Iimpawu zezentlalo zempilo (SDOH) zidibene ngokusondeleyo kunye nezinto ezininzi zentlalo kunye nezoqoqosho.Ukucingisisa kubalulekile ekufundeni iSDH.Nangona kunjalo, zimbalwa iingxelo ezihlalutya iinkqubo zeSDH;uninzi lwezifundo ezinqamlezileyo.Siye safuna ukwenza uvavanyo lwexesha elide lweprogram ye-SDH kwimfundo yezempilo yoluntu (CBME) eyasungulwa ngo-2018 ngokusekelwe kwinqanaba kunye nomxholo wokubonakaliswa kwengxelo yomfundi kwi-SDH.
Uyilo lophando: Indlela yokufundisa ngokubanzi kuhlalutyo lwedatha esemgangathweni.Inkqubo yezeMfundo: I-internship yeeveki ezi-4 enyanzelekileyo kwiyeza eliqhelekileyo kunye nokhathalelo oluphambili kwiYunivesithi yaseTsukuba School of Medicine, eJapan, inikezelwa kubo bonke abafundi bezonyango beminyaka yesihlanu neyesithandathu.Abafundi bachithe iiveki ezintathu besemsebenzini kwiiklinikhi zoluntu nakwizibhedlele ezikwidolophu yase-Ibaraki Prefecture.Emva komhla wokuqala weentetho zeSDH, abafundi baceliwe ukuba balungiselele iingxelo zeemeko ezicwangcisiweyo ezisekelwe kwiimeko ezifunyenwe ngexesha lekhosi.Ngosuku lokugqibela, abafundi babelane ngamava abo kwiintlanganiso zeqela baza banikezela ngephepha leSDH.Le program iyaqhubeka nokuphucula nokubonelela ngophuhliso lootitshala.Abathathi-nxaxheba bokufunda: abafundi abagqibe inkqubo phakathi kuka-Oktobha 2018 noJuni 2021. Uhlalutyo: Inqanaba lokubonisa lihlelwa njengento ebonisayo, ehlalutyayo okanye echazayo.Umxholo uhlalutywa kusetyenziswa iqonga leeNgcaciso eziSolid.
Sihlalutye iingxelo ze-118 ze-2018-19, iingxelo ze-101 ze-2019-20 kunye neengxelo ze-142 ze-2020-21.Bekukho 2 (1.7%), 6 (5.9%) kunye nesi-7 (4.8%) iingxelo ezibonakalisiweyo, 9 (7.6%), 24 (23.8%) kunye nama-52 (35.9%) iingxelo zohlalutyo, 36 (30.5%) ngokulandelelanayo, Ama-48 (47.5%) kunye nama-79 (54.5%) eengxelo ezichazayo.Andizophawula ngokuseleyo.Inani leeprojekthi zeeNgcaciso eziSolid kwingxelo yi-2.0 ± 1.2, 2.6 ± 1.3, kunye ne-3.3 ± 1.4, ngokulandelanayo.
Njengoko iiprojekthi ze-SDH kwizifundo ze-CBME zicokiswa, ukuqonda kwabafundi i-SDH kuyaqhubeka nokuba nzulu.Mhlawumbi oku kwaququzelelwa luphuhliso lwefaculty.Ukuqonda okubonakalayo kwe-SDH kunokufuna uphuhliso olongezelelweyo lwefakhalthi kunye nemfundo edibeneyo kwisayensi yezentlalo kunye namayeza.
Izichasi zentlalo zempilo (i-SDH) zizinto ezingezizo ezonyango ezichaphazela imeko yezempilo, kubandakanywa nokusingqongileyo apho abantu bazalelwa khona, bakhula, basebenza, bahlala kunye nobudala [1].I-SDH inempembelelo enkulu kwimpilo yabantu, kwaye ukungenelela kwezonyango yedwa akukwazi ukuguqula imiphumo yezempilo ye-SDH [1,2,3].Ababoneleli bezempilo kufuneka baqaphele i-SDH [4, 5] kwaye bafake isandla kuluntu njengabameli bezempilo [6] ukunciphisa imiphumo emibi ye-SDH [4,5,6].
Ukubaluleka kokufundisa i-SDH kwimfundo yezonyango yesidanga sokuqala yaziwa ngokubanzi [4,5,7], kodwa kukho nemingeni emininzi ehambelana nemfundo ye-SDH.Kubafundi bezonyango, ukubaluleka okubalulekileyo kokudibanisa i-SDH kwiindlela zesifo se-biological [8] ingaba yinto eqhelekileyo, kodwa uxhulumaniso phakathi kwemfundo ye-SDH kunye noqeqesho lweklinikhi lusenokunciphisa.Ngokutsho kwe-American Medical Association Alliance for Accelerating Change in Medical Education, imfundo engaphezulu ye-SDH ibonelelwa kunyaka wokuqala kunye nowesibini wemfundo yezonyango yesidanga kunonyaka wesithathu okanye wesine [7].Ayizizo zonke izikolo zonyango e-United States ezifundisa i-SDH kwinqanaba leklinikhi [9], ubude bekhosi buyahluka [10], kwaye izifundo zihlala zikhetha [5, 10].Ngenxa yokunqongophala kwemvumelwano ngobuchule beSDH, izicwangciso zovavanyo zabafundi kunye neenkqubo ziyahluka [9].Ukukhuthaza imfundo ye-SDH ngaphakathi kwemfundo yezonyango yesidanga sokuqala, kuyimfuneko ukuphumeza iiprojekthi ze-SDH kwiminyaka yokugqibela yemfundo yezonyango yesidanga sokuqala kunye nokwenza uvavanyo olufanelekileyo lweeprojekthi [7, 8].IJapan ikwaqaphele ukubaluleka kwemfundo yeSDH kwimfundo yezonyango.Kwi-2017, imfundo ye-SDH yayibandakanyiwe kwikharityhulam engundoqo yokubonisa imfundo yezokwelapha, icacisa iinjongo eziza kufezekiswa ekuphumeleleni kwisikolo sezonyango [11].Oku kugxininiswe ngakumbi kuhlaziyo luka-2022 [12].Nangona kunjalo, iindlela zokufundisa kunye nokuvavanya i-SDH azikasekwa eJapan.
Kuphononongo lwethu lwangaphambili, siye savavanya inqanaba lokucingisisa kwiingxelo zabafundi bezonyango abaphezulu kunye neenkqubo zabo ngokuvavanya uvavanyo lweprojekthi yeSDH kwikhosi yemfundo yezonyango esekelwe kuluntu (CBME) [13] kwiyunivesithi yaseJapan.Ukuqonda iSDH [14].Ukuqonda iSDH kufuna uguqulo lokufunda [10].Uphando, kubandakanywa nolwethu, lugxininise kwiingcamango zabafundi ekuhloleni iiprojekthi zeSDH [10, 13].Kwizifundo zokuqala esazinikayo, abafundi babonakala beqonda ezinye izinto ze-SDH kangcono kunabanye, kwaye inqanaba labo lokucinga nge-SDH laliphantsi [13].Abafundi baye bakhulisa ukuqonda kwabo nge-SDH ngamava oluntu kwaye baguqula iimbono zabo zemodeli yonyango ibe yimodeli yobomi [14].Ezi ziphumo zibalulekile xa imigangatho yekharityhulam ye-SDH imfundo kunye novavanyo kunye novavanyo lwabo ayikamiselwa ngokupheleleyo [7].Nangona kunjalo, uvandlakanyo lwexesha elide lweenkqubo zeSDH zesidanga sokuqala azifane zixelwe.Ukuba sinokubonisa ngokuqhubekayo inkqubo yokuphucula nokuvavanya iinkqubo zeSDH, iya kuba ngumzekelo woyilo olungcono kunye novavanyo lweenkqubo zeSDH, eziya kunceda ukuphuhlisa imigangatho kunye namathuba e-SDH yesidanga sokuqala.
Injongo yolu phononongo yayikukubonisa inkqubo yokuphuculwa okuqhubekayo kwenkqubo yemfundo ye-SDH yabafundi bezonyango kunye nokuqhuba uvavanyo lwexesha elide lwenkqubo yezemfundo ye-SDH kwikhosi ye-CBME ngokuvavanya inqanaba lokucinga kwiingxelo zabafundi.
Uphononongo lusebenzise indlela yokufundisa ngokubanzi kwaye lwaqhuba uhlalutyo olusemgangathweni lwedatha yeprojekthi ngonyaka iminyaka emithathu.Ivavanya iingxelo zeSDH zabafundi bezonyango ababhalise kwiinkqubo zeSDH kwiikharityhulam zeCBME.Ukungeniswa ngokubanzi yinkqubo ecwangcisiweyo yokuhlalutya idatha esemgangathweni apho uhlalutyo lunokukhokelwa ngeenjongo ezithile zokuvavanya.Injongo kukuvumela ukufunyaniswa kophando ukuba kuvele kwimixholo rhoqo, eyongameleyo, okanye ebalulekileyo ekhoyo kwidatha ekrwada kunokuba ichazwe ngendlela eyakhiweyo [15].
Abathathi-nxaxheba kuphononongo yayingabafundi bezonyango abakunyaka wesihlanu kunye nowesithandathu kwiYunivesithi yaseTsukuba School of Medicine abagqibe umsebenzi onyanzelekileyo weeveki ezi-4 zoqeqesho lwezonyango kwikhosi ye-CBME phakathi kukaSeptemba 2018 noMeyi 2019 (2018-19).NgoMatshi 2020 (2019-20) okanye ngo-Oktobha 2020 nangoJulayi 2021 (2020-21).
Ulwakhiwo lwekhosi ye-CBME yeeveki ezi-4 lwaluthelekiswa nezifundo zethu zangaphambili [13, 14].Abafundi bathatha i-CBME kunyaka wabo wesihlanu okanye wesithandathu njengenxalenye yeNtshayelelo yekhosi yezoNyango, eyilelwe ukufundisa ulwazi olusisiseko kwiingcali zokhathalelo lwempilo, kubandakanya ukukhuthaza impilo, ubungcali, kunye nentsebenziswano phakathi kweengcali.Iinjongo zekharityhulam ye-CBME kukuveza abafundi kumava oogqirha beentsapho ababonelela ngononophelo olufanelekileyo kwiindawo ezahlukeneyo zeklinikhi;xela iinkxalabo zempilo kubemi, izigulane, kunye neentsapho ezikwinkqubo yokhathalelo lwempilo yengingqi;kunye nokuphuhlisa izakhono zokuqiqa zonyango..Rhoqo kwiiveki ezi-4, abafundi abali-15-17 bathatha ikhosi.Ukujikeleza kubandakanya i-1 iveki kwindawo yoluntu, iiveki ezi-1-2 kwikliniki yoluntu okanye isibhedlele esincinci, ukuya kwiveki ye-1 kwisibhedlele soluntu, kunye neveki ye-1 kwisebe lezonyango kwintsapho kwisibhedlele saseyunivesithi.Ngeentsuku zokuqala nezokugqibela, abafundi bahlanganisana eyunivesithi ukuze bazimase iintetho kunye neengxoxo zamaqela.Ngosuku lokuqala, ootitshala bacacisela abafundi iinjongo zekhosi.Abafundi kufuneka bangenise ingxelo yokugqibela enxulumene neenjongo zekhosi.Amacandelo amathathu angundoqo (AT, SO, kunye ne-JH) acwangcisa uninzi lwezifundo ze-CBME kunye neeprojekthi zeSDH.Le nkqubo inikezelwa licandelo eliphambili kunye ne-10-12 adjunct faculty ababandakanyekayo ekufundiseni isidanga sokuqala eyunivesithi ngelixa behambisa iinkqubo ze-CBME njengogqirha beentsapho okanye ifakhalthi yezonyango engekhoyo eqhelene ne-CBME.
Ubume beprojekthi ye-SDH kwikhosi ye-CBME ilandela isakhiwo sezifundo zethu zangaphambili [13, 14] kwaye ihlaziywa rhoqo (umzobo 1).Ngosuku lokuqala, abafundi baya kwintetho ye-SDH yezandla kwaye bagqiba izabelo ze-SDH ngexesha lokujikeleza kweeveki ze-4.Abafundi bacelwa ukuba bakhethe umntu okanye usapho abadibana nalo ngexesha lokufunda kwabo kwaye baqokelele ulwazi lokuqwalasela izinto ezinokuchaphazela impilo yabo.UMbutho wezeMpilo weHlabathi ubonelela ngeeNgcaciso eziZiqilima uHlelo lweSibini [15], amaphepha okusebenzela eSDH, kunye nesampulu egqityiweyo yamaphepha okusebenzela njengezinto zokubhekisela.Ngosuku lokugqibela, abafundi babonise iimeko zabo zeSDH ngokwamaqela amancinane, iqela ngalinye linabafundi aba-4-5 kunye notitshala omnye.Emva kwenkcazo-ntetho, abafundi banikwe uxanduva lokungenisa ingxelo yokugqibela yekhosi yeCBME.Bacelwa ukuba bachaze kwaye badibanise namava abo ngexesha lokujikeleza kweeveki ze-4;bacelwa ukuba bachaze i-1) ukubaluleka kwabasebenzi bezempilo abaqonda i-SDH kunye ne-2) indima yabo ekuxhaseni indima yempilo yoluntu ekufuneka idlalwe.Abafundi banikwa imiyalelo yokubhala ingxelo kunye neenkcukacha ezithe vetshe malunga nendlela yokuvavanya ingxelo (izinto ezongezelelweyo).Kuvavanyo lwabafundi, malunga namalungu e-faculty ali-15 (kubandakanywa namalungu aphambili e-faculty) avavanye iingxelo ngokuchasene neenqobo zovavanyo.
Isishwankathelo seprogram ye-SDH kwikharityhulam ye-CBME yeYunivesithi yaseTsukuba Faculty of Medicine kunyaka wezifundo we-2018-19, kunye nenkqubo yokuphucula inkqubo ye-SDH kunye nophuhliso lwe-faculty kwi-2019-20 kunye ne-2020-21 iminyaka yezifundo.I-2018-19 ibhekisela kwisicwangciso esivela ku-Oktobha 2018 ukuya kuMeyi 2019, i-2019-20 ibhekisela kwisicwangciso esivela ku-Oktobha 2019 ukuya ku-Matshi 2020, kwaye i-2020-21 ibhekisela kwisicwangciso ukususela ngo-Oktobha 2020 ukuya kuJuni 2021. I-SDH: I-Social Determinants of Health, I-COVID-19: Isifo seCoronavirus ngo-2019
Ukusukela ekusungulweni kwayo ngo-2018, siye sayiguqula ngokuqhubekayo inkqubo yeSDH kwaye sibonelela ngophuhliso lwefaculty.Ukuqala kweprojekthi ngo-2018, ootitshala abaphambili abayiphuhlisayo bafundisa abanye ootitshala ababeza kuthatha inxaxheba kwiprojekthi yeSDH.Isifundo sokuqala sophuhliso lwe-faculty sigxile kwi-SDH kunye neembono zentlalo yoluntu kwizicwangciso zeklinikhi.
Emva kokugqitywa kweprojekthi kunyaka wesikolo ka-2018-19, siye sabamba intlanganiso yophuhliso lootitshala ukuze sixoxe kwaye siqinisekise iinjongo zeprojekthi kunye nokuguqula iprojekthi ngokufanelekileyo.Ngenkqubo yonyaka wesikolo ka-2019-20, eqale ngoSeptemba ka-2019 ukuya kutsho kuMatshi ka-2020, sibonelele ngeziKhokelo zoMququzeleli, iiFom zoVavanyo, kunye neekhrayitheriya zabaNxibelelanisi beFakhalthi ukuba baqhube iiNkcazo zeQela leSihloko seSDH ngosuku lokugqibela.Emva kwentetho yeqela ngalinye, sasiba nodliwano-ndlebe lwamaqela nomnxibelelanisi ongumfundisi-ntsapho ukuze sicamngce ngocwangciso.
Kunyaka wesithathu weprogram, ukususela ngoSeptemba 2020 ukuya kuJuni 2021, siye sabamba iintlanganiso zophuhliso lwefaculty ukuxoxa ngeenjongo zeprogram yezemfundo yeSDH sisebenzisa ingxelo yokugqibela.Senze utshintsho olungephi kulwabiwo lwengxelo yokugqibela kunye neendlela zokuvavanya (izinto ezongezelelweyo).Sikwayitshintshile ifomathi kunye nemihla ebekiweyo yokufaka izicelo ngesandla kunye nokufakwa phambi kosuku lokugqibela ekufakeni nasekufakweni kwe-elektroniki kwiintsuku ezi-3 zetyala.
Ukuchonga imixholo ebalulekileyo kunye neqhelekileyo kwingxelo yonke, siye savavanya ubungakanani benkcazo ye-SDH ebonakaliswe ngayo kwaye sakhupha izinto ezinobungqina obuqinileyo obukhankanywe.Ngenxa yokuba uphononongo lwangaphambili [10] luye lwaqwalasela ukubonakaliswa njengendlela yokuvavanya imfundo kunye neprogram, sinqume ukuba inqanaba elichaziweyo lokubonisa ekuvavanyeni lingasetyenziselwa ukuvavanya iinkqubo zeSDH.Njengoko ukucamngca kuchazwa ngokwahlukileyo kwiimeko ezahlukeneyo, samkela inkcazo yokucamngca kumxholo wemfundo yezonyango “njengenkqubo yokuhlalutya, ukubuza kunye nokwakha kwakhona amava ngenjongo yokuwavavanya ngeenjongo zokufunda.”/ okanye ukuphucula ukuziqhelanisa,” njengoko kuchazwe ngu-Aronson, ngokusekelwe kwinkcazo ye-Mezirow yokucamngca okubalulekileyo [16].Njengakwisifundo sethu sangaphambili [13], ixesha leminyaka emi-4 ngo-2018-19, 2019-20 kunye no-2020-21.kwingxelo yokugqibela, uZhou wahlelwa njengento echazayo, ehlalutyayo, okanye ebonakalisayo.Olu lwahlulo lusekelwe kwisimbo sokubhala kwezemfundo esichazwe yiYunivesithi yokuFunda [17].Ekubeni ezinye izifundo zemfundo ziye zavavanya inqanaba lokubonisa ngendlela efanayo [18], sinqume ukuba kufanelekile ukusebenzisa olu lwahlulo ukuvavanya inqanaba lokubonisa kule ngxelo yophando.Ingxelo echazayo yingxelo esebenzisa isakhelo se-SDH ukucacisa imeko, kodwa apho kungabikho ukuhlanganiswa kwezinto.Ingxelo yohlalutyo yingxelo edibanisa izinto ze-SDH.Ukubonakaliswa kweengxelo zezesondo ziingxelo apho ababhali babonisa ngakumbi ngeengcinga zabo malunga ne-SDH.Iingxelo ezingazange ziwele kolunye lwezi ndidi zahlelwa njengezingavavanywanga.Sisebenzise uhlalutyo lomxholo olusekelwe kwinkqubo ye-Solid Facts, inguqulo ye-2, ukuvavanya izinto ze-SDH ezichazwe kwiingxelo [19].Imixholo yengxelo yokugqibela iyangqinelana neenjongo zenkqubo.Abafundi bacelwa ukuba bacamngce ngamava abo ukuze bachaze ukubaluleka kwabasebenzi bezempilo baqonde iSDH kunye nendima yabo.eluntwini.I-SO yahlalutya inqanaba lokubonakalisa elichazwe kwingxelo.Emva kokuqwalasela izinto ze-SDH, i-SO, i-JH, kunye ne-AT ixubushe kwaye yaqinisekisa i-criteria yecandelo.SO waphinda uhlalutyo.I-SO, i-JH, kunye ne-AT yaxoxa ngakumbi ngohlalutyo lweengxelo ezifuna utshintsho kuhlelo.Bafikelele kwimvumelwano yokugqibela ekuhlalutyweni kwazo zonke iingxelo.
Bebonke be-118, i-101 kunye ne-142 yabafundi bathathe inxaxheba kwiprogram ye-SDH kwi-2018-19, 2019-20 kunye ne-2020-21 iminyaka yokufunda.Bekukho ama-35 (29.7%), 34 (33.7%) kunye nama-55 (37.9%) abafundi basetyhini, ngokulandelelanayo.
Umzobo we-2 ubonisa ukuhanjiswa kwamanqanaba okubonakalisa ngonyaka xa kuthelekiswa nesifundo sethu sangaphambili, esihlalutye amanqanaba okucamngca kwiingxelo ezibhalwe ngabafundi kwi-2018-19 [13].Ngo-2018-2019, iingxelo ezingama-36 (30.5%) zachazwa njengengxelo, ngo-2019-2020 – 48 (47.5%) iingxelo, ngo-2020-2021 – 79 (54.5%) iingxelo.Kwakukho iingxelo zohlalutyo ze-9 (7.6%) ngo-2018-19, 24 (23.8%) iingxelo zohlalutyo ngo-2019-20 kunye ne-52 (35.9%) ngo-2020-21.Kwakukho iingxelo ezi-2 (1.7%) zokubonisa ngo-2018-19, 6 (5.9%) ngo-2019-20 kunye ne-7 (4.8%) ngo-2020-21.Iingxelo ezingama-71 (60.2%) zahlelwa njengezingenakuvavanywa ngo-2018-2019, ezingama-23 (22.8%) iingxelo ngo-2019-2020.kunye ne-7 (4.8%) iingxelo ngo-2020-2021.Ihlelwe njengengenakuvavanywa.Itheyibhile 1 ibonelela ngengxelo yomzekelo kwinqanaba ngalinye lokubonisa.
Inqanaba lokubonisa kwiingxelo zabafundi zeeprojekthi ze-SDH ezibonelelwa kwi-2018-19, 2019-20 kunye ne-2020-21 iminyaka yezifundo.I-2018-19 ibhekisela kwisicwangciso ukususela ngo-Oktobha 2018 ukuya kuMeyi 2019, i-2019-20 ibhekisela kwisicwangciso ukususela ngo-Oktobha 2019 ukuya ku-Matshi 2020, kwaye i-2020-21 ibhekisela kwisicwangciso ukususela ngo-Oktobha 2020 ukuya kuJuni 2021. I-SDH: I-Social Determinants of Health
Ipesenti yezinto ze-SDH ezichazwe kwingxelo iboniswe kuMfanekiso 3. Inani eliqhelekileyo lezinto ezichazwe kwiingxelo zaziyi-2.0 ± 1.2 kwi-2018-19, 2.6 ± 1.3 kwi-2019-20.kunye ne-3.3 ± 1.4 ngo-2020-21.
Ipesenti yabafundi abathe baxela ukukhankanya into nganye kwiSakhelo seNqanaba eliQinisekileyo (uHlelo lwe-2) kwiingxelo ze-2018-19, 2019-20, kunye ne-2020-21.Ithuba lika-2018-19 libhekiselele ku-Oktobha 2018 ukuya kuMeyi 2019, 2019-20 libhekiselele ku-Oktobha 2019 ukuya kuMatshi 2020 kwaye u-2020-21 ubhekiselele ku-Oktobha 2020 ukuya kuJuni 2021, le yimihla yeskim.Kunyaka wokufunda ka-2018/19 bekukho abafundi abayi-118, kunyaka wokufunda ka-2019/20 – abafundi abayi-101, kunyaka wokufunda ka-2020/21 – ngabafundi abayi-142.
Sazisa inkqubo yemfundo yeSDH kwikhosi efunekayo ye-CBME yabafundi bezonyango abangekathweswa zidanga kwaye sanikezela ngeziphumo zovavanyo lweminyaka emithathu yenkqubo evavanya inqanaba lokubonakaliswa kweSDH kwiingxelo zabafundi.Emva kweminyaka eyi-3 yokuphumeza iprojekthi kunye nokuphucula ngokuqhubekayo, abaninzi abafundi bakwazi ukuchaza i-SDH kwaye bachaze ezinye zezinto ze-SDH kwingxelo.Ngakolunye uhlangothi, bambalwa abafundi abakwaziyo ukubhala iingxelo ezibonisayo kwi-SDH.
Xa kuthelekiswa nonyaka wesikolo ka-2018-19, unyaka wesikolo ka-2019-20 no-2020-21 ubone ukunyuka okuthe ngcembe kwenani leengxelo zocazululo nezichazayo, ngelixa umyinge weengxelo ezingavavanywanga wehle kakhulu, nto leyo enokuthi ibangelwe luphuculo lweengxelo. inkqubo nophuhliso lootitshala.Uphuhliso lootitshala lubalulekile kwiinkqubo zemfundo zeSDH [4, 9].Sibonelela ngophuhliso lobungcali oluqhubekayo kootitshala abathatha inxaxheba kule program.Xa inkqubo yasungulwa ngo-2018, i-Japan Primary Care Association, enye yamayeza osapho lwezemfundo yaseJapan kunye nemibutho yezempilo yoluntu, yayisandula ukupapasha ingxelo nge-SDH yoogqirha baseJapan baseJapan.Uninzi lwabafundisi-ntsapho abalazi igama elithi SDH.Ngokuthatha inxaxheba kwiiprojekthi kunye nokusebenzisana nabafundi ngeenkcazo-ntetho, ootitshala ngokuthe ngcembe baye benza nzulu ukuqonda kwabo iSDH.Ukongeza, ukucacisa iinjongo zeeprogram zeSDH ngophuhliso lootitshala emsebenzini oqhubekayo kunokunceda ekuphuculeni iziqinisekiso zootitshala.Enye ingqikelelo enokwenzeka kukuba inkqubo iye yaphucuka ngokuhamba kwexesha.Uphuculo olucetywayo olunjalo lusenokufuna ixesha nomgudu omkhulu.Ngokumalunga nesicwangciso sika-2020–2021, impembelelo yobhubhani we-COVID-19 kubomi babafundi nakwimfundo [20, 21, 22, 23] inokubangela ukuba abafundi bajonge i-SDH njengomba ochaphazela ubomi babo kwaye ibancede bacinge ngeSDH.
Nangona inani lemiba ye-SDH ekhankanywe kwingxelo iye yanda, iziganeko zezinto ezahlukeneyo ziyahluka, ezinokuhambelana neempawu zendawo yokusebenza.Amazinga aphezulu enkxaso yentlalo ayimangalisi xa ujongana rhoqo nezigulana esele zifumana unyango.Ezothutho nazo zazikhankanywa rhoqo, ezinokuthi zibangelwe kukuba iisayithi ze-CBME zimi kwindawo engasedolophini okanye emaphandleni apho ngokwenene abafundi bafumana iimeko zothutho eziphazamisayo kwaye babe nethuba lokunxibelelana nabantu abakwiindawo ezinjalo.Kwakhona kukhankanyiwe luxinzelelo, ukuhlala wedwa, umsebenzi kunye nokutya, abafundi abaninzi abanokuthi bafumane ithuba lokuziqhelanisa.Ngakolunye uhlangothi, impembelelo yokungalingani kwezentlalo kunye nokungabikho kwemisebenzi kwimpilo kunokuba nzima ukuyiqonda ngeli xesha lifutshane lokufunda.Imiba ye-SDH abafundi abadibana nayo xa besebenza nayo inokuxhomekeka kwiimpawu zendawo yokuziqhelanisa.
Uphononongo lwethu lubalulekile kuba sihlala sivavanya inkqubo ye-SDH ngaphakathi kwenkqubo ye-CBME esiyinika abafundi abangekabinazidanga zobugqirha ngokuvavanya inqanaba lokubonisa kwiingxelo zabafundi.Abafundi bezonyango abaphezulu abafunde unyango lweklinikhi iminyaka emininzi banombono wezonyango.Ke, banethuba lokufunda ngokunxibelelanisa isayensi yezentlalo efunekayo kwiinkqubo zeSDH kwiimbono zabo zonyango [14].Ke ngoko, kubaluleke kakhulu ukubonelela ngeenkqubo zeSDH kwaba bafundi.Kule sifundo, sakwazi ukuqhuba uvavanyo oluqhubekayo lweprogram ngokuvavanya inqanaba lokubonisa kwiingxelo zabafundi.Campbell et al.Ngokwengxelo, izikolo zezonyango zase-US kunye neenkqubo zokuncedisa ugqirha zivavanya iinkqubo ze-SDH ngophando, amaqela agxininisekileyo, okanye idatha yokuvavanya phakathi kweqela.Iikhrayitheriya zokulinganisa ezisetyenziswa ngokuqhelekileyo kuvavanyo lweprojekthi yimpendulo yomfundi kunye nokwaneliseka, ulwazi lomfundi, kunye nokuziphatha komfundi [9], kodwa indlela esemgangathweni kunye nesebenzayo yokuvavanya iiprojekthi zemfundo zeSDH ayikasekwa.Olu phononongo luqaqambisa utshintsho lwexesha elide kuvavanyo lweprogram kunye nokuphuculwa kweprogram eqhubekayo kwaye luya kuba negalelo kuphuhliso novavanyo lweenkqubo zeSDH kwamanye amaziko emfundo.
Nangona inqanaba labafundi lilonke lokucingisisa linyuke kakhulu kulo lonke ixesha lokufunda, umyinge wabafundi ababhala iingxelo ezibonisa ukucamngca uhleli usezantsi.Kusenokufuneka ukuba kuphuhliswe iindlela ezongezelelweyo zesosiyoloji ukuze kuphuculwe ngakumbi.Izabelo kwiprogram ye-SDH zifuna ukuba abafundi badibanise iimbono zentlalo kunye nezonyango, ezihluke ngobunzima xa kuthelekiswa nomzekelo wezokwelapha [14].Njengoko sele sikhankanyile ngasentla, kubalulekile ukubonelela ngezifundo zeSDH kubafundi bezikolo eziphakamileyo, kodwa ukulungelelanisa kunye nokuphucula iinkqubo zemfundo eziqala kwangethuba kwimfundo yezonyango, ukuphuhlisa imbono yentlalo kunye nezonyango, kunye nokudibanisa kunokusebenza kakuhle ekuqhubeleni phambili kwabafundi.'phuhlisa.Ukuqonda iSDH.Ukwandiswa okungaphezulu kweembono zootitshala ngezentlalo yoluntu nako kusenokunceda ekwandiseni ukubonakalisa umfundi.
Olu qeqesho lunemida eliqela.Okokuqala, ukusetwa kwesifundo kwakukhawulelwe kwisikolo esinye sezonyango eJapan, kwaye ukusetwa kwe-CBME kwakukhawulelwe kwindawo enye kwidolophu yaseJapan okanye emaphandleni aseJapan, njengezifundo zethu zangaphambili [13, 14].Siyichazile imvelaphi yolu phando kunye nezifundo zangaphambili ngokweenkcukacha.Nokuba kukho le mida, kubalulekile ukuqaphela ukuba siye sabonisa iziphumo kwiiprojekthi ze-SDH kwiiprojekthi ze-CBME kule minyaka idlulileyo.Okwesibini, ngokusekelwe kolu phononongo lodwa, kunzima ukumisela ukuba kunokwenzeka ukuphumeza ukufunda okubonakalayo ngaphandle kweenkqubo zeSDH.Uphando olongezelelweyo luyafuneka ukukhuthaza ukufunda okubonakalayo kwe-SDH kwimfundo yezonyango yabangekabinazidanga.Okwesithathu, umbuzo wokuba ingaba uphuhliso lwefaculty lunegalelo ekuphuculeni inkqubo lungaphaya kwemida yeengqikelelo zolu phononongo.Ukusebenza ngempumelelo kokwakhiwa kweqela lootitshala kufuna ufundo novavanyo olongezelelweyo.
Senze uvandlakanyo olude lwenkqubo yemfundo yeSDH kubafundi abakwinqanaba eliphezulu lobugqirha kwikharityhulam yeCBME.Sibonisa ukuba ukuqonda kwabafundi i-SDH kuyaqhubeka nokuba nzulu njengoko inkqubo ikhula.Ukuphucula iiprogram zeSDH kunokufuna ixesha nomgudu, kodwa uphuhliso lootitshala olujolise ekwandiseni ukuqonda kootitshala iSDH lunokusebenza ngempumelelo.Ukuphucula ngakumbi ukuqonda kwabafundi iSDH, iikhosi ezidityaniswe ngakumbi kwinzululwazi yezentlalo namayeza kunokufuneka ukuba ziphuhliswe.
Yonke idatha ehlalutyiweyo ngexesha lokufunda ngoku ifumaneka kumbhali ohambelanayo ngesicelo esifanelekileyo.
I-World Health Organization.Intlalontle emisela impilo.Ifumaneka apha: https://www.who.int/health-topics/social-determinants-of-health.Ifikeleleke ngoNovemba 17, 2022
Braveman P, Gottlieb L. Social determinants of health: Lixesha lokujonga oonobangela.IiNgxelo zezeMpilo zoLuntu zowama-2014;129:19–31 .
2030 Abantu abasempilweni.Intlalontle emisela impilo.Ifumaneka apha: https://health.gov/healthypeople/priority-areas/social-determinants-health.Ifikeleleke ngoNovemba 17, 2022
IKomishoni yoQeqesho lweeNgcweti zezeMpilo ukujongana neeNgcaciso zeNtlalo yezeMpilo, iKhomishoni yezeMpilo yeHlabathi, iZiko lezoNyango, iiZiko leSizwe leSayensi, ubuNjineli kunye neMedicine.Inkqubo yokuqeqesha abaqeqeshi bezempilo ukujongana nemiba yentlalo yezempilo.Washington, DC: IiZikolo zeSizwe Press, ngo-2016.
U-Siegel J, uColeman DL, uJames T. Ukudibanisa imimiselo yentlalo yoluntu kwimfundo yezonyango ephumeleleyo: ikhwelo kwisenzo.IAkhademi yeNzululwazi yezoNyango.2018; 93 (2): 159-62.
IKholeji yaseRoyal yeeGqirha kunye noGqirha baseCanada.Ubume beCanMEDS.Ifumaneka apha: http://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e.Ifikeleleke ngoNovemba 17, 2022
Lewis JH, Lage OG, Grant BK, Rajasekaran SK, Gemeda M, Laik RS, Santen S, Dekhtyar M. Ukujongana nezithinteli zentlalo zempilo kwikharityhulam yemfundo ye-undergraduate Education Medical: Ingxelo yoPhando.Ukuziqhelanisa nemfundo ephakamileyo yezonyango.2020;11:369–77.
UMartinez IL, u-Artze-Vega I, u-Wells AL, uMora JC, uGillis M. Iingcebiso ezilishumi elinesibini zokufundisa intlalontle yempilo kwiyeza.Ukufundiswa kwezonyango.2015;37(7):647–52.
Campbell M, Liveris M, Caruso Brown AE, Williams A, Ngongo V, Pessel S, Mangold KA, Adler MD.Ukuphonononga kunye nokuvavanya imilinganiselo yentlalontle yemfundo yezempilo: Uvavanyo lwesizwe lwezikolo zonyango zase-US kunye neenkqubo zokuncedisa ugqirha.J Gen uMqeqeshwa.2022;37(9):2180–6.
UDubay-Persaud A., u-Adler MD, uBartell TR Ukufundisa imiba yentlalo yezempilo kwimfundo yezonyango yabaphumeleleyo: ukuphononongwa kwe-scoping.J Gen uMqeqeshwa.2019;34(5):720–30.
UMphathiswa weMfundo, iNkcubeko, iMidlalo, iNzululwazi kunye nobuChwepheshe.Imodeli yekharityhulam engundoqo yemfundo yezonyango ihlaziywe ngo-2017. (ulwimi lwesiJapan).Ifumaneka apha: https://www.mext.go.jp/comComponent/b_menu/shingi/toushin/__icsFiles/afieldfile/2017/06/28/1383961_01.pdf.Ifikeleleke: ngoDisemba 3, 2022
UMphathiswa weMfundo, iNkcubeko, iMidlalo, iNzululwazi kunye nobuChwepheshe.IKharityhulam enguNdoqo yeMfundo yezoNyango, uHlaziyo luka-2022.Ifumaneka apha: https://www.mext.go.jp/content/20221202-mtx_igaku-000026049_00001.pdf.Ifikeleleke: ngoDisemba 3, 2022
I-Ozone S, i-Haruta J, i-Takayashiki A, i-Maeno T, i-Maeno T. Ukuqonda kwabafundi kwi-social determinants of health in a community-based course: indlela yokufundisa ngokubanzi ukuhlalutya idatha esemgangathweni.Imfundo yezoNyango ye-BMC.2020;20(1):470.
UHaruta J, uTakayashiki A, u-Ozon S, uMaeno T, uMaeno T. Abafundi bezonyango bafunda njani nge-SDH kuluntu?Uphando olusemgangathweni usebenzisa indlela yokwenyani.Ukufundiswa kwezonyango.2022: 44 (10): 1165-72.
UGqr. Thomas.Indlela yokufundisa ngokubanzi yokuhlalutya idatha yovavanyo lomgangatho.Igama lam nguJay Eval.2006;27(2):237–46.
Aronson L. Iingcebiso ezilishumi elinambini zokufunda okubonakalayo kuwo onke amanqanaba emfundo yezonyango.Ukufundiswa kwezonyango.2011;33(3):200–5.
IYunivesithi yokuFunda.Ubhalo oluchazayo, olucazululayo nolubonakalisayo.Ifumaneka apha: https://libguides.reading.ac.uk/writing.Ihlaziywe nge-2 kaJanuwari 2020. Ifikeleleke ngoNovemba 17, 2022.
Hunton N., Smith D. Ukucingisisa ngemfundo yootitshala: inkcazo kunye nokuphunyezwa.Fundisa, fundisa, fundisa.1995;11(1):33-49.
I-World Health Organization.Intlalontle emisela impilo: Iinyani ezinzima.uhlelo lwesibini.Ifumaneka apha: http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf.Ifikeleleke: ngoNovemba 17, 2022
Michaeli D., Keogh J., Perez-Dominguez F., Polanco-Ilabaca F., Pinto-Toledo F., Michaeli G., Albers S., Aciardi J., Santana V., Urnelli C., Sawaguchi Y., Rodríguez P, Maldonado M, Raffic Z, de Araujo MO, Michaeli T. Imfundo yezonyango kunye nempilo yengqondo ngexesha le-COVID-19: isifundo kumazwe alithoba.Ijenali yeHlabathi yeMfundo yezoNyango.2022;13:35–46.
Ixesha lokuposa: Oct-28-2023