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段涛医生：混乱的医学教育体系与纠结的住院医生培养制度

2016-01-20 段涛医生 段涛医生微信公众号

医学教育体系住院医师规培
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最近的年轻医生“双规”（住院医生规培和专科医生规培）成了大家的讨论热点和吐槽的对象，朋友圈里有不少让人觉得既好笑又心酸的段子。 其实，对于住院医生和专科医生的规范化培训的必要性，大家没有什么异议，关键在于怎么做。大家最不满意的是，对于绝大多数的规培生来讲，培训期间根本学不到真本领，沦落为每天写病史，拉钩，值夜班的劳动力；还有就是待遇太低，不少人的收入只有每月1000-2000元，每月收入

最近的年轻医生“双规”（住院医生规培和专科医生规培）成了大家的讨论热点和吐槽的对象，朋友圈里有不少让人觉得既好笑又心酸的段子。

其实，对于住院医生和专科医生的规范化培训的必要性，大家没有什么异议，关键在于怎么做。大家最不满意的是，对于绝大多数的规培生来讲，培训期间根本学不到真本领，沦落为每天写病史，拉钩，值夜班的劳动力；还有就是待遇太低，不少人的收入只有每月1000-2000元，每月收入超过5000元的很少。

原来想咬咬牙3年也就过去了，现在好，接下来还要再来2-4年的专科医生规培，也难怪消息一出就让小医生们炸了锅。

混乱的医学教育体系

中国医疗现状混乱的根子在于我们的医学教育体系，只要仔细比较一下中国和美国的医学教育体系的区别，高下立刻就分出来了：

美国的医学教育是精英教育，注重的是质量而不是数量；美国每年每个专科给出的License（医生执照）的数量是相对固定的，每年招收住院医生的数量也是相对固定的，与医学院毕业学生的数量有一个相对固定的比例。其精英教育的理念是要保持一定的淘汰率，尽管能够考进医学院的学生都是成绩优秀的，但是还是要保持淘汰机制，有些人并不适合做医生。

美国医学教育的定位清晰，分工明确，医学院的重点是基础教育，出来的毕业生是半成品。医生的临床能力取决于毕业后的住院医生培训制度和专科医生培训制度，不取决于你在医学院读5年还是8年。

医学院培养的是基础知识，研究生培养的是科研能力，住院医生和专科医生培养的是临床能力。

美国医学教育制度的设计很简单，要想做临床医生，必须有MD，要想做学术型的医生，还要在MD的基础上读PhD。多数情况下是以4+4的8年MD为主：4年的本科学习，毕业后进入医学院进行4年学习。如果是MD+PhD的话，需要在MD的基础上增加4-5年。

美国大多数MD+PhD 项目采用“2 年+3-5年+2 年”的学制。第一、二年学习基础课程，然后用三到五年时间完成PhD阶段的训练，最后再用两年进行临床课程学习和技能训练。基础和临床的相互穿插使学生能够同时把握科研和诊疗两个视角；另外，把临床训练放在最后阶段的设计，有利于学生顺利进入毕业后的住院医师规范化培训。

中国的医学教育体系一直比较混乱，定位不清，就连最基本的学制也是随便改来改去，有时候连一届学生还没有毕业就又出台新政策。

在学制方面，我们有3年，5年，6年，7年，8年制。在学位方面除了学士以外，我们还有科研硕士，临床硕士，科研博士，临床博士，这些人毕业出来都可以做医生。

同样是博士，我们既有临床博士，又有科研博士，还有八年制博士，TA们的水平和能力是千差万别。

以8年制为例，号称是培养未来的医学精英，毕业给的是博士学位，招收的也都是好学生。由于多数时间还是花在学校读书，进临床又没有动手机会，又不安排时间进实验室做科学研究，结果毕业以后既看不到临床能力好在哪里，又没有在实验室泡过，科研基础几乎为零，成了四不像，真是糟蹋了这帮孩子。

纠结的住院医生培养制度

我们的住院医生规培制度也是在学习美国，但是由于纠结太多，最后还是招致很多的抱怨和不满。

美国住院医生的培养时间因学科不同而异，多数是4-5年，例如妇产科住院医生培训时间就是4年。Fellow（专科医生）的培训也是因学科不同而异，多数是2-3年。

我们在设计住院医生规培制度时，担心完全和美国接轨会带来很大的社会不稳定，就做了让步。首先是不给铁饭碗了，从原来的单位人变为社会人，这样使得规培生一下子没了安全感，而且收入非常低。为了减少大家的抵触情绪，在规培的时间上做了让步，缩短为1-3年（博士可以一年，硕士可以2年，本科可以三年考试出基地），新出台的专科医生培训时间为2-3年。

其实，从培训时间和培训的内容来看，我们的住院医生规培只是相当于住院医生规培的第一阶段，我们的专科医生培训只是相当于住院医生规培的第二阶段，这又成了四不像。

以妇产科为例，美国的专科医生培训结束以后，出来的是母胎医学专科医生，是妇科肿瘤专科医生，而我们目前的“住规培”＋“专规培”培养出来的人充其量只是个妇产科住院医生的水平。

我们一妇婴的尝试

1. 对接美国的住院医生和专科医生培训体系：正在和美国的大学医院商谈，准备系统引进美国的妇产科住院医生和Fellow的培训理念，培训要求，培训的Curriculum，聘请美国的妇产科住院医生和Fellow的Program Director做我们的顾问。

2. 组建真正的Teaching Faculty：我们在选拔合适的临床骨干送往美国进行培训，让我们的规培生有真正合格的，和国际接轨的，愿意带教的临床导师，让规培生的临床能力可以达到美国住院医生的水平，这个队伍已经有了雏形。

3. 建立国际水平的临床模拟实训中心：我们拿出2000多平方米的一个楼面，投资超过2000万人民币建立了全中国最好的（也可能是全世界最好的）state of art妇产科临床模拟实训中心，单个妇产科模拟机器病人的价格就要超过一百万。模拟实训团队已经建立，已经在编写、试行和优化模拟各种妇产科和新生儿科危急重症抢救的模块化课程，今年3月份就可以试运行。

在这里，规培生首先要在模型上进行手术操作培训，熟练掌握考核通过以后才可以在患者身上实际操作。

除了个人的临床技术要过硬以外，还要和整个多学科医护团队一起参与抢救危重患者的模拟实训，要经风雨，见世面，扛得住才行。

我们还在招募志愿者做SP（Standard Patient标准化病人）来培训我们住院医生的临床诊断能力和医患沟通能力，我们也在招聘专职的模拟实训中心的主任，约吗？

4. 别亏待孩子们：人心都是肉长的，我们要善待规培生，给TA们合理的收入。一妇婴一年级规培生的平均年收入是11W＋，二年级规培生的平均年收入是17W＋，如果你是优秀规培生（有SCI文章的要求）的话，在此基础上每年再多6W。

此文一发布，引来大家的热议，以下是微信朋友圈的对话截屏：


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    2016-04-20 1de7460am01(暂无匿称)

    不同尝试总是好，不好的终被淘汰。

    0

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    2016-05-31 shizhenshan

    #住院医生#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=79850, encodeId=de5ae985083, content=不同尝试总是好，不好的终被淘汰。, beContent=null, objectType=article, channel=null, level=null, likeNumber=179, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=225a1697989, createdName=1de7460am01(暂无匿称), createdTime=Wed Apr 20 22:07:00 CST 2016, time=2016-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1950030, encodeId=7aa6195003063, content=<a href='/topic/show?id=d525264302b' target=_blank style='color:#2F92EE;'>#住院医生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26430, encryptionId=d525264302b, topicName=住院医生)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ccbd84, createdName=shizhenshan, createdTime=Tue May 31 13:40:00 CST 2016, time=2016-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635909, encodeId=b0dc163590905, content=<a href='/topic/show?id=a2ac6348397' target=_blank style='color:#2F92EE;'>#段涛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63483, encryptionId=a2ac6348397, topicName=段涛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd7e22540886, createdName=ms1065684921169360, createdTime=Sun May 29 07:40:00 CST 2016, time=2016-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61202, encodeId=d13061202ca, content=混乱不堪, beContent=null, objectType=article, channel=null, level=null, likeNumber=149, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 19:11:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61203, encodeId=86a6612037b, content=体制啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 19:11:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61204, encodeId=6a446120454, content=瞎改, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 19:11:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508781, encodeId=80af1508e8144, content=<a href='/topic/show?id=6be8264220c' target=_blank style='color:#2F92EE;'>#住院医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26422, encryptionId=6be8264220c, topicName=住院医)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Fri Jan 22 04:40:00 CST 2016, time=2016-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=58510, encodeId=c3615851057, content=典型的东施效颦。, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLAibgOibuZnfdFE64hJHibbD6WwEgyaXx7DtibMOSicJ6JZoLEAIdAdkhDmHWO7P7OXg2tkTicZy9libryicw/0, createdBy=aa991670466, createdName=sword20000, createdTime=Wed Jan 20 14:01:00 CST 2016, time=2016-01-20, status=1, ipAttribution=)]
    2016-05-29 ms1065684921169360

    #段涛#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=79850, encodeId=de5ae985083, content=不同尝试总是好，不好的终被淘汰。, beContent=null, objectType=article, channel=null, level=null, likeNumber=179, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=225a1697989, createdName=1de7460am01(暂无匿称), createdTime=Wed Apr 20 22:07:00 CST 2016, time=2016-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1950030, encodeId=7aa6195003063, content=<a href='/topic/show?id=d525264302b' target=_blank style='color:#2F92EE;'>#住院医生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26430, encryptionId=d525264302b, topicName=住院医生)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ccbd84, createdName=shizhenshan, createdTime=Tue May 31 13:40:00 CST 2016, time=2016-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635909, encodeId=b0dc163590905, content=<a href='/topic/show?id=a2ac6348397' target=_blank style='color:#2F92EE;'>#段涛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63483, encryptionId=a2ac6348397, topicName=段涛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd7e22540886, createdName=ms1065684921169360, createdTime=Sun May 29 07:40:00 CST 2016, time=2016-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61202, encodeId=d13061202ca, content=混乱不堪, beContent=null, objectType=article, channel=null, level=null, likeNumber=149, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 19:11:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61203, encodeId=86a6612037b, content=体制啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 19:11:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61204, encodeId=6a446120454, content=瞎改, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 19:11:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508781, encodeId=80af1508e8144, content=<a href='/topic/show?id=6be8264220c' target=_blank style='color:#2F92EE;'>#住院医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26422, encryptionId=6be8264220c, topicName=住院医)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Fri Jan 22 04:40:00 CST 2016, time=2016-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=58510, encodeId=c3615851057, content=典型的东施效颦。, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLAibgOibuZnfdFE64hJHibbD6WwEgyaXx7DtibMOSicJ6JZoLEAIdAdkhDmHWO7P7OXg2tkTicZy9libryicw/0, createdBy=aa991670466, createdName=sword20000, createdTime=Wed Jan 20 14:01:00 CST 2016, time=2016-01-20, status=1, ipAttribution=)]
    2016-01-27 李继凯

    混乱不堪

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=79850, encodeId=de5ae985083, content=不同尝试总是好，不好的终被淘汰。, beContent=null, objectType=article, channel=null, level=null, likeNumber=179, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=225a1697989, createdName=1de7460am01(暂无匿称), createdTime=Wed Apr 20 22:07:00 CST 2016, time=2016-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1950030, encodeId=7aa6195003063, content=<a href='/topic/show?id=d525264302b' target=_blank style='color:#2F92EE;'>#住院医生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26430, encryptionId=d525264302b, topicName=住院医生)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ccbd84, createdName=shizhenshan, createdTime=Tue May 31 13:40:00 CST 2016, time=2016-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635909, encodeId=b0dc163590905, content=<a href='/topic/show?id=a2ac6348397' target=_blank style='color:#2F92EE;'>#段涛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63483, encryptionId=a2ac6348397, topicName=段涛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd7e22540886, createdName=ms1065684921169360, createdTime=Sun May 29 07:40:00 CST 2016, time=2016-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61202, encodeId=d13061202ca, content=混乱不堪, beContent=null, objectType=article, channel=null, level=null, likeNumber=149, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 19:11:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61203, encodeId=86a6612037b, content=体制啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 19:11:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61204, encodeId=6a446120454, content=瞎改, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 19:11:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508781, encodeId=80af1508e8144, content=<a href='/topic/show?id=6be8264220c' target=_blank style='color:#2F92EE;'>#住院医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26422, encryptionId=6be8264220c, topicName=住院医)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Fri Jan 22 04:40:00 CST 2016, time=2016-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=58510, encodeId=c3615851057, content=典型的东施效颦。, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLAibgOibuZnfdFE64hJHibbD6WwEgyaXx7DtibMOSicJ6JZoLEAIdAdkhDmHWO7P7OXg2tkTicZy9libryicw/0, createdBy=aa991670466, createdName=sword20000, createdTime=Wed Jan 20 14:01:00 CST 2016, time=2016-01-20, status=1, ipAttribution=)]
    2016-01-27 李继凯

    体制啊

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=79850, encodeId=de5ae985083, content=不同尝试总是好，不好的终被淘汰。, beContent=null, objectType=article, channel=null, level=null, likeNumber=179, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=225a1697989, createdName=1de7460am01(暂无匿称), createdTime=Wed Apr 20 22:07:00 CST 2016, time=2016-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1950030, encodeId=7aa6195003063, content=<a href='/topic/show?id=d525264302b' target=_blank style='color:#2F92EE;'>#住院医生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26430, encryptionId=d525264302b, topicName=住院医生)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ccbd84, createdName=shizhenshan, createdTime=Tue May 31 13:40:00 CST 2016, time=2016-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635909, encodeId=b0dc163590905, content=<a href='/topic/show?id=a2ac6348397' target=_blank style='color:#2F92EE;'>#段涛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63483, encryptionId=a2ac6348397, topicName=段涛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd7e22540886, createdName=ms1065684921169360, createdTime=Sun May 29 07:40:00 CST 2016, time=2016-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61202, encodeId=d13061202ca, content=混乱不堪, beContent=null, objectType=article, channel=null, level=null, likeNumber=149, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 19:11:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61203, encodeId=86a6612037b, content=体制啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 19:11:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61204, encodeId=6a446120454, content=瞎改, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 19:11:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508781, encodeId=80af1508e8144, content=<a href='/topic/show?id=6be8264220c' target=_blank style='color:#2F92EE;'>#住院医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26422, encryptionId=6be8264220c, topicName=住院医)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Fri Jan 22 04:40:00 CST 2016, time=2016-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=58510, encodeId=c3615851057, content=典型的东施效颦。, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLAibgOibuZnfdFE64hJHibbD6WwEgyaXx7DtibMOSicJ6JZoLEAIdAdkhDmHWO7P7OXg2tkTicZy9libryicw/0, createdBy=aa991670466, createdName=sword20000, createdTime=Wed Jan 20 14:01:00 CST 2016, time=2016-01-20, status=1, ipAttribution=)]
    2016-01-27 李继凯

    瞎改

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=79850, encodeId=de5ae985083, content=不同尝试总是好，不好的终被淘汰。, beContent=null, objectType=article, channel=null, level=null, likeNumber=179, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=225a1697989, createdName=1de7460am01(暂无匿称), createdTime=Wed Apr 20 22:07:00 CST 2016, time=2016-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1950030, encodeId=7aa6195003063, content=<a href='/topic/show?id=d525264302b' target=_blank style='color:#2F92EE;'>#住院医生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26430, encryptionId=d525264302b, topicName=住院医生)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ccbd84, createdName=shizhenshan, createdTime=Tue May 31 13:40:00 CST 2016, time=2016-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635909, encodeId=b0dc163590905, content=<a href='/topic/show?id=a2ac6348397' target=_blank style='color:#2F92EE;'>#段涛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63483, encryptionId=a2ac6348397, topicName=段涛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd7e22540886, createdName=ms1065684921169360, createdTime=Sun May 29 07:40:00 CST 2016, time=2016-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61202, encodeId=d13061202ca, content=混乱不堪, beContent=null, objectType=article, channel=null, level=null, likeNumber=149, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 19:11:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61203, encodeId=86a6612037b, content=体制啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 19:11:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61204, encodeId=6a446120454, content=瞎改, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 19:11:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508781, encodeId=80af1508e8144, content=<a href='/topic/show?id=6be8264220c' target=_blank style='color:#2F92EE;'>#住院医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26422, encryptionId=6be8264220c, topicName=住院医)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Fri Jan 22 04:40:00 CST 2016, time=2016-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=58510, encodeId=c3615851057, content=典型的东施效颦。, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLAibgOibuZnfdFE64hJHibbD6WwEgyaXx7DtibMOSicJ6JZoLEAIdAdkhDmHWO7P7OXg2tkTicZy9libryicw/0, createdBy=aa991670466, createdName=sword20000, createdTime=Wed Jan 20 14:01:00 CST 2016, time=2016-01-20, status=1, ipAttribution=)]
    2016-01-22 仁者大医

    #住院医#

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=79850, encodeId=de5ae985083, content=不同尝试总是好，不好的终被淘汰。, beContent=null, objectType=article, channel=null, level=null, likeNumber=179, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=225a1697989, createdName=1de7460am01(暂无匿称), createdTime=Wed Apr 20 22:07:00 CST 2016, time=2016-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1950030, encodeId=7aa6195003063, content=<a href='/topic/show?id=d525264302b' target=_blank style='color:#2F92EE;'>#住院医生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26430, encryptionId=d525264302b, topicName=住院医生)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ccbd84, createdName=shizhenshan, createdTime=Tue May 31 13:40:00 CST 2016, time=2016-05-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635909, encodeId=b0dc163590905, content=<a href='/topic/show?id=a2ac6348397' target=_blank style='color:#2F92EE;'>#段涛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63483, encryptionId=a2ac6348397, topicName=段涛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd7e22540886, createdName=ms1065684921169360, createdTime=Sun May 29 07:40:00 CST 2016, time=2016-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61202, encodeId=d13061202ca, content=混乱不堪, beContent=null, objectType=article, channel=null, level=null, likeNumber=149, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 19:11:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61203, encodeId=86a6612037b, content=体制啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 19:11:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61204, encodeId=6a446120454, content=瞎改, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 19:11:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1508781, encodeId=80af1508e8144, content=<a href='/topic/show?id=6be8264220c' target=_blank style='color:#2F92EE;'>#住院医#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26422, encryptionId=6be8264220c, topicName=住院医)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8e886, createdName=仁者大医, createdTime=Fri Jan 22 04:40:00 CST 2016, time=2016-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=58510, encodeId=c3615851057, content=典型的东施效颦。, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLAibgOibuZnfdFE64hJHibbD6WwEgyaXx7DtibMOSicJ6JZoLEAIdAdkhDmHWO7P7OXg2tkTicZy9libryicw/0, createdBy=aa991670466, createdName=sword20000, createdTime=Wed Jan 20 14:01:00 CST 2016, time=2016-01-20, status=1, ipAttribution=)]
    2016-01-20 sword20000

    典型的东施效颦。

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