Kauka o ka ʻoihana lapaʻau (MD)

Hiki ke loaʻa nā MD i loko o ka laulā o nā hoʻonohonoho hoʻomaʻamaʻa, e like me nā hana pilikino, nā hana pūʻulu, nā haukapila, nā hui mālama ola, nā wahi aʻo, a me nā hui olakino lehulehu.

ʻO ka hana lāʻau lapaʻau i ʻAmelika Hui Pū ʻIa e hoʻi mai ana i nā manawa koloneial (mau makahiki 1600). I ka hoʻomaka ʻana o ke kenekulia 17, ua hoʻokaʻawale ʻia ka hana lapaʻau ma ʻEnelani i ʻekolu mau hui: ʻo nā kauka, nā kauka, a me nā apothecaries.

Ua ʻike ʻia nā kauka he poʻe koʻikoʻi. Ua paʻa pinepine lākou i ke kekelē. Hoʻomaʻamaʻa maʻamau nā kauka lāʻau lapaʻau a hana haumana haumana lākou. Ua lawelawe pinepine lākou i ka hana pālua o ka barber-surgeon. Ua aʻo pū nā Apothecaries i kā lākou kuleana (kuhikuhi, hana ʻana, a me ke kūʻai aku ʻana i nā lāʻau) ma o ka haumāna, ma kekahi manawa i nā haukapila.

ʻAʻole i ola kēia hoʻokaʻawale ma waena o ka lāʻau lapaʻau, ʻoki kino, a me ka hale kūʻai lāʻau i ʻAmelika kolone. I ka hōʻea ʻana o MDs i hoʻomākaukau ʻia no ke kulanui mai ʻAmelika mai i ʻAmelika, ua manaʻo ʻia lākou e hana ʻoki kino a hoʻomākaukau lāʻau hoʻi.

ʻO ka New Jersey Medical Society, i kau ʻia i ka makahiki 1766, ʻo ia ka hui mua o nā kauka lapaʻau i nā kolone. Ua hoʻomohala ʻia e "hoʻokumu i kahi papahana e ʻapo ana i nā mea āpau e pili nui ana i ka ʻoihana: ka hoʻoponopono o ka hana; nā kūlana aʻo no nā haumana; nā papa manawa uku, a me kahi code of ethics." Ma hope ua lilo kēia hui i Medical Society o New Jersey.

Ua hoʻomaka nā hui ʻoihana i ka hoʻoponopono ʻana i ka hana olakino e ka ninaninau ʻana a me ka laikini ʻana i nā loio i ka makahiki 1760. I ka hoʻomaka ʻana o ka makahiki 18, ua mālama nā hui kauka i ka hoʻokumu ʻana i nā lula, nā kūlana o ka hana, a me ka hōʻoia o nā kauka.

ʻO kahi kūlohelohe aʻe no nā kaiāulu e hoʻomohala i kā lākou mau papahana hoʻomaʻamaʻa ponoʻī no nā kauka. Ua kapa ʻia kēia mau papahana pili i ke kaiāulu i nā koleke lapaʻau "ponoʻī".

ʻO ka mua o kēia mau papahana ponoʻī ke koleke lapaʻau o ka Medical Society o ke Kalana o Nu Ioka, i hoʻokumu ʻia ma Malaki 12, 1807. Hoʻomaka ka ulu ʻana o nā papahana ponoʻī ma nā wahi āpau. Ua ʻumeʻume lākou i kahi helu nui o nā haumāna no ka mea ua kāpae lākou i nā hiʻohiʻona ʻelua o nā kula kauka e pili ana i ke kulanui: kahi aʻo lōʻihi lōʻihi a me kahi wā haʻi ʻōlelo lōʻihi.

I mea e hōʻino ai i ka hōʻino ʻia i ka aʻo olakino ʻana, ua mālama ʻia kahi ʻaha kūkā aupuni ma Mei 1846. ʻO nā mea i hāpai ʻia mai loko mai o ua ʻaha kūkā nei ka mea i lalo.

• ʻO kahi code code of ethics no ka ʻoihana
• ʻO ka lawe ʻana i nā pae kiʻekiʻe o ke kula kiʻekiʻe no MD, me nā papa o ka aʻo mua
• ʻO ka hoʻokumu ʻia ʻana o kahi hui kauka lāhui

Ma Mei 5, 1847, ʻaneʻane 200 mau ʻelele e pani ana i 40 mau kauka olakino a me nā koleke 28 mai nā mokuʻāina 22 a me ka Apana o Columbia i hui. Ua hoʻoholo lākou iā lākou iho i ke kau mua o ka American Medical Association (AMA). Ua koho ʻia ʻo Nathaniel Chapman (1780-1853) i pelekikena mua o ka hui. Ua lilo ka AMA i hui i nui ka mana ma luna o nā pilikia e pili ana i ka mālama olakino ma United States.

Ua hoʻonohonoho ka AMA i nā kūlana aʻo no MD, me kēia mau mea:

• ʻO kahi aʻo liberal i nā ʻoihana a me nā ʻepekema
• He palapala hōʻoia o ka hoʻopau ma kahi haumāna ma mua o ke komo ʻana i ke koleke lapaʻau
• ʻO kahi kekelē MD i uhi ʻia i 3 mau makahiki o ke aʻo ʻana, me ʻelua mau manawa haʻi ʻōlelo ʻelima mau mahina, 3 mau mahina i hoʻolaʻa ʻia no ka hoʻokaʻawale ʻana, a me ka liʻiliʻi o hoʻokahi kau 6 mahina o ka hele ʻana i ka haukapila.

I ka 1852, ua hoʻoponopono hou ʻia nā kūlana e hoʻohui i nā koi hou aku:

• Pono nā kula lapaʻau e hāʻawi i kahi papa kuhikuhi he 16 mau pule i komo pū me ka anatomy, ka lāʻau lapaʻau, ke ʻoki kino ʻana, ka palekeiki, a me ke kemika.
• Ma lalo o 21 mau makahiki o nā haumāna puka
• Pono nā haumāna e hoʻopau i kahi palena iki o 3 mau makahiki o ke aʻo ʻana, 2 mau makahiki ma lalo o kahi mea ʻoluʻolu

Ma waena o 1802 a me 1876, ua hoʻokumu ʻia he 62 mau kula lapaʻau paʻa. I ka 1810, aia he 650 mau haumāna i kākau inoa ʻia a he 100 puka puka mai nā kula kauka i United States. Ma o 1900, ua piʻi aʻe kēia mau helu i nā haumāna 25,000 a me nā haumāna puka he 5,200. Ma kahi kokoke i kēia mau haumāna puka he kāne keʻokeʻo.

ʻO Daniel Hale Williams (1856-1931) kekahi o nā MD ʻeleʻele mua. Ma hope o ke kēkelē ʻana mai ke Kulanui o Northwestern i ka makahiki 1883, ua hoʻomaʻamaʻa ʻo Kauka Williams i ke ʻoki kino ma Kikako a ma hope ua lilo ia i pūʻali koa nui i ka hoʻokumu ʻana i ka Halemai ʻo Provident, kahi e lawelawe nei ma ka ʻaoʻao hema o Chicago. Ma mua ua ʻike nā kauka ʻeleʻele he hiki ʻole ke loaʻa nā pono e hoʻomaʻamaʻa i ka lāʻau lapaʻau i nā haukapila.

ʻO Elizabeth Blackwell (1821-1920), ma hope o kona puka ʻana mai ke Keʻena Lapaʻau ʻo Geneva ma New York, lilo ʻo ia ka wahine mua i hāʻawi ʻia i kekelē MD ma United States.

Ua wehe ʻia ke Kula Nui o ke Kulanui ʻo Johns Hopkins ma 1893. Kuhi ʻia ʻo ia ke kula lapaʻau mua loa ma ʻAmelika ʻo "ke ʻano kulanui maoli, me nā ʻāpana kūpono, nā hale hana lako pono, nā kumu o kēia manawa i hoʻolaʻa ʻia no ka noiʻi lapaʻau a me ke aʻo ʻana, a me kāna ka haukapila kahi e hoʻomaʻamaʻa ai nā kauka a me ka hoʻōla ʻana i nā mea maʻi i hui pū ʻia me ka pono kūpono o nā mea ʻelua. " Ua manaʻo ʻia ʻo ia ka mea mua, a me ke kumu hoʻohālikelike no nā kulanui noiʻi ma hope. Ua lawelawe ʻo Johns Hopkins Medical School ma ke ʻano he kumu hoʻohālikelike no ka hoʻoponopono hou ʻana o ka ʻike lapaʻau. Ma hope o kēia, pani ʻia nā kula kauka lāʻau lapaʻau sub-standard he nui.

Ua lilo ka nui o nā kula kauka i nā mīkini diploma, koe wale nō kekahi o nā kula ma nā kūlanakauhale nui. Ua hoʻololi ʻelua mau hanana i kēlā. ʻO ka mea mua ka "Flexner Report," i paʻi ʻia ma 1910. He kumu aʻo alakaʻi nui ʻo Abraham Flexner i noi ʻia e hoʻopaʻa i nā kula kauka ʻAmelika. ʻO kāna hōʻike maikaʻi ʻole a me nā ʻōlelo aʻoaʻo no ka hoʻomaikaʻi i alakaʻi ʻia i ka panina o nā kula palena ʻole a me ka hoʻokumu ʻana i nā kūlana o ka maikaʻi loa no ka lāʻau lapaʻau maoli.

ʻO Sir William Osler kahi hoʻomohala ʻē aʻe, kahi Kanada ʻo ia kekahi o nā polofesa ʻoi loa o ka lapaʻau i ka mōʻaukala hou. Ua hana ʻo ia ma ke Kulanui ʻo McGill ma Kanada, a laila ma ke Kulanui o Pennsylvania, ma mua o ke kiʻi ʻia ʻana e lilo i kauka-ʻo ka luna mua a me kekahi o nā mea hoʻokumu o ke Kulanui ʻo Johns Hopkins. Ma laila ʻo ia i hoʻokumu ai i ka hoʻomaʻamaʻa noho mua (ma hope o ka puka ʻana mai ke kula kauka) a ʻo ia ka mea mua e lawe i nā haumāna i ka moena o ka mea maʻi. Ma mua o kēlā manawa, ua aʻo ʻia nā haumāna lapaʻau mai nā puke aʻo ʻana a hiki i ko lākou hele ʻana i waho e hoʻomaʻamaʻa, no laila ʻaʻole lākou i ʻike iki i ka hana. Ua kākau pū ʻo Osler i ka puke kākau lapaʻau ʻepekema mua loa, a ma hope ua hele i Oxford ma ke ʻano he loea Regent, kahi naita ʻo ia. Ua hoʻokumu ʻo ia i ka mālama hoʻomanawanui a me nā kūlana moʻomeheu a ʻepekema hoʻi.

Ma ka 1930, ʻaneʻane nā kula lapaʻau āpau e koi i kahi kekelē laepua liberal no ke komo ʻana a hāʻawi ʻia i kahi papa hana papa 3 i ʻehā mau makahiki i ka lāʻau lapaʻau a me ke ʻoki kino. Ua koi aku nā mokuʻāina he nui i nā moho e hoʻopiha i kahi makahiki he 1 mau makahiki i ka hale maʻi ma hope o ka loaʻa ʻana o kahi kekele mai kahi kula kauka i ʻike ʻia e laikini ai i ka hana o ka lāʻau.

ʻAʻole i hoʻomaka nā kauka ʻAmelika e hana loea a hiki i ka waena o ke kenekulia 20. Ua ʻōlelo ka poʻe kūʻē i ka loea "ua hana kaulike ʻole nā ​​specialty i ka loea maʻamau, e hōʻike ana he kūpono ʻole ʻo ia e mālama pono i kekahi mau ʻano maʻi." ʻLelo pū kekahi ua mālama ka loea "e hoʻohaʻahaʻa i ka loio i ka maka o ka lehulehu." Eia nō naʻe, i ka hoʻonui ʻia ʻana o ka ʻike olakino a me nā ʻenehana he nui nā kauka i koho e noʻonoʻo i kekahi mau kikoʻī kikoʻī a ʻike i ka hiki ke kōkua hou aku kā lākou mākau i kekahi mau hanana.

He mea nui hoʻi ka ʻepekema, no ka mea, ʻo ka loaʻa ʻana o nā loaʻa kālā kiʻekiʻe ma mua o nā kauka laula. Ke hoʻomau nei nā hoʻopaʻapaʻa ma waena o nā loea a me nā mea laulaha, a ua hoʻonāukiuki ʻia e nā pilikia e pili ana i ka hoʻoponopono olakino hou.

SCOPE O KA HANA

ʻO ka hana o ka lāʻau lapaʻau me ke kuhi, ka lapaʻau ʻana, ka hoʻoponopono ʻana, ka ʻōlelo aʻoaʻo, a i ʻole kauka no kekahi maʻi kanaka, maʻi, ʻeha, nāwaliwali, deformity, ʻeha, a i ʻole nā ​​ʻano ʻē aʻe, kino a noʻonoʻo paha, maoli a kuhi paha.

KANAWAI O KA OIHANA

ʻO ka lāʻau lapaʻau ka mea mua o nā ʻoihana e koi ai i ka laikini. Ua hōʻike ʻia nā kānāwai mokuʻāina e pili ana i ka laikini olakino i ka "diagnose" a me ka "lapaʻau" ʻana o nā kūlana kanaka i ka lāʻau. ʻO kēlā me kēia kanaka i makemake e ʻike pono a mālama paha ma ke ʻano he ʻoihana e hiki ke hoʻopiʻi ʻia me ka "hoʻomaʻamaʻa ʻana i ka lāʻau me ka ʻole o kahi laikini."

I kēia lā, mālama ʻia ka lāʻau lapaʻau, e like me nā ʻoihana ʻē aʻe, i nā pae like ʻole.

• Pono nā Kula Lapaʻau e pili i nā kūlana o ka American Association of Medical Colleges
• ʻO ka laikini kahi hana e hana ai ma ka pae mokuʻāina e like me nā kānāwai mokuʻāina kikoʻī
• Hoʻokumu ʻia ka hōʻoia ma o nā hui aupuni me nā koi āpau āpau no nā pae hana ʻoihana liʻiliʻi

Laikini: Koi ʻia nā mokuʻāina āpau i nā mea noi no ka laikini MD nā haumāna puka o ke kula kauka i ʻae ʻia a hoʻopau i ke Kuhi Laikini Laikini ʻAmelika Hui Pū ʻIa (USMLE) ʻAnuʻu 1 a i ka 3. Hoʻopau ʻia nā ʻanuʻu 1 a me 2 ma ke kula kauka a ua pau ka ʻanuʻu 3 ma hope o kekahi hoʻomaʻamaʻa lapaʻau. (maʻamau ma waena o 12 a 18 mau mahina, kaukaʻi ʻia i ka mokuʻāina). ʻO ka poʻe i loaʻa i kā lākou kekelē lapaʻau i nā ʻāina ʻē aʻe pono nō hoʻi e māʻona i kēia mau koi ma mua o ka hoʻomaʻamaʻa ʻana i ka lāʻau i ʻAmelika Hui Pū ʻIa.

Me ka hoʻolauna ʻana o telemedicine, aia ka hopohopo e pili ana i ka mālama ʻana i nā pilikia laikini mokuʻāina ke kaʻana ʻia ka lāʻau ma waena o nā mokuʻāina ma o ke kelepona ʻana. Ke kamaʻilio ʻia nei nā kānāwai a me nā alakaʻi. Ua hoʻokumu hou kekahi mau mokuʻāina i nā kaʻina hana no ka ʻike ʻana i nā laikini o nā kauka e hoʻomaʻamaʻa nei i nā mokuʻāina ʻē aʻe i nā manawa pilikia, e like me ma hope o ka ʻino a me nā ōlaʻi.

Palapala hoʻomaikaʻi: Pono nā MD e makemake e loea e hoʻopau i kahi 3 hou aʻe a 9 mau makahiki o ka hana laepua ma kā lākou wahi loea, a laila hala i nā hōʻike hōʻoia hōʻoia papa. ʻO ka lāʻau lapaʻau ʻohana ka loea me ka laulā ākea o ka hoʻomaʻamaʻa ʻana a me ka hana. ʻO nā kauka nāna e koi e hana i kahi loea e pono e hōʻoia ʻia i ka papa i kēlā ʻano hana. Eia naʻe, ʻaʻole nā ​​"palapala hōʻoia" āpau e hele mai nā keʻena ʻoihana ʻike. ʻO ka hapa nui o nā ʻoihana hōʻoiaʻiʻo ʻia he ʻāpana ia o ka Papa ʻAmelika o nā Kauka Lapaʻau. ʻAʻole ʻae nā haukapila he nui i nā kauka a lāʻau lapaʻau paha e hoʻomaʻamaʻa i kā lākou koʻokoʻo inā ʻaʻole lākou e hōʻoia ʻia i ka papa i kahi loea kūpono.

Kauka

• Nā ʻano o nā lawelawe mālama ola

Pūnaewele ʻo Federation Boards Medical State. E pili ana iā FSMB. www.fsmb.org/about-fsmb/. Loaʻa iā Pepeluali 21, 2019.

ʻO Goldman L, Schafer AI. ʻO ke hoʻokokoke aku i ka lāʻau, ka mea hoʻomanawanui, a me ka ʻoihana olakino: ʻo ka lāʻau lapaʻau ma ke ʻano he ʻano aʻo a ʻoihana kanaka. I: Goldman L, Schafer AI, eds. ʻO ka lāʻau lapaʻau Goldman-Cecil. 25th hua. Piladelapia, PA: Elsevier Saunders; 2016: chap 1.

Kaljee L, Stanton BF. Nā pilikia moʻomeheu i ka mālama pediatric. I: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. ʻO Puka Textbook of Pediatrics ʻo Nelson. 20 ouk. Piladelapia, PA: Elsevier; 2016: chap 4.