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Assist with rich of hospital surgery PanCame in Feburary 2005 in May, I had favour to participate in China assist with medical university - California university san Francisco is divided school (UCSF) international communication activity, be in total hospital of the Moffitt/Long hospital with accessary UCSF, VA veteran hospital and san Francisco (SFGH) the clinical cycle that many section office shared in hospitals of 3 large omnibus teaching. I am ordinal the blood that treats hospital of advisory group, Moffitt/Long in surgery of the common internal medical of SFGH of san Francisco total courtyard, traumatic emergency treatment, AIDS / tumor changes pancreas of kidney of cure division, liver the common internal medical of veteran hospital of transplanting center and VA was participated in respectively 1 - 2 weeks cycle view and emulate; Follow the fire alarm emergency treatment of san Francisco city member the emergency treatment that attended one day on the ambulance; The outpatient service surgery of the emergency call family that saw san Francisco total courtyard and Moffitt/Long hospital, anaesthetic division. The exotic study of two many months and life make I harvest fine much, impressional good people is much.
Without the university of enclosureCalifornia especially beautiful sunshine shines the street scenery of area of Sunset setting sun so that shake an eye a bit, in lively bright beautiful a halation was added again outside the rough sketch that colour makes. San Francisco is judged this to be the most beautiful city on the world to spread all over country for many times, mix uphill declivous very steep, if drive in this,can want slope to rise with adroitness of art of trick-cycling of Buddhist templeput on the brakes. N-Judah of old-style red railroad car climbs the mountain on slope all the way, the college of medical of California university san Francisco that takes me to famed far and near from coast of Pacific Ocean gold (UCSF) . I look up stannum of look into the distance is installed (Zion) hill apical UCSF Panasasi campus (Parnassus) , quite one kind comes the feeling of pilgrim. Allegedly Parnassus takes the name from hill of a god in Greek mythology, serve as Baal and literary goddess in ancient times people clever ground. Now, the United States is here on the west one of top class college of medicals with the famousest coast.
American university can divide two kinds roughly, one kind has school gate and enclosing wall, for instance Berkeley of university of haing Buddha university, Masschusetts Institute of Technology, California divides university of school, Stanford to wait; Another kind does not have enclosure and school gate, campus building blends in a society directly, border with block photograph. UCSF is this kind of university that does not have courtyard wall, building of hall of the library, coffee, education, hospital is open to the society, campus itself is the one part of block; This and my alma mater China assist with medical university unusual appearance resembles. Library a week is opened 7 days to all citizens, you can sit in comfortable leather sofa to browse in playday medical history an album of paintings, or the edge drinks coffee, hear music, the golden gate big bridge that far looks at from be born large window by the side of and Pacific Ocean. The library is opened even to Zhou Wu in Zhou Yi in the evening at 11 o‘clock, the person that read is offerred inside its self-study teapoy elegance is practical, what can arouse you greatly is curious desire, letting you feel to read is one kind is enjoyed, see a book insensibly late night. Inside the house fragmentary distributinging move a few discussion rooms, have desk and chair and the brief facility that show computer slide show, the study group that 56 people can lay after the course makes an appointment undertakes discussion. American values group collaboration to discuss the study method of type very much, and to medic, communicate clinical practice experience each other, discuss difficulty the examine of discussion make one‘s rounds of complex case appears particularly important. Every outstanding medic or clinical doctor must report medical history, analysis adroitly in the short time that can be in 35 minutes illness, offer means of make a diagnosis and give treatment, or it is to explain scientific research flow and experimental result; Of their achievement very big the expression in also coming from panel discussion partly. Of these so little discussion room make an appointment very popular, the program of every hour is discharged completely. The seat before coffee hall glazing is another discussion good place, and need not make an appointment. Probably you just bought lunch, encounter the professor that carrying coffee opportunely, good, you can be consulted immediately that considers the issue that be illogical last week, the newest data that just examined you chats with him. Everywhere is wearing Bai Yi it is thus clear that here or be the medic of athletic clothing, be in and wearing a suit or be the doctors that the operation takes are discussed freely. Respecting is being worn, in the United States medic and doctor of be in hospital can wear white jacket only commonly, namely white short A Chinese-style unlined garment, wait only promote to a high office advocate order a physician, enter the range that teaching and administrative staff is versed in, ability is qualified clad place wave waving white coat. I can‘t help cherishing my to be able to wear the qualification of white coat in home very. The society is right of the doctor approbate degree very tall, and very natural. If you are wearing white coat, white short A Chinese-style unlined garment or the brush a hand to be taken block that are surgery by chance, shop to the supermarket or be to take by bus, others can become aware the move is strange not at all, return the view that can deliver envy to admire even, and chat actively with you.
UCSF does not have his playground, students can go more the kickball of community playground ran beyond a block. From rise into a day that of school, the medic of UCSF lives in Sunset community namely, is not to be kept apart to be in the tower of ivory. College of medical and confluence of social harmony ground arrived one case. A day of general internal medicalThe history is long the general internal medical of famed far and nearThe college of medical with a long history often can refract a city even the phylogeny of a country, for instance UCSF chime is mixed. San Francisco is placing more than 10 to exhibit in total courtyard dining-room board, it is the precious history camera lens about san Francisco city and SFGH; What be familiar with like me very much assist with building of hospital be in hospital 2, also hang over there full assist the old photograph that fizzles out with extensive, recorded the phylogeny of Chinese modern medical. In the gold rush of 19 centuries middle period, a large number of population emerge to san Francisco. While the city that they expand quickly for this brought economy to flourish, also caused such as choleraic, n/med tuberculosis, smallpox, venereal the popularity that waits for a variety of contagion, violent incident and traumatic everywhere are visible. Below such historical society setting, san Francisco total courtyard (SFGH) only then built 1857, be in after this for many times extend, become the United States the coast builds the earliest, medical treatment on the west one of public hospitals with integrated top level. Because be public hospital, so safe without medical treatment poor also can arrive here sees a doctor, be in consequently natural resources of SFGH case of illness is very substantial, often can see scarce disease has as heavy as difficulty danger patient. The common internal medical of SFGH more because ward of the first AIDS was founded in July 1983 and celebrated at the world. Now, SFGH general internal medical shares bed to make an appointment with 120 pieces, the amount resides internal medical first of each major group. The doctor of SFGH general internal medical is divided in all treat a group for 6 (Team) , every group includes 1 advocate order medical service (Attending) , a cure of the 3rd year of be in hospital (call Residentof Secondyear, namely R2) , 1-2 name cure of the 2nd year of be in hospital (R1) , a cure of the first year of be in hospital (Intern) and a 3 grade or 4 grade medic (MS3/MS4) . The group doctor in charge of a case that I am in is American white man, r2 is Korea descendants, r1 is Indian descendants, intern and MS3 are a Taiwanese, reflected the phyletic diversification of san Francisco adequately. To the group inside each general, 3 days are worth a the bottom class in a kindergarten, receive 1-3 patient; 6 days are worth a the top class in a kindergarten, receive 10-20 patient. The working hours of doctors suffers law to set strictly, the whole Team after be worth the top class in a kindergarten must be in morrow afternoon 1:00 before leave a hospital to come home rest, the patient gives relay doctor, with avoiding the error that causes because of exhaustion, assure to be below any time and circumstance, the processing that the patient gets is most seasonable and accurate. Advocate treat cure and R2 to not be in charge of specific patient, r1 and Intern are in charge of each 8 - 10 patients, MS is responsible 1 - 2 patients. Although medic is in charge of 9 patients only, but because they also want solid dozen assume medical treatment responsibility on the spot, their management patient is very serious, so meticulous, the little detail that any does not know can check ask, ask for instructions repeatedly. In the morning 7: 30 - 8: 30The medical service of be in hospital that has everyday reported early meeting to begin, each groups R2 can discuss 1 - the more interesting case of illness of courtyard of income of 2 near futures, r1, Intern, MS is handling the be a visitor at a meeting after his responsible patient. 8:30 when R2 begins to taking this group to divide advocate treat the member make the rounds of the wards beyond cure, directive R1, Intern, MS treats respective patient, resemble country a bit advocate the function that controls cure early make the rounds of the wards. More interesting is to meet early be over, the member of each Team can carry coffee, taking biscuit group, chewing chocolate, arm is placing him to be in charge of circumstance note of the patient, confused dispute grabs more comfortable sofa, surround into circle to discuss the patient of this group. Because time is limited, everybody can say the English of all sorts of accent rapidly, you have to suit to the English that incorporates the different oral speech sound such as Japan, Korea, India, Taiwan, Africa, England, France articulates and express kind, still have the Chinese style English of myself of course, very interesting. No matter be to discuss,differentiate diagnose or at the back of token likely pathogeny, everybody is gabble carries data of collect of train of thought, make a speech very eagerly, atmosphere is very enthusiastic. After such draw on the wisdom of the masses, the patient‘s circumstance often is generalized very in the round by the analysis. Wait for everybody to drink the coffee in the hand, eat biscuit circle and chocolate, brief discussion also ended, begin to treat a patient to the make the rounds of the wards other the bed. Everybody chases after after this respectively assay, check video learn a result, new examination, change medical service gaze, ask specialized subject consultation, treat respective patient. In the morning 10: 00, 12: 00The member of the group can be in fixed office Li Juqi, each groups advocate the issue that studies cure to be able to have a patient to encounter in the light of this group undertakes education make the rounds of the wards. For example, the bosom of patient action in chief of the hook cell anaemia with our group once responsible MS3 is painful, advocate treat be in morrow is ready newest relevant overview, appear very easily with respect to patient of hook cell anaemia " acute bosom is painful ask for integratedly " (Acutechestsyndrome) this one special subject undertook half hours explain. Be worth what carry is, advocate treat total meeting to practice analysing a patient‘s condition to the time with MS3 and special Intern, undertake commenting on. Be like again, encounter the on the low side of hematic natrium redound of an AIDS patient, advocate treat can capture this opportunity not tire of what its review disease of low natrium blood irritatedly for everybody again is clinical differentiate train of thought: She reduces hematic sodium cent to be first tall piece of sex, wait piece of sex, low piece of sex, list relevant and clinical condition respectively, for example tall low natrium sees piece of sex reach tall lipemia at tall blood sugar, again commonner low low blood natrium divides piece of sex to measure gender, sex waiting for a look and small size sex for Gao Rong, low natrium of Gao Rong sex is visible decline at disease of liver cirrhosis, kidney, chronic heart etc, the patient that just analyses our place to discuss finally belongs to HIV dependency nephrosis (HIVAN) the low Zhang Gaorong that cause sexual low natrium. Whole be less than 3 minutes to the reviewing of disease of low natrium blood, and this train of thought is R2, R1, Intern place is hep, but advocate treat still review fastidiously in the light of MS3 and me. Next the newest overview that she distributes HIVAN for us again. Noonday 12: 00-17: 00Physician assemble attends a meeting all 6 panels general together a lunch. It is to discuss commonly 1 - 2 case of illness or it is to discuss a special subject. The content of special subject is multifarious, the likelihood is a clinical issue, or it is to ask druggist to discuss new drug of a research and development, or it is to be told low year endowment how does the doctor get promoting to a high office waiting a moment in the hospital, but the content that great majority is education of lay particular stress on. General afternoon meeting has a lecture that is aimed at medic, member of other time inter block treats respective patient, in 5:00 or so everybody allows nowadays class. This is their program of a day. The joins specific patient teacher and student that prepares meticulously everyday has 3 at least - 4, lecture of clinical special subject 1 - 2. the MS3 that begins to enter clinical cycle to, such loop move back and forth 5 years, to he basically has been mixed when R2 country is common advocate the level that order medical service considered, the education efficiency of medical treatment personnel is taller still. Social medical treatment of the United StatesSocial medical treatment of the United States is by community hospital and family doctor (Primary Hospital And Primary Careprovider) , hospital of each public, private integrated, specialized subject, and the patient‘s insurance company assumes jointly, the investment that country and each state government are like public hospital to common medical treatment is very large also. The onefold internal medical such as similar high blood pressure, diabetic, emphysema is common ill patient is in community hospital more or cure of family doctor punish, and the internal medical of the polyclinic is to be in reason community hospital to turn more the patient with the relatively complex or more serious illness that examine comes to. After side patient spends difficulty, the polyclinic can turn the patient again the family doctor that answers him continues to treat. Such medical treatment resource allocation are relatively reasonable also. The total cost seeing a doctor of the patient that bought medical treatment insurance will pay by insurance company. Appear lesser so a few unreasonable phenomena, in such as small hospital unmanned make inquires, have simple internal medical in great quantities the patient of common disease embraces the outpatient service that is blocked up in large hospital not to look to go up ill, or it is some examination does not submit an expense account in outpatient service, but do during be in hospital can submit an expense account etc. Compare to it, the system of domestic community medical treatment of our country and system of medical treatment insurance still remain to be perfected further; Those who believe both is perfect also land of can older rate alleviates between doctors and patients relatively intense concern. The scar of SFGH is surgical
The difference of domestic and international traumatic surgeryHad felt when internal medical program is discharged quite completely, can drink a cup of coffee repeatedly now and then, eat lunch the time of very consummate toilet is done not have, but the work that after outer division cycle began, I just knew what to calls high strength. The general of SFGH is surgical (Generalsurgery) cent is emergency call team of traumatic value team and group, groovy surgery, an associate professor or professor do guidance in second line every groups that day, base outside doctor of total be in hospital is responsible and harmonious. Surgery arrives first, a lot of things become aware the move is new, a few surgical principles that stress strictly in home are put more loosely however in UCSF. For instance we enter surgery to be about to change appropriative to take off a shoe, the person that enter an operation cannot wear a sock, and in SFGH everybody is wearing his footgear to go up directly operation. Begin me to still ask next one belts the leader of the group, need not we change slipper? His shrug says modestly for fun, need not, after all we are hospitals of a county only (Countyhospital) . For instance, clean between the laminar flow besides surgery area, be guaze mask of the cap on requirement belt affirm in home, and clean between the laminar flow outside SFGH surgery area however somebody asks me, why are you taking a mask to hold off a face? Do I am indescribably. Again for instance, their cystic resection patient is OK first and last need not antibiotic; If discover cut heal is good,medical is being changed after their art may be to change merely dressing and do not disinfect; Change medical to also carry cap and guaze mask rarely, what unless be,have special infection is open achieve a face. Surgery is very much appliance nurse is handsome man, and many surgical professors are cheesy lady; The nurse becomes a doctor possibly also through training gradually and taking an exam. Another is very big differring is, antibody of the hepatitis of operation patient, AIDS is not groovy sieve consults a project, if clinical need examination must ask for those who get a patient to agree, consequently operation or it is right when the patient undertakes having achieving operating, uniform requirement takes double deck glove, this calls catholicity to defend principle (Generalprecaution) , assume namely think all patients have infectious possibility. Because abide card medical studies clew, glove of double deck rubber can reduce pinprick to hurt the disease that cause to travel greatly. Program of a week of SFGH general surgerySFGH general surgery is traumatic all doctor of group and surgery team every morning 6:00 to ward and ICU make the rounds of the wards, and low year endowment cure of be in hospital and medic often are in 5:3The 0 patients that control ward to see his first. 7:30 the left and right sides, surgery team can begin an operation into surgery. A week is operation day 5 days, discharge about everyday 3 - 4 small operations, if hernia is repaired, celiac lens cuts gallbladder, or 1 - 2 bigger operations, afternoon 4 - the left and right sides can complete an operation at 5 o‘clock, handle respective patient to be able to be in about to ward 6 - came off work at 7 o‘clock. Doctor of traumatic value team and group all is worth 24 hours of classes, be in charge of going up emergency call operation, bye of whole group of value number day rests. Zhou Yi arrives traumatic paging of Zhou Si is less, general everyday 3 - 5; Arrived people is met on the weekend wingding or go out violent wind car, so Zhou Wu arrives the traumatic paging of weekday is very much, can achieve more than 10 in the evening. Traumatic emergency treatment of the United StatesThe center of emergency call scar of all to complete beauty hospital undertakes the United States unified assessment, cent is I~IV in all 4 level, evaluate a standard to include to be able to receive the working hours that treats traumatic patient paragraph, receive those who treat danger to weigh a patient the largest amount, whether to assume the many respects such as relevant research. The traumatic general surgery of SFGH attributes I level, it is complete san Francisco it is even on the west the coast is the most outstanding. Traumatic emergency treatment of the United States is by emergency treatment fireman (Paramedics) finish together with the doctor. In a lot of cities of the United States, first-aid station and orgnaization of fire control put out a fire are set together, fireman (Firefighter) also often be emergency treatment team member at the same time (Paramedic) . They participate in the course of proper time, it is 100 hours about, member of reserve force of emergency call medical can be become after assessment is eligible (EMT) , the first aid that enlists an ambulance to go up next jackarooes (Ambulanceridealong) , like assessment qualification can become team member of official first aid after a year. Such, when the emergencies such as fire, traffic accident happens, eyewitness can call directly 911 specifications circumstance, be being decided by telephonist is to turn to *** bureau or fire control first-aid station, a lot of circumstances issue two branches to be able to dispatch. If personnel gets hurt, before recent first-aid station expedites an ambulance, dot of space accident ground is gone to, the person that illness of the person that the basis after emergency treatment team member undertakes be handlinged simply is hurt will be hurt sends a distance recently and the traumatic center with corresponding level, be in traumatic center after that basically abide by relevant and traumatic make a diagnosis and give treatment to handle clinical guideline to undertake to the processing of the wounded. Of traumatic emergency treatment be admitted to hospital evaluateWhen emergency treatment member when first treatment the wounded decides to send toward SFGH emergency call, they can press illness weight to send ill National People‘s Congress cent to be 900 (extremely danger is serious) , 911 (very danger is serious) , 912 (general) 3 kinds, and will roughly illness phone informs SFGH of emergency call. So the traumatic and special Beep-Pager of all doctor that the group outside scar radical was on duty that day can receive traumatic paging, substandard of the level of 912 and traffic accident, bullet wound hurts 911 ／ of sexual distinction of the person that simple specification is hurt, age, 900 ／ type. For example, "911trauma Call, f42, MVA " the patient of traffic accident of 42 years old of females that expresses to compare danger to weigh. Division of SFGH emergency call has room of 4 traumatic rescue, once the patient is sent by the ambulance, the doctor of traumatic group began division of labor of land of in an orderly way to cooperate together with emergency call nurse and technician. Nurse A to emergency treatment member as specific as eyewitness inquiry traumatic medical history and get hurt the mechanism tries to record on form anamnesis, nurse B exsanguinate sends groovy assay. Base outside group the order of the ABCDE that the R2 that be on duty or R3 press guideline of traumatic emergency treatment undertakes to the patient preliminary evaluate (Primarysurvey) , include to enrage Airway, breath Disability of obstacle of motion of Circulation of Breathing, loop, limbs and limbs expose circumstance Exposure to wait, enrage suffocate suffocate for example or do not have own breath, criterion doctor at once intubate; Life style is asked for not stable, for example blood pressure is low, criterion nurse B can open vein passageway to undertake fluid infusion. If preliminary evaluate a circumstance to be stabilized basically, criterion the assessment that the doctor can begin the 2nd step (Secondarysurvey) , chat simply with the patient and undertake roughly examine system, he can call the result that gives an examination, nurse C is recorded at any time on form anamnesis; Survival meets cure to speak him to think the inspection that make at any time according to his judgement. There is the abdomen other the bed in rescue room supersonic, heart and hemal colour exceed, the X smooth machine of portable probe is waited a moment. Every time he cries give an examination that he thinks to do, technician pulls device make this inspection instantly. Such, resemble burst of pneumothorax, fracture, celiac viscera ram of haemorrhage, pericardium such traumatic it is in rescue room can establish was diagnosed. If patient consciousness condition has,be possible skull internal haemorrhage, they can push a patient to go radiative division does emergency call CT. If have an operation,point to proof send into surgery. The movement of the everybody in rescue room is very steady, the efficiency that whole cooperates is very tall. , one is gone up to grind 82 years old of senile women that spend from the body by the lorry, when pressing emergency call of 911 paging service shock of already low blood pressure, evaluated service CT room to use half hours only from the preliminary check-out that finish; CT discovers the haematoma inside skull, need instantly operation, the patient after half hours has been sent surgery to begin anaesthesia. Such processing speed basically does not have sluggish segment.
Lovely doctor of the team outside respected traumatic general
General surgery is weekly regular meeting of 3 whole families, handle since discussion a week proper or be not proper is traumatic case of illness, undertake the patient discusses dead, sum up experience lesson. Traumatic surgery not only working intensity is high, and the physical strength to the doctor, energy, reaction and lash-up judgement processing ask quite tall, often be called to be by play " the youth‘s game " ; But on the group outside traumatic general of age advocate treat and professors love this one major very greatly, they not only driving, the fine long hair of serious and consecratory degree that handles the work doctor of no less than young be in hospital; And often still be in ground of operating-table begin handle to coach cure of be in hospital undertakes operating by right of rich clinical experience, your person is admired already touch again.
The transplanting center of MoffittTwo week hind I the center of transplanting of liver kidney pancreas that cycle reached Moffitt/Long hospital. Moffitt/Long is a private hospital, of the Parnassus in near neighbour UCSF advocate campus, having here on the west the center of transplanting of liver kidney pancreas with best coast, equipment is top-ranking. American organ shares a network through completely beautiful organ almost for body (UnitedNetwork Of Organs Sharing, UNOS) will consolidate management, the transplanting of the person that the organ suffers points to ask for control to must comparative strict. For example the patient of cirrhosis of alcohol sex liver if not abstinence, or the AIDS patient that is cirrhosis of third hepatitis, liver if not Buddhist monastic discipline drops drugs, no matter he appears how serious complication, the doctor also won‘t become organic transplanting operation for them. When taking the organ that supply system, the organ such as liver, kidney, pancreas often gets off by same group doctor; And no matter liver transplanting still is kidney transplant patient, depressor of immunity of the application after art, raising the question such as leucocyte medical and precautionary infection is very similar, so UCSF does not have surgery of make water of secrete of put under of surgery of general of put under of liver transplanting, will pancreatic transplanting, kidney transplant, establish center of surgery of a transplanting to consolidate management however. Transplanting center has bed about 30 pieces, the case of illness of pancreatic transplanting is less, basically be the patient of liver kidney transplant. Because the patient‘s the primary affection is multifarious, and regular meeting has patient of children, baby, so the working group of this center transplants by general surgery group, internal medical, paediatrics doctor and apothecary are comprised jointly, the battle array is giant. Because every patient patient‘s condition is very complex, plus became large transplanting operation, so basically everyday every patient can appear new issue should discuss processing. Everyday make the rounds of the wards treats 30 patients often last a period of time 3 - 4 hours, so the physician in the group often says them for fun everyday the job is " preparative make the rounds of the wards, make the rounds of the wards, prepare the make the rounds of the wards tomorrow " (Pre-rounding, rounding, and Preparing For The Rounds Tomorrow) . The generation of transplanting surgery advocate treat (Fellow, for the moment interpret becomes era advocate treat) be on duty is to belong to 24 ／ more of 7, namely everyday 24 hours, every week 7 days, the all the time is inappropriate class. Because offer body organ to may arrive in any time, so their operation can begin in any time. When a batch the organ that supply system is in nightly when arriving, they can do 2 kidney transplant to add operation of transplanting of a liver repeatedly overnight, the following day goggle at pinkeye continues make the rounds of the wards. The appliance nurse of surgery says the person of this Team is bedlamite for fun. That Fellow that I imagine surgery very hard still can have time accomplishing his research task -- he calculates do not sleep every day, the time that makes a task also is very finite. During cycle, I visited a few operations, the liver kidney of 9 hours when still favour participated in one desk calendar combines transplanting operation. Arrive from medic doctorMedic phaseAfter American undergraduate students graduates 4 years, can choose to apply for school of college of medical to become medic. A medic of UCSF reads 4 years, tuition restrains 80 thousand dollar; The total expenditure that takes degree of MD of a M.d. can exceed 100 thousand dollars commonly. Tuition of such high specified number makes major medic relies on loan to pay tuition, a lot of people still are done not have inside 10 years after graduation becomes a doctor aid learn loan to pay off. Academic lesson learns before the college of medical two years in the classroom, OK take as an elective course a variety of course related to medical, if doctor of traditional Chinese medical or acupuncture are waited a moment. They can be in commonly the 2nd year curricular end times takes an examination of USMLE. Qualification of American profession doctor takes an exam -- USMLEUSMLE is exam of qualification of American profession doctor, the Board that often says namely takes an exam, each state government asks to differ to the difficulty of the exam; Among them Step1 is exam of much selection of subject of a computer, content basically is involved anatomize, physiology, pathology, ill unripe, pharmacodynamics, biochemistry and molecular cell biology, the need when the 2nd school year ends passes this Step1. Begin the 3rd year to enter teaching hospital cycle clinical, manage 1 - 3 patients. Had taken an examination of the Step2 of USMLE when the 4th year first half of the year commonly, content basically includes Fu of inside and outside ear-nose-throat of god, eye the clinical section office such as the tooth is relevant content, still include once at the same time 8 - 10 standardization patient (Standardpatient) interrogation checks body interview. The examination questions of USMLE is multifarious, all-embracing, also have certain space with clinical work, medic people often be one edge cycle clinical do exercise problem to prepare an exam more even at the same time, the circumstance of this and home is held out those who resemble. When before was being passed two Steps, medic can begin choose major in second half of the year when, application participates in doctor of be in hospital to training plan (Residencytrainingprogram) . Everybody can be in complete beauty to apply for commonly 20 - the cure of be in hospital of 30 hospitals training, part the resume oneself, recommendation, hospital that during school the material such as report and USMLE report sends application. If the other side is interested in applicant, they can ask applicant attends interview to place. More successful medic can be him to strive for 10 interview opportunities of the left and right sides commonly. Such, the accession that arrived to apply for every year, the time that they often need to spend a month is in the United States with on 10 thousand dollars each are big between the city flitter, attend an another interview. Next they press 10 hospitals that want to go most oneself volunteer sort, at the same time all hospitals that plan to recruit doctor of be in hospital also are met a wanted interview person sort, then has two kinds of sort computer " conjugate (Matching) " , allocate each medic a medical service of only be in hospital training quota of people. Arrived so annual when the Matching at the beginning of April is announced, countrywide medic resembles awaiting " final judgement " same. If they are right distributive whereaboutldirection is dissatisfactory, or it is to do not have whereaboutldirection temporarily, a few levels are differred a bit or they often can be chosen only is have not the hospital of all seats taken, or it is to await the coming year to come again. Doctor of be in hospital training -- InternBe brought into successfully doctor of be in hospital training the medic of the plan can begin next Intern phase. Intern by a definite date a year, the work is very hard, it is right purgatorial time, but a year also be advance rapidly of clinical skill level. Everybody can choose to had taken an examination of the Step3 of USLME when Intern ends commonly. The title that takes an exam this also includes computer to select problem and standardization patient two parts, but pay attention to processing of make a diagnosis and give treatment and clinical and integrated knowledge more than Step2. So far USLME is finished entirely, our Intern can begin medical service of be in hospital the 2nd year namely the phase of R1. Finished base of first doctor of 3 years of be in hospital to training, still have 3-4 year the specialized subject that length varies training waiting for them, the way of the grow into useful timber is very long. From on the college of medical arrives finish in 10 years of or so time of doctor of be in hospital, they can choose to rest in aleatoric year false 1 - 2 years, this is a kind mix relatively generally popular way. Most person can choose to do scientific research to the lab, american national hospital (NIH) as big as each college of medical has a lot of by a definite date 1 - short-term research task of 2 years. Return somebody to be able to use this 1-2 year rest false time circumnavigation or it is to marry to give birth to a child, begin in any full year next when, they can continue finish school and cure of be in hospital training. The medic of more than 30 years old in the hospital and cure of be in hospital are not accordingly scarce. Because be in the United States, everybody thinks from cure it is a lifetime career (Lifelong Career) . Diplomate is fostered -- AttendingGenerally speaking, cure of medical be in hospital is in achieve cure of the 4th year of be in hospital namely when R3, can choose to make class of medical total value, or it is to do professional research (Specialtyfellowship) , to promote to a high office advocate order a physician (Attending) prepare. And cure of surgical be in hospital often needs to accomplish R6 is cure of the 7th year of be in hospital, ability makes total value class or do Fellow. Arrived Attending phase, the teaching and administrative staff that has been college of medical and teaching hospital is versed in (Faculty) , general component is taught for assistant (Assistantprofessor) , associate professor (Associateprofessor) , professor (Professor) 3 class. Task of the individual data that all teaching and administrative staff are versed in, resume, research, publish bear the palm of article, place metropolis on the website that is put to the college of medical by detailed ground, with will attract source of student. The cure of be in hospital of college of medical or teaching hospital is so possible horizontal the good and bad are intermingled, but its teaching and administrative staff is versed in is picked troops strong will, everybody has his research direction and task. Not be all finished the teaching and administrative staff that the person that doctor of be in hospital training can choose to become teaching hospital to be versed in, the family doctor that other job whereaboutldirection includes to become community hospital (Primarycareprovider) , the clinic that runs oneself, becomes clinical work not to do research teacher and student only full-time doctor that becomes large hospital of blame education sex (Hospitalist) , enter private hospital to work and become its copartner (Partner) , . American medic training conceptMedical knowledge does not use mechanical memorizing, use what search quickly however, because medical knowledge always is,updating ceaselessly. The computer everywhere that is linked together with Internet in the hospital is visible, medic hand a palmtop computer (it is Palm more or Ppc) , if you ask them a specific detail question, all as usual use the dose of medicaments or be deputy reaction, they won‘t remember likely, but they can go up very quickly from the net or be the solution is found in palmtop computer. They are very tall to the familiar degree of all sorts of networks, special suit to discover useful information from the network. The characteristic that American medic makes another times I am impressive is, they can face reality very much, acclimatization. There also are a variety of places that fare badly in American hospital, the cycle arrangement of medic, exam arrangement achieves sheer fairness very hard also, but they very the one side that is good at seeing the thing is good lets a thing actively develop to good one side hard. They are mixed to medical career the life, also have the guideline regulations of own ABCD: A represents Aspiration, be pair of medical careers is cordial with true love; B represents Believethat Everything Will Improve But It ‘ S Gonna Taketime, believe the thing can make progress to good way but this need time; C represents Complainnever, do not complain forever, this meeting lets you become depression and unable to decide which is right; D represents Devotion And Design Yourlife, systemic a person‘s mind throws the job, and compasses equalize leaves his life. I want what we learn and draw lessons from to these are worth while.
(above quote from a secondary source from Beijing assist sign up for with hospital courtyard 2009 the 5th period, picture part was not reprinted, think farther understanding walks please)
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