学会誌

近藤 諭*1，2　武島 健人*1　木戸 敏喜*1　高村 昭輝*1，2

要旨：
Longitudinal Integrated Clerkship（LIC）は，長期間患者への包括的ケアに従事し，継続的学習関係を担当医師と構築し，診療科横断的な統合的臨床能力を得る教育手法である．医学生は地域の病院・診療所で継続的に診療・地域活動に従事し学ぶ．現在の医療ニーズに対応するため，継続性と包括性を持つLICが世界の医学部で導入されている．
本稿では，LICの効果，導入と発展について検討し概説する．LICは，医学生の臨床能力向上や地域定着に加え，ケアへの責任感・倫理観向上などのプロフェッショナリズムを向上させる．LICの導入には，これまで専門診療科を短期間グループで研修してきた日本の文脈に応じた学習環境整備，医学生・地域の指導医・多職種・住民への説明が必要不可欠である．LICの発展には，医学教育学の理論に基づく振り返り支援を通じて，医学生に深い省察をもたらすことが重要である．
キーワード：卒前医学教育，長期間統合型臨床実習，地域基盤型医学教育，プロフェッショナリズム，総合的に患者・生活者をみる姿勢

Satoshi Kondo*1，2　Kento Takeshima*1　Toshiki Kido*1　Akiteru Takamura*1，2

Abstract:
Longitudinal Integrated Clerkship (LIC) is an educational approach in medical education that enables medical students to engage continuously in comprehensive patient care. LIC also allows medical students to establish ongoing learning relationships with attending physicians and to acquire integrated clinical competencies with a cross-disciplinary scope. In LIC, medical students participate in continuous medical practice and community activities at local hospitals and clinics. With its emphasis on continuity and comprehensiveness, LIC has been gradually introduced in medical schools worldwide to address current medical needs. In this article, we employed a narrative review to summarize the effects, implementation, and development of LIC. LIC enhances medical students’ clinical skills and regional retention, as well as their professionalism, including responsibility and ethical conduct in patient care. Implementing LIC requires the preparation of learning environments adapted to the Japanese context, along with clear explanations provided to medical students, local supervising physicians, healthcare professionals, and community members. The development of LIC also requires facilitating deeper reflection among students by providing feedback grounded in medical education theory.
Keywords: undergraduate medical education, longitudinal integrated clerkship, community-based medical education, professionalism, generalism

---

*1 富山大学学術研究部医学系医学教育学講座，Department of Medical Education, Graduate School of Medicine, University of Toyama
*2 富山大学学術研究部医学系医師キャリアパス創造センター，Center for Medical Education and Career Development, University of Toyama

生野 真嗣*

要旨：
本研究は，ナラティブ教材を取り入れた授業について，その教育的効果を学生の自由記述から探索的に分析したものである．共起ネットワーク分析の結果，「患者」を中心に「自分」「家族」「告知」「思い」「認知」などの語が語りの種類に応じて異なる構造で連関しており，個別の語りが多角的に解釈されている様子が読み取れた．特に「この」と「患者」の語の共起は，語り手を一個人として捉えつつ，他の患者像を想起しながら解釈する姿勢の表れと考えられた．これらの結果は，n=1の語りがグループワークを通じて相対化・一般化され，医学生の共感的理解の涵養に寄与している可能性を示唆する．
キーワード：ナラティブ，病いの語り，患者の語り，共感性，医学教育，臨床実習準備教育

Masashi Ikuno*

Abstract:
This study explored the educational impact of using narrative-based teaching materials by analyzing medical students’ reflective writings. Co-occurrence network analysis revealed that words such as “self,” “family,” “disclosure,” “feelings,” and “cognition” were structurally linked to the central node “patient,” with the configuration varying depending on the type of narrative. In particular, the frequent co-occurrence of “this” and “patient” suggested that students perceived the narrator as an individual while also interpreting the narrative in relation to other potential patient experiences. These findings indicate that even a single patient narrative （n=1）, when embedded in group discussion, can be interpreted in a relativized and generalized manner, potentially fostering empathetic understanding among medical students.
Keywords: narrative, illness narrative, patient stories, empathy, medical education, preclinical education

---

*京都大学医学研究科医学教育・国際化推進センター，Center For Medical Education and Internationalization

濵田 千枝美*1，2　恒川 幸司*3　川上 ちひろ*4，5　今福 輪太郎*6　尾辻 健*2　西城 卓也*4，5

要旨：
背景・目的：4C/IDモデルは，内的動機づけの向上に寄与する可能性のある教育デザインとされている．しかしながら，医学生の学習動機づけに与える影響を量的に検討した研究はなされていない．そこで本研究では，4C/IDモデルを用いた救急科診療参加型臨床実習を実施し，医学生の学習動機づけの変化を実習前後で検討した．
方法：医学部5年生30名に対し，日本語版MSLQを用いて測定した．
結果：「内的目標志向」（p = 0.04， d =0.44）， 「学習価値」（p = 0.03 ，d =0.46）， 「学習や成績に対する自己効力感」（p = 0.001， d =0.83）で有意な向上が認められた．
考察：段階的な学習タスク習得と指導者からの支援調整が自己効力感等を向上させる要因となったと考えられる．
結語：4C/IDモデルを基盤としたSRLを駆動させる救急科実習は， 医学生の学習動機づけの向上に寄与した可能性があることが示唆された．
キーワード：4C/ ID,　自己決定理論,　自己効力感理論，　動機づけ， 診療参加型臨床実習

Chiemi Hamada*1，2　Koji Tsunekawa*3　Chihiro Kawakami*4，5
Rintaro Imafuku*6　Ken Otsuji*2　Takuya Saiki*4，5

Abstract:
Background and Objective:The Four-Component Instructional Design (4C/ID) model is considered an educational framework that can enhance intrinsic motivation. However, few quantitative studies have examined its effect on medical students’ learning motivation. This study aimed to investigate changes in motivation before and after a clinical clerkship in emergency medicine designed based on the 4C/ID model.
Methods:Thirty fifth-year medical students participated. Motivation was measured before and after the clerkship using the Japanese version of the Motivated Strategies for Learning Questionnaire (MSLQ).
Results:Statistically significant improvements were observed in intrinsic goal orientation (p = 0.04, d = 0.44), task value (p = 0.03, d = 0.46), and self-efficacy for learning and performance (p = 0.001, d = 0.83).
Discussion:The structured sequencing of learning tasks and the gradual fading of instructional support likely contributed to improvements in self-efficacy and other components of learning motivation.
Conclusion:An emergency medicine clerkship grounded in the 4C/ID model, and designed to activate self-regulated learning (SRL), may have contributed to the enhancement of medical students’ learning motivation.
Keywords: Four-component instructional design, self-determination theory, self-efficacy theory, motivation, clinical clerkship

---

*1 産業医科大学医学教育改革推進センター，Center for Medical Education, University of Occupational and Environmental Health
*2 産業医科大学病院救急・集中治療科，Department of Emergency and Intensive Care Medicine, Hospital of the University of Occupational and Environmental Health
*3 名古屋市立大学大学院医学研究科医学部医療人育成学寄附講座，Department of Medical Career and Professional Development, Nagoya City University Graduate School of Medical Sciences
*4 岐阜大学医学教育開発研究センター，Medical Education Development Center, Gifu University
*5 岐阜大学大学院医学系研究科医療者教育学専攻，Research Field of Health Professions Education, Graduate School of Medicine Gifu University
*6 名古屋市立大学大学院看護学研究科看護研究推進センター，Nursing Research Promotion Center, Graduate School of Nursing, Nagoya City University

平井 克城*1　伊藤 貴康*2　野村 理*3　久保田 伊代*1　浅野 茜*1
志水 貴之*1　上村 小雪*4　磯部 真倫*4　西城 卓也*3　牛越 博昭*1

要旨：
本研究では，XR（Extended Reality）を用いた臨床推論シミュレーションにおいて，ファシリテーションの形式の違いが学習者の感情に与える影響を検討した．2024年度岐阜大学医学部の4・5年生49名を対象に，指導歴18年の熟練教員による双方向型ファシリテーション群（A群）と，指導歴1年未満の教員による講義主体型ファシリテーション群（B群）を比較した．感情評価には日本語版Medical Emotion Scale（J-MES）を用いた．その結果，A群はB群と比較して，陽性活動的感情と陽性非活動的感情で有意に高スコアを示した（p＜0.01およびp＝0.01）．本研究では，XR教育の効果を最大化するにはファシリテーションの質が極めて重要であることが示唆された．
キーワード：XR，医学教育，シミュレーション，感情，ファシリテーション

Katsuki Hirai*1　Takayasu Ito*2　Osamu Nomura*3　Iyo Kubota*1
Akane Asano*1　Takayuki Shimizu*1　Koyuki Uemura*4　Masanori Isobe*4
Takuya Saiki*3　Hiroaki Ushikoshi*1

Abstract:
This study examined the impact of facilitation styles on learners’ emotions in clinical reasoning simulation using Extended Reality （XR）. Forty-nine fourth-and fifth-year medical students at Gifu University in 2024 participated in XR-based clinical reasoning scenarios using Hololens2 and Holopatient. Participants were divided into two groups： Group A （n=24）, led by an experienced instructor using interactive facilitation, and Group B （n=25）, facilitated by less experienced instructors using lecture-based methods. Learners’ emotions were assessed using the Japanese version of the Medical Emotion Scale （J-MES）, which categorizes emotions into four dimensions. Group A showed significantly higher scores in positive activating and positive deactivating emotions compared to Group B （p < 0.01 and p = 0.01, respectively）, while no significant differences were found in negative emotions. These findings suggest that the quality of facilitation plays a critical role in enhancing emotional engagement in XR-based medical education.
Keywords: XR, medical education, simulation, emotion, facilitation

---

*1 岐阜大学医学部附属地域医療医学センター，Gifu University School of Medicine Center for Regional Medicine，
*2 岐阜大学医学部附属病院医師育成推進センター，Gifu University Hospital Center for Clinical Training and Career Development
*3 岐阜大学医学教育開発研究センター，Gifu University Medical Education Development Center
*4 岐阜大学医学部附属病院産婦人科，Gifu University Hospital Department of Obstetrics and Gynecology

Ei Thinzar Khin*1　Yuko Takeda*1　Hirono Ishikawa*2
Midori Nii*3　Kazunari Iwata*4

イ ティンザ キン*1　武田 裕子*1　石川 ひろの*2　新居 みどり*3　岩田 一成*4

Abstract:
Background: “Plain Japanese”(やさしい日本語), which refers to Japanese that is easy to understand and adapted to the listener, has become a potential tool to bridge language barriers between healthcare providers and foreign residents in Japan. This study aimed to assess the impact of Plain Japanese training on healthcare professionals’ attitudes, focusing on their motivation to support and their anxiety when interacting with non-native Japanese-speaking patients.
Methods: A questionnaire survey was conducted before and after 27 face-to-face workshops in Tokyo. Out of 602 participants, 525 responses were collected(response rate: 87%). Among them, 286 medical professionals were included in this study. We used a mixed-methods approach: quantitative data were analyzed using the Wilcoxon signed-rank test and paired t-test, while qualitative data were examined through thematic analysis with inductive coding.
Results: The proportion of participants who responded “very willing to actively support foreign patients” increased from 148(52%)to 196(68%)(p < 0.0001), while those who answered “feeling very anxious when providing care to them” decreased from 123(43%)to 70(24%)(p < 0.0001). Thematic analysis revealed five themes:(1)a deeper understanding of language barriers;(2)recognizing the effectiveness of Japanese in communicating with foreign patients;(3)self-reflection on communication habits and areas for improvement;(4)recognition of cultural differences in communication; and(5)the impact of role-play and feedback with simulated foreign patients.
Conclusion: The training helped reduce the emotional distance between healthcare providers and patients. Follow-up studies are needed to assess how Plain Japanese is applied in practice and its effect on patient care.
Keywords: Plain Japanese, Yasashii Nihongo, cross-cultural communication, healthcare access, medical professional training

---

*1 Department of Medical Education, Graduate School of Medicine, Juntendo University, 順天堂大学大学院医学研究科医学教育学
*2 Graduate School of Public Health, Teikyo University, 帝京大学大学院公衆衛生学研究科
*3 NPO: Citizen’s Network for Global Activities. NPO法人国際活動市民中心
*4 Faculty of Liberal Arts, University of the Sacred Heart, Tokyo, Japan. 聖心女子大学現代教養学部

林 幹雄*1　野村 理*2　鋪野 紀好*3　清水 郁夫*4　水本 潤希*5，6　藤川 裕恭*7　菊川 誠*8

要旨：
医療者教育分野における世界的な学術的活動の隆盛に伴い，近年，同分野の国際誌の論文出版や国際学会の抄録採択が，より競争的になっている．我が国における医療者教育研究論文の出版数の伸び悩みを解消するため，これまでにも医学教育誌において学術的活動の意義が論じられ，日本医学教育学会研究推進委員会でも医療者教育研究支援を目的とした取り組みが実践されてきた．一方，医療者教育研究論文あるいは抄録の「執筆活動」に重点を置いた体系的な取り組みはない．論拠に基づいた医療者教育実践を促進するためには，教育実践と学術的活動が連動し相補的に向上するプロセスが定着する必要がある．そこで，日常の教育現場で実施された医療者教育の成果を学会発表としてまとめ，学術的に出版する学術的活動を支援することを目的として，MolleyとBermanが提唱する「知的素直さ」に着目し教育実践を行った．執筆論文や抄録に対する批評は，執筆者個人に対する批評と誤解されやすく，その批評が正確で役立つ可能性があったとしても，個人がそれを処理することは困難となる可能性に十分な配慮が必要と考えられる．
キーワード：医療者教育研究，論文出版，抄録採択，知的素直さ，フィードバック

Mikio Hayashi*1　Osamu Nomura*2　Kiyoshi Shikino*3　Ikuo Shimizu*4
Junki Mizumoto*5，6　Hirohisa Fujikawa*7　Makoto Kikukawa*8

Abstract:
Amid the global rise in academic productivity within medical education, competition for publishing in international journals and presenting at international conferences has become increasingly intense. In Japan, the stagnation in medical education research output has prompted national journals to underscore the importance of scholarly contributions. In response, the Education Research Committee of the Japanese Society for Medical Education has implemented initiatives to promote research in medical education. However, structured programs specifically aimed at developing skills for writing research manuscripts and conference abstracts remain lacking. To promote evidence-based healthcare education practices, we must establish a process that links and complements educational practices and academic activities to achieve mutual improvement. Therefore, we focused on the intellectual candor, conducting educational practices that support academic activities summarizing the results of healthcare education implemented in daily settings and submitting them in journals and academic conferences. Crucially, it addressed the psychological barriers often associated with receiving critical feedback—recognizing that even constructive comments are sometimes misinterpreted as personal criticism.
Keywords: research in medical education, manuscript publication, abstract acceptance, intellectual candor, feedback

---

*1 関西医科大学教育センター，Kansai Medical University, Center for Health Professions Education
*2 岐阜大学医学教育開発研究センター，Gifu University, Medical Education Development Center
*3 千葉大学大学院医学研究院地域医療教育学，Chiba University, Graduate School of Medicine, Department of Community-Oriented Medical Education
*4 千葉大学大学院医学研究院医学教育学，Chiba University Graduate School of Medicine, Department of Medical Education
*5 愛媛生協病院家庭医療科，Department of Family Practice, Ehime Seikyo Hospital
*6 慶應義塾大学総合診療教育センター，Center for General Medicine Education, School of Medicine, Keio University
*7 順天堂大学医学部総合診療科学講座，Juntendo University Faculty of Medicine, Department of General Medicine
*8 九州大学大学院医学研究院医学教育学講座，Kyushu University, Faculty of Medical Sciences, Department of Medical Education

宮地 純一郎*1，2

Junichiro Miyachi*1，2

---

*1 名古屋大学大学院医学系研究科総合医学教育センター，Center for Medical Education, Graduate School of Medicine, Nagoya University
*2 医療法人　北海道家庭医療学センター，Hokkaido Centre for Family Medicine