and needs to be changed, but what about it is broken?

並需要改變，但它有什麼地方是壞的？

How exactly is medical education failing students?

醫學教育究竟是如何讓學生失敗的？

Let’s talk about it.

讓我們來談談。

Dr. Jubbal, Medschoolinsiders.com.

Jubbal博士，Medschoolinsiders.com。

In an ideal world, the goal of medical education would be to mold students into the best, most

在一個理想的世界裡，醫學教育的目標是將學生塑造成最好、最優秀的人。

competent, and most caring physicians they can be.

他們可能是最有能力和最有愛心的醫生。

Curriculums and clinical experiences would be optimized for learning and systems would

課程和臨床經驗將為學習而優化，系統將

exist to support students who are struggling.

存在支持有困難的學生。

Unfortunately, this is not often the case with medical education in the United States.

不幸的是，美國的醫學教育往往不是這樣的。

It is estimated that nearly half of all medical students suffer from anxiety and nearly a

據估計，近一半的醫學生患有焦慮症，近1/3的醫學生患有焦慮症。

third from depression.

第三個來自抑鬱症。

Moreover, according to the American Foundation for Suicide Prevention, 28% of residents experience

此外，根據美國預防自殺基金會的數據，28%的居民經歷過

a major depressive episode during training compared to only 7-8% of similar-aged individuals

訓練期間出現嚴重的抑鬱症發作，而類似年齡的人中只有7-8%。

in the U.S. population.

在美國人口中。

Given these unsettling trends, it is clear that there are deeply-rooted problems within

鑑於這些令人不安的趨勢，很明顯的是，國內存在著根深蒂固的問題。

medical education that need to be addressed.

需要解決的醫學教育問題。

Here are 5 ways that medical education is failing students.

以下是醫學教育讓學生失望的5個方面。

Let’s start with the elephant in the room: the culture of medical education.

讓我們從房間裡的大象開始：醫學教育的文化。

Becoming a doctor requires countless hours of studying and hard work.

成為一名醫生需要無數個小時的學習和努力工作。

Although many argue that medical education should be difficult given the responsibilities

儘管許多人認為，鑑於醫學教育的責任，它應該是困難的。

that come with being a physician, others believe that the current system places too heavy of

醫師所帶來的好處，而其他人則認為，目前的制度對醫生的要求太高了。

a mental and physical burden on students and residents.

對學生和居民來說是一種精神和身體的負擔。

Aspiring physicians must regularly endure sleep deprivation, long nights, and work after

有抱負的醫生必須經常忍受睡眠不足、長夜漫漫，以及在工作之餘

hours and on days off.

小時和休息日。

According to a recent Medscape survey, two-thirds of residents work greater than 50 hours per

根據Medscape最近的一項調查，有三分之二的住院醫生每星期工作超過50小時。

week with a large percentage of residents exceeding 70-80 hours per week.

每週超過70-80小時的居民佔很大比例。

Although duty hour restrictions exist that limit residents to 80 hours and require at

雖然有值班時間的限制，將居民的值班時間限制在80小時以內，並要求在規定時間內完成。

least one day off per week, this is averaged over 4 weeks.

每週至少休息一天，這是4周的平均數。

And even then, many programs violate these restrictions.

而即使如此，許多項目也違反了這些限制。

As such, there are many residents working in excess of 80 hours per week, which translates

是以，有許多居民每週工作時間超過80小時，這意味著

to 13 to 14 hours per day, 6 days per week.

到每天13至14小時，每週6天。

In addition, the environment during medical school is often extremely competitive.

此外，醫學院期間的環境往往競爭非常激烈。

Everyone is trying to achieve the highest grades, the best test scores, and the most

每個人都在努力取得最高的成績，最好的考試分數，以及最

research to match into their desired specialty.

研究，以匹配到他們所期望的專業。

Not only does this immense pressure to perform often lead to feelings of inadequacy and impostor

這種巨大的表現壓力不僅經常導致不充分和冒名頂替的感覺。

syndrome, but it can also lead to fierce competition between students as well – which some students

綜合症，但它也可能導致學生之間的激烈競爭--一些學生

take too far.

牽扯太遠。

Some overly-competitive students will throw their peers under the bus in order to elevate

一些過度競爭的學生為了抬高自己的地位，會把自己的同伴扔到公車上。

themselves in class or in rotations.

自己在課堂上或輪換中。

Instead of fostering a collaborative environment where students work together to maximize their

而不是培養一個合作的環境，讓學生一起工作，最大限度地提高他們的能力。

learning, the competitive nature of medical school can sometimes pit students against

學習，醫學院的競爭性質有時會使學生與其他學生競爭。

one another.

彼此之間。

This has many consequences.

這有很多後果。

To start, it causes many students to feel inadequate – like their peers are always

首先，它使許多學生感到不足--好像他們的同齡人總是

doing more than them – which ultimately leads to feelings of inferiority and impostor

做得比他們多--這最終導致了自卑和冒名頂替的感覺

syndrome.

綜合症。

Over time, these feelings can develop into more serious mental health issues such as

隨著時間的推移，這些感覺會發展成更嚴重的心理健康問題，如

anxiety, depression, and even suicide.

焦慮、抑鬱，甚至自殺。

Next, this competition between students perpetuates the culture of overwork.

接下來，學生之間的這種競爭使過度勞累的文化得以延續。

It’s not uncommon for students to brag about how much they study, how little they sleep,

學生們吹噓自己的學習量有多大，睡眠有多少，這並不罕見。

and how much they’ve sacrificed to excel in medical school and residency.

以及他們為在醫學院和住院醫師中取得優異成績而做出了多少犧牲。

As a result, many students are pushed further and further to excel academically, often sacrificing

是以，許多學生為了在學業上取得優異成績，被逼得越來越遠，往往犧牲了

things like self-care and hobbies in the pursuit of performance.

在追求業績的過程中，像自我照顧和愛好這樣的事情。

Lastly, it can strain the relationships that students build with their peers and instructors

最後，它可能使學生與他們的同伴和導師建立的關係緊張。

and make medical school feel like an “every person for themself” experience.

並使醫學院感到是一種 "人人為自己 "的體驗。

Although this isn’t the case at every medical school and the transition to pass-fail curriculums

儘管不是每所醫學院都是如此，而且過渡到通過-失敗的課程

during the first two preclinical years has helped to address some of these issues, it

在前兩年的臨床前階段，我們已經幫助解決了其中的一些問題。

is still an unfortunate reality for many students today.

仍然是今天許多學生的一個不幸的現實。

The next reason that medical education is failing students is that it relies too heavily

醫學教育讓學生失望的另一個原因是，它過於依賴

on standardized tests.

在標準化測試中。

Prior to January 2022, USMLE Step 1 was considered the most important exam that future physicians

在2022年1月之前，USMLE Step 1被認為是未來醫生最重要的考試。

took during their training.

在他們的訓練中，他們採取了。

The reason was that your score on Step 1 was a major determinant of your competitiveness

原因是，你在步驟1中的分數是決定你競爭力的主要因素。

for residency applications.

用於申請居留權。

As a result, a low score on Step 1 often prohibited students from pursuing highly competitive

是以，步驟1的低分往往禁止學生追求高度競爭性的目標。

specialties.

專長。

If you wanted to become a dermatologist or a plastic surgeon, for instance, but you didn’t

例如，如果你想成為一名皮膚科醫生或整形外科醫生，但你沒有

score high enough on Step 1, you could pretty much kiss your dream specialty goodbye – all

在步驟1中獲得足夠高的分數，你幾乎可以和你的夢想專業說再見--所有的

because of a single, 8-hour test.

因為一次8小時的測試。

Although Step 1 has officially transitioned to pass-fail as of January 2022, this still

雖然從2022年1月起，步驟1已經正式過渡到通過-失敗，但這仍然是

doesn’t change the overreliance on standardized tests.

並不能改變對標準化考試的過度依賴。

Step 2CK is still graded on a numerical scale and will likely become the new Step 1 in terms

步驟2CK仍然採用數字評分法，並可能成為新的步驟1。

of its weight on residency applications.

其在居留權申請中的權重。

The pressure to perform is just being shifted from one standardized test to another.

表現的壓力只是從一個標準化測試轉移到另一個。

The problem is that standardized tests aren’t necessarily reflective of a student’s ability

問題是，標準化考試不一定能反映出學生的能力。

to be a good physician, but rather their ability to take standardized tests.

成為一名好醫生，而是他們參加標準化考試的能力。

There are many other factors that play into being a great physician beyond test scores

除了考試成績之外，還有許多其他因素對成為一名優秀的醫生起作用

such as integrity, compassion, empathy, and other soft skills that cannot be evaluated

如正直、同情心、同理心和其他無法評估的軟技能。

effectively with a computer-based exam.

有效地使用基於計算機的考試。

Speaking of components of a medical student’s residency application, the overemphasis on

談到醫學生申請住院醫師資格的內容，過度強調的是

research is another way that medical education is failing students.

研究是醫學教育辜負學生的另一種方式。

Although it is important to have the skills to analyze and understand research as a physician,

儘管作為一名醫生，擁有分析和理解研究的技能很重要。

playing the “research game” in medical school often consumes time that students could

在醫學院裡玩 "研究遊戲 "往往會耗費學生的時間，而這些時間本可以用於

spend developing skills that will make them better physicians instead.

培養能使他們成為更好的醫生的技能，而不是花錢。

Research in medical school is a numbers game and quantity is prioritized over quality.

醫學院的研究是一個數字遊戲，數量優先於品質。

If you’re trying to match into a competitive specialty, you are encouraged to get your

如果你想進入一個有競爭力的專業，我們鼓勵你獲得你的

name on as many research projects as possible to pad your CV.

儘可能多地參與研究項目，以填補你的履歷。

The result is that many students end up spending large amounts of time producing research,

其結果是，許多學生最終花了大量的時間來製作研究報告。

most of which is of little impact and doesn’t meaningfully progress the body of scientific

其中大部分影響不大，對科學的發展也沒有意義。

literature or our understanding of medicine.

文學或我們對醫學的理解。

The reality is that most physicians will not continue to do research once they have completed

現實情況是，大多數醫生一旦完成了研究，就不會再繼續做研究了。

their training, so why then do medical students have to commit so much time to research during

他們的訓練，那麼為什麼醫學生在訓練期間要投入這麼多時間進行研究呢？

medical school?

醫學院？

That time could be better spent studying, seeing patients, and developing the skills

這些時間可以更好地用於學習、看病人和發展技能。

and knowledge necessary to become a competent physician.

以及成為一名合格醫生所需的知識。

Next are subjective evaluations.

接下來是主觀評價。

During the third year of medical school, students must complete a series of rotations in a variety

在醫學院的第三年，學生們必須完成一系列的輪換，在不同的地方進行輪換。

of specialties.

的專業性。

At the end of each rotation, they are given a grade that is determined by two things:

在每次輪換結束時，他們會得到一個分數，這個分數由兩件事決定。

their shelf scores and their subjective evaluations by their supervising resident and attending

他們的架子上的分數和他們的主管住院醫生和主治醫生的主觀評價。

physicians.

醫生。

The weight given to shelf scores and subjective evaluations varies depending on the program

對書架上的分數和主觀評價的權重因項目不同而不同

and the rotation; however, there are some clerkships that are predominantly determined

然而，有一些實習主要是由政府決定的。

by subjective evaluations.

通過主觀的評價。

This is problematic as it puts the focus on trying to impress your preceptors as opposed

這是有問題的，因為它把重點放在試圖打動你的教官上，而不是放在

to trying to learn.

到試圖學習。

You may just get lucky or unlucky that you click or don’t with your preceptor.

你可能只是運氣好或運氣不好，與你的戒律師合拍或不合拍。

If you both bond over your shared love of Formula 1, you’re likely to get a stronger

如果你們都因共同熱愛F1而結合在一起，你們很可能會得到一個更強大的

evaluation than if you have nothing in common.

比起你們沒有任何共同點的情況下的評價。

Additionally, many students will avoid asking questions when they don’t know something

此外，許多學生在不知道的情況下會避免提出問題

just to avoid looking bad in front of their preceptors.

只是為了避免在他們的教官面前看起來很糟糕。

As such, these subjective evaluations may disincentivize students from asking questions

是以，這些主觀的評價可能會抑制學生提出問題的積極性

and addressing their gaps in knowledge.

並解決他們在知識方面的差距。

Clinical rotations sometimes feel like they’re no longer about learning but rather about

臨床輪換有時感覺不再是為了學習，而是為了

politics and the fear of getting a bad grade instead.

政治和對獲得壞成績的恐懼，而不是。

Lastly, mistreatment and discrimination are not uncommon, both in terms of getting into

最後，虐待和歧視並不少見，無論是在進入

medical school and throughout the medical training process.

在醫學院和整個醫學培訓過程中。

When you look at medical school admissions data, it is evident that students from certain

當你看到醫學院的錄取數據時，很明顯，來自某些國家的學生

racial backgrounds have a much more difficult time getting into medical school than others.

種族背景的人要比其他人更難進入醫學院。

Although affirmative action in medical school admissions aims to help increase diversity

儘管醫學院招生中的平權行動旨在幫助提高多樣性

among medical students, one of the unintended consequences is that it has made it significantly

在醫科學生中，一個意想不到的後果是，它使醫科學生大大增加了他們的負擔。

more difficult for some students to get into medical school.

對一些學生來說，進入醫學院更加困難。

Asian students in particular are hurt the most by affirmative action policies.

特別是亞裔學生受到平權政策的傷害最大。

The average Asian matriculant during the 2021-2022 application cycle had an average GPA of 3.79

在2021-2022年申請週期內，亞裔預科生的平均GPA為3.79。

and MCAT score of 514.5.

和MCAT分數為514.5。

If we compare this to the average Black matriculant during this same year, the average Asian matriculant

如果我們將這一數字與同年的黑人平均入學人數相比較，那麼亞裔平均入學人數就會增加。

achieved a GPA that was nearly 0.25 points higher and an MCAT score that was nearly 8

他們的GPA高出近0.25分，MCAT成績高出近8分。

points higher.

高點。

For perspective, a 506 on the MCAT is a 65th percentile score and a 515 is a 90th percentile

從這個角度看，MCAT考試中的506分是第65個百分點的分數，515分是第90個百分點的分數。

score.

分。

Ask anyone who has taken the MCAT, and they’ll tell you how big of a difference this is.

問問任何參加過MCAT考試的人，他們會告訴你這是多大的區別。

Asian matriculants, despite being minorities in the US and facing discrimination beyond

亞裔預科生，儘管是美國的少數民族，面臨的歧視超出了他們的想象。

academics, averaged a GPA and MCAT that was higher than even Caucasian matriculants.

學術方面，平均GPA和MCAT甚至高於高加索人的預科生。

Each year these differences vary, but recently Asians have averaged a GPA close to 0.1 points

每年的這些差異都有所不同，但最近亞洲人的平均GPA接近0.1分。

higher and an MCAT more than 2 points higher than their Caucasian colleagues.

比他們的白種人同事要高，MCAT要高2分以上。

We cover this topic in depth in our Affirmative Action in Medical School Admissions video

我們在《醫學院招生中的平權行動》視頻中深入介紹了這個話題

- link in the description.

- 描述中的鏈接。

Unfortunately, discrimination and mistreatment don’t end once one gets into medical school

不幸的是，一旦進入醫學院，歧視和虐待並沒有結束。

either.

或者。

According to a 2022 study published in JAMA, students from underrepresented groups who

根據2022年發表在《美國醫學會雜誌》上的一項研究，來自代表性不足的群體的學生，他們

reported mistreatment or discriminatory behavior had the highest attrition rates of any group.

在所有群體中，報告受到虐待或歧視行為的人的流失率最高。

Students who reported recurrent experiences of mistreatment had attrition rates of 4.1%

報告反覆遭受虐待的學生的減員率為4.1%。

compared to 1.2% of students who reported no mistreatment.

而報告沒有受到虐待的學生為1.2%。

In addition, students reporting recurrent experiences of discrimination had attrition

此外，報告反覆遭受歧視的學生有減員現象。

rates of 1.9% compared to 1.3% for students reporting no discrimination.

的比例為1.9%，而報告沒有歧視的學生的比例為1.3%。

From this research, it is evident that there are issues with mistreatment and discrimination

從這項研究中可以看出，存在著虐待和歧視的問題

within medical education that are causing some students to leave their medical training

醫學教育中導致一些學生離開醫學培訓的問題

altogether.

總的來說。

This comes at a time when we are facing looming physician shortages across a wide variety

在此之際，我們正面臨著各種各樣的醫生短缺問題。

of specialties as well.

的專業也是如此。

These reasons just scratch the surface of the bigger issues in medical education.

這些原因只是醫學教育中更大問題的表面現象。

We could go all day talking about issues of the rising costs of medical education, the

我們可以整天談論醫學教育成本上升的問題。

stigma of mental health among physicians and trainees, and burnout; however, we have covered

在醫生和受訓人員中對心理健康的汙名化，以及職業倦怠；然而，我們已經涵蓋了

these topics in depth in previous videos.

在以前的視頻中，我們對這些主題進行了深入研究。

We also plan to cover the topic of the residency bottleneck and unmatched residents in a comprehensive

我們還計劃在一份全面的報告中涵蓋住院醫師瓶頸和不匹配的住院醫師這一主題。

future video, so make sure you’re subscribed so you don’t miss out.

未來的視頻，所以請確保你訂閱了，這樣你就不會錯過。

Although medical education has its flaws, it’s not all doom and gloom.

雖然醫學教育有其缺陷，但並不全是厄運和陰霾。

There are many things that medical education does well to prepare students for careers

醫學教育在為學生做好職業準備方面有許多方面做得很好

in medicine.

在醫學上。

That being said, it is still important to be aware of its shortcomings to better prepare

話雖如此，但意識到它的缺點以更好地準備仍然很重要。

yourself for what to expect.

你自己會有什麼期待。

At Med School Insiders, our goal is to empower a generation of happier, healthier, and more

在Med School Insiders，我們的目標是賦予一代人更快樂、更健康和更多的機會。

effective future doctors, and part of that is managing expectations.

有效的未來醫生，而其中的一部分是管理預期。

Whereas others are hesitant to talk about the issues in medicine and medical education,

而其他人則對談論醫學和醫學教育方面的問題猶豫不決。

we believe it is important to understand these issues so you can better prepare yourself

我們認為了解這些問題是很重要的，這樣你就可以更好地做好準備。

to tackle them.

來解決這些問題。

Although medical education in the U.S. has its issues, if your dream is to become a doctor,

雖然美國的醫學教育有其問題，但如果你的夢想是成為一名醫生。

it is a necessary hurdle to overcome – and we’re here to help you at each step of the

這是一個需要克服的障礙--我們將在每一個步驟中幫助你。

way.

辦法。

From MCAT tutoring and medical school admissions to USMLE tutoring and residency applications,

從MCAT輔導和醫學院招生到USMLE輔導和住院醫生申請。

we have a variety of resources to help you along your path to becoming a doctor.

我們有各種資源來幫助你走上成為醫生的道路。

Our team is made up of top-performing doctors who received merit-based scholarships and

我們的團隊是由表現優異的醫生組成的，他們獲得了擇優錄取的獎學金和

matched into the best and most sought-after residency programs, even when the odds were

匹配到最好的和最受歡迎的住院醫師項目，即使在賠率是

stacked against them.

對他們不利。

Despite coming from financially disadvantaged backgrounds or ethnic groups that made the

儘管他們來自經濟上處於劣勢的背景或種族群體，使

process more challenging, these are real doctors who beat the odds, got to the top of their

更具挑戰性的過程，這些是真正的醫生，他們戰勝了困難，達到了他們的頂峰。

class, and can show you how to do the same.

類，並可以告訴你如何做同樣的事情。

You’re not going to find this level of expertise and value anywhere else, because, simply put,

你不可能在其他地方找到這種水準的專業知識和價值，因為，簡單地說。

other companies weren’t built by and comprised of elite performing doctors.

其他公司並不是由精英醫生建立和組成的。

You can’t learn how to become a top performer and have medical schools fighting over you,

你不可能學會如何成為一個頂尖的表演者，而讓醫學院為你爭奪。

trying to win you over with full-ride merit-based scholarships from someone who wasn’t able

試圖用全額擇優錄取的獎學金來贏得你的青睞，而這個人卻無法做到。

to do that themself.

自己來做這件事。

And be careful, as several companies are comprised of and built by people who never went to medical

而且要小心，因為有幾家公司是由從未上過醫學院的人組成和建立的。

school and never served on medical school admissions committees.

學校，而且從未在醫學院招生委員會任職。

Some of these bad actors will mislead you into thinking they did by calling themselves

其中一些不良行為者會誤導你，讓你以為他們是通過自稱

doctors when in reality they earned a Ph.D., which is completely different from the medical

而實際上，他們獲得的是博士學位，這與醫學上的 "博士 "完全不同。

school process.

學校過程。

If you want to be a stellar applicant and receive one-on-one advising, tutoring, interview

如果你想成為一個優秀的申請人，並獲得一對一的諮詢、輔導、面試和培訓。

preparation, personal statement or secondary editing, mentorship, and more to become the

準備、個人陳述或二次編輯、導師指導，以及更多，以成為

strongest applicant you can be, visit MedSchoolInsiders.com.

你可以成為最強的申請人，請訪問MedSchoolInsiders.com。

Thank you all so much for watching, if you enjoyed this video be sure to check out Affirmative

非常感謝大家的觀看，如果你喜歡這個視頻，請務必查看《肯定》。

Action in Medical School Admissions or Surprising Facts From the 2022 Match over on the Kevin

在醫學院招生中的行動或來自2022年比賽的令人驚訝的事實在凱文上。

Jubbal, M.D.

Jubbal, M.D.

channel.

管道。

Much love, and I’ll see you guys there.

非常感謝，我們會在那裡見到你們。