Systemic issues are being highlighted.

系統性問題正在凸顯。

US.

美國：

Emily Step one is becoming past fail, and some propose we abolish medical school grades entirely.

艾米麗第一步正在成為過去的失敗，有人提議我們完全取消醫學院的成績。

Let's separate the signal from the noise and explore the reality of competition in the medical training system.

讓我們把信號從噪音中分離出來，探尋醫學培訓體系中的現實競爭。

Dr.

博士

Duval medical insiders dot com In recent years, there has been an increased focus on the competitive nature of medical school and its downsides.

杜甫醫學內參網 近年來，人們越來越關注醫學院的競爭性及其弊端。

The line of thinking goes that high degrees of competition lead to increased stress, resulting in burnout and depression, which is the driving force of the mental health epidemic amongst medical trainees.

其思路是，高度競爭導致壓力增大，導致職業倦怠和抑鬱症，而這正是醫學學員心理健康流行的動力。

Many point to abolishing the numerical score for us, Emily Step one as a big step in the right direction.

很多人指出取消數字分數對我們來說，艾米麗第一步是朝著正確的方向邁出的一大步。

They argue this should reduce the overwhelming stress students face, given its importance in the residency selection process.

他們認為，鑑於其在住院醫師選拔過程中的重要性，這應該減少學生面臨的巨大壓力。

Plus, the students who earned a seat in medical school have already proven themselves.

另外，在醫學院贏得一席之地的學生已經證明了自己的實力。

They're smart enough, So do we really need grades or scores at all?

他們已經夠聰明瞭，那麼我們真的需要成績或分數嗎？

What's being pushed is an overly simplistic view of the problem with a half baked solution.

推崇的是一種過於簡單化的問題觀，解決方法半生不熟。

It's addressing a symptom rather than the root cause.

這是在解決一個症狀而不是根本原因。

First the burnout and depression epidemic is the most important issue, but it's not due to grades or us.

首先職業倦怠和抑鬱症的流行是最重要的問題，但這不是因為成績或我們。

Emily Step one.

艾米麗 第一步

It's something I deeply care about and is highly relevant to both doctors and patients alike.

這是我非常關心的事情，與醫生和患者都有很大的關係。

I've spoken about it many times and even created the Save Our Doctors initiative to raise awareness.

我已經說過很多次了，甚至還發起了 "拯救我們的醫生 "的倡議來提高人們的認識。

But well intentioned medical students and residents are pointing at us.

但好心的醫學生和住院醫師卻對我們指指點點。

Emily Step one grades and other downstream effects and not recognizing the root issue.

艾米麗一步成績和其他下游效應，沒有認識到根本問題。

The problem isn't actually grades or U.

問題其實不在於成績和U。

S.

S.

M l E, but rather the culture of medicine.

M l E，而是醫學文化。

US.

美國：

Emily Step one.

艾米麗 第一步

Becoming past fail doesn't change anything in the big picture.

成為過去的失敗，在大局上並不能改變什麼。

Sure, you're less stressed as a medical student about Step one.

當然，作為醫學生，你對第一步的壓力會小一些。

But guess what?

但你猜怎麼著？

Residencies still need Cut offs.

住所仍需切開。

Now they'll be putting greater weight into us.

現在他們會把更大的砝碼放在我們身上。

Emily Step two CK or perhaps clinical grades or shelf exam scores, and you'll be more stressed about each of those in making step one pass fail.

艾米麗第二步CK或許臨床成績或架子機考試成績，你會更有壓力，每一個人在使步驟一通過失敗。

You don't fix the problem, you just shift it.

你不解決問題，你只是轉移問題。

We're playing whack a mole.

我們在玩打鼴鼠的遊戲。

I recently came across an article on Kevin MD written by a current medical student, putting forward the case to abolish medical school grades.

最近看到一個在校醫學生寫的關於Kevin MD的文章，提出了取消醫學院成績的理由。

The author argues that grades feed competition, which feeds students lack of self worth, which threatens future doctors, compassion for patients and so on.

筆者認為，成績養成了競爭，競爭養成了學生缺乏自我價值，威脅到未來的醫生、對病人的同情心等。

To me, this seems to be more of an issue with the author's relationship to competition and self worth rather than a logically sound argument of the relationship of competition to practicing medicine compassionately during the 3rd and 4th year and medical school, also known as the Clinical Years, medical students receive most of their education through clinical rotations in the hospitals.

在我看來，這似乎更多的是作者與競爭和自我價值的關係問題，而不是從邏輯上論證競爭與行醫慈悲的關係，在三、四年級和醫學院，也就是臨床歲月，醫學生通過在醫院的臨床輪轉接受大部分教育。

As he explains, When I was a third year student completing core clerkships, I found myself approaching each of my patients as a determinant in how I would do in a given clerkship.

正如他所解釋的那樣，當我是一個三年級的學生完成核心實習時，我發現自己對待每一個病人都是我在特定實習中如何做的決定因素。

Imagine you are a patient, and your medical student frontline provider is sticking you with a butterfly needle three, maybe four times in a desperate search for a flash, because they want the president to know how competent they are.

想象一下，你是一個病人，而你的醫學生一線提供者正在用蝴蝶針扎你三次，也許四次，以絕望地尋找閃光，因為他們想讓總統知道他們有多能幹。

The goal in medical school is to learn extensively and become the best future doctor you can be in focusing on this as your primary goal.

在醫學院的目標是廣泛學習，併成為最好的未來醫生，你可以在專注於這個作為你的主要目標。

During your clinical rotations, you'll end up getting favorable evaluations if you find yourself so stressed about your grades that you're sticking a patient four times to draw blood.

在臨床輪轉的過程中，如果你發現自己的成績壓力太大，以至於給一個病人紮了四次血，最終會得到好評。

You should first go back to basics and practice.

你應該先回到基礎知識和實踐中去。

And second, examine your relationship with your clerkship evaluations.

其次，考察你與書記評價的關係。

Because maintaining this attitude will compound and become dangerous for both yourself and your patients, the further along you go in medical training.

因為保持這種態度，對自己和病人來說，都會雪上加霜，越往後的醫學訓練越危險。

The issue with blaming grades or competition is that it lacks deeper thought on the 2nd and 3rd order effects.

歸咎於成績或競爭的問題是，它缺乏對二、三階效應的深思。

By removing grades, how will medical schools ensure that their students are studying and learning to a sufficient capacity to become competent physicians?

取消成績，醫學院如何保證學生的學習和學習能力，使其成為合格的醫生？

How will residency programs select between candidates?

住院醫師計劃將如何在候選人之間進行選擇？

Large swaths of society have been shifting toward the everyone is a winner philosophy.

社會上大片的人都在向人人都是贏家的理念轉變。

Sure, we're all equally valuable as human beings, but that doesn't mean we each have to be a winner in everything we apply ourselves in.

當然，作為人，我們都是同等價值的，但這並不意味著我們每個人都要在應用於任何事情上成為贏家。

Imagine if I raced Michael Phelps in the swimming pool and we both received equivalent blue ribbons because everyone's a winner.

想象一下，如果我和邁克爾-菲爾普斯在游泳池裡比賽，我們都獲得了同等的藍絲帶，因為每個人都是贏家。

It's a slippery slope and dangerous way of thinking.

這是一種滑坡和危險的思維方式。

When people focus on equal outcome as opposed to equal opportunity, the two are very different and should not be confused.

當人們關注結果平等與機會平等時，兩者是截然不同的，不應混淆。

Life is competitive and life is hard.

生活是競爭的，生活是艱苦的。

Trying to shield ourselves from this truth isn't doing ourselves any favors.

試圖屏蔽這個真相，對我們自己沒有任何好處。

Just because losing doesn't feel good.

只是因為輸了感覺不好。

That doesn't mean we must abolish losing altogether.

這並不意味著我們必須完全廢除輸球。

There's value in both winning and losing in the swimming pool or in any competition, just as there is value in Excel ng or falling short in the classroom.

游泳館或任何比賽中的輸贏都是有價值的，就像在課堂上的Excel ng或落差都是有價值的。

During my time in medical school, I worked my tail off.

在醫學院的時候，我一直在努力工作。

I didn't relax as much as most of my classmates.

我並沒有像大多數同學那樣放鬆。

I studied harder and spent less time relaxing and having fun because I wanted to get into something competitive like plastic surgery.

我因為想從事整形外科這種競爭性的工作，所以學習更加努力，放鬆和娛樂的時間更少。

One of my good friends, on the other hand, had decided on family medicine since the first day of class.

而我的一個好朋友，從上課的第一天就決定了家庭醫學。

He had also maintained that life is short, and he didn't want to sacrifice his work life balance for getting higher grades in class or scoring higher on Step one.

他也曾堅持認為，人生苦短，他不想為了在班上取得更高的成績或步步高的分數而犧牲自己的工作生活平衡。

We were two people with two different approaches to medical school.

我們是兩個人，有兩種不同的學醫方法。

Neither approach was right or wrong.

這兩種做法都沒有對錯。

We simply had to different priorities.

我們只是必須要有不同的優先級。

By the end of medical school, I had stronger preclinical and clinical grades.

到了醫學院，我的臨床前和臨床成績都比較強。

A higher US Emily score more publications and was a stronger residency candidate again.

較高的美國艾米麗得分更多的出版品，又是一個更強的住院醫師候選人。

Neither is right or wrong.

兩者都沒有對錯。

It's simply a trade off.

這根本就是一種交易。

He probably enjoyed medical school more and definitely had a less stressful and more balanced life.

他可能更喜歡醫學院，生活壓力肯定更小，更平衡。

But I was a more compelling applicant or something like plastic surgery.

但是我是一個比較有說服力的申請者，或者是整容之類的。

If you want to reduce competition, it needs to be less competitive to secure a residency position.

如果你想減少競爭，就需要減少競爭，以確保居住位置。

To do that, we must open more residency positions.

為此，我們必須開放更多的住院醫師崗位。

The greater the discrepancy there is between the number of medical school graduates and residency positions, the greater the degree of competition.

醫學院畢業生數量與住院醫師崗位之間的差距越大，競爭程度越大。

Making us Emily Pass fail or abolishing greats doesn't remove the fact that residencies need to rank and filter applicants for a limited number of positions.

讓我們艾米麗通關失敗或廢除偉大的人，並不能消除一個事實，即住院醫師需要對有限的職位進行排名和過濾申請人。

Life is hard and life isn't fair.

生活是艱難的，生活是不公平的。

There are two mindsets with which we can approach the current dialogue.

我們可以用兩種心態來處理目前的對話。

Option one is to point the finger at other people and systemic failures for your problems.

選擇一是將自己的問題指向他人和制度性失誤。

You lament that if only X and why were different, then you'd be successful or happy.

你感嘆，如果X和為什麼不一樣就好了，那你就會成功或幸福。

Option two is to be proactive, make the most of the situation and even help move the needle and spark change in productive ways.

選擇二是主動出擊，因勢利導，甚至以有效的方式幫助推動變革，引發變革。

The student that subscribes to option one is dissatisfied with his academic performance and complains that grades cause them to be stressed.

認購方案一的學生對自己的學習成績不滿意，抱怨成績導致他們壓力大。

The student that subscribes to option two questions why he isn't achieving the marks he desires and seeks out ways to improve his study strategies or test taking skills.

認購選項二的學生，會質疑自己為什麼沒有取得理想的分數，並尋求改善學習策略或應試技巧的方法。

The student with a victim mindset seeks to quash discomfort and negativity in his life by changing the world around him without examining himself.

具有受害者心態的學生試圖通過改變周圍的世界來平息生活中的不適和消極情緒，而不審視自己。

The student with an empowered mindset understands it is far more effective to improve and adapt himself first.

有了能力心態的學生明白，先提高和調整自己，效果會更好。

Only then can he best assess the situation around him and begin working towards meaningful change.

只有這樣，他才能最好地評估周圍的情況，並開始努力實現有意義的改變。

We need more people who are willing to speak out against the cultural issues in medicine.

我們需要更多的人願意對醫學文化問題發聲。

Physicians are who we look to for guidance on how to live healthier lives.

醫生是我們尋求指導的對象，如何生活得更健康。

Yet many physicians leave terribly imbalanced lives themselves.

然而很多醫生自己卻離開了可怕的失衡生活。

We can only do so much through our own efficiency and optimization.

我們只能通過自己的效率和優化來做這麼多。

Yet we continue to propagate an antiquated training culture that does more harm than good.

然而，我們卻繼續宣揚著陳舊的訓練文化，弊大於利。

Knowing what we know about sleep, why is it the norm to be sleep deprived beyond belief in medical school, clerkship, rotations and residency by using loopholes like home called residents are often expected to work for 30 hours straight or longer and then expected to return back the next day after less than 18 hours off.

知道了我們對睡眠的瞭解，為什麼在醫學院、實習、輪轉和住院期間，利用諸如家叫住院醫師經常要連續工作30小時或更長時間，第二天休息不到18小時就有望回來等漏洞，睡眠不足是常態。

And yes, I've had to do that more times than I would like to admit our grades really the issue, or are there bigger issues that deserve more attention?

是的，我不得不這樣做的次數比我願意承認的多，我們的成績真的是問題，還是有更大的問題值得更多的關注？

On the other hand, we shouldn't fool ourselves into thinking that all medical students or residents have the same priorities, same work ethic or same level of mastery.

另一方面，我們不應該自欺欺人地認為所有的醫學生或住院醫師都有相同的優先級、相同的工作態度或相同的掌握程度。

Not everyone needs to work their tail off to be a great physician, but those who are willing to make the sacrifices and work harder will continue to outshine those who don't, regardless of what metrics are used to assess.

並不是每個人都需要拼命工作才能成為一名優秀的醫生，但那些願意做出犧牲、更加努力工作的人，無論用什麼指標來評估，都會繼續超越那些不願意的人。

Residency candidacy decide on what it is that you want to optimize for for those that want to match into something hypercompetitive, like dermatology or plastic surgery.

住院醫師候選資格決定你想優化的是什麼，對於那些想匹配到東西超強競爭力的人，比如皮膚科或整形外科。

Yes, you'll certainly have to work harder.

是的，你肯定要更加努力。

But even if you're going into something less competitive, like pediatrics or family medicine, but want to match at prestigious academic programs like UCSF or MGH, you'll have to work harder than your colleagues who are perfectly content going to a community programme.

但即使你要進入一些競爭性較弱的領域，比如兒科或家庭醫學，但想在UCSF或MGH這樣的著名學術項目中進行匹配，你也要比那些完全滿足於去社區項目的同事更加努力。

One is not better than the other.

一個不比另一個好。

It all depends on your value system and what you prioritize.

這一切都取決於你的價值體系和你優先考慮的事情。

Whatever you decide, my mission with med school insiders is to help you realize that dream.

不管你決定了什麼，我和醫學院內部人員的任務就是幫助你實現這個夢想。

We're in this to create a generation of happier, healthier and more effective future doctors, and I'm not afraid to show you some tough love.

我們的目的是為了打造一代更快樂、更健康、更高效的未來醫生，我不怕向你展示一些強硬的愛。

If you complain grades are evil and causing you to lose compassion for your future patients.

如果你抱怨成績是邪惡的，使你失去對未來病人的同情心。

Maybe you don't want to be at the top of your class, But by honing your study strategies and time management, you'll save a couple hours every day, which means you can explore other hobbies or be a gunner end.

也許你不想成為班上的佼佼者，但通過磨練你的學習策略和時間管理，你會每天節省幾個小時，這意味著你可以探索其他的愛好，或者做一個槍手端。

Put that extra time into securing some publications if you want to go into neurosurgery.

如果你想進入神經外科，就多花點時間去爭取一些出版品。

But don't consider yourself the smartest.

但不要認為自己是最聰明的。

Understand that it's not about how smart you are.

要明白，這不是你有多聰明的問題。

It's about how intelligently you approach studying time management and effort allocation.

這關係到你如何聰明地對待學習時間管理和精力分配。

In summary, it's important we question the medical training establishment and seek to improve it in meaningful ways.

總之，我們必須對醫學培訓機構提出質疑，並尋求有意義的改進方式。

At the same time, we must be careful not to fall into a victim mentality and always maintain an empowered frame.

同時，我們要注意不要陷入受害者的心態，要始終保持一個被授權的框架。

If you came this far, check out my weekly newsletter where I explore these and similar topics, visit medical insiders dot com forward slash newsletter to sign up or click the card in the middle of the screen.

如果你走到這一步，請查看我的每週通訊，在那裡我探索這些和類似的主題，訪問醫療內幕點com轉發斜線通訊註冊或點擊螢幕中間的卡片。

Much love, and I'll see you guys in that next one.

很愛你們，我們下一場見。