論文

【目的】地域一般病院の緩和ケア外来で療養支援した患者の経過を検討した．【方法】当院緩和ケア外来を受診しその後死亡した患者を後ろ向きに調査した．外来は週2回，がん治療状況に依らず診療した．【結果】対象93例中，病状悪化時の療養希望は72例に聴取し，療養から看取りまで緩和ケア病棟を希望（緩和ケア病棟希望）が25例，訪問診療を受けつつ自宅療養を行い最期は緩和ケア病棟での看取りを希望（訪問診療→緩和ケア病棟希望）が25例，療養から看取りまで自宅を希望（訪問診療希望）が17例だった．緩和ケア病棟希望患者の96%が緩和ケア病棟を利用し，84%が緩和ケア病棟で看取り，訪問診療→緩和ケア病棟希望患者の76%が訪問診療を利用し，80%が緩和ケア病棟で看取り，訪問診療希望患者の76%が自宅療養し，47%が自宅で看取られた．【結論】緩和ケア外来の療養支援にて希望場所での療養・看取りの実現可能性が示唆された．

大学病院における総合診療科の臨床実習において医学生が総合診療の専門性をどのように理解しているのかを明らかにするために，実習前後の「総合診療の専門性とは？」というアンケートの自由記載に対して内容分析を行った．大学病院での臨床実習を通して，診断学だけではなく心理・社会的側面を踏まえた診療や健康維持なども総合診療の専門性であることが学生により獲得されていることが明らかになった．

Background: We aimed to explore what kind of social networks characterizable as “consult/be consulted” are built among healthcare professionals in a community and the impact of providing the professionals with these findings. Methods: We adopted mixed methods exploratory study using social network analysis (SNA) and content analysis. SNA can visualize social network structures such as relationships between individuals. The healthcare professionals were asked about the key persons they consulted and were consulted by concerning these healthcare issues: (1) daily work; (2) a person with acute back pain; (3) a garbage-filled house reported by a neighbor; (4) a person with dementia; and (5) a study meeting. We identified the key roles depending on the issues using SNA. After analysis, the analytical findings were shared with the participants. To explore their cognitive responses, an open-ended questionnaire was delivered and a content analysis was implemented. Results: Of 54 healthcare professional participants, the data of 52 were available for analysis. The findings (in the respective order of the five topics above) were as follows: the number of nodes was 165, 95, 85, 82, and 68; clustering coefficient was 0.19, 0.03, 0.02, 0.11, and 0.23; assortativity was −0.043, −0.11, −0.23, −0.17, and −0.23; reciprocity was 0.35, 0.31, 0.39, 0.29, and 0.48. The top three centralities included nurses. Eighty-seven free comments were received, of which 39 were categorized as descriptive, 10 as analytical, and 38 as critical. Discussion: The structure of “consult/be consulted” networks differed by topic. SNA is available to detect the healthcare resources network and it may have helped them to reflect on their own networks.

Background: Social determinants of health (SDH) are intricately intertwined with various social and economic factors. Reflection is essential for learning about SDH. However, only a few reports have focused on reflection in SDH programs; most were cross-sectional studies. We aimed to longitudinally evaluate a SDH program in a community-based medical education (CBME) curriculum that we introduced in 2018 based on the level of reflection and content on SDH in students’ reports. Methods: Study design: General inductive approach for qualitative data analysis. Education program: A 4-week mandatory clinical clerkship in general medicine and primary care at the University of Tsukuba School of Medicine in Japan was provided to all fifth- and sixth-year medical students. Students underwent a 3-week rotation in community clinics and hospitals in suburban and rural areas of Ibaraki Prefecture. After a lecture on SDH on the first day, students were instructed to prepare a structural case description based on encounters during the curriculum. On the final day, students shared their experiences in a small group session and submitted a report on SDH. The program was continuously improved and faculty development was provided. Study participants: Students who completed the program during October 2018–June 2021. Analysis: Levels of reflection were categorized as reflective, analytical, or descriptive. The content was analyzed based on the Solid Facts framework. Results: We analyzed 118 reports from 2018–19, 101 reports from 2019–20, and 142 reports from 2020–21. There were 2 (1.7%), 6 (5.9%), and 7 (4.8%) reflective reports; 9 (7.6%), 24 (23.8%), and 52 (35.9%) analytical reports; and 36 (30.5%), 48 (47.5%), and 79 (54.5%) descriptive reports, respectively. The others were not evaluable. The number of Solid Facts framework items in reports were 2.0 ± 1.2, 2.6 ± 1.3, and 3.3 ± 1.4, respectively. Conclusions: Students’ understanding of SDH deepened as the SDH program in the CBME curriculum improved. Faculty development might have contributed to the results. Reflective understanding of SDH might require more faculty development and integrated education of social science and medicine.

Introduction/Objectives: This study aimed to clarify what primary care physicians (PCPs) in Japan understand of the role of physical therapists (PTs) through the experience of working with PTs in hospitals, and what roles PCPs expect for PTs in future primary care. Methods: Semi-structured interviews were conducted individually with 9 purposively sampled PCPs with sufficient experience of collaboration with PTs. Interview data were analyzed by theme analysis focusing on “What does the PCP understand about the role of PTs through the experience of working with PTs in hospitals?” and “What roles and purposes does the PCP wish for PTs in primary care settings?” Results: PCPs viewed PTs as providers of rehabilitation in the traditional medical model, and understood their role as an occupation having a mono-causal viewpoint, namely a specific and well-defined outcome for individual patients, and intervening with patients within a short clinical course with the aim of improvement or maintenance of the patient’s condition. With regard to future primary care, PCPs expected that PTs would interpret various factors related to patient lives from the viewpoint of causal interactions; become important stakeholders in the community; and respond flexibly to patients and the environmental factors around them with continued support to the individual. Conclusions: PCPs understood the role of PTs in hospitals as “Rehabilitation in the traditional medical model,” and expected the future role of PTs in primary care as “Rehabilitation in integrated community care.”

Background: In the enhancement of allergy care involving multidisciplinary and multiple medical departments, there is a perceived need for education that targets not only specialists but also non-specialists. However, research on the need for and methods of such education remains inadequate. Objective: To design a remote allergy care education program for all medical practitioners and to validate its necessity and utility. Methods: The Empowering Next Generation Allergist/immunologist toward Global Excellence Task Force (ENGAGE-TF), supported by the Japanese Society of Allergology, initiated a virtual educational program called 'Outreach Lectures' in collaboration with Keio University and Fukui University. This initiative was widely promoted through social media and various institutions, and a survey was conducted through its mailing list. Results: 1139 responses were obtained. More than half were physicians from non-allergy specialties, representing a diverse range of healthcare professions. Over 70% expressed being 'very satisfied, ' and over 60% found the difficulty level 'appropriate. ' Free-form feedback revealed differences in learning focus based on profession and learning approach based on years of experience. Conclusion: The high participation rate (90%) of non-specialist physicians underscores the demand for addressing allergic conditions in primary care. The effectiveness of virtual/recurrent education, particularly for healthcare professionals with over 11 years of experience, was implied. Further follow-up investigation focusing on quantitative and objective assessment of educational effectiveness is indispensable.

Purpose: This study examines the impact of the 2010 and 2016 Model Core Curriculum (MCC) revisions on medical education across all 82 medical schools in Japan. Methods: A cross-sectional survey was conducted in 2021, focusing on the response to the MCC revisions, curriculum changes, and factors influencing these changes. The survey included questions on approaches to implementing the MCC revisions, timing of curriculum updates, factors triggering these revisions, changes in student performance and career paths, and the introduction of new subjects. Results: The response rate was 100%. Most universities rapidly implemented changes following the 2016 MCC revision, demonstrating agility in adapting to national standards. Key factors influencing curriculum revisions included external evaluations and the MCC revisions themselves. Despite no significant changes in student performance or career paths from faculties’ perspective, an increase in scholarly activities was noted. The introduction of new subjects post-2016 reflects a shift toward holistic perspectives such as behavioral science, general medicine/community medicine, and professionalism. Conclusions: The findings highlight a commitment to maintaining educational quality in Japanese medical education. The responsiveness to MCC revisions suggests a growing interest in medical education among faculties and an alignment with global medical education trends to meet evolving healthcare needs.

Capturing complex hierarchical human activities, from atomic actions (e.g., picking up one present, moving to the sofa, unwrapping the present) to contextual events (e.g., celebrating Christmas) is crucial for achieving high-performance video question answering (VideoQA). Recent works have expanded multimodal models (e.g., CLIP, LLaVA) to process continuous video sequences, enhancing the model's temporal reasoning capabilities. However, these approaches often fail to capture contextual events that can be decomposed into multiple atomic actions non-continuously distributed over relatively long-term sequences. In this paper, to leverage the spatial visual context representation capability of the CLIP model for obtaining non-continuous visual representations in terms of contextual events in videos, we convert long-term video sequences into a spatial image domain and finetune the multimodal model LLaVA for the VideoQA task. Our approach achieves competitive performance on the STAR task, in particular, with a 78.4% accuracy score, exceeding the current state-of-the-art score by 2.8 points on the NExTQA task.

令和4年改訂版医学教育モデル・コア・カリキュラム(以下,コアカリ)では,アウトカム基盤型教育において,さらなる展開として,新たに『学修方略・評価』の章が追加された.カリキュラムの重要な要素である方略・評価の章を加え,資質・能力に紐づけることで,学修者や指導者にコアカリを活用していただけるよう工夫した.また,教育現場ですぐに実践していただけるように11の方略・評価事例をGood Practiceとして紹介した.ただし,これらのGood Practiceは,各施設での実施を必須とするものではなく,あくまで参考例として掲載している.各大学の特徴を生かした独自の方略・評価が策定され,本章がさらに発展していくことを期待する.(著者抄録)

＜文献概要＞Point　◎医師の働き方改革で,タスクシェア・シフトが開始された.◎タスクシェア・シフトする業務範囲を明確にするだけでなく,各職種の役割やコンピテンシーを明示することが求められる.◎医師は多職種連携コンピテンシーを意識しながら,タスクシェア・シフトに従事することが求められる.

＜文献概要＞「クリニカル・パール」は2012年の『JIM』(本誌の前身雑誌)で、筆者が大学院生時に初めて商業誌へ寄稿した際のテーマであった。今回は12年前を振り返り、文献を見直して、新たに情報社会やAI(artificial intelligence)などのトピックを盛り込んだ内容に書き直した。定義や基準などは一部再掲となることはご容赦いただきたい。