This article is converted by 简悦 SimpRead, original at mp.weixin.qq.com
Hunan, Guangxi, Shanghai — there have been three cases related to standardized training (规培) reported within a month recently.
I am reluctant to call the protagonists of these stories martyrs. Martyrdom is clearly a positive term, carrying connotations of impulsive self-destruction. Regarding the recent related events, I do not want to hear similar news anymore, nor see vibrant lives vanish under oppression, along with their own meanings disappearing as well. As long as one is alive, there is hope.
Where does the oppression come from? Improper mentorship from individuals is only a direct cause; the root cause lies in the ecological environment within the system.
Many people study medicine not out of genuine interest but because their families believe the medical profession is “stable,” so they follow their family’s advice to pursue medicine. This is a very reasonable phenomenon—not ideal, but very realistic and reasonable.
In several previous essays, I have mentioned that I hope junior schoolmates “have a plan for the future” and “find what they want to do and what kind of person they want to be,” regardless of whether their ideals relate to medicine. However, “having ideals” itself is an ideal state. Most people find it hard to clearly define their goals early on and take them as their “original intention,” continuously advancing with this original intention as support.
Without the support and anchoring of an “original intention,” some people may lose sight of their behavioral goals under pressure, mistakenly treating unimportant matters as necessary, and hesitate to fight for rights and interests that should belong to them.
Public hospitals belong to the system, and this ecological environment is characterized by a clear hierarchy, where superiors have significant decision-making power over subordinates. This is the “price of stability.” This is also quite reasonable; from an individual choice perspective, there are gains and losses — choosing stability naturally entails losing some freedom.
In this ecological environment, pressure naturally transmits downward layer by layer. This is the so-called “White Tower.” Departments have turnover requirements, so attending physicians in charge must admit and discharge many patients; residents under them must manage many patients; and standardized trainees must work hard, handling numerous trivial tasks, becoming the backbone of daily hospital operations.
Improper mentorship is certainly detestable, but the pressure on trainees does not appear out of thin air at the mentorship level; it originates from the structural ecological environment inside the system and is transferred layer by layer from top to bottom.
That said, these are still realistic and reasonable.
The economic base determines the superstructure — large public hospitals are established to solve the basic healthcare needs of the general population. The iron triangle of healthcare — efficiency, low cost, and good service — in China’s public hospitals adapts to the specific situation by choosing efficiency and low cost, which means doctors are very busy.
From a pure input-output perspective, medical acts are a typical behavior that requires cost control, because medical acts themselves do not directly generate economic benefits. Plus, wanting low costs means there will be virtually no economic benefits. No matter how much investment goes into it, it’s like water poured into a sand pit. This further increases pressure on hospitals and doctors, requiring more work to “earn more.”
Normally, more positions and hiring more people to work would be the solution, but that would increase costs. From the perspective of those in power in the ecological environment, it is better if the workforce is cheap labor, which can further control costs: you work hard, I take the money — how wonderful.
The classic question “Are standardized trainees doctors or students?” arises here. I need you to work more, so when working you are a doctor; I want you to earn less, so when paid you are a student.
These are phenomena naturally arising within this ecological structure. If the ecological structure does not change, these things cannot truly change.
In summary, many factors together build the tall, sturdy White Tower, which bears the heaviest weight at its bottom layer. This is the current state of large public hospitals, and I currently see no possibility for fundamental change.
Japanese drama “Shiroi Kyotō” (White Tower), a classic medical drama
The above is the external environment; now let’s turn the perspective to “individual choices of professional master’s standardized training medical students.”
Everyone knows standardized training is tough, so why do most postgraduates who take entrance exams choose professional master’s degrees that require standardized training instead of academic master’s degrees? It is because of a standardized training certificate.
Having this certificate grants the opportunity to enter hospitals as residents, tightly controlling all medical students who want to get a “secure job” in public hospitals.
Countless medical students need this certificate, and there is no competitor with similar effect; nothing else has the same authority as the certificate. Isn’t this a kind of monopoly?
Being monopolized means being controlled.
All choices have costs; you could say these “three years of being controlled” are one of the costs for gaining the “secure job.” To say it more plainly, memes like “996 is a blessing” and “if you don’t do it, others will” are very appropriate here.
Of course, improper mentorship is always a minority. Most standardized trainees are not in particularly severe situations. But for me, if I were in an environment where “my quality of life depends more on others’ moral bottom line than on my own ability,” I would find it very uncomfortable and try to do something.
Facing the reality of standardized training, what should medical students do? This is a more instructive and worthy question.
Although I am still at the undergraduate stage, I always collect information. During hospital internships, observing the work content of trainees: admitting patients, writing medical records, issuing orders, discharging patients, doing miscellaneous labor, nothing hard to understand. So the information I have collected should not be wildly off.
From the information collected and my own thoughts, roughly three types of situations can be identified, corresponding to three kinds of advice:
- Healthy mindset for daily work
Zhihu article—click and long press the image to scan to read
- Sample breakup operations in extreme cases
Recommended to read and study repeatedly, sort out action steps and key points
This one is really worth reading, with fully replicable handling methods. First protect yourself, learn to preserve evidence, then break off relations with appropriate methods and targets while maintaining good relations with others to avoid unnecessary enemies. Finally, confront leadership with courage for a fight to the death, and be able to hold their vulnerabilities. Very reasonable and elegant.
Generally, large hospitals have many things to consider, so pay attention regularly.
- Preventive measures before the problem occurs
- A gentleman does not stand by a dangerous wall — avoid pitfalls in time and seek other wise leaders
- Cut off root causes, be strong through desirelessness, break free from the system
This is my current thought too. If I can establish a foothold outside the system, I won’t be restricted by standardized training. This presupposes my clinical ability. Only with ability can one have the right to choose.
Standardized Training Journal 6 (Conclusion) XX Department
This is actually where our traditional Chinese medicine (TCM) major is superior to clinical majors — we don’t only have this one route to enter hospitals. Outside the system lies a vast world; as long as you are willing to learn and work hard, you can also achieve great things.
If enduring the pressure of standardized training and studying medicine becomes unbearable, switching careers is also reasonable. Refer to some people’s extreme expressions:
This article does not intend to discourage or defame any subject. It is just a reflection prompted by recent events. The author tentatively speaks, and all readers may listen tentatively. If you can recall a phrase from this article in your future work and life, it will be an honor.
Wishing everyone peace, happiness, and hope.