The author of this article: Ding LiuchengFrom April 2021 to March 2022, he was supported by the Jiangsu Provincial Scholarship Committee and the 789 key talents of the Second Affiliated Hospital of Southern Medical University. Jointly funded, I went to the Affiliated Hospital of the University of Hamburg Medical School for a one-year visiting study. During this period, I participated in 3 clinical studies on urethral strictures and also participated as a Clinical observer in the UKE Urology and Prostate Cancer Centre Martini-Clinic Clinical practice and teaching. During my one year at the University of Hamburg Medical School, I have been thinking: How can I use other stones to solve my confusion? Now I will share with you my learning experiences and thoughts during this period. One-Stop ClinicThe doctor can decide the patient’s Time to see a doctorHamburg has a long history and beautiful environment. It is the center of culture, education and health care in northern Germany, with large areas of green space and countless canals. The University Hospital of Hamburg (UKE), located on the Klinikum University campus, is the most modern hospital in Europe with a history of 120 years and is home to many of Germany’s leading medical departments, such as the Martini-clinic prostate Cancer Center, Urology, Stem Cell Transplantation, Neurology, etc. 
Appearance of University Hospital of Hamburg (UKE) (photo by the author) UKE is located in the green Eppendorf district of Hamburg, opposite the Eppendorf Park, which is full of green trees and flowers. Coming here, I can deeply feel the importance and creation of the “cultural concept” by the hospital. UKE The hospital’s design philosophy fundamentally wants patients to feel as comfortable and comfortable as home. Convenience rather than coming to a place that is stressful due to illness. The entire hospital is open, with old buildings from various periods. The courtyard is very quiet, there is no bustling crowd, and everything is orderly. In the hospital, there are rest centers where patients drink coffee and talk. The corridors are decorated with various works of art. The hospital also provides full translation services for non-English-speaking patients who come to seek treatment. No matter what language the patient speaks, there is no need to worry about language problems when visiting a doctor. Martini-Clinic, one of the best prostate cancer centers in the world, adheres to the value system of “patient care is the core of everything”,this culture is also reflected in the hospital’s “” One-stop outpatient clinic” treatment process. 
The vast majority of the authors make appointments at the Martini-Clinic>German Prostate Cancer Center Patients can start outpatient appointments from the homepage of the hospital or medical school, and they can quickly lock in the target doctor by entering the doctor’s name, specialty or their own symptoms. Usually, it takes about 2 weeks to wait. Doctors can set the average time for each patient according to their specialty characteristics, and the outpatient time will be accurate to the minute, such as 10:20 am or 2:30 pm. After the appointment is successful, the doctor’s secretary will keep in touch with the patient, and will communicate in time if the clinic hours are changed. The patient arrives at the one-stop outpatient unit of the department according to the appointment time, and the nurse at the front desk collects the medical history, distributes the questionnaire and brings the patient to the clinic. Take urology as an example, patients can complete routine examinations such as urine routine without leaving the clinic, and the examination results are read by nurses in the clinic. After seeing that the patient is ready in the office area, the doctor first reads the patient’s medical record through the computer, and then asks the patient’s medical history in a focused manner. If further ultrasound, uroflow, and urodynamic tests are required, they can also be done directly in the outpatient unit. If a physical examination or cystoscopy is required, the nurse will assist the patient to position and change the clothes. The doctor can use this time gap to go to another clinic to ask another patient. This one-stop outpatient setting can basically allow patients to complete most of the necessary examinations in the clinic, eliminating the need for patients to be unfamiliar with the hospital’s institutions. There is also the pain of running around on various floors, departments, and examination rooms. Doctors can also shuttle between several clinics to improve work efficiency. On the day of the outpatient clinic, the doctor will clearly inform the patient about the current diagnosis, options for treatment, possible effects of surgery and complications, etc. If the patient accepts the operation plan, the secretary will arrange the operation schedule for the doctor according to the doctor’s schedule and the time required for the operation, usually after two weeks. The doctor decides whether the patient needs surgery, and the patient’s ability to undergo surgery requires further anesthesia evaluation. The anesthesia assessment is also carried out through the outpatient clinic, also in the one-stop anesthesia clinic (CPAP), where the anesthesiologist evaluates the patient’s condition through an evaluation system, and evaluates the surgical risk through simple and necessary examinations. Talking TraineeShow Me Authority Relationship with StudentsThe University of Hamburg Medical School and UKE are located in the same area, making the combination of clinical and teaching as convenient and efficient as possible. Germany is currently repositioning professional training from the current checklist model to a competency-based curriculum, introducing new professional training regulations in 2018. There are 10 surgical subspecialties in Germany: general surgery, visceral surgery, cardiac surgery, thoracic surgery, paediatric surgery, orthopaedic and trauma surgery, plastic surgery, vascular surgery, neurosurgery and oral and maxillofacial surgery. The first eight subspecialties of postgraduate surgical training are organized consistently, with separate training structures for neurosurgery and oral and maxillofacial surgery. German surgical training takes 6 years, the first 2 years include Basic clinical training, including 6 months in the emergency department, 6 months in the ICU, and 1 year in the surgical ward, can be done in any of the eight subspecialties listed above. The next 4 years are structured differently depending on the specialty, but the main part is carried out in the surgical department of the chosen specialty. In UKE, surgical operations are basically performed by two doctors. , and sometimes a resident. Each resident physician has a strict standardized rotation training program, and Internships are strictly 1-to-1 There is a lot of interaction and communication between students and teachers. The department has large ward rounds, case discussions, and business learning every week. UKE da Vinci robots are widely used, and the rate of robotic surgery in prostate cancer centers is over 70%. And I have my own training center. I can participate in training and on-board training once a month, which is very rewarding. 
Da Vinci robot-assisted radical prostatectomy (photo by the author)is what impressed me the most A few trainees, many times their questions seem to have thorns on their bodies, and sometimes they even ask indifferently, lest their words be surprising. Professor Fisch is good, every time he listens carefully and carefully and tells the details and opinions of surgical treatment of each disease without reservation; at the same time, he listens humbly to the rebuttals of students , and guide each other to ask questions. In particular, Professor Fisch was always able to persuade me to guide me into in-depth discussions, and never put on an authoritative posture. Every operation will make me feel the academic rigor and the excellence of surgical skills, and it will also burst out some new ideas or bring new inspiration. I have learned a lot of knowledge in one year. Here, what I learned the most and was deeply shocked was the relationship between authority and students, This completely open and free discussion between students and tutors is not only a form, but also a character and spirit. Comparing the Chinese and German training systems and systems, there is currently no specialized training system in my country. The following three points may be worth learning from: ① Increase financial expenditure, especially Financial appropriation from the State Department of Finance; ② the establishment of professional management institutions for non-governmental departments; 
Photo by the authorLet research results serve the clinic Comparatively speaking, German doctors do not feel so much research pressure. Of course, just like China, if you want to be promoted, you also need a thesis blessing, but it is not a necessary condition. German doctors have the right to choose whether to do scientific research or not. Under the current German system, doctors who only do clinical work and do not conduct scientific research can still be promoted. Of course, you can also rely on scientific research to get promoted, the two do not conflict. In UKE, many professors have their own laboratories. For professors who are committed to scientific research, in addition to clinical working hours, the hospital also rations They have a certain amount of research time. For residents who want to do scientific research, in addition to using their spare time, they also have the opportunity to apply for funding support, and they can do basic research full-time. They also regularly hold small academic conferences to exchange their scientific research results. Most of the research here focuses on clinical prospective and retrospective research, and the center’s research data is obtained through the research results, and the diagnosis and treatment system of diagnosis and treatment behavior and itinerary science are continuously adjusted according to the research results. Basic scientific research topics mostly come from the clinic, and fully consider the feasibility and clinical practical value. Once the research results are available, the clinical problems can be solved quickly, which is helpful for the establishment and standardization of the disease treatment system. For example, Martini-clinic, as the world’s largest prostate cancer center, is also the world’s largest clinical database with more than 30,000 cases. Through the prospective and retrospective analysis of the huge database, it can solve the problems of postoperative urinary control and sexual function recovery. Key factors and design were further studied by prospective RCT. High self-discipline and clear division of laborrules guard everything< /span>A brief introduction to Martini-Clinic’s weekly group meeting schedule. Every Monday morning at 7:10 am the basic scientific research academic report, the whole clinic will report and discuss the basic research field of prostate cancer; Every Tuesday morning at 7:00: 30 major ward rounds, in addition to undergraduate professors, there will also be prostate cancer experts from the world’s top hospitalsspeaking;Every Wednesday morning at 7:00 am in the Faculty of the Department, no matter the weather is good or bad, the thunder is unshakable,there are many old professors with gray hair and directors of various centers;< span>Clinical practice class is held at 7:30 every Thursday morning, and at the same time, the difficult cases and complications in the department are regularly summarized, reported and discussed; every Friday morning at 7:00, the whole hospital case discussion, not only Experts from the hospital will comment on the cases, and experts and professors from major hospitals in Germany will also be invited to comment on typical cases. Whether doctors or medical students, work from 7:00 am to 7:00 pm every day, no break at noon, self-discipline and efficient; whether it is surgery or scientific research, All demonstrate a strong sense of teamwork. During one year in the Affiliated Hospital of the Hamburg Medical College, I met many famous experts and scholars. Their dedication and high self-discipline have always touched and inspired me. 
Photo by the authorGermans give me the biggest impression in life It has its own place, and even everything has its proper place. German society abides by the rules very much, and “rules guard everything” is a true portrayal of German people’s daily life. This clear division of labor is also reflected in the collaboration of various departments in the hospital. For example, the surgical department in a hospital has a special secretary who is responsible for making patient reservations and scheduling operations; if clinical research is required, specialized researchers are responsible for it;Even small daily matters like the doctor’s need to book a meeting room are arranged and coordinated by a special secretary. 
The surgical robot system introduced by the prostate cancer center (photo by the author) >Contrast and ReflectionThis high division of labor in the whole society allows doctors and Medical students are generally in a more comfortable and step-by-step state, and the competition is relatively less intense. This down-to-earth work style also allows doctors to have more energy to do research that they are really interested in. However, this highly detailed division of labor can also lead to overstaffing, many people go to work on time and leave work on time, lack of initiative, and students may lack risk-taking Spirit. and Compared with domestic doctors, the overall work pressure of German doctors is indeed much less; but if compared with other industries in Germany, the weekly working hours of German doctors far exceed other industries. Also because of this highly detailed division of labor and detailed and clear training paths, most German clinicians currently specialize in a subspecialty. This is very different from our country. Because of the large number of patients in our country, all operations are carried out by the directors, so it is impossible to cover so many medical work, so The sub-specialties in our domestic hospitals are actually more like sub-organ departments. The doctors in the corresponding specialties cover more sub-specialties, and they can come into contact with different patients, diseases, and exercise opportunities. From the patient’s point of view, compared with domestic patients, the overall consultation period and out-of-hospital waiting time will be longer. Features. A Chinese friend in Germany gave me such an analogy: “In China, it is waiting for the number, and in Germany, it is waiting for the air”. On the other hand, too strong regularity of disease diagnosis and treatment may also cause certain problems. To a certain extent limit the subjective initiative of the doctor. In addition, although German academia adheres to the pragmatic tradition, does not blindly follow the trend, and does not regard the ranking list as the direction of the university’s development, the brand effect affects the This is one of the main reasons why the popularity of German university hospitals lags far behind that of British and American universities. From my communication with Chinese professors working in Germany, Germany has also made some adjustments in recent years, hoping to make its doctors more international and communicate more with the outside world . 
During his stay in Germany, his cooking skills improved significantly. span>Although the one-year study time in Hamburg is short, I have experienced the profound meaning of “reading ten thousand books, traveling ten thousand miles” and “the stone of other mountains can be used to attack jade”. Looking back on this year, I think the biggest “sutra” is to develop good habits: focus on time management; maintain self-discipline and preparation; emphasize teamwork. I would like to express my heartfelt thanks to the hospital departments for their strong support in the training of young teachers, as well as to the teachers, friends and family who have given me caring, loving and selfless help on my overseas study journey. Hamburg is indeed the door to the world, and now this door is open to meIt was an unforgettable experience in my life. The author Ding Liucheng, Deputy Chief Physician, Associate Professor, Ph.D. Young member of Jiangsu Urology Society, member of lithology group, young member of neuromodulation group of Jiangsu Medical Doctor Association. Planning: gyouza｜Image source: Author photoLilac Garden Recruitment 1. New Media Operations Intern (Lilac Garden)Independent operation of the Lilac Garden official account Lilac Morning Reading ColumnAssist in the operation of the Lilac Garden official accountWork location: HangzhouClick here Submit your resume directly2. New media operation (Lilac Garden) span>Complete original content planning independentlyAssist in the operation of Lilac Garden official account WeiboWork location: HangzhouPoint This direct resume can also be sent to the mailbox [email protected]Mail Title: Post Name-Name