介绍： 1 Want to get great at something? Get a coach
想要擅长某个领域，那就请教练吧

speaker:Atul Gawande.

00:00:
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’...

介绍： 1 Want to get great at something? Get a coach
想要擅长某个领域，那就请教练吧

speaker:Atul Gawande.

00:00:
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.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.
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。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。

00:47:
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.
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。

01:37:
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.
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。

02:08:
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 a-l-i-v-e,but only just.no clean cloth,has not been dried,not warming skin to skin,and unsterile clamp across the cord.he’s an infection waiting 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.
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。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。

03:05:
the thing is they are all experienced professionals.I didn’t meet anybody who hadn’t been part of thousand 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.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 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.
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。 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。

04:16:
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 including in them habits of thinking and of learning so that they could make their way in the world without her when they were done.
比如朱利亚音乐学院的传奇教师多萝西·迪蕾。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。

04:45:
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.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.so then which view is right?
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。 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。 那么，哪一个观点是正确的呢？

05:25:
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 foot-b-all games.Yale hired a head coach;Harvard did not.the results?over the next three decades,Harvard won the just four times.harvard hired a coach.and it became the way that sports works.but is it necessary then?does it transfer into other fields?
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。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？

06:00:
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”The New Yorker”is I call people up and they return my phone calls.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.
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。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。

06:30:
and I asked him,I said,”why don’t violinists have coaches?”and he said,”I don’t know,but I always had a coach.””you always had a coach?””oh yeah,my wife,Toby.”they had graduated together from Juilliard,and she had given up her job as a concert violist to be his coach,sitting in the audience,observing him and giving him feedback.”

07:00:
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.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.

07:30:
and I thought about that and I realized that was exactly what had happened to me as a surgeon.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?”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.

08:20:
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.”just small things.”he said.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.