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Anasayfa : Basında THD : Türk Hematoloji Derneğinden Sağlık Bakanlığı, YÖK ve Türk Tabipleri Birliği’ne ‘yan dal uzmanlık sınavı’ ile ilgili mektup

Türk Hematoloji Derneğinden Sağlık Bakanlığı, YÖK ve Türk Tabipleri Birliği’ne ‘yan dal uzmanlık sınavı’ ile ilgili mektup

Ülkemizde tıpta yan dal uzmanlık sınavlarının yapılamıyor olması geleceğimiz açısından büyük tehlike oluşturmaktadır. Hematoloji eğitimi verecek kurumlara uzunca bir süredir yan dal araştırma görevlisi kabul edilememektedir. Bunun yanı sıra “zorunlu hizmet” olarak bilinen uygulamanın tekrar başlatılmış olması yaşanan sorunları daha da derinleştirmiştir. Yetişen iç hastalıkları uzmanları, yan dala başlayamadıkları gibi yürüttükleri proje ve çalışmaları yarıda keserek zorunlu hizmete gönderilmişlerdir. Ülkemizde hematoloji uzmanı sayısı zaten yetersizken, bu eksikliği giderecek yeni hekimlerin yetişmesi sekteye uğramış ve yeni aday bulunması da güçleşmiştir. Yetişmiş hematologlar ile bugün için bu durum katlanılabilir gibi görünse de, uygulamanın olumsuz sonuçları birkaç yıl içinde kendini gösterecektir.

 

Hematoloji sonrası özel bir deneyim gerektiren kök hücre (veya kemik iliği) nakli alanında çalışan “özel yetişmiş eleman” sayısı da olması gerekenden çok azdır(1)..Ülkemizde yıllık 600-800 civarı kök hücre nakli yapılmakta olup, bu sayı benzer nüfuslu ülkelerde çok daha fazladır. Bunun anlamı ülkemizde bu hizmeti alması gereken tüm hastalara bu tedavinin henüz yeterince sunulamadığıdır. Kemik iliği nakli gibi “zamana karşı yarış” olgusunun yaşamsal önemli olduğu bir alanda, gelişmiş ülkelerde bir ayın altında bekleme sürelerine karşın, ülkemizde nakil listesinde bekleme süresi ayları bulabilmektedir. Aktif merkezlerin sayısının artırılması çözüm yollarından birisi olmakla birlikte, buralarda çalışacak deneyimli elemanların da yetiştirilmesi gerekmektedir. Aksi halde hasta yararına düşünüldüğünde bu hastaların bekleme sırasında ölmelerini engellemenin yolu, onları yurt dışı merkezlere göndermek olacaktır. Bu da ülke çıkarları ile bağdaşmaz bir durumdur. Anılan nedenlerle Hematolojide -yan dallarda- araştırma görevlilerinin eğitime başlayabilmesi için gereken düzenlemelerin bir an önce yapılmasının acil önem taşıdığının altını çiziyoruz.

 

Yan dal uzmanlık sınavı yapılırken dünyadaki uygulamaların göz önüne alınmasında yarar bulunmaktadır. Yan dal uzmanlık sınavı, TUS benzeri tek aşamalı bir yerleştirme sınavı şeklinde yapılmamalıdır. Yan dal araştırma görevliliği akademisyenliğinin kapısıdır. Bu nedenle bu aşamada eğitim veren kurumlar sadece bilgi düzeyine değil, akademisyenlik ve o özel alan için gereken özelliklere bakabilmelidir. Ayrıca İç Hastalıkları uzmanlık eğitimi sırasında araştırma görevlileri özel alanlara (yan dal) yönlenmekte ve çalışmalarını bu alanlarda yoğunlaştırmaktadırlar. Bu durumda da kısmen deneyim kazanmaktadırlar. Tüm gelişmiş ülkelerde olduğu gibi ülkemizde de eğitimi verecek olan kurumlar “karşılıklı görüşme-mülakat” yaparak aday seçebilmelidirler. Sadece bilgi düzeyi değil, bir araştırmacı da bulunması gereken diğer özellikler ancak bu şekilde değerlendirilebilecektir. Yapılacak merkezi bir sınav nesnel değerlendirmeye temel oluşturabilir. Bu sınava göre merkezi bir eşik veya kurumsal ayrı eşikler seçilebilir. Bu tür iki aşaması olmayan test tabanlı merkezi bir sınav TUS sınavının şu anda düştüğü açmazlardan olan TUS dershaneleri gerçeğine bir yenisini eklemekten öteye geçemeyecektir. Hedef ülke biliminin daha iyiye gitmesi ise, bu hedefe iyi hekimlerle gidilebileceği unutulmaksızın, düzenleme yapılmalıdır.

 

Türk Hematoloji Derneği, sorumluluğunun bilincinde olarak konunun tüm paydaşlarına durumu aktarmaktadır.

 

Ref(1): Results of the EBMT activity survey 2005 on haematopoietic stem cell transplantation: focus on increasing use of unrelated donors A Gratwohl1, H Baldomero1, K Frauendorfer2, A Urbano-Ispizua3 and DNiederwieser 4, for the Joint Accreditation Committee of the International Society for Cellular Therapy ISCT and the European Group for Blood and Marrow Transplantation EBMT (JACIE). Bone Marrow Transplantation 2007; 39: 71–87.

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