ハーバード留学英語３年目編014:USMLE 2CS英語レッスン3回目（神経学的所見）

USMLE　2CS英語レッスン３回目

今回は割とシステムに慣れてきたで、２症例をやってかつ前回の神経学的所見の取り方をおさらいしました。大体の流れはつかめるようになったものの、

１）ところどころスムーズさに欠ける
２）重複が多い
３）必要な医学的質問を忘れている（糖尿病の現状の把握など）

という課題が見えてきますね。あとpatient noteの部分はカバーできていないのですが、これもまた必要な鑑別を忘れてしまいますね。もうちょい突っ込んだトレーニングが必要なようです。

今回からは音声録音で対応することにしました。特に神経学的所見の取り方を含めた復習の部分は忘れそうなのでしっかり録音したのち書き起こしておきました。症例はドラッグが原因と思われる幻覚が主訴の２７歳男性。
多少違っているかもしれませんが、いろいろな意味でテンプレートとしては使えそうです。

テープ起こし

Ah I’m just coming to the physical exam and let me wash my hands.
Ok. One thing frist. I would like to look up Please Ok, and look down, Ok.

Can you clone your eyes tightly like this, and can you open?

Can you raise your eye brows?

I want you to follow my finger without moving your head.

Thank you very much.

I would like you to look at the wall right behind me like at the point there.
I’m just gonna shine you slightly.

I would like you to close your eyes and I’m just gonna touch your head.

Do you feel this?
Do you feel this?
Do you feel this?
Do you feel this?

Is it the same on both sides?

Please keep your eyes closed.

Do you hear this?
Do you hear this?

Is it the same on both sides?

Thank you very much.

OK

Can you tell me your name?

XXXX

Ok, where are we?

Hospital.

OK, who is the president of United States?

Barak Obama

Good I’m gonna give you three words.

Apple, Cat, Pen.

Please remember that, I’m gonna ask you abut that.

What did you have for breakfast?

Bread and Egg.

Can you spell backwards the word Table?

ELBAT

OK good.

Can you remember the words I gave you?

Apple, Cat, Pen

Good, thank you very much.

I’m just going to check your chest and I’m just going through anther practice.

Just breath normally?

You can take deep breath in and out?

In and Out.

In and Out

In and Out.

I’m just gonna listen from behind.

In and Out.

In and Out.

In and Out.

OK good.

Just breath normally.

All right. I would like you to go like this?

I am gonna push you, so please resist me?
OK

I am gonna pull you and please resist me?

Ok

I am gonna push you and please resist me?

OK

Please pull me?

OK. Thank you very much.

Please put your arms like this?

I’m gonna press down.

OK

Please go like this.

OK.


Please squeeze my fingers.

OK. Thank you very much.

Hey, I would like you to stand up. And I would like you close your eyes.

OK, just a few moment.

Good.

Please open up!

I would like you to walk to the door please

Sorry, Are you OK?

Yeap.

Could you walk back to me? And this time, you can walk heel to toe and heel to toe.

All right, good you can sit down.

Last thing, I’m gonna check your reflex.

OK.

I’m just gonna check your feet.

OK.

OK good. I’m all done with my physical exams, and let me give you my impressions.

One possibility is that you have an abnormality right in your brain and so we can diagnose that by imaging studies.

However there is a strong possibility that your hallucinations are caused by the drugs you took. You had Ecstacy and Angel dust yesterday and that is when it started.

So sometimes these drugs if they are taken regular basis, can cause these hallucinations. I need to do some tests and I will do blood test and a few other tests.

In the meantime, I would really strongly like to recommend you to stay away from taking these drugs. These drugs can cause serious health consequences such as hallucinations. Once you start hallucinations, it can get worse. I will also recommend you to give up tobacco. I understand it hard, but tobacco can also cause serious heath problems in the future. If you are interested, I can have a counselor to speak with you for smoking cessation and resources here at the hospital as well as the drugs.

Once again, I would recommend you to stop taking Ecstacy and Angel dust and I hope you stop tobacco. I will go get those tests setup right now and once we get the test results back, I will meet with you again. Ok. Thank you very much.

ハーバード留学英語３年目編013:toastmasterいよいよファイナル”inspire your audience”

inspire your audienceって

toastmastersのcompetent communicator manualの最後の課題は”inspire your audience”！
最後の課題だけあって、総集編的な課題ですね。

inspire your audienceといえば、ふと思いつくのが、スティーブジョブズがスタンフォード大の卒業式で行った。
スピーチが有名ですね。荷が思いなと思いつつテーマを考えていたら、toastmaster magazineの記事に

"Breaking language barriers"

というのがあったので思わずいただいてしまいました！

10回目の発表”Breaking Your Barriers to Public Speaking”



Good afternoon, fellow toastmasters and welcome guests. (brief pause….)

My talk tonight is “Breaking Your Barriers to Public Speaking”. English is a second language for ME. My language barrier is one of my biggest concerns about public speaking. That is why I joined the toastmasters club for more than 1 year.

As I mentioned several times in the toastmasters meeting, the experience in the toastmasters general club has helped me a lot to overcome my language barrier. At this moment, I am still working on breaking of my language barrier. However I have some ideas on what it is and how it is to break my language barrier. I believe this insight could be applicable to breaking other types of language barriers. (EXCELLENT IDEA….PAUSE).

Therefore I would like to share my insights with you.
(dramatic pause…two seconds). I hope that it could also help you to overcome your barriers.



According to my experience in toastmasters, I realized that there are four important things to be aware of when you are trying to break your barriers.

These important things are…

First: have a goal……a good goal using the “SMART” goal setting technique. This is an excellent way of structuring any presentation or meeting.
Second: Is to enjoy your challenge is also very important. Embrace any anxiety or fear that you have about public speaking and use that for your benefit.
Third: Enjoy your fellows or working partners and the environment. The audience, in most cases, are your friends and they want you to succeed.
Forth: Learn from your mentors and the feedback that the audience provides, especially the speech evaluators…these are the keys to your success.



First, I would like to start with the aspect of goal setting. In general, there are 5 golden rules to set your goal in order to achieve outcome you need. The five rules are: Your goals should be Specific, Measurable, Achievable, Relevant, and Time-bound. This is also called smart goal setting.
I realized that the toastmasters’ competent communicator track is a good example of SMART goal setting.
As you can see in the manual, a different sets of objectives is assigned to each of the project, therefore goal should be very specific. Your fellow toastmasters help you to evaluate your skills and your improvement should be measurable. It might not be easy but it is achievable to give a talk in the toastmasters meeting once in 1-2 month. The projects in the manual are well constructed and the objectives of each projects become deeper and wider from earlier to later projects and the challenge you will face in the projects should be relevant. Finally, it is also time-bound. The speed is not clearly indicated in the manual, but most of the participant probably want to improve communication skills not within a month but within one year or two. That makes it possible to find good pace makers for your achievement among the club members.
I believe that this types good goal setting in competent communicator track allows you to improve your communication skills very efficiently and effectively.



Second, I would like to talk about the fun aspects of public speaking challenges. I can think of the many enjoyable things in my challenges and you may find more in your challenges.
This could be side products of your challenge but it promotes you to step further.
First it is a very encouraging moment when you realized your improvement or accomplishment. I think it is important to make use of this kind of feeling for continuing your challenge.
In addition, I could learn a lot of things from my challenge in the toastmasters. As for communication skills, I have learned many things such as speech structures, vocal varieties, the techniques to inspire audiences. As for topics, I could also learn a lot of things such as myself, time management, and cognitive behavioral therapy. It is very enjoyable and makes my life more rich.
Finally, I also would like to point out you could get something you did not expect at the beginning during your challenge. In my case, I could get some confidence in communication and it helps me to widen my perspectives as well as the chance or opportunities that I had dismissed before.



Finally, I would like to mention about the aspects of your working partners. Friendly and warmful environment of toasmtasters general club always helps me to continue my challenge.
I also have two good mentors, GXXXX at the beginning and KXXX now. GXXXX helped me to familiar with everything in the toastmasters and Kevin always helps me to edit my speech. I also have two good pace makers RXXX and KXXX. They helped me to follow the track of competent communicator manual.
I realized these human factors are also important for your accomplishments.



IN CONCLUSION: (Pause)…Today I talked about four things that are important to break your barriers. (I changed to four, you can change back if you want)
Three things are
S.M.A.R.T goal setting
Enjoying your challenge
Your Fellows – Environment, Mentor, and Pace maker
I believe these three factors are key to any kinds of challenge for everyone.
I hope it helps you to break your barrier, cross the boundary, and continue your journey to the new world.
Thank you very much for your attention.

さすがに10回目となると、ある程度の自信、度の暗い準備すれば良いのかというノウハウが付いてきて、かなり発表に余裕ができるようになります。スピーチのスピードも自分の中で一番良いと思えるスピードがわかってくるのも面白いですね。
またここでできた自信とかスピーチのさばき方は、実際のscientificな発表にも使えるので、かなり最近ラボでの発表が楽になった気がします。スピーチに自信のない方はtoastmaters是非試されると、世界が変わる気がしますね！おすすめです。

ちなみやり始める前は、ネィティブに混じって英語で発表なんてとてもと思っていましたが、結果的には我がtoastmasters general clubで10回やり通したのは、ネィティブでない自分が一番早っかったりしました！

ハーバード留学英語３年目編012:toastmaster 9 回目"Persuade with power"

Persuade with power

先月予定が幾つか変更になった影響もあり、立て続けにtoastmastersの発表を行い、今年度中の目標だったcompetent communicator manualのプロジェクトを終わらせた！

これはその1つめ。９つめのプロジェクトであるPersuade with powerである。なんらかの説得できるような発表をしないといけないのだけれど、なかなかネタが思い浮かばないので、日本ネタに逃げ、”そうだ京都。行こう”的な発表にした！

この会はなかなかmanuscriptが覚え切れなくて苦労したがなんとかクリア！

９回目の発表”How about thinking of traveling to Japan?"

Have you decided the destination of your vacation for this year? (Brief Pause…) Perhaps for spring break or during the summer?
Since I am from Japan and I want you to learn about and enjoy my country, I would like to suggest you to think of traveling to Japan!



You may ask yourself….What are the most appealing points of traveling to Japan? I’ve asked several people who love to go to Japan, and they all said that there are three aspects that appeal to most wise tourists. These three aspects are…Nature…traditional culture…and modern culture. I would like to mention attractive points of traveling to Japan in terms of these three very broad aspects of Japan and of Japanese culture.


The first aspect is Nature in Japan. These are advertisements designed to attract tourists to go to Kyoto - the old capital in Japan. The beauty seen in nature in Japan is inspiring. (Pause….)



There are four seasons and every season has its own beauty, just like in New England and Boston. There are Cherry Blossoms blooming in spring, there are beautiful Green Mountains in reaching to the sky in summer. In the fall the leaves change color like in New England. And finally, in the winter there is some snow. Every time you visit Japan, you can enjoy the natural beauty and changing seasons of Japan.

Among the things the tourists find interesting is traditional culture. An example of the beauty is shown in the simplicity that originated from Zen Philosophy. Zen philosophy is one of the most important aspects of traditional Japanese culture, as well as, our modern culture.
(brief pause…)



Some of you may know about the famous story that the former Apple CEO - Steve Jobs - was greatly influenced by Zen philosophy. He designed many of his products with great design simplicity. Products like the Mac computer, the iPhone and the iPad have a basis in Zen Philosophy. You can feel that Zen simplicity influencing our daily life when you are take a picture of the Stone Garden in the Ryoan-ji temple with your iphone.
I’m sure this is an exciting moment when you feel a connection between traditional Japanese Culture and our every day technology driven life.

Another fascinating thing in every travel is food and Japanese traditional food is one of the things I would like to recommend you to try very strongly. This is a beautiful collection of small sized sushi and as you can see here, Japanese traditional food is sophisticated in terms of its taste as well as its appearance. You could enjoy both two aspects when you try to taste them.




Lastly I would like to show some aspects of modern culture of Japan. Tokyo is also a modern city. (brief pause…)


You can access everything you want similar to many modern cities, such as, New York, Boston, Toronto. There are plenty of museums both for fine arts and natural history. Great restaurants and excellent educational facilities.




You could visit a museum for a famous anime movie producer, Hayao Miyasaki.
(brief pause…)
Or a museum for Hello Kitty that most children are crazy about and enjoy Japanese famous animation.
(brief pause…)
Or you could visit a Ramen noodle Museum and taste several types of noodle that most Japanese like to eat.

In summary, I talked about three aspects of Japan that, I hope, will make you think about traveling to Japan.
(brief pause….)
These aspects are…Nature, traditional and modern culture and there are many more wonders waiting for you to discover in Japan.



As a personal note: I think that Spring is the best season to visit Japan. If you have time and money, I strongly recommend you to plant to visit Japan during this spring.

ハーバード留学英語３年目編011：USMLE2CS用英語レッスン２回目

２回目の今回は神経学的な所見に関する英語のおさらいでした。
授業メモはこんな感じ。
神経学的所見はやはり難しいですね。
ちょっと復習が必要です。



Neurological
MMS(mental) AlZ, PARK

Can you tell me your name?
What is today’s date?
Where are we?
I’m going to give you three words.
Please repeat them
Pen-Apple-Chair
I want you to remember them
Please subtract 7 from 100?
Please spell the word TABLE backwards.

This is the test for baseline of your mental status.
The test for full mental status will be required later.

Physical (Muscle/Gait)
Face:
Do you feel this? Is that the same on both sides?
Raise your eyebrows for me?
Shut your eyes tightly.
Smile
Please follow my finger without moving your head.

Hand and Arms:
Please pull me and please push (resist) me.
Stick out your arms and resist me.
Please squeeze my fingers.
Make a first, Open your hands, and shake like this.
I am going to check your reflexes.

Foot and Gate:
Please walk heel and toe.
Raise your foot up.
Raise your toes
Step on the gas.

ハーバード留学英語３年目編010:toastmasters８回目と世界初のエーテル麻酔

toastmasters発表８回目

toastmastersで自分で発表をし始めてから、ほぼ一年！ようやく８回目の発表を終えることができた。ここまでくると大分場数をこなしてきた感じがあり、ちょっと英語での発表が楽になってきた気がする。

未だに英語の発表の前は緊張するが、すくなくともどのくらい事前に用意すれば大丈夫か（少なくとも３－４回声に出してリハーサルすると大分違う）ということがわかった。

またいくつか質問その他をうまくかわす方法も身についてきたので、やはりtoastmastersやって良かったと思う。

Using Visual Aids

Using Visual Aidsというのが今回の課題だ。

ちょっとお題選びに苦しんだのだけれど、MGHで1846年に世界で始めに行われてたエーテル麻酔のデモンストレーションをお題にとって、その周辺の話題をうまく取り入れつつ、エーテルドーム及びMGHのRussel博物館に取材にいって題材を盛り込んだ。

















というのが発表内容だ。

なおMGHのエーテル麻酔は、世界で最初に麻酔を発明したというところに意義があるのではない。
実はこの発表にも述べらているようにこのMGHのできごとよりも前に何人もの医者が麻酔を試みていたらしい。

日本でも華岡青洲が1804年に朝鮮朝顔からとった毒で麻酔をおこなっている。MGHでこのデモンストレーションをおこなったボストンの歯科医Dr.Mortonはコネチカットの医師がおこなった笑気でも麻酔にインスパイアされ、自分自身でエーテル麻酔の手法を開発し、自分の歯科治療にもつかっていたらしい。

それに目をつけたハーバードの医師がMGHでエーテル麻酔のデモを行うことを提案し、1846年にMGHのエーテルドーム（当時のオペ室）で首の腫瘍を取る手術の際に麻酔のデモおこなったらしい。このデモは非常に説得力があり、また当代一流の医師のグループに対しておこなったために、この技術が世界中に瞬く間に広まったらしい！

教訓としてはやはり技術を広めるためには、技術の中心にいないといけないということであろうか？

それはさておき、今回も無事に発表が終わりました。あと２回でようやく一区切りつきますね。頑張ります。