Dokotala wa zamankhwala (MD)

Ma MD atha kupezeka m'malo osiyanasiyana, kuphatikiza machitidwe azinsinsi, magulu azipatala, zipatala, mabungwe osamalira azaumoyo, malo ophunzitsira, ndi mabungwe azachipatala.

Ntchito zamankhwala ku United States zidayamba kale nthawi yamakoloni (koyambirira kwa zaka za m'ma 1600). Kumayambiriro kwa zaka za zana la 17, ntchito zamankhwala ku England zidagawika m'magulu atatu: asing'anga, ochita opaleshoni, ndi othandizira.

Madokotala amawoneka ngati osankhika. Nthawi zambiri amakhala ndi digiri ya kuyunivesite. Madokotala ochita opaleshoni nthawi zambiri amaphunzitsidwa kuchipatala ndipo amaphunzira ntchito. Nthawi zambiri amagwiranso ntchito ngati dokotala wometa. Ogwiritsira ntchito mankhwalawa adaphunziranso ntchito yawo (kulembera, kupanga, ndi kugulitsa mankhwala) mwa kuphunzira ntchito, nthawi zina muzipatala.

Kusiyanitsa uku pakati pa mankhwala, opaleshoni, ndi mankhwala sikunapitirire ku America atsamunda. A MDs omwe adakonzekera kuyunivesite ochokera ku England atafika ku America, amayembekezeredwa kuchitanso opaleshoni ndikukonzekera mankhwala.

New Jersey Medical Society, yolembedwa mu 1766, inali bungwe loyamba la akatswiri azachipatala m'malo omwe amakhala. Adapangidwa kuti "apange pulogalamu yokhudzana ndi zonse zofunika kwambiri pantchitoyi: malamulo oyendetsera ntchito; miyezo yophunzitsira ophunzira, magawo amalipiro, ndi malamulo amakhalidwe abwino." Pambuyo pake bungweli lidakhala Medical Society yaku New Jersey.

Mabungwe akatswiri anayamba kuwongolera zamankhwala pofufuza ndi kupereka zilolezo kwa 1760. Pofika koyambirira kwa zaka za m'ma 1800, mabungwe azachipatala anali ndiudindo wokhazikitsa malamulo, miyezo yogwirira ntchito, komanso kupatsa chilolezo madotolo.

Gawo lotsatira lachilengedwe linali loti mabungwe amenewa apange mapulogalamu awoawo azachipatala. Mapulogalamuwa omwe amagwirizana ndi anthu amatchedwa makoleji azachipatala.

Pulogalamu yoyamba yamakampaniyi inali koleji ya zamankhwala ya Medical Society ya County of New York, yomwe idakhazikitsidwa pa Marichi 12, 1807. Mapulogalamu azachuma adayamba kupezeka paliponse. Adakopa ophunzira ambiri chifukwa adachotsa magawo awiri m'masukulu azachipatala omwe amagwirizana ndi yunivesite: maphunziro ataliatali komanso nthawi yayitali yophunzitsira.

Pofuna kuthana ndi nkhanza zambiri zamaphunziro azachipatala, msonkhano wamayiko unachitika mu Meyi 1846. Zopangira za msonkhanowu zinali izi:

• Makhalidwe oyenerera pa ntchitoyi
• Kukhazikitsidwa kwa miyezo yofananira yamaphunziro a MDs, kuphatikiza maphunziro amakonzedwe
• Kupanga kwa bungwe lazachipatala ladziko lonse

Pa Meyi 5, 1847, nthumwi pafupifupi 200 zoyimira mabungwe azachipatala 40 ndi makoleji 28 ochokera kumayiko 22 ndi District of Columbia adakumana. Adatsimikiza kukhala gawo loyamba la American Medical Association (AMA). Nathaniel Chapman (1780-1853) adasankhidwa kukhala Purezidenti woyamba wa bungweli. AMA yakhala bungwe lomwe limakhudza kwambiri nkhani zokhudzana ndiumoyo ku United States.

AMA idakhazikitsa miyezo yophunzitsira a MD, kuphatikiza izi:

• Maphunziro owolowa manja muzojambula ndi sayansi
• Satifiketi yakumaliza kuphunzira asanapite kukoleji yamankhwala
• Digiri ya MD yomwe idakwanitsa zaka 3 zophunzira, kuphatikiza magawo awiri a miyezi isanu ndi umodzi yophunzitsira, miyezi itatu yoperekedwa kuchipatala, komanso gawo limodzi la miyezi isanu ndi umodzi yopezekera kuchipatala

Mu 1852, miyezo idasinthidwa kuti iwonjezere zofunikira zina:

• Sukulu zamankhwala zimayenera kupereka maphunziro a milungu 16 omwe amaphatikizapo anatomy, mankhwala, opareshoni, azamba, ndi chemistry
• Omaliza maphunziro amayenera kukhala osachepera zaka 21
• Ophunzira amayenera kumaliza zaka zochepa zophunzira za 3, zaka 2 zomwe zinali pansi pa akatswiri ovomerezeka

Pakati pa 1802 ndi 1876, sukulu zachipatala zokwanira 62 zinakhazikitsidwa. Mu 1810, panali ophunzira 650 omwe adalembetsa ndipo omaliza maphunziro 100 m'masukulu azachipatala ku United States. Pofika 1900, manambalawa anali atakwera mpaka ophunzira 25,000 ndi omaliza maphunziro 5,200. Pafupifupi onse omaliza maphunzirowa anali azungu azungu.

Daniel Hale Williams (1856-1931) anali m'modzi mwa MDs wakuda woyamba. Atamaliza maphunziro awo ku Northwestern University ku 1883, Dr. Williams adachita opareshoni ku Chicago ndipo pambuyo pake adakhala gawo lalikulu pakukhazikitsa Chipatala cha Provident, chomwe chimatumikirabe ku South Side ku Chicago. M'mbuyomu asing'anga akuda adapeza kuti ndizosatheka kupeza mwayi wochita zamankhwala muzipatala.

Elizabeth Blackwell (1821-1920), atamaliza maphunziro ake ku Geneva College of Medicine kumpoto kwa New York, adakhala mayi woyamba kulandira digiri ya MD ku United States.

Johns Hopkins University School of Medicine idatsegulidwa mu 1893. Amanenedwa kuti ndi sukulu yoyamba ya zamankhwala ku America ya "yunivesite yeniyeni, yopatsidwa ndalama zokwanira, ma laboratories okhala ndi zida zokwanira, aphunzitsi amakono ochita kafukufuku wazachipatala ndi malangizo, ndi ake chipatala momwe maphunziro a asing'anga ndi kuchiritsa odwala amaphatikizidwa kuti athandizire onsewa. " Ikuwerengedwa kuti ndi yoyamba, komanso mtundu wamayunivesite onse ofufuza pambuyo pake. Johns Hopkins Medical School idakhala ngati chitsanzo pakukonzanso kwamaphunziro azachipatala. Zitatha izi, masukulu ambiri azachipatala otseguka amatsekedwa.

Masukulu azachipatala anali atakhala mphero za diploma, kupatula masukulu ochepa m'mizinda yayikulu. Zochitika ziwiri zidasintha izi. Loyamba linali "Flexner Report," lofalitsidwa mu 1910. Abraham Flexner anali mphunzitsi wamkulu yemwe adapemphedwa kuti akaphunzire masukulu azachipatala aku America. Lipoti lake loipa kwambiri ndi malingaliro ake pakukonzanso zidatsogolera kutsekedwa kwa masukulu ambiri omwe sanayende bwino ndikupanga miyezo yabwino kwambiri pamaphunziro azachipatala.

Kukula kumeneku kunachokera kwa Sir William Osler, wa ku Canada yemwe anali m'modzi mwa akatswiri odziwa zamankhwala m'mbiri yamakono. Anagwira ntchito ku Yunivesite ya McGill ku Canada, kenako ku University of Pennsylvania, asanalembedwe kuti akhale dokotala wamkulu woyamba komanso m'modzi mwa omwe adayambitsa University of Johns Hopkins. Kumeneko adakhazikitsa maphunziro oyamba okhala (atamaliza maphunziro awo ku sukulu ya zamankhwala) ndipo anali woyamba kubweretsa ophunzira pabedi la wodwalayo. Nthawi imeneyo isanafike, ophunzira zamankhwala amaphunzira m'mabuku mpaka pomwe amapita kukachita masewera olimbitsa thupi, motero anali ndi chidziwitso chochepa. Osler adalembanso buku loyambirira, lamankhwala la sayansi ndipo pambuyo pake adapita ku Oxford ngati pulofesa wa Regent, komwe adaphunzitsidwa. Anakhazikitsa chisamaliro cha odwala komanso miyezo yambiri yamakhalidwe abwino komanso yasayansi.

Pofika 1930, pafupifupi masukulu onse azachipatala amafunikira digiri yaukadaulo kuti alowe ndikuwapatsa maphunziro azaka 3 mpaka 4 azamankhwala ndi opaleshoni. Mayiko ambiri amafunikiranso kuti ofuna kumaliza maphunziro awo azitha kumaliza chaka chimodzi mchipatala atalandira digiri kuchokera kusukulu yovomerezeka ya zamankhwala kuti apatse chilolezo chamankhwala.

Madokotala aku America sanayambe kuchita bwino mpaka pakati pa zaka za zana la 20. Anthu omwe amatsutsana ndi ukadaulo adati "ukadaulo wagwira ntchito mosasamala kwa asing'anga, kutanthauza kuti sangathe kuchita bwino mitundu ingapo yamatenda." Anatinso ukatswiri umakonda "kunyozetsa akatswiriwa pamaso pa anthu." Komabe, chidziwitso ndi ukadaulo wazachipatala zikukulira madotolo ambiri adasankha kuyang'ana kwambiri pazinthu zina ndikuzindikira kuti luso lawo lingakhale lothandiza nthawi zina.

Economics idatenganso gawo lofunikira, chifukwa akatswiri amapeza ndalama zambiri kuposa asing'anga wamba. Zokambirana pakati pa akatswiri ndi generalists zikupitilirabe, ndipo posachedwa zalimbikitsidwa ndi zovuta zokhudzana ndi kusintha kwamankhwala masiku ano.

ZOCHITIKA ZOCHITA

Ntchito zamankhwala zimaphatikizapo kuzindikira, kulandira chithandizo, kuwongolera, kuwalangiza, kapena kukupatsani mankhwala amtundu uliwonse wamunthu, matenda, kuvulala, kufooka, kupunduka, kupweteka, kapena vuto lina lililonse, mwakuthupi kapena m'maganizo, zenizeni kapena zongoyerekeza.

MALANGIZO A NTCHITO

Mankhwala anali oyamba paukadaulo wofuna ziphaso. Malamulo aboma opatsirana chilolezo kuchipatala adalongosola za "kuwunika" ndi "chithandizo" cha momwe anthu azithandizira. Munthu aliyense amene angafune kudziwa kapena kuthandizira ngati gawo la ntchitoyi atha kulipidwa "kugwiritsa ntchito mankhwala popanda chilolezo."

Masiku ano, mankhwala, monga ntchito zina zambiri, amalamulidwa m'magulu osiyanasiyana:

• Sukulu Zachipatala ziyenera kutsatira miyezo ya American Association of Medical Colleges
• Chilolezo ndi njira yomwe imachitikira kuboma molingana ndi malamulo aboma
• Chitsimikizo chimakhazikitsidwa kudzera m'mabungwe adziko lonse omwe ali ndi zofunikira mdziko momwe angakhalire akatswiri ochepa

Chilolezo: Mayiko onse amafuna kuti ofunsira chilolezo cha MD akhale omaliza maphunziro azachipatala ovomerezeka ndikumaliza United States Medical Licensing Exam (USMLE) Gawo 1 mpaka 3. Gawo 1 ndi 2 amaliza ali pasukulu ya udokotala ndipo gawo 3 limamalizidwa ataphunzira zamankhwala (nthawi zambiri pakati pa miyezi 12 mpaka 18, kutengera boma). Anthu omwe adalandira madigiri awo azachipatala m'maiko ena ayeneranso kukwaniritsa zofunikira izi asanayambe zamankhwala ku United States.

Pakukhazikitsidwa kwa telemedicine, pakhala pali nkhawa yokhudza momwe angathetsere zovuta zamalamulo aboma pomwe mankhwala akugawidwa pakati pa mayiko kudzera patelefoni. Malamulo ndi malangizo akuthandizidwa. Maboma ena posachedwapa akhazikitsa njira zololeza ziphaso za asing'anga omwe akugwira ntchito m'maiko ena pakagwa tsoka, monga mkuntho kapena zivomezi.

Chitsimikizo: Ma MD omwe akufuna kuchita bwino ayenera kumaliza 3 yowonjezera mpaka zaka 9 zamaphunziro omaliza m'dera lawo, kenako kuti athe mayeso a board. Mankhwala Amankhwala ndiwofunika kwambiri pophunzitsa ndi kuchita. Madokotala omwe amati amachita mwapadera ayenera kutsimikiziridwa ndi komiti m'derali. Komabe, sizovomerezeka zonse zomwe zimachokera ku mabungwe odziwika bwino. Mabungwe ambiri odalirika ali m'gulu la American Board of Medical Specialties. Zipatala zambiri sizilola kuti madotolo kapena asing'anga azigwira pamitengo yawo ngati siomwe ali ndi mbiri yabwino.

Sing'anga

• Mitundu ya othandizira azaumoyo

Tsamba la Federation of State Medical Boards. Pafupifupi FSMB. www.fsmb.org/zokhudza-fsmb/. Inapezeka pa February 21, 2019.

Goldman L, Schafer AI. Njira zamankhwala, wodwala, ndi zamankhwala: zamankhwala monga ntchito yophunzira komanso yothandiza anthu. Mu: Goldman L, Schafer AI, olemba. Mankhwala a Goldman-Cecil. Wolemba 25. Philadelphia, PA: Elsevier Saunders; 2016: chap 1.

Kaljee L, Stanton BF. Nkhani zachikhalidwe posamalira ana. Mu: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, olemba. Nelson Textbook of Pediatrics. Wolemba 20th. Philadelphia, PA: Elsevier; 2016: chap 4.