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老军医: 考版俱乐部的新同学要多说话 (讨论)
作者:USMedEdu
发表时间:2010-11-20
更新时间:2010-11-20
浏览:961次
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http://www.mitbbs.com/clubarticle_t/Pre_Resident_Club/20837.html



发信人: hemocell (老军医PGYN+4), 信区: Pre_Resident_Club
标 题: 新同学要多说话
发信站: BBS 未名空间站 (Fri Oct 22 12:51:16 2010, 美东)



买买提已经有个住院医俱乐部,老刀建这个考版俱乐部的目的是给还没进住院的同学们提供一个清净的讨论环境。我们好几个老ID都因为麦地杂草丛生先后跟麦地说再见了,只有老刀还在坚持不懈。现在有老刀这杆旗在这竖着,麦地以前的毕业生应该都会经常进来看看。

进住院以后大家都很忙,也不一定关心新同学关注的话题,所以你们要主动发言,活跃讨论,才会有老ID们才思喷涌的精华帖。

根据我个人这两年的观察,来我们这面试的CMG,最后排得比较高的,都是特能说会道的,不爱说话的同学吃亏很大,基本上老美就认为你语言不行。我觉得我当年在这面试的时候有点胡侃,没想到歪打正着,呵呵。

这一段讨论的主要话题大概是面试,等我周末有空了再来胡侃一段。
--

You are not deep
You are not an intellectual
You are not a critic
You just have Internet access.

※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 96.44.]


发信人: aemon (麦地小核桃), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Oct 22 12:54:40 2010, 美东)

请教前辈如何训练自己从不爱说话到爱说话?

做实验与一个印度同学合作,感觉他特别爱说话,而且是“印度风格”的。跟我老
板说话,是左一个Dr. XXX,右一个Dr.XXX。我在一旁听着深觉不如啊。

--

※ 修改:•aemon 于 Oct 22 12:56:58 2010 修改本文•[FROM: 129.7.]
※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 129.7.]



发信人: USMedEdu (US_CMGs), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Oct 22 13:01:33 2010, 美东)

totally totally agree!

It's true, I wrote many articles on many issues of how to go this track
just
because I saw so many wrong info, wrong discussion which disclosed on the
forum. If you don't talk and disclose those, I even have no idea, or
motivation or inspiration to write those stuff!


So, as Jimmy said, talk, talk and talk, don't be afraid or scared if you
talked or thought wrong and would be laughed by others! Here, I, or we,
guarantee and assure you to have a very ideal, clean and suggestive
environment for discussion, argue and communication.

No communication, no such good skill, you won't be a successful applicant
for resident, no way to be a good doctor!!!


Jimmy, acne, againstwind, KD, etc, many of them are very experienced and
heart-warmed resident/fellow, and willing to help you here when they have
time.

wish you enjoy and SHARING here!


dok
--

※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 142.200.]



发信人: daisyy (Daisy), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Oct 22 13:19:47 2010, 美东)

恩。同意。 老美会认为不爱说话的人不自信。

我以前也是不爱说,工作了以后老板提feedback就说你在会议上怎么很少
发言啊,是语言还是性格问题啊,faint。

我只好说因为我新来不熟悉,所以说得少了。当然也表达了一下语言也是其中一小部分,大公司很关心员工的成长,老板就让去参加 英语口语,纠正口音,英文写作之类的培训。惭愧,培训完了还是又忘了不少。

后来就注意在meeting上总要说上几句话,让人知道你的存在,还有你有在听。

个人感觉在美国工作几年后人变得'aggressive'一点了,呵呵,当然是往好的方面变。 工作是最锻炼人的地方啊,读书的时候没法比。


--

※ 修改:•daisyy 于 Oct 22 13:51:45 2010 修改本文•[FROM: 69.134.]
※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 69.134.]


发信人: triathlon (三湘四水春暖花开), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Oct 22 13:26:07 2010, 美东)

I am deeply grateful for your willingness to help, all of you. Your help
is
much needed to me and all of us.
I have been a very shy person all my life. Right now I am preparing step1
full-time at home, not talking all day. With the exam date schadulled early
next month, I am more busy than ever. This makes my habit of not talking
worse. This post is really inspiring! I think no matter how busy I am, I
should have the habit of being open, sharing, communicating. I will be more
active here after step1.
Go back to NBME7 now. I am in the middle of it. :-)


--

※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 75.85.]



发信人: usmle123456 (Judy), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Oct 22 14:23:27 2010, 美东)

这个话题很好,特别是对于即将进入美国医疗系统的人,所以这里想请教下各位前辈,到底应该如何把握这个说多说少的“度”,我记得以前有人发帖说过在observer的时候,查房的时候不能先于住院医生发言,一般只在attending点名发问的时候才回答,否则别人会认为你"show-off"或者“aggressive”,不利于维持和住院医生之间的关系。

所以到底应该怎样处理才不会让人觉得你的语言或者性格有问题,同时又能让别人觉得你的personality很好?
--

※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 143.111.]



发信人: kaye ([email protected][email protected]~埋底海豚~热爱游泳), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Oct 22 15:45:57 2010, 美东)

买个小录音机,录一下自己读英文的或者说英文,然后回放听一下,和native
speakers的发音比较。你会发现很多提高的地方。前提是你对发音都很了解了。如果发音本身就有缺陷,就上个esl的发音课,会有非常大的帮助。

不想买小录音机的话,在计算机上下载个audacity,免费的。

要多说话,也得有多说话的来源。工作上的,就不多说了。兴趣上的,体育和npr,一样别落吧。



※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 128.111.]



发信人: USMedEdu (US_CMGs), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Oct 22 15:56:10 2010, 美东)

totally true.

when you go IV, IVers not only ask you your research or family, they may ask many out-of-med-pro questions, especially if you go Psych IV!!!

You need store many info on culture, history, daily news, sports, fashion,movies, TV series, best seller books, etc......


dok




※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 142.200.]



发信人: daisyy (Daisy), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Oct 22 16:28:06 2010, 美东)

If you don't have much chance to talk in English with others, you may
consider reading an article everyday.

You need to read it out loud. I know several people with good spoken
English practice this way. Turn on the TV, follow and repeat the
conversations on TV when you're making dinner.

Record what you say, listen, and practice again.

The key is to practice, practice, practice.

--

※ 修改:•daisyy 于 Oct 22 16:31:47 2010 修改本文•[FROM: 69.134.]
※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 69.134.]



发信人: bufushu (bufu), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Oct 22 16:41:18 2010, 美东)

I have a feeling that the criterion of good English is different from
Chinese and American. American believe you are good at English if you can make them understood, they care less on magnificent vocabulary or
complicated grammar. They can tolerate the accent, but they feel annoy if you can not express things clearly.

I think the bad part of this is that no one corrected my accent, my
grammar
during conversation, so no much progress in English for years.

Another thing, some one in the medical career often corrects others
English, and often express something regular people can not understand
without checking dictionary, I wonder is that a good English or a good
English vocabulary? I don't like that style, however, if you guys believe it is good, I may begin recite some new English words from now.

--

※ 修改:•bufushu 于 Oct 22 16:44:13 2010 修改本文•[FROM: 192.55.]
※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 192.55.]



发信人: aemon (麦地小核桃), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Oct 22 17:05:20 2010, 美东)

Agree. Language reflects thoughts. If I don't have a clear idea, I
cannot say it very clearly. If I think slowly, I speak slowly too. The key point is, maybe I should train myself to think fast, speak clearly and accurately. Next to this, is the accent.

Content and manner of the language is the most important thing, and I
believe is also the weakest point of us. Question is how to overcome
this?



发信人: bufushu (bufu), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Oct 22 17:09:33 2010, 美东)

Indian English has accent in every word, however, people enjoy it.

One American postdoc told me, Chinese people often only spoke half sentence
, so she could not understand. To my understanding, Chinese is a simple
language, we don't care about time, place, gender, etc, we don't change
verbs in any circumstance.
--

※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 192.55.]



发信人: shine11 (shine), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Oct 22 19:36:48 2010, 美东)

I think it's more about the contents of the conversations most of the time.
Essentially we need to have more exposures to the western culture.

I found reading 1-2 articles/day from NYTimes Health section is very helpful
to me.

http://www.nytimes.com/pages/health/index.html.

--

※ 修改:•shine11 于 Oct 22 19:38:20 2010 修改本文•[FROM: 143.111.]
※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 143.111.]


发信人: meigui0714 (rose), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Oct 22 19:51:25 2010, 美东)

Thank everyone for the good advices.

I know there are ways to learn English---such as watch movie and TV, listen
to radio program and so on. My situation is like this. Because I graduated
from Medical School too long time ago, I have to spend much more time to
study the USMLE books than those young folks. I haven't watched TV for many
years. No mention to attend social activities or read fashion magazine.

These years, my focus is (1) to work to keep the job for Green Card and
to
bring the bread on my table. (2)study USMLE. It is a very simple life. I
do
know. But, I don't have any regret today.

I have dedicated too much for USMLE. That is also the reason I don't want
to
quit now.

I do listen to the radio program as much as I can. But, it only help
listening.

It is a good idea to read loud or just speak to the mirror. I would like
to
try.

Thanks again, good night.
--

※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 128.23.]



发信人: knockingdown (KD), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Oct 22 20:20:53 2010, 美东)

就是就是,都潜水,哪里来的水. 说话有时难免偏颇,这样会引发讨论,也是一个互相学习的过程。
--

※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 96.242.]


发信人: dojo (麦地里的豆角), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Oct 22 20:48:21 2010, 美东)

说到学英语,我现在最大的问题是只能听得懂白人的标准英语,黑人说的基本上听不懂,医院里的黑人护士很亲切的跟我打了招呼以后说的我基本上只能傻笑。又不好意思逐字逐句去问人家。以后看黑人病人真是个大问题。这方面有什么可以提高的途径?电视里的毕竟都是标准白人英语啊。
--

※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 128.231.]


发信人: scrub2008 (jobsmac), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Oct 22 21:16:25 2010, 美东)

没那么严重,关键多和他们接触,我们这里一般的患者50%是黑人,护士大约60%,多聊聊就没问题了。
--

※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 68.47.]


发信人: lingzMainz (lingzMainz), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Oct 22 21:59:45 2010, 美东)

我的问题是如果一对一的跟人谈话还可以,可是人一多我就不敢发言了。这种性格怎么改啊?我觉得不光是英语的问题,还有个性和家庭教育养成的习惯问题。
--

※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 72.78.]


发信人: sillybird (sillybird), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Sat Oct 23 01:09:03 2010, 美东)

郁闷,我也是这样性格的,人少的时候我很talktive的,可人一多我基本上就不说话了,跟美国人中国人在一起时都是这样的。我也不知道该怎么样提高。


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※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 99.85.]


发信人: kaye ([email protected][email protected]~埋底海豚~热爱游泳), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Sat Oct 23 01:46:39 2010, 美东)

my suggestion is to accept what you are for now - and then try to figure
out
your comfort zone, try to figure out how to create your own comfort zone,
then you may be able to overcome this problem.


--

※ 来源:•BBS 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 128.111.]



发信人: kaye ([email protected][email protected]~埋底海豚~热爱游泳), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Sat Oct 23 12:18:26 2010, 美东)

I also found that sometimes some people are just bitches anyway - for those
people, don't try too hard to make communication with them, it only makes
you feel too bad and less confident; they will try to connect with you when
you draw enough attention to yourself by building up good communication
with
nice people. Based on my observation, 1/10 (10%) people are always kind
of
snobbish, they only like talking to people who are kind of having some "
power" and they like drawing attention to themselves - I found I was
discouraged by these type of people before and later figured it out. So
even
though we should try hard to build connections, but when with these type
of
people, don't try hard.

In a word, just be yourself, listen well, and speak slow, be humorous, and
then of course, pay attention to something that are interested, such as
news
, sports and culture etc.

Having a certain amount of proper humor, in both understanding others and
expressing yourself, is very important in building up good communication
in
this culture.

P.S. I strongly encourage people to forward their posts to the MedicalCareer
Board to help those who cannot visit here. Thanks!


发信人: cyrup (fico), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Sat Oct 23 12:53:37 2010, 美东)

If you have kids at school or daycare center, try hard to talk to their
parents. That is the way you can learn real oral English and pronounciation.
--

※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 71.10.]


发信人: wwyjedi (乔布斯老爷子), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Sat Oct 23 13:21:17 2010, 美东)

我也这样。我觉得可能跟话题也有关系。人少的时候能很快找着自己有话说的话题,人多的时候就困难很多。我LD是个随便扔到哪个人堆里都能说上三个小时不带停的人。据我观察他就属于能不断创造话题的那种。


--

※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 68.40.]

发信人: bufushu (bufu), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Sat Oct 23 13:28:13 2010, 美东)

改性格很难的,自己难受,别人看着也不舒服,保持自我,稍加改进最好,话不多,但是句句在理也行。我想面试的目的是预防jerk,不是挑选演讲家。住院医, 就是多干活少惹事的。
--

※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 192.55.]


发信人: hemocell (老军医PGYN+4), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Sat Oct 23 16:32:06 2010, 美东)

改性格很难,我完全同意。

但是有些性格、习惯,你如果已经注意到了对自己的人生、事业有影响,我个人觉得,改一改还是有必要的。记得卡耐基有一本书里面提到,你如果有意识地去锻炼做一些事情,每天有意识做一点点,几个月以后,你自己会看到你的变化。
上面有人说到创造话题,这个是完全可以锻炼出来的。你每天坚持创造两个话题,三个月以后再看看效果如何?

另外,不能总强调忙就没时间了解别的。世界很大,生活不仅仅是USMLE,虽然我们跟老美有些文化差距,每天看看电视、读读报纸、听听NPR、找几本畅销小说睡前消遣一下,话题自然就来了。

在实验室上班,一天下来你有可能一句话都不用说(我有个朋友来了半年还听不懂老板说啥,跟老板通过写字交流,也做出了不错的文章),但是,你如果有意识锻炼自己,每天找个话题花上十分钟跟老美聊聊是完全可以做到的,每天换个人聊,换个话题聊,一年时间下来,这也学不少东西吧。


【 在 bufushu (bufu) 的大作中提到: 】
: 改性格很难的,自己难受,别人看着也不舒服,保持自我,稍加改进最好,话不
多,但
: 是句句在理也行。我想面试的目的是预防jerk,不是挑选演讲家。住院医, 就是
多干
: 活少惹事的。



--

老军医糊墙,不信也罢。


※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 74.178.]



发信人: USMedEdu (US_CMGs), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Sun Oct 24 11:16:03 2010, 美东)

不错,至少老卡的两本书“人性的弱点”、“如何加强交流技巧”都有中文译本而且极火--俺兄弟买了送俺而且一再强调要俺反复读--他在花尔街金融业讨饭,对老卡那些都是五体投地的推崇。

老卡的系列从1930到今天,一直是美国甚至其他国家热销的人生指南参考书之榜首。


光潜水想藏拙,起结果是在面试时必然露拙!

多说话提问,暴露问题,才能得到有经验得老ID过来人帮助和指导!
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※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 24.78.]

发信人: vvdoc (vvdoc), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Thu Oct 28 04:29:40 2010, 美东)

有时候潜水就是藏拙。老刀是一语中砥。 sign。 以前觉得会说话的人都是天生的,感谢这个帖子,看来任何事都要学习。从今天起,修正以前认为只要踏踏实实把事情做好,考试考好,不会说话就不说的心态。 英文以前是能用email就不用电话。现在一定要逼自己多说多练。

【 在 USMedEdu (US_CMGs) 的大作中提到: 】
: 光潜水想藏拙,起结果是在面试时必然露拙!
: 多说话提问,暴露问题,才能得到有经验得老ID过来人帮助和指导!



--

※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 174.26.]


发信人: medIT (麦地IT), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Thu Oct 28 12:37:57 2010, 美东)

提醒一下:内向、话少、埋头苦干在一定程度上的的意味着communication会多多少少有问题,尤其在和boss及colleague的交流上。在住院医的面试及工作中我没资格评价,但职场中你和能说会道的已经不在一条起跑线上了。所以,尽管话少,但也要做到时不时常地和老板交流,不要想当然觉得自己的埋头苦干老板会看得见。

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※ 修改:•medIT 于 Oct 28 12:38:25 2010 修改本文•[FROM: 198.140.]
※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 198.140.]


发信人: YHZ (fielding), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Nov 19 15:08:32 2010, 美东)

Dear Dok

I am going to ask you a question in my recent interview:

the assistant program director asked a question: a STEMI patient, how do
you
treat him?

I answered: aspirin, nitroglycerin, and metoprolol, heparin, tPA (when
there is no catheter lab) or catherization.
But the director said: no heparin, that's why you can learn from your
mistake.

Then I was confused, and I did not want to argue with him on that occasion,
and I kept a little confused. finally he asked me: any question? after that,
the interview was done. The director is an ambulatory doctor and I don't
think he would take care of patients with STEMI now. Obviously heparin is
being used in ACS patients evryday.

You know in this program, the director just asked me the medical question:
1
. diagnosis of Diabetes,2 jaundice's DDx, 3 STEMI's treatment.
I think they would evaluate me by my answers to their question. I intended
to write a letter to them to talk about the issue. How do you think about
it?


【 在 USMedEdu (US_CMGs) 的大作中提到: 】
: 不错,至少老卡的两本书“人性的弱点”、“如何加强交流技巧”都有中文译本
而且
: 极火--俺兄弟买了送俺而且一再强调要俺反复读--他在花尔街金融业讨饭,对老

: 那些都是五体投地的推崇。
: 老卡的系列从1930到今天,一直是美国甚至其他国家热销的人生指南参考书之榜
首。



--

※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 99.189.]


发信人: chipmunk (花栗鼠), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Nov 19 15:37:28 2010, 美东)

If STEMI is dx, the pt is an candidate and the consent is made, we need
to
cath him/her asap. Heparin drip is used for the pt with suspicious MI +
chest pain but can't undergo cath for various reasons. Think it this way,
heparin or warfarin should be held before the surgery otherwise the pt is
in
risk of bleeding.

【 在 YHZ (fielding) 的大作中提到: 】
: Dear Dok
: I am going to ask you a question in my recent interview:
: the assistant program director asked a question: a STEMI patient, how
do
you
: treat him?

发信人: YHZ (fielding), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Nov 19 16:16:55 2010, 美东)

Hi, Chipmunk,
am I wrong? but obviously I checked the textbooks heparin is being used
in
treating NSTEMI or all CHS. Even if in the transit to Catheter lab, a dose
of heparin is used. Also used with tPA. Yes, the ideal treatment is cath
the
patient.
But my answer--heparin is used in STEMI is not wrong at all. please advise
me. I know that heparin can lead to bleeding but in the textbook--the
antithrombin(heparin) can be used in conjunction with PCI. The role of which
remians fully understaood, but it seems to be safe and effective. Please
advise me. and thank you very much!


【 在 chipmunk (花栗鼠) 的大作中提到: 】
: If STEMI is dx, the pt is an candidate and the consent is made, we need
to

发信人: springstep (春天的脚步........), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Nov 19 18:18:32 2010, 美东)

替老刀回答一下这个问题.

没有任何面试的经验,但从纯学科的角度,可以这样对付PD:

Eye-Contact,冷静地告诉PD如下:

For STEMI patient, time is myocytes, time is cardiac function, time is life.

The most critical problem is re-opening the IRA (Infarct Related Artery).

So, if it is available, without any hesitation, my first choice is emergent
PCI. Most probablely (98.5%), we can catch the "culprit lesion"(尽量用这

术语:culprit lesion,行话!) by 1 catherter and 1 stent. If so, we win and
save the myocytes and the life.

If emergent PCI is unavailabe, I must use t-PA or SK immediately.By this
way, we
still can get about 55-70% IRA patent rate.

Later on, we maybe need to perform a thorough coronary flow re-construction
by CABG or PCI accroding to the CAG and other related test results.
Meanwhile, we should make a reasonable preventive strategy for the patient.

Before the patient leave the hospital, I will give him a brief
health education, telling him some health knowledge such as "Simple Life's
7"
etc.

........

我语言可能没有组织好,但"时间就是心肌","时间就是生命","梗死相关血管的开通
","
Simple Life's 7"等都是行话和热门话.明智的PD,听你说的前面几句话,就那个啦!

当然,nitroglycerin啊,什么PCI前Aspirin,或者氯比格雷嚼碎啊,这些太小儿科的问

也准备一下,PD问,你就答.

PD问你问题的实质,就是:不惜一切代价,在最短的时间内开通IRA.


你把语言再组织好点,下次遇上这种问题,争取"秒杀"PD______至少,从学科的角度......



【 在 YHZ (fielding) 的大作中提到: 】
: Dear Dok
: I am going to ask you a question in my recent interview:
: the assistant program director asked a question: a STEMI patient, how
do
you
: treat him?
: I answered: aspirin, nitroglycerin, and metoprolol, heparin, tPA (when
: there is no catheter lab) or catherization.
: But the director said: no heparin, that's why you can learn from your
: mistake.
: Then I was confused, and I did not want to argue with him on that occasion
,
: and I kept a little confused. finally he asked me: any question? after
that,
: ...................






--
你踏着冰雪,
你踏着冰雪走来......

※ 修改:•springstep 于 Nov 19 19:33:32 2010 修改本文•[FROM: 152.11.]
※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 152.11.]

chipmunk
进入未名形象秀
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发信人: chipmunk (花栗鼠), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Nov 19 18:51:38 2010, 美东)

Hmm, this is a great question! Thank you for helping us to think this more
thoroughly. Here is what I got from UpToDate:

Anticoagulant therapy ─ Patients undergoing primary PCI typically receive intravenous unfractionated heparin (UFH) during the procedure to prevent acute vessel closure due to thrombosis. Heparin monitoring is usually performed via serial monitoring of the activated clotting time (ACT).

Careful monitoring of the ACT is important because some patients have
persistent thrombin activity despite heparin therapy.




发信人: chipmunk (花栗鼠), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Nov 19 19:05:24 2010, 美东)

springstep, u r awesome!

For both UA/USTEMI and STEMI:
1) Revascularization - time is life, time is of the essence.
2) Anti-platelet w/ asa, plavix, glycoprotein IIb/IIIa antagonist; anti-
coagulation w/ LMWH, UFH;
3) Anti-ischemic: O2, pain medication, NTG, BB, Ca++ blocker, ACEI.



--

※ 来源:•WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn•[FROM: 74.74.]


发信人: YHZ (fielding), 信区: Pre_Resident_Club
标 题: Re: 新同学要多说话
发信站: BBS 未名空间站 (Fri Nov 19 19:38:21 2010, 美东)

thank you,springstep and chipmunk, for your wonderful answer. I think your
answer is perfect medical one. There are lots of answers to non-medical
questions, but few medical answers. Generally the model of answers to the
medical questions should be similar, but we need to prepare lots of common
diseases.
However, you did not answer my question: if the director made a mistake

which may affect the final evaluation of my performance, I think I should
make it clear to him, because , on the one hand, the evaluation should be
fair, on the other hand, if he teaches other residents in this way, it will
hurt patients if the patient indeed needs heparin and he don't use it.
hw do you think about it?
--

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