Практика Shadowing: I wish I'd learned this mental exercise in medical school - Изучайте разговорный английский по видео

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Think about those physicians who seem to always have control of a room

where it's hitting the fan around them and they just seem composed, calm.

They have equanimity, composure in the midst of chaos.

I want to tell you about this game-changing exercise, this mental framework that I learned as a pediatric resident in the ICU.

It makes you so much better as a clinician and it makes things so much better for your patient.

If we haven't met, my name is Paul Tran.

I'm a pediatric gastroenterologist.

I'm a faculty at two medical schools.

I travel around the country to empower my future colleagues.

I want to share all of these cool things that I've picked up along the way.

So this tool is called situational awareness and it's really organized catastrophizing.

It is rewarding your anxiety.

And the exercise, if we're talking about an inpatient setting, is you look at your list.

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.

As a resident, you might be assigned half the list.

but generally you start out choose a patient one of your patients

and you think what is the worst thing

that could happen to this patient tonight when I'm not here

or when I'm alone if I'm cross covering overnight

and three steps of this framework the first just what could

happen what could happen tonight the second how would I know

how would I be notified what would need to happen what What would a patient or a family member tell me?

What would a nurse communicate to me?

And then the third thing, how would I react?

What would I do?

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,

you could take your list and choose a single chief complaint.

Let's say tachycardia or rapid heart rate for patient A.

could that be from?

And then what are the tests that help me differentiate between these things?

And then you can do that for every single patient on your list.

So the example I like to use is a patient with ulcerative colitis,

inflammatory bowel disease, coming into the hospital and they have a flare.

That means they're having a maybe atypical response or resurgence of their symptoms.

In this case, abdominal pain and bloody stools.

So usually you have to tamp down inflammation.

This patient might be admitted to the hospital for IV steroids, something to turn off the stove, as I like to say.

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.

What's the worst thing that could happen to this patient overnight?

And there's no wrong answer here.

you essentially are preparing for the worst.

The patients don't always present like the textbook.

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.

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.

People asking you what to do, What do you think expecting you to act a certain way?

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.

So going back to the example, patient with ulcerative colitis, the worst thing that could happen off the top of my brain, toxic megacolon.

Okay.

Toxic megacolon is a known complication of ulcerative colitis.

number two how would I know how would I be notified well first thing

that comes to mind well abdominal pain severe abdominal pain and

when I walk through this exercise I say that's not good enough

if someone says abdominal pain I'm like that's it oh my belly's hurting is

that what a patient's gonna say my stomach is killing me

with toxic mega colon no I'm catastrophizing I'm Think of the worst.

So I might think about the pain being so intense that someone's sweating.

Someone is grimacing.

They're yelling.

They want more pain control because it hurts so bad.

They're writhing in the bed.

They don't let you examine them.

That's the picture I think of in my mind, not the words severe abdominal pain.

Because I want to be ready when I see the patient.

I don't want them to just have bad abdominal pain maybe that's from the flare.

I'm thinking about the things that I can't miss.

So intense, the most intense abdominal pain I've ever seen, not just abdominal distension, but their belly is ballooning.

It's huge.

It's doubled in size.

I want to think about the picture of the patient, not the words that describe the patient.

This is no longer an Anki or a flashcard.

This is not a board review question.

This is real life and I'm preparing for real life.

I want to be aware of the situation and situational awareness.

So a nurse might communicate with me severe abdominal pain,

reporting 10 out of 10 pain, tachycardia, hypotension, not good enough to think about that for me.

Now I'm a pediatric gastroenterologist, so I see kids.

So my vitals might be off, but let's say heart rate is 140, severe tachycardia.

Blood pressure is 70 over 40.

I'm thinking about these things like I'll see them.

How would I be notified?

Now, last part, what do I do?

What do I do?

So I might think imaging.

And when people say imaging, I say, not good enough.

You're gonna go into your EMR and type imaging.

What imaging?

Abdominal imaging.

Great, what?

X-ray.

X-ray of the abdomen.

How many views?

What orientation?

One view, two views, AP, lateral, left lateral to cubitus, upright.

So you have to be prepared.

What are you actually going to do in this situation?

For what reason?

What are you looking for?

How is it going to help the patient?

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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Лексика и советы по произношению к этому уроку

Этот урок разговорной практики уровня C1 построен на видео «I wish I'd learned this mental exercise in medical school». Чаще всего повторяются слова: patient, abdominal, pain, toxic, happen. В этом видео 188 предложений и 2085 слов для шедоуинга. Речь длится 13:16. Говорящий говорит в естественном темпе, около 157 слов в минуту, близком к повседневной речи. Только 80% слов входят в 3000 самых частых слов английского языка, поэтому лексика сложная. Вопросов здесь 29 из 188 предложений, так что это хорошая тренировка вопросительной интонации и коротких ответов.

Ключевая лексика этого видео

Самые сложные слова из видео (15), с произношением и значением:

Слово	Произношение	Значение
abdominal прилагательное	/æbˈdɑm.ə.nl̩/	брюшно́й, абдомина́льный
situational прилагательное	/sɪtjuːˈeɪʃənəl/	ситуацио́нный
tachycardia существительное	/ˌtæk.ɪˈkɑː.di.ə/	тахикарди́я
antibiotic существительное	/ˌæn.taɪ.baɪˈɑ.tɪk/	антибио́тик
bowel существительное	/ˈbaʊ.əl/	то́лстая кишка́
abdomen существительное	/ˈæb.də.mən/	живо́т
colon существительное	/ˈkoʊ.lən/	двоето́чие
complication существительное	/ˌkɑm.pləˈkeɪ.ʃən/	усложне́ние, затрудне́ние
hypotension существительное		гипоте́нзия, гипотони́я
flare существительное	/flɛɚ̯/	вспы́шка, взрыв
notify глагол	/ˈnoʊtɪfaɪ/	уведомля́ть, уве́домить
lateral прилагательное	/ˈlætəɹəl/	латера́льный, боково́й
stat наречие	/stæt/	немедленно
steroid существительное	/ˈstɛɹɔɪd/	стеро́ид
assign глагол	/əˈsaɪn/	назнача́ть, назна́чить

Фразовые глаголы, которые вы услышите

Слово	Произношение	Значение
look up глагол	/ˌlʊk ˈʌp/	улучша́ться
come up with глагол		придумывать, приходить в голову
end up глагол		зака́нчиваться, зако́нчиться
go down глагол		спуска́ться, спусти́ться
pick up глагол		подбира́ть, подобра́ть
rule out глагол		исключа́ть, исключи́ть
turn off глагол		выключа́ть, вы́ключить

Фразы, которые стоит повторять

Короткие законченные фразы из видео, которые пригодятся в повседневном разговоре:

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?

Грамматика в этом видео

Конструкции, которые говорящий использует чаще всего, с точными словами из видео:

Конструкция	В видео
Пассивный залог be + причастие прошедшего времени — важно, что происходит, а не кто это делает	is called · might be assigned · be notified
Present Perfect have/has + причастие прошедшего времени — прошлое действие, важное сейчас	haven't met · I've picked · you've thought
Придаточные определительные who / which + предложение — уточнение о человеке или предмете	load, which is · someone who doesn

Произношение, на которое стоит обратить внимание

Говорящий использует 63 сокращённых и редуцированных форм, например I'm, you're, don't. Произносите их коротко, так, как слышите.

Звуки «sh» и «zh»: situational /sɪtjuːˈeɪʃənəl/, distension /dɪsˈtɛnʃən/, complication /ˌkɑm.pləˈkeɪ.ʃən/, perforation /ˌpɚfəˈreɪʃən/, anticipation /ænˌtɪs.əˈpeɪ.ʃən/
Длинные слова — следите за ударением: situational /sɪtjuːˈeɪʃənəl/, tachycardia /ˌtæk.ɪˈkɑː.di.ə/, antibiotic /ˌæn.taɪ.baɪˈɑ.tɪk/, complication /ˌkɑm.pləˈkeɪ.ʃən/, pediatric /ˌpiːdiːˈætrɪk/

Звуки, трудные для русскоязычных:

/h/ — лёгкий выдох, а не русское «х»: hemodynamic /himoʊdaɪˈnæmɪk/, hemorrhage /ˈhɛm(ə)ɹɪd͡ʒ/, hemorrhagic /ˌhɛməˈrædʒɪk/, rehearsal /ɹɪˈhɝsl̩/
Звонкие согласные в конце слова — не оглушайте их: catastrophize /kəˈtæstɹəfaɪz/, steroid /ˈstɛɹɔɪd/, colleague /ˈkɒliːɡ/, catalyze /ˈkætəˌlaɪz/, compose /kəmˈpəʊz/

Как заниматься с этим видео

Прослушайте всё видео один раз молча и выпишите незнакомые слова.
Начните со скорости 0,75×, повторяйте предложение за предложением и вернитесь к обычной скорости, когда станет легко.
Запишите себя и сравните с оригиналом, обращая внимание на такие слова, как abdominal, situational, tachycardia.

Что такое техника Shadowing?

Shadowing — это научно обоснованная техника изучения языка, изначально разработанная для подготовки профессиональных переводчиков и популяризированная полиглотом доктором Александром Аргуэльесом. Метод прост, но эффективен: вы слушаете аудио на английском от носителей языка и немедленно повторяете вслух — как тень, следующая за говорящим с задержкой в 1–2 секунды. В отличие от пассивного прослушивания или грамматических упражнений, Shadowing заставляет мозг и мышцы рта одновременно обрабатывать и воспроизводить реальные речевые паттерны. Исследования показывают, что это значительно улучшает точность произношения, интонацию, ритм, связную речь, понимание на слух и беглость речи — что делает его одним из самых эффективных методов для подготовки к IELTS Speaking и реального общения на английском.

Техника шедоуинга: читать полное пошаговое руководство →

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