論文

Background: Existing literature highlights the potential of arts and humanities activities to support the professional development in medical education. However, most initiatives have been conducted in Western contexts and have encountered challenges related to feasibility. Thus, we aimed to develop and assess the educational effectiveness of a three-hour classroom-based course employing culturally responsive arts- and humanities-based pedagogies in Japan, particularly visual thinking strategies (VTS) and Haiku writing. Methods: We conducted a convergent mixed-methods study among fourth-year medical students in May 2024. The course consisted of VTS and Haiku writing workshops/lectures, each of which lasted 90 min in the classroom. Pre- and post-tests were used to assess the Capacity for Wonder (CfW) scale and the Tolerance for Ambiguity (TFA) scale. A post-course questionnaire included closed-ended questions on course quality and relevance and open-ended questions soliciting learning content. Results: 98 of 111 (88.3%) students were analyzed. Paired t-test showed that participants demonstrated significant improvement in CfW scores. No statistically significant change was observed in TFA scores; however, a modest trend toward improvement was noted. The majority of participants agreed that the course was relevant. Content analysis of free-text responses revealed that many participants gained a variety of insights into professional development, including the importance of observation and attention to detail and professional identity formation. Conclusion: Integrating arts and humanities activities, including VTS and Haiku rooted in Japanese culture, within a short classroom session has the potential to facilitate professional development. The course has wide application potential and will inform medical educators worldwide.

　少子高齢化社会の背景と令和2年度からの調査を踏まえ, 患者の抱える問題を臓器横断的に捉えた上で, 心理社会的背景も踏まえた総合的な視点とアプローチの必要性が示され, 医学教育モデル・コア・カリキュラム (令和4年改訂版) に総合的に患者・生活者をみる姿勢が資質・能力に新設された. 下位目標として「全人的な視点とアプローチ」「地域の視点とアプローチ」「人生の視点とアプローチ」「社会の視点とアプローチ」が位置づけられた. 抽象と具体, 概念と経験, 自己と他者等の視点を統合し, 自己の在り方を省察できるような複数の学習理論を踏まえた教育方法が提案された. このような医学教育を通じて, 患者・生活者のウェルビーイングが向上することを期待する.

Introduction: The need to learn social determinants of health (SDH) is increasing in disparate societies, but educational interventions are complex and learning mechanisms are unclear. Therefore, this study used a realist approach to identify SDH learning patterns, namely context (C), mechanism (M), and outcomes (O) in communities. Methods: A 4-week clinical practice program was conducted for 5th- and 6th-year medical students in Japan. The program included SDH lectures and group activities to explore cases linked to SDH in the community. The medical students' structural reflection reports for learning SDH were thematically analyzed through CMO perspectives. Results: First, medical students anticipated the concept of SDH and participated in a community in which a social model was central. They then transformed their perspective through observational learning and explanations from role models. Second, medical students’ confrontation of contradictions in the medical model triggered integrated explanations of solid facts. Third, conceptual understanding of SDH was deepened through comparison and verbalization of concrete experiences in multiple regions. Fourth, empathy for lay people was fostered by participating from a non-authoritative position, which differed from that in medical settings. Conclusion: Medical students can learn about the connections between society and medicine through four types of SDH learning patterns.

Introduction: The pandemic caused by the novel coronavirus (COVID-19) has produced dramatic changes in the learning environment for clinical practice in medical education, and the impact on medical students has been significant. However, few program evaluation studies involving professional identity, now emphasised in medical education, have compared current with pre-COVID-19 programs. Here, we compared the professional identity recognised by medical students in the years before and during COVID-19. Methods: Medical students who participated in clinical practice were evaluated using the Japanese version of the Professional Self-Identity Questionnaire (PSIQ), a 9-item inventory rated using 7-point Likert scales. They answered on the first day of a 4-week clinical practice module within a community-based medical education (CBME) program and at graduation in 2018-2019 (pre-COVID-19 pandemic) and in 2019-2020 (during-COVID-19 pandemic). We compared the mean difference in total PSIQ score of the 2019-2020 students to those of the 2018-2019 students as a historical cohort using an unpaired t-test. Results: Participants were 104 medical students in the 2018-2019 academic year and 92 in the 2019-2020 academic year. PSIQ was increased at graduation. Mean difference in total PSIQ score was statistically higher for the 2019-2020 students (13.5 ± 9.4) than for the 2018-2019 students (10.3 ± 8.1) (t =2.6, df =195, p = 0.01). Conclusion: Although clinical practice was restricted by COVID-19, this had some positive impact on the strengthening of professional identity recognised by medical students. This finding may have been influenced by the imprinting of professional norms and changes in society.

Background: The need to engage medical students in understanding the social and environmental determinants of health in disparate communities is increasing. However, previous reviews have noted the limited community diagnosis programs and program evaluation. Given the feasibility of the programs, it is expected to be widely available online. Therefore, this study used a realist approach to identify learning patterns through an online community diagnosis program, namely context (C), mechanism (M), and outcomes (O) patterns. Methods: A 2-week general medicine clinical practice program was conducted for 4th- and 5th-year medical students at a medical university in Japan. The program included a one-hour zoom-based lecture, feedback for students on their presentations on community diagnosis, and a structural report on community diagnosis. We developed the program based on variation theory, which views discernment and variation in situations having time, space, and social dimensions as core learning. The students' reflections on their learning through the program were thematically analyzed through CMO perspectives. The realist approach used in the online diagnosis program evaluation allows us to explore, test, and refine what mechanisms work under what conditions (context) and with what interventions (including opportunities and resources), from which we can describe iteratively explainable results. Results: First, the medical students, who spent most of their time in the limited residential areas they lived in, discovered the characteristics of their own community by discovery learning and comparison among peers. Second, they increased their intrinsic interest in the community by discerning specific issues in their familiar community through community diagnosis. Third, they valued community diagnosis by identifying relationships between local data on health issues under their learning responsibility. Fourth, they become more flexible in their thinking and created new knowledge that would fit the local community, and their reflection on themselves was encouraged. Conclusion: In this online community diagnosis program, medical students learned about the community through four types of learning patterns. Medical students may develop an understanding of community with interest using variation theory as a program development perspective and cognitive flexibility theory surrounding the essential ambiguity and abstraction of community.

保健医療福祉領域における多職種連携教育や複雑な課題を解決するためには，効果的な協働とそれを 支える研究の知見が重要である。しかし，この分野の研究は複雑であるため，視座・視点・対象をよ り意識する必要がある。そのため，本論文では，視座としてのミクロ・メゾ・マクロへの影響，研究 の視点の補助線となる学習理論や組織理論などを使用し，個人から地域まで幅広い対象の健康やQOL などの指標を用いて評価する方法論を整理した俯瞰図を提案する。この俯瞰図に基づき，多職種連携 コンピテンシーを理論的枠組みとした具体的な研究を例に，視座・視点・対象・研究デザイン・方法 論について紹介する。また，医学・歯学・薬学教育のモデル・コア・カリキュラムにおいて，多職種 連携能力が資質・能力に組み込まれたことを皮切りに，今後の多職種連携教育・協働の研究の種を共 有する。

Background: Ambiguity tolerance is important because it contributes to both better patient care and physician well-being. Although a recent study showed that family physicians have greater ambiguity tolerance than non-family physicians, the question of when family physicians develop tolerance remains unanswered. Thus, the aim of this study was to examine the associations between the number of postgraduate years (PGYs) and ambiguity tolerance. Methods: This was a nationwide cross-sectional study involving family physicians in 14 residency programs throughout Japan. Ambiguity tolerance was assessed as the primary outcome using the Japanese version of the Tolerance for Ambiguity in Medical Students and Doctors scale. Secondary outcomes were burnout and work engagement, assessed using the Japanese version of the Burnout Assessment Tool and the ultra-short version of the Utrecht Work Engagement Scale, respectively. Results: 173 family physicians were included in the analysis. Physicians of PGY ≥7 had significantly greater ambiguity tolerance and lower burnout risk than those of PGY 3–6. Physicians of PGY 7–20 had significantly higher work engagement than those of PGY 3–6. Conclusions: Family medicine resident physicians may be vulnerable for the duration of the residency program, although they may develop ambiguity tolerance and improve well-being over the course of the program. Supervisors in family medicine residency programs should examine the learning environment of their program, considering the vulnerability of their trainees.