Kufanana nenyika dzakawanda, Australia inotarisana nekupararira kusina kuenzana kwevashandi vehutano kwenguva refu, vanachiremba vashoma pamunhu mumwe nemumwe munzvimbo dzekumaruwa uye nzira yekuenda kunyanzvi yepamusoro. Longitudinal Integrated Clerkship (LIC) imhando yedzidzo yezvekurapa iyo inogona kuita kuti vadzidzi vakapedza kudzidza vashande munharaunda dziri kure uye dziri muzvipatara. Kunyange hazvo data iri rehuwandu richikosha, data repurojekiti chaiyo rekutsanangura chiitiko ichi harisipo.
Kuti vagadzirise musiyano uyu weruzivo, nzira yekuvaka yakavakirwa padzidziso yemhando yepamusoro yakashandiswa kuona kuti ruzivo rwekumusha rwakabatana rweDeakin University rwakachinja sei sarudzo dzebasa dzevadzidzi vakapedza kudzidza (2011–2020) maererano nehunyanzvi hwekurapa nenzvimbo.
Vadzidzi makumi matatu nevapfumbamwe vakapinda mubvunzurudzo dzemhando yepamusoro. Hurongwa hwesarudzo dzebasa reLIC rekumaruwa hwakagadzirwa, zvichiratidza kuti musanganiswa wezvinhu zvemunhu nehurongwa mukati mepfungwa huru ye "sarudzo yekutora chikamu" zvinogona kukanganisa sarudzo dzebasa revadzidzi vepayunivhesiti, zvese pachavo uye nekubatsirana. Kana zvabatanidzwa mukuita, pfungwa dzehunyanzvi hwekugadzira kudzidza uye kudzidziswa panzvimbo dzinowedzera kubatanidzwa nekupa vatori vechikamu mukana wekuona nekuenzanisa zvidzidzo zvehutano nenzira yakazara.
Hurongwa hwakagadzirwa hunomiririra zvinhu zviri muchirongwa zvinoonekwa sezvine simba muzvisarudzo zvebasa zvevadzidzi vanopedza kudzidza. Zvinhu izvi, pamwe chete nechinangwa chechirongwa, zvinobatsira mukuzadzisa zvinangwa zvevashandi vekumaruwa zvechirongwa. Kuchinja kwakaitika pasinei nekuti vadzidzi vaida kutora chikamu muchirongwa kana kwete. Kuchinja kunoitika kuburikidza nekufungisisa, uko kungave kunopikisa kana kusimbisa pfungwa dzevadzidzi pamusoro pekuita sarudzo dzebasa, nokudaro zvichipesvedzera kuumbwa kwehunhu hwebasa.
Kufanana nenyika dzakawanda, Australia inotarisana nekusawirirana kwenguva refu uye kunoramba kuripo mukugoverwa kwevashandi vehutano [1]. Izvi zvinoratidzwa nehuwandu hushoma hwevanachiremba pamunhu mumwe nemumwe munzvimbo dzekumaruwa uye mafambiro ekuchinja kubva kuhutano hwekutanga kuenda kuhutano hwakanyanya [2, 3]. Zvikasanganiswa, zvinhu izvi zvinokanganisa hutano munzvimbo dzekumaruwa, kunyanya nekuti hutano hwekutanga hwakakosha kune vashandi vehutano munharaunda idzi, vachipa kwete mabasa ehutano hwekutanga chete asiwo dhipatimendi rekukurumidzira nechipatara [4]. ]. Longitudinal Integrated Clerkship (LIC) imhando yedzidzo yezvekurapa yakatanga kugadzirwa senzira yekudzidzisa vadzidzi vezvekurapa munharaunda diki dzekumaruwa uye yakagadzirwa kukurudzira kudzidzira munharaunda dzakafanana [5, 6]. Iyi pfungwa inowanikwa nekuti vakapedza kudzidza veLIC dzekumaruwa vane mukana wekushanda munzvimbo dzekumaruwa, dziri kure uye muhutano hwekutanga [7,8,9,10]. Maitiro evapedza kudzidza zvekurapa anosarudza mabasa akatsanangurwa senzira yakaoma inosanganisira zvinhu zvakawanda zvemukati nekunze, zvakaita sesarudzo dzemararamiro uye chimiro chehurongwa hwehutano [11,12,13]. Hapana kutarisirwa kwakawanda kwakaitwa pazvinhu zviri mukudzidziswa kwechiremba kwevadzidzi vepakoreji zvinogona kukanganisa maitiro aya ekuita sarudzo.
Nzira yekudzidzisa yeLIC yakasiyana netsika yekutenderera kweblock muchimiro nenzvimbo [5, 14, 15, 16]. Nzvimbo dzekumaruwa dzine mari shoma dzinowanzo kuwanikwa munharaunda diki dzekumaruwa dzine hukama hwekiriniki nezvipatara [5]. Chinhu chakakosha cheLIC ipfungwa ye "kuenderera mberi," iyo inofambiswa nekubatana kwenguva refu, zvichibvumira vadzidzi kukudziridza hukama hwenguva refu nevatariri, mapoka ehutano, nevarwere [5,14,15,16]. Vadzidzi veLIC vanodzidza makosi zvakakwana uye panguva imwe chete, kusiyana nezvidzidzo zvinotevedzana kwenguva pfupi zvinoratidza kutenderera kweblock kwetsika [5, 17].
Kunyangwe huwandu hweruzivo rwevashandi veLIC hwakakosha pakuongorora mhedzisiro yechirongwa, hapana humbowo hwakajeka hunotsanangura kuti sei vadzidzi vekumaruwa veLIC vangangoshanda munzvimbo dzekumaruwa nedzekutarisirwa kwevanachiremba vepuraimari zvichienzaniswa nevaya vakapedza kudzidza mabasa ehutano kubva kune mamwe mamodheru ebasa [8, 18]. Brown et al (2021) vakaita ongororo yekuongorora kuumbwa kweruzivo rwebasa munyika dzine mari shoma (mumaguta nemumaruwa) uye vakataura kuti ruzivo rwakawanda runodiwa pazvinhu zvinoita kuti basa revanhu vane mari shoma rive nyore kuti vape ruzivo nezvenzira dzinopesvedzera sarudzo dzevadzidzi nezvebasa [18]. Pamusoro pezvo, pane chikonzero chekunzwisisa zvakapfuura sarudzo dzebasa dzevadzidzi veLIC, tichivabata mushure mekunge vava vanachiremba vane hunyanzvi vachiita sarudzo dzehunyanzvi, sezvo zvidzidzo zvakawanda zvakatarisa pamaonero nezvinangwa zvevadzidzi nevanachiremba vechidiki [11, 18, 19].
Zvingave zvinonakidza kudzidza kuti mapurogiramu eLIC ekumaruwa anobatsira sei sarudzo dzebasa dzevakapedza kudzidza maererano nehunyanzvi hwekurapa nenzvimbo. Nzira yedzidziso yekuvaka yakashandiswa kupindura mibvunzo yekutsvagisa nekugadzira hurongwa hwepfungwa hunotsanangura zvinhu zvebasa revashandi zvakapesvedzera maitiro aya.
Iyi ipurojekiti yedzidziso yekuvaka ine qualitative constructivist. Iyi yakaonekwa senzira yakakodzera kwazvo yedzidziso nekuti (i) yakaona hukama huripo pakati pemuongorori nemutori wechikamu hwakaumba hwaro hwekuunganidzwa kwedata, izvo zvakavakwa pamwe chete nemativi ese (ii) yaionekwa senzira dzakakodzera dzekutsvaga kururamisira kwevanhu. , semuenzaniso, kugoverwa kwakarurama kwezviwanikwa zvehutano, uye (iii) inogona kutsanangura chiitiko chakadai sekuti "zvakaitika" pane kungozviongorora nekutsanangura [20].
Dhigirii reDeakin University reDoctor of Medicine (MD) (raimbova Bachelor of Medicine/Bachelor of Surgery) rakapihwa muna 2008. Dhigirii reDoctor of Medicine chirongwa chemakore mana chekupinda muyunivhesiti chinopihwa munzvimbo dzemaguta nedzekumaruwa, kunyanya kumadokero kweVictoria, Australia. Sekureva kweAustralian Modified Monash Model (MMM) geographical distance classification system, nzvimbo dzedzidzo dzeMD dzinosanganisira MM1 (nzvimbo dzemaguta makuru), MM2 (nzvimbo dzematunhu), MM3 (mataundi makuru ekumaruwa), MM4 (mataundi ekumaruwa ari pakati nepakati) uye MM5 (mataundi madiki ekumaruwa)) [21].
Makore maviri ekutanga echikamu chekutanga chekurapa (ruzivo rwezvekurapa) akaitwa muGeelong (MM1). Mugore rechitatu nerechina, vadzidzi vanodzidziswa zvekurapa (hunyanzvi hwekurapa) pane chimwe chezvikoro zvishanu zvekurapa muGeelong, Eastern Health (MM1), Ballarat (MM2), Warrnambool (MM3) kana chirongwa cheLIC - Rural Community Clinical Schools (RCCS); ), chinozivikanwa zviri pamutemo seIMMERSE Program (MM 3-5) kusvika 2014 (Mufananidzo 1).
RCCS LIC inonyoresa vadzidzi vanosvika makumi maviri gore rega rega vanoshanda mudunhu reGrampians neSouth Western Victoria mugore ravo rekupedzisira (rechitatu) reMD. Nzira yekusarudza ndeyekushandisa nzira yekusarudza umo vadzidzi vanosarudza chikoro chekiriniki mugore ravo rechipiri. Chirongwa ichi chinogamuchira vadzidzi vane zvakasiyana-siyana zvavanoda kubva pakutanga kusvika pashanu. Maguta chaiwo anogoverwa zvichienderana nezvinodiwa nevadzidzi uye kubvunzurudzwa. Vadzidzi vanogoverwa mumaguta akawanda mumapoka evanhu vaviri kusvika vana.
Vadzidzi vanoshanda navanachiremba vezvirwere zvese pamwe nemasangano ehutano ekumaruwa, uye chiremba wezvirwere zvese (GP) ndiye mukuru wavo.
Vaongorori vana vari muchidzidzo ichi vanobva kwakasiyana-siyana uye mabasa, asi vane chido chakafanana mudzidzo yezvekurapa uye kugoverwa kwakaenzana kwevashandi vezvekurapa. Patinoshandisa dzidziso yekuvaka, tinofunga nezvekwatakatangira, ruzivo, zvitendero, uye zvatinofarira kuti tibatsire pakuvandudzwa kwemibvunzo yekutsvagisa, maitiro ekubvunzurudza, kuongorora data, uye kuvaka dzidziso. JB muongorori wehutano hwekumaruwa ane ruzivo mukutsvaga kwemhando yepamusoro, anoshanda kuLIC uye anogara munzvimbo yekumaruwa yenzvimbo yekudzidzira yeLIC. LF inyanzvi yezvekurapa uye director wekiriniki wechirongwa cheLIC paDeakin University uye anoshanda mukudzidzisa vadzidzi veLIC. MB naHB vaongorori vekumaruwa vane ruzivo mukuita mapurojekiti ekutsvagisa kwemhando yepamusoro uye kugara munzvimbo dzekumaruwa sechikamu chekudzidziswa kwavo kweLIC.
Kugona kushandura mafungiro uye ruzivo rwemuongorori nehunyanzvi hwake zvakashandiswa kududzira nekuwana zvinoreva kubva muruzivo urwu rwakapfuma. Mukati mehurongwa hwekuunganidza nekuongorora ruzivo, hurukuro dzakawanda dzakaitika, kunyanya pakati paJB naMB. HB naLF vakapa rutsigiro mukati mehurongwa hwese uye kuburikidza nekuvandudza pfungwa dzepamusoro nedzidziso.
Vatori vechikamu vaiva vadzidzi vekurapa veDeakin University (2011–2020) vakapinda muLIC. Kukokwa kwekutora chikamu muchidzidzo ichi kwakatumirwa nevashandi vehunyanzvi veRCCS kuburikidza nemeseji yekunyoresa vanhu. Vatori vechikamu vanofarira vakakumbirwa kuti vadzvanye pane chinongedzo chekunyoresa uye vape ruzivo rwakadzama kuburikidza neongororo yeQualtrics [22], zvichiratidza kuti (i) vakanga vaverenga chirevo chemutauro wakajeka chinotsanangura chinangwa chechidzidzo uye zvinodiwa nevatori vechikamu, uye (ii) vaida kutora chikamu mukutsvagisa. avo vakataurwa nevaongorori kuti varonge nguva yakakodzera yekubvunzurudzwa. Nzvimbo yebasa revatori vechikamu yakanyorwawo.
Kutora vatori vechikamu kwakaitwa muzvikamu zvitatu: danho rekutanga kune vakapedza kudzidza muna 2017–2020, danho rechipiri kune vakapedza kudzidza muna 2014–2016, uye danho rechitatu kune vakapedza kudzidza muna 2011–2013 (Mufananidzo 2). Pakutanga, kutora sampuro nechinangwa kwakashandiswa kubata vakapedza kudzidza vanofarira uye kuona kuti mabasa akasiyana. Vamwe vakapedza kudzidza pakutanga vakaratidza kufarira kutora chikamu muchidzidzo havana kubvunzurudzwa nekuti havana kupindura chikumbiro chemuongorori chekuti vapihwe nguva yekubvunzurudzwa. Maitiro ekutora vatori vechikamu akabvumira maitiro ekudzokorora ekuunganidza nekuongorora data, kutsigira kutora sampuro, kuvandudza pfungwa nekunatsiridza, uye kugadzira dzidziso [20].
Chirongwa chekutsvaga vatori vechikamu. Vadzidzi veLIC vakapedza kudzidza vanotora chikamu muLongitudinal Integrated Clerkship Program. Kutora sampuli nechinangwa zvinoreva kutora vatori vechikamu vakasiyana-siyana.
Kubvunzurudzwa kwakaitwa nevaongorori JB naMB. Mvumo yekutaura yakawanikwa kubva kune vatori vechikamu uye odhiyo yakatorwa hurukuro isati yatanga. Gwaro rekubvunzurudzwa rakarongwa zvishoma pamwe neongororo dzakabatana nadzo dzakatanga kugadzirwa kuti dzitungamirire maitiro ekubvunzurudzwa (Tafura 1). Bhuku iri rakazogadziriswazve uye rakaedzwa kuburikidza nekuunganidzwa kwedata nekuongorora kuti ribatanidze nhungamiro dzekutsvagisa nekuvandudzwa kwedzidziso. Kubvunzurudzwa kwakaitwa nefoni, odhiyo yakatorwa, yakanyorwa shoko neshoko, uye isina kuzivikanwa. Hurefu hwekubvunzurudzwa hwaive hwemaminitsi makumi maviri kusvika makumi mashanu nematatu, neavhareji yehurefu hwemaminitsi makumi matatu nematatu. Vasati vaongorora data, vatori vechikamu vaitumirwa makopi ezvinyorwa zvekubvunzurudzwa kuitira kuti vagone kuwedzera kana kugadzirisa ruzivo.
Zvinyorwa zvekubvunzurudzwa zvakaiswa musoftware yeQSR NVivo vhezheni 12 (Lumivero) yeWindows kuti iwedzere ongororo yedata [23]. Vaongorori JB naMB vakateerera, vakaverenga, uye vakanyora makodhi kubvunzurudzwa kwega kwega. Kunyora manotsi kunowanzo shandiswa kunyora pfungwa dzisina kurongeka nezvedata, makodhi, uye mapoka edzidziso [20].
Kuunganidzwa kwedata nekuongororwa kunoitika panguva imwe chete, uye maitiro ese achizivisa mumwe. Iyi nzira yekuenzanisa inogara ichishandiswa mumatanho ese ekuongorora data. Semuenzaniso, kuenzanisa data nedata, kupatsanura nekugadzirisa makodhi kuti vagadzire mamwe marongero ekutsvagisa zvichienderana nekuvandudzwa kwedzidziso [20]. Vaongorori JB naMB vaisangana kakawanda kuti vakurukure nezvekutanga kunyora makodhi uye kuona nzvimbo dzekutarisa panguva yekudzokorora kwekuunganidza data.
Kunyora makodhi kwakatanga nekunyora makodhi ekutanga emutsara nemutsara umo data "rakakamurwa" uye makodhi akavhurika akapihwa aitsanangura zviitiko nemaitiro ane chekuita ne "zviri kuitika" mudata. Danho rinotevera rekunyora makodhi ikunyora makodhi epakati, umo makodhi emutsara nemutsara anoongororwa, kuenzaniswa, kuongororwa, uye kufungwa pamwe chete kuti vaone kuti makodhi api anonyanya kukosha pakuongorora data [20]. Chekupedzisira, kunyora makodhi edzidziso kwakawedzerwa kunoshandiswa kuvaka dzidziso. Izvi zvinosanganisira kukurukura nekubvumirana pamusoro pehunhu hwekuongorora dzidziso muchikwata chose chekutsvagisa, kuve nechokwadi chekuti inotsanangura zvakajeka chiitiko ichi.
Ruzivo rwehuwandu hwevanhu rwakaunganidzwa kuburikidza neongororo yepamhepo yehuwandu hwevanhu vasati vabvunzurudzwa kuti pave nechokwadi chekuti pane vanhu vakawanda vakatora chikamu uye kuti zvienderane neongororo yehunhu. Ruzivo rwakaunganidzwa rwaisanganisira: murume kana mukadzi, zera, gore ravakapedza kudzidza, kwavakabva kumaruwa, kwavanoshanda pari zvino, hunyanzvi hwekurapa, uye kwavanoenda kuchikoro chekiriniki chegore rechina.
Zvakawanikwa izvi zvinopa ruzivo nezvekugadzirwa kwehurongwa hwepfungwa hunoratidza kuti LIC yekumaruwa inokanganisa sei sarudzo dzenzvimbo nebasa revadzidzi vakapedza kudzidza.
Vadzidzi makumi matatu nevapfumbamwe veLIC vakapinda muchidzidzo ichi. Muchidimbu, 53.8% yevatori vechikamu vaiva vakadzi, 43.6% vaibva kumaruwa, 38.5% vaishanda kumaruwa, uye 89.7% vakanga vapedza kudzidza kana kudzidziswa kwezvokurapa (Tafura 2).
Iyi hurongwa hwesarudzo dzebasa reLIC yekumaruwa hunotarisa pazvinhu zviri muchirongwa cheLIC chekumaruwa zvinopesvedzera sarudzo dzebasa dzevakapedza kudzidza, zvichiratidza kuti kusanganiswa kwezvinhu zvemunhu mumwe nemumwe nezvirongwa mukati mepfungwa huru ye "sarudzo yekutora chikamu" kunogonawo kukanganisa nzvimbo yevakapedza kudzidza. sezvisarudzo zvebasa rehunyanzvi, kungave kwega kana kuti kwekubatana (Mufananidzo 3). Zvakawanikwa zvinotevera zvinotsanangura zvinhu zvehurongwa uye zvinosanganisira mashoko kubva kuvatori vechikamu kuratidza zvazvinoreva.
Mabasa echikoro chekiriniki anopedzwa kuburikidza nehurongwa hwekusarudza, saka vatori vechikamu vanogona kusarudza mapurogiramu zvakasiyana. Pakati peavo vakasarudza kutora chikamu, paive nemapoka maviri evakapedza kudzidza: avo vakasarudza nemaune kutora chikamu muchirongwa (vakasarudza vega), uye avo vasina kusarudza asi vakatumirwa kuRCCS. Izvi zvinoratidzwa mupfungwa dzekushandisa (boka rekupedzisira) uye kusimbiswa (boka rekutanga). Kana zvabatanidzwa mukuita, pfungwa dzehunyanzvi hwekugadzira kudzidza uye kudzidziswa panzvimbo dzinowedzera kubatanidzwa nekupa vatori vechikamu mukana wekuona uye kuenzanisa zvidzidzo zvehutano nenzira yakazara.
Pasinei nezera rekuzvisarudzira, vatori vechikamu vaiwanzova nepfungwa dzakanaka nezveruzivo rwavo uye vakataura kuti LIC raive gore rekudzidza iro harina kungovaudza nezvemamiriro ekurapa chete, asiwo rakavapa mukana wekuenderera mberi muzvidzidzo zvavo uye hwaro hwakasimba hwemabasa avo. Kuburikidza nenzira yakabatana yekupa chirongwa ichi, vakadzidza nezvehupenyu hwekumaruwa, mushonga wekumaruwa, maitiro akajairika uye hunyanzvi hwakasiyana-siyana hwekurapa.
Vamwe vatori vechikamu vakataura kuti dai vasina kupinda chirongwa ichi uye vakapedza kudzidziswa kwese munzvimbo yemaguta, vangadai vasina kumbofunga kana kunzwisisa kuti vangasangana sei nezvinodiwa zvavo zvemunhu nemabasa munzvimbo yekumaruwa. Izvi zvinozopedzisira zvaita kuti pave nekusangana kwezvinhu zvemunhu nemabasa, zvakaita serudzi rwechiremba wavanoda kuva, nharaunda yavanoda kudzidzira, uye mararamiro akaita sekuwana nharaunda uye mukana wekuwana hupenyu hwekumaruwa.
Zvinoita sekuti dai ndakangogara paX [metropolitan facility] kana chimwe chinhu chakadaro, saka pamwe tingadai takangogara panzvimbo imwe chete, handifungi kuti isu (vatinoshanda navo) tingadai takazviita, kusvetuka uku (pabasa munzvimbo dzekumaruwa) kwaisazofanira kumanikidzwa (general practice registrar, rural practice).
Kutora chikamu muchirongwa ichi kunopa mukana wekufungisisa nekusimbisa zvinangwa zvevakapedza kudzidza zvekushanda kumaruwa. Izvi zvinowanzokonzerwa nekuti wakakurira kumaruwa uye une chinangwa chekuita internship munzvimbo yakafanana mushure mekupedza kudzidza. Kune avo vakatanga vachida kupinda muchirongwa ichi, zvaive pachenawo kuti ruzivo rwavo rwakanga rwazadzisa zvavaitarisira uye rwakasimbisa kuzvipira kwavo kutevera nzira iyi.
Zvaiva (kuva muLIC) zvakasimbisa zvandaifunga kuti ndizvo zvandaida uye zvakasimbisa chibvumirano uye handina kana kumbofunga nezvekunyorera basa remu metro mugore rangu rekudzidzira basa kana kutofunga nezvazvo nezvekushanda mu metro (chiremba wepfungwa, kiriniki yekumaruwa).
Kune vamwe, kutora chikamu kwakaratidza kuti hupenyu/hutano hwekumaruwa hahuna kuzadzisa zvinodiwa zvavo zvemunhu nemabasa. Matambudziko emunhu mumwe nemumwe anokonzera kure nemhuri neshamwari, pamwe nekuwana masevhisi akadai sedzidzo nehutano. Vakaona kuwanda kwebasa rinoitwa nevanachiremba vekumaruwa senzira yekudzivisa basa.
Maneja weguta rangu anogara achindibata. Saka, ndinofunga kuti mararamiro aya haana kukodzera ini (chiremba wechipatara pakiriniki yeguta guru).
Mikana yekuronga zvidzidzo uye chimiro chekudzidza kwevadzidzi zvinopesvedzera sarudzo dzebasa. Zvinhu zvikuru zvekuenderera mberi kweLIC uye kubatanidzwa kwayo zvinopa vatori vechikamu kuzvitonga uye mikana yakasiyana-siyana yekutora chikamu mukutarisira varwere, kukudziridza hunyanzvi, uye kuita kuti kuwanikwa nekuenzanisa mhando dzekurapa munguva chaiyo zvinoenderana nezvinodiwa zvavo zvega uye zvebasa.
Nekuti zvidzidzo zvehutano zviri mukosi iyi zvinodzidziswa zvakakwana, vatori vechikamu vane rusununguko rwakanyanya uye vanogona kuzvitungamira vowana mikana yavo yekudzidza. Kuzvitonga kwevatori vechikamu kunokura mukati megore rose sezvavanowana kunzwisisa kwekuzvarwa uye kuchengetedzeka mukati mehurongwa hwechirongwa, vachiwana kugona kwekuzviongorora zvakadzama munzvimbo dzakasiyana-siyana dzekiriniki. Izvi zvakabvumira vatori vechikamu kuenzanisa hunyanzvi hwekurapa munguva chaiyo, zvichiratidza kukwezva kwavo nzvimbo dzekiriniki dzavanowanzo sarudza sehunyanzvi.
KuRCCS unosangana nemabasa aya kare uye wobva wawana nguva yakawanda yekutarisa pane zvaunonyatsofarira, saka zvechokwadi vadzidzi vakawanda vemetro havana mukana wekusarudza nguva yavo nenzvimbo yavo. Kutaura zvazviri, ndinoenda kuchipatara zuva rega rega… zvinoreva kuti ndinogona kupedza nguva yakawanda ndiri mukamuri rekukurumidzira, nguva yakawanda ndiri mukamuri rekuvhiyiwa, uye kuita zvandinonyanya kufarira (anesthesia, practice yekumaruwa).
Maumbirwo echirongwa ichi anobvumira vadzidzi kusangana nevarwere vasina musiyano uku vachipa mukana wakachengeteka wekuzvitonga kuti vawane nhoroondo yekiriniki, vagadzire hunyanzvi hwekufunga nezvekiriniki, uye vape chiremba chirongwa chekuongororwa kwakasiyana uye chirongwa chekurapa. Kuzvitonga uku kunosiyana nekudzokera ku-block rotation mugore rechina, apo zvinoonekwa kuti mikana mishoma yekupesvedzera varwere vasina musiyano uye pane kudzokera kubasa rekutarisira. Semuenzaniso, mumwe mudzidzi akataura kuti dai ruzivo rwavo rwekiriniki chete mukurapa kwakajairika rwaive rwekutenderera kwenguva pfupi kwegore rechina, iro raakatsanangura semucherechedzi, angadai asina kunzwisisa hupamhi hwekurapa kwakajairika uye akapa zano rekutsvaga kudzidziswa mune imwe hunyanzvi.
Uye handina kuwana ruzivo rwakanaka zvachose (kutenderera GP blocks). Saka, ndinofunga kuti dai iyi yaive iyo yega ruzivo rwangu mu general practice, pamwe sarudzo yangu yebasa ingadai yakasiyana… Ndinongonzwa sekunge kutambisa nguva sezvo ndiri kungoona (GP, rural practice) kuti iyi inzvimbo yebasa. .
Kubatanidzwa kwenguva refu kunobvumira vatori vechikamu kukudziridza hukama hunogara huripo nevanachiremba vanoshanda sevanopa mazano uye mienzaniso yekutevedzera. Vatori vechikamu vakatsvaga vanachiremba zvakanyanya uye vakapedza nguva yakareba navo nekuda kwezvikonzero zvakasiyana-siyana, zvakaita senguva nerutsigiro rwavakapa, kudzidziswa muhunyanzvi, kuwanikwa, kuyemurwa kwemuenzaniso wavo wekushanda, uye hunhu hwavo netsika dzavo. Kuenderana newe kana nevamwe. Chido chekukura. Vatungamiriri/varayiridzi vaive vasiri vatori vechikamu chete vakapihwa basa pasi pekutarisirwa kwachiremba anotungamira, asiwo vamiririri vehunyanzvi hwakasiyana-siyana hwekurapa, kusanganisira vanachiremba, vanachiremba vekuvhiya nevanopa mishonga yekunyaradza.
Pane zvinhu zvakati wandei. Ndiri panzvimbo yeX (LIC location). Kwaiva nenyanzvi yekurapisa nzeve uyo aitarisira ICU zvisina kunanga, ndinofunga kuti aitarisira ICU kuchipatara cheX (kumaruwa) uye aive netsika dzakadzikama, vanachiremba vazhinji vekurapisa nzeve vandakasangana navo vaive netsika dzakadzikama pazvinhu zvakawanda. Ndiwo maitiro aya akasimba akandibata mwoyo. (nyanzvi yekurapisa nzeve, chiremba weguta)
Kunzwisisa kwakajeka kwekusangana kwehupenyu hwechiremba nebasa rake kwakatsanangurwa sekunopa ruzivo rwakakosha mumararamiro avo uye kwakafungidzirwa kuti kunokurudzira vatori vechikamu kutevera nzira dzakafanana. Kunewo fungidziro yehupenyu hwechiremba, inobva mumabasa emunharaunda epamba.
Mugore rose, vatori vechikamu vanovandudza hunyanzvi hwekiriniki, hwemunhu uye hwebasa kuburikidza nemikana yekudzidza nemaoko inopihwa kuburikidza nehukama hwakagadzirwa navanachiremba, varwere nevashandi vehutano. Kuvandudzwa kwehunyanzvi uhwu hwekiriniki uye hwekutaurirana kunowanzo sanganisira nzvimbo chaiyo yekiriniki, senge mushonga wezvese kana kuti anesthesia. Semuenzaniso, muzviitiko zvakawanda, vanopedza kudzidza vanorapwa nevanorapwa vakatsanangura kukura kwavo kwehunyanzvi hwekutanga muchikoro kubva mugore ravo reLIC, pamwe nekuzvishandira kwavakaita apo hunyanzvi hwavo hwepamusoro hwakazivikanwa uye hwakapihwa mubayiro. Kunzwa uku kuchasimbiswa nekudzidziswa kunotevera. uye pachava nemikana yekuwedzera kukura.
Zvinofadza chaizvo. Ndinofanira kuita intubations, spinal anesthesia, nezvimwewo, uye mushure megore rinouya ndichapedza kudzidziswa kwekurapwa kwechirwere chekurwadziwa kwepfungwa (anesthesiology). Ndichave chiremba wekurwadziwa kwepfungwa (general anesthetist) uye ndinofunga kuti ndicho chaive chikamu chakanakisa cheruzivo rwangu rwekushanda ikoko (LIC scheme) (general anesthesia registrar, ndichishanda munzvimbo yekumaruwa).
Mamiriro ekudzidziswa panzvimbo kana mapurojekiti akatsanangurwa seane chekuita nesarudzo dzebasa dzevatori vechikamu. Nzvimbo dzakatsanangurwa semusanganiswa wenzvimbo dzekumaruwa, nzvimbo dzekurapa, zvipatara zvekumaruwa nenzvimbo dzekurapa dzakati wandei (semuenzaniso nzvimbo dzekuvhiyira) kana nzvimbo dzekurapa. Pfungwa dzine chekuita nenzvimbo, kusanganisira kunzwa kwenharaunda, kunyaradzwa kwezvakatipoteredza, uye rudzi rwekusangana nekiriniki, zvakapesvedzera sarudzo dzevatori vechikamu dzekushanda munzvimbo dzekumaruwa uye/kana nzvimbo dzekurapa dzakajairika.
Kunzwa sevanhu vemunharaunda kwakapesvedzera sarudzo dzevatori vechikamu dzekuti varambe vachiita basa ravo. Chinonyanya kufadza kurapa kwakajairika ndechekuti kunoita kuti pave nenzvimbo ine hushamwari isina hutungamiriri hwakawanda apo vatori vechikamu vanogona kutaurirana nekuona vanachiremba navanachiremba vanoita sevanonakidzwa nekuwana kugutsikana nebasa ravo.
Vatori vechikamu vakaonawo kukosha kwekuvaka hukama nenharaunda yevarwere. Kugutsikana kwemunhu nekwebasa kunowanikwa nekuziva varwere uye kuvaka hukama hunoramba huripo nekufamba kwenguva pavanenge vachitevera nzira yavo, dzimwe nguva chete mumabasa ese, asi kazhinji munzvimbo dzakasiyana-siyana dzekiriniki. Izvi zvinosiyana nezvisarudzo zvisina kunaka zvekutarisira varwere panguva dzezviitiko, senge mumadhipatimendi ekukurumidzira, uko kungasave neruzhowa rwakavharwa rwemigumisiro yekutevera varwere.
Saka, unonyatsoziva varwere vako, uye ndinofunga kuti, pamwe chandinonyanya kuda nezvekuva chiremba wezvirwere zvese hukama huripo pakati pako nevarwere vako… uye kuvaka hukama ihwohwo navo, uye kwete dzimwe nguva muzvipatara nedzimwe nzvimbo dzekurapa, unogona… unovaona kamwe chete kana kaviri, uye kazhinji hauzombovaoni zvakare (general practitioner, metropolitan clinic).
Kuziva nezvekurapa kwakajairika uye kutora chikamu mukubvunzana panguva imwe chete kwakaita kuti vatori vechikamu vanzwisise hupamhi hwemishonga yechivanhu yechiChinese mukurapa kwakajairika, kunyanya mukurapa kwakajairika kumaruwa. Vasati vava vadzidzi, vamwe vatori vechikamu vaifunga kuti vangangotanga kurapwa kwakajairika, asi vazhinji vakazova vanachiremba vezvirwere zvepfungwa vakati pakutanga vakanga vasina chokwadi kana hunyanzvi hwacho hwaive sarudzo yakakodzera kwavari, vachinzwa kuti mufananidzo wekiriniki weacuity waive wakaderera uye nekudaro vaisakwanisa kuramba vachifarira basa ravo kwenguva refu.
Ndakaita kudzidzira kwachiremba semudzidzi anonyudza, ndinofunga kuti ndiyo yaive nguva yangu yekutanga kusangana nevanachiremba vakasiyana-siyana uye ndakafunga kuti vamwe varwere vaive vakaomerwa sei, huwandu hwevarwere uye kuti vanachiremba vanogona kufadza sei, kudzidzira kwemari).
Nguva yekutumira: Chikunguru-31-2024