研究者詳細 - 錦織　宏

臨床研修の充実化による地域の医師確保モデルの提唱（その2）

錦織宏, 鈴木富雄

医学教育 40 巻 ( 1 ) 頁： 27 - 33 2009年

記述言語：日本語出版者・発行元：日本医学教育学会

新臨床研修制度下において，地域の医師不足問題が深刻化している．その解決のための一案として，本研究では，地方都市の郊外にある海南病院における臨床研修カリキュラム改変に対する評価を行って，それを基に臨床研修の充実化による医師確保モデルを提唱する．本稿では前稿に加えてさらに中期的なカリキュラム評価を行い，上記モデルの提示を行った． 1) カリキュラム評価のため研修責任者を対象に行ったインタビュー調査の結果，臨床研修の充実化に必要な8個の項目が明らかになった． 2) 臨床研修の充実化によって初期研修医が増加した後，後期研修の質を保証することで初期研修修了者が残留し，それが医師確保に繋がる． 3) また初期・後期の研修医が多い病院は大学の関心を呼ぶため，指導医を派遣してもらうことがより容易になり，これも医師確保に繋がる． 4) 臨床研修の充実化による医師確保の一定の成果が出るまでは最低約3～5年の期間が必要であるが，医学部の定員増の結果を待つよりは即効性がある．

DOI： 10.11307/mededjapan.40.27

臨床研修の充実化による地域の医師確保モデルの提唱（その1）

錦織宏, 鈴木富雄, 三島信彦, 山本直人

医学教育 40 巻 ( 1 ) 頁： 19 - 25 2009年

記述言語：日本語出版者・発行元：日本医学教育学会

新臨床研修制度下において，地域の医師不足問題が深刻化している．その解決のための一案として，本研究では，地方都市の郊外にある海南病院における臨床研修カリキュラム改変に対する評価を行って，それを基に臨床研修の充実化による医師確保モデルを提唱する．本稿ではまずアクションリサーチの形で短期的なカリキュラム評価を行った． 1) カリキュラム改変では，屋根瓦方式の診療チーム体制をとり，研修医がより主体的に診療に参加できるシステムを整備した．また教育回診やカンファランスを積極的に導入した． 2) 研修医を対象に行ったカリキュラム評価の結果「研修医に対する教育の機会の保証」や「臨床研修の充実化という病院の明確な方向性」などが臨床研修の充実化に必要な点としてあげられた． 3）カリキュラム改変後，海南病院の研修医数は増加した．臨床研修の充実化は一定の成果を収めたと考えられた． 4) 開業医に臨床研修に参加してもらって研修医に教育の機会を保証する方法は，より一般化可能性の高い教育資源確保の手法と考えられた．

DOI： 10.11307/mededjapan.40.19

序　章

鈴木康之, 吉岡俊正, 吉田素文, 田川まさみ, 錦織宏, 西城卓也, 守屋利佳, 大谷尚, 渡邊洋子

医学教育 40 巻 ( 4 ) 頁： 235 - 236 2009年

記述言語：日本語出版者・発行元：日本医学教育学会

1) 日本医学教育学会では医学・医療教育専門家の系統的な教育システムを検討することを目的として，アドホックのマスターコース検討委員会を設置し，委員相互の意見交換，ニーズ調査，海外のマスターコースの情報収集，公開委員会での議論に基づき方向性を検討した． 2) 今後の医学・医療教育の発展のためには，(1)医学教育学の深い素養を身につけた専門家を育成する大学院教育と，(2)実践的な教育スキルを身につけた医療教育者を幅広く育成する認定制度を構築することが必要と考えられる．

DOI： 10.11307/mededjapan.40.235

A mixed-methods study comparing human-led and ChatGPT-driven qualitative analysis in medical education research

米国医科大学協会総会 (AAMC) in Seattle, USA参加報告

青松棟吉, 錦織宏, 大滝純司, 伴信太郎

医学教育 38 巻 ( 2 ) 頁： 119 2007年4月

What's your diagnosis? [33] こんな結果でええんか?

菊川誠, 小島啓尚, 傍島由香, 飯島亜由子, 錦織宏, 鈴木富雄, 伴信太郎

JIM 15 巻 ( 9 ) 頁： 715 - 718 2005年9月

What's your diagnosis? [28] はれのちはれ

錦織宏, 小島啓尚, 鈴木富雄, 伴信太郎

JIM 15 巻 ( 4 ) 頁： 275 - 277 2005年4月

第2回アジア太平洋医学教育会議に出席して

錦織宏, 吉田一郎

医学教育 36 巻 ( 1 ) 頁： 44 2005年2月

Kondo, T; Miyachi, J; Jönsson, A; Nishigori, H

NAGOYA JOURNAL OF MEDICAL SCIENCE 86 巻 ( 4 ) 頁： 620 - 644 2024年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Nagoya Journal of Medical Science

Qualitative research, used to analyse non-numerical data including interview texts, is crucial in understanding medical education processes. However, it is often complex and time-consuming, leading to an interest in technology for streamlining the analysis. This study investigated the applicability of ChatGPT, a large language model, in thematic analysis for medical qualitative research. Previous research has used ChatGPT to explore the deductive process as a qualitative study. This study evaluated thematic analysis including the inductive process by ChatGPT with reference to human qualitative analysis. A convergent design mixed-methods study was used. Using a thematic analysis approach, ChatGPT (model: GPT-4) analysed some interview data from a previously published medical research article. The assessors evaluated the qualitative analysis of ChatGPT using human qualitative analysis as a benchmark. Three assessors compared the human-conducted and ChatGPT-driven qualitative analyses. ChatGPT scored higher in most aspects but showed variable transferability and mixed depth scores. In the integrated analysis including qualitative data, six themes were identified: superficial similarity of results with human analysis, good first impression, explicit association with data and process, contamination by directions in prompts, deficiency of thick descriptions based on context and research questions, and lack of theoretical derivation. ChatGPT excels at extracting key data points and summarising information; however, it is prone to prompt contamination, which necessitates careful scrutiny. To achieve deeper analysis, it is essential to supplement the research context with human input and explore the theoretical framework.

DOI： 10.18999/nagjms.86.4.620

Implementing digital transformation in the revision process for Japan's Model Core Curriculum: A qualitative document analysis

To teach is to learn twice, revisited: a qualitative study of how residents learn through teaching in clinical environments 査読有り Open Access

Kondo, T; Takahashi, N; Aomatsu, M; Nishigori, H

BMC MEDICAL EDUCATION 24 巻 ( 1 ) 頁： 829 2024年8月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：BMC Medical Education

Background: Teaching helps the teacher’s own learning as a professional—as the saying goes, ‘to teach is to learn twice’. Near-peer teaching in clinical practice has been shown to contribute to the development of both teaching skills and necessary competencies for doctors. Research on how near-peer teachers learn through their teaching roles has mainly focused on classroom learning. However, understanding how the phenomenon of ‘teaching is learning twice’ occurs in clinical settings and its influencing factors is important for the development of a quality workplace learning environment. Therefore, this study investigated how residents learn through teaching in clinical practice and the factors influencing this process. Methods: This study’s methodology is based on the constructivist grounded theory from a social constructivist perspective. Several teaching hospitals in Japan were included, and the study participants were post-graduate year 2 residents (PGY2s) from these hospitals. The interviews were recorded, transcribed into text, and analysed by the first author. Results: From January 2016 to July 2022, 13 interviews were conducted with 11 PGY2s from nine educational hospitals. The PGY2s played diverse educational roles in clinical settings and learned competencies as physicians in almost all areas through such roles. We found that knowledge transfer and serving as role models stimulated PGY2s’ intrinsic motivation, encouraged reflection on their own experiences, and promoted self-regulated learning. Further, educating about procedural skills and clinical reasoning prompted reflection on their own procedural skills and thought processes. Supporting post-graduate year 1 residents’ reflections led to the refinement of PGY2s’ knowledge and thought processes through the verbal expression of their learning experiences. Such processes required the formation of a community of practice. Thus, education promoted learning through reflection and clarified the expert images of themselves that PGY2s envisaged. Conclusions: The study found that residents acquire various physician competencies through multiple processes by teaching as near-peer teachers in clinical settings, that a community of practice must be formed for near-peer teaching to occur in a clinical setting, and that teaching brings learning to those who teach by promoting reflection and helping them envision the professionals they aim to be.

DOI： 10.1186/s12909-024-05814-3

その他リンク： https://link.springer.com/article/10.1186/s12909-024-05814-3/fulltext.html

教育実践報告フィードバックリテラシー涵養を目指した医学生授業の試み

木村武司, 錦織宏

医学教育 55 巻 ( Suppl. ) 頁： 311 - 311 2024年7月

令和4年度改訂コアカリ導入に向けたニーズ調査結果とそれに応える資材の紹介令和4年度改訂版医学教育モデル・コア・カリキュラムの普及事業を通じて見えてきた今後の課題

松島加代子, 淺田義和, 高桑修, 長谷川仁志, 松山泰, 三浦聖子, 高橋誠, 錦織宏

医学教育 55 巻 ( Suppl. ) 頁： 139 - 139 2024年7月

Kondo, T; Onoue, T; Kou, S; Asada, Y; Isobe, M; Nishigori, H

MEDICAL TEACHER 46 巻 ( sup1 ) 頁： S53 - S60 2024年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Medical Teacher

Purpose: Digital transformation (DT) is significantly impacting medical education. Despite advancements such as virtual reality and remote education, the influence of DT on the development of curricula and guidelines has not been thoroughly explored. This study aims to explore the enabling factors and impacts of DT on the revision process for Japan’s Model Core Curriculum (MCC) in 2022. Materials and methods: Taking a constructivist perspective, this study investigated the enabling factors and impacts of DT through qualitative document analysis. Thematic analysis was conducted on materials including emails from the MCC revision team, meeting minutes, and survey responses. Results: Enabling factors were experimentation spaces for users, deep integration between revision and digitalization teams, continuous development, and coordination with existing methods. The impacts of DT included ensuring accuracy and consistency, gaining the ability to preview and aggregate data, and expediting and reducing workload. Conclusion: DT not only streamlined the revision process but also improved the quality of the guidelines and changed the nature of the MCC into an interactive infrastructure. The involvement of personnel with expertise bridging IT and medical education, combined with an environment conducive to user acceptance and opportunities for practice, were crucial for successful DT.

DOI： 10.1080/0142159X.2024.2385196

Development of a competency-based national model core curriculum in Japan: A case study

Urushibara-Miyachi, Y; Matsushita, K; Nishigori, H

MEDICAL TEACHER 46 巻 ( sup1 ) 頁： S11 - S20 2024年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Medical Teacher

Purpose: The 2022 revision of the Model Core Curriculum (MCC) for Japanese undergraduate medical education aimed to develop a stratified, national-level competency framework. This paper aims to explore what innovations emerge during the process of competency-based medical education (CBME) glocalisation, driven by the interplay between global and local language and the dynamics among multiple stakeholders. Methods: This is an explanatory, retrospective, single-case study with a mixed-methods approach, combining document review and participant reflections. Meeting minutes, documents, email exchanges and data from the Delphi rounds (ratings, free-text comments and panellist demographics) were analysed to identify the influence of stakeholder interactions and external contexts when deliberating competency frameworks and their hierarchical structure. Results: The development of a shared language of imported educational concepts required the critical reframing of terminology rather than direct translation. This process involved the interweaving of expressions rooted in the local educational context and highlighted the importance of developing a unique structure that embodies the CBME philosophy through the educational language generated. Conclusions: The localisation of global educational trends into a country’s own context may reveal the universality of imported educational concepts, provided that the process is underpinned by discussions with a robust, grounded rationale.

DOI： 10.1080/0142159X.2024.2388906

Fujikawa, H; Ando, T; Endo, A; Kaneko, M; Shikino, K; Nagamine, Y; Nakayama, T; Nishigori, H; Yamanashi, H; Haruta, J

MEDICAL TEACHER 46 巻 ( sup1 ) 頁： S21 - S30 2024年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Medical Teacher

Objective: To identify generalism-related competencies that medical students in Japan should acquire in order to provide comprehensive care for patients. Methods: The team responsible for developing the new ‘Generalism’ section of the 2022 revision of the Model Core Curriculum for Medical Education in Japan (MCC) consisted of nine members from diverse medical backgrounds across Japan. We adopted pragmatism paradigm and analyzed to identify decision-making processes using a qualitative document analysis. Results: The competency list was presented as a four-tier structure. The first tier of generalism was defined as ‘take a multi-systemic view of the patient’s problems and consider the patient’s psychosocial background in order to provide comprehensive, flexible medical care that responds to the needs of the patient and is not limited to one’s own specialty, supporting the achievement of individual and societal well-being.’ The second tier was framed in terms of ‘perspectives’ and constructed of four different domains: ‘holistic,’ ‘community,’ ‘life,’ and ‘social.’ Conclusion: We identified and defined the competencies required by medical students in Japan to provide comprehensive care for patients. By including these competencies in the MCC, undergraduate medical education will be better placed to respond to anticipated changes in the demand for medical care in Japan. Success factors in our guideline development process include facilitating a collaborative and iterative development process, ensuring that diverse perspectives are integrated, and using practical examples and feedback to refine competencies based on a pragmatic approach.

DOI： 10.1080/0142159X.2024.2385133