論文

日本のシミュレーション教育に関する大学教員研修についての全国調査を行った。シミュレーションFDを実施している大学は47校(68%)であった。OSCE関連の項目の実施率が高く、インストラクショナルデザイン、テクノロジー、プログラム評価、総括的評価、などの項目の実施率は低かった。特に、省察的実践、論文執筆の指導については15%に満たなかった。また障壁としては、学生の要因は少なく、シミュレーション教育にかかわる指導者の多忙が90%と最も多かった。(著者抄録)

© 2018 Taylor & Francis. Effective interaction in interprofessional collaboration requires skills in interprofessional facilitation. The need for interprofessional learning and practice in Japan is highlighted by Japan’s status as one of the most rapidly aging societies because good care for elderly people with complex needs requires effective collaboration between different professional groups. The development of interprofessional facilitation skills (including management of the additional complexities) among learners or professionals enhances interprofessional learning and consensus building and empowers them to make appropriate commitments when faced with difficult challenges. The 18-item interprofessional facilitation scale (IPFS) can be used to enhance interprofessional facilitation skills. Here, we aimed to develop a Japanese adapted version of the IPFS and to validate it for use with Japanese healthcare professionals. Consistent with guidelines for cross-cultural adaptation, three translators translated the original IPFS from English into Japanese, and an expert and all authors confirmed its face and content validity. The translated items were amended during backtranslation and expert reviews. Exploratory factor analysis was performed with 167 healthcare professionals to explore the underlying structure of the items. This analysis revealed two factors with good internal consistency (Cronbach’s alpha > 0.8), which were labelled as: (1) encouraging interprofessional interaction and (2) respect for each professional. The original factor ‘Encouraging interprofessional interaction’ was divided into two factors in the study. One reason for this division might be related to the behaviour of Japanese health professionals, that is, most Japanese might understand that ‘facilitation’ encourages relationships as contextual belonging that are distinct from relationships based on respect for others. This mindset is likely based on the notion of ‘relationalism’, which is fundamental in Japanese culture. Further investigation of this Japanese version of the IPFS will strengthen factor construction and improve scrutiny of the relationships between factors.

Background: To create an effective community-based integrated care system, interprofessional collaboration based on healthcare professionals’ mutual understanding of their respective roles must be promoted. This study aimed to identify the role conception and role expectation that other healthcare professionals have towards physicians in the context of a community-based integrated care system. Methods: We organized focus groups and adopted ‘Role Theory’ as a theoretical framework. We collected data from healthcare professionals attending a conference on community-based integrated care systems in Japan. Fifty-four non-physician healthcare professionals consented to participate in 7 focus groups. Theme analysis based on the verbatim recorded transcripts was conducted in accordance with the framework of “Role Theory”. Results: The role conception of physicians is as a figure of intellectual authority positioned at the top of a traditional hierarchy, with a personal character of criticism/autonomy/closedness, not accommodative of interference from others, and upholding the Biomedical Model as an absolute standard. In response to this, the role expectation of physicians in the community is that they undertake actions that only physicians can undertake to ensure that a flat organization functions properly in providing medical explanations during patient transitions, and to offer healthcare support for patients who are difficult to access. This role expectation also includes the perception of patients as human beings, with physicians adapting to the Bio-Psycho-Social Model, explaining to patients about their disease as an authoritative voice based on an understanding of psychosocial circumstances, and sharing the prognosis of disease or disability. The expected personal character is a person with an open mind who allows others to seek advice, as well as a sense of approachableness which facilitates such seeking of advice. Conclusion: In the context of a community-based integrated care system, physicians should consider the understanding of their role conception and role expectation that other professionals have of them, and endeavor to create an open relationship with all healthcare professionals while giving careful consideration to their own role.

Objectives: To validate the Professional Self Identity Questionnaire (PSIQ) for medical students during clinical practice. Methods: We conducted a single-year longitudinal questionnaire study using the PSIQ. The PSIQ rates the nine items of "teamwork", "communication", "conducting assessment", "cultural awareness", "ethical awareness", "using records", "dealing with emergencies", "reflection", and "teaching" on a scale of 1-7 points. The study participants consisted of 118 fifth- and sixth-grade medical students who completed a mandatory 4-week clinical practice in a community-based medical education (CBME) curriculum. The data were collected before and after the CBME curriculum and after clinical practice at the time of graduation. To validate the internal structure of the PSIQ, we calculated Cronbach's alpha in the three phases. Additionally, to assess construct validity, we analyzed the trends and differences in each of the nine items of the PSIQ using repeated measures analysis of variance (ANOVA). We also showed the differences in effect size before and after the CBME curriculum. Results: The data of 105 medical students were analyzed. Cronbach's alpha in the three phases was 0.932, 0.936, and 0.939, respectively. PSIQ scores increased progressively for all items, and the F-test for repeated measures ANOVA of nine items' average score across the three phases showed a significant difference F(2,208) = 63.59, p<0.001. The effect size for professional identity of cultural awareness before and after the CBME curriculum was 0.67, or medium. Conclusions: We validated the PSIQ for medical students during clinical practice. Reflecting on professional identity may provide an opportunity for meaningful feedback on readiness to become a doctor.

　教室での多職種連携教育はCOVID-19のため困難となった. オンラインでの多職種連携教育のノウハウを共有するため, 2大学で実施したオンラインの初年次学生を対象とした多職種連携教育の実践報告を行う. 三重大学ではZoomを用いた授業を実施し, クイズやチャットなどで教員と学生とのインタラクションを促す仕掛けが機能した. 北海道科学大学ではZoomとLearning Management System (LMS) を用いてチーム医療体験ゲームを行い, ゲーム性と明確な指示のもと学生間のインタラクションが促進された. どちらも既存の多職種連携教育をオンラインでうまく活用し, 学生の職種役割の理解やメンバーシップ/チームシップの理解は達成されたが, 教員の慣れや時間配分などの課題があった.

© 2018, © 2018 Taylor & Francis. Rapid aging of the population necessitates improved collaboration among healthcare professionals. Unfortunately, interprofessional collaboration has yet to be implemented effectively in Japan. Therefore, we aimed to develop an interprofessional competency framework for Japanese healthcare professionals. The project was conducted as a four-step process, starting with initial categorization of potential competency domains, followed by guiding principle and prototype development, feedback on the prototype, and final consensus. First, authors (JH and MO) collected opinions about competency in interprofessional collaboration at two academic meetings of the Japan Association for Interprofessional Education (JAIPE) and then analyzed the data thematically. Second, a project team consisting of JAIPE and University representatives extracted the domains and statements as prototype 1. Third, seven representatives from professional organizations joined the project team and developed prototype 2. We then called for feedback on the revised prototype 2 at both an open symposium and via public comments. Following revision of prototype 2, a new project team including 20 university, professional organization and health practitioner representatives finally discussed prototype 3, developed the final draft and reached a consensus. In analysis after collecting the data, we extracted 11 themes. We developed four key principles which applied to six domains as prototype 1–3. Finally, our competency framework included two core domains of “Patient-/client-/family-/community-centered” and “Interprofessional communication”, and four peripheral domains of “Role contribution”, “Facilitation of relationships”, “Reflection” and “Understanding of others”. We developed an interprofessional competency framework in Japan which consists of two core and four peripheral domains. The interprofessional competency framework is likely to affect the understanding of “high-context” and “relationalism” in Japanese healthcare. We hope that our interprofessional competency framework will encourage the systematic implementation of interprofessional education and collaboration in Japan.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Objective Becoming a doctor involves transforming a lay person into a medical professional, which is known as professional socialisation. However, few studies have clarified differences in the professional socialisation process in detail. The aim of this study was to clarify the process of professional socialisation of medical students to residents to staff doctors. Design We used narrative analysis in qualitative research as a theoretical framework. Setting This study was conducted in Japan. Participants Participants were collected using a purposive sample of doctors with over 7 years of medical experience. We conducted semistructured interviews from September 2015 to December 2016, then used a structured approach to integrate the sequence of events into coherent configurations. Results Participants were 13 males and 8 females with medical careers ranging from 8 to 30 years. All participants began to seriously consider their own career and embodied their ideal image of a doctor through clinical practice. As residents, the participants adapted as a member of the organisation of doctors. Subsequently, doctors exhibited four patterns: first, they smoothly transitioned from peripheral' to full' participation in the organisation; second, they could no longer participate peripherally but developed a professional image from individual social interactions; third, they were affected by outsiders' perspectives and gradually participated peripherally; fourth, they could not regard the hospital as a legitimate organisation and could not participate fully. Conclusion The professional socialisation process comprises an institutional theory, professional persona, legitimate peripheral participation and threshold concepts. These findings may be useful in supporting professional development.

This article presents a project that aimed to identify a set of competencies (domains and statements) to prepare Japanese students and healthcare practitioners for collaborative practice. The Japan Association for Interprofessional Education (JAIPE) has started a government-funded project to formulate its interprofessional competency framework, in cooperation with professional organisations (e.g. Japan Society for Medical Education) in healthcare and social sciences. This three-year project is underway as part of the Initiative to Build up the Core Healthcare Personnel programme of Mie University. This project consists of five stages: literature review, data collection, prototype development, consensus formation, and finalisation. Our efforts will culminate in Japan's first interprofessional competency framework, with consensus from relevant academic societies and other stakeholders. We hope that the involvement of stakeholder participation will improve the usability of the final interprofessional competency framework.

Background: Within the vague system of primary care and COVID-19 infection control in Japan, we explored how primary care (PC) physicians exhibited adaptive performance in their institutions and communities to cope with the COVID-19 pandemic from January to May 2020. Methods: Narrative analysis conducted by a team of medical professionals and anthropologists. We purposefully selected 10 PC physicians in community-based hospitals and clinics and conducted a total of 17 individual and group interviews. The verbatim transcript data were analyzed using the conceptual framework of adaptive performance. Results: We identified three “phases” of the time period (January–May 2020). In Phase 1, PC physicians initially perceived the disease as a problem unrelated to them. In Phase 2, the Diamond Princess outbreak triggered adaptive performance of the physicians, who began to deal with medical issues related to COVID-19 by using social networking services and applying the collected information to their organization and/or communities. Following this, in Phase 3, the PC physicians’ adaptive performance in their own communities and institutions emerged in the face of the pandemic. Reflecting their sensitivity to local context, the PC physicians were seen to exhibit adaptive performance through dealing with context-dependent problems and relationships. Conclusions: PC physicians exhibited adaptive performance in the course of coping with the realities of COVID-19 in shifting phases and in differing localities in the early stages of the pandemic. The trajectories of adaptive performance in later stages of the pandemic remain to be seen.