關於 cuhk address ，我們在網路上蒐集到這些相關的討論、資訊與評價

講CUHK單嘢都講到口臭，今日想講下現代醫學急速發展，科學醫學基因學一日千里後對醫學院學生同初級醫生嘅影響

拿，頭盔，我唔係故意要同senior們作對，而係有d好重要嘅概念我覺得一路都無人address過。而醫學界仍然有股好重嘅「當年都係咁捱咁讀，點解你咁多意見」嘅風氣

的確，當年前輩們嘅非人on call生活、要去library睇文獻睇書而唔係方便地用Microsoft surface神速打筆記、開uptodate、開pubmed/medline等等。

無可否認，上個年前代嘅醫生們要增進知識要靠嘅自動波去睇論文去溫書，甚至要自己去R導師做臨床教學等等。無人否認當年環境無咁豐富，上堂無精美PowerPoint、臨床教學今時今日已經好structured，分哂history session, examination session, skills session，有像真度極高嘅假人俾你練習，呢d係上代無嘅luxuries

No one is denying this fact

但上一代都一樣無嘅係咩，大家有無諗過？

就係千千萬萬種過去20年發展出來嘅科學醫學理論同治療方法。

O&G 幾十年前都未知道preeclampsia嘅實際原因係乜，原來可以early pregnancy low dose aspirin prevent or delay onset of preeclampsia。廿年前都無HPV疫苗, 都無話原來screen HPV virology比Pap smears更有效發現子宮頸病變，廿年前無人需要知道呢d

Rheumatology幾十年都無一堆biologics, TNFa, IL inhibitor 。原來autoimmune inflammatory arthritis failed NSAID/MTX可以轉infliximab, adalimumab。psoriatic可以用secukinumab但如果有IBD/enteropathic features要小心IL-17 inhibitor，廿前年無人需要知道呢d

Immunology/ID，幾十年前HIV邊有咁多種antiretroviral？今時今日ART多到就算你de novo resistance都可以換藥換到U=U，廿年前都係得舊式治療，無人需要知種種嘅新式療法。immunology仲多咗幾十種唔同嘅complement, complement inhibitor etc etc嘅investigation

Respiratory醫ILD或pulmonary HTN幾十年前個療法來來去去都係得幾種。今時今日IPF有nintedanib，Pul HTN有成堆endothelin antagonist、PDE5 inhibitor同prostacyclin類嘅藥要知。asthma當年來來去去都係ventolin+inhaled/oral steroid，今時今日分埋IgE asthma, eosinophilic asthma，有成堆唔同嘅SABA-LABA, SAMA-LAMA, IgE monoclonal antibodies, IL-5, IL-4 and IL-13，到底eosinophil要幾多先會大機會有response，用緊steroid嘅eosinophil個cutoff係幾多。

Hematology/oncology幾十年前都未有monoclonal antibodies，無rituximab、nivolumab、targeted therapy等等，幾十年來個發現多咗好多唔同gene mutation同targeted site，EGFR, VEGFR, CTLA-4, PD-1，PD-L1、BRAF，HER-2, you name it you got it。以前癌症病人你大多只要beware of neutropenic fever/infection，今時今日你要screen埋immune checkpoint inhibitor autoimmune hepatitis, pneumonitis, thyroditis, colitis，你要知埋有個病人用緊nivolumab時突然變黃，你要screen咩autoimmune，落咩藥，high dose steroid定點，之後仲可唔可以rechallenge。乳癌病人HER-2依加唔止用herceptin，仲有埋pertuzumab，你仲要screen埋cardiomyopathy，echo drop幾多可以接受，係唔係reversible，可唔可以rechallenge

Endocrine幾十年前糖尿病來來去去都係metformin, gliclazide, insulin今時今日T2DM有GLP-1, SGLT-2, gliptin等等，有埋continuous glucose monitoring device又有bump又有唔同林林總總嘅治療。唔止T1/T2DM，今時今日仲有埋LADA，你要知埋個autoimmune panel screen咩。骨質疏鬆當年玩來玩去都係bisphosphonate，今時今日有denusumab有teriparatide，仲有更多新藥。

Gastroenterology幾十年前IBD來來去去都係steroid/steroid sparing agent 5-ASA/aza，今時今日有TNFa blocker有a4b7 inhibitor vedolizumab。當年hepC得幾種antiviral今時今日有sofosbuvir, velpatasvir, glecaprevir等等，仲變成curative。

Neurology MS幾十年前邊有natalizumab，今時今日如果MS on natalizumab with rapid neurological decline，你要諗埋會唔會可能係JC virus reactivation。GBM以前都係只靠surgical resection，今時今日可以用avastin, temozolomide仲要screen埋MGMT hypermethylation去決定有無得用chemo

呢啲改變同發展只係佔各system嘅一小部分，只係我細小嘅腦袋突然諗到嘅小部分內容。世界不斷發展，學海無涯，我們有愈來愈多嘅知識要學，呢一點無人懷疑過。

醫生擁有比一般人更多嘅權力同地位，就自然需要更大嘅責任。

但係，值得大家反思嘅係，當個knowledge base不斷擴大嘅時候，考試仍然要期望你記埋某張slide嘅角落嘅minute details時，呢個係唔係一個合理嘅期望？

當一個basic trainee去考PACES/long case嘅時候，到底係唔係同以前一樣要知得咁深入？當深度一樣，而個base不斷widen broaden時，新世代嘅醫生應該如何應對？

而考試嘅範圍似乎未有被address過，呢點好值得我地一齊諗諗

《非主流意見》

最近係CUHK見到有preclinical醫學系二年級嘅同學抱怨無限個lectures同考試成日會考萬幾張slides裡面其中一個角落嘅minute details

首先，其實講粗口我覺得真係無乜所謂。私人生活同工作要有嘅專業形象係可以分開。不過要小心嘅係日後要確保真係私人生活同it won’t come back and bite you，呢一行好窄同好多人對粗口敏感，而你嘅事業好取決於同行對你嘅評價。

我覺得成件事有幾個好重要嘅點值得所有人反思下

1. 考試內容有無必要考d偏到無得再偏嘅details

全世界醫學院考試都有類似嘅題目，問一些上堂其中一張slide個角落嘅其中嘅minute detail。好多人話靠這些題目可以分辨邊d學生係精英中嘅精英，邊d學生值得攞distinction

我同意要有differentiating questions，但如果條題目問你AdenoCa Lung with EGFR mutation T790M應該用邊隻TKI時，呢類嘅題目又係唔係適合去分一個學生嘅能力？係咪今日無背到個mutation panel係咪代表你唔係好學生，係咪差過其他有背到張Slide嘅同學？

如果要differentiate一個學生嘅能力，我會覺得complicated clinical presentation +/- multiple comorbidity同藥物相沖etc去睇下個學生會點clinically prioritize同workup個病人，會更加能夠分辨到精英中嘅精英。

如果preclinical basic science嘅題目我倒唔覺得有幾需要分辨有背到minute details同無背到嘅同學，反而更加應該加多少少clinical relevance on basic sciences例如pharmacology, microbiology, drug interaction, disease presentation with regards to physiology etc

2. 真係唔好睇考試睇得太重

醫學唔係淨係科學，同時係充滿人性嘅一門藝術。傳統考試並唔代表d乜嘢，考得好考得差，合格嘅你就係醫生。

Don’t ever be defined by exam

你需要嘅係合格，達到醫學界對醫生知識嘅最低要求同埋擁有應對困難嘅能力。當刻你醒唔起lecture 134第48張slide嘅內容唔代表你唔識，亦唔代表你之後會醫死人，會係庸醫。考試其間有種種因素，時間嘅壓力、大腦突然mind blank、一時諗唔通等等，令你答錯呢條題目。

呢個並無咩咁大不了，如果你真心唔識嘅，就吸收呢次經驗同知識，be better next time 。如果你係識但因種種原因答錯嘅，唔緊要，下次更小心就好，無須覺得自己比別人低等。

香港學校好容易會出現一種互相比較嘅氣氛，really there is no need for such culture，相信自己嘅能力，記著，你唔需要一份筆試去定義你嘅人生。

*不過當然你仍然要合格，只係無必要去同人競爭鬥高分

當你看開d唔再區泥分數時，就算你無背到d rare minute details時，你一樣會合格會progress，呢d古怪題目唔會佔多過10-20%

我明好多時會覺得個考試唔公平，覺得個分數唔能夠充分反映你嘅努力同能力。

你絕對entitle你對考試內容不滿嘅感受，this should be acknowledged and not dismissed and framed as you are just a whining child

3. 基本重要defining features你其實真係要識

你未必需要知道concurrent chemoRT for NPC個platinum based regimen係乜嘢，但你起碼都要知個mainstream treatment係乜，chemo要be aware of neutropenic fever，RT個概念係乜嘢，呢d真心同你以後日常工作有關嘅知識

你的確可以以後睇症時up to date所有嘢，但你起碼要有個概念先知要uptodate乜嘢，如果唔係真係search到2046無都未搵到個答案。

至於whole genome sequencing其實我覺得你唔需要知得好詳細，但都可以了解下到底迎l近年醫學因為基因學嘅發展而有幾大嘅進步，癌症同autoimmune等疾病嘅治療近年咁大嘅改變，基因研究功不可沒。

都係果句，唔識或答錯唔緊要，從中學習睇下知識，只份卷10%嘅題目真係唔會令你唔合格。

4. 好多前輩們其實可以諗諗你覆個學生嘅objective係乜嘢

如果你只係想開心share呀叔同老娘當年都係狂背書，呢d嘢係well expected嘅時候，你想achieve d咩嘢

現實就係有學生覺得考試唔能夠全面評核佢地嘅知識同能力，呢個係一個legitimate嘅感受。當我地立即judge佢嘅心態再下埋判決覺得佢唔會survive medical career，覺得佢無做醫生嘅資格或質素，甚至叫佢quit U or transfer，你係無address過個root cause and culprit

當然你絕對有權去覺得新世代都係whining child，心態有問題，但當你睇症時都可以嘗試去從病人角度出發再adjust your approach時，點解面對師弟師妹又唔可以呢？

我唔同意單憑一個secret post就落judgement去判一個人死罪再圍鞭一輪。

的確世界唔係圍繞一個人而轉，世界亦未必會為咗一個人而改變，但如果我地真心覺得有地方值得改善，係唔應該submit to the culture or system

The world might not change for you
But if you believe a change is needed
Be that change yourself

非主流意見遇咗實有人會唔同意

最後只想同所有讀緊醫嘅同學們講
Preclinical係好悶，clinical years會好好多。唔好睇考試睇太重，the last one who passes is still a doctor

相信自己嘅能力，捱過難關後便會有另一番天地

Don’t ever be defined by exams or other people

今早為Asian Medical Students Association Hong Kong (AMSAHK)的新一屆執行委員會就職典禮作致詞分享嘉賓，題目為「疫情中的健康不公平」。
感謝他們的熱情款待以及為整段致詞拍了影片。以下我附上致詞的英文原稿：

It's been my honor to be invited to give the closing remarks for the Inauguration Ceremony for the incoming executive committee of the Asian Medical Students' Association Hong Kong (AMSAHK) this morning. A video has been taken for the remarks I made regarding health inequalities during the COVID-19 pandemic (big thanks to the student who withstood the soreness of her arm for holding the camera up for 15 minutes straight), and here's the transcript of the main body of the speech that goes with this video:

//The coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, continues to be rampant around the world since early 2020, resulting in more than 55 million cases and 1.3 million deaths worldwide as of today. (So no! It’s not a hoax for those conspiracy theorists out there!) A higher rate of incidence and deaths, as well as worse health-related quality of life have been widely observed in the socially disadvantaged groups, including people of lower socioeconomic position, older persons, migrants, ethnic minority and communities of color, etc. While epidemiologists and scientists around the world are dedicated in gathering scientific evidence on the specific causes and determinants of the health inequalities observed in different countries and regions, we can apply the Social Determinants of Health Conceptual Framework developed by the World Health Organization team led by the eminent Prof Sir Michael Marmot, world’s leading social epidemiologist, to understand and delineate these social determinants of health inequalities related to the COVID-19 pandemic.

According to this framework, social determinants of health can be largely categorized into two types – 1) the lower stream, intermediary determinants, and 2) the upper stream, structural and macro-environmental determinants. For the COVID-19 pandemic, we realized that the lower stream factors may include material circumstances, such as people’s living and working conditions. For instance, the nature of the occupations of these people of lower socioeconomic position tends to require them to travel outside to work, i.e., they cannot work from home, which is a luxury for people who can afford to do it. This lack of choice in the location of occupation may expose them to greater risk of infection through more transportation and interactions with strangers. We have also seen infection clusters among crowded places like elderly homes, public housing estates, and boarding houses for foreign domestic helpers. Moreover, these socially disadvantaged people tend to have lower financial and social capital – it can be observed that they were more likely to be deprived of personal protective equipment like face masks and hand sanitizers, especially during the earlier days of the pandemic. On the other hand, the upper stream, structural determinants of health may include policies related to public health, education, macroeconomics, social protection and welfare, as well as our governance… and last, but not least, our culture and values. If the socioeconomic and political contexts are not favorable to the socially disadvantaged, their health and well-being will be disproportionately affected by the pandemic. Therefore, if we, as a society, espouse to address and reduce the problem of health inequalities, social determinants of health cannot be overlooked in devising and designing any public health-related strategies, measures and policies.

Although a higher rate of incidence and deaths have been widely observed in the socially disadvantaged groups, especially in countries with severe COVID-19 outbreaks, this phenomenon seems to be less discussed and less covered by media in Hong Kong, where the disease incidence is relatively low when compared with other countries around the world. Before the resurgence of local cases in early July, local spread of COVID-19 was sporadic and most cases were imported. In the earlier days of the pandemic, most cases were primarily imported by travelers and return-students studying overseas, leading to a minor surge between mid-March and mid-April of 874 new cases. Most of these cases during Spring were people who could afford to travel and study abroad, and thus tended to be more well-off. Therefore, some would say the expected social gradient in health impact did not seem to exist in Hong Kong, but may I remind you that, it is only the case when we focus on COVID-19-specific incidence and mortality alone. But can we really deduce from this that COVID-19-related health inequality does not exist in Hong Kong? According to the Social Determinants of Health Framework mentioned earlier, the obvious answer is “No, of course not.” And here’s why…

In addition to the direct disease burden, the COVID-19 outbreak and its associated containment measures (such as economic lockdown, mandatory social distancing, and change of work arrangements) could have unequal wider socioeconomic impacts on the general population, especially in regions with pervasive existing social inequalities. Given the limited resources and capacity of the socioeconomically disadvantaged to respond to emergency and adverse events, their general health and well-being are likely to be unduly and inordinately affected by the abrupt changes in their daily economic and social conditions, like job loss and insecurity, brought about by the COVID-19 outbreak and the corresponding containment and mitigation measures of which the main purpose was supposedly disease prevention and health protection at the first place. As such, focusing only on COVID-19 incidence or mortality as the outcomes of concern to address health inequalities may leave out important aspects of life that contributes significantly to people’s health. Recently, my research team and I collaborated with Sir Michael Marmot in a Hong Kong study, and found that the poor people in Hong Kong fared worse in every aspects of life than their richer counterparts in terms of economic activity, personal protective equipment, personal hygiene practice, as well as well-being and health after the COVID-19 outbreak. We also found that part of the observed health inequality can be attributed to the pandemic and its related containment measures via people’s concerns over their own and their families’ livelihood and economic activity. In other words, health inequalities were contributed by the pandemic even in a city where incidence is relatively low through other social determinants of health that directly concerned the livelihood and economic activity of the people. So in this study, we confirmed that focusing only on the incident and death cases as the outcomes of concern to address health inequalities is like a story half-told, and would severely truncate and distort the reality.

Truth be told, health inequality does not only appear after the pandemic outbreak of COVID-19, it is a pre-existing condition in countries and regions around the world, including Hong Kong. My research over the years have consistently shown that people in lower socioeconomic position tend to have worse physical and mental health status. Nevertheless, precisely because health inequality is nothing new, there are always voices in our society trying to dismiss the problem, arguing that it is only natural to have wealth inequality in any capitalistic society. However, in reckoning with health inequalities, we need to go beyond just figuring out the disparities or differences in health status between the poor and the rich, and we need to raise an ethically relevant question: are these inequalities, disparities and differences remediable? Can they be fixed? Can we do something about them? If they are remediable, and we can do something about them but we haven’t, then we’d say these inequalities are ultimately unjust and unfair. In other words, a society that prides itself in pursuing justice must, and I say must, strive to address and reduce these unfair health inequalities. Borrowing the words from famed sociologist Judith Butler, “the virus alone does not discriminate,” but “social and economic inequality will make sure that it does.” With COVID-19, we learn that it is not only the individuals who are sick, but our society. And it’s time we do something about it.

Thank you very much!//

Please join me in congratulating the incoming executive committee of AMSAHK and giving them the best wishes for their future endeavor!

Roger Chung, PhD
Assistant Professor, CUHK JC School of Public Health and Primary Care, @CUHK Medicine, The Chinese University of Hong Kong 香港中文大學 - CUHK
Associate Director, CUHK Institute of Health Equity

我都開通左Patreon了！我懇請大家訂閱我嘅Patreon，等我有資源同大家分享更多更高質嘅片！Stay Tune！

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?下面有主題目錄，直接跳轉?

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我地創作者團隊不斷製作左各式各樣嘅影片、文章 (由讀書、DSE到大學生活都有)，都放左上Flowsophic了！? 另外知道在場有好多中四中五嘅同學，上面有由狀元、神科學生創作嘅DSE筆記同模擬試卷，一定幫到你係屋企都可以有效學習！

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大家成日笑三大Science係水泡科，但係有無了解過實際有咩要讀? 仲聽講出路好狹窄，第時人工好難高得去邊? 今次邀請左UST IRE + CU BME (BioMed)嘅3位同學，同大家分享呢兩科嘅內幕資訊，同大家拆開Medic嘅神秘面紗！仲同大家分享面試Interview嘅絕密內容！

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鳴謝今次贊助場地的ST Music!
?Instagram帳號: https://www.instagram.com/stmusichk
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?Address地址: 觀塘工業中心第四期三樓E室

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追蹤我的動態！

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0:38 IRE有咩Major可以選擇?
1:07 IRE同Science有咩分別?
2:40 IRE同Biomed多唔多人轉入去?
3:56 IRE有無安排Exchange?
4:23 Biomed會讀咩範疇的知識?
5:17 兩科讀書競爭大唔大?
6:00 IRE收生比例係點?
6:26 UST Science的新收生模式!
7:00 每個UST Science都要讀的課程
7:20 CU Biomed真係能Trans入Medic?
10:01 抱咩心態讀IRE?
10:58 DSEr入IRE要點準備?
11:31 兩科Science讀書量有幾多?
12:21 科大的Honours Course係咩黎?
13:35 中大Biomed求生指南!
14:46 中大BMED與科大IRE畢業後的出路
17:37 Science科的入學面試係點?
20:33 讀Science會玩咩活動?
22:39 Biomed都要做Intern?
22:58 可以由Asso上番IRE?


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?更多影片?

【學系．大格鬥】第一回：三大環球商業學(GBUS) | 學生、老鬼同場交流 | JUPAS面試內幕
https://youtu.be/1N4Gr13caxk

【考前必看】7科5**榜眼的DSE一天：如何盡用時間，計劃Study Leave時間表？
https://youtu.be/gqy4bwV66xs

【學系．大格鬥】第二回：港大、中大醫學士(MBBS/MbChB) | Year 2至5學生同場交流 | JUPAS面試內幕
https://youtu.be/W90lb1jlons

【中大生活 CUHK Vlog】疫情下的中大一日遊：深入中大探險各處，停課後猶如空城？
https://youtu.be/lfIIWl5npBY

Royalty Free Music by Bensound (https://www.bensound.com/)

#jupas #cumed #hkumed

?下面有主題目錄，直接跳轉?

我地創作者團隊不斷製作左各式各樣嘅影片、文章 (由讀書、DSE到大學生活都有)，都放左上Flowsophic了！? 另外知道在場有好多中四中五嘅同學，上面有各款幫到你地嘅DSE筆記同Past Paper，快啲去支持下啊！

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讀MBBS/MBCHB嘅Medic醫科學生好似自成一角？會唔會個個都日日溫書？定係係Lab瘋狂做實驗？今日邀請左HKU MBBS + CU MBCHB嘅4位同學，同大家分享呢一科嘅內幕資訊，同大家拆開Medic嘅神秘面紗！仲同大家分享面試Interview嘅絕密內容！

——-

鳴謝今次贊助場地的ST Music!

?Instagram帳號: https://www.instagram.com/stmusichk
?Website網站: http://www.stmusic.com.hk/
?Address地址: 觀塘工業中心第四期三樓E室

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追蹤我的動態！

?Instagram帳號: https://www.instagram.com/ffclassroom
?Website網站: https://ffclassroom.com
?合作請洽: freezyflameff@gmail.com

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0:57 - 點解選擇HKU/CU Med?
3:31 - 咩係PBL (Problem Based Learning)?
4:42 - HKU vs CU 六年的課程編排
7:38 - 中大的Direct Year 2是甚麼?
8:28 - 入學面試內幕資訊?!
11:39 - 其他醫科轉到醫學士唔機會大唔大?
12:59 - Retake能考進Medic嗎?
13:13 - 讀6科能進CU Medic?
13:44 - 邊間大學生活比較豐富?
16:17 - HKU Med的One Night Stay活動
17:03 - HKU的High Table Dinner
17:42 - HKU、CU醫科學生必玩活動
19:45 - 讀Medic的未來出路係點?
21:11 - 一次過讀哂PhD + Master?
21:40 - Medic學生有咩Exchange機會?

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?更多影片?

【學系．大格鬥】第一回：三大環球商業學(GBUS) | 學生、老鬼同場交流 | JUPAS面試內幕
https://youtu.be/1N4Gr13caxk

【考前必看】7科5**榜眼的DSE一天：如何盡用時間，計劃Study Leave時間表？
https://youtu.be/gqy4bwV66xs

【考前衝刺】DSE LS 通識：有咩係大家一定要溫？ | 答題技巧以外的溫習方法 - 拆字、推論、例子
https://youtu.be/oxy5vFjTO64

【中大生活 CUHK Vlog】疫情下的中大一日遊：深入中大探險各處，停課後猶如空城？
https://youtu.be/lfIIWl5npBY

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#jupas #cumed #hkumed