Name: 你想成為一名普通外科醫生嗎[第29集] (So You Want to Be a GENERAL SURGEON [Ep. 29])
Uploaded: 2021-10-23T18:10:29.000Z
Duration: 12 min 57 s

So you want to be a general surgeon. You like the idea of being the generalist of the operating

所以你想成為一名普通外科醫生。你喜歡成為手術室的通才的想法。

room, having the knowledge and skills for a wide range of surgical interventions. Or

室，擁有廣泛的外科干預的知識和技能。或

maybe it's just a stepping stone for you to get to the subspecialization you're after.

也許這只是你達到你所追求的亞專業的一個墊腳石。

Let's debunk the public perception myths, and give it to you straight. This is the reality

讓我們揭穿公眾認知的神話，並直接告訴你。這就是現實

of general surgery. Dr. Jubbal, MedSchoolInsiders.com.

的普通外科。Jubbal醫生，MedSchoolInsiders.com。

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

歡迎來到《你想成為什麼樣的人》的下一期節目。在這個系列中，我們將重點介紹一個

specific specialty within medicine, such as general surgery, and help you decide if it's

醫學中的特定專業，如普通外科，並幫助你決定它是否是

a good fit for you. You can find the other specialties on our So You Want to Be playlist.

很適合你。你可以在我們的 "你想成為 "播放列表中找到其他專業。

If you want to vote in upcoming polls to decide what future specialties we cover, make sure

如果你想在即將舉行的投票中投票，以決定我們未來涵蓋的專業，請確保

you're subscribed. If you'd like to see what being a general

你已經訂閱了。如果你想看看作為一個普通的

surgeon looks like, check out my second channel, Kevin Jubbal, M.D., where we'll be covering

外科醫生看起來，看看我的第二個頻道，凱文-朱巴爾，醫學博士，我們將在那裡報道

a day in the life of a general surgeon in the future.

General surgery is the broadest of surgical fields, covering the surgical management of

普通外科是最廣泛的外科領域，包括以下的外科管理

diseases from head to toe. This may include head and neck surgeries to thoracic to interventions

從頭到腳的疾病。這可能包括從頭頸部手術到胸腔手術再到介入手術。

inside the abdomen. Operations can range from removing cancer, to treating traumatic injuries,

腹部內的手術。手術的範圍包括從切除癌症，到治療創傷性損傷。

to restoring function to diseased tissue. We think of surgeons most commonly in the

以恢復病變組織的功能。我們最常想到的外科醫生是指

act of performing surgery, but a big part of the work surgeons do is taking care of

進行手術的行為，但外科醫生所做的工作的很大一部分是照顧

surgical patients. This includes diagnosing a patient's illness, assessing various interventions,

外科病人。這包括診斷病人的疾病，評估各種干預措施。

and caring for the patient before and after surgery. Examples include staging a cancer

並在術前和術後對病人進行護理。例子包括對癌症進行分期

patient prior to surgical intervention or managing ICU patients who are postoperative

手術前的病人或管理術後的ICU病人。

yet remain very sick. Even the busiest surgeons are in the operating

但仍然病得很重。即使是最忙碌的外科醫生也在手術中

room only a couple days per week. The rest of their time is spent seeing new patients

每星期只有幾天在病房裡。其餘的時間都用來看新病人。

or postoperative patients in clinic. If the surgeon is part of an academic center, they'll

或門診中的術後病人。如果外科醫生是學術中心的一部分，他們會

also have to divide their time between academic responsibilities, including teaching and research.

他們還必須在學術責任之間分配時間，包括教學和研究。

This brings us to an important method of differentiating a general surgeon's practice.

這給我們帶來了區別普通外科醫生的一個重要方法。

In academia, general surgeons tend to be more specialized, meaning they've done a fellowship

在學術界，普通外科醫生往往更加專業，這意味著他們已經做了一個研究金。

after residency and are managing patients within a specific niche. At these larger academic

在住院醫師培訓結束後，他們正在管理一個特定領域的病人。在這些較大的學術機構

institutions, you're also more likely to see complex and rare pathologies that are infrequently

機構，你也更有可能看到複雜和罕見的病症，這些病症不常發生。

managed at smaller community practices. In community or private practice settings,

在較小的社區診所管理。在社區或私人診所環境中。

general surgeons are more likely to operate without fellowship training, although several

普通外科醫生更有可能在沒有研究金培訓的情況下進行手術，儘管有幾個

are still fellowship-trained. Compared to an academic practice, community and private

他們仍然接受過獎學金培訓。與學術實踐相比，社區和私人

practice general surgeons have higher average compensation.

執業普通外科醫生的平均報酬更高。

Let's clear up some of the misconceptions about general surgery.

讓我們來澄清一些關於普通外科的誤解。

First, some think that general surgery is the specialty for medical students who want

首先，有些人認為普通外科是醫學生的專業，他們想要

to be surgeons but aren't competitive enough to match into a more desirable surgical subspecialty,

想成為外科醫生，但沒有足夠的競爭力來匹配更理想的外科亞專業。

like plastic surgery, neurosurgery, orthopedic surgery, and so on. The truth is that general

像整形外科、神經外科、骨科手術等等。事實是，普通

surgery has a great deal to offer that is unique from other surgical fields, and for

外科有很多不同於其他外科領域的獨特之處，對於

that reason attracts a large number of candidates. Second, the challenging lifestyle aspects

這個原因吸引了大量的候選人。第二，具有挑戰性的生活方式方面

are often overstated, at least for when you're a fully trained attending physician. Ultimately,

往往被誇大了，至少在你是一個受過充分訓練的主治醫生時是如此。歸根結底。

your work-life balance comes down to the type of specialization within general surgery you

你的工作與生活的平衡取決於你在普通外科中的專業類型。

pursue, in addition to the type of job you seek out. You have the ability to negotiate

除了你所尋求的工作類型外，你還可以追求。你有能力進行談判

toward a true lifestyle specialty to something more stereotypically intense.

朝著一個真正的生活方式專業的方向發展，以更多的陳規定型的激烈的東西。

After medical school, general surgery residency is 5 years, although some programs have 2

醫學院畢業後，普通外科住院醫師是5年，儘管有些項目是2年。

mandatory research years built in for a total of 7 years. The 7 year residencies are usually

在總共7年的時間裡，有強制性的研究年限。7年的實習期通常是

at academic residency programs and are preferred by medical students who are either seeking

在學術性的住院醫師項目中，那些正在尋找新工作的醫科學生更願意選擇這種方式。

an academic career or want to apply into a more competitive fellowship.

在學術生涯中，或想申請更有競爭力的獎學金。

As a PGY1, also known as your intern year, you're usually not operating much, and are

作為PGY1，也被稱為你的實習年，你通常不怎麼操作，而且是

instead focused on managing surgical patients on the wards, meaning those staying in the

相反，他們專注於管理病房裡的外科病人，也就是說，那些留在病房裡的病人。

hospital, usually requiring post-operative care. You ensure floor work is taken care

醫院，通常需要術後護理。你確保地板工作得到照顧

of and act as the eyes and ears for the rest of the team who are usually scrubbed into

的，並充當團隊其他成員的眼睛和耳朵，他們通常被洗刷成

cases or handling clinic. Once you finish your work, you're generally welcome to join

案件或處理診所。一旦你完成你的工作，一般歡迎你加入

your team in the operating room and scrub into cases.

你的團隊在手術室和擦洗的情況下。

As a junior resident, meaning your PGY2 and PGY3 years, you'll have one intern below you

作為初級住院醫師，即你的PGY2和PGY3年，你將有一個實習生在你下面。

and one senior above you on any service. If new consults come in, you'll be seeing them.

以及比你高一級的任何服務的高級人員。如果有新的諮詢者，你就會看到他們。

If you're in the operating room, you're likely doing smaller or more straightforward cases,

如果你在手術室，你很可能在做較小或較直接的病例。

while the more complex cases are handled by the senior resident.

而更復雜的案件則由高級住院醫師處理。

As a senior resident, meaning your PGY4 and PGY5 years, you handle the most complicated

作為高級住院醫師，即你們的PGY4和PGY5年，你們處理最複雜的問題。

cases and have the most autonomy, both inside and outside of the operating room. That translates

在手術室內外，他們都擁有最大的自主權。這就意味著

to making treatment decisions and putting plans into place, and operating with less

做出治療決定並將計劃落實到位，並以較低的成本運作。

supervision. In your chief year, meaning as a 5, when you are most senior, you will also

監督。在你的首席年，即作為5級，當你是最資深的時候，你也將

have the added responsibility of handling light administrative work for the residency

有額外的責任，處理居住地的輕微行政工作

program, such as schedules and responsibilities for the residents below you.

計劃，例如你下面的居民的時間表和責任。

Research years, if required by the program, are typically done after either PGY2 or PGY3.

如果項目要求，研究年通常在PGY2或PGY3之後進行。

Residents typically maintain some level of clinical involvement during this time to keep

在這段時間裡，住院醫師通常會保持一定程度的臨床參與，以保持

their clinical acumen sharp, such as by taking call occasionally or covering overnight shifts.

他們的臨床敏銳度很高，例如偶爾接聽電話或值通宵班。

In terms of competitiveness, general surgery is middle of the pack with 70 points in our

在競爭力方面，普通外科在我們的調查中以70分位居中游。

MSI Competitive Index, ranking below vascular surgery and above med/peds. Of the surgical

MSI競爭力指數，排名低於血管外科，高於內科/兒科。外科中

specialties, general surgery is the most attainable. The match rate is 84%, average USMLE Step

專業，普通外科是最容易達到的。匹配率為84%，平均USMLE Step

1 is 235, and average Step 2CK is 247. After completing general surgery residency,

1是235，步驟2CK的平均數是247。在完成普通外科住院醫師培訓後。

you can further subspecialize with fellowship. Historically, any form of surgical specialization

你可以通過研究金進一步實現亞專業化。從歷史上看，任何形式的外科專業都有其特殊性。

through fellowship always followed a general surgery residency. This is termed the independent

在普通外科住院醫師培訓之後，他們將通過研究金的方式來完成工作。這就是所謂的獨立

pathway. If you wanted to become a plastic surgeon, you would first complete 5 years

路徑。如果你想成為一名整形外科醫生，你將首先完成5年的學習。

of general surgery residency, followed by 3 years of plastic surgery, for a total of

普通外科住院醫生，然後是3年的整形外科，總共有3年的時間。

8 years. As medicine has moved further toward specialization,

8年了。隨著醫學進一步走向專業化。

combined pathway programs cropped up, whereby you would complete 3 years of general surgery

越來越多的人開始採用組合式課程，即完成3年的普通外科課程。

residency followed by a few years of specialty training. For example, combined plastic surgery

在住院醫生的指導下，再進行幾年的專業培訓。例如，聯合整形外科

programs combined 3 years of general surgery residency with 3 years of plastic surgery,

這些項目將3年的普通外科住院醫師培訓與3年的整形外科培訓相結合。

for a total of 6 years. And finally, the integrated pathway is now

總共6年的時間。最後，綜合途徑現在是

gaining momentum, whereby you match and complete training in your surgical specialization from

越來越多的勢頭，據此，你在你的外科專業中匹配和完成培訓，從

day 1 of residency. Neurosurgery and orthopedic surgery have done the integrated pathway for

住院醫師的第1天。神經外科和骨科手術已經完成了綜合路徑，用於

some time now, and there are no independent or combined options. Plastic surgery has followed

一段時間以來，沒有獨立或合併的選擇。整形手術已經跟隨

suit, but there are still some independent and combined programs available, although

適合，但仍有一些獨立的和合並的方案可供選擇，儘管

they are declining in number. More recently, cardiothoracic surgery integrated programs

它們的數量正在減少。最近，心胸外科綜合項目

have been cropping up around the nation. Integrated pathway programs are shorter and more focused

已經在全國各地出現了。綜合途徑項目時間更短，重點更突出

on your ultimate specialization. However, they are usually substantially more competitive

在你的最終專業領域。然而，它們通常具有更大的競爭力

than going the independent pathway, and some are concerned about weaker training in the

擔心會比走獨立的道路更糟糕，而且有些人擔心會有更弱的培訓。

fundamentals of surgery. To specialize in critical care you'll complete

外科的基礎知識。要專攻重症護理，你將完成

a 1 year fellowship, although a 2nd year is usually completed for those who ultimately

1年的研究金，儘管那些最終完成了第2年的研究金的人，通常會完成第2年的研究金。

want to work at busy trauma centers. Trauma and critical care combine the best of both

希望在繁忙的創傷中心工作。創傷和重症護理結合了兩者的優點

worlds – you get both high-intensity surgeries but also clock out when you're not on shift.

世界--你既能得到高強度的手術，又能在不當班時打卡下班。

As a result, you get decent control over your lifestyle.

是以，你可以對你的生活方式有適當的控制。

Typically these surgeons also have a component of their month for elective general surgery

通常情況下，這些外科醫生在他們的月度工作中也有一部分是選擇性的普通外科。

and emergency general surgery call, which can be flexible depending on the surgeon's

和普通外科急診電話，可以根據外科醫生的情況靈活安排。

preferences. We have a full episode on trauma surgery linked below.

偏愛。我們有一個關於創傷手術的完整情節，鏈接在下面。

Colorectal surgery is a 1 year fellowship for the general surgeons who appreciate a

結直腸外科是一個為期1年的研究項目，為普通外科醫生提供了機會。

decent lifestyle and a wide variety of procedures, from colonoscopies to small outpatient procedures

體面的生活方式和多種多樣的程序，從結腸鏡檢查到小型門診手術

to bigger cancer operations, including both minimally invasive and open cases.

到更大的癌症手術，包括微創和開放病例。

Pediatric surgery is a 2 year fellowship whereby you essentially become a general surgeon for

小兒外科是一個為期2年的研究項目，你基本上成為一個普通的外科醫生。

children. Compared to adults, your patients will bounce back faster from surgeries. Your

兒童。與成人相比，你的病人從手術中反彈的速度會更快。您的

bread and butter will include a large amount of gastrointestinal surgeries, treating emergencies,

麵包和黃油將包括大量的胃腸道手術，治療急症。