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演讲MP3+双语文稿:想要成为行业的精英?去找个教练吧

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2022年03月11日

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听力课堂TED音频栏目主要包括TED演讲的音频MP3及中英双语文稿,供各位英语爱好者学习使用。本文主要内容为演讲MP3+双语文稿:想要成为行业的精英?去找个教练吧,希望你会喜欢!

【演讲人】Atul Gawande

阿图尔·加万德白天是外科和公共卫生教授,晚上是作家

【演讲主题】《想要成为行业的精英?去找个教练吧》

【演讲文稿-中英文】

翻译者 Cheng Paul 校对 Yiyang Piao

I don't come to you today as an expert. I come to you as someone who has been really interested in how I get better at what I do and how we all do. I think it's not just how good you are now, I think it's how good you're going to be that really matters.

今天我并非以一个 专家的身份来这里演讲, 我是为了那些一直非常想要 在自己的领域成为行家的人 而来。 我想,重要的不是现在你有多优秀, 而是未来你将多精彩。

I was visiting this birth center in the north of India. I was watching the birth attendants, and I realized I was witnessing in them an extreme form of this very struggle, which is how people improve in the face of complexity -- or don't. The women here are delivering in a region where the typical birth center has a one-in-20 death rate for the babies, and the moms are dying at a rate ten times higher than they do elsewhere. Now, we've known the critical practices that stop the big killers in birth for decades, and the thing about it is that even in this place -- in this place especially, the simplest things are not simple. We know for example you should wash hands and put on clean gloves, but here, the tap is in another room, and they don't have clean gloves. To reuse their gloves, they wash them in this basin of dilute bleach, but you can see there's still blood on the gloves from the last delivery. Ten percent of babies are born with difficulty breathing everywhere. We know what to do. You dry the baby with a clean cloth to stimulate them to breathe. If they don't start to breathe, you suction out their airways. And if that doesn't work, you give them breaths with the baby mask. But these are skills that they've learned mostly from textbooks, and that baby mask is broken.

我曾经到访印度北边的 这个生育中心。 我看着这些产护人员, 发现她们正在与复杂的局面 进行艰苦的斗争—— 当然,也许是我多虑了。 但在当地生育中心 出生的婴儿,死亡率高达5%, 孕妇的死亡率也是其他地区的十倍。 现在,我们已经知道降低几十年来 新生儿死亡率居高不下的关键举措, 以及造成这一现象的原因—— 像这种地方, 稀松小事也可以举步维艰。 众所周知,产护人员应该 洗手后戴上干净的手套, 然而在这里, 手术室没有水龙头 产护人员也没有干净的手套。 为了重复利用手套 她们用稀释的漂白水清洗手套, 但手套上仍有之前使用留下的血迹。 世界上10%的孩子出生时就 伴有呼吸困难的症状。 人们知道如何解决这一问题。 用干净的毛巾轻抚婴儿 以刺激他们呼吸。 如果没有作用, 应疏通他们的呼吸道。 如果效果仍然不明显, 应该给他们戴上婴儿(氧气)面罩。 这些是学校教授的方法, 然而在这儿,婴儿面罩 根本无法使用。

In this one disturbing image for me is a picture that brings home just how dire the situation is. This is a baby 10 minutes after birth, and he's alive, but only just. No clean cloth, has not been dried, not warming skin to skin, an unsterile clamp across the cord. He's an infection waiting to happen, and he's losing his temperature by the minute. Successful child delivery requires a successful team of people. A whole team has to be skilled and coordinated; the nurses who do the deliveries in a place like this, the doctor who backs them up, the supply clerk who's responsible for 22 critical drugs and supplies being in stock and at the bedside, the medical officer in charge, responsible for the quality of the whole facility. The thing is they are all experienced professionals. I didn't meet anybody who hadn't been part of thousands of deliveries. But against the complexities that they face, they seem to be at their limits. They were not getting better anymore. It's how good you're going to be that really matters.

这一幕给我留下了深刻的印象, 不断提醒着我,情况实在太糟糕了。 这是一个刚出生10分钟的婴儿, 他还活着, 但是仅仅活着。 不仅没有干净的绵毯, 也没有干燥的毛巾, 它感受不到任何温暖, 只有一个未经消毒的夹子夹着脐带。 他即将被感染, 正面临着体温下降的危险。 每一个婴儿的顺利出生, 背后都少不了一个出色的团队。 由技艺高超且配合默契的 成员组成的团队, 产护人员在团队的相互配合下工作, 有医生的支持, 供应员会在床边和仓库里 准备充足的药品和所需的用具, 医疗主管负责 医疗设备的质量。 他们都是熟练的专业人士。 每个人都参与过上千次的接生。 但当他们面对这种复杂的局面时, 却变得束手无策。 他们已经尽力做到最好了。 但关键在于,未来 他们能否改变这一现状。

It presses on a fundamental question. How do professionals get better at what they do? How do they get great? And there are two views about this. One is the traditional pedagogical view. That is that you go to school, you study, you practice, you learn, you graduate, and then you go out into the world and you make your way on your own. A professional is someone who is capable of managing their own improvement. That is the approach that virtually all professionals have learned by. That's how doctors learn, that's how lawyers do, scientists ... musicians. And the thing is, it works. Consider for example legendary Juilliard violin instructor Dorothy DeLay. She trained an amazing roster of violin virtuosos: Midori, Sarah Chang, Itzhak Perlman. Each of them came to her as young talents, and they worked with her over years. What she worked on most, she said, was inculcating in them habits of thinking and of learning so that they could make their way in the world without her when they were done.

由此延伸出一个基本的问题。 行家是怎么做到精益求精的? 他们怎么变得杰出? 关于此问题有两类观点。 一类是传统的教学观点。 去学校学习, 上课,做功课,考试,毕业, 然后走向社会, 独自前行。 成为一个能自我管理, 不断进步的专家。 这几乎是所有专业人士学习的方法。 是医生学习的方法, 是律师学习的方法, 是科学家学习的方法, 也是音乐家学习的方法..... 并且这个方法效果显著。 比如朱利亚音乐学院的 传奇教师多萝西·迪蕾(Dorothy DeLay)。 她培养了一大批杰出的小提琴演奏家: 美岛莉, 张莎拉,伊扎克·帕尔曼等。 他们拜入她门下时都已锋芒毕露, 经历数年的练习后, 最终达到了很高的水准。 她说,她最大的贡献是 培养了他们思考和学习的习惯, 当他们毕业后 可以独自走好以后的路。

Now, the contrasting view comes out of sports. And they say "You are never done, everybody needs a coach." Everyone. The greatest in the world needs a coach.

另一类观点来自运动项目。 教练往往说:“你们还差的远呢!” 每个运动员都需要一个教练。 是的,每一个。 即使是世界上最杰出的运动员。

So I tried to think about this as a surgeon. Pay someone to come into my operating room, observe me and critique me. That seems absurd. Expertise means not needing to be coached.

我试着用一名外科医生的 思维来考虑这一观点。 请一个人来手术室, 对我进行观察及评判。 这听起来很可笑。 因为专业技能意味着 不需要再被训练。

So then which view is right? I learned that coaching came into sports as a very American idea. In 1875, Harvard and Yale played one of the very first American-rules football games. Yale hired a head coach; Harvard did not. The results? Over the next three decades, Harvard won just four times. Harvard hired a coach.

那么,哪一个观点是正确的呢? 我了解到,教练模式源于美国。 1875年, 哈佛和耶鲁之间举行了 美国历史上早期的橄榄球比赛。 耶鲁聘请了一位主教练。 然而哈佛没有这样做。 至于结果? 在之后30年的比赛里, 哈佛只赢了四场。 后来哈佛不得不也聘请教练。

(Laughter)

(笑声)

And it became the way that sports works. But is it necessary then? Does it transfer into other fields?

之后聘请教练成了体育界的标配。 但教练真的这么有用吗? 这一模式有没有进入其它领域?

I decided to ask, of all people, Itzhak Perlman. He had trained the Dorothy DeLay way and became arguably the greatest violinist of his generation. One of the beautiful things about getting to write for "The New Yorker" is I call people up, and they return my phone calls.

我决定请教一下他人, 伊扎克·帕尔曼。 他按照多萝西·迪蕾的方式练习, 成为了同时代最杰出的小提琴家。 为《纽约客》写文章的 一个美妙之处在于, 我给人们打电话,他们都会回我电话。

(Laughter)

(笑声)

And Perlman returned my phone call. So we ended up having an almost two-hour conversation about how he got to where he got in his career.

伊扎克·帕尔曼回了我的电话。 围绕着他如何取得如此成就, 我们进行了两个小时的长谈。

And I asked him, I said, "Why don't violinists have coaches?"

我问他:为什么小提琴家没有教练?

And he said, "I don't know, but I always had a coach."

他回道:我不知道别人有没有, 但是我一直都有。”

"You always had a coach?"

“你有教练?”

"Oh yeah, my wife, Toby."

“对,就是我的爱人托比。”

They had graduated together from Juilliard, and she had given up her job as a concert violinist to be his coach, sitting in the audience, observing him and giving him feedback.

他们一起从朱丽亚音乐学院毕业, 为了当他的教练, 她放弃了担任乐团小提琴手的工作, 在观众席中 对他进行观察,并给予反馈。

"Itzhak, in that middle section, you know you sounded a little bit mechanical. What can you differently next time?" It was crucial to everything he became, he said.

“伊扎克,中间那部分 听起来没有灵气。 下次你会进行不同的处理吗?” 这对他如今取得的成就 至关重要,他说。

Turns out there are numerous problems in making it on your own. You don't recognize the issues that are standing in your way or if you do, you don't necessarily know how to fix them. And the result is that somewhere along the way, you stop improving. And I thought about that, and I realized that was exactly what had happened to me as a surgeon.

当你独自一人时,会面对很多问题。 你意识不到自身的问题, 即使你意识到了, 也可能不知道怎么改正。 一路走来,你所面临的就是 自己的能力开始停滞不前了。 这使我陷入沉思, 意识到这正是出现在我身上的问题。

I'd entered practice in 2003, and for the first several years, it was just this steady, upward improvement in my learning curve. I watched my complication rates drop from one year to the next. And after about five years, they leveled out. And a few more years after that, I realized I wasn't getting any better anymore. And I thought: "Is this as good as I'm going to get?"

我从03年开始从医, 在最初的若干年中, 我的学习曲线在稳步改善。 术后并发症逐年下降。 之后五年, 这一数字不再变化了。 再往后几年, 我基本上是在原地踏步。 我不禁暗想:“难道 我的能力已经达到顶峰了吗?”

So I thought a little more and I said ... "OK, I'll try a coach." So I asked a former professor of mine who had retired, his name is Bob Osteen, and he agreed to come to my operating room and observe me. The case -- I remember that first case. It went beautifully. I didn't think there would be anything much he'd have to say when we were done. Instead, he had a whole page dense with notes.

再次忖度后,自言自语地说, “好吧, 我要需要一个教练。” 于是我邀请了教过我的 已退休教授, 鲍勃 · 欧斯丁, 他答应了我的请求, 到手术室来观察我。 那次手术—— 我清晰地记得, 手术堪称完美。 手术结束后, 我以为他没什么好说的。 结果,他写了满满一页的笔记。

(Laughter)

(笑声)

"Just small things," he said.

“都是些小问题,”他说。

(Laughter)

(笑声)

But it's the small things that matter. "Did you notice that the light had swung out of the wound during the case? You spent about half an hour just operating off the light from reflected surfaces." "Another thing I noticed," he said, "Your elbow goes up in the air every once in a while. That means you're not in full control. A surgeon's elbows should be down at their sides resting comfortably. So that means if you feel your elbow going in the air, you should get a different instrument, or just move your feet." It was a whole other level of awareness. And I had to think, you know, there was something fundamentally profound about this. He was describing what great coaches do, and what they do is they are your external eyes and ears, providing a more accurate picture of your reality. They're recognizing the fundamentals. They're breaking your actions down and then helping you build them back up again. After two months of coaching, I felt myself getting better again. And after a year, I saw my complications drop down even further. It was painful. I didn't like being observed, and at times I didn't want to have to work on things. I also felt there were periods where I would get worse before I got better. But it made me realize that the coaches were onto something profoundly important.

但是细节决定成败。 “在手术中,你注意到 光源没有很好地 对着伤口了吗? 这半个小时的手术 都是在光照不足的情况下进行的。” “另一件事是,”他说, 你会不时地抬起你的手肘。 这说明你有些地方不受控制。 手术时手肘应该自然的下垂。 以后你感觉手肘抬起时, 应该换一个更称手的器械, 或者调整一下站姿。” 这席话让我醍醐灌顶。 我不得不思考, 这背后一定有着更深的意义。 他不愧为一个出色的教练, 因为出色的教练就是 充当你的第三只眼睛和耳朵, 为你的状态提供一个更真实的描述。 他们更注重细节。 他们会细致地剖析你的行为, 并帮你建立正确的习惯。 经历两个月的训练后, 我犹如脱胎换骨。 一年之后, 我发现术后的并发症 进一步减少了。 这一过程是非常煎熬的。 我不喜欢被监督, 有时候也厌倦工作。 在达到最佳状态之前, 我也经历过低谷。 但这使我意识到 教练扮演着极其重要的角色。

In my other work, I lead a health systems innovation center called Ariadne Labs, where we work on problems in the delivery of health care, including global childbirth. As part of it, we had worked with the World Health Organization to devise a safe childbirth checklist. It lays out the fundamentals. It breaks down the fundamentals -- the critical actions a team needs to go through when a woman comes in in labor, when she's ready to push, when the baby is out, and then when the mom and baby are ready to go home. And we knew that just handing out a checklist wasn't going to change very much, and even just teaching it in the classroom wasn't necessarily going to be enough to get people to make the changes that you needed to bring it alive. And I thought on my experience and said, "What if we tried coaching? What if we tried coaching at a massive scale?"

除了本职工作, 我还领导着一个叫阿里阿德涅实验室 (Ariadne Labs)的医疗系统创新中心, 致力于提供医疗保健服务, 包括全球生育。 同世界卫生组织合作, 我们共同设计出了 一个安全可行的生育检查表, 这也是该项目的内容之一。 这张表列出了基本要求, 并细化了这些要求—— 强调了一个团队 必须遵守的行为规范, 比如一个孕妇进入产房时, 她准备用力时, 婴儿出来之后, 母亲跟孩子准备回家时, 他们应该分别采取怎样的行动。 我们知道 仅仅制定出检查表, 效果并不会有太大的改观, 甚至在学校里着重强调这些内容, 也不一定能有多少效果。 于是,我又想到了自己的经历, “我们尝试一下教练模式如何? 在大规模范围内进行试验怎么样?”

We found some incredible partners, including the government of India, and we ran a trial there in 120 birth centers. In Uttar Pradesh, in India's largest state. Half of the centers basically we just observed, but the other half got visits from coaches. We trained an army of doctors and nurses like this one who learned to observe the care and also the managers and then help them build on their strengths and address their weaknesses. One of the skills for example they had to work on with people -- turned out to be fundamentally important -- was communication. Getting the nurses to practice speaking up when the baby mask is broken or the gloves are not in stock or someone's not washing their hands. And then getting others, including the managers, to practice listening. This small army of coaches ended up coaching 400 nurses and other birth attendants, and 100 physicians and managers. We tracked the results across 160,000 births.

我们找了一些出色的合作伙伴, 比如印度政府, 并在印度最大的邦,北方邦的 120个生育中心 进行了试验。 我们观察了半数的生育中心, 但另一半即使没有被监督, 也有教练进行指点。 我们训练了一组 医疗人员充当教练队伍, 学着观察护理过程还有管理人员, 然后帮助他们发挥长处, 弥补不足的地方。 比如,他们要学着与他人打交道—— 为日后能进行高效的交流 打下坚定的基础。 当婴儿面罩坏掉,手套没有库存, 或者有人没有洗手, 护士们应学着去指出这些问题。 而其他人,包括管理人员, 应该学会倾听。 这支教练队伍已经 培训了400个产护人员 和一些助理, 还有100个医生和管理人员。 我们追踪了16万个出生案例。

The results ... in the control group you had -- and these are the ones who did not get coaching -- they delivered on only one-third of 18 basic practices that we were measuring. And most important was over the course of the years of study, we saw no improvement over time. The other folks got four months of coaching and then it tapered off over eight months, and we saw them increase to greater than two-thirds of the practices being delivered. It works. We could see the improvement in quality, and you could see it happen across a whole range of centers that suggested that coaching could be a whole line of way that we bring value to what we do. You can imagine the whole job category that could reach out in the world and that millions of people could fulfill.

至于结果—— 在对照组, 也就是没有接受培训的结果—— 我们要考察的18个基本要求中, 他们只做到了1/3。 最重要的是,经过数年的跟踪, 对照组的表现没有任何改善。 而实验组的人经过4个月的训练, 死亡率连续八个月都有所下降, 我们看到了他们的进步, 成功分娩的婴儿数量 比以前足足多了2/3。 教练模式起作用了。 我们发现很多生育中心 都发生了质的改善, 这意味着整个过程有教练的参与, 可以为我们的工作带来更多价值。 想象一下,如果世界上 所有的工作都有教练的加入, 无数的人就可以从中获益。

We were clearly at the beginning of it, though, because there was still a distance to go. You have to put all of the checklist together to achieve the substantial reductions in mortality. But we began seeing the first places that were getting there, and this center was one of them because coaching helped them learn to execute on the fundamentals. And you could see it here.

尽管在起初,我们成效显著, 但我们还有很长的路要走。 我们需要整合所有的检查表, 以在降低死亡率方面 实现实质性的进展。 最早实施这一项目的地方 已取得了一些进展, 这个生育中心就是其中之一, 因为教练模式帮助他们 学会了解决根本问题。 你们可以看到这一过程。

This is a 23-year-old woman who had come in by ambulance, in labor with her third child. She broke her water in the triage area, so they brought her directly to the labor and delivery room, and then they ran through their checks. I put the time stamp on here so you could see how quickly all of this happens and how much more complicated that makes things. Within four minutes, they had taken the blood pressure, measured her pulse and also measured the heart rate of the baby. That meant that the blood pressure cuff and the fetal Doppler monitor, they were all there, and the nurse knew how to use them. The team was skilled and coordinated. The mom was doing great, the baby's heart rate was 143, which is normal. Eight minutes later, the intensity of the contractions picked up, so the nurse washed her hands, put on clean gloves, examined her and found that her cervix was fully dilated. The baby was ready to come. She then went straight over to do her next set of checks. All of the equipment, she worked her way through and made sure she had everything she needed at the bedside. The baby mask was there, the sterile towel, the sterile equipment that you needed. And then three minutes later, one push and that baby was out.

这个23岁的产妇 是被救护车送来的, 她即将迎来第三个孩子。 她的羊水在分流区破裂, 因此医护人员直接 给她安排了产房接生, 并且着手检查。 我为这些照片加了时间标记, 大家可以看到, 这一切都发生得如此迅速, 大大增加了整个过程的复杂程度。 在四分钟以内, 她们测量了产妇的血压,脉搏, 还有婴儿的心率。 这意味着血压袖带和 胎儿多普勒监视器都在现场, 并且产护人员知道怎么操作。 团队技术娴熟,配合默契。 这位妈妈状态良好, 婴儿的心率是143,属正常范围。 八分钟后,子宫收缩的 强度开始增加, 产护人员将手清洗后, 带上干净的手套给她做检查, 发现她的子宫颈完全张开。 婴儿即将出生。 产护人员立即进行剩余的检查项目。 她对各项逐一进行检查, 确保需要的所有设备都已就绪。 婴儿面罩,无菌毛巾 和需要的无菌设备,全部就位。 三分钟后,产妇开始用力, 婴儿出来了。

(Applause)

(掌声)

I was watching this delivery, and suddenly I realized that the mood in that room had changed. The nurse was looking at the community health worker who had come in with the woman because that baby did not seem to be alive. She was blue and floppy and not breathing. She would be one of that one-in-20. But the nurse kept going with her checkpoints. She dried that baby with a clean towel. And after a minute, when that didn't stimulate that baby, she ran to get the baby mask and the other one went to get the suction. She didn't have a mechanical suction because you could count on electricity, so she used a mouth suction, and within 20 seconds, she was clearing out that little girl's airways. And she got back a green, thick liquid, and within a minute of being able to do that and suctioning out over and over, that baby started to breathe.

当时我正在注视着产房, 突然发现产房里的气氛变了。 产护人员正看着护送产妇进来的 社区保健人员, 因为那个婴儿似乎状态不妙。 她全身发紫,皮肤松弛 并且没有呼吸。 她似乎就是被死神选中的那一个。 但是产护人员按部就班地 行动了起来。 她用一个干净的毛巾擦拭婴儿。 但一分钟后,婴儿还是毫无反应, 她立刻跑去拿婴儿面罩, 另一个产护人员拿来了吸管。 因为没有可靠的电力供应, 她没有用电动吸管,而是用口用吸管 清理小女孩的呼吸道, 在20秒内, 异物被一点点吸了出来。 在一分钟内, 她不间断地重复着, 最终吸出了粘稠的异物, 婴儿开始了呼吸。

(Applause)

(掌声)

Another minute and that baby was crying. And five minutes after that, she was pink and warming on her mother's chest, and that mother reached out to grab that nurse's hand, and they could all breathe.

孩子的哭声紧随而至。 5分钟后, 她的肤色变得正常, 被母亲抱在了怀里, 那位母亲激动地 握住的产护人员的手, 那一刻,大家都松了一口气。

I saw a team transformed because of coaching. And I saw at least one life saved because of it. We followed up with that mother a few months later. Mom and baby were doing great. The baby's name is Anshika. It means "beautiful." And she is what's possible when we really understand how people get better at what they do.

我目睹了一个在教练模式下 发生华丽转变的团队。 目睹了无数生命因此获救。 数月之后,我们拜访了那个母亲。 母女健康平安。 女婴名叫安西卡, 意为“美丽”。 她的存活证明了, 当我们真正明白 如何更出色地做好本职工作时, 一切皆有可能。

Thank you.

谢谢。

(Applause)

(掌声)

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