ฝึกพูดภาษาอังกฤษด้วยเทคนิค Shadowing จากวิดีโอ: How to Present a Patient Case: The Signpost Method

Hi, my name is David Keegan.

⏸ หยุดชั่วคราว

ความเร็ว:

249 ประโยค

หากประโยคสั้นหรือยาวเกินไป กดที่ Edit เพื่อปรับแก้

Hi, my name is David Keegan.

I'm an academic family doctor here at the University of Calgary.

We're here today to talk about how to present a patient case to one of your preceptors.

So in medical training we're doing this all the time.

I don't know how many hundreds or thousands of patients over the years in my medical school training,

my residency, and so on,

I ended up having to present to somebody above me,

one of my preceptors.

We're doing this all the time.

And as a preceptor, I hear all the time from medical students how they find it's hard to negotiate

and figure out what kind of preceptor, what kind of presentation.

Sometimes they want it short and sweet,

sometimes they want it long.

And they find it really confusing to negotiate that.

And sometimes it actually causes problems in even their relationship with their preceptor.

And we'll see it on summaries at the end

when a preceptor talks about a trainee who's presenting cases in a certain way,

and then you talk to that trainee and nobody ever talked to them and they never negotiated this upfront,

what's the right way, what's the most helpful way that people need to hear a case presentation.

So this is all about how to do that.

This is sort of like level one,

sort of like a good foundational approach.

And then there's a sort of more fancy one,

Level 2, which we'll get into in another video.

So when you're presenting a case to a preceptor,

the trick is a preceptor is a human too.

And I've probably just been dealing with something else and now I suddenly,

you suddenly have my attention as a preceptor.

And so, but I'm only a human.

And that means that I didn't see the patient because you've seen the patient first.

And it's going to be hard for me to process everything all at once.

And so a mistake that some trainees will do is actually just give me tons

and tons and tons of information to the point that I get kind of lost.

Now why are you presenting a case?

You're presenting a case so that I,

as the primary or the most responsible physician,

know kind of what's going on with the patient so that I know it'll help me in their patient care.

Number two, it's also so that I know where your knowledge ends and where your gaps begin

so that I know what I have to do to fill in things,

and I can also then know when I can stop relying upon you and all that kind of stuff.

It's also important for you to be able to show me that,

because then you're going to demonstrate who you are as a clinical thinker.

You don't want, as an outcome,

presenting a case presentation, and then you're going into the past medical history,

and you're seeing that I'm getting all fidgety and agitated.

You don't want me to suddenly say, you know what?

That's great.

Thanks very much.

Let's go in and talk to the patient.

Because what I've done then is I've just basically stopped you at some of the history details.

You might have in your head really good thinking about the likely diagnosis or the likely problem going on with this patient.

You might have a good plan that you've kind of put together.

Or at the very least,

you've got a plan put together.

It might not be perfect.

But I don't get to even know

that you've even been thinking about a plan if we are only ever stuck on past medical history.

so this method is a way to make it clear to Your your preceptors where you are.

It's called the signpost method

So the signpost method starts

and I'm gonna be playing both roles with the trainee telling the preceptor a little bit of a heads up

So when I'm over there,

I'm the trainee when I'm over here.

I'm the preceptor.

So Excuse me, Dr. Keegan,

can I talk to you about this patient that I just saw?

Sure.

Great.

So overall, she's a clinically stable 29-year-old,

but I'm worried she could be seriously ill with an ectopic pregnancy.

Whoa, okay, tell me more.

Tell me kind of quickly what's going on.

Okay, so just so you know,

I've seen her, I've done a history,

a physical exam, I've checked some investigations,

and I have a proposed plan of management.

Do you want me to get started?

with the history.

So what the student is doing then is making it clear to the preceptor

that he or she has already thought about this patient in detail.

So they've got history, they've got physical,

they've done investigations, they've got a provisional diagnosis,

and they've already had some thinking about a plan.

So at this point what you've done is you've planted signposts about where the preceptor can drive this conversation.

And these signposts are critical.

So the preceptor might say,

you know what, just tell me what are the key things in history

and the key things on physical that make you think it's an ectopic pregnancy that this patient has.

Or the preceptor might say,

okay, you said she's stable,

tell me more about that and how I know she's stable or how do you know she's stable.

Or the preceptor might say,

because the situation is a bit urgent,

say, you know what, okay,

let's just go straight to the bedside.

Regardless, you got the key message across.

You've seen a patient who actually has a serious medical condition,

or a potentially serious medical condition.

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.

TRENDING

ยอดนิยม

เทคนิค Shadowing คืออะไร?

Shadowing เป็นเทคนิคการเรียนรู้ภาษาที่ได้รับการรับรองทางวิทยาศาสตร์ พัฒนาขึ้นสำหรับการฝึกนักแปลมืออาชีพ วิธีการนี้เรียบง่ายแต่ทรงพลัง: คุณฟังเสียงภาษาอังกฤษจากเจ้าของภาษาและพูดตามทันที — เหมือนเงาที่ตามผู้พูดด้วยช่วงเวลาห่าง 1-2 วินาที การวิจัยแสดงว่าเทคนิคนี้ปรับปรุงความแม่นยำในการออกเสียง ทำนองเสียง จังหวะ การเชื่อมเสียง การฟังเข้าใจ และความคล่องแคล่วในการพูดได้อย่างมีนัยสำคัญ

☕ เลี้ยงกาแฟเราสักแก้ว

ShadowingEnglish ยังคงเปิดให้ใช้งาน ฟรี 100% ได้ด้วยการสนับสนุนจากคุณ ค่าใช้จ่ายสำหรับเซิร์ฟเวอร์และ AI นั้นสูงมาก — กาแฟของคุณช่วยให้เราเดินหน้าต่อไปได้! 🙏

บริจาคผ่าน PayPal

ShadowingEnglish.com – ฝึกพูดภาษาอังกฤษแบบ Shadowing

ฝึกพูดภาษาอังกฤษด้วยเทคนิค Shadowing จากวิดีโอ: How to Present a Patient Case: The Signpost Method

ยอดนิยม

ทำไมต้องฝึกพูดกับวิดีโอนี้?

ไวยากรณ์และสำนวนในบริบท

กับดักการออกเสียงที่พบบ่อย

เทคนิค Shadowing คืออะไร?

ฝึกพูดภาษาอังกฤษด้วยเทคนิค Shadowing จากวิดีโอ: How to Present a Patient Case: The Signpost Method

ดาวน์โหลดแอป

ทำไมต้องฝึกพูดกับวิดีโอนี้?

ไวยากรณ์และสำนวนในบริบท

กับดักการออกเสียงที่พบบ่อย

เทคนิค Shadowing คืออะไร?