Pratique du Shadowing: I wish I'd learned this mental exercise in medical school - Apprendre l'anglais à l'oral avec la vidéo
Création de la leçon...
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Think about those physicians who seem to always have control of a room
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where it's hitting the fan around them and they just seem composed, calm.
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They have equanimity, composure in the midst of chaos.
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I want to tell you about this game-changing exercise, this mental framework that I learned as a pediatric resident in the ICU.
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It makes you so much better as a clinician and it makes things so much better for your patient.
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If we haven't met, my name is Paul Tran.
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I'm a pediatric gastroenterologist.
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I'm a faculty at two medical schools.
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I travel around the country to empower my future colleagues.
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I want to share all of these cool things that I've picked up along the way.
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So this tool is called situational awareness and it's really organized catastrophizing.
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It is rewarding your anxiety.
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And the exercise, if we're talking about an inpatient setting, is you look at your list.
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If you have a patient list of 10, 20 patients on the team, as a medical student, you might be assigned one, two, three patients.
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As a resident, you might be assigned half the list.
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but generally you start out choose a patient one of your patients
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and you think what is the worst thing
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that could happen to this patient tonight when I'm not here
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or when I'm alone if I'm cross covering overnight
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and three steps of this framework the first just what could
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happen what could happen tonight the second how would I know
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how would I be notified what would need to happen what What would a patient or a family member tell me?
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What would a nurse communicate to me?
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And then the third thing, how would I react?
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What would I do?
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Then you can actually flip the framework and you, instead of saying what's the worst thing that could happen to my patient and go down the list,
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you could take your list and choose a single chief complaint.
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Let's say tachycardia or rapid heart rate for patient A.
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could that be from?
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And then what are the tests that help me differentiate between these things?
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And then you can do that for every single patient on your list.
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So the example I like to use is a patient with ulcerative colitis,
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inflammatory bowel disease, coming into the hospital and they have a flare.
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That means they're having a maybe atypical response or resurgence of their symptoms.
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In this case, abdominal pain and bloody stools.
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So usually you have to tamp down inflammation.
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This patient might be admitted to the hospital for IV steroids, something to turn off the stove, as I like to say.
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So for that patient, you think, okay, I'm taking care of an uncomplicated patient with ulcerative colitis here for IV steroids and a flare.
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What's the worst thing that could happen to this patient overnight?
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And there's no wrong answer here.
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you essentially are preparing for the worst.
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The patients don't always present like the textbook.
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And when you're seeing things for the first time, it's really hard on your brain on cognitive load, which is essentially working memory.
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It's really hard to see something for the first time, think about it for the first time, and then have the pressures of maybe a chaotic moment.
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People asking you what to do, What do you think expecting you to act a certain way?
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So if you could prepare for that, do a dress rehearsal mentally where you might be seeing something for the first time, maybe to a patient with ulcerative colitis, but you've thought about it before.
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So going back to the example, patient with ulcerative colitis, the worst thing that could happen off the top of my brain, toxic megacolon.
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Okay.
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Toxic megacolon is a known complication of ulcerative colitis.
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number two how would I know how would I be notified well first thing
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that comes to mind well abdominal pain severe abdominal pain and
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when I walk through this exercise I say that's not good enough
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if someone says abdominal pain I'm like that's it oh my belly's hurting is
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that what a patient's gonna say my stomach is killing me
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with toxic mega colon no I'm catastrophizing I'm Think of the worst.
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So I might think about the pain being so intense that someone's sweating.
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Someone is grimacing.
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They're yelling.
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They want more pain control because it hurts so bad.
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They're writhing in the bed.
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They don't let you examine them.
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That's the picture I think of in my mind, not the words severe abdominal pain.
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Because I want to be ready when I see the patient.
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I don't want them to just have bad abdominal pain maybe that's from the flare.
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I'm thinking about the things that I can't miss.
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So intense, the most intense abdominal pain I've ever seen, not just abdominal distension, but their belly is ballooning.
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It's huge.
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It's doubled in size.
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I want to think about the picture of the patient, not the words that describe the patient.
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This is no longer an Anki or a flashcard.
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This is not a board review question.
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This is real life and I'm preparing for real life.
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I want to be aware of the situation and situational awareness.
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So a nurse might communicate with me severe abdominal pain,
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reporting 10 out of 10 pain, tachycardia, hypotension, not good enough to think about that for me.
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Now I'm a pediatric gastroenterologist, so I see kids.
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So my vitals might be off, but let's say heart rate is 140, severe tachycardia.
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Blood pressure is 70 over 40.
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I'm thinking about these things like I'll see them.
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How would I be notified?
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Now, last part, what do I do?
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What do I do?
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So I might think imaging.
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And when people say imaging, I say, not good enough.
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You're gonna go into your EMR and type imaging.
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What imaging?
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Abdominal imaging.
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Great, what?
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X-ray.
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X-ray of the abdomen.
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How many views?
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What orientation?
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One view, two views, AP, lateral, left lateral to cubitus, upright.
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So you have to be prepared.
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What are you actually going to do in this situation?
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For what reason?
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What are you looking for?
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How is it going to help the patient?
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How is it going to help guide your decision making? so
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when I walk people through this process ultimately we end up
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with a one view KUB kidney ureter bladder view one one view AP view that's okay because we're looking for the
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colon diameter massive colonic distension or ballooning I'm just looking for the colon being huge
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but there's some nuances there because that might not be the best test if you're trying to rule things out.
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It's really good if you're trying to rule in toxic megacolon, but a patient like this has multiple reasons for an abdomen like that.
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So that's where your clinical reasoning can improve.
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But just for the sake of situational awareness, you think toxic megacolon, the picture that you've painted of severe abdominal pain and distension,
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maybe hypotension, maybe tachycardia, maybe altered mental status
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and then what would you do stat abdominal imaging whether it's
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an one of you x-ray to look at the colon
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or a stat CT abdomen pelvis okay think about other things
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that you might do well maybe call surgery maybe start antibiotics
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the great thing is you can do this mental exercise every single day for your one patient,
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if you're a medical student, for your three patients, however many patients you have, have a different situational awareness every single day.
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So day one of that patient, maybe they stay for a week.
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Day one is toxic megaholone.
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Day two is spontaneous bowel perforation.
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Day three is sepsis.
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Day four is hemorrhage and hemorrhagic shock.
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You are just thinking in your mind and applying it to the patient.
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you're going to be on a rocket ship for clinical development, anticipation, awareness.
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This is a game-changing tool.
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But it can get even better.
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Because we sit around bored more often than we'd care to admit in training.
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You have spurts and sprints throughout the day, but then you have moments where you are just sitting there waiting to be discharged to go home.
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waiting for someone to pay attention to you.
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In this case, I'm learning.
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I can look things up.
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I can look up toxic megacolon.
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I can look up the management.
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I can think about it for myself.
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I don't need people to prompt me.
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The cool thing about this is you continue to grow every single day, improving your clinical reasoning, your anticipation, your situational awareness.
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You improve all of that and grow despite other people around you.
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So if the attending is not around.
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If the team is busy, you still learn, but here's where it gets super charged.
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How do you engage a team?
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Come to them, come to the resident, come to the attending with your thoughts.
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Doesn't have to be long at all.
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Come to them and say, Hey, I was thinking about the patient with ulcerative colitis I'm following, and think about some of the things that could happen to them, a complication like toxic megacolon.
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I would be on the lookout for intense abdominal pain, severe pain, patient needing pain medications, hypotension or tachycardia and vital sign changes,
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hemodynamic instability, maybe altered mental status, distension.
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And if that were to happen, I would want a CT abdomen or a STAT1 view abdominal x-ray.
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And I was thinking about getting maybe antibiotics and a surgery consult.
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And then follow that up.
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Tell them what you think.
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And then follow that up with the magic words.
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What would you do differently?
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I tell people all the time, this is the best way to ask for advice because you are essentially inviting a critique.
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You're inviting them to build upon what you've already done.
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You're removing the cognitive load from them for having to come up with a teaching pearl for you.
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Like, teach me about IBD, teach me about UC.
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It's hard for them, especially someone who doesn't like teaching or someone who's really busy or distracted.
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So here you're like, I'm thinking UC, I'm thinking a complication, I'm thinking about what to do.
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What would you do differently?
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I'm inviting you to critique me.
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They might say, that's exactly what I do, nice.
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they might say antibiotics what antibiotics what what antibiotics would you
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choose teaching point you open up the door for a teaching point um not an opportunity to impress them
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but let's say you've already looked it up you can be intrepid by showing them
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that you know it's the game i don't like playing the game i just want you to be better
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but they might say no no no no no i i would always get CT.
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Do you know why?
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They might ask you.
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They may or may not, but they might be like, you know, I'm looking for a large bowel perforation
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and CT will show me both that and the toxic megacolon or abdominal x-rays, positional films upright to see the free air below the diaphragm,
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left lateral decubitus to see it above the liver.
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You always get positional films or a CT, so I just default to the CT, especially I'm trying to rule out things.
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There's also small bowel obstruction.
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And if they don't say all of that and they say, no, I would always get a CT, say, what would make you get a CT over x-rays?
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You're asking why, except you're not asking why.
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Don't ask why.
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It sounds accusatory.
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Ask what or how or when.
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What makes you choose this?
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When would you choose this over that?
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How do you decide between what imaging is best?
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You ask them for their clinical expertise, their experience.
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So what would you do differently?
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And you'll see, as you continue to do this, you'll grow by yourself, but then you engage other people.
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They'll enjoy it.
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You're doing the work for them.
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You are catalyzing the reaction.
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You are lowering the activation energy for them to teach you.
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And it's not going to work all the time, but the more you do, the more reactions can take place more opportunities for you.
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To all my colleagues, future or current, you are seeing you matter.
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Thank you for what you do.
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Thank you for being you.
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See you next time.
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Vocabulaire et conseils d’expression pour cette leçon
Cette leçon d’expression orale de niveau C1 s’appuie sur la vidéo « I wish I'd learned this mental exercise in medical school ». Les mots qui reviennent le plus souvent : patient, abdominal, pain, toxic, happen. Cette vidéo contient 188 phrases et 2085 mots à répéter en shadowing. La partie parlée dure 13:16. Le locuteur parle à un rythme naturel d’environ 157 mots par minute, proche d’une conversation courante. Seuls 80 % des mots font partie des 3 000 mots les plus courants en anglais, le vocabulaire est donc exigeant. 29 de ses 188 phrases sont des questions : un bon entraînement pour l’intonation interrogative et les réponses courtes.
Vocabulaire clé de cette vidéo
Les 15 mots les plus avancés de la vidéo, avec leur prononciation et leur sens :
| Mot | Prononciation | Sens |
|---|---|---|
| abdominal adjectif | /æbˈdɑm.ə.nl̩/ | abdominal |
| megacolon nom | mégacôlon | |
| colitis nom | /kəˈlaɪtɪs/ | colite |
| situational adjectif | /sɪtjuːˈeɪʃənəl/ | situationnel |
| tachycardia nom | /ˌtæk.ɪˈkɑː.di.ə/ | tachycardie |
| antibiotic nom | /ˌæn.taɪ.baɪˈɑ.tɪk/ | antibiotique |
| bowel nom | /ˈbaʊ.əl/ | gros intestin |
| abdomen nom | /ˈæb.də.mən/ | abdomen |
| colon nom | /ˈkoʊ.lən/ | deux points |
| complication nom | /ˌkɑm.pləˈkeɪ.ʃən/ | complication |
| hypotension nom | hypotension | |
| pediatric adjectif | /ˌpiːdiːˈætrɪk/ | pédiatrique |
| flare nom | /flɛɚ̯/ | fusée lumineuse |
| notify verbe | /ˈnoʊtɪfaɪ/ | notifier |
| lateral adjectif | /ˈlætəɹəl/ | latéral |
Les verbes à particule que vous entendrez
| Mot | Sens |
|---|---|
| come up with verbe | inventer, imaginer |
| end up verbe | se terminer, se finir |
| go down verbe | descendre |
| open up verbe | ouvrir |
| pick up verbe | soulever |
| rule out verbe | barrer, biffer |
| turn off verbe | éteindre |
Des phrases à répéter
Des phrases courtes et complètes de la vidéo, à réutiliser dans la conversation de tous les jours :
- What would a nurse communicate to me?
- How would I be notified?
- What are you looking for?
- How do you engage a team?
- What would you do differently?
La grammaire de cette vidéo
Les structures que le locuteur utilise le plus, avec les mots exacts de la vidéo :
| Structure | Dans la vidéo |
|---|---|
| Voix passive be + participe passé — l’accent est mis sur ce qui arrive, pas sur qui le fait | is called · might be assigned · be notified |
| Present perfect have/has + participe passé — une action passée qui compte encore maintenant | haven't met · I've picked · you've thought |
| Propositions relatives who / which + proposition — une précision sur une personne ou une chose | load, which is · someone who doesn |
Prononciation à surveiller
Le locuteur utilise 63 contractions et formes réduites, comme I'm, you're, don't. Prononcez-les sous leur forme courte, telles que vous les entendez.
- Les sons « sh » et « zh »: situational /sɪtjuːˈeɪʃənəl/, distension /dɪsˈtɛnʃən/, complication /ˌkɑm.pləˈkeɪ.ʃən/, perforation /ˌpɚfəˈreɪʃən/, anticipation /ænˌtɪs.əˈpeɪ.ʃən/
- Mots longs — placez bien l’accent: situational /sɪtjuːˈeɪʃənəl/, tachycardia /ˌtæk.ɪˈkɑː.di.ə/, antibiotic /ˌæn.taɪ.baɪˈɑ.tɪk/, complication /ˌkɑm.pləˈkeɪ.ʃən/, pediatric /ˌpiːdiːˈætrɪk/
Les sons difficiles pour les francophones :
- /h/ — il se souffle, il n’est pas muet: hemodynamic /himoʊdaɪˈnæmɪk/, hemorrhage /ˈhɛm(ə)ɹɪd͡ʒ/, hemorrhagic /ˌhɛməˈrædʒɪk/, rehearsal /ɹɪˈhɝsl̩/
- /tʃ/ et /dʒ/ — à ne pas adoucir en « ch » et « j »: hemorrhage /ˈhɛm(ə)ɹɪd͡ʒ/, hemorrhagic /ˌhɛməˈrædʒɪk/, discharge /dɪsˈtʃɑɹdʒ/
- /r/ anglais — langue recourbée, sans frotter la gorge: pediatric /ˌpiːdiːˈætrɪk/, lateral /ˈlætəɹəl/, catastrophize /kəˈtæstɹəfaɪz/, perforation /ˌpɚfəˈreɪʃən/, steroid /ˈstɛɹɔɪd/
Comment s’entraîner avec cette vidéo
- Écoutez la vidéo en entier une fois sans parler et notez les mots que vous ne connaissez pas.
- Commencez à la vitesse 0,75×, répétez phrase par phrase, puis revenez à la vitesse normale quand cela devient facile.
- Enregistrez-vous et comparez avec l’original, en faisant attention à des mots comme abdominal, megacolon, colitis.
Qu'est-ce que la technique du Shadowing ?
Le Shadowing est une technique d'apprentissage des langues fondée sur la science, développée à l'origine pour la formation des interprètes professionnels. Le principe est simple mais puissant : vous écoutez de l'anglais natif et le répétez immédiatement à voix haute — comme une ombre suivant le locuteur avec un décalage de 1 à 2 secondes. Les recherches montrent une amélioration significative de la précision de la prononciation, de l'intonation, du rythme, des liaisons, de la compréhension orale et de la fluidité.