Doctor na aikin likita (MD)

Ana iya samun MDs a cikin saitunan aikace-aikace masu yawa, gami da ayyuka masu zaman kansu, ayyukan rukuni, asibitoci, ƙungiyoyin kula da lafiya, wuraren koyarwa, da kungiyoyin kiwon lafiyar jama'a.

Aikin likita a Amurka ya faro ne daga lokacin mulkin mallaka (farkon 1600s). A farkon karni na 17, aikin likita a Ingila ya kasu kashi uku: likitoci, likitocin tiyata, da masu ba da magani.

An ga likitocin a matsayin fitattu. Galibi suna rike da digiri na jami'a. Likitocin tiyata galibi sun sami horo a asibiti kuma sun yi aikin koyon aiki. Sau da yawa sukan yi aiki sau biyu na likitan aski. Apothecaries sun kuma koyi matsayin su (rubutawa, yin, da siyar da magunguna) ta hanyar koyon aiki, wani lokacin a asibitoci.

Wannan bambancin tsakanin magani, tiyata, da kantin magani bai wanzu a mulkin mallakar Amurka ba. Lokacin da MDs da suka shirya jami'a daga Ingila suka isa Amurka, ana tsammanin suma suyi tiyata kuma su shirya magunguna.

Medicalungiyar Kula da Lafiya ta New Jersey, wacce aka yi haya a cikin 1766, ita ce ƙungiya ta farko ta ƙwararrun likitocin kiwon lafiya a cikin yankuna. An kirkiro shi ne don "ƙirƙirar shirin wanda ya ƙunshi dukkan al'amuran da suka fi damun masu sana'a: ƙa'idar aiki; ƙa'idodin ilimi ga masu koyon aiki, jadawalin kuɗin; da kuma ka'idojin da'a." Daga baya wannan ƙungiyar ta zama Medicalungiyar Kula da Lafiya ta New Jersey.

Professionalungiyoyin ƙwararru sun fara tsara aikin likita ta hanyar bincika da ba da lasisi a farkon 1760. A farkon 1800s, ƙungiyoyin likitocin sun kasance masu kula da kafa ƙa'idodi, ƙa'idodin aikin, da kuma ba da takardar shaidar likitoci.

Abinda yakamata ayi shine ga irin wadannan al'ummomin su samarda nasu tsarin na horo ga likitoci. Wadannan shirye-shiryen da ke da alaƙa da jama'a an kira su "mallakan" kwalejojin likitanci.

Na farko daga cikin waɗannan shirye-shiryen mallakar mallakar kwalejin likita na Medicalungiyar Kula da Lafiya ta Medicalasar ta New York, wanda aka kafa a ranar 12 ga Maris, 1807. Shirye-shiryen mallakar mallakar sun fara ɓullowa ko'ina. Sun jawo hankalin ɗalibai da yawa saboda sun kawar da fasali biyu na makarantun likitancin da ke da alaƙa da jami'a: dogon ilimi na gama gari da dogon lacca.

Don magance yawan cin zarafi a cikin ilimin likitanci, an yi babban taron ƙasa a watan Mayu 1846. Shawara daga wannan taron sun haɗa da masu zuwa:

• Matsayi mai kyau na ƙa'idodin sana'a
• Amincewa da daidaitattun ƙa'idodin ilimi don MDs, gami da kwasa-kwasan ilimin premedical
• Irƙirar ƙungiyar likitocin ƙasa

A ranar 5 ga Mayu, 1847, kusan wakilai 200 da ke wakiltar kungiyoyin likitancin 40 da kwalejoji 28 daga jihohi 22 da Gundumar Columbia sun hadu. Sun warware kansu a farkon zama na Medicalungiyar Likitocin Amurka (AMA). An zabi Nathaniel Chapman (1780-1853) a matsayin shugaban kungiyar na farko. AMA ta zama ƙungiya wacce ke da tasirin gaske akan lamuran da suka shafi kiwon lafiya a Amurka.

AMA ta saita ƙa'idodin ilimi ga MDs, gami da waɗannan masu zuwa:

• Ilimi mai sassaucin ra'ayi a cikin zane-zane da kimiyya
• Takardar shaidar kammalawa a cikin aikin koya kafin shiga kwalejin likita
• Wani digiri na MD wanda ya rufe karatun shekaru 3, gami da lacca na wata 6, watanni 3 da aka ware don rarrabawa, kuma mafi ƙarancin zaman watanni 6 na halartar asibiti.

A cikin 1852, an sake yin la'akari da matsayin don ƙara ƙarin buƙatu:

• Dole ne makarantun likitanci su samar da kwas na tsawon sati 16 wanda ya hada da ilmin jikin mutum, magani, tiyata, ungozoma, da kuma ilmin sunadarai
• Masu karatun dole ne su kasance aƙalla shekaru 21
• Dalibai sun kammala karatun shekaru 3 mafi ƙaranci, shekaru 2 waɗanda ke ƙarƙashin mai karɓar aiki

Tsakanin 1802 da 1876, an kafa ingantattun makarantun likitanci 62. A 1810, akwai ɗalibai 650 da suka yi rajista kuma ɗaliban da suka kammala karatun digiri daga makarantun likitanci a Amurka. Zuwa 1900, waɗannan lambobin sun tashi zuwa ɗalibai 25,000 da masu digiri 5,200. Kusan dukkanin waɗannan ɗaliban sun kasance farare maza.

Daniel Hale Williams (1856-1931) yana ɗaya daga cikin farkon bakar MD. Bayan kammala karatunsa daga Jami'ar Arewa maso Yamma a cikin 1883, Dokta Williams ya yi aikin tiyata a Chicago kuma daga baya ya kasance babban karfi a kafa Asibitin Provident, wanda har yanzu yake hidimar Chicago ta Kudu Side. A baya likitocin baƙar fata sun gagara samun gatan yin magani a asibitoci.

Elizabeth Blackwell (1821-1920), bayan ta kammala karatunta a Kwalejin Medicine ta Geneva da ke arewacin New York, ta zama mace ta farko da aka ba ta digirin MD a Amurka.

An buɗe Makarantar Koyar da Magunguna ta Johns Hopkins a 1893. An ba da labarin cewa ita ce makarantar likita ta farko a Amurka na "na ainihi irin na jami'a, tare da wadataccen kyauta, dakunan gwaje-gwaje da aka wadata, malamai na zamani masu himma ga bincike da koyarwa na likita, da nasa asibitin da ake horar da likitoci da kuma warkar da marasa lafiya haɗe da fa'idar duka. " An dauke shi na farko, kuma samfurin ga duk jami'o'in bincike na gaba. Makarantar Koyon Likita ta Johns Hopkins ta zama abin koyi don sake tsara ilimin likitanci. Bayan wannan, makarantun likitanci da yawa na yau da kullun sun rufe.

Makarantun likitanci sun zama galibi masan difloma, ban da 'yan makarantu a cikin manyan biranen. Abubuwa biyu suka canza hakan. Na farko shi ne "Rahoton Flexner," wanda aka buga a 1910. Abraham Flexner ya kasance babban malamin ilimi wanda aka nemi ya yi karatun makarantun likitancin Amurka. Rahotonsa mara kyau da kuma shawarwari don ingantawa ya haifar da rufe makarantu da yawa marasa inganci da kuma samar da kyawawan halaye na ainihin ilimin likitanci.

Sauran ci gaban ya fito ne daga Sir William Osler, ɗan ƙasar Kanada wanda yana ɗaya daga cikin manyan furofesoshi na likita a tarihin zamani. Ya yi aiki a Jami’ar McGill da ke Kanada, sannan a Jami’ar Pennsylvania, kafin a dauke shi ya zama babban-likita-na farko kuma daya daga cikin wadanda suka kafa Jami'ar Johns Hopkins. A can ya kafa horo na farko na zama (bayan kammala karatunsa daga makarantar koyon aikin likita) kuma shi ne na farko da ya kawo ɗalibai zuwa gadon mara lafiya. Kafin wannan lokacin, ɗaliban likitanci suna koyo ne daga littattafan karatu har sai sun tafi yin atisaye, don haka ba su da ƙwarewar aiki sosai. Osler ya kuma rubuta littafi na farko na farko, littafin ilimin kimiyya sannan daga baya ya tafi Oxford a matsayin farfesa a Regent, inda aka yi masa kwalliya. Ya kafa tsarin kulawa da haƙuri da ƙa'idodin ɗabi'a da kimiya.

Ta hanyar 1930, kusan dukkanin makarantun likitanci sun buƙaci digiri na zane-zane don karɓar shiga kuma sun ba da tsarin karatun digiri na 3 zuwa 4 a cikin magani da tiyata. Jihohi da yawa suma sun buƙaci candidatesan takara su kammala horon shekara 1 a cikin asibiti bayan sun sami digiri daga wata makarantar likitanci da aka sani don ba da lasisin aikin likita.

Likitocin Amurka ba su fara kwarewa ba har zuwa tsakiyar karni na 20. Mutanen da ke ƙin yarda da ƙwarewa sun ce "ƙwararrun masanan sun yi aiki ba daidai ba ga likitan, yana nuna cewa bai da ikon magance wasu nau'o'in cututtuka yadda ya kamata." Har ila yau, sun ce kwarewa ta kasance "ta kaskantar da likitan da ke gaban jama'a." Koyaya, yayin da ilimin likitanci da dabaru suka faɗaɗa likitoci da yawa sun zaɓi su mai da hankali kan wasu takamaiman yankuna kuma su gane cewa ƙwarewar ƙwarewar su na iya zama mafi taimako a wasu yanayi.

Tattalin arziki kuma ya taka muhimmiyar rawa, saboda kwararru galibi suna samun kuɗaɗen shiga fiye da na likitocin gaba ɗaya. Muhawara tsakanin kwararru da kuma janar-janar na ci gaba, kuma a 'yan kwanakin nan an tursasa su ta batutuwan da suka shafi sake fasalin kiwon lafiya na zamani.

BANGAREN AIKI

Aikin likitanci ya hada da ganewar asali, magani, gyara, ba da shawara, ko takardar magani don kowane cuta na mutum, rashin lafiya, rauni, rauni, nakasa, ciwo, ko wani yanayi, na zahiri ko na hankali, na hakika ko na kirki.

HUKUNCIN SANA'A

Magunguna shine farkon sana'a don buƙatar lasisi. Dokokin jihohi game da lasisin likitanci sun bayyana "ganewar asali" da "magani" na yanayin ɗan adam a cikin magani. Ana iya tuhumar duk wani mutum da ke son gano asali ko ɗauka a matsayin ɓangare na aikin da "yin aikin likita ba tare da lasisi ba."

A yau, magani, kamar sauran ayyukan yau da kullun, ana tsara shi a matakai daban-daban:

• Makarantun likitanci dole ne su bi ƙa'idodin theungiyar Kolejin Kiwon Lafiyar Amurka
• Lasisin lasisi tsari ne da ke gudana a matakin jiha daidai da takamaiman dokokin jihar
• An kafa takaddun shaida ta ƙungiyoyi na ƙasa tare da daidaitattun ƙa'idodin ƙasa don ƙa'idodin aikin ƙwarewar ƙwararru

Lasisi: Duk jihohi suna buƙatar masu neman izinin lasisi na MD su kasance masu digiri na makarantar likitanci da aka yarda da su kuma kammala Licwararren lasisin lasisin likitancin Amurka (USMLE) Matakai na 1 zuwa 3. An kammala Matakai 1 da 2 yayin da suke makarantar likitanci kuma an kammala mataki na 3 bayan wasu horo na likita. (yawanci tsakanin watanni 12 zuwa 18, ya danganta da yanayin jihar). Mutanen da suka sami digirin likita a wasu ƙasashe suma dole ne su cika waɗannan buƙatun kafin fara aikin likita a Amurka.

Tare da bullo da magani, akwai damuwa game da yadda za a magance matsalolin lasisin lasisi yayin da ake raba magani tsakanin jihohi ta hanyar sadarwa. Ana magance dokoki da jagororin. Wasu jihohin sun kwanan nan sun tsara hanyoyin don amincewa da lasisin likitocin da ke aiki a wasu jihohi a lokacin gaggawa, kamar bayan guguwa ko girgizar ƙasa.

Takardar shaida: MDs da ke son ƙwarewa dole ne su ƙara ƙarin shekaru 3 zuwa 9 na aikin kammala karatun digiri a cikin yankinsu na musamman, sannan kuma su ci jarabawar takaddun shaida. Magungunan Iyali shine sana'a tare da mafi girman ikon horo da aiki. Doctors da ke da'awar yin aiki a cikin sana'a ya kamata a tabbatar da su a cikin wannan takamaiman yankin aikin. Koyaya, ba duk "takaddun shaida" suka fito daga hukumomin ilimi da aka sani ba. Mafi yawan cibiyoyin bayar da tabbaci na daga cikin Hukumar Kwararrun Likitocin Amurka. Yawancin asibitoci ba za su ba da izinin likitoci ko likitocin tiyata su yi aiki a kan ma'aikatansu ba idan ba a ba su takardar izinin shiga cikin ƙwararren likita ba.

Likita

• Ire-iren masu bada kiwon lafiya

Websiteungiyar Yanar gizo ta Hukumar Kula da Lafiya ta Jiha. Game da FSMB. www.fsmb.org/about-fsmb/. An shiga Fabrairu 21, 2019.

Goldman L, Schafer AI. Hanyar zuwa magani, mai haƙuri, da kuma likitancin likita: magani azaman sana'ar koyo da mutuntaka. A cikin: Goldman L, Schafer AI, eds. Magungunan Goldman-Cecil. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016: babi na 1.

Kaljee L, Stanton BF. Al'amuran al'adu a cikin kulawar yara. A cikin: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Littafin koyar da ilimin yara. 20th ed. Philadelphia, PA: Elsevier; 2016: babi na 4.