Chiremba wezvekurapa (MD)

MDs inogona kuwanikwa mukati meakasiyana siyana masisitimu ekudzidzira, kusanganisira maitiro akazvimirira, maitiro eboka, zvipatara, masangano ekuchengetedza hutano, nzvimbo dzekudzidzisa, uye nemasangano ehutano eruzhinji.

Muitiro wemishonga muUnited States wakadzokera kunguva dzekoloni (kutanga kwema1600s). Pakutanga kwezana ramakore rechi 17, kurapa muEngland kwakakamuraniswa mumapoka matatu: vanachiremba, vanovhiya, uye vapoti.

Vanachiremba vakaonekwa sevakuru. Ivo kazhinji vaibata dhigirii rekuyunivhesiti. Vanachiremba vanovhiya vaiwanzodzidziswa muchipatara uye vaidzidzira basa. Ivo vaiwanzoshandira iwo maviri basa reyekugera-chiremba wechiremba. Apothecaries vakadzidzawo mabasa avo (kunyorera, kugadzira, uye kutengesa mishonga) kuburikidza nekudzidzira basa, dzimwe nguva muzvipatara.

Uku kupesana pakati pemushonga, kuvhiya, uye chitoro chemishonga hakuna kurarama mukolonial America. Pakasvika MD-dzakagadzirirwa kuyunivhesiti kubva kuEngland dzakasvika muAmerica, vaitarisirwa kuitawo oparesheni nekugadzirira mishonga.

New Jersey Medical Society, yakarongedzwa muna 1766, ndiyo yaive yekutanga sangano revashandi vekurapa mumakoloni. Yakagadziridzwa "kuumba chirongwa chinobatanidza zvese zvine chekuita nepamusoro pebasa: kudzora maitiro, zviyero zvedzidzo zvevadzidzi, mashejisheni emitero, uye kodhi yetsika." Gare gare iri sangano rakava Medical Society yeNew Jersey.

Nyanzvi dzehunyanzvi dzakatanga kudzora mashandiro ekurapa nekuongorora nekupa marezenisi varidzi kutanga kwa1760. Pakazosvika makore ekuma1800, masangano ezvekurapa aive pamusoro pekumisikidza mirau, zviyero zvekuita, uye kupihwa chitupa kwachiremba.

Nhanho inotevera yechisikigo yaive yenzanga dzakadai kugadzira zvirongwa zvavo zvekudzidzisa vanachiremba. Aya mapurogiramu akabatana nesosaiti akadaidzwa kunzi "proprietary" zvekurapa makoreji.

Yekutanga yeaya mapurogiramu ekuchengetedza yaive koreji yekurapa yeMedical Society yeCentral of New York, yakavambwa munaKurume 12, 1807. Zvirongwa zvepfuma zvakatanga kumuka kwese kwese. Vakakwezva nhamba huru yevadzidzi nekuti vakabvisa maviri maficha ezveyunivhesiti-zvakabatana zvikoro zvekurapa: dzidzo refu yakarebesa uye yakareba hurukuro yehurukuro.

Kugadzirisa kushungurudzwa kwakawanda muzvidzidzo zvekurapa, musangano wenyika wakaitwa muna Chivabvu 1846. Zvirongwa kubva pagungano iri zvaisanganisira zvinotevera:

• Iyo yakajairika kodhi yetsika yebasa
• Kugamuchirwa kweiyunifomu yakakwira zviyero zvedzidzo zveMDC, kusanganisira makosi edzidzo yepamberi
• Kugadzirwa kwesangano renyika yekurapa

Musi waMay 5, 1847, vangangoita mazana maviri mamiririri anomiririra makumi mana emakiriniki uye 28 makoreji kubva kumatunhu makumi maviri nemaviri uye Dunhu reColumbia vakasangana. Vakazvisarudzira pachavo muchikamu chekutanga cheAmerican Medical Association (AMA). Nathaniel Chapman (1780-1853) akasarudzwa semutungamiriri wekutanga wesangano. AMA rave sangano rine simba rakakura pamusoro penyaya dzine chekuita nezvehutano muUnited States.

AMA inogadza zviyero zvedzidzo zveMDC, kusanganisira zvinotevera:

• Dzidzo yakasununguka mune hunyanzvi nesainzi
• Chitupa chekupedzisa mukudzidzira usati wapinda kukoreji yezvokurapa
• Dhigirii reMD rakafukidza makore matatu ekudzidza, kusanganisira maviri emwedzi-mitanhatu hurukuro hurukuro, mwedzi mitatu yakapihwa dissection, uye mashoma emwedzi mitanhatu musangano wekupinda muchipatara.

Muna 1852, zviyero zvakagadziridzwa kuwedzera zvimwe zvinodiwa:

• Zvikoro zvekurapa zvaifanirwa kupa kosi yemavhiki gumi nematanhatu edzidziso yaisanganisira anatomi, mushonga, kuvhiya, kusununguka, uye kemesitiri
• Vakapedza kudzidza vaifanira kuve vangangoita 21 zera
• Vadzidzi vaifanira kupedzisa hushoma hwemakore matatu ekudzidza, maviri emakore ayo aive pasi peye anogamuchirwa murapi

Pakati pe1802 na1876, zvikoro zvekurapa zvakagadzikana zvakagadzwa. Muna 1810, pakanga paine vadzidzi mazana matanhatu nemakumi mashanu vakanyoresa uye zana vakapedza kudzidza kubva kuzvikoro zvekurapa muUnited States. Pakazosvika 1900, idzi nhamba dzaive dzakwira kusvika pa25,000 vadzidzi uye 5,200 vakapedza kudzidza. Vanenge vese vakapedza kudzidza ava vaive vachena varume.

Daniel Hale Williams (1856-1931) aive mumwe wevatema vekutanga MD. Mushure mekupedza kudzidza kubva kuNorthwestern University mu1883, Dr. Williams akaita zvekuvhiya muChicago uye akazove simba guru mukumisikidza Provident Hospital, iyo ichiri kushandira Chicago yekuSouth Side. Pakutanga varapi vatema vakaona zvisingaiti kuwana mikana yekudzidzira mushonga muzvipatara.

Elizabeth Blackwell (1821-1920), mushure mekupedza kudzidza kubva kuGeneva College yeMedicine kumusoro kweNew York, akazove mukadzi wekutanga kupihwa degree reMD muUnited States.

Iyo Johns Hopkins University Chikoro cheMishonga chakavhurwa muna 1893. Inodomwa seye yekutanga chikoro chekurapa muAmerica che "chaiyo yunivhesiti-mhando, ine zvipo zvakakwana, marabhoritari akashongedzerwa, vadzidzisi vemazuva ano vakazvipira kutsvagurudzo yezvekurapa nekuraira, uye pachayo chipatara umo kudzidziswa kwavanachiremba uye kuporesa kwevanorwara kwakabatanidzwa mukubatsira kwakanyanya kwevaviri. " Inofungidzirwa yekutanga, uye iyo modhi kune ese akazotevera ekutsvagisa mayunivhesiti. Johns Hopkins Medical Chikoro chakashanda semuenzaniso wekurongwazve kwedzidzo yezvokurapa. Mushure meizvi, mazhinji epasi-akaenzana zvikoro zvekurapa zvakavharwa.

Zvikoro zvekurapa zvaive zvave zvikuru zvigayo zve diploma, kunze kwezvikoro zvishoma mumaguta makuru. Zviitiko zviviri zvakachinja izvo. Yekutanga yaive "Flexner Report," yakaburitswa muna 1910. Abraham Flexner aive mudzidzisi anotungamira akakumbirwa kudzidza zvikoro zvekuAmerica zvekurapa. Chirevo chake chisina kunaka uye kurudziro yekuvandudza zvakatungamira mukuvharwa kwezvikoro zvakawanda zvisina kutsarukano uye kugadzirwa kwemipimo yekugona kwedzidzo chaiyo yekurapa.

Kumwe kusimudzira kwakabva kuna Sir William Osler, wekuCanada aive mumwe wevaporofesa vakakurumbira vekurapa munhoroondo yazvino. Akashanda paYunivhesiti yeMcGill muCanada, uyezve kuYunivhesiti yePennsylvania, asati atorwa basa rekutanga kuve chiremba-mukuru uye mumwe wevatangi veJohns Hopkins University. Ikoko akatanga kudzidziswa kwekugara kwekutanga (mushure mekupedza kudzidza kubva kuchikoro chekurapa) uye aive wekutanga kuunza vadzidzi kumubhedha wemurwere. Nguva iyoyo isati yasvika, vadzidzi vezvechiremba vaidzidza kubva mumabhuku ekuverenga chete kusvikira vaenda kunodzidzira, saka vaive neruzivo rwushoma. Osler akanyora zvakare bhuku rekutanga rakazara, resainzi remushonga uye akazoenda kuOxford saRegent purofesa, kwaakapihwa knight. Akasimbisa kuchengetedzwa kwevarwere uye akawanda maitiro uye esainzi zviyero.

Pakazosvika 1930, dzinenge dzese zvikoro zvekurapa zvaida hunyanzvi hunyanzvi hwekugamuchira uye zvakapa 3- kusvika mana-makore akapihwa kosi yezvokurapa nekuvhiya. Nyika zhinji dzaidawo kuti vanokwikwidza vapedze gore-gore rekudzidzira muchipatara mushure mekugamuchira dhigirii kubva kuchikoro chinozivikanwa chekurapa kuitira kuti vabvumire tsika yekurapa.

Vanachiremba veAmerica havana kutanga kuita hunyanzvi kusvika pakati pezana ramakore rechi20. Vanhu vanopokana nehunyanzvi vakati "hunyanzvi hwaishanda zvisina tsarukano kuna chiremba, zvichireva kuti haakwanise kurapa mamwe marapirwo ezvirwere." Vakatiwo hunyanzvi hwaiwanzo "kudzikisira varapi pamberi peveruzhinji." Nekudaro, sezvo ruzivo rwekurapa uye hunyanzvi zvakawedzera vanachiremba vazhinji vakasarudza kutarisisa pane dzimwe nzvimbo dzakananga uye vachiziva kuti kugona kwavo kwakaringana kunogona kubatsira zvakanyanya mune mamwe mamiriro.

Economics yakaitawo basa rakakosha, nekuti nyanzvi dzaiwanzotambira mari dzakakwira kupfuura varapi vechiremba. Iyo nhaurirano pakati pevanyanzvi uye generalists inoenderera, uye munguva pfupi yapfuura yakasimudzirwa nenyaya dzine chekuita neshanduko yemazuva ano ekuchengetedza hutano.

CHIKURU CHEMAITIRO

Kuita kwemushonga kunosanganisira kuongorora, kurapwa, kururamisa, kuraira, kana kunyorerwa chero chirwere chemunhu, chirwere, kukuvara, hurema, kuremara, kurwadziwa, kana imwewo mamiriro, epanyama kana epfungwa, chaiye kana kufungidzira.

MUTEMO WENZVIMBO

Mishonga yaive yekutanga yemabasa ekuda kupihwa marezenisi. Mitemo yenyika pamusoro pekupa marezinesi ekurapa yakaratidza "kuongororwa" uye "kurapwa" kwemamiriro ezvinhu emunhu mukurapa. Chero ani munhu aida kuongorora kana kurapa sechikamu chebasa anogona kubhadhariswa "kudzidzira kurapwa pasina rezinesi."

Nhasi, mushonga, senge mamwe mabasa mazhinji, anotungamirwa pamatanho akasiyana siyana:

• Zvikoro zvekurapa zvinofanirwa kutevedzera zviyero zveAmerican Association of Medical Makoreji
• Licensure chiitiko chinoitika padanho rehurumende zvinoenderana nemitemo yenyika
• Certification inosimbiswa kuburikidza nemasangano emunyika ane zvinowirirana zvemunyika zvinodiwa kune mashoma hunyanzvi maitiro maitiro

Rezinesi: Nyika dzese dzinoda kuti vanyoreri rezinesi reMDC vange vari vakapedza kudzidza pachikoro chekurapa chakabvumidzwa uye vapedzise United States Medical Licensing Exam (USMLE) Matanho 1 kusvika 3. Matanho 1 ne2 anopedzwa vachiri muchikoro chekurapa uye nhanho 3 inopedzwa mushure mekumwe kudzidziswa kwekurapa. (kazhinji pakati pemwedzi gumi nemaviri kusvika gumi neshanu, zvinoenderana nedunhu). Vanhu vakawana madhigirii avo ekurapa mune dzimwe nyika zvakare vanofanirwa kuzadzikisa izvi zvisati zvaitika vasati varapa muUnited States.

Nekuunzwa kwetelemedicine, kwave nekufunganya pamusoro pemaitiro ekugadzirisa nyaya dzerezinesi yenyika apo mushonga uri kugoverwa pakati penyika kuburikidza nefoni. Mitemo nenhungamiro zviri kugadziriswa. Dzimwe nyika dzichangobva kumisikidza nzira dzekucherechedza marezinesi evarapi vanoshanda mune dzimwe nyika munguva dzekukurumidzira, senge mushure memupupuri kana kudengenyeka kwenyika.

Certification: MDs vanoshuva kuita hunyanzvi vanofanirwa kupedzisa yakawedzera 3 kune 9 makore ebasa repashure munzvimbo yavo yehunyanzvi, vobva vapasa bvunzo dzebhodhi. Mhuri Mishonga ndeye hunyanzvi pamwe nehupamhi nzvimbo yekudzidzira uye kuita. Vanachiremba vanozviti vanoita mune hunyanzvi vanofanirwa kuve bhodhi-yakasimbiswa munzvimbo iyoyo yekudzidzira. Nekudaro, kwete ese "zvitupa" zvinobva kune anozivikanwa masangano evadzidzi. Mazhinji masevhisi ekuvimbika anovimbika ari chikamu cheAmerican Board of Medical Specialties. Zvipatara zvakawanda hazvibvumidze varapi kana vanovhiya kuti vadzidze pamatanda avo kana vasina bhodhi rakazivikanwa mune yakakosha hunyanzvi.

Chiremba

• Mhando dzevapi vezvehutano

Federation of State Medical Boards webhusaiti. Nezve FSMB. www.ga./bout-fsmb/. Yakasvika munaFebruary 21, 2019.

Goldman L, Schafer AI. Maitiro ekurapa, murwere, uye rezvekurapa: mushonga sebasa rakadzidza uye rine hunhu. Mune: Goldman L, Schafer AI, eds. Goldman-Cecil Mushonga. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016: chits 1.

Kaljee L, Stanton BF. Nyaya dzechivanhu mukuchengetwa kwevana. Mune: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Chinyorwa chePediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016: chits.