Shadowing Practice: How to Present a Patient Case: The Signpost Method - Learn English Speaking with YouTube
C1
Hi, my name is David Keegan.
249 sentences
If sentences are too short or too long, click Edit to adjust them.
1
Hi, my name is David Keegan.
2
I'm an academic family doctor here at the University of Calgary.
3
We're here today to talk about how to present a patient case to one of your preceptors.
4
So in medical training we're doing this all the time.
5
I don't know how many hundreds or thousands of patients over the years in my medical school training,
6
my residency, and so on,
7
I ended up having to present to somebody above me,
8
one of my preceptors.
9
We're doing this all the time.
10
And as a preceptor, I hear all the time from medical students how they find it's hard to negotiate
11
and figure out what kind of preceptor, what kind of presentation.
12
Sometimes they want it short and sweet,
13
sometimes they want it long.
14
And they find it really confusing to negotiate that.
15
And sometimes it actually causes problems in even their relationship with their preceptor.
16
And we'll see it on summaries at the end
17
when a preceptor talks about a trainee who's presenting cases in a certain way,
18
and then you talk to that trainee and nobody ever talked to them and they never negotiated this upfront,
19
what's the right way, what's the most helpful way that people need to hear a case presentation.
20
So this is all about how to do that.
21
This is sort of like level one,
22
sort of like a good foundational approach.
23
And then there's a sort of more fancy one,
24
Level 2, which we'll get into in another video.
25
So when you're presenting a case to a preceptor,
26
the trick is a preceptor is a human too.
27
And I've probably just been dealing with something else and now I suddenly,
28
you suddenly have my attention as a preceptor.
29
And so, but I'm only a human.
30
And that means that I didn't see the patient because you've seen the patient first.
31
And it's going to be hard for me to process everything all at once.
32
And so a mistake that some trainees will do is actually just give me tons
33
and tons and tons of information to the point that I get kind of lost.
34
Now why are you presenting a case?
35
You're presenting a case so that I,
36
as the primary or the most responsible physician,
37
know kind of what's going on with the patient so that I know it'll help me in their patient care.
38
Number two, it's also so that I know where your knowledge ends and where your gaps begin
39
so that I know what I have to do to fill in things,
40
and I can also then know when I can stop relying upon you and all that kind of stuff.
41
It's also important for you to be able to show me that,
42
because then you're going to demonstrate who you are as a clinical thinker.
43
You don't want, as an outcome,
44
presenting a case presentation, and then you're going into the past medical history,
45
and you're seeing that I'm getting all fidgety and agitated.
46
You don't want me to suddenly say, you know what?
47
That's great.
48
Thanks very much.
49
Let's go in and talk to the patient.
50
Because what I've done then is I've just basically stopped you at some of the history details.
51
You might have in your head really good thinking about the likely diagnosis or the likely problem going on with this patient.
52
You might have a good plan that you've kind of put together.
53
Or at the very least,
54
you've got a plan put together.
55
It might not be perfect.
56
But I don't get to even know
57
that you've even been thinking about a plan if we are only ever stuck on past medical history.
58
so this method is a way to make it clear to Your your preceptors where you are.
59
It's called the signpost method
60
So the signpost method starts
61
and I'm gonna be playing both roles with the trainee telling the preceptor a little bit of a heads up
62
So when I'm over there,
63
I'm the trainee when I'm over here.
64
I'm the preceptor.
65
So Excuse me, Dr. Keegan,
66
can I talk to you about this patient that I just saw?
67
Sure.
68
Great.
69
So overall, she's a clinically stable 29-year-old,
70
but I'm worried she could be seriously ill with an ectopic pregnancy.
71
Whoa, okay, tell me more.
72
Tell me kind of quickly what's going on.
73
Okay, so just so you know,
74
I've seen her, I've done a history,
75
a physical exam, I've checked some investigations,
76
and I have a proposed plan of management.
77
Do you want me to get started?
78
with the history.
79
So what the student is doing then is making it clear to the preceptor
80
that he or she has already thought about this patient in detail.
81
So they've got history, they've got physical,
82
they've done investigations, they've got a provisional diagnosis,
83
and they've already had some thinking about a plan.
84
So at this point what you've done is you've planted signposts about where the preceptor can drive this conversation.
85
And these signposts are critical.
86
So the preceptor might say,
87
you know what, just tell me what are the key things in history
88
and the key things on physical that make you think it's an ectopic pregnancy that this patient has.
89
Or the preceptor might say,
90
okay, you said she's stable,
91
tell me more about that and how I know she's stable or how do you know she's stable.
92
Or the preceptor might say,
93
because the situation is a bit urgent,
94
say, you know what, okay,
95
let's just go straight to the bedside.
96
Regardless, you got the key message across.
97
You've seen a patient who actually has a serious medical condition,
98
or a potentially serious medical condition.
99
You got that message clearly across in your first sentence by giving the overview.
100
And then you put out some signposts about where the preceptor could bring the discussion next.
101
Now for a different patient,
102
when there's a bit more time to think about things,
103
it can still the same flavor.
104
So let's say you're in an outpatient clinic,
105
maybe a family medicine office,
106
and the story goes like this.
107
The preceptor says, sorry, the student says,
108
hi, I've just seen a 10 year old boy accompanied by his parents who's here because of continuing nighttime cough,
109
which I think might be asthma.
110
Can, can, do you want me to go into,
111
sorry, can I present this patient to you now?
112
Or do you want me to go into more detail?
113
Or, or you can even be explicit at this point and say I've done a history,
114
a physical, I've got a provisional diagnosis and a differential diagnosis,
115
and I've got a plan for where we should move forward.
116
So again the preceptor knows you've given a one sentence encapsulation of this patient.
117
Great.
118
That's then that's pretty an impressive skill to begin with.
119
You've now situated the preceptor to understand the story a little bit
120
so that now they can start thinking and understanding where you're going with
121
and you've told him or her what are the potential options,
122
like it's like a buffet menu from which they can pick and hear about you're thinking about this patient.
123
So with that signposting the preceptor might say,
124
okay well sure give me more of the history.
125
And then you'll proceed to tell the preceptor about the history.
126
Say well this 10 year old fellow,
127
he's got this nighttime cough,
128
it's been there pretty much every night over the last several years.
129
The family notices that he,
130
whenever he gets a chest infection of any type of flu or a virus,
131
it always seems to affect him far more than everybody else that they know.
132
And then he has like a prolonged cough afterwards.
133
He's though fully active in sports and doesn't seem to appear restrained in any way,
134
he's a very active little fellow and has been previously medically well up until now.
135
In terms of review of systems,
136
he's got no other cough during the daytime,
137
he's got no sputum, there's no exposure to secondhand smoke,
138
and the rest of his past history is is completely clear,
139
no surgeries, he's on no medications,
140
no drug allergies, and everything else seems pretty clean.
141
Do you want me to go into detail on any more of the history elements,
142
or do you want me to move to the physical?
143
So again, you've put up a signpost showing that this is branching.
144
You're almost giving your preceptor a chance to choose their own adventure.
145
Some preceptors will want more detail on the history,
146
and that's great, and hopefully you've done it.
147
You've gotten into any dust precautions they've talked about,
148
or any recent construction or renovations or any other respiratory triggers and you've already got all that detail and so on.
149
You've got the family history about whether or not there's allergic entities like allergic rhinitis,
150
eczema or other family members with asthma,
151
all that sort of stuff.
152
Or maybe this preceptor now say,
153
you know what, why don't you just actually tell me what you found on a physical exam?
154
Say, great.
155
So he's in no distress,
156
he's sitting comfortably reading his book when I walked into the room.
157
When I look at him,
158
he seems to be physically mature,
159
his height and weight are appropriate for his age at the 50th percentile.
160
When I listen to his lungs though,
161
I don't hear any wheezes,
162
but I do notice that his expiratory phase is prolonged compared to his inspiratory phase,
163
which that sounds like a reverse.
164
It should actually be a shorter time period to hear the expiratory phase.
165
I took a peak flow and today it was a 175 liters per minute.
166
And, and, oh, forgive me,
167
viewer, I don't have the exact age-appropriate peak flow.
168
But let's say for this case,
169
say, and that's, that's about 90% of what he would have had for his height and weight,
170
for his height and age, rather.
171
Great.
172
And then the preceptor would say,
173
okay, so what do you think is going on?
174
You said earlier you were thinking of asthma.
175
And then again, the, now the student,
176
because they've signposted that they've had some diagnostic thinking and even have a planned thinking.
177
You can say, yes, I'm seeing it as asthma.
178
I guess some other possibilities that there's some reflux going on,
179
or maybe it's primarily only allergic rhinitis,
180
and he's got some post-nasal drip,
181
which is triggering some cough late at night.
182
And that's why he's getting nighttime cough and not daytime cough.
183
But I still think actually most likely it is asthma.
184
So it gives you a chance to kind of think through your differential diagnosis in real time,
185
and then the preceptor can say,
186
and what were you thinking about doing?
187
saying, well, he's not distressed now,
188
so we could certainly send him for peak flow,
189
sorry, pulmonary function testing right now,
190
since he's not like sick.
191
But if there's any delay in getting that,
192
we could actually just start a therapeutic trial of inhaled steroids and PRN or as needed beta agonists.
193
And then, you know, see how he does with that and get him back and check his peak flows throughout.
194
And then if there's greater than a 20% variation,
195
then that's diagnostic for asthma as well.
196
So what's incredible about that is
197
that you've been able to show the preceptor you had this the number one the encapsulating overview sentence
198
or maybe two sentences at most and then you told the preceptor I've done these different elements.
199
That and that's great and and then you'll get used to
200
that this one preceptor preceptor a might always want more history
201
and so pretty soon you'll know to not keep signposting every single time
202
but you'll have learned their preference and you'll give them more data on the history.
203
And there's other people who you'll learn,
204
oh, they really just want you to consistently,
205
you know, describe what you think is the diagnosis and your plan
206
and then work backwards and tell them the history and physical.
207
Which is a completely other appropriate way to do things too.
208
And there's a whole bunch of other ways that preceptors can have these conversations.
209
But the key thing is,
210
you've made clear the summary sentence.
211
You've made clear in that if there's any major problem,
212
like the ectopic pregnancy patient earlier.
213
You've made clear about the overview picture, about what's going on.
214
And then by signposting what you've done,
215
you've made it clear that whether or not you get into it,
216
that you've thought about those things.
217
And then your preceptor will feel now confident and comfortable going into that.
218
Now be prepared.
219
They're going to challenge you on that.
220
And that's OK.
221
That's part of good medicine training,
222
is that they might ask you to give evidence.
223
Well, you say it's asthma,
224
but tell me why you think it's asthma.
225
Why is it asthma more than reflux disease?
226
Or why is it asthma not allergic rhinitis?
227
And so they might challenge you for sure, but that's okay.
228
This means that you're being challenged on clinical reasoning,
229
you know, therapeutic care plans and so on.
230
Not on the basics of did you correctly report that there's nighttime cough on so many nights out of the year,
231
which is an important fact,
232
but you're probably at a higher level than just a conversation that focuses on some grainy details of the history.
233
So that's how you do it.
234
In the signpost method, you just one,
235
give a quick overview and two,
236
tell the preceptor that I've done the history,
237
the physical, I've looked into old charts,
238
I've got differential diagnosis and a preferred diagnosis and I've got a possible plan of management for moving forward on this patient.
239
And then they'll know that you're on it,
240
that you're on the ball,
241
Plus they know
242
that they can ask about all these different sorts of things
243
to help them figure out how to provide good care for the patient
244
And then also how to actually get a good sense of where you are with your clinical reasoning
245
and understanding and To also find out where you're wrong and
246
if you make a terribly big mistake You know what there's all there's good research that says that's fine,
247
too You will learn better because at least you're talking about the gaps the errors you make
248
Instead of the basics of a history element that you've done a hundred times before Thanks very much.
249
I hope your case presentations go awesomely.
Download App
AI scoring for every sentence you speak
TRENDING
Popular
Context & Background
In the realm of medical training, presenting a patient case is a crucial skill that learners frequently engage in. David Keegan, an academic family doctor at the University of Calgary, shares insight into the complexities of case presentations. He emphasizes that the relationship between medical trainees and their preceptors hinges upon effective communication during case presentations. Understanding the nuances of what preceptors expect can alleviate confusion and foster better interactions. This segment provides foundational strategies to enhance your presentation skills and facilitate smoother discussions within medical settings.
Top 5 Phrases for Daily Communication
- "I've seen the patient first, and here's the summary." - This phrase establishes your role and sets the stage for the presentation.
- "Can you follow along with my thought process?" - Encouraging feedback can create an engaging dialogue.
- "Let me highlight the key concerns." - This helps in emphasizing crucial information for the preceptor.
- "Where do you feel my knowledge is lacking?" - A humble approach that invites constructive criticism and guidance.
- "Would you like a brief overview or a detailed history?" - This phrase helps tailor your presentation to your preceptor's preference.
Step-by-step Shadowing Guide
To effectively improve your English communication skills while preparing to present a patient case, utilizing the shadowing technique is highly beneficial. Here’s a step-by-step guide to tackle the specific challenges mentioned in this video:
- Watch and Listen: Begin by focusing on the video content. Pay attention to how David structures his presentation, noting the clarity and conciseness of his speech.
- Shadow Speech: Play the video. Pause frequently to repeat phrases or full sentences. This will enhance your pronunciation and intonation, helping you sound more natural.
- Summarize: After watching, attempt to summarize the key points you’ve learned without looking at your notes. This reinforces memory recall and comprehension.
- Role-Play: Enlist a friend to role-play a preceptor. Present a case using the phrases learned from the video, practicing your delivery and receiving feedback.
- Reflect and Adjust: After practicing, identify areas where you struggled or felt uncertain. Focus your next shadow speak session on these areas, refining your skills continuously.
By incorporating these techniques into your routine, you will not only improve your English speaking skills but also gain confidence in presenting complex information clearly, enabling you to excel in both medical and everyday conversations. Embrace the journey of learning English with YouTube, and remember, consistent practice leads to mastery!
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.
☕ Buy us a coffee
ShadowingEnglish remains 100% free thanks to your support. Server and AI costs are high — your coffee keeps us going! 🙏