Medicine as a profession and even the medical training process

醫學作為一種職業，甚至是醫學培訓程序

have evolved drastically over the past several decades.

在過去的幾十年裡，已經發生了巨大的變化。

Technological advancements, cultural shifts, and regulation changes have resulted in an entirely different animal.

技術的進步、文化的轉變、法規的變化，導致了一種完全不同的動物。

Is it better, or is it worse?

是更好，還是更差？

Let's compare medicine today to how it was back then.

讓我們把今天的醫學和當年的醫學做個比較。

Dr. Jubbal, MedSchoolInsiders.com.

朱波醫生，醫派內參網。

In the early 1900's, medical school was nothing like it is today.

在20世紀初，醫學院與今天完全不同。

Schools were concerned more about making money

學校更關心的是如何賺錢

than they were about science or training competent physicians.

而不是關於科學或培養合格的醫生。

Basic science was more of a “nice-to-have” rather than a “need-to-have.”

基礎科學與其說是 "需要"，不如說是 "需要"。

In 1910, Abraham Flexner published the Flexner Report,

1910年，亞伯拉罕-弗萊克斯納發表了《弗萊克斯納報告》。

urging medical schools to adopt several standards to improve medical education and training.

敦促醫學院採用若干標準，以改善醫學教育和培訓；

It's no surprise that some schools,

這並不奇怪，有些學校。

many of which were completely off base in what medical education should look like,

其中很多完全偏離了醫學教育應有的樣子。

were closed shortly after.

不久後被關閉。

It was this report that prompted the medical school pre-requisites for pre-med students,

正是這份報告促使醫學院對預科生的預科要求。

including biology, chemistry, and physics, which have since evolved and expanded.

包括生物學、化學和物理學，後來不斷髮展壯大。

If organic chemistry is the bane of your existence, you have Mr. Flexner to thank.

如果有機化學是你生存的禍根，你要感謝Flexner先生。

Clinical rotations became a standard part of medical school, and the 2 + 2 format was standardized,

臨床輪轉成為醫學院的標配，2+2的形式也被標準化。

meaning the first two years emphasized pre-clinical didactics in the classroom,

意味著前兩年強調課堂上的臨床前講授。

and the latter two years comprised of clinical rotations.

而後兩年則由臨床輪轉組成。

In 1942, the Liaison Commission for Medical Education, or LCME, was founded.

1942年，醫學教育聯絡委員會，即LCME成立。

As an accrediting body performing on-site reviews,

作為進行現場審查的認證機構，：

its purpose was to uphold medical schools to the new and evolving standards.

其目的是按照新的和不斷變化的標準來維護醫學院。

In the last couple of decades, medical school has evolved at a rapid pace.

在過去的幾十年裡，醫學院的發展日新月異。

While some medical schools rely exclusively on lectures,

雖然有些醫學院完全依靠講座。

more and more have begun transitioning to more interactive and effective forms of teaching,

越來越多的人開始向互動性更強、更有效的教學形式轉型。

including problem-based learning, team-based learning, and flipped classrooms.

包括基於問題的學習、團隊學習和翻轉課堂。

Problem-based learning, or PBL, consists of small groups of students, usually around 6-10,

基於問題的學習，或稱PBL，由學生組成的小組，通常在6-10人左右。

and a physician facilitator, who together go through a hypothetical patient scenario.

和一名醫生主持人，他們共同經歷了一個假設的病人場景。

Team-based learning, or TBL, is similar,

基於團隊的學習，即TBL，也是類似的。

but it's one teacher who is facilitating several smaller groups at the same time, often in a lecture hall setting.

但它是一個老師同時促進幾個小團體，通常是在一個講堂環境下。

A flipped classroom is one where students study the textbook at home,

翻轉課堂是指學生在家學習課本的課堂。

and class time is reserved for questions and hands-on work.

並將課堂時間留給提問和動手操作。

Most schools also now have students seeing patients far before their third year.

現在大多數學校也是讓學生在第三年之前就看病。

At my school, we were interacting with patients during the second week of first year.

在我校，初一第二週我們就在和病人交流。

As medical research has evolved and improved,

隨著醫學研究的發展和提高。

the medical knowledge covered in medical schools has also grown exponentially.

醫學院的醫學知識也成倍增長。

Students now have more to memorize than ever before,

現在，學生需要記憶的內容比以往任何時候都多。

and it's for this reason so many pre-med and med students turn to Anki as their new lord and savior.

也正是因為這個原因，所以很多醫學預科生和醫學生都把安琪當成了新的主宰和救世主。

There's also a new kid on the block, Memm,

還有一個新來的孩子，Memm。

which is a new and improved study tool that is 2 years in the making.

這是一個新的改進的學習工具，是2年的時間。

If you want to check it out and test drive the beta,

如果你想查看並試駕測試版。

subscribe to the Med School Insiders newsletter where we will be announcing its release and how to get involved.

訂閱Med School Insiders通訊，我們將在那裡宣佈它的發佈和如何參與。

The medical school application process has also radically transformed over the preceding decades.

在之前的幾十年裡，醫學院的申請過程也發生了根本性的變化。

Not so lucky for you,

你就沒那麼幸運了。

getting into medical school has been trending towards being more and more competitive each and every year.

進入醫學院，每年的競爭都有越來越激烈的趨勢。

In 1957, there were 12 applicants per spot.

1957年，每個名額有12名申請人。

In 2010, that number rose to 40 applicants per spot.

2010年，這一數字上升到每個名額40人。

The MCAT is also a completely different beast than the first version released in the 1940's.

與上世紀40年代發佈的第一個版本相比，MCAT也是一個完全不同的野獸。

Back in the 1920's, students were flunking out of medical school left and right,

早在上世紀20年代，醫學院的學生們就已經左右開弓了。

at some schools even close to 50%.

在一些學校甚至接近50%。

In response, The Moss test, which is the precursor to the MCAT,

對此，The Moss test，是MCAT的前奏。

was developed to test one's readiness for medical school.

是為了測試一個人是否為醫學院做好準備而開發的。

That, combined with stricter medical school admission procedures and higher educational standards,

再加上醫學院招生程序更嚴格，教育標準更高。

dropped the attrition rate to a more reasonable 7% in the 1940's.

在20世紀40年代將損耗率降到了比較合理的7%。

The MCAT has been redesigned several times since, most recently in 2015,

此後MCAT多次重新設計，最近一次是在2015年。

and now has a greater emphasis on the humanities than its predecessors.

而且現在比以前更加重視人文科學。

And that makes sense.

這也是有道理的。

After all, we're beginning to appreciate that being a good doctor is about much more than being good at science.

畢竟，我們開始體會到，作為一個好醫生，其意義遠不止於擅長科學。

Teamwork and communication skills have been emphasized not only in medical school,

團隊合作和溝通能力不僅在醫學院裡被強調。

but even in the admissions process.

但即使在錄取過程中。

Multiple mini-interviews, or MMI for short,

多次小型訪談，簡稱MMI。

uses a series of short scenarios to assess a candidate's soft skills more effectively than a traditional interview.

與傳統的面試相比，使用一系列簡短的場景來更有效地評估候選人的軟技能。

Ask any doctor, and they'll tell you that the golden years of medicine are behind us.

問任何一個醫生，他們會告訴你，醫學的黃金時代已經過去了。

What's less agreed upon is when the golden years exactly were.

不太認同的是，黃金年代到底是什麼時候。

Most contemporary physicians would consider the 1980's as the good ol' days of medicine.

當代大多數醫生都會認為80年代是醫學的好時代。

But in 1982, you had physicians lamenting about unwarranted criticism

但在1982年的時候，你讓醫生們為無端的責備而哀嘆。

and how doctors needed more R-E-S-P-E-C-T.

以及醫生如何需要更多的R-E-S-P-E-C-T。

Clearly, the changing opinions and decreasing job satisfaction of physicians

顯然，醫生意見的變化和工作滿意度的下降。

has been a slow and steady process.

一直是一個緩慢而穩定的過程。

There are many benefits to being a doctor today compared to being a doctor a few decades ago.

與幾十年前做醫生相比，今天做醫生有很多好處。

As Robert Wachter writes in The Digital Doctor,

正如羅伯特-瓦赫特在《數字博士》中寫道。

radiology before the computer revolution was an inefficient and slow process.

在計算機革命之前，放射學是一個低效而緩慢的過程。

You had to walk to the radiology department, schmooze with the radiologists,

你得走到放射科，和放射科醫生哈拉。

have them find the film, and so on.

讓他們找到電影，以此類推。

It was tedious.

這是很乏味的。

Nowadays, we can quickly access images from our computer,

如今，我們可以從電腦中快速獲取影像。

mobile devices, and reference the radiologists' formal readings written in the note.

移動設備，並參考放射科醫生的正規讀片寫在病歷上。

But it hasn't been all sunshine and rainbows.

但它並不都是陽光和彩虹。

I've used EPIC for a few years, the most dominant electronic medical record,

我用了幾年的EPIC，最主流的電子病歷。

and it's far from pleasant to use.

而且使用起來也遠沒有那麼愉快。

Dr. Wachter doesn't hold back in pointing out EPIC's shortcomings,

Wachter博士並沒有迴避指出EPIC的缺點。

inefficiencies, and the potential for improvement in the marriage between computing and medicine.

效率低下，以及計算和醫學之間的結合有改進的潛力。

Don't get me wrong, while it's far from perfect,

別誤會，雖然它遠非完美。

I definitely prefer EPIC over other EMR's or, even worse, the dreaded paper chart.

與其他EMR相比，我絕對更喜歡EPIC，甚至更糟的是，可怕的紙質圖表。

The added regulations and billing requirements have made being a doctor less about being a doctor,

新增的規章制度和計費要求，讓做醫生變得不那麼重要了。

and more about doing administrative work.

而更多的是做行政工作。

Charting requirements and documenting are at an all-time high.

製圖要求和記錄工作達到了前所未有的高度。

Atul Gawande elegantly explained Why Doctors Hate Their Computers in The New Yorker,

Atul Gawande在《紐約客》中優雅地解釋了為什麼醫生討厭他們的電腦。

pointing out that specialists who spend more time charting,

指出，花更多時間製圖的專家。

meaning documenting on their computers rather than interfacing with patients,

意味著在他們的電腦上進行記錄，而不是與患者進行交流。

are more likely to be burned out.

更容易被燒燬。

He explains that this is why emergency medicine doctors have higher burnout rates than neurosurgeons,

他解釋說，這就是為什麼急診科醫生的職業倦怠率高於神經外科醫生的原因。

even though neurosurgeons work way harder.

儘管神經外科醫生的工作更辛苦。

The numbers don't lie.

數字是不會說謊的。

Burnout, depression and suicide rates are at an all-time high, and there doesn't seem to be an easy solution.

職業倦怠、抑鬱症和自殺率處於歷史高位，似乎沒有一個簡單的解決方案。

Doctors of yesteryear are quick to say

昔日的醫生們很快就會說... ...

that the issue is simply that millennials are too entitled and constantly complaining.

問題只是千禧一代太有權利，不斷抱怨。

But these doctors are also the same people that say they used to walk to school 15 miles in the snow,

但這些醫生也是那些說自己曾經在雪地裡步行15英里去上學的人。

uphill both ways.

兩邊都是上坡。

Whether or not us millennials are whiny and entitled is beside the point.

我們這些千禧一代是否牢騷滿腹，是否有權，這不是重點。

Being a medical student or doctor today is simply a completely different animal than it was back in their day.

今天作為一名醫學生或醫生，與他們那個時代相比，簡直是完全不同的動物。

First off, the amount of information medical students need to learn today

首先，當今醫學生需要學習的信息量大。

is an order of magnitude greater than it was half a century ago.

比半個世紀前大了一個數量級。

It's not even a comparison.

這根本不是比較。

The pressure is higher due to ever increasingly intense levels of competition.

由於競爭程度越來越激烈，壓力越來越大。

As residents, they didn't have to worry about writing crazy detailed notes

作為住戶，他們不用擔心寫瘋狂的詳細筆記。

to avoid issues with insurance coverage.

以避免保險範圍的問題。

Doctors were paid well without the crushing levels of student loans.

醫生的工資很高，沒有學生貸款的壓榨水準。

Mistakes were made,

犯了錯誤。

but because of the lack of well-intentioned yet poorly-implemented protocols of today,

但由於當今缺乏用心良苦卻執行不力的協議。

they weren't subject to frequent penalties.

他們沒有受到頻繁的處罰。

We like to think that patient care is vastly improved today compared to decades ago,

我們喜歡認為，與幾十年前相比，今天的病人護理有了很大的改善。

but even that isn't as clear cut as you might think.

但即使是這樣也不像你想象的那麼清楚。

The practice of Medicine may be evolving and changing,

醫學的實踐可能在不斷髮展和變化。

but the fundamentals remain the same.

但基本面不變。

That's why if you're a pre-med or medical student,

所以如果你是醫學預科生或者醫學生。

I recommend that you check out

我建議你去看看

Medical School for Everyone: Grand Rounds Cases from The Great Courses Plus.

大家的醫學院。"偉大課程 "中的 "大巡迴醫療 "案例：

In this course, pediatrician Dr. Benaroch

在本課程中，兒科醫生貝納羅赫博士。

walks you through patient cases, starting with how to gather a history,

從如何收集病歷開始，引導您瞭解病人的情況。

perform a physical exam, develop your differential diagnosis,

進行體檢，制定你的鑑別診斷。

order tests, and finally formulate a plan.

序測試，最後制定計劃。

Most importantly, he walks you through the why,

最重要的是，他帶你瞭解為什麼。

how doctors think, and the skills necessary to be an effective physician.

醫生是如何思考的，以及成為一名有效醫生所需的技能。

The Great Courses Plus is a subscription on-demand video learning service

優秀課程Plus是一個訂閱式的視頻學習服務。

with top-quality lectures and courses from experts at top universities and institutions like

頂尖大學和機構的專家提供高質量的講座和課程，如

National Geographic, The Smithsonian, and The Culinary Institute of America.

國家地理雜誌、史密森學會和美國烹飪協會。

You can watch on your computer, TV or even phone,

你可以在電腦、電視甚至手機上觀看。

so it's easy to sit back, relax and learn wherever you are.

所以無論你在哪裡，都可以輕鬆地坐下來，放鬆地學習。

You get unlimited access to a huge library of over 11,000 video lectures from science, to math, to history,

您可以無限制地訪問超過11,000個視頻講座的巨大圖書館，從科學，數學，到歷史。

to how to cook, or even how to study more effectively.

到如何烹飪，甚至如何更有效地學習。

The Great Courses Plus is offering a free trial to viewers of Med School Insiders.

大課加為《醫派內參》的觀眾提供免費試用。

Simply visit TheGreatCoursesPlus.com/MedSchoolInsiders to sign up.

只需訪問TheGreatCoursesPlus.com/MedSchoolInsiders進行註冊。

Click on the link on the description below to start your free trial today.

點擊下面描述的鏈接，開始您的免費試用。

Thank you guys so much for watching.

非常感謝你們的觀看。

What are your thoughts on medical school and the application process today versus in the past?

你對今天的醫學院和申請過程與過去相比有什麼看法？

I would love to hear your thoughts so let me know with a comment below.

我很想聽聽你的想法，所以請在下面留言告訴我。

Much love to you all and I will see you guys in that next one.

很愛你們，我們下一場見。