跟读练习: Why the CPC Method Changes How You Learn Medicine (And Why Memorization Fails) - 通过视频学习英语口语
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I think that med school is harder for your generation than it was for mine but not for the reason that you think you think it's because you've got a lot more to learn and all of the molecular
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well that's not right because what you've got to understand is with all that molecular comes greater understanding so that you can actually tell a more complete story than we did so while there's more to learn
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it's a better story and easier to remember so the reason it's harder is not that in my opinion it's harder because you guys are learning from the desk
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and not from patients and autopsy rooms so let's talk about what that means if we go way back to the beginning of modern medicine so we're talking William Osler he said this shocking idea
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and it makes you laugh to hear it he said that the reason your patient has the symptoms and the signs that you find is because it correlates with abnormalities in their bodies
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and that is a whole multiple generations of ideas called clinical pathological correlation I mean it seems laughable now doesn't it but it's actually a profound idea
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I'm Doctor Philip Tisdale I practice medicine for over four decades I've been teaching for over 10 years every system in my book starts with the chapter labeled
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Clinical Pathological Correlation you're gonna want that book to be able to follow along so click the link in the description one of the benefits of my extreme old age is that I go way back into parts of history
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that really just aren't talked about anymore and it's hard to believe that medicine is so much better now doesn't mean that today's doctors are better doctors it means that they have better tools
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but if you go back to my day I started before there was widespread CT scanning and MRI physicians simply had to be better at physical exam the challenge that they faced was
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they had these very insensitive and non specific tools like the stethoscope and palpation and so lots of times they literally didn't know what was going on
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and because of that quality in medicine was based on autopsy findings when I first came out in practice in early 1980s over 50% of hospital deaths would have an autopsy
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so my life as a young practicing pathologist was to come in each day and see who had died and then call medicine and surgery teams and say to them when did you want to do the autopsy
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can you imagine that experience this was a patient you might have cared for for years and now despite all of your best attempts they had died I mean it's clearly failure
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and it was obviously very upsetting because now you're coming down to the corpse of someone you might have known for decades
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and you had to understand was there anything we could have done better and so I would be there with their patient and they I would say did you have any questions and you know someone would say you know
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I never knew what that lump was in the right lower quadrant we had no imaging
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and so we would open the abdomen and I would go in and I'd say well it's a 3 centimeter abscess
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and everyone go well that explains it and I wish I'd known because then we could have drained it
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it was such a profound idea and our tools were so limited back in my early practice days that somewhere between a third and a half of all autopsies would find significant
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enough abnormalities that were missed that it would have altered patient outcomes
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and so everyone in my generation has this very deep relationship with this idea that you're patient has underlying pathology that you personally have to discover
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and the way we would communicate that was what we would call morbidity and mortality rounds and of course quickly it became slang to death rounds but this was the most important intellectual event
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in our hospital the doors were locked no one was allowed in but the doctors and the pathologist would discover what he found and the attending physicians would criticize each other
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for should they have found it was it knowable would it have changed things these were deep very personal events and we were all very close because we trusted each other with this idea
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of clinical correlated to pathology
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the other thing that it did was it developed this idea that you started with a patient who had a disease time frame and there was a really deep idea that was called
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natural history and it meant what happens if we did nothing and all of us would know this because by large we didn't have a lot of tools I mean we had some antibiotics
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a few handful of cardiac drugs but really most of what we saw was natural history absolutely true in cancer and so because we had so few treatments and they were so toxic everyone would understand
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if you didn't know natural history what happens if we do nothing you wouldn't know whether it was worthwhile doing your treatment or not every treatment has side effects so every treatment is a risk benefit calculus
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now we have such marvelous treatments you don't intuitively think of it trust me 50 years ago we all thought of it and so you can see as I came to teach and everything was broken into these small
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little domains of small subject based experts I grew increasingly frustrated that students were lacking this totality they were lacking two fundamental ideas that all of us knew from experience
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the first was all of your patient complaints correlated to something underlying in pathology the tool you used to discover it was really a trade off of sensitivity and specificity
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but not the idea it's not magic wand where a report comes out of imaging and gives you the answer it seems like magic but for those of us of our generation
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it's merely a better tool and the second idea is natural history I had to actually write a whole chapter on chronic progressive disease Chapter 3
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because it's not intuitive to your generation that you start with a well person and they go through this disease progression of homeostasis adaptation
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then intermittent failure and then permanent failure I actually wrote a whole chapter on it because it's not intuitive if everyone's parceled into their specialty domain and only answers a specific problem in the patient
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so the more I taught the more I realized the problem that we had with two things first of all the first two years were taught by Phds
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it's not that there's anything wrong with a PhD but they are by definition subject based experts they can't tell you why you're learning that my generation they were useful
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but we were overall taught by practicing MDs so when we were taught their physiology it was the physiology they used in patient care and then the second was
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there wasn't this deep understanding of clinical pathological correlation and the natural history of disease
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and so as I used all the resources I just became increasingly frustrated
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and it's obviously frustrating with the teaching system all of you know that right I come into a group to teach a course and I always start with heart who doesn't love a panda and I always start with this
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a patient walks in the door and they have shortness of breath go
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and it's a uniform response from our medical students they give me this look that says you mean I've been studying my guts out for two years you've asked a perfectly fair question
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and I have no idea how to answer it and I go that's right because it's clinical pathological correlation
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the patient has shortness of breath why don't you walk me through the organs and the diseases and the subdiseases all the way to a specific diagnosis and once you've done that
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why don't you tell me where in the patient's natural history are we
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as I'm now coming out on social media I have to sort of conform to the needs and wants of social media and one of them is you have to capture an idea so that you don't have to keep explaining it
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and so you can imagine over the past 10 years the frustration I've had trying to explain this idea of clinical pathological correlation to today's doctors who have never seen an autopsy
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by the way our autopsies we did them in little hospitals half of all hospital deaths when I came out but over my career so I start like 1980 two ish by 1996 we closed our morgues
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the widespread CT scanning MRI universal fantastic chemistry wonderful microbiology the autopsy really
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wasn't revealing surprises anymore you know you'll hear conventional old time pathologist say oh yeah yeah we need autopsies they're great truth is they're really not like back in my day they those were revelatory
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and so with the advent of AIDS and the need to have sort of level 4 virus prevention systems it all went away not the need for this idea of clinical
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pathological correlation not this idea of natural history of disease but the way we did it and so the problem we have now is there are no autopsies most of you have never even seen one
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we don't all get together by our patients and say what did you think was happening and then go look so this really cohesive culture practicing physicians had
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that always came back to morbidity and mortality rounds that's all gone most modern day doctors don't practice in the hospital
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and so with that we've lost it in our teaching the idea hasn't gone has it
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and so you can see I'm the lonely voice in the wilderness looking wandering around trying to explain you've got to think and teach disease as clinical pathological correlation across a time frame called natural history
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I have to explain it and no one understands it because they've never experienced it so here we are I'm staking my ground and I'm calling this way of learning the right way to learn medicine
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you start with a patient and you have to know where in their disease path they are and know that their symptoms in your signs relate to the underlying pathology and that's an ancient
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old term that I'm re bringing back to life and I'm calling it clinical pathological correlation this is the CPC way of learning it's just been so badly fragmented we've forgotten it
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but it's the right way to learn medicine clinical pathological correlation why does your patient have a gurgle why are they short of breath what are you feeling there
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well if you do a test what specific part of the pathology you're looking for testing teaches pathophysiology CPC clinical pathological correlation applied over the time frame of natural history
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it is the right way to learn medicine I've been doing this increasingly more specifically for the past 10 years
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and I'm telling you it's the right way to get ready for exams and it's certainly the right way to get ready for patient care okay so pretty attractive when I say CPC is the right way to get ready for exams you know the clerkship
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you'll solve that problem when you get there right now you've got to solve the problem of exams let's talk about the step exams you know no one but the step people are there to talk about the questions
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but you know I've taught a lot of you and a small portion of you call me after the exam that I've specifically taught you for just to talk about how my teaching went I never ask about specific questions wouldn't remotely help you
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there's a gazillion of them but I can promise you this the spirit of the Step 1 exam is this clinical medicine is built on a foundation of basic
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medical sciences what does that mean it means they're starting with a patient clinical medicine and they expect you to say why
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so if you're short of breath why are you short of breath and congestive heart failure it's because you have pulmonary edema that gives you a diffusion defect and it gives you a VQ mismatch
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I guess we're pretty deep in the weeds of basic sciences aren't we they're going to ask you questions in such a way that they don't want to know that you've memorized them they want you to know why do they work
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here's an example so let's just do lung I'm teaching some students lung now happens to be at the institution I'm at so these are count last week I did this this is completely true I offered this course for these 200 students
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I'm gonna show you how you need to know histology to understand lung disease if you come and listen this lecture your whole course will make great sense to you and out of 200 students I got two
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well two is enough for me I love teaching and so I went through talking about why do you think that's true and you could see them slowly start to internalize this idea
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why when you have emphysema do you breathe like this
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slow and with pursed lips do you have a mental image of the structure underlying that because they all do that's a basic science mental image of lung and its pathology correlating specifically to that patient
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so those two students are gonna have a really happy course but I promise you everyone else will go to first Aid and U World and they'll plug away going this is unpleasant I wish I could see patients well
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I'm gonna start you with your shorter breath when you read the stem in your questions you'll go I can feel the mind of the examiner she's talking to me she's saying
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I have a patient coming in and they breathe like this
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what do you think happens in their lungs that is the spirit of the exam clinical medicines built on a foundation of basic medical sciences and it's a really easy way to study
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you just keep asking why am I learning this and so true story I was teaching with this preeminent immunology microbiology educator and you know we were really close friends we taught all over the world together
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and she was staying at my house and we were sort of going through our curriculum of joining each other she went into this long complex discussion of immunology I'm sure you've been through many of them and I looked at her and said
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you know I'm just not gonna learn that and she was shocked
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I mean I'm the expert you have to know something you know it just looks like a lot of work and I I just don't see the benefit of it and she will tell you that was when her whole teaching philosophy changed
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20 years she's been teaching this right and she suddenly went oh my goodness I'm teaching doctors not immunology microbiology and so she coined this phrase we use it all the time and it's perfectly true
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hashtag make me care
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so as you're studying hashtag make me care ask yourself how does this make me understand my patient better clinical pathological correlation
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and I promise you that is the spirit of Step 1 exam and for all the tension and high stakes you kind of start enjoying your questions more so as you can tell I I've done lots of different teaching
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I've taught classic medical schools in the Caribbean I've done pure step on prep for many years and now I'm actually with a traditional medical school and they are teaching exactly the way I was
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back in 1972 they start with a little introduction and then they go straight to subjects right I mean you've done it right it's anatomy histology physiology
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microbiology that's their first year and then they come to second year where they're supposed to do the clinical integration of that and then they go to clerkship got it we all do that the other variant that you see in this
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might be your school is we do it by system so we're gonna do cardiovascular pulmonary renal but if you go take a look at how those system based are done
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they took each chapter from the subject and put it into that organ in other words you still have whoever did the PhD of lung physiology in the physiology course
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just takes his lung physiology and does it in lung it's still fragmented by subject based experts and this is how you can tell when you get that clinical person
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coming in to talk about lung disease does she teach the physiology because if she doesn't you know what you're saying well thanks PhD but my clinician didn't need it
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so this is just for exam if you as a practicing physician don't need that basic sciences then you don't need it so don't teach it there's a lot to learn
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well you can imagine my increasing frustration right I'm using these physiology books and I go hashtag make me care I don't I've spoken to lots of pulmonologists they just don't need it
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they memorize what they had to for their exams and then dropped it they do what they do in practice all you're gonna get from me in clin path correlation in each system is what you have to be able to do
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to understand disease and its treatment every time you're studying hashtag make me care but make me care is what practicing doctors do that's a clinical subject and it doesn't exist
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so I had to write the book and look at its title what else could I call it right it's clinical pathophysiology hashtag make me care
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clinical medicine is built on basic sciences every system starts CPC and then goes to structure function because we start with the patient it's patient centered learning
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if you haven't already be sure to subscribe each week I'm gonna be doing a new podcast and we're going from these basic discussions to more specific things like test
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step prep how we use testing to teach path of fizz I'm gonna be talking to former students I'm gonna be talking to the very small handful of educators who have moved over to the CPC style of teaching
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what that feels like and how their experience in teaching who has been so I hope you'll tune in if you like this video
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my previous video was on the idea of completeness see you next time
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背景与上下文
在医学教育的演变中，医生们面临的挑战与现实是不断变化的。许多现代医学学生在学习过程中感到困惑，因为他们的学习方式更多地是通过教科书而非患者及其病理进行。这种学习方式导致了临床与病理之间的联系却未能被充分理解。对于许多曾经历过传统医学训练的医生来说，患者的病理与临床症状之间的相互关系是至关重要的。掌握这一理念能够帮助学生深入理解疾病的自然历史和临床病理相关性，从而提高他们的医学能力。
日常交流的五个常用短语
- 为何会出现这些症状？ - 了解患者的病理背景。
- 我们能采取哪些措施？ - 询问可能的治疗方案。
- 这种情况的自然历史是什么？ - 探讨病情发展过程。
- 我是否能够再得到更多的信息？ - 请求更详细的数据支持。
- 你的回答让我更清楚了，谢谢！ - 表达感谢。
逐步模仿指导
要有效地提升你的英语口语并掌握医学领域的沟通技巧，可以遵循以下步骤进行影子跟读练习：
- 选择并观看一段不超过五分钟的医学相关视频或录音，确保内容与你的学习需求相符。
- 在观看时，注意讲者的语调、发音和语速，尝试理解每一句话的意思。
- 第一次观看时，暂时不做笔记，主要专注于理解内容。
- 第二次观看时，暂停录音并重复每一句话，这样可以提高你的英语发音和听力。
- 利用网络上的英语影子跟读工具，练习与模仿讲者的说话方式，这样能帮助你自信地与患者或同事交流。
- 定期回顾和反复练习这段材料，逐步提升你的表达清晰度和流利度，尤其在雅思口语练习中。
通过运用这些方法，你将能够有效地吸收医学相关的英语知识，并将其应用于实际交流中，进一步提升你的临床能力和沟通技巧。
视频中的语法
说话人最常用的结构，并附上视频中的原话：
| 结构 | 视频中的用法 |
|---|---|
| 现在完成进行时 have/has been + -ing — 以前开始、现在仍在继续的动作 | I've been teaching · I've been studying · I've been doing |
| 条件句 if + 从句，will/would + 动词 — 条件及其结果 | if we do nothing you wouldn't know |
| 现在完成时 have/has + 过去分词 — 过去发生但与现在仍有关联的事 | have found · you've asked · you've done |
| 被动语态 be + 过去分词 — 强调发生了什么，而不是谁做的 | aren't talked · was based · were missed |
什么是跟读法？
跟读法 (Shadowing) 是一种有科学依据的语言学习技巧，最初开发用于专业口译员的培训，并由多语言者Alexander Arguelles博士普及。这个方法简单而强大：您在听英语母语原声的同时立即大声重复——就像是一个延迟1-2秒紧跟说话者的影子。与被动听力或语法练习不同，跟读法强迫您的大脑和口腔肌肉同时处理并模仿真实的讲话模式。研究表明它能显着提高发音准确性，语调，节奏，连读，听力理解和口语流利度——使其成为雅思口语备考和真实英语交流最有效的方法之一。