Public Speaking Anxiety? Here’s How Healthcare Professionals Prepare

Imagine hearing your name bounce off the walls of the auditorium as you finish scribbling the last line of your progress note. A sea of white coats turns, with the microphone vacant. You’re expected to walk to the podium, break down a complex code-blue case, and respond to rapid-fire questions, all while keeping your voice steady and mind calm. Your heart beats so loudly that you begin to wonder if the audience can hear it too. That same stomach-dropping sensation has a clinical name: glossophobia, or the fear of public speaking, and according to a study by Heeren et al. in 2013 from the Neuropsychiatric Disease & Treatment journal, “about 77% of the general population fears public speaking.” While glossophobia may not be a major deal in most other fields, in healthcare, that anxiety isn’t a minor inconvenience; it can have a ripple effect on patient safety, teamwork, and can even cause legal issues.

Glossophobia is fueled by the pressure of high-stakes situations. A mistake in ordinary life, like mixing up street names or right and left when giving someone directions, simply results in friends having a delightful laugh and ending up at the wrong location. However, on a hospital stage, the repercussions are far more serious. For example, a similar mix-up might lead to incorrect antibiotic dosing or a delay in a life-saving scan. Research from a JAMA issue from 1997 and the Academic Medicine Journal in 2011 illustrates that solid communication skills correlate with fewer malpractice claims and better patient outcomes. Consequently, clinicians treat public speaking as a serious part of their training in being competent health professionals in the workforce. Therefore, it’s critical for us to answer the question, how do healthcare professionals deal with public speaking anxiety and transform it into a beneficial skill?

First up is simulation. Similar to how pilots use flight simulators before flying an actual plane, hospitals now use practice sessions with standardized patients (actors who pretend to be sick) and high-fidelity mannequins (lifelike medical dummies that can blink, bleed, or talk). In these simulations, trainees can practice presenting diagnoses, breaking bad news, or debriefing with fellow health professionals, all while faculty can score the trainees on their clarity, tone, and empathy. There is an abundance of evidence to support this, as a 2011 JAMA meta-analysis by Cook DA et al. discovered that this simulation-style training can boost clinical performance while also cutting down on real-world errors. Overall, repeated “dress rehearsals” under realistic stress can help reduce the paralyzing fear or the fight-or-flight response before it happens in a real-life situation.

Next, what do residents use when they don’t have access to a simulation lab? Virtual Reality (VR). Recently this spring, a team at the University of Cambridge released a free VR platform that drops users onto a digital stage that seems to be packed with animated listeners. Although the application of this technology is fairly new, some data indicates drops in self-reported anxiety and increases in speech quality. After a single 30-minute VR session, there was a drop from 65% of secondary school students who self-identified as “anxious public speakers” to 25%, a remarkable 45 percentage-point drop, according to an original research paper published in December of 2024 by Dr. Chris Macdonald in the Frontiers in Virtual Reality Journal. Doubly beneficial is that the headset can be used in various locations, from a call room to a bedroom desk, and as such, VR offers a portable and low-cost method of receiving that experience without needing to schedule out an auditorium. If you’re interested in taking a look at how the system works, check out the platform yourself using this link.

Following VR is a simple but often-overlooked biological function: breathing. Regardless of how much you rehearse, it won’t matter if your voice still quivers when you grab the clicker. That’s why many health professionals rely on controlled-breathing drills—most famously box breathing, where you inhale, hold, exhale, and hold again for a consistent slow 4-4-4-4 count. Essentially, this technique shifts your body from a fight-or-flight state into a calmer state. Other common patterns that have similar results include 4-6, 4-7-8, or 2-1-4 counts, where the first number is the length of the inhale, the second is typically the brief hold (except for the 4-6 pattern), and the third number is the exhale. The key to this technique, irrespective of which pattern you use, is ensuring that the out-breath is longer than the in-breath to activate the vagus nerve and boost heart rate variability (HRV), according to Gerritsen & Band in 2018 in the Frontiers in Human Neuroscience Journal. The vagus nerve, which is the main highway of the parasympathetic nervous system, is the longest nerve running from the brainstem down to the chest and abdomen; moreover, it is the branch that calms the body after stress. In addition, as highlighted by Lehrer PM & Gevirtz R in 2014 in Frontiers in Psychology, increased vagal activity leads to a higher HRV, which means the body can calm itself faster, think more clearly, and recover faster after a surge of adrenaline.

Even after calming their pulse, it is still entirely possible that a speaker can drown in the details of lab values, imaging, medications, next steps, etc. To slow that flood of information, healthcare teams rely on mental blueprints that have been proven to be reliable, such as the Situation, Background, Assessment, Recommendation framework (SBAR) or the Subjective, Objective, Assessment, Plan framework (SOAP). These frameworks give information in bite-sized pieces, helping both the speaker and listener digest the information. Frequently, some units include flash-feedback loops where colleagues record five-minute updates on a phone and have a fellow colleague peer-review notes on pace, jargon, filler words, etc. Over time, these small corrections can make a massive difference in the delivery and quality of information. 

Now that we’ve answered the question proposed at the start of this blog, how can you use this information to create a recipe for calmer, clearer public speaking? First, try rehearsing out loud to a real listener—maybe a friend, classmate, teacher, or family member. Following this “dress rehearsal,” ask for one thing that worked and one change that should be made so that feedback is focused and quick. After doing this a couple of times with a variety of people, you will likely see a significant improvement in your comfort level with the material and your confidence while speaking. Let’s say those around you are particularly busy, or you’d rather work your way up to presenting to real people, and you have access to a VR headset available at home or on a campus. In that case, run a free public-speaking scenario to see how you do and if it can improve your confidence in your ability as a public speaker. When you go to speak, slow down that pulsing fight-or-flight feeling with box breathing or any longer-exhale pattern to keep the adrenaline from overpowering your hard work in practicing your speech. Finally, get creative and build your own simple framework for delivering your speech, or even research templates/frameworks until you find one that fits to help develop a killer speech and to help your audience truly retain your key points. If you take the time to master these four habits and are willing to fight through the failures of practicing them, then on every podium you face, from the classroom to the conference hall to an auditorium full of people, you will feel like you're on home turf.

Yonathan Bezza - President

2025