idea of babies, mommies, and taking care of lady  parts. Let's debunk the public perception myths,  

寶寶、媽媽、照顧女士部位的觀念。讓我們來揭穿公眾的認知誤區。

and give it to you straight.  This is the reality of OB/GYN.

並直接給你。 這就是婦產科的現實。

Dr. Jubbal, MedSchoolInsiders.com.

朱波醫生，醫派內參網。

Welcome to our next installment in So You Want  to Be. In this series, we highlight a specific  

歡迎來到我們的下一期《所以你想成為》。在這個系列中，我們將重點介紹一個特定的

specialty within medicine, such as OB/GYN, and  help you decide if it's a good fit for you.  

醫學內的專業，如婦產科，並幫助你決定是否適合你。

You can find the other specialties on our  So You Want to Be playlist. If you want  

你可以在我們的 "所以你想成為 "的播放列表中找到其他的特產。如果你想

to vote in upcoming polls to decide what future  specialties we cover, make sure you're subscribed.

在即將到來的民意調查中投票，以決定我們未來的專業覆蓋，確保你訂閱。

If you'd like to see what being an OB/GYN  looks like, check out my second channel,  

如果你想看看作為一個婦產科醫生是什麼樣子的，看看我的第二個頻道。

Kevin Jubbal, M.D., where we'll be covering  a day in the life of an OB/GYN in the future.

凱文-朱巴爾，醫學博士，未來我們將報道婦產科醫生的一天生活。

OB/GYN is comprised of two components:  obstetrics and gynecology. Obstetrics is  

婦產科由產科和婦科兩部分組成。婦產科是

the medical and surgical management of pregnancy,  whereas gynecology is the medical and surgical  

懷孕的醫學和外科治療，而婦科則是醫學和外科治療。

management of the female reproductive tract.  OB/GYN is a form of primary care and includes  

婦產科是一種初級保健，包括對女性生殖道的管理。 婦產科是初級保健的一種形式，包括：

a heavy longitudinal care element. After all,  you'll be seeing your patients during puberty,  

濃重的縱向護理元素。畢竟，你會在青春期給病人看病。

through adult life, during pregnancy, and  then continued through menopause and later.

直到成年後，在懷孕期間，然後繼續到更年期和以後。

As my OB/GYN colleague says, it's "The  perfect combination of primary care and  

正如我的婦產科同事所言，它是 "初級保健和......的完美結合"。

surgery. The only thing you give up is the  prostate and male reproductive organs."

手術。你唯一放棄的是前列腺和男性生殖器官。"

In obstetrics, the bread and butter includes  delivering babies in the form of vaginal delivery  

在產科方面，麵包和黃油包括以陰道分娩的方式接生。

or cesarean delivery, also known as a  C-section. When caring for pregnant women,  

或剖腹產，又稱剖腹產。護理孕婦時。

you'll see them approximately once  per month in the first trimester,  

在懷孕的頭三個月，你大約每個月會見到他們一次。

every 2-4 weeks in the second trimester,  and every 1-2 weeks in the third trimester.  

妊娠後期每2-4週一次，妊娠後期每1-2週一次。

You'll be making sure the mom and fetus are doing  well, looking out for problems and symptoms.  

你要確保媽媽和胎兒的情況良好，注意問題和症狀。

The interesting thing about this stage is that  women are highly engaged with their medical care.  

這個階段的有趣之處在於，女性對醫療服務的參與度很高。

Many people are usually less willing  to see their primary care physician,  

很多人通常不太願意看主治醫生。

but once they're pregnant, they often  reprioritize their own and their baby's health.

但一旦懷孕，她們往往會重新優先考慮自己和寶寶的健康。

In gynecology, you'll be doing the annual  well woman exam in clinic, in addition to  

在婦科，你會在門診做一年一度的女性健康檢查，此外還有

treating pelvic pain, infections like vaginitis  or STI's, and providing contraception options.  

治療盆腔疼痛、陰道炎或性病等感染，並提供避孕方案；

If you're on call, you'll rush to the ED to  treat ectopic pregnancy, ovarian torsion,  

如果你隨叫隨到，就會趕到急診科治療宮外孕、卵巢扭轉。

and vaginal bleeding of various etiologies. And  if you're in the operating room, the most common  

和各種病因的陰道出血。而如果你在手術室裡，最常見的就是

surgery is the hysterectomy, or removal of the  uterus. This can be emergent if there is bleeding,  

手術是子宮切除術，或切除子宮。如果有出血，可以緊急進行。

as the patient can exsanguinate, meaning  experience a severe loss of blood.  

因為病人可以出血，即經歷嚴重失血。

And for those who want to remove the  possibility of future pregnancies,  

而對於那些想要消除未來懷孕的可能性。

you can do a tubal ligation. Think of this  as the female equivalent of a vasectomy.

你可以做輸卵管結紮手術。把它看成是女性的輸精管結紮術。

There are a few ways to categorize the specialty.

專業的分類有幾種方法。

First, you can divide the specialty  as having an OB-focus, Gyn-focus,  

首先，你可以把專業劃分為有婦產科重點、婦科重點。

or being a generalist and dealing with both.

還是做一個通才，處理好這兩方面的問題。

Immediately out of training, you'll be  a generalist, able to handle both the  

培訓結束後，你將立即成為一名全能型人才，能夠同時處理以下兩個方面的工作

obstetrics and gynecology side of things. Some  continue down this path and don't want to give  

婦產科方面的事情。有些人繼續沿著這條路走下去，不願意給

up either part of the practice, while others  choose one to focus on. Being a generalist  

而其他人則選擇其中一個重點。作為一個通才

is the most common and dominant form of OB/GYN  practice in the United States. You'll be on call  

是美國最常見、最主要的婦產科實踐形式。您將隨叫隨到

for both labor & delivery as well as on gynecology  emergency department call, often at the same time.

婦產科急診室的電話，經常是在同一時間。

Those that want to focus on pregnancy and  delivering babies will focus their practice  

那些想專注於懷孕和分娩的人將會專注於他們的實踐。

on just OB. Obstetrics is divided into office and  labor & delivery. Office visits will be primarily  

就只是OB。產科分為辦公室和產科。辦公室就診主要是

around regular checkups with pregnant women  across all three trimesters of pregnancy. Labor  

圍繞著孕婦在懷孕三個孕期的定期檢查。分娩

and delivery is when the woman is in the hospital  and you help deliver the baby. As an obstetrician,  

和分娩是指產婦在醫院裡，你幫助分娩。作為一名產科醫生。

you can be a solo-practitioner, although this  is increasingly uncommon in modern times,  

你可以是一個單獨的從業者，雖然這在現代越來越不常見。

or work in a group practice. Babies don't  care about your 9 to 5 working schedule and  

或在團體診所工作。寶寶們不會在意你朝九晚五的工作時間，也不會在意你的工作時間。

are delivered at all hours of the day, which  means a more demanding schedule and lifestyle.  

在一天中的所有時間都可以送達，這意味著更苛刻的時間表和生活方式。

Compared to being a generalist or pure  gynecologist, obstetrics has the lowest  

與做全科醫生或純婦科醫生相比，產科是最低的。

compensation. The reason being that pregnancy  is reimbursed as a single bundled payment from  

補償。原因是懷孕是作為單一的捆綁付款從以下方面進行報帳：

insurance companies and Medicare, including  all office visits and labor and delivery.

保險公司和醫療保險，包括所有的門診和分娩。

Those that want to focus on women's reproductive  health will adopt a gynecology-only practice. This  

想要關注女性生殖健康的人，會採取只做婦科的做法。這

is more common as practitioners advance in their  careers, as there's a lower risk of being called  

隨著從業人員的職業發展，這種情況比較常見，因為被叫作 "小三 "的風險較低。

in the middle of the night. When you're 50 years  old, you probably won't be as eager to run to the  

在半夜的時候。當你50歲的時候，你可能就不會那麼急切地跑向

hospital in the middle of the night. Compared  to being a generalist or pure obstetrician,  

半夜裡去醫院。相比於做全科醫生或純產科醫生。

this is the more lucrative path, as there are more  procedures. Think of the lifestyle as similar to a  

這是一條更賺錢的道路，因為有更多的程序。把這種生活方式看作是類似於

urologist, where you can be in the operating room  more or less, depending on your desired balance,  

泌尿外科醫生，你可以在手術室或多或少，這取決於你想要的平衡。

and can transition to a heavier clinic  focused practice in later years.

並可在晚年過渡到以臨床為主的重度執業。

OB/GYN can also be divided by  practice setting - namely academic,  

婦產科醫生還可以按執業環境劃分--即學術。

community, and private practice types.

社區和私人診所類型。

In academia, you'll of course be  teaching medical students and residents,  

在學術界，你當然會教醫學生和住院醫師。

in addition to conducting research on top of your  clinical duties. Compared to other practice types,  

除了在您的臨床職責之外，還要進行研究。與其他執業類型相比。

this generally has lower compensation. However,  you'll be more likely to see more complicated and  

這一般有較低的補償。然而，你會更容易看到更復雜和。

often interesting cases in academia, as these  are tertiary care centers with state of the  

往往是學術界有趣的案例，因為這些都是三級護理中心，擁有最先進的技術。

art equipment, copious resources, and experts  in other specialties for consults if needed.  

藝術設備，豐富的資源，必要時還有其他專業的專家進行諮詢。

Severely preterm deliveries are also  best handled by academic centers,  

嚴重的早產也最好由學術中心處理。

which can handle premies or babies  with congenital issues in the NICU.  

它可以處理新生兒重症監護室的早產兒或有先天性問題的嬰兒。

Community institutions and private practice  groups are generally not as well equipped.  

社區機構和私人執業團體的設備普遍不完善。

Remember, delivering babies isn't just about  making sure the mom is safe, but also the baby.

記住，接生不僅僅是要保證媽媽的安全，還要保證寶寶的安全。

In a community based practice, you'll be working  at a medical group not affiliated with a teaching  

在社區實踐中，您將在一個不隸屬於教學的醫療集團工作。

hospital. This is the most common practice  type and serves the majority of the population.  

醫院。這是最常見的實踐類型，服務於大多數人。

They're able to handle the bread and butter  straightforward cases and presentations,  

他們能夠處理麵包和黃油的直接案例和介紹。

such as hysterectomies and other  basic gynecologic surgeries.  

如子宮切除術和其他基本婦科手術；

In terms of labor and delivery, they can  again handle straightforward deliveries,  

在分娩方面，他們又可以直接處理分娩。

but will often transfer out moms or babies  requiring more advanced levels of care.

但通常會將需要更高級別的護理的媽媽或嬰兒轉出。

Private practice groups can have an affiliation  with an academic center or community hospital.  

私人執業團體可以與學術中心或社區醫院建立附屬關係。

Private practice physicians own part of their  practice, and the more work they put in,  

私家診所的醫生擁有部分業務，他們投入的工作越多。

the more money they earn. While private practice  OB/GYNs make more money than either academic or  

他們賺的錢越多。雖然私人診所的婦產科醫生比學術型或。

community based ones, they have more pressure  to see more patients, schedule more cases,  

以社區為基礎的，他們有更大的壓力，要看更多的病人，安排更多的病例。

take more call, and work harder overall. The  smaller your practice, the more frequently you'll  

接更多的電話，整體上更加努力。你的練習規模越小，你就會越頻繁地練習。

have to take call, but the fewer people you'll  have to split the profits with. Whereas academic  

不得不接電話，但你要分利潤的人就越少。而學術

institutions take all patients, including those  without insurance, private practice groups may  

機構接受所有病人，包括那些沒有保險的病人，私人執業團體可以。

only accept patients with insurance and who are  less complicated in terms of medical presentation.

只接受有保險的患者，而且在醫療表現上不太複雜。

There's a lot of misinformation floating  around about obstetrics and gynecology.  

婦產科有很多錯誤的資訊流傳。

Let's set the record straight.

讓我們把話說清楚。

First, no, they don't all wear pink  scrubs (like in Grey's Anatomy),  

首先，不，他們並不都是穿粉色的手術服（像《實習醫生格蕾》裡那樣）。

although you're free to should  you decide to become an OB/GYN.

雖然你是自由的，如果你決定成為一名婦產科醫生。

Second, many surgeons from the traditional  surgical subspecialties look down on OB/GYN  

其次，許多傳統外科亞專業的外科醫生看不起婦產科醫生

as not being real surgery. This comes from C  sections being less refined than other types.  

作為不是真正的手術。這源於C型科的精細度不如其他類型。

There's wiggle room involved in a cesarean  section and multiple steps will be done with blunt  

剖腹產涉及到迴旋餘地，多個步驟都會用鈍器來完成。

dissection, meaning with your hands, rather than  a surgical dissection using scissors and pickups,  

解剖，即用手，而不是用剪刀和鎬頭進行手術解剖。

which is much slower and more precise. Still, this  requires knowledge of the anatomic planes between  

的速度要慢得多，也更精確。不過，這還是需要了解以下兩個解剖平面之間的知識。

the bladder and uterus and other anatomical  structures to be wary of. The stakes are high too  

膀胱、子宮等解剖結構要警惕。賭注也很高

– things often go well, but if things go sideways,  you have the baby's and mom's lives in your hands.  

- 事情往往很順利，但如果事情出了岔子，寶寶和媽媽的生命就掌握在你手裡了。

Closure is also much faster and less precise,  but this view oversimplifies the complexity  

閉合也更快、更不精確，但這種觀點過於簡化了複雜性

and intensity of the procedure, even though it  may appear straightforward from the surface.

和強度，儘管從表面上看可能是簡單的。

This "not real surgery" mindset also overlooks the  

這種 "不是真正的手術 "的思維方式也忽略了。

surgeries that gynecologists do  on the female reproductive tract,  

婦科醫生對女性生殖道進行的手術；

such as hysterectomies. Gynecologists are  surgeons just as much as urologists. The  

如子宮切除術。婦科醫生和泌尿科醫生一樣都是外科醫生。婦科醫生和泌尿科醫生一樣，都是外科醫生。

main difference being the former operates on  females and the latter primarily on males.

主要區別是前者對女性進行操作，後者主要對男性進行操作。

The third misconception is that residencies are  malignant and it's full of unsavory personality  

第三個誤區是認為住校是惡性的，它充滿了不光彩的人格魅力

types. My OB/GYN colleague states "this is a  byproduct of any residency filled with women  

類型。我的婦產科同事說："這是任何充滿女性的居住地的副產品。

who are very tired and overworked. Let's  acknowledge our potential gender biases!"

誰是非常疲憊和過度勞累的人。讓我們承認我們潛在的性別偏見！"

After medical school, OB/GYN  residency is 4 years in duration.  

醫學院畢業後，婦產科住院醫師的學制為4年。

You can go either down the categorical  or advanced paths. With categorical,  

你可以走分類或高級的道路。有了斷然的。

you attend all 4 years at one institution. With  advanced programs, you'll first complete your  

您在一個機構參加所有4年的課程。對於高級課程，您將首先完成您的以下課程

intern year at one institution. This can be in the  form of a preliminary year or transitional year,  

在一個機構實習一年。這可以是一個初步年或過渡年的形式。

after which you'll complete your three years  of OB/GYN residency at a separate program.

之後，你將在另一個項目中完成三年的婦產科住院醫師培訓。

In your first year of residency, or PGY1, known  as your intern year, you'll rotate on emergency  

在您住院醫師的第一年，或PGY1，也就是您的實習生年，您將輪換到急診。

medicine, ICU, medicine, and sometimes a NICU  rotation, with other rotations depending on  

內科、ICU、內科，有時也會輪換新生兒科，其他輪換的情況根據

the program. During PGY2 through PGY4, you'll  rotate on labor and delivery spit between days  

該計劃。在PGY2到PGY4期間，您將輪流在產科和分娩日之間進行

and nights. You'll also have benign gynecology  rotations and gynecologic oncology rotations.  

和晚上。你還會有良性婦科輪轉和婦科腫瘤輪轉。

In your later years, you'll get  subspecialty exposure opportunities,  

在你晚年的時候，你會得到次專業的接觸機會。

such as family planning, high risk  obstetrics, urogynecology, and infertility.

如計劃生育、高危產科、泌尿婦科、不孕症等。

According to my OB/GYN attending colleague,  

據我的婦產科主治同事說。

there are two primary types of medical  students who apply into the specialty:  

報考該專業的醫學生主要有兩種類型。

shiny pretty women with perfect manicures  or women who eat granola for breakfast and  

閃亮的漂亮女人與完美的指甲或女人誰吃燕麥片的早餐和

perform at the vagina monologues. Regardless of  the stereotyping, these are medical students who  

陰道獨白時的表演。無論刻板印象如何，這些都是醫學生，他們

can handle the gamut of pap smears to emergency  c-sections. In the early 2000's the field was  

可以處理從子宮頸抹片檢查到緊急剖腹產的各種情況。在2000年初，該領域是

more evenly split between men and women, but  now close to 90% of OB/GYN residents are female.

男女比例更加平均，但現在接近90%的婦產科住院醫師是女性；

In terms of competitiveness,  OB/GYN is middle of the pack,  

從競爭力來看，婦產科是中游。

between internal medicine and pathology. The  average match rate is 89%, average Step 1 is 229,  

內科和病理科之間。平均匹配率為89%，平均步數為229。

Step 2CK is 245, and average number of  publications hovers around 4 and a half.

步2CK是245，平均出版品數量徘徊在4.5左右。

After completing OB/GYN residency, you can opt  to further subspecialize with a fellowship.

在完成婦產科住院醫師資格後，您可以選擇進一步的亞專業研究，並獲得獎學金。

Maternal fetal medicine, or MFM, is the only  obstetrics-specific fellowship and is 3 years  

母體胎兒醫學，或MFM，是唯一的產科專用獎學金，為期3年。

in duration. There's a high degree of ultrasound,  labor & delivery, and it may include some neonatal  

在時間上。有很高的超聲、產程，可能包括一些新生兒。

surgery. You'll primarily be dealing with  more complicated diseases of pregnancy,  

手術。你主要面對的是比較複雜的妊娠疾病。

like cardiovascular issues, diabetes in  pregnancy, or a patient with mechanical  

如心血管問題、妊娠期糖尿病或機械性病人

heart valves requiring fine tuning  of the patient's anticoagulants.  

心臟瓣膜，需要對患者的抗凝劑進行微調。

You'll also help coordinate care for fetuses  that are ill or have rare conditions.

你還會幫助協調對患病或有罕見病症的胎兒的護理。

This is the fellowship for the  OB/GYN nerds who want to sit down  

這是為那些想坐下來的婦產科醫生而設的聯誼會。

and review 3 papers to make  one decision, hours later.

並審閱3份文件做出一個決定，幾個小時後。

Gynecologic oncology, or gyn-onc for short,  is also 3 years in duration. There's generally  

婦科腫瘤學，簡稱婦瘤學，學制也是3年。一般有

1 year of research and 2 years of surgical  training. These are the cowboys and cowgirls  

1年的研究和2年的手術訓練。這些都是牛仔和牛仔女郎。

of surgery – nothing scares them. If something  goes down with the female reproductive tract  

的手術--沒有什麼能讓她們害怕。如果女性生殖道發生了什麼問題

in the hospital, you can count on gyn-onc to  help save the day, even if it isn't cancer.

在醫院裡，即使不是癌症，你也可以依靠婦科手術來挽救生命。

Gyn-onc surgeons are unique in that they handle  their own chemo, meaning they handle both  

婦科手術醫生的獨特之處在於他們自己處理自己的化療，這意味著他們既處理了

the medical and surgical aspects of  oncology. In most other parts of medicine,  

腫瘤學的醫學和外科方面。在醫學的大多數其他方面：

you'll have separate medical  and surgical oncologists.

你會有單獨的內科和外科腫瘤專家。

The most common types of cancers they  deal with include uterine, ovarian,  

他們處理的最常見的癌症類型包括子宮癌、卵巢癌。

cervical, and sometimes breast cancer,  which is sometimes handled by general  

宮頸癌，有時是乳腺癌，有時是一般的處理。

surgeons who have completed a breast fellowship.

已完成乳腺獎學金的外科醫生；

Urogynecology is another 3 year fellowship,  and it has some overlap with urology.  

泌尿婦科又是一個3年制的科室，與泌尿外科有一定的重疊。

For example, both do plenty of cystoscopy and  bladder procedures. As a urogynecologist, you'll  

比如，都會做大量的膀胱鏡檢查和膀胱手術。作為一名泌尿婦科醫生，你會

primarily be dealing with incontinence, meaning  the lack of voluntary control over urination,  

主要是處理尿失禁，即缺乏對排尿的自願控制。

and prolapse, or the bulging or falling of certain  body parts into others. There are various sling  

和脫垂，或身體某些部位鼓起或落入其他部位。有各種吊帶

and mesh procedures to address continence, and  various procedures to affix a prolapsing bladder,  

和網狀手術來解決尿失禁問題，以及各種貼附脫垂膀胱的手術。

uterus, or rectum. This is for those who are  comfortable with lots of urine and older patients.

子宮，或直腸。這對於那些尿量多的人和年齡大的患者來說是很舒服的。

Reproductive Endocrinology and  Infertility, or REI for short,  

生殖內分泌與不孕症，簡稱REI。

is a 3 year fellowship focusing  on primarily infertility.  

是以不孕不育為主要研究對象的3年獎學金。

That means dealing with in vitro fertilization,  egg transfers, polycystic ovarian syndrome,  

也就是處理體外受精、卵子移植、多囊卵巢綜合症。

and hormonal issues like precocious puberty, also  known as early puberty. You'll be harvesting eggs,  

和荷爾蒙問題，如性早熟，也被稱為青春期早期。你會收穫雞蛋。

freezing them, defrosting them, injecting  sperm, and making dreams come true.

冷凍、解凍、注射精子，讓夢想成真。

Of all the subspecialties,  this has the best lifestyle.  

在所有的分科中，這裡的生活方式是最好的。

These are the OB/GYNs with super fancy  clothes and who are making serious bank.

這些婦產科醫生都是穿著超級花哨的衣服，而且是賺大錢的人。

There are a few non-ACGME accredited fellowships,  each of which are 2 years in duration.  

有一些非ACGME認證的研究金，每個研究金的期限為2年。

These include minimally invasive surgery,  which deals with lots of laparoscopy.  

其中包括微創手術，涉及大量的腹腔鏡手術。

Family planning fellowship focuses on  complex abortion and contraception.  

計劃生育研究會重點研究複雜的人工流產和避孕問題。

And reproductive infectious  disease is rather self explanatory.

而生殖傳染病則相當自圓其說。

There's a lot to love about OB/GYN. There's the  continuity of care. The specialty is truly womb  

婦產科有很多值得愛的地方。有護理的連續性。這個專業是真正的子宮

to grave, taking care of patients for their entire  lives, including their best and worst days. If you  

照顧病人的一生，包括他們最好和最壞的日子。如果你

enjoy building longitudinal relationships  with patients, this has a strong draw.

喜歡與患者建立縱向關係，這具有很強的吸引力。

For those who enjoy excitement and  adrenaline, there's an emergency element to  

對於那些喜歡刺激和腎上腺素的人來說，有一個緊急元素，可以讓你的生活變得更美好。

get your fix. There are enough gynecologic and  obstetric emergencies to keep you on your toes.  

得到你的修復。婦科和產科急診足以讓你提心吊膽。

Plus, since you have two  patients, the mom and the baby,  

另外，因為你有兩個病人，媽媽和寶寶。

there's an added degree of  uncertainty to add to the excitement.

刺激的同時，也增加了不確定性。

OB/GYN is also unique in providing a  strong primary care and advocacy element.  

婦產科在提供強大的基礎護理和宣傳元素方面也是獨一無二的。

There's a strong public health focus that's  emphasized, particularly women's health advocacy,  

這裡強調的是公共衛生，尤其是婦女健康的宣傳。

and while that's common amongst primary  care specialties, it's harder to find in  

雖然這在基層醫療機構中很常見，但在基層醫療機構中卻很難找到。

other surgical subspecialties. If you care  about infertility, abortion, contraception,  

其他外科亞專業。如果你關心不孕不育、流產、避孕。

and being a part of social and political change  in women's health, OB/GYN is where you want to be.

併成為女性健康領域社會和政治變革的一部分，婦產科是你想去的地方。

And finally, the patient population.  Particularly in OB, you'll be dealing  

最後，患者群體。 特別是在產科，你會面對的是

with many young or middle adulthood patients,  giving you the opportunity for meaningful and