I-Social determinants of health (SDOH) isondelene kakhulu nezici eziningi zomphakathi nezomnotho.Ukuzindla kubalulekile ekufundeni i-SDH.Nokho, imibiko embalwa kuphela ehlaziya izinhlelo ze-SDH;eziningi ziyizifundo ezihlukene.Sifune ukwenza ukuhlolwa kwesikhathi eside kohlelo lwe-SDH esifundweni semfundo yezempilo yomphakathi (i-CBME) esasungulwa ngo-2018 ngokusekelwe ezingeni nokuqukethwe kokucabangisisa okubikwe umfundi nge-SDH.
Idizayini yocwaningo: Indlela ejwayelekile yokufundisa yokuhlaziya idatha yekhwalithi.Uhlelo Lwezemfundo: I-internship yamasonto ama-4 eyimpoqo emkhakheni wezokwelapha kanye nokunakekelwa okuyisisekelo e-University of Tsukuba School of Medicine, e-Japan, inikezwa bonke abafundi bezokwelapha bonyaka wesihlanu nowesithupha.Abafundi bachithe amasonto amathathu besemsebenzini emitholampilo yomphakathi nasezibhedlela ezisezindaweni zasemadolobheni nasezindaweni zasemakhaya esifundeni sase-Ibaraki.Ngemva kosuku lokuqala lwezifundo ze-SDH, abafundi bacelwa ukuba balungiselele imibiko yamacala ahlelekile esekelwe ezimweni abahlangabezane nazo phakathi nesifundo.Ngosuku lokugcina, abafundi babelane ngolwazi lwabo emihlanganweni yeqembu futhi bethula iphepha nge-SDH.Lolu hlelo luyaqhubeka nokwenza ngcono futhi luhlinzeke ngokuthuthukiswa kothisha.Abahlanganyeli bocwaningo: abafundi abaqede uhlelo phakathi kuka-Okthoba 2018 noJuni 2021. Ukuhlaziya: Izinga lokuzindla lihlukaniswa njengokucabangela, ukuhlaziya noma okuchazayo.Okuqukethwe kuhlaziywa kusetshenziswa inkundla Yamaqiniso Aqinile.
Sihlaziye imibiko engu-118 yango-2018-19, imibiko engu-101 yango-2019-20 kanye nemibiko engu-142 yango-2020-21.Kube nemibiko engu-2 (1.7%), engu-6 (5.9%) kanye ne-7 (4.8%) yokucabangisisa, 9 (7.6%), 24 (23.8%) kanye ne-52 (35.9%) yemibiko yokuhlaziya, 36 (30.5%) ngokulandelana, 48 (47.5%) kanye nemibiko echazayo engama-79 (54.5%).Ngeke ngiphawule kokunye.Inombolo yamaphrojekthi Aqinile Embikweni ingu-2.0 ± 1.2, 2.6 ± 1.3, kanye no-3.3 ± 1.4, ngokulandelanayo.
Njengoba amaphrojekthi e-SDH ezifundweni ze-CBME elungiswa, ukuqonda kwabafundi i-SDH kuyaqhubeka nokujula.Mhlawumbe lokhu kwenziwe lula wukuthuthukiswa kobuhlakani.Ukuqonda okuboniswayo kwe-SDH kungase kudinge ukuthuthukiswa kobuhlakani obuqhubekayo kanye nemfundo ehlanganisiwe kusayensi yezenhlalo nezokwelapha.
I-Social determinants of health (SDH) yizici ezingezona ezezokwelapha ezithonya isimo sezempilo, okuhlanganisa indawo lapho abantu bazalelwa khona, bakhula, basebenza, baphila neminyaka yobudala [1].I-SDH inomthelela omkhulu empilweni yabantu, futhi ukungenelela kwezokwelapha kuphela akukwazi ukuguqula imiphumela yezempilo ye-SDH [1,2,3].Abahlinzeki bezempilo kufanele baqaphele i-SDH [4, 5] futhi bafake isandla emphakathini njengabameli bezempilo [6] ukunciphisa imiphumela emibi ye-SDH [4,5,6].
Ukubaluleka kokufundisa i-SDH emfundweni yezokwelapha yeziqu zabafundi yaziwa kabanzi [4,5,7], kodwa futhi kunezinselele eziningi ezihlobene nemfundo ye-SDH.Kubafundi bezokwelapha, ukubaluleka okubalulekile kokuxhumanisa i-SDH nezindlela zezifo zebhayoloji [8] kungase kujwayeleke kakhudlwana, kodwa ukuxhumana phakathi kwemfundo ye-SDH nokuqeqeshwa komtholampilo kusenganqunyelwa.Ngokusho kwe-American Medical Association Alliance for Accelerating Change in Medical Education, imfundo eyengeziwe ye-SDH inikezwa onyakeni wokuqala nowesibili wemfundo yezokwelapha ye-undergraduate kuneminyaka emithathu noma yesine [7].Akuzona zonke izikole zezokwelapha e-United States ezifundisa i-SDH ezingeni lomtholampilo [9], ubude bezifundo buyahlukahluka [10], futhi izifundo zivame ukukhetha [5, 10].Ngenxa yokuntuleka kokuvumelana ngamakhono e-SDH, amasu okuhlola abafundi nezinhlelo ayahluka [9].Ukuze kuthuthukiswe imfundo ye-SDH ngaphakathi kwemfundo yezokwelapha ye-undergraduate, kuyadingeka ukusebenzisa amaphrojekthi e-SDH eminyakeni yokugcina yemfundo yezokwelapha ye-undergraduate kanye nokuhlola okufanele kwamaphrojekthi [7, 8].I-Japan iphinde yabona ukubaluleka kwemfundo ye-SDH emfundweni yezokwelapha.Ngo-2017, imfundo ye-SDH yafakwa kukharikhulamu ewumgogodla yemfundo yezokwelapha ebonisayo, icacisa imigomo okufanele ifinyelelwe lapho ngiphothula esikoleni sezokwelapha [11].Lokhu kugcizelelwa futhi ekubuyekezweni kuka-2022 [12].Kodwa-ke, izindlela zokufundisa nokuhlola i-SDH azikakasungulwa e-Japan.
Ocwaningweni lwethu lwangaphambilini, sihlole izinga lokucabangisisa emibikweni yabafundi abaphezulu bezokwelapha kanye nezinqubo zabo ngokuhlola ukuhlolwa kwephrojekthi ye-SDH esifundweni semfundo yezokwelapha esisekelwe emphakathini (CBME) [13] enyuvesi yaseJapane.Ukuqonda i-SDH [14].Ukuqonda i-SDH kudinga ukufunda okuguquguqukayo [10].Ucwaningo, okuhlanganisa nolwethu, lugxile ekucabangeni kwabafundi ekuhloleni amaphrojekthi e-SDH [10, 13].Ezifundweni zokuqala esazinikeza, abafundi babonakala beziqonda kangcono ezinye izici ze-SDH, futhi izinga labo lokucabanga nge-SDH laliphansi kakhulu [13].Abafundi bajulise ukuqonda kwabo nge-SDH ngokuhlangenwe nakho komphakathi futhi baguqula imibono yabo yemodeli yezokwelapha yaba imodeli yempilo [14].Le miphumela ibalulekile uma izindinganiso zekharikhulamu yemfundo ye-SDH kanye nokuhlola nokuhlola kwazo kungakamiswa ngokugcwele [7].Kodwa-ke, ukuhlolwa kwe-longitudinal kwezinhlelo ze-SDH ze-undergraduate akuvamile ukubikwa.Uma singabonisa ngokungaguquki inqubo yokuthuthukisa nokuhlola izinhlelo ze-SDH, izosebenza njengemodeli yokuklama okungcono nokuhlolwa kwezinhlelo ze-SDH, okuzosiza ekuthuthukiseni amazinga namathuba e-SDH yabafundi abathola iziqu.
Inhloso yalolu cwaningo kwakuwukukhombisa inqubo yokuthuthukiswa okuqhubekayo kohlelo lwezemfundo lwe-SDH lwabafundi bezokwelapha kanye nokwenza ukuhlolwa kwesikhathi eside kohlelo lwezemfundo lwe-SDH esifundweni se-CBME ngokuhlola izinga lokuzindla emibikweni yabafundi.
Ucwaningo lusebenzise indlela yokufundisa evamile futhi lwenze ukuhlaziya okufanelekile kwedatha yephrojekthi minyaka yonke iminyaka emithathu.Ihlola imibiko ye-SDH yabafundi bezokwelapha ababhalise ezinhlelweni ze-SDH ngaphakathi kwekharikhulamu ye-CBME.Ukungeniswa okujwayelekile kuyinqubo ehlelekile yokuhlaziya idatha yekhwalithi lapho ukuhlaziya kungaqondiswa imigomo ethile yokuhlola.Umgomo ukuvumela okutholwe ocwaningweni ukuthi kuvele kuzindikimba ezivamile, ezibusayo, noma ezibalulekile ezitholakala kudatha eluhlaza kunokuba kuchazwe kusengaphambili indlela ehlelekile [15].
Abahlanganyeli bocwaningo bekungabafundi bezokwelapha bonyaka wesihlanu nowesithupha e-University of Tsukuba School of Medicine abaphothule i-internship yomtholampilo eyimpoqo yamaviki ama-4 esifundweni se-CBME phakathi kukaSepthemba 2018 noMeyi 2019 (2018-19).Mashi 2020 (2019-20) noma Okthoba 2020 kanye noJulayi 2021 (2020-21).
Isakhiwo sesifundo se-CBME samasonto ama-4 siqhathaniseka nezifundo zethu zangaphambilini [13, 14].Abafundi bathatha i-CBME onyakeni wabo wesihlanu noma wesithupha njengengxenye Yesifundo Se-Introduction to Medicine, esiklanyelwe ukufundisa ulwazi oluyisisekelo kochwepheshe bezokunakekelwa kwempilo, okuhlanganisa ukukhuthazwa kwezempilo, ubungcweti, nokusebenzisana phakathi kochwepheshe.Imigomo yekharikhulamu ye-CBME iwukuveza abafundi kokuhlangenwe nakho kodokotela bomndeni abanikeza ukunakekelwa okufanele ezindaweni ezihlukahlukene zomtholampilo;bika ukukhathazeka kwezempilo ezakhamuzini, ezigulini, nasemindenini ohlelweni lokunakekelwa kwezempilo lendawo;nokuthuthukisa amakhono okucabanga emtholampilo..Njalo emavikini ama-4, abafundi abayi-15-17 bathatha izifundo.Ukushintshashintsha kufaka phakathi isonto eli-1 endaweni yomphakathi, iviki elingu-1-2 emtholampilo womphakathi noma esibhedlela esincane, kufika evikini elingu-1 esibhedlela somphakathi, kanye nesonto eli-1 emnyangweni wemithi yomndeni esibhedlela sasenyuvesi.Ngosuku lokuqala nelokugcina, abafundi bahlangana enyuvesi ukuze bathamele izinkulumo nezingxoxo zamaqembu.Ngosuku lokuqala, othisha bachazela abafundi izinjongo zezifundo.Abafundi kufanele balethe umbiko wokugcina ohlobene nezinjongo zezifundo.Amakhono amathathu ayisisekelo (AT, SO, kanye ne-JH) ahlela izifundo eziningi ze-CBME namaphrojekthi we-SDH.Lolu hlelo lwethulwa yi-core faculty kanye ne-10-12 adjunct faculty okungenzeka ukuthi ibambe iqhaza ekufundiseni iziqu enyuvesi ngenkathi iletha izinhlelo ze-CBME njengodokotela bemindeni noma uphiko lwezokwelapha okungezona odokotela olujwayelene ne-CBME.
Isakhiwo sephrojekthi ye-SDH esifundweni se-CBME silandela ukwakheka kwezifundo zethu zangaphambilini [13, 14] futhi silungiswa njalo (Fig. 1).Ngosuku lokuqala, abafundi bahambele inkulumo ye-SDH yezandla futhi baqeda izabelo ze-SDH ngesikhathi sokuzungezisa amaviki ama-4.Abafundi bacelwa ukuthi bakhethe umuntu noma umndeni abahlangane nawo ngesikhathi befunda bese beqoqa imininingwane ukuze bacabangele izinto ezingase zibe nomthelela empilweni yabo.I-World Health Organization ihlinzeka ngoHlelo Lwesibili Oluqinile lwamaqiniso [15], amakhasi okusebenzela e-SDH, kanye namasampula okusebenza aqediwe njengezinto eziyinkomba.Ngosuku lokugcina, abafundi bethula amacala abo e-SDH ngamaqembu amancane, iqembu ngalinye elinabafundi abangu-4-5 nothisha oyedwa.Ngemva kokwethulwa, abafundi banikezwe umsebenzi wokuhambisa umbiko wokugcina wesifundo se-CBME.Bacelwe ukuthi bachaze futhi bakuhlobanise nolwazi lwabo ngesikhathi sokujikeleza kwamasonto ama-4;bacelwa ukuba bachaze 1) ukubaluleka kochwepheshe bezokunakekelwa kwempilo ukuqonda i-SDH kanye 2) nendima yabo ekusekeleni indima yezempilo yomphakathi okufanele idlalwe.Abafundi banikezwe imiyalelo yokubhala umbiko kanye nolwazi oluningiliziwe mayelana nendlela yokuhlola umbiko (izinto ezengeziwe).Ekuhloleni kwabafundi, cishe amalungu e-faculty ayi-15 (okuhlanganisa namalungu ayinhloko we-faculty) ahlole imibiko ngokumelene nenqubo yokuhlola.
Uhlolojikelele lohlelo lwe-SDH kukharikhulamu ye-CBME yeNyuvesi yaseTsukuba Faculty of Medicine ngonyaka wezifundo ka-2018-19, kanye nenqubo yokuthuthukiswa kohlelo lwe-SDH nokuthuthukiswa kobuhlakani eminyakeni yokufunda ka-2019-20 kanye no-2020-21.I-2018-19 ibhekisela ohlelweni olusuka ku-Okthoba 2018 kuya ku-May 2019, u-2019-20 ubhekisela ohlelweni olusuka ku-Okthoba 2019 kuya ku-March 2020, futhi u-2020-21 ubhekisela ohlelweni olusuka ku-Okthoba 2020 kuya kuJuni 2021. I-SDH: Izinqumo Zomphakathi Zezempilo, I-COVID-19: Isifo SeCoronavirus 2019
Kusukela yethulwa ngo-2018, siye salungisa ngokuqhubekayo uhlelo lwe-SDH futhi sanikeza ukuthuthukiswa kobuhlakani.Ngenkathi iphrojekthi iqala ngo-2018, othisha abakhulu abayithuthukisa banikeza izinkulumo zokuthuthukisa othisha kwabanye othisha ababezobamba iqhaza kuphrojekthi ye-SDH.Inkulumo yokuqala yokuthuthukiswa kobuhlakani igxile ku-SDH kanye nemibono yezenhlalo ezilungiselelweni zomtholampilo.
Ngemva kokuphothulwa kwephrojekthi onyakeni wesikole wezi-2018-19, sibe nomhlangano wokuthuthukiswa kothisha ukuze sixoxe futhi siqinisekise izinjongo zephrojekthi futhi silungise iphrojekthi ngokufanele.Ohlelweni lonyaka wesikole ka-2019-20, oluqale ngoSepthemba 2019 lwaya kuMashi 2020, sinikeze Imihlahlandlela Yabafundisi, Amafomu Okuhlola, kanye Nemibandela Yabaxhumanisi Bomkhakha ukuze benze Izethulo Zeqembu Lesihloko Se-SDH ngosuku lokugcina.Ngemva kokwethulwa kweqembu ngalinye, sasiba nezingxoxo zamaqembu nomxhumanisi wothisha ukuze sizindle ngesimiso.
Ngonyaka wesithathu wohlelo, kusukela ngoSepthemba 2020 kuya kuJuni 2021, saba nemihlangano yokuthuthukiswa kwamakhono ukuze sidingide izinjongo zohlelo lwezemfundo lweSDH sisebenzisa umbiko wokugcina.Senze izinguquko ezincane kumbiko wokugcina ozokwenziwa kanye nenqubo yokuhlola (izinto ezingeziwe).Siphinde sashintsha ifomethi kanye nezinsuku zokugcina zokufaka izicelo ngesandla nokugcwalisa ngaphambi kosuku lokugcina ekugcwaliseni nasekugcwaliseni nge-elekthronikhi zingakapheli izinsuku ezi-3 zecala.
Ukuze sihlonze amatimu abalulekile navamile embikweni wonke, sihlole izinga izincazelo ze-SDH eziboniswe ngalo futhi sakhipha izici eziyiqiniso ezishiwoyo.Ngenxa yokuthi ukubuyekezwa kwangaphambilini [10] kucabange ukucabangela njengendlela yokuhlola yezemfundo nohlelo, sinqume ukuthi izinga elishiwo lokuzindla ekuhloleni lingase lisetshenziswe ukuhlola izinhlelo ze-SDH.Uma kubhekwa ukuthi ukuzindla kuchazwa ngendlela ehlukile ezimweni ezihlukene, samukela incazelo yokucabangisisa kumongo wemfundo yezokwelapha njengokuthi “inqubo yokuhlaziya, ukubuza kanye nokwakha kabusha okuhlangenwe nakho ngenjongo yokuyihlolela izinjongo zokufunda.”/noma uthuthukise umkhuba,” njengoba kuchazwe u-Aronson, ngokusekelwe encazelweni kaMezirow yokucabangisisa okubalulekile [16].Njengasocwaningweni lwethu lwangaphambilini [13], inkathi yeminyaka emi-4 ngo-2018–19, 2019–20 nango-2020–21.embikweni wokugcina, u-Zhou ubekwe kusigaba esichazayo, esihlaziyayo, noma esicabangisisayo.Lokhu kuhlukaniswa kususelwa kusitayela sokubhala kwezemfundo esichazwe yiNyuvesi Yokufunda [17].Njengoba ezinye izifundo zemfundo zihlole izinga lokuzindla ngendlela efanayo [18], sinqume ukuthi kufanelekile ukusebenzisa lesi sigaba ukuze sihlole izinga lokuzindla kulo mbiko wocwaningo.Umbiko wokulandisa umbiko osebenzisa uhlaka lwe-SDH ukuchaza icala, kodwa lapho kungekho khona ukuhlanganiswa kwezinto.Umbiko wokuhlaziya umbiko ohlanganisa izici ze-SDH.Imibiko yezocansi yokucabanga imibiko lapho ababhali beqhubeka becabanga ngemicabango yabo mayelana ne-SDH.Imibiko engazange iwele kwesinye salezi zigaba ifakwe kusigaba njengengahloleki.Sisebenzise ukuhlaziywa kokuqukethwe okusekelwe kusistimu Yamaqiniso Aqinile, inguqulo 2, ukuze sihlole izici ze-SDH ezichazwe emibikweni [19].Okuqukethwe umbiko wokugcina kuhambisana nezinjongo zohlelo.Abafundi bacelwe ukuthi bacabange ngokuhlangenwe nakho kwabo ukuze bachaze ukubaluleka kochwepheshe bezokunakekelwa kwempilo ukuqonda i-SDH kanye neqhaza labo.emphakathini.I-SO ihlaziye izinga lokubonisa elichazwe embikweni.Ngemva kokucubungula izici ze-SDH, i-SO, JH, ne-AT yaxoxa futhi yaqinisekisa imibandela yesigaba.SO waphinda ukuhlaziywa.I-SO, JH, kanye ne-AT baphinde baxoxa ngokuhlaziywa kwemibiko eyayidinga izinguquko ekuhlukaniseni.Bafinyelele ukuvumelana kokugcina ngokuhlaziywa kwayo yonke imibiko.
Isamba sabafundi abayi-118, 101 kanye ne-142 ababambe iqhaza ohlelweni lwe-SDH eminyakeni yezifundo ka-2018-19, 2019-20 kanye no-2020-21.Bekunabafundi besifazane abangama-35 (29.7%), abangama-34 (33.7%) kanye nabafundi besifazane abangama-55 (37.9%), ngokulandelana.
Umfanekiso wesi-2 ubonisa ukusatshalaliswa kwamazinga okucabanga ngonyaka uma kuqhathaniswa nocwaningo lwethu lwangaphambilini, oluhlaziye amazinga okuzindla emibikweni ebhalwe abafundi ngo-2018-19 [13].Ngo-2018-2019, imibiko engama-36 (30.5%) yafakwa kusigaba njengezindaba ezixoxwayo, ngo-2019-2020 - 48 (47.5%) imibiko, ngo-2020-2021 - 79 (54.5%) imibiko.Kube nemibiko yokuhlaziya engu-9 (7.6%) ngo-2018-19, 24 (23.8%) imibiko yokuhlaziya ngo-2019-20 kanye nama-52 (35.9%) ngo-2020-21.Kube nemibiko yokubonisa engu-2 (1.7%) ngo-2018-19, 6 (5.9%) ngo-2019-20 kanye ne-7 (4.8%) ngo-2020-21.Imibiko engama-71 (60.2%) ifakwe kusigaba njengengahloleki ngo-2018-2019, engu-23 (22.8%) imibiko ngo-2019-2020.kanye nemibiko engu-7 (4.8%) ngo-2020–2021.Kuthathwa njengokungahloleki.Ithebula 1 linikeza imibiko eyisibonelo yeleveli ngayinye yokubonisa.
Izinga lokucabangisisa emibikweni yabafundi yamaphrojekthi e-SDH anikezwa eminyakeni yezifundo ka-2018-19, 2019-20 kanye no-2020-21.U-2018-19 ubhekisele ohlelweni olusuka ku-Okthoba 2018 kuya ku-May 2019, u-2019-20 ubhekisela ohlelweni olusuka ku-Okthoba 2019 kuya ku-March 2020, futhi u-2020-21 ubhekisele ohlelweni olusuka ku-Okthoba 2020 kuya kuJuni 2021. I-SDH: Izinqumo Zezempilo Zomphakathi
Iphesenti lezinto ze-SDH ezichazwe embikweni liboniswa kuMfanekiso 3. Isilinganiso senani lezici ezichazwe emibikweni sasingu-2.0 ± 1.2 ngo-2018-19, 2.6 ± 1.3 ngo-2019-20.kanye no-3.3 ± 1.4 ngo-2020-21.
Iphesenti labafundi ababike ukusho into ngayinye ku-Solid Facts Framework (i-2nd Edition) kumbiko wango-2018-19, 2019-20, kanye nowezi-2020-21.Isikhathi sika-2018-19 sibhekisa ku-Okthoba 2018 kuya kuMeyi 2019, 2019-20 sibhekisa ku-Okthoba 2019 kuya kuMashi 2020 kuthi u-2020-21 sibhekise ku-Okthoba 2020 kuya kuJuni 2021, lezi izinsuku zesikimu.Ngonyaka wezifundo ka-2018/19 bekunabafundi abayi-118, onyakeni wezifundo ka-2019/20 - abafundi abayi-101, onyakeni wezifundo ka-2020/21 - abafundi abayi-142.
Sethule uhlelo lwemfundo ye-SDH esifundweni se-CBME esidingekayo sabafundi abathola iziqu zobudokotela futhi sethula imiphumela yokuhlolwa kweminyaka emithathu yohlelo oluhlola izinga lokubonakala kwe-SDH emibikweni yabafundi.Ngemva kweminyaka engu-3 yokusebenzisa le phrojekthi nokuyithuthukisa ngokuqhubekayo, abafundi abaningi bakwazi ukuchaza i-SDH futhi bachaze ezinye zezinto ze-SDH embikweni.Ngakolunye uhlangothi, bambalwa abafundi abakwazile ukubhala imibiko ekhombisayo nge-SDH.
Uma kuqhathaniswa nonyaka wesikole ka-2018-19, iminyaka yesikole ka-2019-20 kanye no-2020-21 ibe nokwenyuka kancane kancane kwengxenye yemibiko ehlaziyayo nechazayo, kuyilapho ingxenye yemibiko engahloliwe yehle kakhulu, okungenzeka kungenxa yentuthuko uhlelo nokuthuthukiswa kothisha.Ukuthuthukiswa kothisha kubalulekile ezinhlelweni zemfundo zeSDH [4, 9].Sihlinzeka ngokuthuthukiswa kochwepheshe okuqhubekayo kothisha ababamba iqhaza ohlelweni.Ngenkathi lolu hlelo lwethulwa ngo-2018, i-Japan Primary Care Association, enye yezifundo zezokwelapha zomndeni zase-Japan kanye nezinhlangano zezempilo zomphakathi, yayisanda kushicilela isitatimende nge-SDH sodokotela base-Japan abanakekela izingane.Iningi lothisha alilazi igama elithi SDH.Ngokubamba iqhaza kumaphrojekthi kanye nokuxhumana nabafundi ngokusebenzisa izethulo zezindaba, othisha bajulisa kancane kancane ukuqonda kwabo kwe-SDH.Ngaphezu kwalokho, ukucacisa izinjongo zezinhlelo ze-SDH ngokuthuthuka kothisha okuqhubekayo kungase kusize ukuthuthukisa iziqu zothisha.Enye inkolelo-mbono engenzeka ukuthi uhlelo luye lwaba ngcono ngokuhamba kwesikhathi.Ukuthuthukiswa okunjalo okuhleliwe kungase kudinge isikhathi nomzamo omkhulu.Mayelana nohlelo luka-2020–2021, umthelela wobhubhane lwe-COVID-19 ezimpilweni nasezifundweni zabafundi [20, 21, 22, 23] ungabangela abafundi ukuthi babheke i-SDH njengenkinga ethinta izimpilo zabo futhi ibasize bacabange nge-SDH.
Nakuba inani lezici ze-SDH ezishiwo embikweni lenyukile, izehlakalo zezinto ezihlukene ziyahlukahluka, ezingase zihlobane nezici zendawo yokusebenza.Amazinga aphezulu okusekelwa komphakathi akumangazi uma kubhekwa ukuxhumana njalo neziguli esezivele zithola ukunakekelwa kwezokwelapha.Ezokuthutha bekukhulunywa ngazo kaningi, okungenzeka ukuthi kungenxa yokuthi iziza ze-CBME zitholakala ezindaweni ezisemadolobheni noma ezindaweni zasemakhaya lapho abafundi behlangabezana nezimo ezingezinhle zokuhamba futhi benethuba lokuxhumana nabantu ezindaweni ezinjalo.Okunye okubalulwe wukucindezeleka, ukuhlukaniswa nabantu, umsebenzi nokudla, okungenzeka abafundi abaningi bakuthole lapho besebenza.Ngakolunye uhlangothi, umthelela wokungalingani kwezenhlalo kanye nokuntuleka kwemisebenzi kwezempilo kungase kube nzima ukuyiqonda ngalesi sikhathi esifushane sokufunda.Izici ze-SDH abafundi abahlangabezana nazo ekusebenzeni zingancika nasezicini zendawo yokuzijwayeza.
Ucwaningo lwethu lubalulekile ngoba sihlala sihlola uhlelo lwe-SDH ngaphakathi kohlelo lwe-CBME esilunikeza abafundi abathola iziqu zobudokotela ngokuhlola izinga lokuzindla emibikweni yabafundi.Abafundi bezokwelapha abaphezulu abafunde ubudokotela bezokwelapha iminyaka eminingi banombono wezokwelapha.Ngakho-ke, banethuba lokufunda ngokuhlobanisa isayensi yezenhlalo edingekayo ezinhlelweni ze-SDH nemibono yabo yezokwelapha [14].Ngakho-ke, kubaluleke kakhulu ukuhlinzeka ngezinhlelo ze-SDH kulaba bafundi.Kulolu cwaningo, sikwazile ukwenza ukuhlola okuqhubekayo kohlelo ngokuhlola izinga lokuzindla emibikweni yabafundi.Campbell et al.Ngokombiko, izikole zezokwelapha zase-US nezinhlelo zomsizi wodokotela zihlola izinhlelo ze-SDH ngohlolo, amaqembu okugxilwe kuwo, noma idatha yokuhlola emaphakathi neqembu.Imibandela yokulinganisa esetshenziswa kakhulu ekuhlolweni kwephrojekthi impendulo nokwaneliseka komfundi, ulwazi lomfundi, nokuziphatha komfundi [9], kodwa indlela emisiwe nephumelelayo yokuhlola amaphrojekthi ezemfundo e-SDH ayikasungulwa.Lolu cwaningo lugqamisa izinguquko zesikhathi eside ekuhlolweni kohlelo nasekuthuthukisweni okuqhubekayo kohlelo futhi luzoba negalelo ekuthuthukisweni nasekuhlolweni kwezinhlelo ze-SDH kwezinye izikhungo zemfundo.
Nakuba izinga lokucabangisisa labafundi lilonke lenyuke kakhulu phakathi naso sonke isikhathi sokufunda, ingxenye yabafundi ababhala imibiko yokucabangisisa ihlale iphansi.Kungase kudingeke ukuthi kuthuthukiswe izindlela ezengeziwe zesayensi yezokuhlalisana kwabantu ukuze kuthuthukiswe okunye.Izabelo ohlelweni lwe-SDH zidinga abafundi ukuthi bahlanganise imibono yezokuhlalisana kwabantu neyezokwelapha, ehluke ngobunkimbinkimbi uma iqhathaniswa nemodeli yezokwelapha [14].Njengoba sishilo ngenhla, kubalulekile ukunikeza izifundo ze-SDH kubafundi bezikole zamabanga aphakeme, kodwa ukuhlela nokuthuthukisa izinhlelo zemfundo eziqala ekuqaleni kwemfundo yezokwelapha, ukuthuthukisa imibono yezokuhlalisana kwabantu neyezokwelapha, nokuzihlanganisa kungaba yimpumelelo ekuqhubekiseleni phambili intuthuko yabafundi.'thuthukisa.Ukuqonda i-SDH.Ukunwetshwa okwengeziwe kwemibono yezenhlalo yothisha nakho kungasiza ekwandiseni ukuzindla kwabafundi.
Lokhu kuqeqeshwa kunemikhawulo eminingana.Okokuqala, isilungiselelo sokufunda sasikhawulelwe esikoleni esisodwa sezokwelapha e-Japan, futhi ukulungiselelwa kwe-CBME kwakukhawulelwe endaweni eyodwa esemaphandleni noma e-Japan, njengasezifundweni zethu zangaphambilini [13, 14].Sichaze kabanzi ngemvelaphi yalolu cwaningo kanye nezifundo ezedlule.Noma sinale mikhawulo, kuyaphawuleka ukuthi siye sabonisa imiphumela evela kumaphrojekthi we-SDH kumaphrojekthi we-CBME phakathi neminyaka edlule.Okwesibili, ngokusekelwe kulolu cwaningo kuphela, kunzima ukunquma ukuthi kungenzeka yini ukusebenzisa ukufunda okubonakalayo ngaphandle kwezinhlelo ze-SDH.Ucwaningo olwengeziwe luyadingeka ukuze kuthuthukiswe ukufunda okubonakalayo kwe-SDH emfundweni yezobudokotela yabangaphothulanga.Okwesithathu, umbuzo wokuthi ngabe ukuthuthukiswa kobuhlakani kuyasiza yini ekuthuthukisweni kohlelo ungaphezu kobubanzi bemibono yalolu cwaningo.Ukusebenza kahle kokwakhiwa kwethimba lothisha kudinga ukufundwa nokuhlolwa okwengeziwe.
Senze ukuhlola okude kohlelo lwezemfundo lwe-SDH lwabafundi abaphezulu bezokwelapha ngaphakathi kwekharikhulamu ye-CBME.Sikhombisa ukuthi ukuqonda kwabafundi i-SDH kuyaqhubeka nokujula njengoba uhlelo lukhula.Ukuthuthukisa izinhlelo ze-SDH kungase kudinge isikhathi nomzamo, kodwa ukuthuthukiswa kothisha okuhloselwe ukwandisa ukuqonda kothisha nge-SDH kungase kusebenze.Ukuze kuthuthukiswe ukuqonda kwabafundi kwe-SDH, izifundo ezihlanganiswe kakhulu nesayensi yezenhlalakahle kanye nezokwelapha kungase kudingeke ukuthi kuthuthukiswe.
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Isikhathi sokuthumela: Oct-28-2023