医学生周记2016FEB28
阿山 (庞静译)
接着上星期，这个星期的节目还是过渡。上星期的重点是生命终止的情形之下的各种处理方法。这星期的重点是帮助我们从学生过渡到医疗团队中的一员。
这个过渡过程中值得一提的是大约75%的同学都是这星期收到他们Step 1的考试成绩。他们都是二月第一个星期参加的考试。在这个过渡过程中这本身就是一个有意思的故事。
去年九月，要定考试时间之前，许多教授，医生和学长们都来劝告我们一月份考。他们说没必要多花两个星期，二月份才考。再多的复习时间不会明显地改进考试分数。我恨不得马上开始这个额外的假期，所以听从了他们的劝告，定了我的考试时间。总共有十五人报名了一月份的考试，我是其中之一。其他人都选择忽略众位经验丰富的前辈的衷告，他们更相信自己的判断。后来我听了好多抱怨，他们在最后两个星期累得灯干油尽，根本学不进去了。
这就标志了一个起点，让我们明白过渡意味着什么。神经科负责住院医的主任说：目前为止，我们的整个一生都是专业学生。大家最普遍的认同就是不惜任何代价得高分。准备考试期间，有些人不许他们的家人打电话。还有些人圣诞节和新年期间不肯回家。还有人一天念书十五个小时。有人担心烧饭浪费时间，只吃微波炉食物。这些都是可以理解的。总之，我们已经当了二十年的专职学生，当然理解这些拼高分数的做法了。二十年的努力就看这最后八小时的考试了。三百多个问答题，三个数字的分数，这三个数的排列组合就是反映了我们对自己的专业学到了什么，以及自己二十年总和的经验和学习能力。
但是，过渡的要求明显地超出了考试的范围。我们参加了一次由各科住院医主管主任们组织的专题讨论。他们众口一词地说 Step 1成绩五分十分甚至十五分的差别根本不能说明一个学生是否能成为一个好医生的能力。分数完全不能告知一个学生在一个高度压力之下的医疗团队中的表现。分数也无法预测一个人工作了十五个小时之后如何应对主治医生的批评，或者应对由于其他队友犯错造成的更多的工作和麻烦。这就是过渡的需要。我们一定得清楚自己要从一个专业的学生变成医护团队的一员。中心的指导思想，或者说聚焦点不再是我们个人的成就。从现在开始，我们的聚焦点就是如何对病患最好。
还是得说々Step 1的分数报告。预定星期三上午十一点出报告。可是那个时间我们有课。三个教授从百忙之中抽空来给我们讲医疗保险的法规。那天课堂上的注意力非常差。教室里出了很多紧张的小把戏。很多双眼睛只盯着电脑或手机屏幕。很多人不断地回头看教室后面那唯一的钟表。大约10:57, 许多人突然要去厕所。教授们很清楚没人在意他们在讲什么。很明显，他们为了使我们对这个题目有兴趣下了很多功夫。他们对他们所讲的内容很投入，也希望我们能受感染，而且也确实希望我们在将来的工作能明白这些信息。但是，大家的注意力都被马上要公布的分数牵住了。
好多老师都说在这个阶段我们只想自己不怨我们。我们一直都是被按一个独立个体的学生培养的。他们说下一个学年将是我们一生中最兴奋的一年。我们不仅要展宽我们的医学知识，我们还要学很多医学领域的社会知识。我们要学会判断屋里的气氛，什么时候适合说什么话，如何根据个性与病患打交道，怎样融入不断变化的团队，怎样从始至终地着眼大局。过渡不可能是平顺的。但是我们对于星期一就要开始的个人及专业的新一轮成长非常兴奋。
原文
Sunday, February 21, 2016 – Saturday 27, 2016
The theme of this week is transitions again, continued from last week. Last week, there was a big focus on transitioning care and what to do in end-of-life situations. This week, we emphasized the transition of our role as students to that as members of the caregiving team.
To mark this transition, this was the week the majority, maybe about 75%, of the class received their score reports for the Step 1 exam. These were the students that took the exam in the first week of February, which itself presents an interesting story fitting within the theme of transitions.
Back in September, when we were scheduling our exams, we had multiple professors, doctors, and older students come and tell us that we should take the exam in January. Supposedly, there was no need to wait the extra 2 weeks to take the exam in February. The extra studying time would not significantly improve our results. I was very eager to jump on the opportunity for extra vacation time and scheduled my exam according to their advice. I was maybe one of 15 students total that took the advice and scheduled their exams in January. Everybody else chose to ignore the advice of multiple mentors, who had been guiding students for many years, because they believed their own judgment to be the best. I have heard from a lot of these students about how burnt out they were during those last extra weeks, and how that extra time only made them more tired, and that they didn’t think they learned anything extra during that time.
And that marks a starting point for understanding how the theme of “transitions” in this week’s context. As the Director of Neurology Residency Program stated, we have been professional students our whole life. We have been exceedingly successful professional students and are accustomed to doing things our own way, and looking after our own best interests.”
This position is pretty easy to understand in terms of the Step 1 exam. My peers knew what worked for them in the past and they were determined to stick with the successful strategies for this exam. The pervading philosophy was to score as high possible, at literally nearly all costs. There were people that told their families not to call them. There were people that refused to go home for Christmas and New Year’s. There were people that studied 15 hours a day. Some people only ate microwavable meals because cooking took too much time. All of this is understandable. After all, we do understand that we have been “professional” students for about 20 years. Two decades of single-minded dedication were going to boil down to a single 8-hour exam, 300+ multiple-choice questions, and a three digit score. Variations in this three digit score were supposed to reflect how we understood our own professional identities and twenty years or experience and work.
But, the need for “transition” becomes more apparent outside of testing situations. We had a panel of Residency Directors come and talk to us. They all unanimously agreed, differences of 5, 10, and even 15 points showed no reflection of a student’s ability to be a caring doctor. The scores gave no indication if they would function well in a high-stress medical team. The scores would not predict how, after working for 15 hours, we would react to being reprimanded by an attending physician or another teammate’s mistake creating a ton of extra work. This highlights the need for transition, from us understanding ourselves as professional students, to members of a caregiving team. The central philosophy, the focus is no longer on our independent achievements. From here on out, it will always be about what is best for the patient.
But getting back to the Step 1 score release. They were scheduled to be released Wednesday at 11a.m. However, we had class at that time. Three professors had taken time out of their very busy schedules to talk to us about healthcare policy. The in-class attention was very poor. There was a lot of nervous fidgeting throughout the room. Lots of eyes were glued to computer and phone screens. People were constantly turning around to look at the single clock at the back of the room. Around 10:57, a lot of people suddenly needed to use the bathroom. The professors could tell that nobody was paying attention to them. It was obvious that they had put in a lot of work on the lecture to try to make the topic interesting for us. They were passionate about the information and hoped we would be excited about it to, sincerely hoping that we would be able to understand that this information would affect all of us in the medical field in the future. And, despite all this, everybody’s focus was on their own impending score release.
Many of our teachers did acknowledge that it is not our fault that we are only able to think of ourselves at this stage of education. After all, we have been groomed and rewarded for being independent learners. They say that this next coming year is the most exciting year of learning we will ever have in our lives. Not only will we be building the broadest base of medical knowledge we will ever have before we start specializing, we will learn extensively the social aspects of medicine. We will learn how to judge the mood of the room, when it is appropriate to say certain things, how to project different aspects of personalities to connect with different patients, how to get along with constantly changing team situations, and ultimately how to look at the bigger picture greater than ourselves. It won’t always be a smooth transition, but we are excited for the amount of personal and professional growth we will be embarking on Monday.