Who needs adults anyway? Let's debunk the public perception myths, and give it to you

到底誰需要成年人？讓我們揭穿公眾認知的神話，並把它交給你

straight. This is the reality of pediatrics.

直。這就是兒科的現實。

Dr. Jubbal, MedSchoolInsiders.com.

Jubbal博士，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 pediatrics, and help you decide if it's

醫學中的特定專業，如兒科，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 pediatrician

你已經訂閱了。如果你想了解作為一名兒科醫生的情況

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

看起來像，看看我的第二個頻道，凱文-朱巴爾，醫學博士，在那裡我們將涵蓋一天的

in the life of a pediatrician in the future.

在未來的兒科醫生生活中。

Pediatrics is the field of medicine providing care for babies, children, and adolescents

兒科是為嬰兒、兒童和青少年提供護理的醫學領域。

from birth up to the age of 25. The age range was capped at 18, but given our new understanding

從出生到25歲。該年齡段的上限為18歲，但鑑於我們的新認識

of human brain development, the age range has been expanded.

在人類大腦發育的過程中，年齡範圍已經擴大。

Think of pediatrics as the equivalent of internal medicine, but for younger patients. That isn't

將兒科視為相當於內科，但針對的是年輕患者。這並不是

to say that children are just little adults, because they're not. Children's physiology

說兒童只是小大人，因為他們不是。兒童的生理學

is different, and certain medications you would use for adults may have dangerous side

不同的是，某些用於成人的藥物可能有危險的副作用。

effect profiles in children.

兒童中的效果圖。

Additionally, because children are more resilient than adults, they tend to crash hard and abruptly,

此外，由於兒童比成人更有彈性，他們往往會猛烈而突然地崩潰。

meaning they may seem relatively ok and stable, followed by a sudden decompensation requiring

這意味著他們可能看起來相對正常和穩定，隨後突然失調，需要

prompt intervention.

迅速干預。

Just like internal medicine, pediatrics is a massive field with a variety of subspecialties

就像內科一樣，兒科是一個龐大的領域，有各種各樣的亞專業

such that it's difficult to generalize the field. You can take care of patients in a

這樣，就很難對該領域進行概括。你可以照顧病人在一個

variety of settings, from premature babies in the NICU, to healthy children at regular

從新生兒重症監護室的早產兒，到普通病房的健康兒童，各種環境都有。

PCP visits, to hospitalized children for various rare genetic anomalies.

初級保健醫生門診，到因各種罕見的遺傳性異常而住院的兒童。

You can view pediatrics from a generalist versus a specialist lens. As a generalist,

你可以從全科醫生和專科醫生的角度來看待兒科。作為一個全科醫生。

you'll be handling a wide variety of presenting pathologies that don't require sub-specialized

你將會處理各種不需要亞專業的病症。

care. If you practice in the inpatient setting, this translates to being a pediatric hospitalist,

護理。如果你在住院環境中執業，這就意味著你是一名兒科住院醫生。

taking care of kiddos admitted to the hospital. This may include infectious diseases like

照顧入院的孩子們。這可能包括傳染病，如

pneumonia and cellulitis, neonatal issues like hyperbilirubinemia and failure to thrive,

肺炎和蜂窩組織炎，新生兒問題，如高膽紅素血癥和未能茁壯成長。

or metabolic problems like diabetes, among others. If you're an outpatient generalist,

或糖尿病等新陳代謝問題，等等。如果你是一個門診的普通醫生。

you'll be seeing patients in clinic, primarily for regular checkups, vaccinations, and less

你將在診所為病人看病，主要是進行定期檢查、接種疫苗，以及更少的費用。

acute conditions, like allergies, eczema, constipation, or ADHD.

急性病，如過敏、溼疹、便祕或多動症。

As a specialist, you focus on a single organ system of the body. Similar to internal medicine,

作為一個專家，你專注於身體的一個器官系統。類似於內科醫學。

this could be cardiology, gastroenterology, rheumatology, endocrinology, and others. Neonatologists

這可能是心臟病學、胃腸病學、風溼病學、內分泌學和其他。新生兒科醫生

specialize in the care of neonates, which are infants less than 4 weeks old.

專注於新生兒的護理，新生兒是指小於4周的嬰兒。

In outpatient adult medicine, the majority of your patients have comorbidities, meaning

在成人門診中，你的大多數病人都有合併症，這意味著

pre-existing medical conditions or risk factors. In outpatient pediatrics, the majority of

以前存在的醫療條件或風險因素。在兒科門診中，大多數的

your patients are well children, and you'll primarily be focusing on health promotion

你的病人是健康的兒童，你將主要關注健康促進。

to prevent rather than manage a diagnosis. You'll build a relationship with the patient

以預防而不是管理診斷。你將與病人建立一種關係

and their family over time, as you may see them for up to 25 years, through all developmental

隨著時間的推移，你可能會看到他們長達25年的時間，經歷所有的發展階段。

stages.

階段。

Beyond well child visits, you'll see the occasional asthma, eczema, or failure to thrive, meaning

在兒童健康檢查之外，你會看到偶爾的哮喘、溼疹或未能茁壯成長，這意味著

poor weight gain. From time to time you'll see a rare diagnosis, like leukemia or retinoblastoma,

體重增加不佳。不時你會看到一個罕見的診斷，如白血病或視網膜母細胞瘤。

but these are exceedingly rare in primary care outpatient settings. You'll still need

但這些在初級保健門診中是非常罕見的。你仍然需要

to be alert, as kids can compensate well and look healthy until they suddenly decompensate.

要保持警惕，因為孩子們可以很好地補償，看起來很健康，直到他們突然失衡。

Outpatient pediatrics has a great work-life balance, and you'll generally work 9 to 5

兒科門診有很好的工作和生活平衡，你一般會朝九晚五地工作。

hours. It's common to have 4 days of clinic and 1 admin day per week.

時間。每週有4天的門診和1個行政日是很常見的。

With inpatient medicine, your focus is on kids who need to be admitted to the hospital.

在住院醫療方面，你的重點是那些需要住院的孩子。

You'll admit patients from the emergency department, working them up with labs, diagnostics, imaging,

你要從急診科收治病人，用實驗室、診斷學、影像學來幫助他們。

and other tests. For certain conditions requiring specialized care, you'll send consults to

和其他測試。對於某些需要專門護理的病症，你會把諮詢意見送到

the specialists for recommendations.

專家的建議。

In adult medicine, you often have disposition disasters, meaning a great deal of frustration

在成人醫學中，你經常會遇到處置災難，這意味著大量的挫敗感

in discharging the patient and getting them to a place that can take care of them, whether

在讓病人出院並把他們送到可以照顧他們的地方，無論是

that's a skilled nursing facility or some place else. However, social situations can

那是一個專業的護理機構或其他地方。然而，社會情況可以

still be complex with kids, such as when they aren't safe at home with their parents. In

與孩子們在一起仍然很複雜，例如當他們在家裡與父母在一起時不安全。在

these instances you'll interface with social workers and child protective services.

在這些情況下，你將與社會工作者和兒童保護服務機構接觸。

Academic pediatrics often includes 12-18 weeks of inpatient care. Beyond clinical practice,

學術性兒科通常包括12-18周的住院治療。在臨床實踐之外。

there's a high amount of research and teaching, in addition to side projects of various types.

有大量的研究和教學工作，此外還有各種類型的副業項目。

These are wide ranging, such as quality improvement for implementing a different electronic medical

這些都是廣泛的，如實施不同的電子醫療的品質改進。

record in the hospital, or partaking in advocacy and going to the capitol, lobbying for better

在醫院的記錄，或參與宣傳活動，去國會遊說，以改善

safety protections for children. Community pediatrics is the most common practice

對兒童的安全保護。社區兒科是最常見的實踐

setting, where you're working with a larger medical group. Private practice is the least

設置，在那裡你與一個較大的醫療集團合作。私人診所是最不

common, as it is for other specialties, in part because hospitals are buying up small

與其他專業一樣，這種情況很普遍，部分原因是醫院正在購買小型的

private practices.

私人診所。

Some think that pediatrics isn't that complicated, and it's just babysitting. That's certainly

有些人認為，兒科沒有那麼複雜，它只是保姆而已。這當然是

not the case, and remember, kids actually have a unique physiology that requires careful

並非如此，請記住，孩子們實際上有一個獨特的生理結構，需要小心翼翼地對待。

attention and nuance. Acuity and sick kids are certainly a part of pediatrics, although

注意力和細微差別。敏銳度和生病的孩子當然是兒科的一部分，雖然

it's fair to say on average there's a lower amount of acuity.

可以說，平均而言，敏銳度較低。

If you think pediatrics includes only talking to children, think again. There's a heavy

如果你認為兒科只包括與兒童交談，那就再想想吧。這裡有一個很重

family relationship building component, and you'll essentially work with at least 2 patients

家庭關係的建立部分，你基本上會與至少2個病人一起工作

– the kid and their parents.

- 孩子和他們的父母。

Last, some think pediatrics is a woman's field, and while the majority are certainly women,

最後，有些人認為兒科是一個女性的領域，雖然大多數人肯定是女性。

it's not as skewed as some other specialties. Approximately 70% of pediatricians are female.

它不像其他一些專業那樣有偏差。大約70%的兒科醫生是女性。

After medical school, pediatrics residency in the U.S. is 3 years. In residency, the

醫學院畢業後，美國的兒科住院醫師是3年。在住院期間，

focus is on inpatient, but there's of course continuity clinic, where you'll act as the

重點是住院病人，但當然也有連續性的診所，在那裡你將充當醫生。

primary pediatrician for your panel of patients. You'll get new babies when starting residency

為你的病人小組提供主要的兒科醫生。開始實習時，你會得到新的嬰兒

and have them for 3 years, offering a longitudinal relationship that many enjoy.

並擁有它們3年的時間，提供了許多人喜歡的縱向關係。

As with most residencies, the hours are challenging, usually ranging between 60 to 80 hours on

與大多數實習生一樣，工作時間很有挑戰性，通常在60至80小時之間。

most weeks. It's not too far off from something like internal medicine. A chief year, meaning

大多數星期。這與內科之類的事情相差不大。一個首席年，意味著

tacking on a fourth year to your residency, is optional, and is best suited for those

增加第四年的住院醫生，是可選的，最適合於那些

looking at academic positions who want to strengthen their CV and leadership experience.

希望加強其履歷和上司經驗的學術職位的人。

In terms of competitiveness, pediatrics is in the bottom 4, with an average USMLE Step

在競爭力方面，兒科處於倒數第四位，平均USMLE Step

1 of 228, USMLE Step 2CK of 245, and match rate of 98.2%. But of course, highly desirable

1的228，USMLE Step 2CK的245，匹配率為98.2%。但當然，非常理想的是

programs are more competitive, even if the overall specialty is less so.

即使整個專業的競爭力較弱，但項目的競爭力也比較強。

Stereotypically, medical students applying to pediatrics are the soft, gentle, kind-hearted

在人們的刻板印象中，申請兒科的醫學生是柔軟、溫和、心地善良的人。

students who care deeply about the community and kids. They tend to be positive, and want

深切關心社區和孩子們的學生。他們往往是積極的，並希望

to come to work smiling and laughing with their patients. These medical students are

來工作，與他們的病人一起微笑和歡笑。這些醫學生是

stereotypically the "do-gooder" types.

屬於刻板印象中的 "行善者 "類型。

After pediatrics residency, there are several subspecialties you can pursue through fellowship.

兒科住院醫師培訓結束後，有幾個亞專業你可以通過研究金進行學習。

All of the following are 3 years in duration.

以下各項的期限都是3年。

Hematology/Oncology, or heme/onc for short, is focused on treating kids with blood or

血液學/腫瘤學，簡稱血液/腫瘤，主要是治療患有血液或腫瘤的孩子。

solid cancers, including leukemia, lymphoma, brain, and the like. You'll also deal with

固體癌症，包括白血病、淋巴瘤、腦部和類似疾病。你還將處理

non-cancerous blood disorders, like sickle cell disease. It's primarily, but not exclusively,

非癌症的血液疾病，如鐮狀細胞病。這主要是，但不完全是。

an outpatient specialty. This is for the pediatricians who are a mix

一個門診專業。這是為混合型的兒科醫生而設的。

of brain and heart. They're able to be there for their patients on one of the worst days

的大腦和心臟。他們能夠在最糟糕的日子裡陪伴著病人

of a parent's life, while also being highly intellectual and strategic about the best

在父母的生活中，同時也是高度智慧和戰略的最佳選擇。

approach. This also tends to be a highly academic subspecialty with many PhD's.

方法。這也往往是一個高度學術化的亞專業，有許多博士。

ICU is exclusively inpatient in nature, unlike the other fellowships listed here. You'll

與這裡列出的其他獎學金不同，ICU完全是住院病人的性質。你將

be dealing with critically ill kids. Instead of focusing on diagnosing conditions, your

是處理危重病人的問題。與其專注於診斷病情，你的

primary aim will be to stabilize and support them for other subspecialists to take over

主要目的是穩定和支持他們，以便其他亞專科醫生接手。

and follow up with. You'll be dealing with sick kids who are intubated,

並採取後續行動。你要面對的是插管的病童。

meaning on breathing tubes, on pressors to maintain blood pressure, and will help with

意味著使用呼吸管，使用加壓劑來維持血壓，並將幫助解決

pre- and post-op surgical care. It's primarily acute conditions, but you'll see some frequent

術前和術後的外科護理。主要是急性病症，但你會看到一些頻繁的

fliers, such as patients with cerebral palsy, who are in and out of the ICU often with infections.

飛人，如腦癱患者，他們經常因感染而進出ICU。

This is for the pediatricians who are the masters of physiology, remembering everything

這是為兒科醫生準備的，他們是生理學的大師，記住了一切

from medical school and applying it the ventilator in front of them. They want to do the fun

從醫學院畢業後，把它應用在他們面前的呼吸機上。他們想做的是有趣的

stuff of treating the physiologic abnormality and then transferring to the next level of

治療生理異常的東西，然後轉移到下一個層次的

care, without getting into the nitty gritty of diagnosis and follow-up.

護理，但不涉及診斷和隨訪的細枝末節。

Cardiology is the most competitive pediatric specialty, and many do additional fellowships

心臟科是競爭最激烈的兒科專業，許多人做額外的研究金。

after to further subspecialize within cardiology, like electrophysiology.

後在心臟病學內進一步細分，如電生理學。

You'll deal with lots of congenital abnormalities, like the tetralogy of fallot. In managing

你會處理很多先天性畸形，如謬誤四聯症。在管理

these congenital conditions, you'll work closely with cardiothoracic surgeons to determine

對於這些先天性疾病，你將與心胸外科醫生緊密合作，以確定

optimal timing of repairs. Sometimes, it's a staged repair, requiring one surgery at

修復的最佳時機。有時，它是一個階段性的修復，需要一個手術在

6 months, another at 1 year, and so on.

6個月，另一個在1年，以此類推。

Stereotypically, these are the pediatricians with a bit of a god complex who love managing

通常情況下，這些兒科醫生都有一點上帝情結，他們喜歡管理。

complex physiology and nerding out about physics.

複雜的生理學和對物理學的痴迷。

Gastroenterology is a highly procedural subspecialty, splitting time between inpatient, clinic,

胃腸病學是一個高度程序化的亞專業，在住院病人和診所之間分配時間。

and the procedure suite for endoscopies and liver biopsies. They primarily deal with chronic

以及用於內窺鏡檢查和肝臟活檢的手術室。他們主要處理慢性

diseases, like inflammatory bowel disease, thus promoting longitudinal relationships.

疾病，如炎症性腸病，從而促進縱向的關係。

But there's much more to it than that, such as getting into the mind-body connection,

但它的意義遠不止於此，比如說進入心身的聯繫。

as there's a large overlap with psychosomatic disorders in children, such as anxious kids

因為它與兒童的心身疾病有很大的重疊，如焦慮的孩子。

with abdominal pain. Nutrition is an increasingly important focus as we are in a child obesity

腹痛。營養是一個越來越重要的焦點，因為我們正處於兒童肥胖症期

epidemic.

疫情。

Stereotypically, these are the down to earth pediatricians who enjoy joking about poop

從陳規定型來看，這些人是腳踏實地的兒科醫生，喜歡拿大便開玩笑。

with kids and enjoy working with their hands, and maybe don't need to be as deeply intellectual

和孩子們在一起，喜歡用他們的雙手工作，也許不需要那麼深的知識。

as some of the other subspecialties, although there is a growing need for research-minded

與其他一些亞專業一樣，儘管對有研究意識的人的需求越來越大

gastroenterologists with the exploding knowledge of the microbiome and intestinal immunology.

胃腸病學家對微生物組和腸道免疫學的知識爆炸式增長。

Pediatric emergency medicine can be approached in one of two ways - as a three year fellowship

兒科急診醫學可以通過兩種方式之一進行--作為三年的研究項目

after pediatrics residency, or a two year fellowship after adult emergency medicine

在兒科住院醫師之後，或在成人急診醫學之後，獲得兩年的獎學金。

residency. There's no outpatient time, no following up on labs, and once you get your

住院期間。沒有門診時間，沒有後續的實驗室，而且一旦你得到你的

shift done, you don't take any work home with you. Your job is to stabilize kids and get

轉移完成後，你不會把任何工作帶回家。你的工作是穩定孩子們的情緒，並讓他們

them to the appropriate level of care. Compared to adult emergency medicine, there's less

他們被送到適當的護理級別。與成人急診醫學相比，有較少的

acuity, but when it does escalate, it escalates quickly. If you want to know more about the

敏銳度，但當它確實升級時，它就會迅速升級。如果你想知道更多關於

field of emergency medicine, we did a So You Want to Be episode on that.

在急診醫學領域，我們做了一集《你想成為這樣的人》。

Pediatrics is a great specialty with lots to love.

兒科是一個偉大的專業，有很多值得喜愛的地方。

First, and most obviously, you're working with kids and you get to joke around with

首先，最明顯的是，你在和孩子們一起工作，你可以和他們一起開玩笑。

them and be silly every day at work. It's unique in that you can make an impact

他們，每天在工作中都很傻。它的獨特之處在於，你可以產生影響

early in someone's life that can compound to yield tremendous changes over a long period.

在一個人的生命早期，可以在很長一段時間內複合產生巨大的變化。

It's a beautiful part of the field that's unique to working with a pediatric population.

這是這個領域的一個美麗的部分，是與兒科人群一起工作的獨特之處。

This is the most powerful form of preventative medicine for the simple fact you're intervening

這是最有力的預防醫學形式，因為你正在進行干預。

early in their life.

在他們的生命早期。

There are subspecialties of pediatrics that don't have great outcomes, like pediatric

兒科的一些亞專業並沒有很好的結果，如兒科

oncology, but for the most part, the majority of your patients will get better. There's

腫瘤學，但在大多數情況下，你的大多數病人會得到改善。有

less death compared to adult populations, and rosier outcomes are always a good thing.

與成年人口相比，死亡人數更少，而更樂觀的結果總是一件好事。

There's a high amount of flexibility within the field, meaning it's family friendly. After

該領域內有很高的靈活性，這意味著它對家庭友好。之後

all, these are the doctors that prioritize children. Even in residency, your program

所有，這些都是優先考慮兒童的醫生。即使在實習期，你的項目

will be more understanding of maternity or paternity leave than something surgical.

將更多地理解產假或陪產假，而不是一些外科手術。

While pediatrics is a great specialty, it's not for everyone.

雖然兒科是一個偉大的專業，但它並不適合所有人。

Compensation for pediatrics is at the bottom of the list, averaging $232,000 per year.

兒科的報酬在榜單中排名墊底，平均每年232,000美元。

Part of this is the payer mix, as many children are on medicaid, which has lower reimbursement

部分原因是支付方的組合，因為許多兒童參加醫療補助，而醫療補助的報帳額度較低。

than commercial insurance. In the fee for service model of U.S. healthcare, you'll generally

而不是商業保險。在美國醫療保健的收費模式中，你一般會

have fewer interventions than adults, which is another reason why adult specialties often

與成人相比，干預措施較少，這也是為什麼成人專科常常

make more.

做出更多。

If you love high acuity and the adrenaline rush, pediatrics has less acuity than most

如果你喜歡高敏度和腎上腺素的刺激，兒科的敏度比大多數人要低。

other specialties, since kids are usually healthy and resilient.

其他專業，因為孩子們通常是健康和有彈性的。

As with other primary care focused specialties, there's lots of charting and computer time,

與其他專注於初級保健的專業一樣，有大量的製圖和計算機時間。

and you may feel like you don't get enough time with your patients.

而且你可能覺得你沒有足夠的時間與你的病人相處。

Seeing child abuse and maltreatment, or seeing young children pass also never gets easier.

看到兒童受虐待和被虐待，或看到年幼的兒童過世也從未變得容易。

And finally, there's not as much research within pediatrics compared to adult medicine,

最後，與成人醫學相比，兒科內的研究沒有那麼多。

which can be frustrating since certain drugs haven't yet been tested in kids for efficacy

這可能是令人沮喪的，因為某些藥物還沒有在兒童身上進行療效測試。

and safety profiles.

和安全概況。

How can you decide if pediatrics is a good fit for you?

你如何決定兒科是否適合你？

While you should certainly love children, you shouldn't mind having essentially two

雖然你當然應該喜歡孩子，但你不應該介意基本上有兩個孩子。

patients – after all, you're dealing with not only the kids but also their parents,

病人--畢竟，你面對的不僅是孩子，還有他們的父母。

who may be more concerned or neurotic with their child's health than with their own.

他們可能對自己孩子的健康比對自己的健康更關心或更神經質。

Pediatricians also tend to think about the health of the whole child, including nutrition,

兒科醫生也傾向於考慮整個孩子的健康，包括營養。

living situation, families, and thinking broadly about what health means more so than just

思考健康的含義，而不只是考慮到生活狀況、家庭，以及廣泛地考慮到健康的含義。

diagnosing and treating conditions.

診斷和治療疾病。

Many pediatricians find enjoyment with the data, puzzles, and detail required of the

許多兒科醫生髮現，他們喜歡數據、謎題和細節方面的要求。

field. They tend to be interested in public health and advocacy work, and are focused

領域。他們往往對公共衛生和宣傳工作感興趣，並專注於

on more than just the medicine aspect, but also the context in which the child grows.

不僅僅是藥品方面，還有兒童成長的環境。

In doing so, they hope to build a better system to promote children's health.

通過這樣做，他們希望建立一個更好的系統來促進兒童的健康。

And finally, the happiest pediatricians tend to be mission driven. After all, it's not

最後，最幸福的兒科醫生往往是由任務驅動的。畢竟，這並不是

a lucrative specialty, and many who go into this field do so because they love kids and

一個有利可圖的專業，許多人進入這個領域是因為他們喜歡孩子和

want to take care of them at the end of the day.

想在一天結束時照顧好他們。

Special thanks to Dr. Erin Elbel Mauney, current Insider at Med School Insiders, for helping

特別感謝Erin Elbel Mauney博士，現任醫學院內幕的內幕人士，為其提供幫助。

me in the creation of this video. Are you hoping to become a pediatrician? To

我在這個視頻的創作中。你希望成為一名兒科醫生嗎？要

get into medical school and match into a desirable pediatrics residency, you'll need to not

進入醫學院並匹配到理想的兒科住院醫生，你需要的不是

only crush your MCAT and USMLE, but also shine on your personal statement, secondaries, interviews,

不僅要粉碎你的MCAT和USMLE，還要在你的個人陳述、課外活動、面試中大放異彩。

and other soft components of your application. At Med School Insiders, our pediatricians