You detest the idea of being around other human beings and find solace in staring down

你厭惡與其他人類相處的想法，並在凝視中找到慰藉。

a microscope.

一個顯微鏡。

Let’s debunk the public perception myths and give it to you straight.

讓我們揭穿公眾認知的神話，直接給你看。

This is the reality of pathology.

這就是病理學的現實。

Dr. Jubbal, MedSchoolInsiders.com

Jubbal醫生，MedSchoolInsiders.com

Welcome to our next installment in So You Want to Be.

歡迎來到《你想成為什麼樣的人》的下一篇文章。

In this series, we highlight a specific specialty within medicine, such as pathology, and help

在這個系列中，我們強調醫學中的一個特定專業，如病理學，並幫助

you decide if it’s a good fit for you.

你決定它是否適合你。

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

你可以在我們的 "你想成為的人 "播放列表中找到其他專業。

If you have a specific specialty you want covered, be sure to vote in our upcoming polls,

如果你有一個特定的專業，你希望覆蓋，一定要在我們接下來的投票中投票。

and to do that you’ll need to be subscribed.

而要做到這一點，你需要被訂閱。

If you’d like to see what being a pathologist looks like, check out my second channel, Kevin

如果你想看看作為一個病理學家是什麼樣子的，請查看我的第二個頻道，凱文

Jubbal, M.D., where we'll be covering a day in the life of a pathologist in the future.

Jubbal, M.D.，未來我們將在這裡報道病理學家的一天。

Pathology is the field of medicine concerned with the study of body tissues and body fluids.

病理學是與身體組織和體液研究有關的醫學領域。

It is considered a “support specialty”, similar to radiology, in that it is ancillary

它被認為是一個 "支持性專業"，類似於放射科，因為它是輔助性的。

to the clinical staff.

對臨床工作人員。

Pathologists examine specimens to give tissue diagnoses as well as manage clinical labs

病理學家檢查標本以提供組織診斷，並管理臨床實驗室。

ordered by other physicians - from microbiology, to hematology, to chemistry, and everything

其他醫生開出的處方--從微生物學到血液學，再到化學，以及所有的東西。

between.

之間。

The field of pathology is heavily intertwined with other fields of medicine.

病理學領域與醫學的其他領域有很大的交集。

Many of the treatment decisions that other physicians make have in some way been influenced

其他醫生做出的許多治療決定都在某種程度上受到了影響。

by the pathologist.

由病理學家負責。

Whether it be the interpretation of a tissue sample or the results of a blood test, pathologists

無論是對組織樣本的解釋，還是對血液測試結果的解釋，病理學家都是如此。

heavily impact many clinical decisions.

嚴重影響許多臨床決策。

There are two main divisions within pathology: anatomic pathology and clinical pathology.

病理學內部有兩個主要部門：解剖學病理學和臨床病理學。

The easiest way to differentiate between the two is by the type of sample they work with.

區分兩者的最簡單方法是看他們工作的樣本類型。

Anatomic pathologists focus primarily on histopathology, or the diagnosis and study of disease by examining

解剖病理學家主要側重於組織病理學，或通過檢查疾病的診斷和研究。

tissues and cells under a microscope.

顯微鏡下的組織和細胞。

These tissue samples may come from more routine procedures such as Pap smears and fine needle

這些組織樣本可能來自更多的常規程序，如子宮頸抹片檢查和細針檢查。

aspirations, or more invasive surgical procedures such as tumor resections and hysterectomies.

抽吸，或更具侵入性的外科手術，如腫瘤切除和子宮切除。

Examining samples underneath a microscope and determining a histologic diagnosis is

在顯微鏡下檢查樣本並確定組織學診斷是

the foundation of anatomic pathology.

解剖病理學的基礎。

Clinical pathologists, on the other hand, focus primarily on laboratory medicine and

另一方面，臨床病理學家則主要關注實驗室醫學和

test blood and other bodily fluids.

測試血液和其他體液。

This includes routine tests such as complete blood counts, or CBCs, and comprehensive metabolic

這包括常規檢查，如全血細胞計數，或CBCs，以及全面的新陳代謝。

panels, or CMPs, as well as more complex tests such as molecular testing for cancer markers

癌症標誌物的分子測試等更復雜的測試。

and genome sequencing.

和基因組測序。

As experts in laboratory medicine, they spend most of their time analyzing and interpreting

作為實驗室醫學的專家，他們大部分時間都在分析和解釋

these tests; however, they also often take on more director-type roles within the lab

然而，他們也經常在實驗室內擔任更多的主任類角色。

and ensure quality control and proper proficiency testing.

並確保品質控制和適當的熟練度測試。

Another important way of differentiating a pathologist’s practice is academic versus

區分病理學家業務的另一個重要方法是學術性與非學術性。

community versus private practice.

社區與私人診所。

Academic pathologists work at universities and research institutions and will further

學術病理學家在大學和研究機構工作，將進一步

split their time between teaching and research responsibilities.

他們在教學和研究職責之間分配時間。

They often see more complex cases than their community or private practice colleagues and

他們經常看到比社區或私人診所同事更復雜的病例，並且

tend to work more hours on average.

傾向於平均工作時間更長。

The additional hours worked each week are not necessarily a consequence of having a

每週的額外工作時間不一定是有了一個人的結果。

greater number of cases, but can instead be attributed to the complexity of the specimens

更多的案例，但可以歸因於標本的複雜性。

they are evaluating.

他們正在進行評估。

Due to this complexity, pathologists in academia tend to be very subspecialized and often only

由於這種複雜性，學術界的病理學家往往是非常亞專業的，往往只有

practice within that subspecialty.

在該亞專業領域內的實踐。

In community or private practice settings, there is often little to no teaching or research

在社區或私人執業環境中，通常很少或沒有教學或研究工作。

involved.

參與其中。

They tend to see more of the bread and butter cases; however, depending on the skill of

他們往往會看到更多的麵包和黃油案件；然而，根據他們的技術

the pathologist, they may take on more complex cases as well.

病理學家，他們也可能承擔更復雜的案件。

This will depend on the pathologist’s individual strengths and weaknesses and what they feel

這將取決於病理學家的個人優勢和劣勢，以及他們的感受。

comfortable with.

舒服。

When pathologists receive difficult samples, it is common to collaborate with other pathologists

當病理學家收到困難的樣本時，通常會與其他病理學家合作。

or send the sample out for evaluation at an academic institution.

或將樣品送出，在學術機構進行評估。

In terms of lifestyle, community and private practice pathologists tend to have more of

就生活方式而言，社區和私人診所的病理學家往往有更多的

a nine-to-five schedule and don’t generally work weekends or take call.

他們的工作時間是朝九晚五，一般不在週末工作或接聽電話。

In the academic setting, however, this will vary greatly depending on where you work and

然而，在學術環境中，這將有很大的不同，取決於你的工作地點和

what your caseload is.

你的案件量是多少。

In terms of compensation, private practice pathologists tend to make the most, followed

在報酬方面，私人執業病理學家的收入往往最高，其次是

by community pathologists, and lastly academic pathologists.

由社區病理學家，最後是學術病理學家。

The differences can be quite significant in some cases, with private practice physicians

在某些情況下，差異可能相當大，私人診所的醫生

sometimes taking home over $100,000 more per year than their academic colleagues.

有時比他們的學術同事每年多拿10多萬美元。

Let’s clear up some of the misconceptions about pathology.

讓我們澄清一些關於病理學的誤解。

The first is that pathologists aren’t “real doctors” because they don’t see patients.

首先是病理學家不是 "真正的醫生"，因為他們不看病人。

Although it is true that most pathologists spend the majority of their time in the lab

儘管大多數病理學家確實把大部分時間花在了實驗室裡

and rarely see patients directly, they are all still physicians.

並且很少直接見病人，他們都還是醫生。

They went to medical school, completed residency, and passed their boards just like any other

他們去了醫學院，完成了住院醫師培訓，並像其他任何人一樣，通過了他們的委員會。

physician.

醫生。

Another common misconception is that all pathologists are geeky and have poor communication skills.

另一個常見的誤解是，所有病理學家都是怪人，溝通能力差。

Contrary to popular belief, pathologists don’t spend all day sitting alone in a room looking

與流行的看法相反，病理學家不會整天獨自坐在房間裡看書。

at slides – nor do they do everything themselves.

在幻燈片上--他們也不自己做所有事情。

Pathologists often manage a team of pathology assistants and techs who do much of the grossing,

病理學家經常管理一個由病理助理和技術員組成的團隊，他們做大部分的毛髮處理。

slide preparation, and actual running of the tests.

幻燈片的準備，以及測試的實際運行。

The pathologist’s primary job is to direct the team and focus on the diagnosis of disease.

病理學家的主要工作是指導團隊並專注於疾病的診斷。

Pathologists also regularly communicate with various physicians, surgeons, and other members

病理學家還經常與不同的醫生、外科醫生和其他成員進行交流。

of the healthcare team to ensure patients receive accurate diagnoses and treatments.

的醫療團隊，以確保病人得到準確的診斷和治療。

It is often said that “a pathologist’s diagnostic skills are only as good as their

人們常說，"病理學家的診斷技能只有在其

ability to communicate them effectively.”

有效溝通的能力"。

Many people also believe that pathology is a dying field that will soon be replaced by

許多人還認為，病理學是一個垂死的領域，很快就會被取代。

artificial intelligence and machine learning; however, based on current technologies, this

人工智能和機器學習；然而，基於目前的技術，這

is unlikely to happen in the foreseeable future.

在可預見的未來不太可能發生。

Although there have been many promising studies where AI algorithms have been able to accurately

儘管已經有許多有希望的研究，人工智能算法已經能夠準確地

diagnose disease, you will ultimately need to have someone knowledgeable to interpret

診斷疾病，你最終將需要一個有知識的人來解釋

the results and determine whether or not they are accurate.

結果，並確定它們是否準確。

That being said, it is possible that AI will be used as a tool to increase pathologists’

也就是說，人工智能有可能被作為一種工具來提高病理學家的

efficiency to the point that we experience decreases in demand for pathologists; however,

效率，以至於我們對病理學家的需求減少；但是。

only time will tell what the true impact of AI on the field of pathology will be.

只有時間才能告訴我們人工智能對病理學領域的真正影響是什麼。

After medical school, pathology residency is 3-4 years depending on which pathway you

醫學院畢業後，病理科住院醫師是3-4年，這取決於你選擇的途徑

choose.

選擇。

The majority of pathology residents complete combined anatomical and clinical pathology

大多數病理科住院醫師完成了解剖學和臨床病理學的結合。

residency which is four years long; however, there are separate anatomic and clinical residency

駐院實習期為四年；但是，有單獨的解剖學和臨床駐院實習。

programs as well which are three years long.

這些項目也是為期三年的。

For combined anatomical and clinical pathology programs, first-year residents will often

對於解剖學和臨床病理學聯合課程，第一年的住院醫師通常會

spend more of their time focused on anatomical pathology.

他們將更多的時間集中在解剖學病理學上。

Years two and three are generally some combination of anatomic pathology and clinical pathology,

第二和第三年一般是解剖病理學和臨床病理學的一些組合。

and year four is generally more focused on clinical pathology.

而第四年一般更專注於臨床病理學。

Since clinical pathology is generally less demanding on a resident’s time, this curriculum

由於臨床病理學通常對住院醫師的時間要求不高，是以該課程

structure provides fourth-year residents with more time to study for boards.

這種結構為第四年的住院醫師提供了更多的時間來學習考試。

It should be noted, however, that some programs have a more simple approach to their curriculums

然而，應該注意的是，有些項目的課程設置比較簡單

and do two years of anatomic pathology followed by two years of clinical pathology.

並做兩年的解剖病理學，然後再做兩年的臨床病理學。

Most pathologists who complete combined AP/CP residency programs will become board-certified

大多數完成AP/CP聯合住院醫師項目的病理學家將成為委員會認證的醫生。

in both anatomic and clinical pathology; however, they will often only practice within one.

在解剖學和臨床病理學方面，他們往往只在其中一個領域工作。

In terms of competitiveness, pathology is at the lower end of average.

在競爭力方面，病理學處於平均水平的低端。

In 2020, the average Step 1 and Step 2 scores for pathology residents were 233 and 242 respectively

2020年，病理科住院醫生的步驟1和步驟2的平均分數分別為233和242。

and the match rate was 98.2%.

且匹配率為98.2%。

This was the second-highest match rate that year only behind radiation oncology at 99.2%.

這是當年的第二高匹配率，僅次於放射腫瘤學的99.2%。

However, as we’ve discussed before on this channel, competitiveness is not purely a function

然而，正如我們之前在本頻道討論的那樣，競爭力並不純粹是一個功能

of Step scores and match rate, but also other official data reported by the NRMP.

階梯分數和匹配率，但也包括NRMP報告的其他官方數據。

When accounting for these other factors, pathology ranks at 8th least competitive, ahead of neurology,

如果考慮到這些其他因素，病理學排名第8，競爭力最低，排在神經病學之前。

emergency medicine, psychiatry, pediatrics, anesthesiology, PM&R, and family medicine.

急診科、精神病科、兒科、麻醉科、婦產科和家庭醫學。

Those wishing to get into a top pathology program will still need high Step scores,

那些希望進入頂級病理學項目的人仍然需要高的Step分數。

lots of research, and everything else that makes them a strong applicant.

大量的研究，以及其他一切使他們成為強有力的申請人的因素。

Medical students best suited for pathology are science-focused and don’t mind skipping

最適合病理學的醫學生以科學為重點，不介意跳過。

out on patient care.

對病人的護理。

They tend to be more detail-oriented, enjoy working independently, and, unlike perhaps

他們往往更注重細節，喜歡獨立工作，而且，也許不同於

most medical students, actually like histology.

大多數醫學生，其實都喜歡組織學。

Because pathology is such a broad field, most pathologists choose to subspecialize after

由於病理學是一個非常廣泛的領域，大多數病理學家都會選擇在畢業後進行專業分工。

residency by completing fellowship training.

通過完成研究金培訓，獲得住院醫師資格。

Subspecialties within pathology can be broken down into anatomical and clinical.

病理學中的亞專業可以細分為解剖學和臨床學。

Let’s start with anatomical pathology subspecialties.

讓我們從解剖學病理學亞專業開始。

Dermatopathology is a 1-year fellowship that provides additional training in the diagnosis

皮膚病理學是一項為期1年的研究，提供診斷方面的額外培訓。

of disorders of the skin.

皮膚失調。

This is one of the most sought-after pathology subspecialties as, like dermatology, it is

這是最受歡迎的病理學亞專業之一，因為與皮膚病學一樣，它也是最受歡迎的。

known for having high compensation and a hard-to-beat lifestyle.

以擁有高額報酬和難得的生活方式而聞名。

That being said, it is also one of the most competitive fellowships to get into as you

也就是說，這也是競爭最激烈的獎學金之一，因為你

are not only competing against fellow pathologists for a spot but also dermatologists, who tend

他們不僅要與病理學家同行競爭一個位置，還要與皮膚科醫生競爭，而皮膚科醫生往往要與病理學家競爭。

to be very competitive applicants.

是非常有競爭力的申請人。

Cytopathology is a 1-year fellowship that provides additional training in the interpretation

細胞病理學是一項為期1年的研究，提供額外的解釋培訓。

of fine-needle aspiration biopsies, or FNAs, endoscopic ultrasound biopsies, pap smears,

細針抽吸活檢，或FNAs，內窺鏡超聲活檢，子宮頸抹片檢查。

pleural and peritoneal fluids, and bile duct and bronchial brushings.

胸膜和腹膜液，以及膽管和支氣管刷子。

Cytopathology is also one of the few pathology specialties where pathologists are trained

細胞病理學也是少數幾個病理學專業之一，病理學家在這裡接受培訓

to perform procedures - specifically superficial FNAs.

來進行手術--特別是淺表的FNAs。

That being said, the majority of FNAs are still performed by the radiologist.

也就是說，大多數的FNA仍然由放射科醫生進行。

There are a number of other anatomic pathology fellowships including pediatric, forensic,

還有一些其他的解剖病理學研究項目，包括兒科、法醫。

ophthalmic, head and neck, breast, thoracic, gastrointestinal, genitourinary, gynecologic,

眼科、頭頸部、乳房、胸部、胃腸道、泌尿生殖系統、婦科。

medical renal, bone and soft tissue, and general surgical pathology.

內科腎臟、骨和軟組織以及普通外科病理學。

In short, if there’s a medical specialty for it, there’s probably a pathology subspecialty

簡而言之，如果有一個醫學專業，就可能有一個病理學亞專業。

that focuses on it as well.

這也是關注的重點。

Next, let’s look at clinical pathology subspecialties.

接下來，讓我們來看看臨床病理學的亞專業。

Blood Bank and Transfusion Medicine is a 1-year fellowship that provides additional training

血庫和輸血醫學是一個為期一年的研究項目，提供額外的培訓

in blood donor collection, blood antibody testing, transfusion practices, and therapeutic

在獻血者收集、血液抗體測試、輸血實踐和治療方面的經驗。

apheresis – the removal of a blood component and replacement with a healthy substitute.

無償獻血 - 移除血液成分，用健康的替代品替代。

Blood bank and transfusion medicine pathologists often go on to serve in medical director roles

血庫和輸血醫學的病理學家經常擔任醫療主管的角色

in hospitals, community blood centers, or reference labs.

在醫院、社區血液中心或參考實驗室。

Of note, pathology is not the only pathway to get into a blood bank and transfusion medicine

值得注意的是，病理學並不是進入血庫和輸血醫學的唯一途徑。

fellowship.

同學們。

Physicians who have completed residency in internal medicine, pediatrics, and anesthesia,

已完成內科、兒科和麻醉科住院醫師培訓的醫生。

among others are also able to apply for these fellowships.

等人也能夠申請這些獎學金。

Hematopathology is a 1-2 year fellowship that provides additional training in the clinical

血液病理學是一個為期1-2年的研究項目，它提供了在臨床上的額外培訓。

and laboratory evaluation of blood, bone marrow, and lymph nodes.

並對血液、骨髓和淋巴結進行實驗室評估。

Hematopathologists are proficient in the diagnosis and classification of cancers of the blood

血液病理學家精通於血液癌症的診斷和分類。