 1. A lecture may amuse but must never communicate. 2. Never use a simple sentence when a complex one will do. 3. The content of the lecture should be obscure and unintelligible. 4. Slides must be complex and made in the smallest possible print. 5. Statistics must be used to obscure facts ¡V not elucidate them.

Rockwood et al.'s conclusion that NOELs may pose a risk to the health of patients might have contradicted with the observations made by Roger Smith. Smith suggests that conference coma, a technique for timid attendants to sit through the meeting with no relief from a poor speaker, may turn a boring lecture into an enjoyable, restful event [3]. Smith has also tactfully provided a formula in which a meeting attendant may calculate the potential amount of time he can apply the technique of conference coma, depending on the distance the lecturer has traveled to the meeting, the proportion of basic science in the presentation, the number of slides, and whether the content is new or widely knowledgeable. Unfortunately, the increasing popularity of electronic presentations has deprived the attendants the opportunity of peeping the amount of 35-mm slides or the number of trays a lecturer would carry to the meeting.

References 1. Rockwood K, Hogen DB, Patterson CJ. Incidence of and risk factors for nodding off at scientific sessions. CMAJ 2004; 171:1443-5. 2. Rose I. Lectureshipmanship. CMAJ 1969; 101:114-6. 3. Smith RP. Conference coma: a formula for appraisal. Obstet Gynecol 1983; 61:647-8.

Conflict of Interest:

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There was a wonderful letter published in the BMJ/Lancet some decades ago. It was written by a doctor who had just returned to his medical school for a class reunion some 25 years after his class had graduated. One of the functions was attending a series of lectures on recent advances.

In describing the lectures he observed how his peers had changed not only physiologically but also in appearances, some rugger-buggers looking surprisingly well groomed and dressed. What had not changed was how people behaved.

Those who had nodded off as students still did. Those who had sat in front and given the apearances of following the lecture intelligently still sat in the front doing the same. Those who had sat at the back talking, fooling around and giving the appearances of not absorbing anything the lecturer was saying still did. What is more, he added, the eager-beavers who had always been the first to raise their arms and ask questions, and those who always asked questions even if it they were stupid ones still did.

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Dr Rockwood and colleagues are to be congratulated on highlighting this unfortunate condition common amongst doctors and health care professionals and until now ignored in the medical literature. There are, however, two issues of dress that have been overlooked - firstly ,the sex of the lecturer (and thus the location of high risk fabrics such as tweed), and secondly the wearing of a bow tie.

In the interest of science, I attempted to test their theory and recreate a high NOEL risk to undergraduate students at King College London university being lectured on the role of dietitians in the media. The wearing of a tweed skirt (gored panels, slimming design, mid-calf length) failed to generate a NOEL response despite post-prandial timing and warm environment. Anecdotally, the wearing of tweed below the waistband cannot be considered a high NOEL risk factor.

The presence of a bow tie - a not uncommon occurance amongst British general surgeons, psychiatrists, and the occasional rheumatologist thankfully confined to consultant grades - is a variable risk factor, representing as it does either a character of whimsy (low NOEL risk) or an uber-bore (high NOEL risk). As such this easily visualised appendage requires consideration as a confounding risk factor, although with little knowledge of Canadian conferences perhaps this neck appendage is a uniquely European sartorial aberration.

Catherine Collins RD Chief Dietitian, St Georges Hospital, London, England SW17 0QT

Conflict of Interest:

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