学会誌

コリー 紀代*1　清水 弘美*2　高橋 望*3　小水内 俊介*3
近野 敦*3　金井 理*3　二宮 伸治*4　大塚 健*5　浅賀 忠義*1

要旨：
背景：在宅医療の高度化により，気管内吸引等の高度ケアを担う人材の育成が喫緊の課題である．
方法：気管内吸引を行う看護師と看護学生の眼球運動を測定し，気管内吸引中の認知・判断面を含めた多重タスク構造を気管内吸引オントロジーとして可視化した．
結果：構築された気管内吸引オントロジーの階層構造からは，手順という手続き的知識のみならず，医療機器に関する知識，気管内吸引が無効であった際の選択肢に関する知識など，多岐にわたった専門知識が要求される行為であることが示された．
考察：オントロジーは「できる」能力の範囲や評価すべき能力の定義を示す教育評価ツールとしても活用の可能性がある表現法と考えられた．
キーワード：可視化，暗黙知，看護技術，教育評価，階層構造

Noriyo COLLEY*1　Hiromi SHIMIZU*2　Nozomi TAKAHASHI*3
Shunsuke KOMIZUNAI*3　Atsushi KONNO*3　Satoshi KANAI*3
Shinji NINOMIYA*4　Ken OTSUKA*5　Tadayoshi ASAKA*1

Abstract:
Introduction：Due to the advancement of the home-based healthcare, increasing the number of professionals who are able to administer homebased treatments, such as endotracheal suctioning, is an urgent issue.
Methods：By measuring the ocular movement of nurses, nursing students and previous researches, an endotracheal suctioning ontology was visualized. It included a multiplex task structure, recognition, and judgment, as well as identifying procedures used during endotracheal suctioning that could contribute to a discussion on educational feasibility.
Results：From the hierarchical structure of the constructed endotracheal suctioning ontology, not only the procedural knowledge but also knowledge about medical devices, knowing what options exist when endotracheal suctioning is ineffective, and a wide range of other expertise is needed to perform endotracheal suctioning safely.
Discussion：An endotracheal suctioning ontology was created from the ocular movement of nurses. Ontologies are a potential tool for defining minimum requirements and the scope of ability that must be evaluated before clinical practicum.
Key words: Visualization, Tacit Knowledge, Nursing Techniques, Educational Evaluation, Clustering

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*1 北海道大学大学院保健科学研究院，Faculty of Health Sciences, Hokkaido University
[〒060-0812　札幌市北区北12条西5丁目]
*2 北翔会医療福祉センター札幌あゆみの園，Hokusyokai Medical Welfare Centre Sapporo Ayumi no Sono
*3 北海道大学大学院情報科学研究科，School of Information Science and Technology, Hokkaido University
*4 広島国際大学保健医療学，Course of Clinical Engineering, Hiroshima International University
*5 標津町役場，Shibetsu Town Public Office
受付：2017年8月24日，受理：2018年3月17日

北村 匡大*1　中村 佳奈*2　礒邊 恵理子*3

要旨：
目的：実力試験と国家試験との関連性および予測試験とカットオフ値を検討した．
方法：対象は理学・作業療法士養成校5校の卒業生とした．統計解析は，Pearsonの相関係数とロジステック回帰分析を実施し，受信者動作特性曲線にて算出した．
結果：各実力試験と国家試験は，理学療法学科（305名，合格率83.6%），作業療法学科（89名，合格率100%）ともに有意な正の相関を示した．予測試験では理学療法学科で模擬試験1・3回目が抽出（p＜0.05），各カットオフ値は130.5点，169.5点，作業療法学科は検討できなかった．
結論：各実力試験と国家試験は関連し，予測試験とカットオフ値が明らかとなった．
キーワード：国家試験，実力試験，予測試験，理学療法，作業療法

 

Masahiro KITAMURA*1　Kana NAKAMURA*2　Eriko ISOBE*3

Abstract:
Purpose: To consider the relationship between undergraduate tests and the national
examinations administered to undergraduate students, predict the outcome of national examinations, and determine the cutoff value for passing national examinations.
Methods: We studied students who graduated in March 2016 from five rehabilitation colleges for physiotherapists and occupational therapists. We investigated the national examination results of physical therapists and occupational therapists, undergraduate tests such as admission tests, first year student final exams, second year student final exams, and three tests administered to third year students. Statistical analysis, Pearson's Correlation coefficient, and logistic regression analysis were used. The cutoff value was determined by recipient operation characteristic curve.
Results: Each performance test and national examination showed a significant positive correlation with the Department of Physical Therapy (305, pass rate 83.6%), Department of Occupational Therapy (89, pass rate 100%) and the predictive examination for the Department of Physical Therapy. The first and third simulation tests were extracted (p <0.05), each cutoff value was 130.5 points and 169.5 points respective.
Conclusion: We established a relationship between undergraduate tests and national examinations. We also clarified the predictive test for the physical therapist national examination and its cutoff value.
Key words: National examination, Undergraduate test, Prediction test, Physical therapy, Occupational therapy

 

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*1 小倉リハビリテーション学院，Kokura Rehabilitation College
[〒800-0206 福岡県北九州市小倉南区葛原東2-2-10]
*2 福岡和白リハビリテーション学院，Fukuoka Wajiro Rehabilitation College
*3 下関看護リハビリテーション学校，Shimonoseki Nursing and Rehabilitation School
受付：2017年9月17日，受理：2018年3月17日

日本医学教育学会 卒後・専門教育委員会
清水 貴子*1　石原 慎*2　青松 棟吉*3　小西 靖彦*4　
高橋 誠*5　中川 晋*6　望月 篤*7　安井 浩樹*8　高橋 弘明*9

要旨：
2004年（平成16年）に開始された現行の卒後臨床研修は，明確な理念に基づいて実施されている．開始時から5年ごとの見直しがうたわれており，3回目の見直し案が2018年（平成30年）3月，医道審議会医師分科会臨床研修検討部会より提示された．それによると，医師としての基本的価値観（プロフェッショナリズム）に重きをおいた目標に改定されたこと，さらに医学部から生涯にわたる目標の一貫性が図られたことが特徴である．
今回の見直しにより，卒後臨床研修が医師の生涯学習に深く関わることが明確になったが，これからは生涯を通じて研鑽し続ける体制の一層の整備が望まれる．
キーワード：卒後臨床研修，生涯学習，継続的専門職能開発（CPD），プロフェッショナリズム

Japan Society for Medical Education, Post-graduate Medical Education Committee
Takako SHIMIZU*1　Shin ISHIHARA*2　Muneyoshi AOMATSU*3
Yasuhiko KONISHI*4　Makoto TAKAHASHI*5　Susumu NAKAGAWA*6
Atsushi MOCHIZUKI*7　Hiroki YASUI*8　Hiroaki TAKAHASHI*9

Abstract:
Under the current postgraduate clinical training system for physicians, three principles have been emphasized in its basic tenets; cultivation of character appropriate for physicians, generation of awareness to the societal role of medical science and healthcare, and mastery of basic clinical skills needed to respond appropriately to injuries and illnesses frequently encountered in general practice. In accordance with its quinquennial review rule, the Clinical Training Committee under the Medical Caucus of the Healthcare Professions Council released draft revisions of a notification published by the Director general of the Health Policy Bureau of the Ministry of Health, Labor and Welfare in March, 2018. The document is entitled “On the operation of the ordinance concerning the postgraduate clinical training prescribed in the paragraph (1) of Article 16-2, Medical Practitioners Act”.
A Key distinction of the revised draft is new learning outcomes featuring core values shared by physicians: commitment to physicians’ societal mission of public health, altruistic behavior, respect for humanity, and maintaining one’s own integrity. Another key distinction is securement of longitudinal consistency in the set of required faculties, from medical school curriculum to continuing professional development programs. Further improvements in systems and environments to enhance devotion to life-long learning are needed.
Key words: continuing professional development (CPD), postgraduate clinical training system, professionalism

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*1 聖隷福祉事業団，Seirei Social Welfare Community
[〒430-0946　静岡県浜松市中区元城町218-26 聖隷ビル]
*2 藤田保健衛生大学地域医療学，Department of Community Medicine, Fujita Health
University
*3 佐久総合病院研修医教育科，Department of Medical Education, Saku Central
Hospital
*4 京都大学医学教育・国際化推進センター，Medical Education Center, Kyoto
University
*5 東京医科歯科大学臨床医学教育開発学，Department of Medical Education
Research and Development, Tokyo Medical and Dental University
*6 東京都済生会中央病院人材育成センター，Center for Human Resource
Development, Tokyo Saiseikai Central Hospital
*7 聖マリアンナ医科大学医学教育文化部門医学教育研究分野，Research Institute for
Medical Education, St. Marianna University School of Medicine
*8 美幌町立国民健康保険病院（呼吸器内科），National Insurance Bihoro Municipal
Hospital
*9 岩手県立中央病院医療研修部，Department of Medical Education, Iwate Prefectural Central Hospital
受付：2018年3月23日，受理：2018年3月26日

西城 卓也*1　池田 貴英*2　森田 浩之*2

要旨：
臨床実習前の医学生4年生を対象とした臨床推論実習の学習者評価の一環として，模擬症例カンファレンスによる口頭試験を実践した．臨床推論能力の総括評価としての利用には，Key Feature Approachの観点から，症例数や試験時間の検討が必要である．しかし論理だった推論過程の症例呈示能力や臨床実習に臨む学生のレディネスなどが，RIME評価を応用して総合的に評価できることを経験した．また困難な状況にある学習者を同定し，個々の学習者の悩みに相談・対応できた経験から，学習支援のきっかけとする利用価値も見出せた．この予行演習的体験や評価ツールとしてのエッセンスが，他大学の臨床実習前教育に応用されることが期待される．
キーワード：卒前教育，臨床推論，模擬症例カンファレンス，RIME評価

Takuya SAIKI*1　Takahide IKEDA*2　Hiroyuki MORITA*2

Abstract:
An oral examination using a simulated case conference format was conducted for fourth year medical students who took a practical course on clinical reasoning prior to their clinical clerkship. Although there were many disadvantages such as fewer cases and shorter testing time to use such examinations for summative purposes, we found that we could assess students’ knowledge and presentation skills based on their logical reasoning. We could also comprehensively evaluate students’ readiness for clerkship by applying the RIME assessment framework. We discovered the practical value of using the examination as a means of supporting learners who are facing difficulty in learning after we successfully used it to detect such learners and address their concerns. We hope that some elements of this simulated case conference can be used not only as a job preview but also as an assessment tool for pre-clinical clerkship education in other medical schools.
Key words: undergraduate medical education, clinical reasoning, simulated case conference, RIME evaluation

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*1 岐阜大学医学教育開発研究センター，Medical Education Development Center, Gifu University
*2 岐阜大学大学院医学系研究科総合病態内科学，Department of General Internal Medicine, Gifu University
受付：2018年3月9日，受理：2018年3月16日

高屋敷 明由美*
Ayumi TAKAYASHIKI

今回リレー・エッセイのバトンを受け取った時に，今までの受賞者の皆様の個性豊かで，医学教育への信念と情熱あふれる文章に感銘を受けてきた「医学教育」誌の読者として，非常に戸惑った．受賞後10年の間に，自分はそれに値する役割を果たせてきたのだろうかと．恩師から受けた数々の教えがあってこそ今の自分があることを改めて自覚し，貴重な誌面を頂戴する決心がついた．

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*筑波大学医学医療系・同医学群医学教育企画評価室，Faculty of Medicine／Department of Planning and Coordination for Medical Education School of Medicine, University of Tsukuba

岐阜大学医学教育開発研究センター　西城卓也
早稲田大学商学学術院　小西由樹子

吉田 絵理子*　松島 雅人*

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*東京慈恵会医科大学臨床疫学研究部