Ugqirha wobungcali bamayeza (MD)

Ii-MDs zinokufumaneka kuluhlu olubanzi lwezicwangciso zokuziqhelanisa, kubandakanya neendlela zabucala, iindlela ezenziwa ngamaqela, izibhedlele, imibutho yolondolozo lwempilo, amaziko okufundisa, kunye nemibutho yezempilo yoluntu.

Ukuziqhelanisa neyeza e-United States kubuyela emva kwixesha lama-colonial (kwii-1600s zakuqala). Ekuqaleni kwenkulungwane ye-17, ezonyango eNgilani zahlulwahlulwa zangamacandelo amathathu: oogqirha, ogqirha, kunye nabapheki.

Oogqirha babonwa njengabantu abakhethekileyo. Bahlala bebambe isidanga saseyunivesithi. Oogqirha babedla ngokuqeqeshwa esibhedlele kwaye benza uqeqesho. Babedla ngokudlala indima yomibini yotyando. Abaphilisi bafunda iindima zabo (ukumisela, ukwenza, kunye nokuthengisa amayeza) ngokufunda, ngamanye amaxesha ezibhedlele.

Lo mahluko phakathi kwamayeza, utyando, kunye nekhemesti awuzange uphile kwi-colonial America. Xa ii-MDs ezilungiselelwe eyunivesithi ezivela eNgilani zifika eMelika, bekulindeleke ukuba baphinde benze utyando kunye nokulungiselela amayeza.

Umbutho woNyango waseNew Jersey, owaqeshwa ngo-1766, yayingumbutho wokuqala woochwephesha kwezonyango. Yaphuhliswa ukuba "yenze inkqubo ebandakanya yonke imicimbi exhalabisa kakhulu kulo msebenzi: umgaqo wokuziqhelanisa; imigangatho yemfundo yabafundi; iishedyuli zemirhumo, kunye nekhowudi yokuziphatha." Emva kwexesha lo mbutho waba nguMbutho Wezonyango waseNew Jersey.

Imibutho yezobugcisa yaqala ukumisela inkqubo yezonyango ngokuvavanya kunye neengcali zeelayisensi kwangoko nge-1760. Ngasekuqaleni kweminyaka ye-1800, imibutho yezonyango yayijongene nokuseka imigaqo, imigangatho yokusebenza, kunye nokuqinisekiswa koogqirha.

Inyathelo elilandelayo lendalo yayikukuba ezo ntlalo ziphuhlise ezazo iinkqubo zoqeqesho loogqirha. Ezi nkqubo zinxulumene noluntu zabizwa ngokuba "zezobunini" iikholeji zonyango.

Eyokuqala yezi nkqubo zokuba yikholeji yezonyango yoMbutho Wezonyango weSithili saseNew York, eyasekwa nge-12 kaMatshi 1807. Iinkqubo zobunini zaqala ukuvela kuyo yonke indawo. Batsala inani elikhulu labafundi kuba bashenxise amanqaku amabini kwizikolo zonyango ezihambelana neyunivesithi: imfundo ngokubanzi ngokubanzi kunye nexesha elide lokufundisa.

Ukuphelisa ukuxhatshazwa okuninzi kwimfundo yezonyango, indibano yesizwe yabanjwa ngoMeyi 1846. Iziphakamiso ezivela kuloo ndibano zazibandakanya oku kulandelayo:

• Ikhowudi esemgangathweni yokuziphatha kwinqanaba lomsebenzi
• Ukwamkelwa kwemigangatho yemfundo efanayo efanayo yee-MDs, kubandakanya nezifundo zemfundo engaphambi kokuqalwa
• Ukuyilwa kombutho wezonyango welizwe

Ngo-Meyi 5, 1847, phantse abathunywa abangama-200 abamele imibutho yezonyango ezingama-40 kunye neekholeji ezingama-28 ezivela kumazwe angama-22 kunye neSithili saseColumbia. Bazigqiba kwiseshoni yokuqala ye-American Medical Association (AMA). UNathaniel Chapman (1780-1853) wonyulwa njengomongameli wokuqala wombutho. I-AMA iye yaba ngumbutho onefuthe elikhulu kwimicimbi enxulumene nokhathalelo lwempilo eMelika.

I-AMA iseta imigangatho yemfundo yee-MDs, kubandakanya oku kulandelayo:

• Imfundo yenkululeko kubugcisa nakwisayensi
• Isatifikethi sokugqitywa kokufunda ngaphambi kokungena kwikholeji yonyango
• Idigri ye-MD egubungele iminyaka emi-3 yokufunda, kubandakanya iiseshoni ezimbini zokufundisa zeenyanga ezi-6, iinyanga ezi-3 ezinikelwe kwi-dissection, kunye neseshoni yeenyanga ezi-6 zokuya esibhedlele ubuncinci.

Ngo-1852, imigangatho yahlaziywa ukongeza iimfuno ezingaphezulu:

• Izikolo zonyango kuye kwafuneka zenze iikhosi zemfundo yeeveki ezili-16 ezibandakanya i-anatomy, amayeza, utyando, ukubelekisa, kunye nemichiza
• Abaphumeleleyo kufuneka babeneminyaka engama-21 ubudala
• Abafundi kwafuneka bagqibe ubuncinci beminyaka emi-3 yokufunda, iminyaka emi-2 yayo eyayiphantsi kwengcali eyamkelekileyo

Phakathi kowe-1802 nowe-1876, kwangqinwa izikolo ezingama-62 ezizinzileyo zonyango. Kwi-1810, bekukho abafundi abangama-650 ababhalise kunye ne-100 abaphumelele kwizikolo zonyango eUnited States. Ngo-1900, la manani ayenyukele kubafundi abangama-25,000 kunye nabaphumeleleyo abangama-5,200. Phantse bonke aba baphumeleleyo yayingamadoda amhlophe.

UDaniel Hale Williams (1856-1931) wayengomnye wee-MDs zokuqala ezimnyama. Emva kokuthweswa isidanga kwiYunivesithi yaseNyakatho-ntshona e1883, uGqirha Williams wenza utyando eChicago kwaye kamva waba ligunya eliphambili ekumiseni isibhedlele seProvident, esisasebenza eSouth Side yaseChicago. Ngaphambili oogqirha abamnyama bebengakwazi ukufumana amalungelo okuba basebenzise amayeza ezibhedlele.

U-Elizabeth Blackwell (1821-1920), emva kokuphumelela eGeneva College of Medicine kumantla eNew York, waba ngumfazi wokuqala owanikwa isidanga se-MD e-United States.

Isikolo iYohns Hopkins University School of Medicine savulwa ngo-1893. Kukhankanywa njengesona sikolo sokuqala kwezonyango eMelika "sohlobo lwenene lweyunivesithi, enesipho esaneleyo, iilebhu ezixhotyiswe kakuhle, ootitshala banamhlanje abazinikele kuphando lwezonyango kunye nemiyalelo, kunye neyayo isibhedlele apho uqeqesho loogqirha kunye nokuphilisa abantu abagulayo kudityaniswe kwinzuzo elungileyo yabo bobabini. " Ithathwa njengeyokuqala, kunye nemodeli yazo zonke iiyunivesithi zophando. Isikolo sezonyango iJohns Hopkins sasebenza njengomzekelo wokulungelelaniswa kwemfundo yezonyango. Emva koku, izikolo ezininzi ezikumgangatho ophantsi zonyango zivaliwe.

Izikolo zonyango ziye zaba yindawo yokusila yediploma, ngaphandle kwezikolo ezimbalwa kwizixeko ezikhulu. Zimbini izinto ezitshintshileyo. Eyokuqala yayiyi "Ngxelo kaFlexner," eyapapashwa ngo-1910. UAbraham Flexner wayengutitshala ophambili owacelwa ukuba afunde kwizikolo zonyango zaseMelika. Ingxelo yakhe embi kakhulu kunye neengcebiso zokuphucula zikhokelele ekuvalweni kwezikolo ezininzi ezingekho mgangathweni kunye nokuyilwa kwemigangatho yokugqwesa kwimfundo yokwenene yezonyango.

Olunye uphuhliso lwavela kuSir William Osler, waseKhanada owayengomnye woonjingalwazi abakhulu beyeza kwimbali yanamhlanje. Usebenze kwiYunivesithi yaseMcGill eCanada, emva koko kwiDyunivesithi yasePennsylvania, ngaphambi kokuba aqeshwe njengogqirha wokuqala kunye nomnye wabasunguli beYunivesithi yaseJohn Hopkins. Apho waseka uqeqesho lokuqala lokuhlala (emva kokuphumelela kwisikolo sezonyango) kwaye waba ngowokuqala ukuzisa abafundi ebhedini yesigulana. Phambi kwelo xesha, abafundi bezonyango babefunda kwiincwadi zesikhokelo kuphela bade baye kuzilolonga, ke babenamava ambalwa. U-Osler naye wabhala incwadi yokuqala ebanzi, yesayensi yamayeza kwaye kamva waya e-Oxford njengoNjingalwazi we-Regent, apho waqeqeshwa khona. Waseka ukhathalelo olujolise kwizigulana kunye nemigangatho emininzi yokuziphatha kunye nesayensi.

Ngo-1930, phantse zonke izikolo zonyango zazifuna isidanga sobugcisa sokwamkelwa kunye nokubonelela ngekharityhulamu yeminyaka emi-3 ukuya kwemi-4 kwezamayeza notyando. Amazwe amaninzi aye afuna ukuba abagqatswa bagqibe unyaka wokufunda u-1 kwisibhedlele emva kokufumana isidanga kwisikolo sezonyango esaziwayo ukuze babenelayisensi yokunyanga.

Oogqirha baseMelika khange baqale ukugxila kude kube phakathi kwinkulungwane yama-20. Abantu abachasayo ubuchwephesha bathi "ubuchule busebenza ngokungafanelekanga kugqirha oqhelekileyo, okuthetha ukuba akanako ukunyanga iindidi ezithile zezifo." Bakwathi ubuchwephesha buthanda "ukuthoba isidima ingcali ngokubanzi kuluntu." Nangona kunjalo, njengoko ulwazi lwezonyango kunye nobuchule busanda oogqirha abaninzi bakhetha ukugxila kwiindawo ezithile kwaye baqonde ukuba iseti yabo yezakhono inokuba luncedo ngakumbi kwezinye iimeko.

Uqoqosho luye lwadlala indima ebalulekileyo, kuba iingcali ziye zafumana umvuzo ophezulu kunogqirha ngokubanzi. Iingxoxo phakathi kweengcali kunye neengcali ngokubanzi ziyaqhubeka, kwaye kutshanje ziye zavuselelwa yimicimbi enxulumene nohlaziyo lwanamhlanje lokhathalelo lwempilo.

UBUDE BENKQUBO

Ukusebenza kwamayeza kubandakanya ukufumanisa isifo, ukunyanga, ukulungisa, ukucebisa, okanye ukumisela nasiphi na isifo sabantu, isigulo, ukwenzakala, ubulwelwe, ukukhubazeka, iintlungu, okanye enye imeko, emzimbeni okanye engqondweni, okwenyani okanye okuthelekelelwa.

UMGAQO WENKQUBO

Amayeza ibingowokuqala kwimisebenzi yokufuna ilayisensi. Imithetho kaRhulumente malunga nelayisensi yezonyango ichaze "ukuxilongwa" kunye "nonyango" lweemeko zabantu kunyango. Nawuphi na umntu ofuna ukuxilonga okanye ukunyanga njengenxalenye yomsebenzi angahlawuliswa "ngokwenza amayeza ngaphandle kwelayisensi."

Namhlanje, amayeza, njengabanye ootitshala abaninzi, alawulwa kumanqanaba ahlukeneyo:

• Izikolo zonyango kufuneka zihambelane nemigangatho yoMbutho waseMelika weeKholeji zezoNyango
• Ilayisenisi yinkqubo eyenzeka kwinqanaba likarhulumente ngokungqinelana nemithetho ethile yelizwe
• Ukuqinisekiswa kusekwe kwimibutho yesizwe eneemfuno zesizwe ezihambelanayo zemigangatho yokusebenza engaphantsi

Ilayisenisi: Onke amazwe afuna ukuba abafake izicelo kwilayisensi ye-MD babe ngabaphumelele kwisikolo sezonyango esivunyiweyo kwaye bagqibe uviwo lwe-United States lweLayisensi yezoNyango (i-USMLE) Amanyathelo oku-1 ukuya kwayi-3. Amanyathelo oku-1 kunye no-2 agqityiwe ngelixa bekwisikolo sezonyango kwaye inyathelo lesi-3 ligqityiwe emva koqeqesho oluthile lonyango (ihlala iphakathi kwe-12 ukuya kwiinyanga ezili-18, kuxhomekeka kurhulumente). Abantu abafumene izidanga zabo zonyango kwamanye amazwe nabo kufuneka banelise ezi mfuno ngaphambi kokuba basebenzise amayeza eMelika.

Ngokwaziswa kwe-telemedicine, kuye kwakho inkxalabo malunga nendlela yokujongana nemicimbi yelayisenisi yombuso xa amayeza esabelana phakathi kwamazwe ngothungelwano ngocingo. Kuqwalaselwa imithetho nezikhokelo. Amanye amazwe asandula ukuseka iinkqubo zokwamkela iilayisensi zoogqirha abasebenza kwamanye amazwe ngamaxesha kaxakeka, njengasemva kwenkanyamba okanye iinyikima.

Isiqinisekiso: Ii-MDs ezinqwenela ukugxila kufuneka zigqibe iminyaka emi-3 ukuya kweli-9 yomsebenzi wokuthweswa isidanga kwindawo yabo ekhethekileyo, emva koko bapase iimviwo zebhodi. Unyango lwezeNtsapho kukuzikhethela kunye nomda obanzi woqeqesho kunye nokuziqhelanisa. Oogqirha abathi basebenza kwindawo ekhethekileyo kufuneka baqinisekiswe ngebhodi kuloo ndawo ithile yokusebenza. Nangona kunjalo, ayizizo zonke "izatifikethi" ezivela kwiiarhente zemfundo ezaziwayo. Uninzi lweearhente ezinokuthenjwa ziyinxalenye yeBhodi yaseMelika yoBuchule kwezonyango. Izibhedlele ezininzi aziyi kuvumela oogqirha okanye oogqirha ukuba bazilolonge kubasebenzi babo ukuba abangaqinisekiswanga kwibhodi kwindawo ekhethekileyo.

Ugqirha

• Iindidi zababoneleli ngezempilo

Umbutho weBhodi yeeBhodi zoNyango kaRhulumente. Malunga neFSMB. www.fsmb.org/emalunga-fsmb/. Ifunyenwe ngoFebruwari 21, 2019.

IGoldman L, iSchafer AI. Indlela yamayeza, isigulana, kunye noqeqesho kwezonyango: iyeza njengomsebenzi ofundileyo noluntu. Ku: IGoldman L, iSchafer AI, ii-eds. Amayeza eGoldman-Cecil. Umhla wama-25. IPhiladelphia, PA: Elsevier Saunders; I-2016: isahluko 1.

IKaljee L, iStanton BF. Imicimbi yenkcubeko kukhathalelo lwabantwana. Ku: Kliegman RM, Stanton BF, St Geme JW, Schor NF, ii-eds. Incwadi kaNelson yeNcwadi yePediatrics. Umhla we-20. IPhiladelphia, PA: Elsevier; 2016: isahluko 4.