Social determinants of health (SDOH) yakanyatsopindirana nezvakawanda zvemagariro uye zvehupfumi zvinhu.Kufungisisa kwakakosha pakudzidza SDH.Nekudaro, mishumo mishoma chete inoongorora zvirongwa zveSDH;mazhinji izvidzidzo zvepamuchinjikwa.Takatsvaga kuita ongororo yenguva refu yechirongwa cheSDH mune kosi yezvehutano munharaunda (CBME) yakatangwa muna 2018 zvichibva padanho uye zviri mukati mechiratidzo chemudzidzi-chakashumwa paSDH.
Dhizaini yekutsvagisa: Iyo yakajairika inductive nzira yemhando yekuongorora data.Chirongwa cheDzidzo: Iyo inomanikidzirwa 4-vhiki yekudzidzira mukurapa zvakajairika uye kutarisirwa kwekutanga paYunivhesiti yeTsukuba Chikoro cheMishonga, Japan, inopihwa kune vese vadzidzi vezvechiremba vegore rechishanu nerechitanhatu.Vadzidzi vakapedza mavhiki matatu vari pabasa kumakiriniki emunharaunda nezvipatara mumadhorobha nemaruwa eIbaraki Prefecture.Mushure mezuva rekutanga rehurukuro dzeSDH, vadzidzi vakakumbirwa kugadzirira nyaya dzakarongwa maererano nemamiriro ezvinhu akasangana panguva yekosi.Pazuva rekupedzisira, vadzidzi vakagovana zvavakasangana nazvo mumisangano yeboka uye vakapa bepa reSDH.Chirongwa ichi chinoenderera mberi nekuvandudza uye kupa budiriro yevadzidzisi.Vatori vechikamu: vadzidzi vakapedza chirongwa pakati paGumiguru 2018 naJune 2021. Ongororo: Chiyero chekufungidzira chinorongerwa sekuratidzira, kuongorora kana kutsanangura.Zvemukati zvinoongororwa pachishandiswa Solid Chokwadi chikuva.
Isu takaongorora 118 mishumo ye2018-19, 101 mishumo ye2019-2020 uye 142 mishumo ye2020-21.Paive ne2 (1.7%), 6 (5.9%) uye 7 (4.8%) mishumo yekufungisisa, 9 (7.6%), 24 (23.8%) uye 52 (35.9%) mishumo yekuongorora, 36 (30.5%) zvakateerana, 48 (47.5%) uye 79 (54.5%) mishumo inotsanangura.Ini handichataura pane zvimwe.Huwandu hweProjekti Solid Chokwadi mushumo ndeye 2.0 ± 1.2, 2.6 ± 1.3, uye 3.3 ± 1.4, zvichiteerana.
Sezvo mapurojekiti eSDH mumakosi eCBME achinatswa, kunzwisisa kwevadzidzi kweSDH kuri kuramba kuchidzika.Zvichida izvi zvakafambiswa nekuvandudzwa kwefaculty.Kunzwisisa kunoratidzira kweSDH kungangoda kumwe kusimudzira faculty uye dzidzo yakabatanidzwa musocial science uye mushonga.
Social determinants of health (SDH) zvinhu zvisiri zvekurapa zvinopesvedzera mamiriro ehutano, kusanganisira nharaunda inoberekerwa vanhu, kukura, kushanda, kurarama uye zera [1].SDH ine simba guru pahutano hwevanhu, uye kupindira kwechiremba chete hakugone kuchinja hutano hweSDH [1,2,3].Vashandi vehutano vanofanira kuziva SDH [4, 5] uye vanobatsira munharaunda sevatsigiri vehutano [6] kuderedza migumisiro yakaipa yeSDH [4,5,6].
Kukosha kwekudzidzisa SDH mune undergraduate dzidzo yezvokurapa kunozivikanwa zvakanyanya [4,5,7], asi kune zvakare akawanda matambudziko ane chekuita neSDH dzidzo.Kune vadzidzi vezvokurapa, kukosha kwakakosha kwekubatanidza SDH kune biological disease pathways [8] inogona kunge yakajairika, asi kuwirirana pakati peSDH dzidzo uye kudzidziswa kwekliniki kunogona kunge kuchiri kushoma.Zvinoenderana neAmerican Medical Association Alliance yeAccelerating Shanduko muDzidzo Yezvokurapa, dzidzo yeSDH yakawanda inopiwa mumakore ekutanga nerechipiri edzidzo yekurapa yevasati vapedza kudzidza kupfuura mugore rechitatu kana rechina [7].Hasi zvikoro zvese zvekurapa muUnited States zvinodzidzisa SDH padanho rekiriniki [9], kureba kwekosi kunosiyana [10], uye makosi anowanzo electives [5, 10].Nekuda kwekushaikwa kwekubvumirana pane kugona kweSDH, nzira dzekuongorora dzevadzidzi uye zvirongwa zvinosiyana [9].Kukurudzira dzidzo yeSDH mukati medzidzo yezvokurapa yepasikiriyiti, zvinodikanwa kuita mapurojekiti eSDH mumakore ekupedzisira edzidzo yezvekurapa uye kuita ongororo yakakodzera yemapurojekiti [7, 8].Japan yakaonawo kukosha kwedzidzo yeSDH mudzidzo yekurapa.Muna 2017, dzidzo yeSDH yakaverengerwa mune yakakosha kosi yekuratidzira dzidzo yekurapa, ichijekesa zvinangwa zvinofanirwa kuwanikwa pakupedza chikoro chekurapa [11].Izvi zvinosimbiswa zvakare mukudzokorora kwe2022 [12].Nekudaro, nzira dzekudzidzisa uye kuongorora SDH haisati yatangwa muJapan.
Muchidzidzo chedu chakapfuura, takaongorora mwero wekutarisisa mumishumo yevadzidzi vepamusoro vezvokurapa pamwe nemaitiro avo nekuongorora kuongororwa kwechirongwa cheSDH mukosi yedzidzo yezvokurapa yenharaunda (CBME) [13] payunivhesiti yekuJapan.Kunzwisisa SDH [14].Kunzwisisa SDH kunoda shanduko yekudzidza [10].Tsvagiridzo, kusanganisira yedu, yakatarisana nemafungiro evadzidzi pakuongorora mapurojekiti eSDH [10, 13].Mumakosi ekutanga atakapa, vadzidzi vaiita sevanonzwisisa zvimwe zvinhu zveSDH zviri nani pane vamwe, uye nhanho yavo yekufunga nezveSDH yaive yakaderera [13].Vadzidzi vakadzamisa kunzwisisa kwavo kweSDH kuburikidza nezvakaitika munharaunda uye vakashandura maonero avo emhando yezvokurapa kuita mararamiro ehupenyu [14].Mhedzisiro iyi yakakosha kana zviyero zvekharikhulamu zveSDH dzidzo uye ongororo yavo uye ongororo haisati yasimbiswa zvizere [7].Nekudaro, ongororo dzenguva refu dze undergraduate SDH zvirongwa hazviwanzo kutaurwa.Kana tikakwanisa kugara tichiratidza maitiro ekuvandudza uye kuongorora zvirongwa zveSDH, zvichashanda semuenzaniso wekugadzirisa zviri nani uye kuongororwa kwezvirongwa zveSDH, izvo zvichabatsira kukudziridza mitemo nemikana yeSDH yepasikiriyiti.
Chinangwa chechidzidzo ichi chaive chekuratidza nzira yekuenderera mberi kwekuvandudza chirongwa cheSDH chedzidzo yevadzidzi vezvokurapa uye kuita ongororo yenguva refu yechirongwa chedzidzo cheSDH mukosi yeCBME nekuongorora mwero wekufungisisa mumishumo yevadzidzi.
Chidzidzo chacho chakashandisa nzira yakajairika uye yakaita ongororo yemhando yedata reprojekiti gore rega kwemakore matatu.Inoongorora mishumo yeSDH yevadzidzi vezvokurapa vakanyoresa muzvirongwa zveSDH mukati meCBME curricula.General induction inzira yakarongeka yekuongorora dhata remhando umo ongororo inogona kutungamirwa nezvinangwa zvekuongorora.Chinangwa ndechekubvumira tsvakiridzo kuti dzibude kubva kune dzinowanzoitika, dzakasimba, kana dzakakosha madingindira anowanikwa mune yakaomeswa data pane kufanotsanangurwa nenzira yakarongeka [15].
Vatori vechikamu mukudzidza vaive vadzidzi vezvekurapa vegore rechishanu nerechitanhatu paYunivhesiti yeTsukuba Chikoro cheMishonga vakapedza inosungirwa 4-vhiki yekiriniki internship muCBME kosi pakati paGunyana 2018 naMay 2019 (2018-19).Kurume 2020 (2019-20) kana Gumiguru 2020 uye Chikunguru 2021 (2020-21).
Chimiro che4-vhiki yeCBME kosi yakanga yakafanana nezvidzidzo zvedu zvekare [13, 14].Vadzidzi vanotora CBME mugore ravo rechishanu kana rechitanhatu sechikamu cheIntroduction to Medicine course, iyo yakagadzirirwa kudzidzisa ruzivo rwekutanga kune vashandi vehutano, kusanganisira kusimudzirwa kwehutano, hunyanzvi, uye kubatana kwevashandi.Zvinangwa zveCBME curriculum ndeyekufumura vadzidzi kune zviitiko zvevanachiremba vemhuri vanopa rubatsiro rwakakodzera munzvimbo dzakasiyana dzekiriniki;taura nezvehutano kuvagari, varwere, uye mhuri dziri munharaunda yehutano hwehutano;uye kukudziridza unyanzvi hwokufunga kwekliniki..Masvondo mana ega ega, vadzidzi 15-17 vanotora kosi.Kutenderera kunosanganisira 1 vhiki munharaunda yenharaunda, 1-2 vhiki mukiriniki yemunharaunda kana chipatara chidiki, kusvika kuvhiki 1 muchipatara chenharaunda, uye 1 vhiki mudhipatimendi remishonga yemhuri pachipatara cheyunivhesiti.Pamazuva ekutanga uye ekupedzisira, vadzidzi vanoungana kuyunivhesiti kuti vapinde hurukuro uye hurukuro dzeboka.Pazuva rokutanga, vadzidzisi vakatsanangura zvinangwa zvekosi kuvadzidzi.Vadzidzi vanofanira kuendesa rondedzero yekupedzisira ine chekuita nezvinangwa zvekosi.Matatu epakati faculty (AT, SO, uye JH) anoronga mazhinji eCBME makosi nemapurojekiti eSDH.Chirongwa ichi chinounzwa neiyo core faculty uye 10-12 adjunct faculty vanogona kunge vari kuita dzidziso yepasikirisiti payunivhesiti vachiendesa zvirongwa zveCBME sevarapi vemhuri kana asiri chiremba wezvekurapa anoziva neCBME.
Chimiro chepurojekiti yeSDH muchirongwa cheCBME chinotevera chimiro chezvidzidzo zvedu zvekare [13, 14] uye inogara ichishandurwa (Fig. 1).Pazuva rokutanga, vadzidzi vakapinda hurukuro yeSDH yemaoko uye vakapedza migove yeSDH panguva yekutenderera kwe4-vhiki.Vadzidzi vakakumbirwa kuti vasarudze munhu kana mhuri yavakasangana nayo panguva yekudzidzira basa uye vaunganidze ruzivo rwekuti vatarise zvinogona kukanganisa hutano hwavo.Sangano reWorld Health Organisation rinopa Solid Chokwadi Chechipiri Edition [15], SDH mapepa ekushanda, uye sampuro akapedzwa mapepa ebasa sezvinyorwa.Pazuva rekupedzisira, vadzidzi vakapa nyaya dzavo dzeSDH mumapoka maduku, boka rimwe nerimwe rine vadzidzi 4-5 uye mudzidzisi mumwe.Zvichitevera mharidzo iyi, vadzidzi vakapihwa basa rekuendesa gwaro rekupedzisira rekosi yeCBME.Vakakumbirwa kuti vatsanangure uye vazvibatanidze kune zvakaitika kwavari panguva yekutenderera kwe4-vhiki;vakakumbirwa kutsanangura 1) kukosha kwevashandi vehutano vanonzwisisa SDH uye 2) basa ravo mukutsigira basa rehutano hwevanhu rinofanira kuitwa.Vadzidzi vakapihwa mirairo yekunyora mushumo uye ruzivo rwakadzama rwekuti vangawongorora sei mushumo (supplementary material).Pakuongorora kwevadzidzi, vangangosvika gumi neshanu nhengo dzefekisheni (kusanganisira nhengo dzekatisi) dzakaongorora mishumo ichipesana nemaitiro ekuongorora.
Mhedziso yechirongwa cheSDH muCBME curriculum yeYunivhesiti yeTsukuba Faculty of Medicine mugore rezvidzidzo ra2018-19, uye maitiro ekuvandudza chirongwa cheSDH uye kuvandudzwa kwehunyanzvi mumakore ezvidzidzo 2019-20 uye 2020-21.2018-19 inoreva chirongwa kubva Gumiguru 2018 kusvika Chivabvu 2019, 2019-20 inoreva chirongwa kubva Gumiguru 2019 kusvika Kurume 2020, uye 2020-21 inoreva chirongwa kubva Gumiguru 2020 kusvika June 2021. SDH: Social Determinants of Health, COVID-19: Chirwere cheCoronavirus 2019
Kubva payakatangwa muna 2018, takaramba tichigadzirisa chirongwa cheSDH uye nekupa budiriro yehunyanzvi.Pakatanga chirongwa ichi muna 2018, vadzidzisi vakuru vakarigadzira vakapa zvidzidzo zvekusimudzira vadzidzisi kune vamwe vadzidzisi vaizopinda muchirongwa cheSDH.Yekutanga faculty yekuvandudza hurukuro yakanangana neSDH uye maonero emagariro mumakiriniki marongero.
Zvichitevera kupera kweprojekiti mugore rechikoro ra2018-19, takaita musangano wekuvandudza vadzidzisi kuti tikurukure nekusimbisa zvinangwa zveprojekiti uye kugadzirisa chirongwa ichi nenzira kwayo.Kuchirongwa chegore rechikoro cha2019-20, chakatanga munaGunyana 2019 kusvika Kurume 2020, takapa Manongedzo eVafambisi, Mafomu Ekuongorora, uye Maitirwo eVarongi Vezvikoro kuti vaite SDH Topic Group Presentations pazuva rekupedzisira.Pashure pehurukuro yeboka rimwe nerimwe, taibvunzurudza boka nomurongi mudzidzisi kuti tifungisise nezvepurogiramu.
Mugore rechitatu rechirongwa, kubva munaGunyana 2020 kusvika Chikumi 2021, takaita misangano yekuvandudza faculty kuti tikurukure zvinangwa zveSDH chirongwa chedzidzo tichishandisa chirevo chekupedzisira.Isu takaita shanduko diki kune yekupedzisira mushumo wekupihwa uye evaluation maitiro (yekuwedzera zvinhu).Isu takashandurawo mafomati uye nemazuva ekupedzisira ekuisa zvikumbiro nemaoko uye kuisa pamberi pezuva rekupedzisira kufaira remagetsi uye faira mukati memazuva matatu enyaya.
Kuti tizive madingindira akakosha uye akajairwa mushumo, takaongorora kuti tsananguro dzeSDH dzakaratidzwa kusvika papi uye takaburitsa zvinhu zvakasimba zvechokwadi zvataurwa.Nekuti ongororo dzakapfuura [10] dzakafunga kufungisisa sechimiro chedzidzo uye chirongwa chekuongorora, takaona kuti iyo yakatsanangurwa nhanho yekufungisisa mukuongorora inogona kushandiswa kuongorora zvirongwa zveSDH.Tichifunga kuti kufungisisa kunotsanangurwa zvakasiyana mumamiriro akasiyana, tinotora tsananguro yekufungisisa mumamiriro ezvinhu edzidzo yezvokurapa se "maitiro ekuongorora, kubvunzurudza uye kuvakazve zvakaitika nechinangwa chekuzviongorora kuti zvive nezvinangwa zvekudzidza."/ kana kuvandudza maitiro, "sezvinotsanangurwa naAronson, zvichibva pane tsanangudzo yaMezirow yekufungisisa kwakakosha [16].Semuchidzidzo chedu chakapfuura [13], 4-makore nguva muna 2018-19, 2019-20 uye 2020-21.mumushumo wekupedzisira, Zhou akarondedzerwa seanotsanangura, kuongorora, kana kuratidza.Iyi kupatsanurwa kwakavakirwa pamaitiro ekunyora ezvidzidzo anotsanangurwa neYunivhesiti yeKuverenga [17].Sezvo zvimwe zvidzidzo zvedzidzo zvakaongorora mwero wekufungisisa nenzira yakafanana [18], takaona kuti zvakakodzera kushandisa kupatsanurwa uku kuongorora mwero wekufungidzira mumushumo wetsvagiridzo uyu.Chirevo cherondedzero ishumo inoshandisa SDH framework kutsanangura nyaya, asi umo pasina kubatanidzwa kwezvinhu.Mushumo wekuongorora ishumo inobatanidza zvinhu zveSDH.Reflection Zvepabonde mishumo umo vanyori vanoramba vachifunga nezvepfungwa dzavo nezveSDH.Mishumo isina kuwira mune chimwe chezvikamu izvi yakarongedzerwa seisingaongororwe.Isu takashandisa ongororo yemukati yakavakirwa pane Solid Chokwadi system, vhezheni 2, kuongorora SDH zvinhu zvinotsanangurwa mumishumo [19].Zviri mukati memushumo wekupedzisira zvinoenderana nezvinangwa zvechirongwa.Vadzidzi vakakumbirwa kufungisisa nezvezviitiko zvavo kuti vatsanangure kukosha kwevashandi vehutano kunzwisisa SDH nebasa ravo pachavo.munzanga.SO yakaongorora mwero wekuratidzira unotsanangurwa mumushumo.Mushure mekufunga nezveSDH zvinhu, SO, JH, uye AT yakakurukura uye yakasimbisa chikamu chemaitiro.SO akadzokorora kuongorora.SO, JH, uye AT vakakurukura zvakare kuongororwa kwemishumo yaida shanduko muchikamu.Vakasvika pakubvumirana kwekupedzisira pakuongororwa kwemishumo yese.
Vadzidzi zana negumi nesere, zana negumi nevaviri vakapinda muchirongwa cheSDH mugore ra2018-19, 2019-20 uye 2020-21 makore ezvidzidzo.Paive ne35 (29.7%), 34 (33.7%) ne55 (37.9%) vadzidzi vechikadzi, zvichiteerana.
Mufananidzo 2 unoratidza kugoverwa kwemazinga ekufungisisa pagore zvichienzaniswa nekudzidza kwedu kwekare, iyo yakaongorora mazinga ekufungisisa mumishumo yakanyorwa nevadzidzi muna 2018-19 [13].Muna 2018-2019, makumi matatu nematanhatu (30.5%) mishumo yakarondedzerwa serondedzero, muna 2019-2020 - makumi mana nemasere (47.5%) mishumo, muna 2020-2021 - 79 (54.5%) mishumo.Paive ne9 (7.6%) yekuongorora mishumo muna 2018-19, makumi maviri nemana (23.8%) yekuongorora mishumo muna 2019-2020 uye 52 (35.9%) muna 2020-21.Paive nembiri (1.7%) yekuratidzira mishumo muna 2018-19, 6 (5.9%) muna 2019-20 uye 7 (4.8%) muna 2020-21.71 (60.2%) mishumo yakarongerwa sevasingayereki muna 2018-2019, makumi maviri nematatu (22.8%) mishumo muna 2019-2020.uye 7 (4.8%) inoshuma muna 2020–2021.Yakarongerwa seisingagone kuongororwa.Tafura 1 inopa mienzaniso mishumo kune yega yega nhanho yekuratidzira.
Chiyero chekufungisisa mumishumo yevadzidzi yemapurojekiti eSDH anopihwa mu2018-19, 2019-20 uye 2020-21 makore ezvidzidzo.2018-19 inoreva chirongwa kubva Gumiguru 2018 kusvika Chivabvu 2019, 2019-20 inoreva chirongwa kubva Gumiguru 2019 kusvika Kurume 2020, uye 2020-21 inoreva chirongwa kubva Gumiguru 2020 kusvika June 2021. SDH: Social Determinants of Health
Nhamba yezvikamu zveSDH zvinotsanangurwa mumushumo inoratidzwa mumufananidzo 3. Ivhareji yenhamba yezvinhu zvinotsanangurwa mumishumo yaiva 2.0 ± 1.2 muna 2018-19, 2.6 ± 1.3 muna 2019-20.uye 3.3 ± 1.4 muna 2020-21.
Muzana wevadzidzi vakataura vachitaura chinhu chimwe nechimwe muSolid Chokwadi Framework (2nd Edition) mune 2018-19, 2019-20, uye 2020-21 mishumo.Iyo nguva 2018-19 inoreva Gumiguru 2018 kusvika Chivabvu 2019, 2019-20 inoreva Gumiguru 2019 kusvika Kurume 2020 uye 2020-21 inoreva Gumiguru 2020 kusvika June 2021, aya ndiwo mazuva echirongwa.Mugore redzidzo ra2018/19 maive nevadzidzi zana negumi nevasere, mugore redzidzo ra2019/20 - vadzidzi zana, mugore redzidzo ra2020/21 - vadzidzi zana nemakumi mana nevaviri.
Takatanga chirongwa chedzidzo cheSDH mukosi inodiwa yeCBME yevadzidzi vezvekurapa vasati vapedza kudzidza uye takapa mhedzisiro yemakore matatu ekuongorora chirongwa ichi kuongorora mwero wekuratidzwa kweSDH mumishumo yevadzidzi.Mushure memakore matatu ekuita chirongwa ichi nekuramba kuchivandudza, vadzidzi vazhinji vakakwanisa kutsanangura SDH uye kutsanangura zvimwe zveSDH mumushumo.Kune rimwe divi, vadzidzi vashoma chete ndivo vakakwanisa kunyora mishumo inofungidzira paSDH.
Zvichienzaniswa negore rechikoro ra2018-19, makore echikoro 2019-20 uye 2020-21 akaona kuwedzera zvishoma nezvishoma muchikamu chekuongorora uye kutsanangura mishumo, nepo chikamu chemishumo isina kuongororwa chakadzikira zvakanyanya, izvo zvingave zvichikonzerwa nekuvandudzwa kwenyaya. chirongwa nekuvandudzwa kwevadzidzisi.Kubudirira kwevadzidzisi kwakakosha kune zvirongwa zvekudzidzisa zveSDH [4, 9].Isu tinopa kuenderera mberi kwehunyanzvi hwekuvandudza vadzidzisi vari kutora chikamu muchirongwa.Pakatangwa chirongwa ichi muna 2018, iyo Japan Primary Care Association, imwe yezvemushonga wemhuri weJapan uye masangano ehutano hweveruzhinji, yakanga ichangobva kuburitsa chirevo paSDH yevanachiremba vekuJapan vekutanga.Vazhinji vadzidzisi havazivi izwi rekuti SDH.Nekutora chikamu mumapurojekiti uye nekudyidzana nevadzidzi kuburikidza nemharidzo dzenyaya, vadzidzisi vakadzamisa zvishoma nezvishoma kunzwisisa kwavo kweSDH.Pamusoro pezvo, kujekesa zvinangwa zvezvirongwa zveSDH kuburikidza nekuenderera mberi kwehunyanzvi hwekuvandudza kwevadzidzisi kunogona kubatsira kuvandudza hunyanzvi hwevadzidzisi.Imwe pfungwa inogona kunge iri yekuti chirongwa chave nani nekufamba kwenguva.Kuvandudzwa kwakarongwa kwakadaro kungada nguva yakawanda nesimba.Panyaya yechirongwa cha2020–2021, kukanganisa kwedenda reCOVID-19 paupenyu nedzidzo yevadzidzi [20, 21, 22, 23] kunogona kuita kuti vadzidzi vaone SDH senyaya iri kukanganisa hupenyu hwavo uye kuvabatsira kufunga nezveSDH.
Kunyange zvazvo nhamba yezvinhu zveSDH inotaurwa mumushumo yakawedzera, chiitiko chezvinhu zvakasiyana-siyana zvinosiyana, izvo zvingave zvakabatana nemaitiro emamiriro ekudzidzira.Huwandu hwerutsigiro rwemagariro evanhu hazvishamise kupihwa kugara uchisangana nevarwere vari kutowana kurapwa.Zvekufambisa zvaitaurwawo kazhinji, izvo zvinogona kunge zvichikonzerwa nekuti nzvimbo dzeCBME dziri munzvimbo dzepasi peguta kana kumaruwa uko vadzidzi vanonyatsoona mamiriro ekufambisa asina kunaka uye vane mukana wekudyidzana nevanhu munzvimbo dzakadai.Zvakare zvakataurwa kwaive kushushikana, kusarudzika munharaunda, basa uye chikafu, izvo vadzidzi vazhinji vangangosangana nazvo mukuita.Kune rumwe rutivi, kukanganisa kwekusaenzana kwevanhu uye kushayikwa kwemabasa pahutano zvingave zvakaoma kunzwisisa munguva ino pfupi yekudzidza.Izvo SDH zvinhu izvo vadzidzi vanosangana nazvo mukuita zvinogona zvakare zvinoenderana nehunhu hwenzvimbo yekudzidzira.
Kudzidza kwedu kwakakosha nekuti tiri kuramba tichiongorora chirongwa cheSDH mukati mechirongwa cheCBME chatinopa kuvadzidzi vezvekurapa vasati vapedza kudzidza nekuongorora nhanho yekutarisisa mumishumo yevadzidzi.Vadzidzi vepamusoro vezvokurapa vakadzidza mushonga wekiriniki kwemakore mazhinji vane maonero ekurapa.Nokudaro, vane mukana wekudzidza nekubatanidza masayenzi emagariro anodiwa kune mapurogiramu eSDH kune avo ezvokurapa maonero [14].Naizvozvo, zvakakosha kupa zvirongwa zveSDH kuvadzidzi ava.Muchidzidzo ichi, takakwanisa kuenderera mberi nekuongorora chirongwa nekuongorora nhanho yekufungisisa mumishumo yevadzidzi.Campbell et al.Sekureva kwemushumo, zvikoro zvekurapa zveUS uye mapurogiramu ekubatsira chiremba anoongorora zvirongwa zveSDH kuburikidza neongororo, mapoka ekutarisa, kana yepakati-boka data yekuongorora.Zviyero zvinonyanya kushandiswa mukuyera kweprojekiti mhinduro yevadzidzi uye kugutsikana, ruzivo rwemudzidzi, uye maitiro emudzidzi [9], asi nzira yakarongeka uye inoshanda yekuongorora mapurojekiti edzidzo eSDH haisati yatangwa.Ichi chidzidzo chinotaridza shanduko yenguva refu mukuongororwa kwechirongwa uye kuenderera mberi kwekuvandudza chirongwa uye zvichabatsira mukuvandudza nekuongororwa kwezvirongwa zveSDH kune mamwe masangano edzidzo.
Kunyangwe hazvo mwero wekufungisisa wevadzidzi wakawedzera zvakanyanya mukati menguva yese yekudzidza, chikamu chevadzidzi vanonyora zvinoratidzira chakaramba chiri pasi.Mamwe maitiro ezvemagariro evanhu angangoda kugadzirwa kuti awedzere kuvandudzwa.Migove muchirongwa cheSDH inoda kuti vadzidzi vabatanidze maonero ezvemagariro evanhu uye ekurapa, ayo akasiyana mukuoma kunzwisisa achienzaniswa nemuenzaniso wekurapa [14].Sezvatataura pamusoro apa, zvakakosha kupa zvidzidzo zveSDH kuvadzidzi vekusekondari, asi kuronga nekuvandudza zvirongwa zvedzidzo kutanga kutanga kwedzidzo yezvokurapa, kukudziridza maonero emagariro evanhu uye ezvokurapa, uye kuzvibatanidza zvinogona kubudirira mukufambisira mberi kwevadzidzi.'develop.Kunzwisisa SDH.Kumwe kuwedzera kwemaonero evadzidzisi vezvemagariro evanhu kungabatsirawo kuwedzera kufunga kwemudzidzi.
Kudzidziswa uku kune zvisingakwanisi.Kutanga, gadziriro yekudzidza yakanga yakaganhurirwa kune chimwe chikoro chezvokurapa muJapan, uye gadziriro yeCBME yakanga yakaganhurirwa kune imwe nzvimbo mudhorobha kana kumaruwa Japan, sezvakaita muzvidzidzo zvedu zvakapfuura [13, 14].Takatsanangura mamiriro echidzidzo ichi uye zvidzidzo zvekare zvakadzama.Kunyangwe nezvipimo izvi, zvakakosha kuziva kuti takaratidza mhedzisiro kubva kumapurojekiti eSDH mumapurojekiti eCBME mumakore apfuura.Chechipiri, zvichibva pachidzidzo ichi chete, zvakaoma kuona kugona kwekuita fundo yekufungisisa kunze kwezvirongwa zveSDH.Kumwe kutsvagurudza kunodiwa kusimudzira kufungisisa kweSDH mune undergraduate dzidzo yekurapa.Chechitatu, mubvunzo wekuti kusimudzirwa kwefaculty kunobatsira here mukuvandudzwa kwechirongwa uri kunze kwechikamu chefungidziro dzechidzidzo chino.Kubudirira kwekuvakwa kwechikwata chevadzidzisi kunoda kumwe kudzidza nekuyedzwa.
Takaita ongororo yenguva refu yeSDH yedzidzo chirongwa chevadzidzi vepamusoro vezvokurapa mukati meCBME curriculum.Isu tinoratidza kuti kunzwisisa kwevadzidzi kweSDH kunoramba kuchidzika sezvo chirongwa chinokura.Kuvandudza zvirongwa zveSDH zvingada nguva nesimba, asi kuvandudzwa kwevadzidzisi kune chinangwa chekuwedzera kunzwisisa kwevadzidzisi kweSDH kunogona kushanda.Kuti uenderere mberi nekuvandudza kunzwisisa kwevadzidzi kweSDH, makosi akabatanidzwa zvakanyanya musainzi yemagariro uye mushonga angangoda kuvandudzwa.
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Nguva yekutumira: Oct-28-2023