Udokotela wezokwelapha (MD)

Ama-MDs angatholakala ngaphakathi kwezindlela ezahlukahlukene zokuzijwayeza, kufaka phakathi imikhuba yangasese, imikhuba yeqembu, izibhedlela, izinhlangano zokulondolozwa kwezempilo, izindawo zokufundisa nezinhlangano zezempilo zomphakathi.

Umkhuba wezokwelapha e-United States usukela ezikhathini zamakholoni (ekuqaleni kweminyaka yama-1600s). Ekuqaleni kwekhulu le-17, ezokwelapha eNgilandi zahlukaniswa zaba ngamaqembu amathathu: odokotela, odokotela abahlinzayo nabapholisayo.

Odokotela babonwa njengabantu abaphezulu. Babevame ukuba neziqu zaseyunivesithi. Odokotela abahlinzayo babejwayele ukuqeqeshwa esibhedlela futhi benza imisebenzi yokufunda. Babevame ukufeza indima ekabili yokuba ngumgundi ohlinzayo. Abaphilisi baphinde bafunda izindima zabo (ukunquma, ukwenza, nokuthengisa imithi) ngokufundela umsebenzi, kwesinye isikhathi ezibhedlela.

Lo mehluko phakathi kwezokwelapha, ukuhlinzwa nekhemisi awuzange uphile eMelika yamakoloni. Lapho ama-MDs alungiselelwe eyunivesithi evela eNgilandi efika eMelika, bekulindeleke ukuthi nabo benze ukuhlinza balungise nemithi.

INew Jersey Medical Society, eyaqashwa ngo-1766, yayiyinhlangano yokuqala yochwepheshe bezokwelapha emakoloni. Yasungulwa ukuze "yakhe uhlelo oluhlanganisa zonke izindaba ezibakhathaza kakhulu kulo mkhakha: ukulawulwa kokusebenza; amazinga ezemfundo abafundela umsebenzi; amasheduli wezimali; kanye nekhodi yokuziphatha." Kamuva le nhlangano yaba yiMedical Society yaseNew Jersey.

Izinhlangano eziqeqeshiwe zaqala ukulawula ukusebenza kwezokwelapha ngokuhlola nokunikeza amalayisense ekuqaleni kuka-1760. Ngasekuqaleni kweminyaka yama-1800, izinhlangano zezokwelapha zaziphethe ukusungula imithetho, izindinganiso zokusebenza, nokunikezwa isitifiketi kodokotela.

Isinyathelo esilandelayo semvelo ukuthi imiphakathi enjalo isungule eyayo izinhlelo zokuqeqesha odokotela. Lezi zinhlelo ezihambisana nomphakathi zabizwa ngamakholishi ezokwelapha "aphathelene".

Olokuqala lwalezi zinhlelo zobunikazi kwakuyikolishi lezokwelapha le-Medical Society of the County of New York, elasungulwa ngoMashi 12, 1807. Izinhlelo zobunikazi zaqala ukuvela yonke indawo. Bahehe inani elikhulu labafundi ngoba basuse izici ezimbili zezikole ezihambisana nemayunivesithi: imfundo ejwayelekile ende kanye nesikhathi eside sokufundisa.

Ukubhekana nokuhlukunyezwa okuningi kwezemfundo yezokwelapha, kwabanjwa umhlangano kazwelonke ngoMeyi 1846. Iziphakamiso ezivela kulowo mhlangano zazihlanganisa okulandelayo:

• Ikhodi ejwayelekile yezimiso zomsebenzi
• Ukwamukelwa kwamazinga afanayo emfundo ephakeme ama-MDs, kufaka phakathi izifundo zemfundo yangaphambi kokulungiselela
• Ukwakhiwa kwenhlangano yezokwelapha kazwelonke

NgoMeyi 5, 1847, izihambeli ezicishe zibe ngu-200 ezazimele izinhlangano zezokwelapha ezingama-40 namakholeji angama-28 avela ezifundazweni ezingama-22 naseSifundeni SaseColombia zahlangana. Bazixazulule ngokwabo esigabeni sokuqala se-American Medical Association (AMA). UNathaniel Chapman (1780-1853) wakhethwa njengomongameli wokuqala wenhlangano. I-AMA isiphenduke inhlangano enethonya elikhulu ezindabeni eziphathelene nokunakekelwa kwezempilo e-United States.

I-AMA ibeka amazinga ezemfundo ama-MDs, kufaka phakathi okulandelayo:

• Imfundo evulekile kwezobuciko nesayensi
• Isitifiketi sokuqedela ukufundela umsebenzi ngaphambi kokungena ekolishi lezokwelapha
• Iziqu ze-MD ezihlanganisa iminyaka emithathu yokufunda, kufaka phakathi izikhathi ezimbili zokufundisa izinyanga eziyisithupha, izinyanga ezi-3 ezinikelwe ekuhlukaniseni, kanye nesikhathi esincane sezinyanga eziyisithupha sokuya esibhedlela

Ngo-1852, amazinga abuyekezwa ukufaka ezinye izidingo:

• Izikole zobudokotela kwakudingeka zinikeze izifundo zemaviki awu-16 ezazifaka i-anatomy, umuthi, ukuhlinza, ukubelethisa kanye namakhemikhali
• Abathweswe iziqu bekufanele okungenani babe neminyaka engama-21 ubudala
• Abafundi bekufanele bagcwalise ubuncane beminyaka engu-3 yokufunda, iminyaka engu-2 yayo ebingaphansi kukadokotela owamukelekayo

Phakathi kuka-1802 no-1876, kwasungulwa izikole zezokwelapha ezingama-62 ezizinzile. Ngo-1810, kwakukhona abafundi abangu-650 ababhalisile nabayi-100 abaphothule ezikoleni zezokwelapha e-United States. Ngo-1900, lezi zinombolo zase zikhuphukele kubafundi abangama-25,000 nabafundi abangu-5 200. Cishe bonke laba abathweswe iziqu kwakungabesilisa abamhlophe.

UDaniel Hale Williams (1856-1931) wayengomunye wama-MDs amnyama okuqala. Ngemuva kokuphothula eNyuvesi YaseNyakatho-ntshonalanga ngonyaka we-1883, uDkt Williams wenza ukuhlinza eChicago futhi kamuva waba ngamandla amakhulu ekusunguleni isibhedlela iProvident, esisasebenza eSouth Side yaseChicago. Phambilini odokotela abamnyama bakuthola kunzima ukuthola amalungelo okwenza ubudokotela ezibhedlela.

U-Elizabeth Blackwell (1821-1920), ngemuva kokuthweswa iziqu eGeneva College of Medicine enyakatho neNew York, waba ngowesifazane wokuqala owathola iziqu ze-MD e-United States.

IJohns Hopkins University School of Medicine ivulwe ngo-1893. Kucashunwa njengesona sikole sokuqala sezokwelapha eMelika "sohlobo lwenyuvesi lwangempela, esinamandla anele, amalabhorethri ahlome kahle, othisha banamuhla abazinikele ekuphenyweni kwezokwelapha nasekufundisweni, isibhedlela lapho ukuqeqeshwa kodokotela nokwelashwa kwabantu abagulayo kuhlangene khona ukuze kuzuze kokubili. " Kuthathwa njengeyokuqala, kanye nemodeli yawo wonke amanyuvesi ocwaningo akamuva. Isikole Sezokwelapha iJohns Hopkins sasebenza njengesibonelo sokuhlelwa kabusha kwemfundo yezokwelapha. Ngemuva kwalokhu, izikole eziningi zezokwelapha ezisezingeni eliphansi zivaliwe.

Izikole zobudokotela zase ziphenduke izigayo eziningi zediploma, ngaphandle kwezikole ezimbalwa ezisemadolobheni amakhulu. Izinguquko ezimbili zikushintshile lokho. Owokuqala kwakungu- "Flexner Report," owashicilelwa ngo-1910. U-Abraham Flexner wayenguthisha oholayo owacelwa ukuba afunde izikole zezokwelapha zaseMelika. Umbiko wakhe ongemuhle kakhulu nezincomo zakhe zokwenza ngcono kwaholela ekuvalweni kwezikole eziningi ezingekho ezingeni nasekusungulweni kwamazinga aphambili emfundo yezokwelapha yangempela.

Okunye ukuthuthuka kwavela kuSir William Osler, waseCanada owayengomunye wosolwazi abakhulu bezokwelapha emlandweni wanamuhla. Usebenze eMcGill University eCanada, wabe esefunda e-University of Pennsylvania, ngaphambi kokuba aqashwe njengodokotela omkhulu wokuqala futhi ongomunye wabasunguli be-Johns Hopkins University. Lapho wasungula ukuqeqeshwa kokuqala kokuhlala (ngemuva kokuphothula esikoleni sobudokotela) futhi waba ngowokuqala ukuletha abafundi embhedeni wesiguli. Ngaphambi kwalesosikhathi, abafundi bezokwelapha babefunda ezincwadini ezifundwayo kuphela kuze kube bayaphuma bayozilolonga, ngakho-ke babengenalwazi olutheni. U-Osler ubuye wabhala incwadi yokuqala ephelele, yesayensi yezokwelapha futhi kamuva waya e-Oxford njengoprofesa waseRegent, lapho afundiswa khona. Usungule ukunakekelwa okugxile ezigulini nezindinganiso eziningi zokuziphatha nezesayensi.

Ngo-1930, cishe zonke izikole zezokwelapha zazidinga iziqu zobuciko obukhulu ukuze zamukelwe futhi zanikeza ikharikhulamu yeminyaka engu-3 kuye kwengu-4 kwezokwelapha nokuhlinzwa. Izifundazwe eziningi bezidinga nokuthi abazobhapathizwa bagcwalise unyaka owodwa wokuqeqeshwa emsebenzini esibhedlela ngemuva kokuthola iziqu esikoleni esaziwayo sezokwelapha ukuze banikeze ilayisense umkhuba wezokwelapha.

Odokotela baseMelika abakaqali ukugxila kuze kube maphakathi nekhulu lama-20. Abantu abaphikisana nokwenza okuthile bathi "amakhono ayengasebenzi ngendlela efanelekile kudokotela ojwayelekile, okusho ukuthi akakwazi ukwelapha izigaba ezithile zezifo." Baphinde bathi ubuchwepheshe bujwayele "ukululaza udokotela ojwayelekile ngokubuka umphakathi." Kodwa-ke, njengoba ulwazi nezindlela zokwelapha zanda odokotela abaningi bakhetha ukugxila ezindaweni ezithile ezithile futhi babone ukuthi isethi yabo yamakhono ingasiza kakhulu kwezinye izimo.

Ezomnotho nazo zadlala indima ebalulekile, ngoba ongoti babehola imali ephezulu ukwedlula odokotela abajwayelekile. Izinkulumompikiswano eziphakathi kochwepheshe kanye nojenene ziyaqhubeka, futhi zisanda kuchukunyiswa yizinkinga eziphathelene nokuguqulwa kwezempilo kwanamuhla.

UKULINGANISWA KOKWENZA

Ukwenza umuthi kufaka phakathi ukuxilongwa, ukwelashwa, ukulungiswa, ukwelulekwa, noma ukwelashwa kwanoma yisiphi isifo somuntu, ukugula, ukulimala, ukukhubazeka, ukukhubazeka, ubuhlungu, noma esinye isimo, ngokomzimba noma ngokwengqondo, okwangempela noma okucatshangwayo.

UKULAWULWA KOMSEBENZI

Ezokwelapha bekungokokuqala emisebenzini yokudinga amalayisense. Imithetho yombuso mayelana nelayisense yezokwelapha ichaze "ukuxilongwa" kanye "nokwelashwa" kwezimo zabantu kwezokwelapha. Noma yimuphi umuntu owayefuna ukuxilonga noma aphathe njengengxenye yomsebenzi angakhokhiswa "ngokwenza umuthi ngaphandle kwelayisense."

Namuhla, ezokwelapha, njengezinye izikhungo eziningi, zilawulwa emazingeni ahlukahlukene ahlukahlukene:

• Izikole Zezokwelapha kumele zinamathele emazingeni e-American Association of Medical Colleges
• Ilayisense inqubo eyenzeka ezingeni likahulumeni ngokuya ngemithetho ethile yezwe
• Izitifiketi zisungulwa ngezinhlangano zikazwelonke ezinezidingo zikazwelonke ezingaguquguquki zamazinga aphansi okwenza umkhuba

Ilayisense: Zonke izifunda zidinga ukuthi abafakizicelo belayisense ye-MD babe abaphothule esikoleni sezokwelapha esivunyelwe futhi baqedele i-United States Medical Licensing Exam (USMLE) Izinyathelo 1 kuye ku-3. Izinyathelo 1 no-2 ziyaqedwa ngenkathi usesikoleni sezokwelapha kanti isinyathelo 3 siqedwa ngemuva kokuqeqeshwa okuthile kwezokwelapha (imvamisa iphakathi kwezinyanga eziyi-12 kuya kwezingu-18, kuya ngesimo). Abantu abazuze iziqu zabo zobudokotela kwamanye amazwe nabo kumele banelise lezi zidingo ngaphambi kokwenza umuthi e-United States.

Ngokwethulwa kwe-telemedicine, kube nokukhathazeka ngokuthi zizosingathwa kanjani izingqinamba zamalayisense wombuso lapho umuthi kwabelwana ngawo phakathi kwamazwe ngokusebenzisa ezokuxhumana ngocingo. Kuyadingidwa imithetho nemihlahlandlela. Ezinye izifundazwe zisanda kusungula izinqubo zokwamukela amalayisense odokotela abasebenza kwezinye izifunda ngezikhathi eziphuthumayo, njengangemva kweziphepho noma ukuzamazama komhlaba.

Isitifiketi: Ama-MD afisa ukugxila kumele aqedele iminyaka engu-3 kuya kwengu-9 yomsebenzi wokuphothula iziqu endaweni yabo ekhethekile, bese ephasa izivivinyo zebhodi. Imithi Yomndeni yiyona ekhethekile enendawo ebanzi yokuqeqeshwa nokwenza. Odokotela abathi basebenza ngokukhethekile kufanele baqinisekiswe ngamabhodi kuleyo ndawo ethile yokusebenza. Kodwa-ke, akuyona yonke "izitifiketi" ezivela ezinhlanganweni zemfundo ezaziwayo. Iningi lama-ejensi athembekile okuqinisekisa ayingxenye ye-American Board of Medical Specialties. Izibhedlela eziningi ngeke zivumele odokotela noma odokotela abahlinzayo ukuthi basebenze kubasebenzi babo uma bengekho ebhodini abaqinisekisiwe ngokukhethekile okufanele.

Udokotela

• Izinhlobo zabahlinzeki bokunakekelwa kwempilo

I-Federation of State Medical Boards iwebhusayithi. Mayelana ne-FSMB. www.fsmb.org/about-fsmb/. Kufinyelelwe ngoFebhuwari 21, 2019.

IGoldman L, iSchafer AI. Indlela yokwelashwa, isiguli, nomsebenzi wezokwelapha: umuthi njengomsebenzi ofundile nobuntu. Ku: IGoldman L, iSchafer AI, ama-eds. Imithi yeGoldman-Cecil. Umhla ka-25. IPhiladelphia, PA: Elsevier Saunders; 2016: isahluko 1.

IKaljee L, iStanton BF. Izinkinga zamasiko ekunakekelweni kwezingane. Ku: Kliegman RM, Stanton BF, St Geme JW, Schor NF, ama-eds. Incwadi kaNelson Yezingane. Umhla ka-20. IPhiladelphia, PA: Elsevier; 2016: isahluko 4.