Shadowing Practice: How Doctors Think (And Students Don't) - Learn English Speaking with Video

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When I see students learning, I think the biggest mistake they make is they don't realize they're studying to be a doctor.

They're so overwhelmed by their exams, everything is right in front of them and you just see them going,

exam coming up, I've got to pass it.

And it's very hard with these exams and the volume of material not to have real anxiety.

I think the biggest challenge I face teaching students is their deep underlying anxiety.

Because anxiety makes you go to ritual behaviors and one of those ritual behaviors is memorizing.

Why do students struggle when they feel that they're working hard?

Why do students insist on memorizing?

How do doctors think through patient problems?

Why is everything that I teach centered on pathophysiology?

What do we say to medical students who are failing?

Why am I wrecking my personal life to do this?

In today's video we're going to address a number of topics

that keep coming up in the letters that you send us and they're important topics.

I see it every day when I'm teaching my medical students.

Any one of these could be an hour's discussion

but I want you to be aware of these subjects and at least make an introduction to them.

Before we get further into this, a number of you have not subscribed to my channel.

Every week we're posting videos on how to help you learn medicine.

Do yourself a favor, hit that subscribe button.

Why do students struggle when they feel that they're working hard?

Well, there's a general truism that I use.

Performance equals talent times effort times directed effort squared.

So most of the time when students feel they're trying really hard, one of two things is true.

They're kidding themselves that that's what trying hard looks like.

And number two is that they're not studying effectively.

So let's talk about each of those in turn.

Everybody has different rhythms through the day.

I'm an early morning person.

So when I have to learn something,

much better for me to get up and start at eight o 'clock and study for the two hours until 10.

And then I can go on to other activities.

Everybody's different.

You have to learn your own body.

So when you say, when do you learn the best?

Don't confuse learning something new with reviewing something that you already know

when you're learning something new that learning has to be really active

if you don't have a pen and paper

and you're not taking multiple sources

and you're not creating this is how i'm going to think about it

and you write it down

and then you know it proves you're learning it you have to turn

that piece of paper over and see if you can do it yourself

so let me give you a practical example

when i assign you something from my book you'll see my book is mostly figures and tables and algorithms.

And I tell students, there's only one reason I give you a table because you clear the contents into blank spaces.

You fill it in.

That's active learning.

And then the second part is you have to be able to come back and do it again tomorrow.

So when you've studied today, you go, these are my notes.

I can do them at the end of my study period.

When you start the next day, you take out that blank piece of paper and you prove that you've still got it.

In other words, you've got to repeat.

It's really hard when you got active classes.

There's a ton of material.

You have to be absolutely ruthless.

So when I was going through med school, I actually studied in the law library because I didn't know anyone.

And people would come over and be friendly and I'd say,

thanks for the invitation, but I don't want to know you because I can't afford to be social right now.

So I blocked off my learning period.

I got the notes that I knew I had to learn.

And I ruthlessly decided I'll learn this and I won't learn that.

And then I came out of the end of that study period with my notes.

And then I practiced them at the end of the time.

And I started them the next day.

You watch how people are studying.

They're socially interacting.

They've got earbuds on.

You know, the proof that someone's not learning, they highlight.

Nothing proves you're not learning effectively than highlighting.

Because you know what that says?

You know what?

I'll learn that tomorrow.

So you've got to go to class or however you're getting your material presented and you've got to take active notes.

That's a third of your learning.

You're not sitting back with your coffee going, you know, I'll learn this tonight.

There's no time.

So you have to be ruthless.

You go to class, you say, this is what I'm going to learn.

That evening you sit down and you say, these are my final notes.

You finish them and then you say blank piece of paper.

Good.

Prove that you know that.

The second part is the directed part.

I know that medicine is built on pathophys.

So make sure when you're making your notes, you take the book and you say what Dr. T said, all that other stuff is fine,

but you've got to have this core pathophysiology to hang it all on.

So go get your notes, go get other sources, but make sure you can do the pathophys.

Why do students insist on memorizing?

Well, the first thing to understand is students have been trained through their university to study for exams.

So when you say, how are they trained to do that?

Well, memorize for the multiple choice, wink, wink.

The professor will often tell you a couple of questions on the test.

Learn that material, pass that test, move on to the next thing.

It's hard to recognize when you come to medical school, that's just not true anymore.

You're not passing exams to pass exams.

You're actually training to be a doctor.

The problem is they start medical school with PhDs who still believe that you're an undergrad.

It's hard for PhDs to understand you're not teaching biochemistry, you're training doctors.

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And it's a constant struggle in every medical school because most of the clinicians actually aren't very good at their basic sciences.

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They never knew much to begin with and they certainly haven't improved since they didn't practice.

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So the clinicians aren't going to teach you that and the PhDs control the early years.

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So we have this terrible gap in which we're learning subjects in the old undergrad system of multiple choice questions, check the box, move on.

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I'll give you a good example.

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Today I'm doing a course

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and part of what I'm doing is thromboembolism for the first your students

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and so i pinged one of my colleagues

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and said have we reviewed coagulation can i assume they do

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that when i'm teaching workout triad and she said oh yes we've done

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that but there's no harm in repeating it

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and i thought to myself what do you mean

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there's no harm in repeating it the question is do they know it

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because i can assume i'm building on it

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or have they never heard of it

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and i'm introducing the subject for the first time

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but it goes to this undergrad mentality and i think the problem is for students, memorizing works for exams.

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Yeah, and you forget it in a month

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and you don't have any of it when you come to me

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and I'm trying to treat hypercoagulable states and you vaguely remember you sort of touched on that last year.

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No, no, you're learning as foundations because you need them to build on more advanced concepts of patient care.

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It's a problem in every medical school.

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How do doctors think through patient problems?

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Well, you know, if I'm really being honest, it's right brain, left brain.

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And what I mean by that is when you've got some experience, you know what 80 % of your patients are going to be.

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You walk in, you go, oh, it's one of those.

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And frankly, you don't think at all.

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So I sort of think of this as the 80 -20 rule.

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I think 80 % of the time doctors aren't thinking.

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They just walk in and know what it is because they've seen it so many times.

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And that works actually quite poorly for medical students.

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And so what I teach medical students is it's actually surprisingly hard to learn from experienced clinicians

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because they look at something and they know what it is.

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And they look at you and go, what's wrong with you?

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This is obvious.

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Well, doctor, I've never seen it before.

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Okay, how about that?

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So what I do very deliberately is I say, find the chief complaint.

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And you'll notice in the book, I have like the mid fifties.

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If you can do these 50 plus chief complaints, you kind of got a lot of it in hand.

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And then I don't say get a shotgun out and hope one of your pellets is a diagnosis.

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Please don't do that.

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It just works really badly.

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What you want to say is with that chief complaint, what organ systems could it be?

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Okay, it could be heart.

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Well, which family of heart diseases?

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Well, left ventricular congestive failure.

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Excellent. Which subfamilies?

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Well, ischemia, valves, hypertension.

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So we really specifically teach the 50 commonest chief complaints so that you learn to do a differential diagnosis.

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I think it's actually quite unhelpful to go see a really experienced doctor because she just knows because she knows.

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And if you ask me what I've been learning in my teaching coming out of decades of practice,

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it's I've worked with students on a personal basis and they've really taught me, don't make assumptions.

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Go explain everything.

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And so I think that's the problem.

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Don't ask how doctors think.

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Ask how should medical students be taught to think?

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Why is everything that I teach centered on pathophysiology?

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And you know, this is the old CPC, which is a legacy term that's died out with the autopsy dying out.

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But clinical pathologic correlation means what you see in your patient has an underlying explanation in the pathology of the disease.

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Pathophysiology is mechanism of disease, but it's way more than that.

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It's how to think about that disease.

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And the challenge is this, and I'm learning more and more as I'm working with my Nerdistines, is if I have a chief complaint,

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you get a list, but that list is more than just a list.

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It's a how do you think about?

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So if I said to you, chief complaint edema.

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Have you got a picture of Starling's forces kind of pathophys, right?

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Once you have your Starling's forces, can you recognize that one of them is cirrhosis?

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Great.

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So now you've got a family of diseases, but here's the problem.

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How are you now going to rule in

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and rule out cirrhosis as a cause of edema if you don't know how to think about it as a disease?

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Well, you think about it with its pathophysiology, which breaks into two clusters, portal hypertension and elevated estrogen.

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So the very act of the most fundamental diagnostic procedure, chief complaint to differential is completely built on pathophys.

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So when I say to you, patient walks in with edema and I say to you, how do you think about right ventricular heart failure?

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Have you got the nice picture backing it all the way up so that you know it's foundationally based on JVD?

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Have you got the picture or did you memorize it?

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Well, good luck memorizing.

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As I always say, if you've got the picture, you'll recognize edema and JVD are inferior vena cava to superior vena cava.

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I really just don't think I can teach you if you don't have pathophys.

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And what I really emphasize now is when I see a disease and I say, how do you think about?

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What I mean is, have you got a clear concept of it's pathophys?

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So I just don't think you can do medicine without it.

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When I see students learning, I think the biggest mistake they make is they don't realize they're studying to be a doctor

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because they're so overwhelmed by their exams.

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Everything is right in front of them.

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And you just see them going, exam coming up, I've got to pass it.

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And it's very hard with these exams and the volume of material not to have real anxiety.

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I think the biggest challenge I face teaching students is their deep underlying anxiety.

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Because anxiety makes you go to ritual behaviors.

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And one of those ritual behaviors is memorizing.

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You know, you might not be learning much and you certainly don't understand it very well, but you feel as though you've tried hard.

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You can show what you've memorized.

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And so it deals with your anxiety.

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It's not getting you to be a better doctor.

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And so when I say to students, take a breath, let's go to pathophys and patient -centered learning.

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Their answer is, can't face it.

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You're asking me to change and people who are anxious don't change.

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Students have one fundamental error in clinical reasoning.

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They somehow think if you have the symptom, you can get a shotgun out,

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shoot a thousand pellets, and one of them is going to hit the diagnosis.

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That works after 20 years experience, because you know, you're 80, 20 split, you know, 80 % of your patients are 20 % of the diagnoses.

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And you're so good at pattern recognition.

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You walk in the room, you can take it all in.

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You sort of go, well, I bet it's one of these three things.

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Yeah, not you.

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That's an experienced clinician.

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For a medical student to learn diagnoses, they have to learn how to identify a chief complaint,

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how to identify the possible organ systems, and then for each organ system, which pathophysiologic family does it represent.

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So yes, you've got to learn your chief complaints, but you notice the differential diagnosis is based on having a pathophysiology in your mind.

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When you've seen a million patients, you just go straight to pattern recognition, but not you when you're just beginning.

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What do we say to medical students who are failing?

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You have to explore, tell me how you're learning.

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And I do this a lot, right?

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The people that do the education send lots of students to me if they think I'll be able to help them.

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And the first thing you've got to get out of the way is whether your personal life's interfering.

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I've had many students who felt they were the responsible member of their family

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and when someone gets sick they're the ones

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that are supposed to take care of it

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so the first thing i teach those students is this is like you're flying in the airplane remember they say

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when the oxygen mask falls put it on yourself first not your kid

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i say well that's the airplane rule for medical students

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you come first you're just gonna have to tell your family

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i'm sorry i'm not available i have to prioritize my medical school

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and if you don't do that well it'll suck you down and you'll fail.

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This is an all -in experience.

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Once you're doing the all -in experience, the question then becomes, tell me how you're learning.

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And almost invariably, you're seeing highlighting and sketchy, socially distracted study periods.

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Nope.

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And so what I do is I learn to assign students something to learn.

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And then I say, you come back and show me your notes

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and that's very helpful because invariably they're not very good and

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so then we say let's just sit down

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and talk about how i would map out these notes

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and they go away and they're just shocked how hard it is

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and how tired they are

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and how your brain turns to porridge i could never study for more than two

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and a half hours and when i did i could actually flip my head

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and it felt like my brains are washing back and forth so differentiate in your mind

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Whether you're learning something new, that's your very precious time.

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Or whether you're reviewing something that you've already completely written your notes on.

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Because you can do that when you're a little more tired.

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And then there's invariable busy work.

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And so you should do that when you're totally crashed.

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The second big challenge in learning is that it's quality over quantity.

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Remember, we've talked about how medical students are always anxious.

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And so you actually study to treat your anxiety, not to learn the material and part of that is to say, oh, four hours of study.

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No, you weren't.

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No one can study that long.

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It's much better that you spend two high quality hours going through something and say, this is what I'm going to learn.

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And here's my practice notes.

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Way better than highlighting for four hours, which you just won't learn anything.

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Once you recognize it's quality over quantity, then you have ways to come back to that and keep practicing it.

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And so that's what I do with students.

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You know, that's why I make you draw pictures

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and fill in blank tables and fill up algorithms because we all have lazy, cheating brains.

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All of our brains say, you've got that.

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Well, okay, go fill in the table.

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Yeah, your lying, cheating brain didn't have it.

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It just hurts to learn.

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And so I have to keep telling students, learning hurts.

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Knowing is fun.

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Go put that quality time into learning.

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Then you can go practice with your friends.

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So almost invariably, it's get your life in order.

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And then number two, show me how you're learning.

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If I could change one thing about medical education, it would be, I would stop exams that give you a percent.

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You're not studying so that you get an A.

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You're studying to prove to me that you've mastered that subject.

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So for example, I'm preparing a little video on thromboembolic disease.

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My first year is finally starting pathology.

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But you know, under their normal subjects, they've done coagulation.

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When I say thromboembolic disease, do you have a clear concept of the difference between fluidics in a vein and fluidics in an artery?

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If we're doing the slow, low pressure fluidics of a vein, can you do Virchow's triangle?

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Okay, they've all been passed to me as passing COAG, haven't they?

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They've all been passed in physiology and anatomy.

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And I guarantee you, not a single one of my students will be able to discuss

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that intelligently for me to discuss deep vein thrombosis.

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So somewhere in here, we've got to stop teaching to percent multiple choice question exams.

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And we've got to switch over to, well, DBTs are coming up.

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You're going to need three concepts here.

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You're going to need the concept of Virchow's triangle.

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You're going to need the concept of fluidics.

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And you're going to have to understand the real fundamental difference between veins and arteries as tubes.

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I'm not holding my breath, but that's what we need.

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Why did I write a textbook?

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You know, all over thousand pages of it and 104 chapters.

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Well, not because I had a burning need to write a book.

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What happened was I was teaching a lot and I was teaching a pathology review course.

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And what I found was I kept repeating myself.

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And when you do it enough, you actually get your standard script that's been tested against teaching.

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So, you know, this teaches well.

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Well, when you do that 10 times a year for five years, you realize, you know, I could write this down.

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And then when a student says, please explain this to me, I could say, why don't you go read this?

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And when you come back, you'll be prepared.

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And there is a standard story taught to me.

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Robbins was a pathologist at University of Toronto.

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And the standard story taught to me by the old timers

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when I was a young student was he was a great autopsy pathologist that taught at the U of T medical school.

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And apparently he just got so tired of repeating himself.

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He wrote it all down and issued notes and said, read this and then we'll talk.

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I don't know if that's a true story, but that's how Robbins pathology came to be what it is.

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And I just thought that always made really good sense.

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And so when I found myself repeating a lot, I just said, you know, why don't I write it down?

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And then there's a hard copy.

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What is wrong with most textbooks is you have to be very clear who your target audience is.

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The hardest thing coming out of practice is trying to understand what can you fairly expect a first

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and second year medical student to know.

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And it's a standard joke amongst medical educators that no matter how little you think that is, it's actually less.

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So most textbooks, their single biggest problem if they're written by clinicians is they're too advanced for a first and second year medical student.

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And by advanced, I don't mean that the ideas are hard.

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I mean that they don't explain everything.

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It's like learning a language.

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You can learn five synonyms, but they all have different meanings and they're all used slightly differently,

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even though they have a core finding this true so that's the challenge for most textbooks is if they're written by doctors

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They don't explain enough.

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The other problem is subject -based books because they're all fine books.

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They don't tell you why would a doctor need to know that.

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So I think those are the two biggest challenges and I got so frustrated.

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That's why I went and wrote mine.

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I mean, I didn't do it for my health.

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I did it because I just couldn't find an acceptable other source.

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Why do you need my textbook as opposed to say Robin's pathology?

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The challenge for most textbooks is who are you writing it for?

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And I'm writing this for medical students, which means you stop and explain everything like any language.

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If you grew up in the language, you assume people know what words mean.

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Well, it's the same in medicine and you've been in it for years.

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You just assume people know what it means.

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Well, you can't with people that are just starting out.

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The second reason is most books don't do it in such a way

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so that it's easy to remember because none of us were taught this way, right?

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All of us were given our subject base.

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We learned anatomy and histology.

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And then we went to the patient floors where we practice with patients.

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So we ended up learning because we just repeated it with patient care.

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Well, that doesn't help you with clinical medicines built on a foundation of basic medical sciences.

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So this book really is a bridge between patient care and the basic sciences they're built on.

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I'm not aware of any other source for that, especially at a medical student level.

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So who should read my textbook?

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Well, the obvious answer is for sure first and second year medical students should read the textbook.

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You are being given all of that volume of what's fundamentally subject -based learning.

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You might be doing it by systems, but let me ask you this.

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Do you have a biochemist come in to do biochemistry?

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Do you have a physiologist come in or is it by your professor of cardiology?

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Yeah.

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It's all those subject -based people.

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So you might say, oh, I'm being taught by system.

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But if you're being taught by a subject -based expert, you're not being taught for patient care.

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You're somehow supposed to figure out all of the anatomy, histology, physiology, and farm.

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You're supposed to synthesize all that.

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Yeah.

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Well, good luck.

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When you come into your system, just read through the book.

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That's how you're going to need it for patient care.

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It's patient centered learning.

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And now when you come to all those lectures, they're great for facts.

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That's not a criticism.

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They're all wonderful facts.

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But when you read the ClinPath book, you'll understand some facts are more important than others because they matter more in patient care.

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Read the book, go to your subject based lectures, and they'll make much better sense to you.

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Well, great news.

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We look like we're going to have our version 2 .0 website up and going in a week or two.

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We've done our beta testing.

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It's been good.

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So what are we going to do?

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Students improve when they use medicine as a language in a conversation.

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And so you will come and it almost doesn't matter where we start.

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That's why when people say let's do multiple choice questions, I always quietly say to myself, well, it takes me about an hour to do one.

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By the time I have to rebuild all the basic sciences you don't have, I can do about a question an hour.

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A new thing that I've started doing is bringing an important picture.

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So for example, I was doing a review class at my medical school

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and I just put a picture up of a hemolytic anemia and I almost blew my two hour budget.

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That was just supposed to introduce the subject I was doing, but it's such an iconic picture.

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And the next thing you know, you're talking about, well, if it has polychromasia, can you do red cell maturation?

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If it has a spherocyte, why would a cystocyte become a spherocyte?

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Well, wait, why is there even a schistocyte?

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Well, that just introduced the subject of the mahas, and then you find out no one's got any core pathophys,

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and the next thing you're discussing endothelial.

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So what are we going to do in this session?

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We're going to have conversations in medicine, and you're going to feel that you are going to take notes and go,

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well I didn't handle that conversation very well I didn't understand

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that term and you're going to learn how we use basic sciences in patient care

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and how words don't have meanings meanings have words

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and what a tutor looks like when they look at you

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and ask a question they say hmm

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that was a pretty slow response let's go explore how you see

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that and so I view these live sessions as a chance for you to come

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and practice your medicine in a clinical way.

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And you'll find, because I've done this for years, what I know is that students have done this over months,

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become different students and they grow in two different ways.

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First of all, they absolutely grow in their medicine

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because all of a sudden they're understanding these ideas that are new to them eventually repeat.

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Well, thank goodness for that.

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But the other is they learn how to be handled by a clinician.

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So when they get on the wards or in the offices,

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they will know exactly what's expected of them and what a good tutoring doctor feels like when when she talks to you.

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So I can promise you, I mean, obviously we've done thousands of students after you diligently practice this for months, you will just be better.

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You'll be a better student and you'll be ready for patient care.

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Why am I wrecking my personal life to do this?

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One of the things I do when I'm starting a class and we're waiting for the time to begin and,

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you know, we get into conversations of why we're becoming doctors.

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And I always tell them, you know, you guys think this is awful.

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You're drenched in anxiety and you just wish you could get to patient care.

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And I always say to them, well, you know, let me tell you how it looks from my perspective 50 years later.

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You're sitting in a nice, comfortable chair with a good cup of coffee and a nice old veteran's going to tell you war stories.

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Yeah, it never gets better than this.

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Next, you're going to be on the wards where you're going to have all those hours of patient care, still get to study.

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So it's worse.

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And I can remember, I said, when I'm an MD and I'm writing my own orders, oh no, we had internships in those days.

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I was working 80, 100 hours a week.

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I was exhausted still had exams coming.

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I said, you know, when I'm a resident, I'll be able to narrow it down and be more thoughtful.

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Of course, that isn't remotely true because now you're still studying and you're now doing all the patient care,

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but you're also responsible for teaching your juniors.

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So it's more.

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And you can see everyone's starting to slump in their chairs at this point.

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And then you say to yourself, you know, but when I'm in practice, it'll be better.

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Yeah, no, it's much worse because when you're in practice,

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now you'll have a family and you'll have a business to run in addition to all that patient care.

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No, it just gets harder.

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And they all look at me with this.

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Well, then why are we doing this?

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And the answer is we don't do medicine to be happy.

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We do it because it's who we are.

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When you see a person collapse on the sidewalk, you run towards them, not away.

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So we don't do medicine to be happy.

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Please don't expect that.

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But do understand, it's infinitely satisfying if you have this in you.

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And so for me, late in light, in my 50s, I just love teaching.

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It's an addiction.

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If I go two or three days without teaching, it's like I'm withdrawing from a drug I'm addicted to.

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And so I don't do it to make me happy.

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I do it because it's who I am.

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If you're willing to embrace this philosophy of how to learn medicine, version 2 .0 of our textbook is now available.

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Click the link in the description.

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If you're ready to start learning with me, come join our community.

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I plan to teach live every week and so you can come

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and participate and learn new ways of thinking about medicine and really test whether you're learning in a clinical way.

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For more information, visit drphiliptisdell .com.

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See you next time.

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Vocabulary and speaking notes for this lesson

This speaking lesson is built on the video “How Doctors Think”. The speaker keeps coming back to these words: student, learning, learn, medical, patient. This video has 439 sentences and 5145 words to shadow. The speech runs for 27:42. The speaker talks fast, about 186 words per minute, so expect linked and reduced sounds. 86% of the words are among the 3,000 most common in English; the rest is worth studying before you start.

Key vocabulary in this video

15 words from the video worth learning, with pronunciation and meaning:

Word	Pronunciation	Meaning
exam verb	/ɪɡˈzæm/	Shortened form of examine
anxiety noun	/æŋˈzaɪ.əti/	An unpleasant state of mental uneasiness, nervousness, apprehension and obsession or concern about some uncertain event.
complaint noun	/kəmˈpleɪnt/	The act of complaining.
textbook noun	/ˈtɛkst.bʊk/	A coursebook, a formal manual of instruction in a specific subject, especially one for use in schools or colleges.
diagnosis noun	/daɪəɡˈnəʊsɪs/	The process of, or an instance of, identification of the nature and cause of a medical condition or illness.
pathology noun	/pəˈθɒləd͡ʒi/	The clinical biomedical specialty that provides microscopy and other laboratory services to clinicians (e.g., cytology, histology, cytopathology…
highlight verb	/ˈhaɪˌlaɪt/	To make prominent; emphasize.
blank noun	/ˈblæŋk/	The white spot in the centre of a target; hence (figuratively) the object to which anything is directed or aimed, the range of such aim.
ritual noun	/ˈɹɪt͡ʃ.u.əl/	A rite; a repeated set of actions, especially in religious contexts.
vein noun	/veɪn/	A blood vessel that transports blood from the capillaries back to the heart.
fundamental adjective	/ˌfʌn.dəˈmɛn.təl/	Related to a foundation, base, or basis; serving as a foundation.
underlying adjective		Lying underneath.
organ noun	/ˈɔːɡən/	The larger part of an organism, composed of tissues that perform similar functions.
anatomy noun	/əˈnætəmi/	The science that deals with the form and structure of organic bodies; anatomical structure or organization.
differential adjective	[dɪfəˈɹənʃəɫ]	Of or pertaining to a difference.

Phrasal verbs you will hear

Word	Meaning
come back verb	To return to a place.
come up verb	To emerge or become known, especially unexpectedly.
go through verb	To travel from one end of something to the other.
sit down verb	To assume a sitting position from a standing position.
think through verb	To fully consider, so as to understand all the consequences of.
come over verb	To affect in a sudden, unprecedented or surprising manner; to overwhelm a person's ordinarily contrary impulse.
end up verb	To bring to a conclusion.
figure out verb	To come to understand; to discover or find a solution; to deduce.

Sentences worth repeating

Short, complete lines from the video that you can reuse in everyday conversation:

Why is everything that I teach centered on pathophysiology?
What do we say to medical students who are failing?
Because you know what that says?
It's a how do you think about?
Why did I write a textbook?

Grammar in this video

The structures the speaker uses most, with the exact words from the video:

Structure	In the video
Conditional sentences if + clause, will/would + verb — a condition and its result	if you've got the picture, you'll recognize · if they think I'll be · if you don't do that well it'll suck
Present perfect have/has + past participle — a past action that still matters now	have not subscribed · you've studied · have been trained
Passive voice be + past participle — the focus is on what happens, not who does it	is built · have been trained · be taught
Relative clauses who / which + clause — extra information about a person or thing	students who are · CPC, which is · people who are

Pronunciation to watch

The speaker uses 228 contractions and reduced forms, such as you're, don't, I'm. Say them the short way, as you hear them.

The “th” sounds: pathology /pəˈθɒləd͡ʒi/, algorithm /ˈælɡəɹɪðm̩/, ruthless /ˈɹuːθləs/, thoughtful /ˈθɔːtfəl/
The “sh” and “zh” sounds: differential [dɪfəˈɹənʃəɫ], recognition /ˌɹɛkəɡˈnɪʃ(ə)n/, examination /ɪɡˌzæm.ɪˈneɪ.ʃən/, anxious /ˈæŋkʃəs/, socially /ˈsoʊʃəli/
Long words — get the stress right: anxiety /æŋˈzaɪ.əti/, pathology /pəˈθɒləd͡ʒi/, fundamental /ˌfʌn.dəˈmɛn.təl/, anatomy /əˈnætəmi/, differential [dɪfəˈɹənʃəɫ]

How to practise with this video

Listen to the whole video once without speaking and note the words you do not know.
Start at 0.75× speed, shadow it sentence by sentence, then go back to normal speed once it feels easy.
Record yourself and compare with the original, paying attention to words like exam, anxiety, complaint.

What is the Shadowing Technique?

Shadowing is a science-backed language learning technique originally developed for professional interpreter training and popularized by polyglot Dr. Alexander Arguelles. The method is simple but powerful: you listen to native English audio and immediately repeat it out loud — like a shadow following the speaker with just a 1–2 second delay. Unlike passive listening or grammar drills, shadowing forces your brain and mouth muscles to simultaneously process and reproduce real speech patterns. Research shows it significantly improves pronunciation accuracy, intonation, rhythm, connected speech, listening comprehension, and speaking fluency — making it one of the most effective methods for IELTS Speaking preparation and real-world English communication.

Shadowing technique: read the full step-by-step guide →