Muchikamu chino chezvikamu zvePrioritizing Equity, dzidza nezvekusarongeka kwezvakaitika kare uye kwazvino mudzidzo yezvekurapa, mabasa, uye mikana yehutungamiriri.
Vhidhiyo yePrioritizing Equity inoongorora kuti kuenzana kwehutano kuri kuumba sei hutano munguva yedenda reCOVID-19.
Mwero wekutarisira hautemerwi nekuti unounzwa sei, saka masevhisi ehutano hwepaindaneti anofanira kuchengetwa zvakaenzana nezvinodiwa nemunhu ari ega.
Pamusangano weChangeMed®️ wa2023, Brian George, MD, MS, akagamuchira mubairo we2023 Accelerating Change in Medical Education Award. Kuti udzidze zvakawanda.
Kuunza sainzi yehurongwa hwehutano muzvikoro zvekurapa zvinoreva kutanga wawana pekugara. Dzidza zvakawanda kubva kuvadzidzisi vezvehutano vakazviita.
Zvichangobva kuitika muAMA zvinofukidza nyaya dzakasiyana-siyana dzehutano dzinokanganisa hupenyu hwevanachiremba nevarwere. Tsvaga kuti ungawana sei chakavanzika chekubudirira kwechirongwa chekugara muchipatara.
Zvichangobva kuitika muAMA zvinofukidza nyaya dzakasiyana-siyana dzehutano dzinokanganisa hupenyu hwevanachiremba nevarwere. Tsvaga kuti ungawana sei chakavanzika chekubudirira kwechirongwa chekugara muchipatara.
Kumbomira kubhadhara zvikwereti zvevadzidzi kwapera. Tsvaga kuti izvi zvinorevei kuna vanachiremba uye kuti vane sarudzo dzipi.
Mudzidzi wezvekurapa kana mugari wemuno angagadzira sei mharidzo yakanaka yekuposita? Mazano mana aya kutanga kwakanaka.
AMA kuCMS: Tora matanho nekukasika kuti uve nechokwadi chekuti vanachiremba havagamuchire kugadziriswa kwemari yekubhadhara yeMIPS muna 2024 zvichibva pakushanda kweMIPS muna 2022 nedzimwe data dzakawanikwa mukuvandudzwa kwazvino kunotsigira kugadziriswa kwemari yekubhadhara yeMedicare.
Dzidza kuti CCB inokurudzira sei shanduko kuBUmbiro reMA neMitemo uye inobatsira sei kugadzirisa mitemo, mirau, uye maitiro ezvikamu zvakasiyana zveAMA.
Tsvaga ruzivo rwakadzama neruzivo rwekunyoresa kwemisangano nezviitiko zveYoung Doctors Section (YPS).
Tsvaga ajenda, magwaro uye rumwe ruzivo rweMusangano we2023 YPS Midterm musi wa10 Mbudzi paGaylord National Resort and Convention Center muNational Harbor, Maryland.
Musangano we2024 weAmerican Medical Association Medical Student Advocacy Conference (MAC) uchaitwa kubva munaKurume 7-8, 2024.
Zvinhu Zvakakosha Pakurwisa Sepsis: Webinar yekupedzisira muCenters for Disease Control and Prevention (CDC) webinar inokurukura nezvemhedzisiro yedzidzo ye sepsis mukuhaya vashandi vehutano. Nyorera.
Zvichangobva kuitika muAMA zvinofukidza nyaya dzakasiyana-siyana dzehutano dzinokanganisa hupenyu hwevanachiremba, vagari, vadzidzi vekurapa nevarwere. Inzwa kubva kune nyanzvi dzezvekurapa, kubva kune vatungamiriri vemakambani ega uye vehutano kusvika kune vesainzi nevakuru vehutano hweveruzhinji, nezveCOVID-19, dzidzo yezvekurapa, kutsigira, kurutsa, majekiseni nezvimwe.
Mu AMA News yanhasi, aimbova Mutungamiriri weAMA Gerald Harmon, MD, anobatanidzwa muhurukuro yekushaikwa kwevashandi vekurapa uye kukosha kwevanachiremba vakwegura. Dr. Harmon anotaurawo pfungwa dzake pamusoro pebasa rake idzva semukuru wenguva pfupi weYunivhesiti yeSouth Carolina School of Medicine muColumbia, basa rake semutevedzeri wemutungamiri wezvekurapa paTidelands Health muPawleys Island, South Carolina, uye zvinodiwa kuti ufambise basa rekurapa sechiremba. Mazano ekuti ungaramba sei uchishanda. Vanachiremba vane makore anopfuura 65 ekuberekwa. Mutariri: AMA Chief Experience Officer Todd Unger.
Mushure mekurwira vanachiremba panguva yedenda, American Medical Association iri kutora dambudziko rayo rinotevera risingawanzoitiki: kusimbisazve kuzvipira kwenyika kuvanachiremba.
Unger: Mhoroi uye tinokugamuchirai kuvhidhiyo yeAMA yakagadziridzwa uye podcast. Nhasi tiri kutaura nezvekushomeka kwevashandi uye kukosha kwevanachiremba vakuru mukugadzirisa dambudziko iri. Nyaya iyi inokurukurwa pano naDr. Gerald Harmon, mukuru wenguva pfupi weYunivhesiti yeSouth Carolina School of Medicine muColumbia, South Carolina, uye aimbova purezidhendi weAMA, kana nemashoko ake, "mutungamiri weAMA akadzorerwa." Ndini Todd Unger, Chief Experience Officer weAMA Chicago. Dr. Harmon, ndafara kukuzivai. Muri sei?
Dr. Harmon: Todd, mubvunzo unonakidza uyu. Kuwedzera pabasa rangu seAMA Recovery Chair, ndawana basa idzva. Mwedzi uno chete, ndakatanga basa idzva mubasa rangu seChief Health System Scientist uye Interim Dean weChikoro cheMishonga paYunivhesiti yeSouth Carolina muColumbia, South Carolina.
Dr. Harmon: Ehe, inhau huru. Yaive shanduko yebasa rangu isingatarisirwi. Mumwe munhu akandibata nezvezvikwaniriso zvavo nezvavaitarisira. Ndinofunga kuti kwandiri iyi inyaya yekufananidza yakagadzirwa kudenga, kana isiri yekufananidza yakagadzirwa kudenga saka pakati penyeredzi.
Unger: Ndine chokwadi chekuti pavakatarisa CV yako, vakafadzwa nezvimwe zvezvawakaita. Wave uri chiremba wemhuri kwemakore makumi matatu nemashanu, Mutevedzeri weMuvhimi Mukuru weUnited States Air Force, Muvhimi Mukuru weNational Guard, uye, hongu, nguva pfupi yadarika, Mutungamiriri weAMA. Izvozvo hazvisi kunyange hafu yehondo. Zvechokwadi wawana kodzero yekurega basa, asi uri kutanga chitsauko chitsva chose. Chii chinokonzera izvi?
Dr. Harmon: Ndinofunga kuti ndaive ndichiziva kuti ndichiri nemukana wekugovana zvakaitika muhupenyu hwangu nevamwe. Izwi rekuti "chiremba" rinobva muchiLatin uye rinoreva "kutakura kana kudzidzisa." Ndinonyatsonzwa kuti ndichiri kugona kudzidzisa, kugovana zvakaitika muhupenyu hwangu, uye kupa dzidzo nekutungamira (kana zvisiri kutungamira) kuchizvarwa chevanachiremba vari kudzidziswa uye kunyange vanachiremba vanoshanda. Saka zvaive zvakanaka kwazvo kuti ndive wechokwadi kutora basa rekubatsira mukutsvagisa uku ndichiramba ndiine hunyanzvi hwangu hwekudzidzisa. Saka ndaisagona kuramba mukana uyu.
Dr. Harmon: Basa rekuva provost chinhu chandisati ndamboona. Ndaive purofesa wepakoreji uye ndaidzidzisa makirasi (ndichidzidzisa) ndiri ndega pane kupa magiredhi nekuongorora kwakanyorwa kuvadzidzi, vagari vemo, nevamwe vashandi vehutano (vanamukoti, vanachiremba ve radiology, sonographers, vabatsiri vechiremba). Kwemakore angu mazhinji e35-40 ekushanda, ndaive mudzidzisi, mudzidzisi anoshanda. Saka basa iri harisi idzva.
Kukwezva kwedzidzo hakugoni kurerutswa. Ndiri kudzidza - ndiri kushandisa fananidzo iyi kwete nepaipi yemoto, asi nemabucket brigades. Ndinokumbira vanhu kuti vandidzidzise ruzivo rumwe chete panguva. Saka rimwe dhipatimendi rinounza bucket ravo, rimwe dhipatimendi rinounza bucket ravo, maneja anounza bucket ravo. Ipapo ndakatora bucket pane kuzara nepaipi yemoto ndonyura. Saka ndinogona kudzora data points zvishoma. Tichaedza rimwe bucket vhiki rinouya.
Unger: Dr. Harmon, mashoko amuri kutanga nawo chitsauko chitsva pano anonakidza. Panguva imwe chete, tinoziva kuti vanachiremba vazhinji vari kusarudza kurega basa nekukurumidza kana kukurumidza nekuda kwedenda. Makamboona kana kunzwa izvi zvichiitika pakati pevamwe vaunoshanda navo here?
Dr. Harmon: Ndakazviona svondo rapfuura, Todd, hongu. Tine data repakati pedenda, pamwe ongororo yedata yeAMA ya2021-2022, inoratidza kuti 20%, kana mumwe chete pavanachiremba vashanu, vakati vaizorega basa. Vacharega basa mukati memwedzi makumi maviri nemana inotevera. Tinoona izvi pakati pevamwe vashandi vezvehutano, kunyanya vanamukoti. 40% yevanamukoti (vaviri pavashanu) vakati ndaizosiya basa rangu rekurapa mukati memakore maviri anotevera.
Saka hongu, sezvandakataura, ndakaona izvi svondo rapfuura. Ndakanga ndine chiremba wepakati akazivisa kuti arega basa. Iye chiremba wekuvhiya, ane makore makumi matanhatu ekuberekwa. Akati: Ndiri kusiya basa rekushanda. Denda iri rakandidzidzisa kutora zvinhu zvakakomba kupfuura basa rangu. Ndiri mumamiriro akanaka emari. Pamba, anofanira kupedza nguva yakawanda nemhuri yake. Saka akasarudza kurega basa zvachose.
Ndine mumwe mushandi pamwe chete akanaka mukurapa mhuri. Kutaura zvazviri, mudzimai wake akauya kwandiri mwedzi mishoma yapfuura akati, “Unoziva, denda iri rakonzera kushushikana kukuru kumhuri yedu.” Ndakakumbira Dr. X, murume wake, pamwe nemumwe wandaishanda naye kuti vaderedze dosage. Nekuti anopedza nguva yakawanda ari muhofisi. Paakadzokera kumba, akagara pakombuta ndokuita mabasa ese ekombuta aasina nguva nawo. Aive akabatikana nekuona varwere vakawanda. Saka anorega. Aive pasi pekumanikidzwa nemhuri yake. Ane vana vashanu.
Zvese izvi zvinokonzera kushushikana kukuru kune vanachiremba vakuru, asi avo vari pakati pebasa, vane makore makumi mashanu zvichikwira, vari panjodzi huru yekushushikana, kungofanana nezvizvarwa zvedu zvechidiki.
Unger: Zvinoita kuti dambudziko rekushomeka kwevanachiremba riome sezvatiri kutoona. Kutaura zvazviri, chidzidzo chakaitwa neAssociation of American Medical Colleges chinoratidza kuti kushomeka kwevanachiremba kuchasvika 124,000 panosvika gore ra2034, izvo zvinosanganisira musanganiswa wezvinhu zvatakurukura, huwandu hwevanhu vakwegura uye vashandi vevanachiremba vakwegura.
Semunhu aimbove chiremba wemhuri anobatsira vanhu vakawanda vekumaruwa, munofungei nezvenyaya iyi?
Dr. Harmon: Todd, une chokwadi. Kushomeka kwevanachiremba kuri kuwedzera zvakanyanya, kana kuti nekuenzanisa nelogarithmic, kwete kungowedzera nekubvisa chete. Vanachiremba vari kukwegura. Tiri kutaura nezvenyaya yekuti mumakore gumi anotevera, varwere muUS vachave nemakore makumi matanhatu nemashanu zvichikwira, uye 34% yavo ikozvino vachada kurapwa. Mumakore gumi anotevera, 42% kusvika 45% yevanhu vachada kurapwa. Vanoda kutarisirwa kwakawanda. Wataura nezvekushomeka kwevanachiremba. Varwere ava vakwegura vanoda kutarisirwa kwepamusoro, uye vazhinji vanogara munzvimbo dzekumaruwa dzisina vanhu vakawanda.
Saka sezvo vanachiremba vachikura, kuenda pamudyandigere hakuregi vanachiremba nevashandi vehutano vakawanda vanoda kuenda kumaruwa, vanoda kuenda kunzvimbo dzisina rubatsiro rwakawanda. Saka, mamiriro ezvinhu kumaruwa achatowedzera kuipa. Zvinoita sekunge varwere vari munzvimbo iyi vari kukwegura uye huwandu hwevanhu vari kumaruwa huri kukura. Hatisi kuonawo kuwedzera kwehuwandu hwevashandi vehutano vanotamira kunzvimbo idzi dzekumaruwa.
Saka tinofanira kuuya nehunyanzvi hutsva, mazano matsva, telemedicine, rubatsiro rwechikwata kuti tibatsire kusangana nezvinodiwa nevanhu vekumaruwa ekuAmerica vasina rubatsiro rwakakwana.
Unger: Huwandu hwevanhu huri kukura kana kukwegura, uye vanachiremba vari kukwegurawo. Izvi zvinogadzira mukaha wakakura. Unogona kungotarisa data raw kuti mukaha iwoyo wakaita sei?
Dr. Harmon: Ngatitii vanachiremba varipo parizvino vanoshumira varwere vanosvika 280,000. Sezvo huwandu hwevanhu vekuUS hwava kukura, hwava 34% ikozvino uye 42% kusvika 45% mumakore gumi, saka sezvamakataura, ndinofunga kuti nhamba idzodzo dziri pakati pevanhu vanosvika 400,000. Saka uyu mukaha mukuru. Kuwedzera pakudiwa kwevanachiremba vakawanda, muchadawo vanachiremba vakawanda kuti vashumire vanhu vakwegura.
Regai ndikuudzei. Kwete vanachiremba chete. Uyu inyanzvi yeX-ray, uyu mukoti, tisingatauri nezvekuti vanamukoti vanorega basa sei. Masisitimu edu ezvipatara kumaruwa eAmerica akawandisa: hapana vanoongorora sonographer, vanoongorora X-ray, uye vanoongorora marabhoritari vakakwana. Sisitimu yega yega yehutano muUnited States yatove yakatetepa nekuda kwekushomeka kwevashandi vehutano vemarudzi ese.
Unger: Kugadzirisa kana kugadzirisa dambudziko rekushomeka kwevanachiremba ikozvino zviri pachena kuti kunoda mhinduro yemativi akawanda. Asi ngatitaurei zvakananga. Munofunga kuti vanachiremba vakuru vanopinda sei mumhinduro iyi? Sei vakakodzera zvakanyanya kutarisira vakwegura?
Dr. Harmon: Zvinonakidza. Ndinofunga hapana mubvunzo kuti vachanzwira tsitsi, kana kwete, varwere vanouya. Sezvatinotaura nezvevanhu vekuAmerica vane makore 65 zvichikwira vanoumba 42% yevanhu, huwandu hwevanhu uhwu hunoonekwawo muvashandi vechiremba: 42–45% yevanachiremba vane makore 65. Saka vachave nezviitiko zvakafanana muhupenyu. Vachakwanisa kunzwisisa kana chiri chisungo chemapfupa nemapfupa, kudzikira kwekuziva kana kudzikira kwemanzwiro, kana kudzikira kwekunzwa nekuona, kana pamwe kutove chimwe chinhu chatinowana patinokura, chirwere chemwoyo. chirwere cheshuga. .
Takataura nezvekuti podcast yandakaita yakaratidza sei kuti vanhu vanosvika mamiriyoni makumi mapfumbamwe vekuAmerica vane prediabetes, uye 85 kusvika 90 muzana yavo havatombozivi kuti vane chirwere cheshuga. Nekuda kweizvozvo, vanhu vakwegura vekuAmerica vanewo mutoro wezvirwere zvisingaperi. Patinosvika panhamba dzevanachiremba, uchaona kuti vane tsitsi, asi vane ruzivo rwehupenyu hwavo. Vane hunyanzvi. Vanoziva maitiro ekuongorora chirwere ichi.
Dzimwe nguva ndinoda kufunga kuti vanachiremba vezera rangu neni tinogona kufunga uye kutoita diagnostic pasina mamwe matekinoroji. Hatifaniri kufunga nezvekuti kana munhu uyu aine dambudziko diki nechikamu ichi kana icho, handizoiti MRI kana PET scan kana chero bvunzo yerabhoritari. Ndinogona kuona kuti mapundu aya ishingles. Izvi hazvisi contact dermatitis. Asi imhaka yekuti ndanga ndichiona varwere kwemakore 35 kana 40 chete ndiyo yandinobatsira kushandisa zvandinodaidza kuti hungwaru hwemunhu chaihwo, kwete hungwaru hwekugadzira, pakuongorora.
Saka handifanirwe kuita bvunzo dzese idzi. Ndinogona kunyatsoongorora, kurapa uye kunyaradza vakwegura.
Unger: Uku kunotevera kwakanaka. Ndinoda kutaura newe zvakawanda nezvenyaya iyi maererano netekinoroji. Uri nhengo inoshanda yeSenior Physician Division, uchitaura mafungiro ako uye uchipa mazano panyaya dzine chekuita nevanachiremba vakuru. Chimwe chezvinhu zviri kutaurwa kakawanda munguva pfupi yapfuura (kutaura chokwadi, ndanga ndichitaura zvakawanda nezvehungwaru hwekugadzira mumavhiki mashoma apfuura) mubvunzo wekuti vanachiremba vakuru vachachinja sei matekinoroji matsva. Ndeapi mazano aunawo nezveizvi? AMA ingabatsira sei?
Dr. Harmon: Zvakanaka, makambondiona kare - ndakambotaura pachena pamisangano nemapaneru - tinofanira kugamuchira tekinoroji iyi itsva. Haizomboperi. Zvatinoona muuchenjeri hwekugadzira (AMA inoshandisa izwi iri uye ndinobvumirana nazvo zvakanyanya) ihungwaru hwakawedzerwa. Nekuti hahuzombofi hwakatsiva komputa iyi zvachose pano. Tine hunyanzvi hwekusarudza nekuita sarudzo husingakwanise kudzidzwa kunyangwe michina yakanakisa.
Asi tinofanira kudzidzira tekinoroji iyi. Hatifaniri kunonotsa kufambira mberi kwake. Hatifaniri kunonotsa kuishandisa. Hatifaniri kunonotsa mamwe marekodhi emagetsi atinotaura nezvawo zvisina kunaka. Iyi tekinoroji itsva. Haizomboperi. Izvi zvichavandudza kupa kwemabasa ekutarisira varwere. Izvi zvichavandudza kuchengetedzeka, kuderedza zvikanganiso uye, ndinofunga, zvichavandudza kunyatsoongorora.
Saka vanachiremba vanofanira kugamuchira izvi uye kuzvitarisa. Chishandiso, kungofanana nezvimwe zvese. Zvakafanana nekushandisa stethoscope, kushandisa maziso ako, kubata nekutarisa vanhu. Izvi zvinowedzera hunyanzvi hwako, kwete chipingamupinyi.
Unger: Dr. Harmon, mubvunzo wekupedzisira. Ndedzipi dzimwe nzira dzingashandiswa navanachiremba vanosarudza kuti havachakwanisi kutarisira varwere kuti varambe vachishanda nesimba mumabasa avo? Sei zvichibatsira vanachiremba nebasa iri kuchengetedza hukama hwakasimba kudaro?
Dr. Harmon: Todd, munhu wese anosarudza zvaanoda achishandisa ruzivo rwake. Saka, kunyange zvazvo chiremba angave nemibvunzo nezve kugona kwake, kuchengetedzeka kwake, kungave kuri mukamuri rekuvhiyiwa kana kuti muchipatara chekunze kwaunenge uchingoongorora chirwere, hausi kuita zvekushandisa kana kuvhiyiwa. Pane kuchinja-chinja kwakajairika. Tese tinofanira kunetseka nezveizvi.
Kutanga, kana uchinyatsonetseka, kana usina chokwadi nezveunyanzvi hwako, hwepfungwa kana hwemuviri, taura nemumwe wako. Usanyara. Tine dambudziko rakafanana nerehutano hwemaitiro. Pandinotaura nemapoka evanachiremba, ndinoziva kuti tinotaura nezvekuneta kwevanachiremba. Tinotaura nezvematambudziko ebasa uye kuti takasuruvara sei. Ruzivo rwedu runoratidza kuti vanachiremba vanopfuura 40% vaifunga nezvesarudzo dzebasa ravo—ndinoreva kuti, inhamba inotyisa.
Nguva yekutumira: Gumiguru-13-2023