演講MP3+雙語文稿:想要成為行業(yè)的精英？去找個教練吧

00:00

00:00

MP3下載

https://online2.tingclass.net/lesson/shi0529/10000/10387/tedyp52.mp3

https://image.tingclass.net/statics/js/2012

聽力課堂TED音頻欄目主要包括TED演講的音頻MP3及中英雙語文稿，供各位英語愛好者學習使用。本文主要內(nèi)容為演講MP3+雙語文稿:想要成為行業(yè)的精英？去找個教練吧，希望你會喜歡！

【演講人】Atul Gawande

阿圖爾·加萬德白天是外科和公共衛(wèi)生教授，晚上是作家

【演講主題】《想要成為行業(yè)的精英？去找個教練吧》

【演講文稿-中英文】

翻譯者 Cheng Paul 校對 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.

今天我并非以一個 專家的身份來這里演講， 我是為了那些一直非常想要 在自己的領(lǐng)域成為行家的人 而來。 我想，重要的不是現(xiàn)在你有多優(yōu)秀， 而是未來你將多精彩。

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.

我曾經(jīng)到訪印度北邊的 這個生育中心。 我看著這些產(chǎn)護人員， 發(fā)現(xiàn)她們正在與復雜的局面 進行艱苦的斗爭—— 當然，也許是我多慮了。 但在當?shù)厣行?出生的嬰兒，死亡率高達5%， 孕婦的死亡率也是其他地區(qū)的十倍。 現(xiàn)在，我們已經(jīng)知道降低幾十年來 新生兒死亡率居高不下的關(guān)鍵舉措， 以及造成這一現(xiàn)象的原因—— 像這種地方， 稀松小事也可以舉步維艱。 眾所周知，產(chǎn)護人員應(yīng)該 洗手后戴上干凈的手套， 然而在這里， 手術(shù)室沒有水龍頭 產(chǎn)護人員也沒有干凈的手套。 為了重復利用手套 她們用稀釋的漂白水清洗手套， 但手套上仍有之前使用留下的血跡。 世界上10%的孩子出生時就 伴有呼吸困難的癥狀。 人們知道如何解決這一問題。 用干凈的毛巾輕撫嬰兒 以刺激他們呼吸。 如果沒有作用， 應(yīng)疏通他們的呼吸道。 如果效果仍然不明顯， 應(yīng)該給他們戴上嬰兒（氧氣）面罩。 這些是學校教授的方法， 然而在這兒，嬰兒面罩 根本無法使用。

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.

這一幕給我留下了深刻的印象， 不斷提醒著我，情況實在太糟糕了。 這是一個剛出生10分鐘的嬰兒， 他還活著， 但是僅僅活著。 不僅沒有干凈的綿毯， 也沒有干燥的毛巾， 它感受不到任何溫暖， 只有一個未經(jīng)消毒的夾子夾著臍帶。 他即將被感染， 正面臨著體溫下降的危險。 每一個嬰兒的順利出生， 背后都少不了一個出色的團隊。 由技藝高超且配合默契的 成員組成的團隊， 產(chǎn)護人員在團隊的相互配合下工作， 有醫(yī)生的支持， 供應(yīng)員會在床邊和倉庫里 準備充足的藥品和所需的用具， 醫(yī)療主管負責 醫(yī)療設(shè)備的質(zhì)量。 他們都是熟練的專業(yè)人士。 每個人都參與過上千次的接生。 但當他們面對這種復雜的局面時， 卻變得束手無策。 他們已經(jīng)盡力做到最好了。 但關(guān)鍵在于，未來 他們能否改變這一現(xiàn)狀。

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.

由此延伸出一個基本的問題。 行家是怎么做到精益求精的？ 他們怎么變得杰出？ 關(guān)于此問題有兩類觀點。 一類是傳統(tǒng)的教學觀點。 去學校學習， 上課，做功課，考試，畢業(yè)， 然后走向社會， 獨自前行。 成為一個能自我管理， 不斷進步的專家。 這幾乎是所有專業(yè)人士學習的方法。 是醫(yī)生學習的方法， 是律師學習的方法， 是科學家學習的方法， 也是音樂家學習的方法..... 并且這個方法效果顯著。 比如朱利亞音樂學院的 傳奇教師多蘿西·迪蕾（Dorothy DeLay）。 她培養(yǎng)了一大批杰出的小提琴演奏家： 美島莉， 張莎拉，伊扎克·帕爾曼等。 他們拜入她門下時都已鋒芒畢露， 經(jīng)歷數(shù)年的練習后， 最終達到了很高的水準。 她說，她最大的貢獻是 培養(yǎng)了他們思考和學習的習慣， 當他們畢業(yè)后 可以獨自走好以后的路。

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.

另一類觀點來自運動項目。 教練往往說：“你們還差的遠呢！” 每個運動員都需要一個教練。 是的，每一個。 即使是世界上最杰出的運動員。

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.

我試著用一名外科醫(yī)生的 思維來考慮這一觀點。 請一個人來手術(shù)室， 對我進行觀察及評判。 這聽起來很可笑。 因為專業(yè)技能意味著 不需要再被訓練。

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，哪一個觀點是正確的呢？ 我了解到，教練模式源于美國。 1875年， 哈佛和耶魯之間舉行了 美國歷史上早期的橄欖球比賽。 耶魯聘請了一位主教練。 然而哈佛沒有這樣做。 至于結(jié)果？ 在之后30年的比賽里， 哈佛只贏了四場。 后來哈佛不得不也聘請教練。

(Laughter)

（笑聲）

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

之后聘請教練成了體育界的標配。 但教練真的這么有用嗎？ 這一模式有沒有進入其它領(lǐng)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.

我決定請教一下他人， 伊扎克·帕爾曼。 他按照多蘿西·迪蕾的方式練習， 成為了同時代最杰出的小提琴家。 為《紐約客》寫文章的 一個美妙之處在于， 我給人們打電話，他們都會回我電話。

(Laughter)

（笑聲）

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·帕爾曼回了我的電話。 圍繞著他如何取得如此成就， 我們進行了兩個小時的長談。

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

我問他：為什么小提琴家沒有教練？

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

他回道：我不知道別人有沒有， 但是我一直都有?！?/p>

"You always had a coach?"

“你有教練？”

"Oh yeah, my wife, Toby."

“對，就是我的愛人托比。”

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.

他們一起從朱麗亞音樂學院畢業(yè)， 為了當他的教練， 她放棄了擔任樂團小提琴手的工作， 在觀眾席中 對他進行觀察，并給予反饋。

"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，中間那部分 聽起來沒有靈氣。 下次你會進行不同的處理嗎？” 這對他如今取得的成就 至關(guān)重要，他說。

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.

當你獨自一人時，會面對很多問題。 你意識不到自身的問題， 即使你意識到了， 也可能不知道怎么改正。 一路走來，你所面臨的就是 自己的能力開始停滯不前了。 這使我陷入沉思， 意識到這正是出現(xiàn)在我身上的問題。

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?"

我從03年開始從醫(yī)， 在最初的若干年中， 我的學習曲線在穩(wěn)步改善。 術(shù)后并發(fā)癥逐年下降。 之后五年， 這一數(shù)字不再變化了。 再往后幾年， 我基本上是在原地踏步。 我不禁暗想：“難道 我的能力已經(jīng)達到頂峰了嗎？”

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，自言自語地說， “好吧， 我要需要一個教練。” 于是我邀請了教過我的 已退休教授， 鮑勃 · 歐斯丁， 他答應(yīng)了我的請求， 到手術(shù)室來觀察我。 那次手術(shù)—— 我清晰地記得， 手術(shù)堪稱完美。 手術(shù)結(jié)束后， 我以為他沒什么好說的。 結(jié)果，他寫了滿滿一頁的筆記。

(Laughter)

（笑聲）

"Just small things," he said.

“都是些小問題，”他說。

(Laughter)

（笑聲）

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.

但是細節(jié)決定成敗。 “在手術(shù)中，你注意到 光源沒有很好地 對著傷口了嗎？ 這半個小時的手術(shù) 都是在光照不足的情況下進行的?！?“另一件事是，”他說， 你會不時地抬起你的手肘。 這說明你有些地方不受控制。 手術(shù)時手肘應(yīng)該自然的下垂。 以后你感覺手肘抬起時， 應(yīng)該換一個更稱手的器械， 或者調(diào)整一下站姿。” 這席話讓我醍醐灌頂。 我不得不思考， 這背后一定有著更深的意義。 他不愧為一個出色的教練， 因為出色的教練就是 充當你的第三只眼睛和耳朵， 為你的狀態(tài)提供一個更真實的描述。 他們更注重細節(jié)。 他們會細致地剖析你的行為， 并幫你建立正確的習慣。 經(jīng)歷兩個月的訓練后， 我猶如脫胎換骨。 一年之后， 我發(fā)現(xiàn)術(shù)后的并發(fā)癥 進一步減少了。 這一過程是非常煎熬的。 我不喜歡被監(jiān)督， 有時候也厭倦工作。 在達到最佳狀態(tài)之前， 我也經(jīng)歷過低谷。 但這使我意識到 教練扮演著極其重要的角色。

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?"

除了本職工作， 我還領(lǐng)導著一個叫阿里阿德涅實驗室 （Ariadne Labs）的醫(yī)療系統(tǒng)創(chuàng)新中心， 致力于提供醫(yī)療保健服務(wù)， 包括全球生育。 同世界衛(wèi)生組織合作， 我們共同設(shè)計出了 一個安全可行的生育檢查表， 這也是該項目的內(nèi)容之一。 這張表列出了基本要求， 并細化了這些要求—— 強調(diào)了一個團隊 必須遵守的行為規(guī)范， 比如一個孕婦進入產(chǎn)房時， 她準備用力時， 嬰兒出來之后， 母親跟孩子準備回家時， 他們應(yīng)該分別采取怎樣的行動。 我們知道 僅僅制定出檢查表， 效果并不會有太大的改觀， 甚至在學校里著重強調(diào)這些內(nèi)容， 也不一定能有多少效果。 于是，我又想到了自己的經(jīng)歷， “我們嘗試一下教練模式如何？ 在大規(guī)模范圍內(nèi)進行試驗怎么樣？”

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.

我們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個生育中心 進行了試驗。 我們觀察了半數(shù)的生育中心， 但另一半即使沒有被監(jiān)督， 也有教練進行指點。 我們訓練了一組 醫(yī)療人員充當教練隊伍， 學著觀察護理過程還有管理人員， 然后幫助他們發(fā)揮長處， 彌補不足的地方。 比如，他們要學著與他人打交道—— 為日后能進行高效的交流 打下堅定的基礎(chǔ)。 當嬰兒面罩壞掉，手套沒有庫存， 或者有人沒有洗手， 護士們應(yīng)學著去指出這些問題。 而其他人，包括管理人員， 應(yīng)該學會傾聽。 這支教練隊伍已經(jīng) 培訓了400個產(chǎn)護人員 和一些助理， 還有100個醫(yī)生和管理人員。 我們追蹤了16萬個出生案例。

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.

至于結(jié)果—— 在對照組， 也就是沒有接受培訓的結(jié)果—— 我們要考察的18個基本要求中， 他們只做到了1/3。 最重要的是，經(jīng)過數(shù)年的跟蹤， 對照組的表現(xiàn)沒有任何改善。 而實驗組的人經(jīng)過4個月的訓練， 死亡率連續(xù)八個月都有所下降， 我們看到了他們的進步， 成功分娩的嬰兒數(shù)量 比以前足足多了2/3。 教練模式起作用了。 我們發(fā)現(xiàn)很多生育中心 都發(fā)生了質(zhì)的改善， 這意味著整個過程有教練的參與， 可以為我們的工作帶來更多價值。 想象一下，如果世界上 所有的工作都有教練的加入， 無數(shù)的人就可以從中獲益。

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.

盡管在起初，我們成效顯著， 但我們還有很長的路要走。 我們需要整合所有的檢查表， 以在降低死亡率方面 實現(xiàn)實質(zhì)性的進展。 最早實施這一項目的地方 已取得了一些進展， 這個生育中心就是其中之一， 因為教練模式幫助他們 學會了解決根本問題。 你們可以看到這一過程。

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.

這個23歲的產(chǎn)婦 是被救護車送來的， 她即將迎來第三個孩子。 她的羊水在分流區(qū)破裂， 因此醫(yī)護人員直接 給她安排了產(chǎn)房接生， 并且著手檢查。 我為這些照片加了時間標記， 大家可以看到， 這一切都發(fā)生得如此迅速， 大大增加了整個過程的復雜程度。 在四分鐘以內(nèi)， 她們測量了產(chǎn)婦的血壓，脈搏， 還有嬰兒的心率。 這意味著血壓袖帶和 胎兒多普勒監(jiān)視器都在現(xiàn)場， 并且產(chǎn)護人員知道怎么操作。 團隊技術(shù)嫻熟，配合默契。 這位媽媽狀態(tài)良好， 嬰兒的心率是143，屬正常范圍。 八分鐘后，子宮收縮的 強度開始增加， 產(chǎn)護人員將手清洗后， 帶上干凈的手套給她做檢查， 發(fā)現(xiàn)她的子宮頸完全張開。 嬰兒即將出生。 產(chǎn)護人員立即進行剩余的檢查項目。 她對各項逐一進行檢查， 確保需要的所有設(shè)備都已就緒。 嬰兒面罩，無菌毛巾 和需要的無菌設(shè)備，全部就位。 三分鐘后，產(chǎn)婦開始用力， 嬰兒出來了。

(Applause)

（掌聲）

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.

當時我正在注視著產(chǎn)房， 突然發(fā)現(xiàn)產(chǎn)房里的氣氛變了。 產(chǎn)護人員正看著護送產(chǎn)婦進來的 社區(qū)保健人員， 因為那個嬰兒似乎狀態(tài)不妙。 她全身發(fā)紫，皮膚松弛 并且沒有呼吸。 她似乎就是被死神選中的那一個。 但是產(chǎn)護人員按部就班地 行動了起來。 她用一個干凈的毛巾擦拭嬰兒。 但一分鐘后，嬰兒還是毫無反應(yīng)， 她立刻跑去拿嬰兒面罩， 另一個產(chǎn)護人員拿來了吸管。 因為沒有可靠的電力供應(yīng)， 她沒有用電動吸管，而是用口用吸管 清理小女孩的呼吸道， 在20秒內(nèi)， 異物被一點點吸了出來。 在一分鐘內(nèi)， 她不間斷地重復著， 最終吸出了粘稠的異物， 嬰兒開始了呼吸。

(Applause)

（掌聲）

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.

孩子的哭聲緊隨而至。 5分鐘后， 她的膚色變得正常， 被母親抱在了懷里， 那位母親激動地 握住的產(chǎn)護人員的手， 那一刻，大家都松了一口氣。

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.

我目睹了一個在教練模式下 發(fā)生華麗轉(zhuǎn)變的團隊。 目睹了無數(shù)生命因此獲救。 數(shù)月之后，我們拜訪了那個母親。 母女健康平安。 女嬰名叫安西卡， 意為“美麗”。 她的存活證明了， 當我們真正明白 如何更出色地做好本職工作時， 一切皆有可能。

Thank you.

謝謝。

(Applause)

（掌聲）