Monga mayiko ambiri, Australia ikukumana ndi kugawika kosalingana kwa ogwira ntchito zachipatala kwa nthawi yayitali, ndi madokotala ochepa pa munthu aliyense m'madera akumidzi ndipo njira yopita ku maphunziro apamwamba kwambiri. Longitudinal Integrated Clerkship (LIC) ndi chitsanzo cha maphunziro azachipatala chomwe chimapangitsa kuti ophunzira azitha kugwira ntchito m'madera akumidzi, omwe ali kutali kwambiri komanso m'malo osamalira odwala. Ngakhale kuti deta iyi ndi yofunika kwambiri, deta yeniyeni ya polojekiti yofotokozera vutoli ikusowa.
Pofuna kuthana ndi vuto la chidziwitso ichi, njira yogwiritsira ntchito njira yolumikizirana yomwe imagwiritsa ntchito chiphunzitso cha qualitative idagwiritsidwa ntchito kuti idziwe momwe maphunziro akumidzi ophatikizidwa a LIC ku Deakin University adakhudzira zisankho za ntchito za omaliza maphunziro (2011-2020) pankhani ya zamankhwala komanso malo.
Ophunzira 39 omwe adamaliza maphunziro awo adatenga nawo mbali pa zokambirana zoyenerera. Ndondomeko yosankha ntchito ya LIC yakumidzi yapangidwa, zomwe zikusonyeza kuti kuphatikiza kwa zinthu zaumwini ndi za pulogalamu mkati mwa lingaliro lalikulu la "kusankha kutenga nawo mbali" kungakhudze zisankho za ophunzira pantchito za malo ndi ntchito, payekha komanso mogwirizana. Akaphatikizidwa muzochita, malingaliro a luso lopanga maphunziro ndi maphunziro pamalopo amawonjezera kutenga nawo mbali popatsa ophunzira mwayi wokumana ndi kufananiza maphunziro azaumoyo mwanjira yonse.
Ndondomeko yokonzedwayi ikuyimira zinthu zomwe zili mu pulogalamuyi zomwe zimaonedwa kuti ndizofunika kwambiri pa zisankho za ntchito zomwe omaliza maphunziro angachite pambuyo pake. Zinthuzi, pamodzi ndi cholinga cha pulogalamuyi, zimathandiza kukwaniritsa zolinga za ogwira ntchito akumidzi za pulogalamuyi. Kusinthaku kunachitika kaya omaliza maphunziro akufuna kutenga nawo mbali mu pulogalamuyi kapena ayi. Kusinthaku kumachitika kudzera mu kusinkhasinkha, komwe kumatsutsa kapena kutsimikizira malingaliro omwe omaliza maphunziro anali nawo kale okhudza kupanga zisankho pantchito, motero kumakhudza kupanga chizindikiritso chaukadaulo.
Monga mayiko ambiri, Australia ikukumana ndi kusalingana kwa nthawi yayitali komanso kosalekeza pakugawa kwa ogwira ntchito zachipatala [1]. Izi zikuwonetsedwa ndi kuchepa kwa madokotala pa munthu aliyense m'madera akumidzi komanso kusintha kuchoka ku chisamaliro choyamba kupita ku chisamaliro chapadera kwambiri [2, 3]. Zonsezi pamodzi zimakhudza thanzi m'madera akumidzi, makamaka chifukwa chisamaliro choyamba chaumoyo ndi chofunikira kwambiri kwa ogwira ntchito zachipatala m'madera awa, osati kupereka chithandizo choyamba chaumoyo komanso chisamaliro chadzidzidzi ndi zipatala [4]. ]. Longitudinal Integrated Clerkship (LIC) ndi chitsanzo cha maphunziro azachipatala chomwe poyamba chinapangidwa ngati njira yophunzitsira ophunzira azachipatala m'madera ang'onoang'ono akumidzi ndipo chinapangidwa kuti chilimbikitse kuchita mobwerezabwereza m'madera ofanana [5, 6]. Cholinga ichi chimakwaniritsidwa chifukwa omaliza maphunziro a LIC akumidzi ali ndi mwayi waukulu kuposa omaliza maphunziro a antchito ena (kuphatikizapo kusinthana kwa anthu akumidzi) kuti azigwira ntchito m'madera akumidzi, omwe ali kutali kwambiri komanso m'zipatala zoyambirira [7,8,9,10]. Momwe omaliza maphunziro azachipatala amapangira zisankho zantchito zafotokozedwa ngati njira yovuta yokhudza zinthu zingapo zamkati ndi zakunja, monga kusankha moyo ndi kapangidwe ka dongosolo lazaumoyo [11,12,13]. Palibe chidwi chachikulu chomwe chaperekedwa ku zinthu zomwe zili mkati mwa maphunziro azachipatala omwe angakhudze njira yopangira zisankho.
Njira yophunzitsira ya LIC imasiyana ndi njira yachikhalidwe yosinthira mabuloko m'mapangidwe ndi malo [5, 14, 15, 16]. Malo akumidzi omwe ali ndi ndalama zochepa nthawi zambiri amakhala m'madera ang'onoang'ono akumidzi omwe ali ndi maulalo azachipatala ku zipatala zonse [5]. Chinthu chofunikira kwambiri pa LIC ndi lingaliro la "kupitiriza," lomwe limathandizidwa ndi kudzipereka kwa nthawi yayitali, kulola ophunzira kukhala ndi ubale wa nthawi yayitali ndi oyang'anira, magulu azaumoyo, ndi odwala [5,14,15,16]. Ophunzira a LIC amaphunzira maphunziro mokwanira komanso nthawi imodzi, mosiyana ndi maphunziro otsatizana omwe amafotokozera njira yachikhalidwe yosinthira mabuloko [5, 17].
Ngakhale kuti deta yochuluka yokhudza ogwira ntchito ku LIC ndi yofunika kwambiri poyesa zotsatira za pulogalamuyo, palibe umboni womveka bwino wofotokozera chifukwa chake omaliza maphunziro a LIC akumidzi amakhala ndi mwayi wogwira ntchito m'malo akumidzi ndi osamalira odwala poyerekezera ndi omaliza maphunziro azaumoyo ochokera ku mitundu ina ya ukalaliki [8, 18]. Brown et al (2021) adachita kafukufuku wofufuza momwe anthu amadziwira ntchito m'maiko osauka (m'mizinda ndi m'midzi) ndipo adati pakufunika chidziwitso chochulukirapo pazinthu zomwe zimapangitsa kuti ntchito ya anthu osauka igwire bwino ntchito kuti apereke chidziwitso cha njira zomwe zimakhudza zisankho za omaliza maphunziro pankhani ya ntchito [18]. Kuphatikiza apo, pakufunika kumvetsetsa bwino ntchito zomwe ophunzira omaliza maphunziro a LIC amasankha, kuwalimbikitsa atakhala madokotala oyenerera kupanga zisankho zaukadaulo, chifukwa maphunziro ambiri ayang'ana kwambiri malingaliro ndi zolinga za ophunzira ndi madokotala aang'ono [11, 18, 19].
Zingakhale zosangalatsa kuphunzira momwe mapulogalamu akumidzi a LIC amakhudzira zisankho za omaliza maphunziro pantchito zokhudzana ndi zachipatala komanso malo omwe ali. Njira yophunzirira yogwiritsira ntchito mfundo za zomangamanga idagwiritsidwa ntchito poyankha mafunso ofufuza ndikupanga dongosolo lamalingaliro lofotokoza zinthu za ntchito ya ogwira ntchito zomwe zidakhudza njirayi.
Iyi ndi pulojekiti ya chiphunzitso cha constructivist. Iyi idadziwika kuti ndi njira yoyenera kwambiri yophunzirira chifukwa (i) idazindikira ubale pakati pa wofufuza ndi wophunzirayo womwe udakhala maziko osonkhanitsira deta, womwe unakhazikitsidwa ndi mbali zonse ziwiri (ii) idawonedwa ngati njira zoyenera zofufuzira chilungamo cha anthu. Mwachitsanzo, kugawa bwino zinthu zachipatala, ndipo (iii) ikhoza kufotokoza chochitika monga "chomwe chinachitika" m'malo mongofufuza ndikufotokozera [20].
Digiri ya Dokotala wa Zamankhwala (MD) ya Deakin University (yomwe kale inali Bachelor of Medicine/Bachelor of Surgery) inaperekedwa mu 2008. Digiri ya Dokotala wa Zamankhwala ndi pulogalamu yolowera maphunziro a digiri yoyamba ya zaka zinayi yomwe imaperekedwa m'mizinda ndi m'midzi, makamaka kumadzulo kwa Victoria, Australia. Malinga ndi dongosolo la Australian Modified Monash Model (MMM) logawa mtunda wa malo, malo ophunzirira a MD akuphatikizapo MM1 (madera a mzinda), MM2 (malo opezeka m'madera), MM3 (matauni akuluakulu akumidzi), MM4 (matauni akumidzi apakatikati) ndi MM5 (matauni ang'onoang'ono akumidzi)) [21].
Zaka ziwiri zoyambirira za gawo loyambirira la matenda (maphunziro azachipatala) zidachitika ku Geelong (MM1). Mu chaka chachitatu ndi chachinayi, ophunzira amaphunzira zachipatala (ntchito yaukadaulo ya zamankhwala) pa imodzi mwa masukulu asanu azachipatala ku Geelong, Eastern Health (MM1), Ballarat (MM2), Warrnambool (MM3) kapena pulogalamu ya LIC - Rural Community Clinical Schools (RCCS); ), yomwe imadziwika kuti IMMERSE Program (MM 3-5) mpaka 2014 (Chithunzi 1).
RCCS LIC imalembetsa ophunzira pafupifupi 20 chaka chilichonse omwe amagwira ntchito ku Grampians ndi South Western Victoria m'chaka chawo chachitatu cha MD. Njira yosankhira ndi kudzera mu njira yosankha yomwe ophunzira amasankha sukulu yachipatala m'chaka chawo chachiwiri. Pulogalamuyi imalandira ophunzira omwe ali ndi zokonda zosiyanasiyana kuyambira choyamba mpaka chachisanu. Kenako mizinda inayake imaperekedwa kutengera zomwe ophunzira amakonda komanso kuyankhulana. Ophunzira amagawidwa m'mizinda makamaka m'magulu a anthu awiri kapena anayi.
Ophunzira amagwira ntchito ndi madokotala a chipatala ndi ogwira ntchito zachipatala akumidzi, ndipo woyang'anira wamkulu ndi dokotala wa chipatala (GP).
Ofufuza anayi omwe akutenga nawo mbali mu kafukufukuyu akuchokera m'makhalidwe ndi ntchito zosiyanasiyana, koma ali ndi chidwi chofanana pa maphunziro azachipatala komanso kugawa mofanana kwa ogwira ntchito zachipatala. Tikagwiritsa ntchito chiphunzitso cha constructivist, timaganizira za mbiri yathu, zomwe takumana nazo, chidziwitso chathu, zikhulupiriro zathu, ndi zomwe timakonda kuti zikhudze chitukuko cha mafunso ofufuza, njira yofunsira mafunso, kusanthula deta, ndi kumanga mfundo. JB ndi wofufuza zaumoyo wakumidzi yemwe ali ndi chidziwitso mu kafukufuku wa qualitative, akugwira ntchito ku LIC komanso amakhala kumidzi komwe kuli malo ophunzirira a LIC. LF ndi katswiri wa zamaphunziro komanso director wa zachipatala wa pulogalamu ya LIC ku Deakin University ndipo amagwira ntchito yophunzitsa ophunzira a LIC. MB ndi HB ndi ofufuza akumidzi omwe ali ndi chidziwitso pakukhazikitsa mapulojekiti ofufuza qualitative ndikukhala kumidzi ngati gawo la maphunziro awo a LIC.
Kusinthasintha maganizo ndi luso la wofufuzayo zinagwiritsidwa ntchito kutanthauzira ndikupeza tanthauzo kuchokera ku deta yochulukayi. Mu ndondomeko yonse yosonkhanitsa ndi kusanthula deta, kukambirana pafupipafupi kunachitika, makamaka pakati pa JB ndi MB. HB ndi LF adapereka chithandizo panthawi yonseyi komanso kudzera mu chitukuko cha malingaliro ndi chiphunzitso chapamwamba.
Ophunzirawo anali omaliza maphunziro azachipatala ku Deakin University (2011–2020) omwe adapita ku LIC. Ogwira ntchito zaukadaulo a RCCS adawatumizira uthenga wolembera anthu ntchito. Ophunzirawo adafunsidwa kuti adina ulalo wolembetsa ndikupereka zambiri kudzera mu kafukufuku wa Qualtrics [22], zomwe zikusonyeza kuti (i) adawerenga mawu osavuta omwe amafotokoza cholinga cha kafukufukuyu ndi zofunikira za ophunzirawo, ndipo (ii) anali okonzeka kutenga nawo mbali mu kafukufukuyu. omwe ofufuzawo adalumikizana nawo kuti akonze nthawi yoyenera yofunsira mafunso. Malo omwe ntchito ya ophunzirawo idachitikira adalembedwanso.
Kulemba anthu ntchito kunachitika m'magawo atatu: gawo loyamba la omaliza maphunziro a 2017-2020, gawo lachiwiri la omaliza maphunziro a 2014-2016, ndi gawo lachitatu la omaliza maphunziro a 2011-2013 (Chithunzi 2). Poyamba, kusankha zitsanzo mwadala kunagwiritsidwa ntchito polumikizana ndi omaliza maphunziro omwe anali ndi chidwi ndikuwonetsetsa kuti ntchito zosiyanasiyana zikugwira ntchito. Ophunzira ena omwe poyamba anasonyeza chidwi chofuna kutenga nawo mbali mu kafukufukuyu sanafunsidwe mafunso chifukwa sanayankhe pempho la wofufuzayo loti apemphe nthawi yoti afunsidwe mafunso. Njira yolembera anthu ntchito yomwe idachitika pang'onopang'ono idalola kuti pakhale njira yobwerezabwereza yosonkhanitsira deta ndi kusanthula, kuthandizira kusankha zitsanzo mwanzeru, kupanga malingaliro ndi kukonza mfundo, komanso kupanga mfundo [20].
Ndondomeko yolembera anthu ntchito. Omaliza maphunziro a LIC ndi omwe akutenga nawo mbali mu Pulogalamu Yogwirizanitsa Ogwira Ntchito ya Longitudinal. Kusankha zinthu mwanzeru kumatanthauza kulemba anthu ntchito osiyanasiyana.
Mafunso anachitika ndi ofufuza JB ndi MB. Chilolezo cha pakamwa chinapezeka kuchokera kwa ophunzira ndipo mawu anajambulidwa kuyankhulana kusanayambe. Buku lotsogolera kuyankhulana losakonzedwa bwino komanso kafukufuku wogwirizana nalo linapangidwa poyamba kuti litsogolere njira yofunsira mafunso (Table 1). Bukuli linasinthidwanso ndikuyesedwa kudzera mu kusonkhanitsa deta ndi kusanthula kuti liphatikize malangizo ofufuza ndi chitukuko cha chiphunzitso. Mafunso anachitika pafoni, mawu anajambulidwa, mawu analembedwa motsatira mawu, ndipo sanatchulidwe dzina. Kutalika kwa kuyankhulana kunali pakati pa mphindi 20 mpaka 53, ndi kutalika kwapakati kwa mphindi 33. Kusanthula deta kusanachitike, ophunzirawo ankatumizidwa makope a zolemba za kuyankhulana kuti athe kuwonjezera kapena kusintha zambiri.
Zolemba za kuyankhulana zidayikidwa mu pulogalamu yoyeserera ya QSR NVivo version 12 (Lumivero) ya Windows kuti igwirizane ndi kusanthula deta [23]. Ofufuza JB ndi MB adamvetsera, kuwerenga, ndi kulemba ma code pa kuyankhulana kulikonse payekhapayekha. Kulemba zolemba nthawi zambiri kumagwiritsidwa ntchito kulemba malingaliro osakhazikika okhudza deta, ma code, ndi magulu a malingaliro [20].
Kusonkhanitsa ndi kusanthula deta kumachitika nthawi imodzi, ndipo njira iliyonse imadziwitsa ina. Njira yofananira imeneyi imagwiritsidwa ntchito nthawi zonse pa magawo onse a kusanthula deta. Mwachitsanzo, kuyerekeza deta ndi deta, kugawa ndi kukonza ma code kuti apange malangizo owonjezera ofufuza mogwirizana ndi chitukuko cha chiphunzitso [20]. Ofufuza JB ndi MB ankakumana pafupipafupi kuti akambirane za kulemba koyamba ndikupeza madera omwe akuyang'aniridwa panthawi yosonkhanitsa deta mobwerezabwereza.
Kulemba ma code kunayamba ndi kulemba koyambirira kwa mzere ndi mzere komwe deta "inasweka" ndipo ma code otseguka adaperekedwa omwe adafotokoza zochitika ndi njira zokhudzana ndi "zomwe zinali kuchitika" mu deta. Gawo lotsatira la kulemba ma code ndi kulemba kwapakati, momwe ma code a mzere ndi mzere amawunikidwanso, kuyerekezeredwa, kusanthulidwa, ndi kuganiziridwa pamodzi kuti adziwe ma code omwe ali ndi tanthauzo kwambiri pakusanthula deta [20]. Pomaliza, kulemba ma code owonjezera a chiphunzitso kumagwiritsidwa ntchito popanga chiphunzitso. Izi zimaphatikizapo kukambirana ndikugwirizana pa makhalidwe osanthula a chiphunzitsocho mu gulu lonse lofufuza, kuonetsetsa kuti chikufotokoza momveka bwino zomwe zikuchitika.
Deta ya chiwerengero cha anthu inasonkhanitsidwa kudzera mu kafukufuku wa pa intaneti asanayambe kuyankhulana kulikonse kuti atsimikizire kuti ophunzira ambiri akutenga nawo mbali komanso kuti agwirizane ndi kusanthula kwa qualitative. Deta yomwe inasonkhanitsidwa inali: jenda, zaka, chaka chomaliza maphunziro, komwe anachokera kumidzi, komwe anagwira ntchito panopa, ukadaulo wa zachipatala, komanso komwe sukulu ya zachipatala ya chaka chachinayi inali.
Zomwe zapezekazi zikuthandizira pakupanga dongosolo la malingaliro lomwe likuwonetsa momwe LIC yakumidzi imakhudzira zisankho za ophunzira m'malo osiyanasiyana komanso pantchito zawo.
Ophunzira 39 a LIC adatenga nawo mbali mu kafukufukuyu. Mwachidule, 53.8% ya omwe adatenga nawo mbali anali akazi, 43.6% anali ochokera kumidzi, 38.5% ankagwira ntchito kumidzi, ndipo 89.7% adamaliza maphunziro azachipatala (Table 2).
Ndondomeko iyi ya zisankho za ntchito za LIC yakumidzi ikuyang'ana kwambiri zinthu za pulogalamu ya LIC yakumidzi zomwe zimakhudza zisankho za ntchito za omaliza maphunziro, zomwe zikusonyeza kuti kuphatikiza kwa zinthu zaumwini ndi za pulogalamu mkati mwa lingaliro lalikulu la "kusankha kutenga nawo mbali" kungakhudzenso malo a omaliza maphunziro. monga zisankho zantchito, kaya payekha kapena mogwirizana (Chithunzi 3). Zotsatira zotsatirazi zikufotokoza zinthu za dongosololi ndipo zikuphatikizapo mawu ochokera kwa ophunzira kuti afotokoze tanthauzo lake.
Ntchito za kusukulu yachipatala zimamalizidwa kudzera mu njira yosankha, kotero ophunzira amatha kusankha mapulogalamu mosiyana. Pakati pa omwe adasankha kutenga nawo mbali mwalamulo, panali magulu awiri a omaliza maphunziro: omwe adasankha mwadala kutenga nawo mbali mu pulogalamuyi (odzisankhira okha), ndi omwe sanasankhe koma adatumizidwa ku RCCS. Izi zikuwonekera m'malingaliro ogwiritsira ntchito (gulu lomaliza) ndi kutsimikizira (gulu loyamba). Akaphatikizidwa muzochita, malingaliro a luso lophunzirira kapangidwe ndi maphunziro pamalopo amawonjezera kutenga nawo mbali popatsa ophunzira mwayi wokumana ndi kufananiza maphunziro azaumoyo mwanjira yonse.
Mosasamala kanthu za kuchuluka kwa kudzisankhira, ophunzirawo nthawi zambiri anali ndi chidaliro pa zomwe adakumana nazo ndipo adati LIC inali chaka chophunzirira chomwe sichinangowaphunzitsa za malo azachipatala okha, komanso chinawapatsa kupitiriza maphunziro awo komanso maziko olimba a ntchito zawo. Kudzera mu njira yophatikizana yoperekera pulogalamuyi, adaphunzira za moyo wakumidzi, mankhwala akumidzi, machitidwe wamba ndi akatswiri osiyanasiyana azachipatala.
Ena mwa ophunzirawo adanena kuti akanakhala kuti sanapite ku pulogalamuyi ndikumaliza maphunziro onse mumzinda, sakanaganizapo kapena kumvetsetsa momwe angakwaniritsire zosowa zawo zaumwini ndi zaukadaulo m'dera lakumidzi. Izi pamapeto pake zimapangitsa kuti pakhale kuyanjana kwa zinthu zaumwini ndi zaukadaulo, monga mtundu wa dokotala amene akufuna kukhala, dera lomwe akufuna kuchita ntchito, ndi moyo wawo monga mwayi wopeza malo ozungulira komanso mwayi wopeza moyo wakumidzi.
Kwa ine zikuwoneka kuti ndikanakhala ku X [mzinda waukulu] kapena china chake chonga chimenecho, ndiye kuti mwina tikadakhala pamalo amodzi, sindikuganiza kuti ife (ogwirizana nawo) tikadachita izi, kulumpha kumeneku (ntchito kumadera akumidzi) sikukanafunika kukakamizidwa (wolembetsa ntchito wamba, ntchito zakumidzi).
Kutenga nawo mbali mu pulogalamuyi kumapereka mwayi woganizira ndi kutsimikizira zolinga za omaliza maphunziro kuti agwire ntchito kumidzi. Izi nthawi zambiri zimachitika chifukwa chakuti munakulira kumidzi ndipo mukufuna kuchita internship pamalo ofanana mukamaliza maphunziro. Kwa ophunzira omwe poyamba ankafuna kulowa mu ntchito yodziwika bwino, zinali zoonekeratu kuti zomwe adakumana nazo zidakwaniritsa zomwe amayembekezera ndipo zidalimbitsa kudzipereka kwawo kutsatira njira imeneyi.
Kuphunzira (ku LIC) kunangolimbitsa zomwe ndimaganiza kuti ndizo zomwe ndimakonda ndipo kunangotsimikizira mgwirizano ndipo sindinaganizepo zofunsira ntchito ya metro mu chaka changa chophunzirira kapena kuganiziranso za kugwira ntchito ku metro (dokotala wa matenda amisala, chipatala chakumidzi).
Kwa ena, kutenga nawo mbali kunatsimikizira kuti moyo/thanzi lakumidzi silinakwaniritse zosowa zawo zaumwini ndi zantchito. Mavuto a munthu aliyense payekhapayekha amachititsa kuti pakhale kutali ndi banja ndi abwenzi, komanso mwayi wopeza ntchito monga maphunziro ndi chisamaliro chaumoyo. Iwo ankaona kuti kuchuluka kwa ntchito zomwe madokotala akumidzi amachita nthawi zonse ngati cholepheretsa ntchito.
Woyang'anira mzinda wanga nthawi zonse amalumikizana nane. Chifukwa chake, ndikuganiza kuti moyo uwu suli woyenera kwa ine (GP ku chipatala chachikulu).
Mwayi wokonzekera maphunziro ndi kapangidwe ka kuphunzira kwa ophunzira zimakhudza zisankho za ntchito. Zinthu zazikulu zomwe LIC imachita komanso kuphatikizana zimapatsa ophunzira ufulu wodziyimira pawokha komanso mwayi wochita nawo mwachangu chisamaliro cha odwala, kukulitsa luso lawo, komanso kuthandizira kupeza ndi kufananiza mitundu ya ntchito zachipatala nthawi yeniyeni yomwe ikugwirizana ndi zosowa zawo zaumwini komanso zaukadaulo.
Popeza maphunziro azachipatala omwe ali pamaphunzirowa amaphunzitsidwa mokwanira, ophunzira amakhala ndi ufulu wodzilamulira ndipo amatha kudziwongolera okha ndikupeza mwayi wawo wophunzirira. Kudzilamulira kwa ophunzira kumakula pakapita chaka pamene akupeza kumvetsetsa kwachibadwa ndi chitetezo mkati mwa dongosolo la pulogalamuyi, kukhala ndi luso lodzifufuza mozama m'malo osiyanasiyana azachipatala. Izi zinathandiza ophunzira kuyerekeza maphunziro azachipatala nthawi yeniyeni, kuwonetsa kukonda kwawo madera enaake azachipatala omwe nthawi zambiri amasankha ngati apadera.
Ku RCCS mumakumana ndi maphunziro awa kale kenako mumapeza nthawi yochulukirapo yoti muganizire kwambiri pa mitu yomwe mukufunadi, kotero ndithudi ophunzira ambiri a metro sakhala ndi mwayi wosankha nthawi ndi malo awo. Ndipotu, ndimapita kuchipatala tsiku lililonse ... zomwe zikutanthauza kuti ndimatha kukhala nthawi yochulukirapo mchipinda chadzidzidzi, nthawi yochulukirapo mchipinda chochitira opaleshoni, ndikuchita zomwe ndimakonda kwambiri (katswiri wa mankhwala oletsa ululu, katswiri wakumidzi).
Kapangidwe ka pulogalamuyi kamalola ophunzira kukumana ndi odwala osasiyana kwinaku akupereka ufulu wodziyimira pawokha kuti apeze mbiri yachipatala, kukulitsa luso loganiza bwino pazachipatala, ndikupereka njira yodziwira matenda osiyanasiyana ndi njira yochizira kwa dokotala. Kudziyimira pawokha kumeneku kumasiyana ndi kubwerera ku kuzungulira kwa block m'chaka chachinayi, pomwe zimamveka kuti pali mwayi wochepa wokhudza odwala osasiyana ndipo pali kubwerera ku udindo woyang'anira. Mwachitsanzo, wophunzira wina adanena kuti ngati zomwe adakumana nazo zokha kuchipatala zikanakhala kusintha kwa nthawi yochepa kwa chaka chachinayi, komwe adafotokoza ngati wowonera, sakanamvetsetsa kukula kwa machitidwe wamba ndipo adapereka lingaliro loti apitirire maphunziro mu ukadaulo wina.
Ndipo sindinakhale ndi chidziwitso chabwino konse (kuzungulira ma GP blocks). Chifukwa chake, ndikumva kuti ngati ichi chinali chidziwitso changa chokhacho pantchito wamba, mwina ntchito yanga ikanakhala yosiyana ... Ndikungomva ngati ndikungotaya nthawi chifukwa ndikungowona (GP, ntchito yakumidzi) momwe iyi ndi malo ogwirira ntchito. .
Kugwirizana kwa nthawi yayitali kumathandiza ophunzira kukhala ndi ubale wopitilira ndi madokotala omwe amagwira ntchito ngati alangizi komanso zitsanzo. Ophunzirawo adafunafuna madokotala mwachangu ndipo adakhala nawo nthawi yayitali pazifukwa zosiyanasiyana, monga nthawi ndi chithandizo chomwe adapereka, maphunziro aukadaulo, kupezeka, kuyamikira chitsanzo chawo cha ntchito, komanso umunthu wawo ndi makhalidwe awo. Kugwirizana ndi inu nokha kapena ena. Chikhumbo chofuna kukula. Zitsanzo/alangizi sanali ophunzira okha omwe adapatsidwa ntchito motsogozedwa ndi dokotala wamkulu, komanso oimira ochokera ku mitundu yosiyanasiyana ya zamankhwala, kuphatikiza madokotala, madokotala ochita opaleshoni ndi akatswiri ogonetsa.
Pali zinthu zingapo. Ndili pamalo a X (LIC). Panali dokotala wogonetsa anthu omwe anali kuyang'anira ICU mwanjira ina, ndikuganiza kuti ankasamalira ICU kuchipatala cha X (kumidzi) ndipo anali ndi khalidwe lodekha, madokotala ambiri ogonetsa anthu omwe ndakumana nawo anali ndi khalidwe lodekha pazinthu zambiri. Unali khalidwe losasinthika limeneli lomwe linandikhudza kwambiri. (katswiri wogonetsa anthu, dokotala wa mzinda)
Kumvetsetsa bwino momwe madokotala amalumikizirana ndi moyo wawo wantchito komanso waumwini kunafotokozedwa kuti kumapereka chidziwitso chofunikira pa moyo wawo ndipo kunaganiziridwa kuti kumalimbikitsa ophunzira kutsatira njira zofanana. Palinso kusintha kwa moyo wa dokotala, kochokera ku zochitika zapakhomo.
Chaka chonse, ophunzira amakulitsa luso lawo lachipatala, laumwini komanso laukadaulo kudzera mu mwayi wophunzira woperekedwa kudzera muubwenzi womwe unakhazikitsidwa ndi madokotala, odwala ndi ogwira ntchito zachipatala. Kukula kwa luso lachipatala ndi kulumikizana kumeneku nthawi zambiri kumaphatikizapo gawo linalake lachipatala, monga mankhwala wamba kapena mankhwala oletsa ululu. Mwachitsanzo, nthawi zambiri, omaliza maphunziro a opaleshoni ya opaleshoni ndi akatswiri oletsa ululu anafotokoza za kukula kwawo kwa luso loyambira mu gawoli kuyambira chaka chawo cha LIC, komanso kudzidalira komwe adakulitsa pamene luso lawo lapamwamba kwambiri linazindikirika ndikupatsidwa mphotho. Kumva kumeneku kudzalimbikitsidwa ndi maphunziro otsatira. ndipo padzakhala mwayi wopita patsogolo.
Ndizabwino kwambiri. Ndiyenera kuchita ma intubation, anesthesia ya msana, ndi zina zotero, ndipo chaka chamawa ndikamaliza maphunziro a rehabilitation… anesthesiology. Ndidzakhala dokotala wa anesthesia ndipo ndikuganiza kuti imeneyo inali gawo labwino kwambiri la zomwe ndakumana nazo ndikugwira ntchito kumeneko (LIC scheme) (general anesthesia registrar, kugwira ntchito kumidzi).
Maphunziro apamalopo kapena momwe ntchito ikuyendera zinafotokozedwa kuti zimakhudza zisankho za ophunzira pantchito. Malowa adafotokozedwa ngati kuphatikiza malo akumidzi, malo ochitira opaleshoni, zipatala zakumidzi ndi malo enaake azachipatala (monga malo ochitira opaleshoni) kapena malo enaake. Malingaliro okhudzana ndi malo, kuphatikizapo kumva kuti anthu ali m'dera linalake, chitonthozo cha chilengedwe, ndi mtundu wa momwe anthu amaonekera kuchipatala, adakhudza zisankho za ophunzira kuti azigwira ntchito m'madera akumidzi ndi/kapena malo ochitira opaleshoni.
Kumva ngati anthu ammudzi kunakhudza zisankho za ophunzira kuti apitirize kuchita ntchito zawo. Chomwe chimapangitsa kuti ntchito zawo zikhale zosangalatsa ndichakuti zimapangitsa kuti anthu azikhala ochezeka komanso kuti azikhala ndi maudindo ochepa pomwe ophunzira amatha kuyanjana ndi kuwona madokotala ndi madokotala omwe akuwoneka kuti akusangalala ndikupeza chisangalalo kuchokera kuntchito yawo.
Ophunzirawo adazindikiranso kufunika komanga ubale ndi odwala. Kukhutira kwaumwini ndi kwaukadaulo kumachitika mwa kudziwana ndi odwala ndikupanga ubale wopitilira pakapita nthawi pamene akutsatira njira yawo, nthawi zina m'machitidwe wamba, koma nthawi zambiri m'malo osiyanasiyana azachipatala. Izi zimasiyana ndi zomwe sizimakonda chisamaliro cha nthawi ndi nthawi, monga m'madipatimenti azadzidzidzi, komwe sipangakhale mzere wotsekedwa wa zotsatira za odwala otsatira.
Kotero, mumadziwa bwino odwala anu, ndipo ndikuganiza kuti, mwina chomwe ndimakonda kwambiri pokhala dokotala wa chipatala ndi ubale womwe mumakhala nawo ndi odwala anu ... ndikumanga ubale umenewo ndi iwo, ndipo nthawi zina osati m'zipatala ndi zina zapadera, mungathe ... mumawawona kamodzi kapena kawiri, ndipo nthawi zambiri simumawawonanso (dokotala wamkulu, chipatala cha mzinda).
Kudziwa zambiri zokhudza chipatala komanso kutenga nawo mbali pa zokambirana nthawi imodzi kunapatsa ophunzirawo kumvetsetsa kukula kwa mankhwala achikhalidwe achi China m'chipatala, makamaka m'machipatala akumidzi. Asanakhale ophunzira, ena mwa ophunzirawo ankaganiza kuti angayambe chipatala, koma ambiri omwe adadzakhala dokotala wa ana adati poyamba sankadziwa ngati chipatalacho chinali choyenera kwa iwo, akumva kuti chithunzi cha matenda a acuity sichinali chotsika kwambiri motero sangathe kupitirizabe chidwi chawo pantchito kwa nthawi yayitali.
Popeza ndakhala ndikuchita GP monga wophunzira wodziwa bwino ntchito, ndikuganiza kuti unali nthawi yanga yoyamba kuonana ndi madokotala osiyanasiyana ndipo ndinaganiza momwe odwala ena anali ovuta, kuchuluka kwa odwala komanso momwe madokotala a GP (GP) angakhalire osangalatsa, komanso momwe madokotala a GP (GP) amagwirira ntchito.).
Nthawi yotumizira: Julayi-31-2024