规培医学生到底有多苦？
这两天，华西医院23岁医学生事件令人痛心也发人深省，「医学生」这个群体及所谓的「规培」制度再次引发人们关注。
据百度百科，「规培」一般指住院医师规范化培训，医学生毕业后要在医院相关科室轮转学习，掌握必备知识技能，通过规培结业考试后方可取得规培证。直白的说，就是在医院里干最苦最累的活，却拿着与付出不成比例的“收入”。
今天我们一起来看一篇中美住院医师培训第一年期间抑郁症患病率及风险因素分析的相关研究[1]。该研究发现，与美国的情况类似，中国住院医师培训第一年抑郁比例从9.1%增加到了35.1%。
[1] Chen, L., Zhao, Z., Wang, Z. et al. Prevalence and risk factors for depression among training physicians in China and the United States. Sci Rep 12, 8170 (2022).
🤔️小作业：
无注释原文：
Prevalence and risk factors for depression among training physicians in China and the United States
From: Scientific Reports
Abstract
During their first year of medical residency (internship), 35% of training physicians in the United States suffer at least one depression episode. We assessed whether there is a similar increase of depression among first year residents in China, and identified predictors of depression in the two systems. 1006 residents across three cohorts (2016–2017, 2017–2018 and 2018–2019) at Shanghai Jiao Tong University and Peking Union Medical College were assessed in parallel with three cohorts of 7028 residents at 100 + US institutions. The Patient Health Questionnaire-9 (PHQ-9) depressive symptoms were measured at baseline and quarterly. Demographic, personal and residency factors were assessed as potential predictors of PHQ-9 depression scores.
Similar to training interns in the US, the proportion of participants in China who met depression criteria at least once during the first year of residency increased substantially, from 9.1 to 35.1%. History of depression and symptoms at baseline were common factors significantly associated with depression during residency. By contrast, neuroticism, early family environment, female gender and not being coupled were associated with depression risk only in the US, while young age was a predictor of depression only in China. Fear of workplace violence also was a predictor in China. Long duty hours and reduced sleep duration emerged as predictors of depression in both countries. The magnitude of depression increase and work-related drivers of depression were similar between China and the US, suggesting a need for effective system reforms in both systems.
Introduction
With high rates of violence committed by patients and their families against healthcare workers in China, the mental health of physicians is of particular concern. In addition, the first year of physician residency training is known as one of the most stressful periods during a medical career, characterized by high workload, new responsibilities, and inconsistent and insufficient sleep. A large meta-analysis including 54 studies across 16 other countries found that depression increases five-fold during the first year of training, with 25% to 30% of residents fulfilling the criteria for depression at any given time. In China, recent data indicate high rates of anxiety and depressive symptoms among healthcare workers during the COVID-19 pandemic, including first year residents, however the prevalence of depression and associated risk factors among training physicians in China is otherwise not known.
In 2014, China introduced a standardized residency program, providing an opportunity to systematically assess depression among residents in China. Given the ongoing COVID-19 risk world-wide and the crucial role of residents in fighting against the pandemic, it is of great importance to call for public attention on their mental health and reveal the driven factors of depression among them. As socioeconomic context and cultural norms can influence the epidemiology of depression, it is imperative to consider the commonalities and differences in drivers of depression between training physicians in the US and China to inform intervention efforts in both countries.
Discussion
This study is the first prospective large-scale assessment of depression during the first year of residency training in China. Despite cultural and structural differences, we find striking parallels in prevalence and system predictors of depression between China and the US, with about 35% of participants fulfilling criteria for depression at least once during the first year of residency in both systems.
Importantly, we identified several individual baseline factors associated with the development of depressive symptoms during residency. Consistent with previous studies, a history of major depression and of other stressful life events, as well as reduction of sleep, longer work hours and stressful events outside of residency were robust predictors of the observed increase in depression during residency in both countries. Notably, residency specialty was not associated with the development of depression in either country.
Interesting differences in the prevalence and risk factors for depression were also identified between China and the US. While the higher baseline score may be attributed to the significantly shorter transition time between medical school and the start of residency in China (two weeks) in contrast to the US (two months), the higher scores throughout the year suggest that young Chinese physicians may face additional stressors. Younger age was also a significant predictor of depression in China but not in the older US sample. This could be due to the earlier starting time of residency in China (after five years of a Bachelor in Medicine) than in the US (four years of undergraduate studies followed by four years of medical school). The difference in reporting of medical errors (20% in the US vs. 2% in China) is likely a consequence of more supervision, such that these younger first year residents in China would not feel being directly responsible for a medical error.
Our study has a number of limitations. First, since only about half of residents completed our questionnaires, it is conceivable that those who are suffering of depression symptoms during residency are more motivated to complete assessments. Second, we were only able to include residents from large hospitals in Shanghai and Beijing, who likely are not representative of training physicians across China. Finally, we focused on first-year residents in this study. Prevalence and predictors of depression may be different in more advanced training physicians.
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注：中文文本为机器翻译仅供参考，并非一一对应
含注释全文：
Prevalence and risk factors for depression among training physicians in China and the United States
From: Scientific Reports
Abstract 摘要
During their first year of medical residency (internship), 35% of training physicians in the United States suffer at least one depression episode. We assessed whether there is a similar increase of depression among first year residents in China, and identified predictors of depression in the two systems. 1006 residents across three cohorts (2016–2017, 2017–2018 and 2018–2019) at Shanghai Jiao Tong University and Peking Union Medical College were assessed in parallel with three cohorts of 7028 residents at 100 + US institutions. The Patient Health Questionnaire-9 (PHQ-9) depressive symptoms were measured at baseline and quarterly. Demographic, personal and residency factors were assessed as potential predictors of PHQ-9 depression scores.
在住院医师（实习）的第一年期间，美国35%的受训医师至少经历过一次抑郁症发作。我们评估了中国住院医师培训第一年期间是否有类似抑郁症增多的迹象，并在两个制度中确定了抑郁症的预测因素。上海交通大学和北京协和医学院的三组住院医师（2016-2017年、2017-2018年和2018-2019年，共1006名）与美国100多个机构的三组住院医师（共7028名）同时接受了评估。患者健康问卷-9（PHQ-9）抑郁症状在基线状态下及每季度都进行了度量。将人口统计学、个人和住院医师培训等因素作为PHQ-9抑郁评分的潜在预测因素进行了评估。
prevalence
prevalence /ˈprev.əl.əns/ 表示“流行，盛行；普遍，广泛”，英文解释为“the fact that something is very common or happens often”如：the prevalence of smoking among teenagers 青少年吸烟的普遍性。
residency
1）熟词僻义，表示“（艺术家、作家、音乐家为某机构工作的）驻留时间，驻留期”，英文解释为“the period of time that an artist, a writer or a musician spends working for a particular institution”
2）表示“居住；居住权”，英文解释为“Someone's residency in a particular place, especially in a country, is the fact that they live there or that they are officially allowed to live there.”举个🌰：
He applied for Canadian residency. 他申请了在加拿大的居住权。
3）表示“高级专科住院医生实习期”，英文解释为“the period of time when a doctor working in a hospital receives special advanced training”
internship
internship /ˈɪn.tɜːn.ʃɪp/ 表示“医生实习期”，英文解释为“a period of training spent in a hospital by a young doctor in order to finish their medical qualification”
physician
表示“医生；（尤指）内科医生”，英文解释为“a medical doctor, especially one who has general skill and is not a surgeon”
episode
在电视/电影节目中，episode表示“一集，一节，片断”（one of the single parts into which a story is divided, especially when it is broadcast on the television or radio），也可以指“事件；（相关的）一连串事件；一段经历”，英文解释为“a single event or group of related events”举个🌰：
This latest episode in the fraud scandal has shocked a lot of people. 诈骗丑闻最新爆出的这一事件让很多人瞠目结舌。
补充：
📍第几集用的是Episode，第几季则为Season. 你下载美剧时可能就会看到S01E02，就是指的第1季第2集。
最后一集finale：the last part of a piece of music or of a show, event etc （演出的）终场，最后一幕；（音乐的）终曲；（事件等的）结尾。
🎬还有，看剧时新一集开头通常会有的一个说法：previously on ...，...的前情提要，前情回顾。
resident
resident /ˈrez.ɪ.dənt/ 熟词僻义，表示“（美国的）高级专科住院实习医生”，英文解释为“a doctor who is still training, and who works in a hospital”
predictor
表示“（可让人预报未来的事件或事实）预报性事物；预测器；预示物；预测因子”，英文解释为“something such as an event or fact that enables you to say what will happen in the future”。
📍长期不读书会降低表达能力吗？文中出现这个词：For the older children — ages 12 to 17 — one of the largest predictors was whether they had time to read on their own during the school day. 而对于年龄较大的孩子（12岁至17岁）来说，最大的预测指标之一是，他们在校期间是否有时间自主阅读。
cohort
cohort /ˈkoʊ.hɔːrt/ 表示“有共同特点（通常指年龄）的一群人”，英文解释为“a group of people who share a characteristic, usually age”举个🌰：
This study followed up a cohort of 100 patients aged 65+ for six months after their discharge home. 这项研究对100位年龄在65岁以上、出院回家的患者进行了6个月的跟踪观察。
baseline
表示“（进行比较时用作起点的）基线”，英文解释为“an imaginary line used as a starting point for making comparisons”如：a baseline assessment 基线评估；摸底评估。
quarterly
quarterly /ˈkwɔː.təl.i/ 表示“一年四次的；每季度（进行或制作）的”，英文解释为“done or produced four times a year”如：a quarterly magazine 季刊杂志。
demographic
1）作形容词，表示“人口的；人口统计的；人口学的”，英文解释为“relating to demography (= the study of populations and the different groups that make them up)”举个🌰：
There have been monumental social and demographic changes in the country. 该国的社会和人口状况已经发生了巨大的变化。
2）作名词，表示“（顾客）族群”，英文解释为“a group of people, for example customers, who are similar in age, social class, etc.”举个🌰：
This demographic (young teenagers) is the fastest-growing age group using the site. 该族群（十几岁的年轻人）是使用这个网站人数增长最快的年龄群体。
Similar to training interns in the US, the proportion of participants in China who met depression criteria at least once during the first year of residency increased substantially, from 9.1 to 35.1%. History of depression and symptoms at baseline were common factors significantly associated with depression during residency. By contrast, neuroticism, early family environment, female gender and not being coupled were associated with depression risk only in the US, while young age was a predictor of depression only in China. Fear of workplace violence also was a predictor in China. Long duty hours and reduced sleep duration emerged as predictors of depression in both countries. The magnitude of depression increase and work-related drivers of depression were similar between China and the US, suggesting a need for effective system reforms in both systems.
与美国受训实习医师类似，在中国的参与者中，在住院医师培训第一年中至少有一次达到抑郁症标准的比例大幅增加，从9.1%增加到35.1%。抑郁症史和基线症状是住院医师培训期间与抑郁症显著相关的常见因素。相比之下，在美国，神经质、早期家庭环境、女性性别和没有配偶与抑郁症风险有关，而在中国，年轻是抑郁症的预测因素。在中国，对工作场所暴力的恐惧也是抑郁症的预测因素。在这两个国家，工作时间长和睡眠时间减少都成为抑郁症的预测因素。中国和美国的抑郁症增加幅度和与工作相关的抑郁症驱动因素相似，这表明两国都需要进行有效的制度改革。
criteria
criterion /kraɪˈtɪərɪən/的复数形式，表示“（判断的）标准，准则，原则”，复数形式为criteria，英文解释为“A criterion is a factor on which you judge or decide something.”举个🌰：
The most important criterion for entry is that applicants must design and make their own work. 参加的最重要标准就是申请人必须设计并制作自己的作品。
substantially
substantially /səbˈstæn.ʃəl.i/ 1）表示“大体上；基本上”，英文解释为“generally”举个🌰：
This model has leather seats, but the two cars are substantially the same. 这一型号有几个附加装置，但两款车大体上是一样的。
2）表示“在很大程度上”，英文解释为“to a large degree”举个🌰：
The new rules will substantially change how we do things. 新规则会在很大程度上改变我们的行事方式。
neuroticism
neuroticism /njʊəˈrɒt.ɪ.sɪ.zəm/ 表示“神经过敏，神经质”，英文解释为“the condition of often feeling worried and nervous, often because of a mental illness”举个🌰：
Researchers found that high levels of neuroticism were linked to lower life expectancy. 研究者发现高度神经过敏症与低预期寿命有相关性。
Introduction 引言
With high rates of violence committed by patients and their families against healthcare workers in China, the mental health of physicians is of particular concern. In addition, the first year of physician residency training is known as one of the most stressful periods during a medical career, characterized by high workload, new responsibilities, and inconsistent and insufficient sleep. A large meta-analysis including 54 studies across 16 other countries found that depression increases five-fold during the first year of training, with 25% to 30% of residents fulfilling the criteria for depression at any given time. In China, recent data indicate high rates of anxiety and depressive symptoms among healthcare workers during the COVID-19 pandemic, including first year residents, however the prevalence of depression and associated risk factors among training physicians in China is otherwise not known.
在中国，患者及其家属对医护人员实施暴力行为的比例很高，医生的心理健康尤其令人担忧。此外，住院医师培训的第一年被认为是医疗生涯中压力最大的时期之一，其特点是高工作量、新责任以及睡眠不足且不稳定。一项包括其他16个国家54项研究的大规模meta分析发现，在培训的第一年，抑郁症增加了五倍，25%至30%的住院医师在任何时间内都符合抑郁症标准。在中国，最近的数据表明，在新冠疫情期间，医护人员的焦虑和抑郁症状发生率较高，包括第一年培训的住院医师，但中国培训的住院医师的抑郁患病率和相关风险因素尚不清楚。
meta-analysis
A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Meta-analysis can be performed when there are multiple scientific studies addressing the same question, with each individual study reporting measurements that are expected to have some degree of error.（Wikipedia）
📍荟萃分析，又称“Meta分析”，Meta意指较晚出现的更为综合的事物，而且通常用于命名一个新的相关的并对原始学科进行评论的学问，不但包括数据结合，而且包括结果的流行病学探索和评价，以原始研究的发现取代个体作为分析实体。荟萃分析产生的主要的理由是：对于多个单独进行的研究而言，许多观察组样本过小，难以产生任何明确意见。（百度百科）
In 2014, China introduced a standardized residency program, providing an opportunity to systematically assess depression among residents in China. Given the ongoing COVID-19 risk world-wide and the crucial role of residents in fighting against the pandemic, it is of great importance to call for public attention on their mental health and reveal the driven factors of depression among them. As socioeconomic context and cultural norms can influence the epidemiology of depression, it is imperative to consider the commonalities and differences in drivers of depression between training physicians in the US and China to inform intervention efforts in both countries.
2014年，中国推出了住院医师规范化培训制度，为系统评估中国住院医师的抑郁症提供了机会。鉴于新冠病毒在全球范围内的持续风险以及住院医师在抗击疫情中的关键作用，呼吁公众关注他们的心理健康并揭示其中抑郁症的驱动因素至关重要。由于社会经济背景和文化规范会影响抑郁症的流行病学，因此必须考虑美国和中国培训住院医师在抑郁症驱动因素方面的共性和差异，以指导两国的干预工作。
norm
表示“规范；行为标准”，英文解释为“standards of behaviour that are typical of or accepted within a particular group or society”，如：social/cultural norms 社会/文化规范。
epidemiology
📍epidemiological /ˌepɪˌdiːmiəˈlɑːdʒɪkl/ 形容词，表示“流行病学”，如：epidemiological research 流行病学研究。
📍epidemiology 名词，英文解释为“the scientific study of the spread and control of diseases”。
imperative
1）作形容词，表示“至关重要的；紧急的；迫切的”，英文解释为“If it is imperative that something be done, that thing is extremely important and must be done.”，举个🌰：
It was imperative that he act as naturally as possible. 至关重要的是他要尽可能地自然行事。
2）作名词，表示“重要紧急的事；必要的事；需要”，英文解释为“a thing that is very important and needs immediate attention or action”。
commonality
commonality /ˌkɒm.ənˈæl.ə.ti/ 表示“共通性”，英文解释为“the fact of sharing interests, experiences, or other characteristics with someone or something”举个🌰：
They found a commonality in discussing their experiences. 他们在讨论各自的经验时找到了共通性。
intervention
表示“干涉，介入；（由家庭成员、朋友或医护人员共同开会劝导有酗酒或毒瘾问题者接受现实并开始治疗的）干预活动”，英文解释为“Intervention is the act of intervening in a situation. A meeting at which someone with a drug or alcohol problem is asked by family members, friends, or health workers to accept the fact that they have a problem and is encouraged to get treatment”
Discussion 讨论
This study is the first prospective large-scale assessment of depression during the first year of residency training in China. Despite cultural and structural differences, we find striking parallels in prevalence and system predictors of depression between China and the US, with about 35% of participants fulfilling criteria for depression at least once during the first year of residency in both systems.
这项研究是首次对中国住院医师培训第一年期间的抑郁症进行前瞻性大规模评估。尽管存在文化和结构差异，但我们发现中美两国抑郁症的患病率和预测指标惊人地相似，约35%的参与者在住院医师培训第一年至少有一次达到抑郁症标准。
prospective
表示“有望的；可能的；预期的；潜在的；即将发生的；行将来临的”，英文解释为“expected to do sth or to become sth；expected to happen soon”如：prospective buyers, employers, parents, etc. 潜在的客户/可能成为雇主的人/即将为人父母者等。
striking
1）表示“异乎寻常的，惊人的；引人注目的；显著的；不同寻常的”，英文解释为“Something that is striking is very noticeable or unusual.”举个🌰：
The most striking feature of those statistics is the high proportion of suicides. 那些统计数据最显著的特征是高自杀率。
2）表示“俊秀的；妩媚动人的；很有魅力的”，英文解释为“Someone who is striking is very attractive, in a noticeable way.”举个🌰：
She was a striking woman with long blonde hair. 她曾是一个留着金色长发的俊秀女子。
parallel
parallel /ˈpær.ə.lel/ 1）表示“平行的”（If two or more lines, streets, etc. are parallel, the distance between them is the same all along their length）如：a pair of parallel lines 两条平行线；
2）表示“同时发生的；相同的，类似的”，英文解释为“used to describe an event or situation that happens at the same time as and/or is similar to another one”如：a parallel example 类似的例子，举个🌰：
Parallel experiments are being conducted in Shanghai, Hangzhou and Beijing.
类似的试验正在上海、杭州和北京同时进行。
作名词，表示“可相比拟的事物；相似之处”，英文解释为“something very similar to something else, or a similarity between two things”举个🌰：
I'm trying to see if there are any obvious parallels between the two cases. 我正试图寻找这两起案件中有没有明显的相似之处。
Importantly, we identified several individual baseline factors associated with the development of depressive symptoms during residency. Consistent with previous studies, a history of major depression and of other stressful life events, as well as reduction of sleep, longer work hours and stressful events outside of residency were robust predictors of the observed increase in depression during residency in both countries. Notably, residency specialty was not associated with the development of depression in either country.
重要的是，我们确定了与住院医师培训期间抑郁症状产生相关的几个单独的基线因素。与以前的研究一致，重度抑郁史和其他应激性生活事件史，以及睡眠减少、工作时间延长和住院医师培训以外的压力事件是两国住院医师培训期间观察到的抑郁症增加的可靠预测因素。值得注意的是，两国中住院医师专业与抑郁症的产生无关。
specialty
specialty /ˈspeʃ.əl.ti/ 表示“专业；专长”，英文解释为“a subject that someone knows a lot about”举个🌰：
LR's specialty is computer science. LR的专业是计算机科学。
Interesting differences in the prevalence and risk factors for depression were also identified between China and the US. While the higher baseline score may be attributed to the significantly shorter transition time between medical school and the start of residency in China (two weeks) in contrast to the US (two months), the higher scores throughout the year suggest that young Chinese physicians may face additional stressors. Younger age was also a significant predictor of depression in China but not in the older US sample. This could be due to the earlier starting time of residency in China (after five years of a Bachelor in Medicine) than in the US (four years of undergraduate studies followed by four years of medical school). The difference in reporting of medical errors (20% in the US vs. 2% in China) is likely a consequence of more supervision, such that these younger first year residents in China would not feel being directly responsible for a medical error.
中国和美国在抑郁症患病率和风险因素方面也存在有趣的差异。虽然较高的基线分数可能归因于中国从医学院到住院医师培训开始的过渡时间（两周）明显短于美国（两个月），但全年较高的分数表明，年轻的中国医师可能面临额外的压力源。在中国，年纪较轻也是抑郁症的一个重要预测因素，但在年龄较大的美国样本中则不是。这可能是因为中国住院医师培训时间（在获得五年医学学士学位后）比美国的（四年本科+四年医学院学习）要早。医疗事故报告的差异（美国为20%，中国为2%）可能是更多监管的结果，这样中国这些年轻的培训第一年住院医师不会觉得自己对医疗事故负有直接责任。
Our study has a number of limitations. First, since only about half of residents completed our questionnaires, it is conceivable that those who are suffering of depression symptoms during residency are more motivated to complete assessments. Second, we were only able to include residents from large hospitals in Shanghai and Beijing, who likely are not representative of training physicians across China. Finally, we focused on first-year residents in this study. Prevalence and predictors of depression may be different in more advanced training physicians.
我们的研究有许多局限性。首先，由于只有大约一半的住院医师完成了我们的问卷，可以想象，那些在住院医师培训期间出现抑郁症状的人更有动力完成评估。其次，我们只考虑了上海和北京大型医院的住院医师，他们在中国各地的受训住院医师中可能并不具有代表性。最后，我们在这项研究中关注的是培训第一年的住院医师。在更高级的培训医师中，抑郁症的患病率和预测因素可能有所不同。
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LearnAndRecord
2015年2月8日
2022年12月15日
第2868天
每天持续行动学外语