学会誌

瀬戸山 陽子*1　武田 裕子*2

Yoko Setoyama*1　Yuko Takeda*2

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*1 東京医科大学教育IRセンター，Institutional Research Center，Tokyo Medical University
*2 順天堂大学大学院医学研究科医学教育学，Department of Medical Education, Juntendo University Graduate School of Medicine

舩越 高樹*

要旨：
2024年4月1日，日本では「障害を理由とする差別の解消の推進に関する法律」の改正法が施行され，国公私立を問わずすべての高等教育機関において合理的配慮の提供が義務化された．それに伴い文部科学省が公開した「障害のある学生の修学支援に関する検討会報告（第三次まとめ）」を参照しつつ，日本における障害学生支援の基本的事項について概観する．それと共に，医療職養成という社会的責任がきわめて重い医療系学部の教育において同時に進められている教育内容・方法，学修成果の評価方法の明確化と個別のニーズに応じた柔軟な対応を求める合理的配慮提供との間のコンフリクトへの対処法について，米国での先行事例を参照しつつ考察する．
キーワード：障害の社会モデル，合理的配慮，建設的対話，テクニカルスタンダード，Diversity, Equity & Inclusion

Koju Funakoshi*

Abstract:
On April 1, 2024, Japan’s revised Act for Eliminating Discrimination against Persons with Disabilities came into effect, mandating the provision of reasonable accommodations at all higher education institutions in Japan, whether national, public, or private. In response to this legislative change, the Ministry of Education, Culture, Sports, Science, and Technology (MEXT) released ‘Report of the Study Group on Support for Students with Disabilities (Third Summary),’ which outlines the fundamental issues regarding support for students with disabilities in Japan. Furthermore, this paper will explore how to address conflicts arising from the need to clarify educational content, teaching methods, and methods for evaluating learning outcomes, alongside the need to provide reasonable accommodations that require flexible responses to individual needs. These challenges are particularly pressing in the context of medical faculties, which bear a significant social responsibility for training medical professionals. We will refer to precedents in the U.S. to inform our discussion.
Keywords: social model of disability, reasonable accommodation, constructive dialogue, technical standards, Diversity Equity & Inclusion

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*筑波大学ヒューマンエンパワーメント推進局，Associate Professor, Breau of Human Empowerment, Tsukuba University

瀬戸山 陽子*

要旨：
日本の医療者の法律には，現在も障害を理由に資格を制限する欠格条項が存在する．欠格条項は，個人の機能障害を問題にする医学モデルに基づく考え方で，日本が批准する障害権利条約の基盤となる障害の社会モデルに反する．また欠格条項は障害に関連するスティグマを増強させ，医療者集団に障害のある人を包摂しづらくしている．
障害のある人の医療格差是正を含む医療の質改善には，医療者集団の中に障害のある人がいることが欠かせない．またお互いに対等な立場で，共通の目標を追求し，両者の接触が制度的に是認されていることが条件である．欠格条項の存在は，長期的視点で医療の質向上を阻む制度であり，早急に是正が求められる．
キーワード：障害のある医療職，障害のある医療系学生，欠格条項，インクルーシブ教育

Yoko Setoyama*

Abstract:
The Japanese laws regulating healthcare professionals currently contain exclusionary clauses that limit qualifications based on individual impairments. These exclusionary clauses are grounded in a medical model focused on individual impairments and contradict the social model that underpins the Convention on the Rights of Persons with Disabilities, which Japan has ratified. Furthermore, these clauses exacerbate the stigma associated with disabilities, complicating the integration of individuals with disabilities into the healthcare professional community.
To enhance the quality of healthcare and address medical disparities faced by individuals with disabilities, it is critical to employ healthcare staff with disabilities. It is an essential requirement that healthcare professionals, with or without disabilities, pursue shared objectives on equal grounds, and their collaboration must be officially sanctioned. The presence of exclusionary clauses presents an obstacle to long-term improvements in healthcare quality and necessitates immediate rectification.
Keywords: healthcare professionals with disabilities, healthcare students with disabilities, exclusionaryclauses, inclusive education.

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*東京医科大学教育IRセンター，Institutional Research Center, Tokyo Medical University

福場 将太*1, 2, 3

要旨：
医学部におけるインクルーシブ教育の実現を阻んでいるものは何か．それは，医学生は医者になるのが当然，そして医者は五体満足であるのが当然という意識である．この意識は長きに渡って日本の医療界を支えてきた．しかし一方で医療界を閉鎖的にしてしまったことは否めず，今なお医学生たちに人間性を蝕むいくつもの症候を引き起こしている．本論ではこの症候群に着目して考察を進め，インクルーシブ教育を実現するための心理面の課題，そのための方法，実現によってもたらされるいくつもの効果についてお示しする．
キーワード：医学部シンドローム，医学生は医者になる，幹細胞のように，バリアバリュー

Shota Fukuba*1, 2, 3

Abstract:
What are the barriers that hinder inclusive education in medical schools? There is an assumption that medical students must inevitably become medical doctors and that they must be completely healthy, without any disabilities. It is true that this assumption has long sustained the medical community in Japan. However, on the flip side, these assumptions have also rendered the medical community insular, and medical students are still subjected to several syndromes that undermine their humanity. In this paper, I will examine these syndromes and discuss the psychological issues and methods to promote inclusive education. Additionally, I will explore the social effects that could result from the implementation of inclusive education within the medical community.
Keywords: medical students syndrome，medical student becomes medical doctor，ｌike a stem cell，varrier value

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*1 医療法人風のすずらん会（精神科医），Medical Corporation, Kaze-No-Suzuran-Kai, psychiatrist
*2 視覚障害をもつ医療従事者の会ゆいまーる（幹事），The Association of Medical Professionals with Visual Impairment, Yuima-ru, secretary
*3 公益社団法人NEXT VISION（理事），NEXT VISION, director

根本 玲*

要旨：
聴覚障害のある医師として，読唇と補聴器，音声認識を使用しながら，医学生から研修医，専攻医そして専門医までの経験を報告する．主に，当事者団体「聴覚障害をもつ医学生の会」のネットワークを通じて，相談・情報交換をしながら，試行錯誤を経て，現在はリハビリテーション科医師として勤務している．ローテクや音声認識の進歩により働きやすくなっていることを実感する．これまでの経験をもとに，安全な医療行為を行う上で，聴覚障害のある医師に必要なスキルは，セルフアドボカシースキルを活かして，人間関係を構築してコミュニケーションをとり，組織と医療資源を適切に見極めることであると考える．
キーワード：聴覚障害，医学教育，情報保障，セルフアドボカシー

Rei Nemoto*

Abstract:
The amendment to the Medical Practitioners Act in March 2001 has significantly opened opportunities for individuals with visual and hearing impairments. Following this, there has been an increase in the number of physicians and medical students with hearing impairments; as of March 2024, the Japanese network of the Association of Deaf and Hearing Impaired Medical Students (ADHIMS) has 42 members.
As a physician with a hearing impairment, I aim to share my experiences transitioning from a medical student to a resident, to a specialist physician in rehabilitation medicine. I have used lip reading, hearing aids, and speech recognition for communication. As a medical student, I faced various challenges in becoming a physician, such as examinations for promotion, the Objective Structured Clinical Examination (OSCE), clinical clerkships, and so on. Thus, during my medical school years, not only was retention of knowledge crucial, but building relationships was equally important. As a resident, I found that effective communication with healthcare professionals became more accessible. Through consultation and information exchange within the ADHIMS, I have evolved into a physician specializing in rehabilitation medicine. Advances in low-technology aids and speech recognition have facilitated my work. I believe that communication skills, including self-advocacy and the ability to assess organizational and healthcare resources, are essential for physicians with hearing impairments to provide safe medical care.
Keywords: hearing impairment，medical education，deaf support system，self advocacy

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*京都田辺記念病院／京都府立医科大学大学院リハビリテーション医学，Kyoto Tanabe Memorial Hospital/Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine

早瀨 久美*

要旨：
2025年11月に100年目となるデフリンピックが日本で開催される．我が国で初めて聴覚障害者として薬剤師となりデフリンピックの日本選手団の医薬品を担当する立場から，デフリンピックとの関わりを通して培ってきた知見をもとに医療従事者として知っておくべき医療現場での聴覚障害者の対応についてまとめた．
キーワード：デフリンピック，スポーツファーマシスト，医療現場での聴覚障碍者

Kumi Hayase*

Abstract:
In November 2025, Japan will host the 100th Deaflympics. As the first hearing-impaired pharmacist in Japan responsible for the pharmaceutical care of the Japanese Deaflympics team, I have compiled a summary of the essential information that healthcare professionals need to know when providing medical services to hearing-impaired individuals, drawing upon my experience with the Deaflympics.
Keywords: the Deaflympics, sports pharmacist, hearing impaired in medical settings

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*昭和大学病院薬剤師，Special Function Hospital pharmacist

加納 佳代子*

要旨：
私は看護師生活49年，てんかん当事者35年，うつ病からのリカバリー16年となる．病とともに過ごした職業生活を振りかえりたい．誰もが失敗から学ぶ権利がある．私もてんかん患者としてたくさんの失敗を重ねてきた．しかし，「発作の主体的コントロール」というストレングスを蓄積することができた．病や障害や諸事情に必要な配慮について知恵を絞り，試み，可能性に賭けていきたい．
キーワード：てんかん当事者，うつからの回復，看護師，職業生活

Kayoko Kanou*

Abstract:
I have been a nurse for 49 years, a person living with epilepsy for 35 years, and in recovery from depression for 16 years. I wish to reflect on my professional life lived alongside my illnesses. Everyone has the right to learn from their errors. As someone with epilepsy, I have made many mistakes. However, I have managed to develop the strength of “independently controlling my seizures.” I aim to compile my insights on illnesses, disabilities, and other necessary considerations, to experiment with them, and to discover their potential.
Keywords: epilepsy patient, recovery from depression, nurse, professional life

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*医療法人財団緑雲会多摩病院，Tama Hospital

菊池 良和*

要旨：
吃音症は言語障害であるが，発達障害者支援法の対象疾患である．吃音症は流暢に話せる時間が多いが，時々，吃音が出て流暢に話すことが妨げられる2面性がある．成長するにつれて，吃音を隠す工夫を覚えて，学校生活に適応できつつあるが，自分の吃音を客観的にとらえることが大切となってくる．吃音がある医師として，周囲の理解を得ながら，自分の吃音を向き合うことに必要な情報を共有する．
キーワード：吃音，発達障害，社交不安症，合理的配慮

Yoshikazu Kikuchi*

Abstract:
Stuttering is a speech disorder as well as a developmental disorder. It is distinguished by its dual nature. Typically, one can speak fluently, yet occasionally, stuttering disrupts this fluency. With growth, learning to conceal the stuttering becomes part of adapting to school life. However, it is also important to understand one’s stuttering objectively. As a physician who stutters, it is vital to impart necessary information about facing one’s stuttering and to gain understanding from others.
Keywords: stuttering, developmental disorders, social anxiety disorder, reasonable accommodations

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*九州大学病院耳鼻咽喉・頭頸部外科助教，Kyushu University Hospital, Department of　Otorhinolaryngology and Head & Neck Surgery, Assistant Professor

里村 嘉弘*1,2　金原 明子*1,2　大久保 紗佳*3　杉本 達哉*3　片岡 朋恵*3　小西 優歌*3　吉川 桜子*3
木之下 遼*4　末松 万宙*4　高橋 優輔*5　熊倉 陽介*1　長谷川 智恵*1　佐々木 理恵*2
山口 創生*6　澤田 宇多子*7　宮本 有紀*2,7　大島 紀人*8　熊谷 晋一郎*9　笠井 清登*1,2

要旨：
東京大学ではこれまで，バリアフリー支援室や医学部附属病院などにより，障害のある構成員のインクルージョン，学術研究のコ・プロダクション，ピアサポートワーカーとの協働に取り組んできた．これらの活動が合流する形で，2021年，医学のダイバーシティ教育研究センターを設立した．本センターでは，障害のある医療人材の活躍できる環境・文化を構築するため，医学教育に社会モデルの視点を導入し，もっともコ・プロダクションが実現しにくい分野である医学領域におけるその実装・普及を目指している．センターでは現在，医学部における教育プログラムの運営，学生主導による調査研究などの教育・研究活動を行っている．
キーワード：ダイバーシティ&インクルージョン，コ・プロダクション，障害，ディスアビリティ，社会モデル

Yoshihiro Satomura*1, 2　Akiko Kanehara*1, 2　Sayaka Okubo*3　Tatsuya Sugimoto*3
Tomoe Kataoka*3　Yuka Konishi*3　Sakurako Yoshikawa*3　Ryo Kinoshita*4
Mahiro Suematsu*4　Yusuke Takahashi*5　Yousuke Kumakura*1　Chie Hasegawa*1
Rie Sasaki*2　Sosei Yamaguchi*6　Utako Sawada*7　Yuki Miyamoto*2, 7
Norihito Oshima*8　Shin-Ichiro Kumagaya*9　Kiyoto Kasai*1, 2

Abstract:
The University of Tokyo Disability Services Office and the University of Tokyo Hospital have striven to advance the inclusion of individuals with disabilities and to encourage the co-production of research as well as mental health services with peer support workers. In convergence with these endeavors, the Center for Diversity in Medical Education and Research (CDMER) was founded in 2021. The Center aims to establish an environment and culture that facilitates the participation and success of medical professionals with disabilities. For this purpose, it is essential to integrate the perspective of the social model of disability into medical education and promote co-production in the medical field, which is among the most challenging areas that can realize co-production. The Center is involved in various educational and research activities, including managing educational programs for medical students and supporting student-led research.
Keywords: diversity＆inclusion，co-production，disability ，social model

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*1 東京大学医学部 精神神経科，Department of Neuropsychiatry, Faculty of Medicine, The University of Tokyo
*2 東京大学医学系研究科 医学のダイバーシティ教育研究センター，Center for Diversity in Medical Education and Research, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo
*3 東京大学医学部健康総合科学科，School of Integrated Health Sciences, Faculty of Medicine, The University of Tokyo
*4 東京大学医学部医学科，Faculty of Medicine, The University of Tokyo
*5 精神医学研究所附属 東京武蔵野病院，Department of Psychiatry, Tokyo Musashino Hospital
*6 国立精神・神経医療研究センター 精神保健研究所 地域精神保健・法制度研究部，Department of Community Mental Health & Law, National Institute of Mental Health, NCNP, National Center of Neurology and Psychiatry (NCNP)
*7 東京大学大学院医学系研究科 精神看護学分野，Department of Mental Health / Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo
*8 東京大学 相談支援研究開発センター，Center for Research on Counseling and Support Services, The University of Tokyo
*9 東京大学先端科学技術研究センター，Research Center for Advanced Science and Technology, The University of Tokyo

武田 裕子*1　大杉 豊*2

要旨：
順天堂大学では，健康格差の社会的決定要因（social determinants of health: SDH）教育の一環として，ろう・難聴者への医療の現状を学び，医療者に求められることを考える選択実習（基礎ゼミ）を医学部3年次に行っている．2022年，23年には，ロチェスター大学医学部が行っているロールプレイ体験実習「Deaf Strong Hospital」に着想を得て，「手話の病院」を実施した．それに伴い，手話言語やろう文化を知る機会を設けている．医療へのアクセスを阻害するSDHを見出すのみならず，それまで気づかなかった内在する思い込みや偏見に学習者が気づく，変容的学修となっている．
キーワード：ろう・難聴者，健康の社会的決定要因（SDH），体験学習，変容的学修

Yuko Takeda*1　Yutaka Osugi*2

Abstract:
At Juntendo University, we offer an elective program for third-year medical students to explore social determinants of health (SDH). Among the topics is ensuring healthcare access for deaf and hard-of-hearing patients. We have implemented role-playing in outpatient clinic scenarios to simulate language barriers. In these role-plays, individuals who are deaf or hard of hearing and use sign language take on the role of healthcare professional, while the students assume the role of patient. This original program was developed by the University of Rochester School of Medicine and Dentistry. Through participation in the program, students learn sign language and deaf culture while having a transformative learning experience that helps them recognize unconscious biases within themselves.
Keywords:  deaf and hard-of-hearing people, social determinants of health (SDH), experiential learning, transformative learning

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*1 順天堂大学大学院医学研究科医学教育学，Department of Medical Education, Juntendo University Graduate School of Medicine
*2 筑波技術大学，Tsukuba University of Technology

海藤 俊行*

要旨：
鳥取大学医学部ではカリキュラムの改変を機に，2008年度から医学科学生に教養科目として手話言語教育を実施している．必修科目の基礎手話言語では，コミュニケーションの基本となる手話表現とともに，聴覚障害者が社会で直面する課題と必要な配慮について学修する．選択科目の医療手話言語では，医療現場のコミュニケーションに必要な手話表現とともに，聴覚障害者が病院で直面している課題と必要な配慮について学修する．このような取り組みの結果，本医学部から手話言語教育を受けた多くの医師が輩出されており，聴覚障害者が安心して受診できる医療の提供に貢献している．今後は，全国の医学部に手話言語教育が広がっていくことが望まれる．
キーワード：基礎手話言語，医療手話言語，コミュニケーション，聴覚障害者，ろう者

Toshiyuki Kaidoh*

Abstract:
The Faculty of Medicine at Tottori University has integrated sign language education into its curriculum since 2008, taking advantage of opportunities arising from curriculum revisions. Through the mandatory course titled “Basic Sign Language,” medical students acquire essential sign language expressions and develop an understanding of the challenges that people with hearing impairments face in society, as well as the necessary accommodations required. In the advanced elective course “Medical Sign Language,” students are taught sign language expressions that are vital for effective communication in medical settings. They also gain insights into the specific difficulties experienced by individuals with hearing impairments in healthcare environments and learn about the appropriate accommodations needed. Owing to these educational efforts, the medical school has produced a number of physicians trained in sign language, enhancing the accessibility and safety of medical services for the hearing impaired. The hope is that sign language education will be adopted by medical schools across the nation moving forward.
Keywords: basic sign language, medical sign language, communication, hearing impairment, deaf individuals.

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*鳥取大学医学部解剖学講座，Department of Anatomy, Faculty of Medicine, Tottori University

武田 裕子*1　皆川 愛*2　吉田 将明*3　大杉 豊*3

要旨：
本報告書は，米国ニューヨーク州ロチェスター市におけるろう・難聴学生向けの包括的教育，医療サービスと研究の先進的取り組みに焦点を当てている．特にロチェスター工科大学（RIT）及びその内部機関である国立ろう工科大学（NTID），そしてロチェスター大学（UR）で展開されている教育プログラムは，ろう・難聴者が健康科学，医療分野で専門職として活躍するための教育とキャリア支援を提供している．
これらの教育機関は，ろう・難聴者が専門知識を活かし，医療現場や科学研究の場でリーダーとして機能するための環境を整えており，彼らのニーズに積極的に応えている．また，ロチェスター大学附属病院は，ろう・難聴者の医療従事者が臨床現場で活躍できるよう，医療現場に充実した通訳支援システムを備えている．このような組織間の連携とインクルーシブな取り組みは，ろう・難聴者が社会の一員として完全に機能し，専門職としてのキャリアを築くための重要なモデルなっている．
キーワード：ろう・難聴者，高等教育，医療者教育

Yuko Takeda*1　Ai Minakawa*2　Masaaki Yoshida*3　Yutaka Osugi*3

Abstract:
This article focuses on inclusive education for deaf and hard-of-hearing students in Rochester, New York, which prepares them to become healthcare professionals or researchers in health science fields. We highlight the unique programs for deaf and hard-of-hearing students to develop their careers at the Rochester Institute of Technology (RIT), the National Technical Institute for the Deaf (NTID), and the University of Rochester (UR). These universities also foster an inclusive work environment that caters to the needs of deaf and hard-of-hearing clinical professionals and faculty specialized in health research, enabling them to play leadership roles in their fields. Notably, Strong Memorial Hospital at UR supports deaf staff by providing interpreter services, allowing them to actively engage in their clinical work as professionals. Such seamless support, spanning from higher education to professional careers in Rochester, demonstrates a compelling model for enabling deaf and hard-of-hearing individuals to pursue and thrive in their chosen professions.
Keywords: the deaf and hard of hearing, higher education, healthcare professionals

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*1 順天堂大学大学院医学研究科医学教育学，Department of Medical Education, Juntendo University Graduate School of Medicine
*2 ギャローデット大学ろう難聴児レジリエンスセンター，Deaf and Hard of Hearing Child Resilience Center, Gallaudet University
*3 筑波技術大学，Tsukuba University of Technology

関口 麻理子*1, 2

要旨：
欠格条項の改正後，聴覚障害をもつ保健医療従事者は増加しており，様々な分野で活躍しているが，その総数は明らかでない．就労環境は充分整備されているとは言い難く，個々の努力や職場ごとの試行錯誤で成り立っているのが現状である．保健医療資格を目指す高等教育機関への入学者はまだ少数派であり，教員や指導者も聴覚障害者と協働した経験が少なく，理解が進んでいない．卒業後も研修やキャリアアップの課題がある．多様性を考慮した医療サービスの提供のためにも聴覚障害をもつ保健医療従事者がいることの意義があり，情報保障やコミュニケーションに配慮した，よりよい就労環境の構築のための情報共有や支援制度の整備が求められている．
キーワード：聴覚障害，欠格条項，情報保障，合理的配慮，保健医療従事者

Mariko Sekiguchi*1, 2

Abstract:
Following the amendment of the Exclusionary Clause, there has been an increase in the number of healthcare professionals with hearing impairments actively contributing in various fields, although the total count remains unclear. Drawing from experiences and inquiries received by the Japan Network of Deaf and Hard of Hearing Medical Professionals, this paper examines the current status and challenges faced by these individuals. The work environment for healthcare professionals with hearing impairments is not adequately established, largely relying on individual efforts and trial and error within workplaces. The enrollment of individuals with hearing impairments in higher education institutions aiming for healthcare qualifications remains limited, with educators and mentors often having limited experience in collaborating with individuals with hearing impairments, indicating a lack of understanding. Barriers to training and career advancement persist even after graduation from higher education institutions.
The presence of hearing-impaired healthcare workers is significant to provide medical services to a diverse population. There is a need for the use of text and sign language interpreters, as well as the development of information sharing and support systems, to create a better working environment that accounts for communication needs.
Keywords: hearing impairments, exclusionary clause, development of information, reasonable accommodation, healthcare professionals

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*1 社会医療法人社団千葉県勤労者医療協会船橋二和病院リハビリテーション科，Funabashi-futawa Hospital
*2 聴覚障害をもつ医療従事者の会，Japan Network of Deaf and Hard of Hearing Medical Professionals

岡部 正隆*

要旨：
先天色覚異常は，男女40人に1人という高い頻度で存在する感覚の多様性の一つである．その特徴は，外見ではわからず，配慮を必要とする人が配慮を求めないことであり，色分けや色名で伝える情報や指示が，姿の見えない当事者に正確に伝わっていない可能性を考える必要がある．多様な色覚への対応は，単に色覚異常を持つ医学生への教育上の配慮に留まらず，すべての医療者にとって，医療チーム内，医師患者間の日常的なコミュニケーションの中でも必要である．また，人々の健康を守る医師になる者にとって，色覚異常に対するかつての優生学的な社会的対応を振り返ることは，多様性を認め合う社会において遺伝子差別をどう防ぐかを考える機会を与える．
キーワード：先天色覚異常，カラーユニバーサルデザイン

Masataka Okabe*

Abstract:
Congenital color vision deficiency (CVD) is a form of sensory diversity found in as many as one in 40 people, regardless of gender. A key characteristic of CVD is that it is not externally apparent, and those who require consideration often do not request it. Therefore, it is necessary to be aware that information and instructions conveyed through color coding and color names may not be accurately received by those affected. Addressing diverse color vision needs is not only an educational consideration for medical students with color blindness but is also essential for all medical personnel in their daily communication within the medical team and between physicians and patients. Moreover, for those aspiring to become physicians and protect people’s health, reflecting on the historical eugenic social response to CVD provides an opportunity to consider how to prevent genetic discrimination in a society that values diversity.
Keywords: congenital color vision deficiency，color universal design，CUD

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*東京慈恵会医科大学解剖学講座，Department of Anatomy, The Jikei University School of Medicine

殿岡 翼（肢体障害，脳性まひ）*，殿岡 栄子（視覚障害，全盲）*

要旨：
近年，全国障害学生支援センターに寄せられる相談や大学対象の調査結果から，医療系学部における入試やカリキュラムの構造，教職員の態度・文化において課題があることがあることが示されてきた．医療系大学の関係者は「障害の社会モデル」を理解し，障害のある医療者と共に社会的障壁を同定し、除去していくことが急務である．
キーワード：医療，合理的配慮，障害学生，受験，障害の社会モデル

Tsubasa Tonooka*，Eiko Tonooka*

Abstract:
In recent years, consultations with the Nationwide Support Center for Students with Disabilities and survey results from university cohorts have revealed occasional issues with admissions, curriculum structures, and the attitudes and culture of faculty and staff within medical faculties. It is imperative for those involved in medical education to understand the ‘social model of disability’ and collaborate with medical professionals who have disabilities to identify and eliminate social barriers.
Keywords: medical care, reasonable accommodation, students with disabilities, examinations, social model of disability

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*一般社団法人全国障害学生支援センター，Nationwide Support Center for Students with Disabilities

藤田 博一*1　野田 泰子*2　荒関 かやの*3　石原 慎*4　岡田 隆夫*5
清水 郁夫*6　清水 貴子*7　原田 芳巳*8　山内 かづ代*9　瀬戸山 陽子*10

要旨：
医学生共用試験は，臨床実習前に行われるCBT（Computer Based Testing）と臨床実習の前後で行われるOSCE（Objective Structured Clinical Examination ）があるが，2023年度から臨床実習前の医学生共用試験が公的化されたことを契機に，共用試験実施評価機構内に合理的配慮支援委員会が設置され，各試験の合理的配慮が検討されている．合理的配慮は，まず受験者の申請から始まり，受験者と大学との建設的な対話によって検討が進められる．また，実習を行っている様子を録画したものを提供していただき，できる限り客観的な根拠をもとに検討を行い，受験者が診療参加型臨床実習や臨床研修の場面を想定した合理的配慮を提供し，円滑な試験実施を進めていきたい．
キーワード：医学生共用試験, CBT, OSCE, 合理的配

Hirokazu Fujita*1　Yasuko Noda*2　Kayano Araseki*3　Shin Ishihara*4
Takao Okada*5　Ikuo Shimizu*6　Takako Shimizu*7　Yoshimi Harada*8
Kaduyo Yamauchi*9　Yoko Setoyama*10

Abstract:
The Common Achievement Tests for medical students consists of Computer Based Testing （CBT） conducted before clinical training, and Objective Structured Clinical Examination （OSCE） conducted before and after clinical training. Since the publicization of the Common Achievement Tests for medical students before clinical training in 2023, the Committee for Reasonable Accommodation has been established within the Common Achievement Tests Organization （CATO）, where reasonable accommodations for each exam are being considered. Reasonable accommodations begin with an assessment based on requests from candidates and proceed through constructive dialogue between candidates and universities. Additionally, recordings of practical training sessions are provided to facilitate objective assessments, enabling the provision of reasonable accommodations tailored to candidates’ participation in clinical training and internships, thereby ensuring smooth examination processes.
Keywords: common achievement tests, Computer Based Testing （CBT）, Objective Structured Clinical Examination （OSCE）, reasonable accommodations

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*1 高知大学医学部附属医学教育創造センター，
Center for Medical Education Development, Kochi Medical School, Kochi University
*2 自治医科大学医学部解剖学，Department of Anatomy, School of Medicine, Jichi Medical University
*3 埼玉医科大学医学教育学，Department of Medical Education, Faculty of Medicine, Saitama Medical University
*4 藤田医科大学臨床医学総論，Department of Introduction of Clinical Medicine, Fujita Health University
*5 順天堂大学医学部医学教育研究室，Department of Medical Education, Juntendo University Faculty of Medicine
*6 千葉大学大学院医学研究院医学教育学，Department of Medical Education, Chiba University Graduate School of Medicine
*7 聖隷福祉事業団，Seirei Social Welfare Community
*8 東京医科大学医学部医学科医学教育学分野，Department of Medical Education, Tokyo Medical University
*9 千葉大学大学院医学研究院地域医療教育学，Department of Community-Oriented Medical Education, Graduate School of Medicine, Chiba University
*10 東京医科大学教育IRセンター，Institutional Research Center, Tokyo Medical Universit

熊谷 晋一郎*

要旨：
社会の多様性と包摂をもとめるマイノリティ運動は，個人の変化ではなく社会環境の変革によって障害者の不利益をなくし，公正な社会を目指す，障害の社会モデルへのパラダイムシフトを引き起こした．この新しいパラダイムの下で，医療や医学は，障害などの少数派性をもつ医療ユーザーや同僚を包摂すべく，その物理的環境や人的・文化的環境を変革していく必要がある．特に，障害のある人々の健康格差を是正し，誰一人取り残さない医療を実現するために，医療者の中に障害などの少数派性をもつ人々が同僚として参加できる環境を整えることが不可欠である．
キーワード：障害の社会モデル，健康格差，医師-患者コンコーダンス効果，多様性と包摂

Shin-ichiro Kumagaya*

Abstract:
The movement for social diversity and inclusion has triggered a paradigm shift toward a social model of disability that aims to eliminate disadvantages for people with disabilities and achieve a just society through changes in the social environment rather than individual change. Under this new paradigm, medicine and medical science need to transform their physical, human, and cultural environments to be inclusive of users and colleagues with disabilities and other minority characteristics. In particular, it is essential to create an environment in which people with disabilities and other minorities can participate as colleagues in the medical profession to reduce health disparities among people with disabilities and to achieve medical care in which no one is left behind.
Keywords: social model of disabilities, health disparities, physician-patient concordance effect, diversity and inclusion

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*東京大学先端科学技術研究センター，Research Center for Advanced Science and Technology, the University of Tokyo

大塚 智子*1　武内 世生*2　関 安孝*3　瀬尾 宏美*2

要旨：
背景：高知大学医学部医学科AO入試は知識だけでなく対人関係の能力やプレゼンテーション能力に優れる人物の選抜を目的とする．入試でグループワークやプレゼンテーション評価を経て入学した学生は，卒業後に至っても持続的に対人関係の能力やプレゼンテーション能力を維持するか検討した．
方法：対人関係の能力やプレゼンテーション能力に関する臨床研修指導医による評価を，AO入試入学者とその他の選抜入学者間で比較した． 結果：患者－医師関係，チーム医療，症例呈示において，AO入試入学者がその他の選抜入学者より有意に優れていた．
考察：高知大学医学部医学科AO入試は，対人関係の能力やプレゼンテーション能力を評価する選抜として有用だと考えられる．
キーワード：入学者選抜方法，卒後追跡調査，対人関係の能力，プレゼンテーション能力，医療人として必要な基本姿勢・態度

Tomoko Otsuka*1　Seisho Takeuchi*2　Yasutaka Seki*3　Hiromi Seo*2

Abstract:
Background: The AO entrance examination for the Medical Course at Kochi Medical School aims to select candidates who are not only knowledgeable but also exhibit strong interpersonal and presentation skills. This study sought to determine the impact of the AO exam’s group work and presentation components on students’ success post-graduation.
Methods: Clinical training supervisors’ evaluations of interpersonal and presentation abilities were compared between AO entrance exam candidates and other selected candidates. Results: AO entrants showed superior performance in establishing patient-physician relationships, participating in team medicine, and delivering case presentations compared to their counterparts.
Discussion: The AO entrance examination at Kochi Medical School proves to be an effective tool for assessing candidates’ interpersonal and presentation skills, which are essential for medical practitioners.
Keywords: selection methodology, postgraduate outcomes, interpersonal engagement, presentation competencies, fundamental dispositions and attitudes for medical professionals.

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*1 高知大学学び創造センター教育企画部門アドミッションユニット，Admission Unit, The Section for Educational Planning and Research, Center for Creative Learning Development, Kochi University
*2 高知大学医学部附属病院総合診療部，Department of General Medicine, Kochi Medical School Hospital
*3 高知大学医学部医学教育IR室，IR Center in Medical Education, Kochi Medical School

Hideaki Watanabe*1　Hirokazu Inoue*2　Yuki Iijima*2 Shinya Hayasaka*3　Katsushi Takeshita*2

Abstract Objective:
This retrospective study was conducted to investigate whether medical students have ever bandaged patients' limbs, whether they feel confident in their ability to bandage, and whether their bandaging skills are adequate.
Methods: The study included consecutive fifth-year medical students who had not been taught bandaging knowledge and skills. In total, 232 students (163 men, 69 women) participated in the study. Prior to the practical session, the students' experiences and confidence in bandaging were assessed. During the practical, an evaluator assessed the students' bandaging skills, determining the correct application of bandages and assigned a numerical score. Correlations were analyzed using the Chi-square test. Results: Of the medical students in this study, 60% had not bandaged a limb by their fifth year, and 91% lacked confidence in their bandaging ability. Only 32% of students could correctly apply a bandage with a perfect score. No significant relationships were identified between experience and bandaging skill (P = 0.64) or confidence and bandaging skill (P = 0.36).
Conclusions: Bandages must be applied perfectly to prevent loosening and contamination of the wound. Nevertheless, most medical students had not bandaged a limb, lacked confidence in their bandaging abilities, and were unable to correctly apply a bandage. It is imperative that medical educators teach bandaging skills to medical students and provide ample opportunities for practice.
Keywords: bandage, bandaging technique, medical student

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*1 Department of Pediatric Orthopedics and Orthopedic Surgery, Jichi Children’s Medical Center, Tochigi, Japan
*2 Department of Orthopedic Surgery, Jichi Medical University, Tochigi, Japan
*3 Faculty of Human Life Sciences, Tokyo City University, Tokyo, Japan