研究者詳細 - 錦織　宏

Association between daily breakfast habit during pregnancy and neurodevelopment in 3-year-old offspring: The Japan Environment and Children’s Study Open Access

Imaizumi K., Murata T., Isogami H., Fukuda T., Kyozuka H., Yasuda S., Yamaguchi A., Sato A., Ogata Y., Shinoki K., Hosoya M., Yasumura S., Hashimoto K., Fujimori K., Nishigori H., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Sobue T., Shima M., Nakamura H., Suganuma N., Kusuhara K., Katoh T.

Scientific Reports 14 巻 ( 1 ) 2024年12月

出版者・発行元：Scientific Reports

The association between daily breakfast habits during pregnancy and offspring neurodevelopment remains unknown. We evaluated the association between breakfast habits during pregnancy and offspring neurodevelopment. Data of 72,260 women with singleton deliveries at and after 37 weeks of gestation enrolled during 2011–2014 in the Japan Environment and Children’s Study were analysed. Offspring neurodevelopmental delays at 3 years of age were evaluated using the Ages and Stages Questionnaire, Third Edition (ASQ-3). Participants were stratified by tertiles of maternal daily energy intake (DEI) (Groups 1, 2, and 3:< 1400, 1400–1799, and ≥ 1800 kcal, respectively) during pregnancy and by offspring sex. The adjusted odds ratio (aOR) for abnormality in communication among participants with daily breakfast consumption habit was 0.87 (95% confidence interval, 0.80–0.96). A stratified analysis based on total DEI showed no significant differences in the neurodevelopment of Group 1 offspring. The aOR for abnormality in communication was 0.80 (95% confidence interval, 0.68–0.94) in Group 2. The aOR for abnormality in personal–social characteristics was 0.84 (95% confidence interval, 0.71–0.99) in Group 3. Maternal daily breakfast habits are associated with offspring neurodevelopment at 3 years of age, with the association influenced by maternal DEI and offspring sex.

DOI： 10.1038/s41598-024-55912-x

What can Japanese medical education contribute to the world?

Exploring yarigai: The meaning of working as a physician in teaching medical professionalism 査読有り Open Access

Nishigori, H; Shimazono, Y; Busari, J; Dornan, T

MEDICAL TEACHER 46 巻 ( 11 ) 頁： 1486 - 1493 2024年11月

記述言語：英語出版者・発行元：Medical Teacher

Introduction: The shift in medical professionalism now considers the well-being of physicians, given the prevalence of burnout and the importance of work-life balance. To reconsider the question ‘Why do doctors work for the patient?’ and explore the meaning of working as a physician, this study adopts the concept of ‘yarigai,’ which represents fulfillment and motivation in meaningful work. The authors’ research questions are: How do doctors recount experiences of yarigai in caring for patients? What kind of values are embodied in their stories about yarigai? Method: They adopted narrative inquiry as the methodology for this study. They interviewed 15 doctors who were recognized by their colleagues for their commitment to patient-centered care or had demonstrated yarigai in caring for patients. The semi-structured interviews were conducted face-to-face with each participant by the Japanese researchers, yielding 51 cases of patient-doctor interactions. After grouping the interview data, they translated the cases into English and identified four representative cases to present based on the set criteria. Results: From the 51 case studies, they constructed four representative narratives about the yarigai as a physician. Each of them spoke of (1) finding positive meaning in difficult situations, (2) receiving gifts embodying ikigai, (3) witnessing strength in a seemingly powerless human being, and (4) cultivating relationships that transcend temporal boundaries, as being rewarding in working as a physician. The main results of the study, which are the narratives, are described in the main body of the paper. Conclusion: The stories on yarigai gave intrinsic meanings to their occupational lives, which can be informative for students, residents, and young physicians when contemplating the meaning of their work as doctors. Rather than demanding selfless dedication from physicians towards patients, they believe it more important to foster yarigai, derived from the contribution to the well-being of others through patient care.

DOI： 10.1080/0142159X.2024.2316227

錦織　宏　名古屋大学総合医学教育センター長・教授

錦織宏

医学教育 55 巻 ( 5 ) 頁： 374 - 376 2024年10月

Nishigori, H; Haruta, J; Urushibara-Miyachi, Y

MEDICAL TEACHER 46 巻 ( sup1 ) 頁： S1 - S3 2024年6月

Medical education in Japan

Nishigori, H

MEDICAL TEACHER 46 巻 ( sup1 ) 頁： S4 - S10 2024年6月

記述言語：英語出版者・発行元：Medical Teacher

The Model Core Curriculum for Medical Education (MCC) currently, there are 82 medical schools in Japan. The combined enrollment capacity of medical schools nationwide stands at 9,217. Students are eligible to enter medical school upon graduation from senior high school. The standard undergraduate medical education curriculum in Japan spans six years. The Model Core Curriculum for Medical Education (MCC), developed by the Ministry of Education, Culture, Sports, Science and Technology (MEXT), serves as the guideline for all medical school curricula. The Common Achievement Tests Organization (CATO) conducts the Computer-Based Testing (CBT) and the Objective Structured Clinical Examination (OSCE) in all medical schools. The Japan Accreditation Council for Medical Education (JACME), formally recognized by the World Federation of Medical Education (WFME), is responsible for the accreditation of undergraduate medical education in Japan. The National Examination for Medical Practitioners, administered by the Ministry of Health, Labour and Welfare (MHLW) and held annually, is a paper-based examination in which examinees answer multiple-choice questions. After graduating from medical school and obtaining a medical license, individuals progress to a two-year basic postgraduate clinical training program. Upon completion, they advance to a three-to-five-year specialty training phase. The lifelong learning of physicians is overseen by the respective medical societies and the Japan Medical Association. Current issues facing medical education in Japan include bloated curricula, faculty members’ busy schedules and burdens, educational disparities and admission selection, and uneven distribution of specialties. The author believes that medical education should continue to evolve to reflect future changes in society.

DOI： 10.1080/0142159X.2024.2372108

Association of cesarean section and infectious outcomes among infants at 1 year of age: Logistic regression analysis using data of 104,065 records from the Japan Environment and Children's Study Open Access

Maeda H., Hashimoto K., Iwasa H., Kyozuka H., Kume Y., Go H., Sato A., Ogata Y., Murata T., Fujimori K., Shinoki K., Nishigori H., Yasumura S., Hosoya M., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Iso H., Shima M., Kurozawa Y., Suganuma N., Kusuhara K., Katoh T.

PLoS ONE 19 巻 ( 2 February ) 2024年2月

出版者・発行元：PLoS ONE

Background There has been a recent decrease in the prevalence of infectious diseases in children worldwide due to the usage of vaccines. However, the association between cesarean delivery and infectious diseases remains unclear. Here, we aimed to clarify the association between cesarean delivery and the development of infectious diseases. Methods This study is a cross-sectional study. We used data from the Japan Environment and Children's Study, which is a prospective, nationwide, government-funded birth cohort study. The data of 104,065 records were included. Information about the mode of delivery, central nervous system infection (CNSI), otitis media (OM), upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), gastrointestinal infection (GI), and urinary tract infection (UTI) was obtained from questionnaires and medical records transcripts. Multiple logistic regression analysis was used to assess the association between cesarean delivery and CNSI, OM, URTI, LRTI, GI, and UTI risk. Results We included a total of 74,477 subjects in this study, of which 18.4% underwent cesarean deliveries. After adjusting for the perinatal, socioeconomic, and postnatal confounding factors, children born by cesarean delivery did not have an increased risk of developing CNSI (95% confidence interval [CI] 0.46-1.35), OM (95% CI 0.99-1.12), URTI (95% CI 0.97-1.06), LRTI (95% CI 0.98-1.15), GI (95% CI 0.98-1.11), or UTI (95% CI 0.95-1.45). Conclusions This nationwide cohort study did not find an association between cesarean delivery and CNSI, OM, URTI, LRTI, GI, and UTI. However, further studies are needed to evaluate the role of cesarean delivery in the development of infectious diseases. Copyright:

DOI： 10.1371/journal.pone.0298950

Prenatal folic acid supplement/dietary folate and cognitive development in 4-year-old offspring from the Japan Environment and Children’s Study Open Access

Nishigori H., Nishigori T., Obara T., Suzuki T., Mori M., Imaizumi K., Murata T., Kyozuka H., Ogata Y., Sato A., Shinoki K., Yasumura S., Hosoya M., Hashimoto K., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Sofue T., Shima M., Nakamura H., Suganuma N., Kusuhara K., Katoh T.

Scientific Reports 13 巻 ( 1 ) 2023年12月

出版者・発行元：Scientific Reports

We evaluated the association between maternal prenatal folic acid supplement use/dietary folate intake and cognitive development in 4-year-old offspring (N = 3445) using data from the Japan Environment and Children’s Study. Cognitive development was evaluated using the Kyoto Scale of Psychological Development 2001. Multiple regression analysis revealed that offspring of mothers who started using folic acid supplements pre-conception had a significantly higher language-social developmental quotient (DQ) (partial regression coefficient 1.981, 95% confidence interval 0.091 to 3.872) than offspring of mothers who did not use such supplements at any time throughout their pregnancy (non-users). Offspring of mothers who started using folic acid supplements within 12 weeks of gestation had a significantly higher cognitive-adaptive (1.489, 0.312 to 2.667) and language-social (1.873, 0.586 to 3.159) DQ than offspring of non-users. Regarding daily dietary folate intake from preconception to early pregnancy, multiple regression analysis revealed that there was no significant association with any DQ area in the 200 to < 400 µg and the ≥ 400 µg groups compared with the < 200 µg group. Maternal prenatal folic acid supplementation starting within 12 weeks of gestation (but not adequate dietary folate intake from preconception to early pregnancy) is positively associated with cognitive development in 4-year-old offspring.

DOI： 10.1038/s41598-023-36484-8

Association between gestational age at threatened preterm birth diagnosis and incidence of preterm birth: the Japan Environment and Children’s Study Open Access

Murata T., Isogami H., Imaizumi K., Fukuda T., Kyozuka H., Yasuda S., Yamaguchi A., Sato A., Ogata Y., Shinoki K., Hosoya M., Yasumura S., Hashimoto K., Nishigori H., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Sobue T., Shima M., Nakamura H., Suganuma N., Kusuhara K., Katoh T.

Scientific Reports 13 巻 ( 1 ) 2023年12月

出版者・発行元：Scientific Reports

We evaluated the association between gestational age at threatened preterm birth (TPTB) diagnosis and preterm birth (PTB) incidence using a nationwide birth cohort. Data of 94,236 women with singleton deliveries from the Japan Environment and Children’s Study (enrolled between 2011 and 2014) were analysed. Participants were divided based on parity and gestational age at TPTB diagnosis (22–24, 25–27, 28–30, 31–33, and 34–36 weeks). Multivariable logistic regression models were used to calculate the odds ratios (ORs) for PTB before 37 and 34 weeks in women from all groups, using participants without TPTB as the reference. The adjusted ORs for PTB before 37 weeks were the highest in the latest gestational age group in nulliparous and multiparous women without previous PTB, while those before 34 weeks were the highest in the earliest and latest gestational age group in multiparous women without previous PTB and in the earliest gestational age group in multiparous women with previous PTB. The association between gestational age at TPTB diagnosis and PTB incidence varies based on maternal parity and PTB before 37 or 34 weeks. Further studies with detailed clinical data and a unified TPTB diagnosis protocol are necessary to clarify this association.

DOI： 10.1038/s41598-023-38524-9

Deconstructing the masculinized assumption of the medical profession: narratives of Japanese physician fathers 査読有り Open Access

Kamihiro, N; Taga, F; Miyachi, J; Matsui, T; Nishigori, H

BMC MEDICAL EDUCATION 23 巻 ( 1 ) 頁： 857 2023年11月

記述言語：英語出版者・発行元：BMC Medical Education

Background: Gender studies in the medical profession have revealed gender biases associated with being a doctor, a profession often regarded as more suitable for men. The path to gender equality inevitably involves deconstructing this masculinized assumption. Despite the decades-long expectation that ikumen–men who actively participate in childcare in Japan–would contribute to a change toward gender equality, Japanese society is still male dominated, and women suffer from a large gender gap. With the aim of exploring implicit gendered assumptions concerning being a caregiver and a doctor, the authors focused on the experience of individuals juggling the binary roles of a professional and a caregiver. Methods: The authors conducted subjectivist inductive research, recruited ten Japanese physician fathers through purposive sampling, and collected data through one-to-one semi-structured interviews between October 2017 and December 2018. The authors recorded and transcribed the narrative data, and extracted themes and representative narratives. Results: The study identified three themes about the reproduction and potential change of the gender gap: maintaining gendered assumptions of the medical profession without experiencing conflict, maintaining gendered assumptions of the medical profession while experiencing conflict, and deconstructing gendered assumptions of the medical profession through conflict. The authors found that these negotiations interplayed with the gendered division of labor between male doctors and their wives as well as the patriarchal family structure. Conclusions: The study revealed how gendered assumptions of the medical profession, as well as gender stereotypes and gendered division of household labor, were reproduced in the course of male doctors’ negotiations when they became fathers. For male doctors to question their unconscious gender bias, the authors emphasize the importance of men gaining knowledge about gender stereotypes, and propose that educators create such opportunities. Moreover, the authors assert that increasing doctors’ awareness of how masculinized assumptions implicitly interact with ideas of being a doctor—an aspect rarely discussed among medical professionals—is crucial for deconstructing the gendered normativity in the medical field.

DOI： 10.1186/s12909-023-04855-4

宮地純一郎, 錦織宏

月刊地域医学 37 巻 ( 9 ) 頁： 65 2023年9月

第55回学会大会における査読ワークショップ開催報告査読有り

武田裕子, 土屋静馬, 西城卓也, 前野貴美, 今福輪太郎, 松山泰, 八木街子, 菊川誠, 尾原晴雄, 椎橋実智男, 中村真理子, 高村昭輝, 長崎一哉, 小林志津子, 鶴田潤, 宮地由佳, 錦織宏

医学教育 54 巻 ( 4 ) 頁： 406 - 409 2023年8月

フィードバック　定義から近年の議論まで査読有り

木村武司, 錦織宏

医学教育 54 巻 ( 3 ) 頁： 255 - 265 2023年6月

記述言語：日本語出版者・発行元：日本医学教育学会

フィードバックは医学教育の様々な場面で行われる教育活動であり, これまで盛んに議論されてきた. 2008年にRidderらが「学修者パフォーマンスの改善を意図した, 学修者に見られたパフォーマンスと到達点 (コンピテンシー) との比較についての情報」と定義し, 以後は効果的なフィードバックについて, 指導者を中心とした行動主義的なアプローチから受容者である学修者を中心に据えた関係性や, 学修者に潜在するフィードバックを活かす能力 (自己調整学修, フィードバックリテラシー) などへと, より多面的に捉えるように議論が展開されてきている. 本稿ではその変遷をナラティブ・レビューの形で概説し, 今後の教育実践や医学教育研究に貢献する.

DOI： 10.11307/mededjapan.54.3_255

職種横断的な内省を通して思いのすれ違いを連携に活かす査読有り

佐野樹, 森下真理子, 錦織宏

医学教育 54 巻 ( 3 ) 頁： 281 - 287 2023年6月

記述言語：日本語出版者・発行元：日本医学教育学会

専門職間で起こる思いのすれ違いを「モヤっと」と名づけ, それを医療/教育現場での連携に活かすため, 2014年から研究会を立ち上げた. 多施設の多職種で月1回1時間のオンライン研究会を行い, モヤっとした経験について内省を行った. 本稿では研究会について振り返る中で, 会の発足と歩み, 会の中で起きている学習プロセスや根拠となっている理論について述べる. さらに研究会での実践とその変化について共有しつつ, 多職種連携 (教育) での内省には, 専門領域内でする一次内省と, 領域の外から自らの専門を見つめる二次内省の両輪が必要であることを示す.

DOI： 10.11307/mededjapan.54.3_281

2. 資質・能力に新設された総合的に患者・生活者をみる姿勢について査読有り

春田淳志, 安藤崇之, 遠藤周, 金子惇, 鋪野紀好, 長嶺由衣子, 錦織宏, 藤川裕恭, 山梨啓友

医学教育 54 巻 ( 2 ) 頁： 142 - 148 2023年4月

記述言語：日本語出版者・発行元：日本医学教育学会

少子高齢化社会の背景と令和2年度からの調査を踏まえ, 患者の抱える問題を臓器横断的に捉えた上で, 心理社会的背景も踏まえた総合的な視点とアプローチの必要性が示され, 医学教育モデル・コア・カリキュラム (令和4年改訂版) に総合的に患者・生活者をみる姿勢が資質・能力に新設された. 下位目標として「全人的な視点とアプローチ」「地域の視点とアプローチ」「人生の視点とアプローチ」「社会の視点とアプローチ」が位置づけられた. 抽象と具体, 概念と経験, 自己と他者等の視点を統合し, 自己の在り方を省察できるような複数の学習理論を踏まえた教育方法が提案された. このような医学教育を通じて, 患者・生活者のウェルビーイングが向上することを期待する.

DOI： 10.11307/mededjapan.54.2_142

総括　医学教育モデル・コア・カリキュラム (令和4年度版) 改訂の統括 : 根拠に基づいた医学教育査読有り

錦織宏

医学教育 54 巻 ( 2 ) 頁： 199 - 202 2023年4月

記述言語：日本語出版者・発行元：日本医学教育学会

日本医学教育学会による医学教育モデル・コア・カリキュラム (以下, コアカリ) の令和4年度改訂にあたっての素案作成は, 学術論文や調査結果など多くの根拠に基づいて行った. 多様な属性からなるチーム編成, Web会議システムを活用した十分な検討, 行政と学会の円滑なコミュニケーション, 医学教育に関連のある組織との丁寧な対話は, 次回改訂でも継続することを推奨する. 一方で, 専門領域の学会との連携・コミュニケーションは今後の課題である. 　今回改訂されたコアカリは, 2020年代前半に本邦の医学教育学分野の有識者が叡智を結集した産物ではあるが, 決して国家が押し付ける正義ではなく, そしてこれに盲目的に従うことを各大学の教員に強要するものでもない. 現場で教育に携わる方には, 20年後の社会を見据えて作成したこのコアカリを, 大いに参考にしつつ, また時に疑いながら, 教育を展開することを期待する.

DOI： 10.11307/mededjapan.54.2_199

序文 : 特集　Making of医学教育モデル・コア・カリキュラムを企画するにあたって査読有り

錦織宏, 小西靖彦

医学教育 54 巻 ( 2 ) 頁： 133 - 133 2023年4月

7. 方略とGood Practice (1) 査読有り

松島加代子, 淺田義和, 野村理, 春田淳志, 山口久美子, 近藤猛, 錦織宏, 小西靖彦

医学教育 54 巻 ( 2 ) 頁： 177 - 181 2023年4月

記述言語：日本語出版者・発行元：日本医学教育学会

令和4年改訂版医学教育モデル・コア・カリキュラム (以下, コアカリ) では, アウトカム基盤型教育において, さらなる展開として, 新たに『学修方略・評価』の章が追加された. カリキュラムの重要な要素である方略・評価の章を加え, 資質・能力に紐づけることで, 学修者や指導者にコアカリを活用していただけるよう工夫した. また, 教育現場ですぐに実践していただけるように11の方略・評価事例をGood Practiceとして紹介した. ただし, これらのGood Practiceは, 各施設での実施を必須とするものではなく, あくまで参考例として掲載している. 各大学の特徴を生かした独自の方略・評価が策定され, 本章がさらに発展していくことを期待する.

DOI： 10.11307/mededjapan.54.2_177

Association of labour duration in spontaneous deliveries with low neonatal Apgar scores and foetal acidosis: the Japan Environment and Children’s Study Open Access

Murata T., Yasuda S., Imaizumi K., Isogami H., Fukuda T., Kyozuka H., Yamaguchi A., Sato A., Ogata Y., Shinoki K., Hosoya M., Yasumura S., Hashimoto K., Nishigori H., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Iso H., Shima M., Nakamura H., Suganuma N., Kusuhara K., Katoh T.

Scientific Reports 12 巻 ( 1 ) 2022年12月

出版者・発行元：Scientific Reports

This study evaluated the association between labour duration (LD) and incidence of low neonatal Apgar scores and foetal acidosis. Data of 37,682 women with full-term singleton spontaneous vaginal deliveries from the Japan Environment and Children’s Study were analysed. Women were classified according to the median LD as nulliparous (< 10 or ≥ 10 h) or multiparous (< 5 or ≥ 5 h) and further into five subcategories: nulliparous (< 10.0, 10.0–12.9, 13.0–15.9, 16.0–18.9, and ≥ 19 h) and multiparous (< 5.0, 5.0–7.9, 8.0–10.9, 11.0–13.9, and ≥ 14.0 h). Multiple logistic regression models were used to determine odds ratios (ORs) for outcomes in women with over-median LD. Over-median LD exhibited no statistically significant association with low neonatal Apgar scores. The adjusted ORs for both umbilical artery (UmA-pH) < 7.2 and < 7.1 were increased in nulliparous women with over-median LD, whereas only the adjusted OR for UmA-pH < 7.2 was increased in multiparous women with over-median LD. Moreover, this association manifested as a plateau in nulliparous women with LD ≥ 13 h and without dose-dependent association in multiparous women.

DOI： 10.1038/s41598-022-24359-3

Association of Chlamydia trachomatis infection with pregnancy outcomes among Japanese pregnant women: The Japan environment and children’s study Open Access

Yasuda S., Kyozuka H., Endo Y., Kanno A., Murata T., Fukusda T., Yamaguchi A., Sato A., Ogata Y., Kuse M., Hosoya M., Yasumura S., Hashimoto K., Nishigori H., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Iso H., Shima M., Kurozawa Y., Suganuma N., Kusuhara K., Katoh T.

PLoS ONE 17 巻 ( 11 November ) 2022年11月

出版者・発行元：PLoS ONE

This study aimed to investigate the impact of Chlamydia trachomatis (CT) infection on pregnancy outcome in pregnant Japanese women. We utilized the data from a nationwide birth cohort study, the Japan Environment and Children’s Study (JECS), for this study. We enrolled 26,385 individuals who could refer to data on pregnancy outcomes and confounding factors, with data on CT. Binominal logistic regression models were used to determine whether pregnant women with CT positivity were at more risk of experiencing adverse pregnancy outcomes, preterm birth (PTB), preterm prelabor rupture of membrane (pPROM), low birth weight (LBW) infants, small for gestational age (SGA) births, or hypertensive disorders of pregnancy (HDP). After adjusting for maternal age, parity, marital status, smoking status, and education status, there were no significantly increased risks of PTB, pPROM, LBW infants, SGA, and HDP in the odds ratios. No significant increase in the risk of adverse pregnancy outcomes was observed in any of the subgroup analyses, which were limited to the pregnancy women in Fukushima prefecture, where CT screening could be confirmed at 28-30 weeks of gestation. We believe that the results of this study will make a significant contribution to the future of medical care for pregnant women in Japan. Our findings are important for medical practitioners to contribute to the future medical treatment of Japanese pregnant women, and also to contribute to pre-conception care for Japanese society as a whole, including pregnant women.

DOI： 10.1371/journal.pone.0275573

精神医療の多職種を対象とした文化的プログラムの開発査読有り

佐野樹, 森下真理子, 錦織宏

医学教育 53 巻 ( 5 ) 頁： 447 - 452 2022年10月

記述言語：日本語出版者・発行元：日本医学教育学会

精神医療の多職種を対象に文化的コンピテンシーの修得を目指した教育プログラムを開発した. 支配的なイデオロギーを批判的に問い直す社会的公正教育を参考に, 特定の集団の文化だけに焦点を当てるのではなく, KumagaiとLypsonの提唱する批判的自己内省を通して「他者には私の知り得ない部分 (他者性) がある」と気づくことを目指し, 会も他者性勉強会と命名した. 医療における人文学の研究者が書いた医療現場の文化についての論考を主な教材として, そのレンズで現場を見たときに, 自分たちの医療文化について問題となることを話し合った. 本稿では, 現在までに見えてきた課題, その対応と今後の展開について考察する.

DOI： 10.11307/mededjapan.53.5_447

「医学教育研究室の抄読会から」 (連載第14回) 査読有り

木村武司, 錦織宏

医学教育 53 巻 ( 4 ) 頁： 393 - 394 2022年8月

「医学教育研究室の抄読会から」 (連載第13回) 査読有り

及川沙耶佳, 木村武司, 錦織宏

医学教育 53 巻 ( 3 ) 頁： 270 - 273 2022年6月

高久史麿先生を偲ぶ査読有り

岩崎榮, 錦織宏

医学教育 53 巻 ( 3 ) 頁： 268 - 269 2022年6月

「医学教育研究室の抄読会から」 (連載第12回) 査読有り

木村武司, 種村文孝, 錦織宏

医学教育 53 巻 ( 2 ) 頁： 184 - 186 2022年4月

アンプロフェッショナルな行動査読有り

木村武司, 錦織宏

医学教育 53 巻 ( 2 ) 頁： 163 - 169 2022年4月

記述言語：日本語出版者・発行元：日本医学教育学会

医学教育においてプロフェッショナリズム教育は重要なテーマの一つだが, その教育や評価は困難である. そのため, プロフェッショナリズム教育における特に評価の観点から, 観察可能な「行動behavior」に焦点をあて, アンプロフェッショナルな行動として捉え直す議論が2000年頃から北米を中心に活発化している. 本稿では, 国内の動向も交えつつ, アンプロフェッショナルな行動についての分類, 評価, 対応に関する概念を整理し, 関連した概念について啓蒙するとともに, 本邦の文脈に即した研究の促進を目指す. また, その適切な対応を通して, より社会の要請に耐える医学生・医師の育成に繋がることを期待したい.

DOI： 10.11307/mededjapan.53.2_163

「医学教育研究室の抄読会から」 (第11回) 査読有り

木村武司, 錦織宏

医学教育 53 巻 ( 1 ) 頁： 104 - 108 2022年2月

小児集中治療に携わる医師に求められる能力とその評価査読有り

染谷真紀, 松井智子, 錦織宏, 及川沙耶佳

医学教育 53 巻 ( 1 ) 頁： 110 - 111 2022年2月

Preface 査読有り

Claramita M., Findyartini A., Samarasekera D.D., Nishigori H.

Challenges and Opportunities in Health Professions Education: Perspectives in the Context of Cultural Diversity 頁： v - vii 2022年1月

文化人類学にとっての医学教育モデル·コア·カリキュラム改訂の意義査読有り

医療者向け人類学教育連携委員会, 木村周平, 飯田淳子, 伊藤泰信, 倉田誠, 錦織宏, 浜田明範, 春田淳志, 星野晋

文化人類学 86 巻 ( 3 ) 頁： 511 - 514 2021年12月

4. 京大FCME (ふくみん) : 現場で働く指導医のための医学教育学プログラム査読有り

錦織宏, 及川沙耶佳, 谷昇子, 木村武司, 種村文孝

医学教育 52 巻 ( 6 ) 頁： 515 - 523 2021年12月

記述言語：日本語出版者・発行元：日本医学教育学会

2015年に文部科学省の助成を受けて開講した京都大学の「現場で働く指導医のための医学教育学プログラムー基礎編」は対面型と遠隔型を組み合わせた形で医学教育学を体系的に学ぶプログラムである. 1年間で約120時間学修することになる受講生は, 課題に追われながらも12名の仲間と強固な学修コミュニティを形成していき, その様は講師が羨むほどである. また, プログラムに思想・哲学を掲げていること, そして文化人類学を重視したプログラムであることが特徴である.

DOI： 10.11307/mededjapan.52.6_515

「医学教育研究室の抄読会から」 (第10回) 査読有り

木村武司, 錦織宏

医学教育 52 巻 ( 6 ) 頁： 574 - 577 2021年12月

Maternal sleep duration and neonatal birth weight: the Japan Environment and Children’s Study Open Access

Murata T., Kyozuka H., Fukuda T., Yasuda S., Yamaguchi A., Morokuma S., Sato A., Ogata Y., Shinoki K., Hosoya M., Yasumura S., Hashimoto K., Nishigori H., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Iso H., Shima M., Kurozawa Y., Suganuma N., Kusuhara K., Katoh T.

BMC Pregnancy and Childbirth 21 巻 ( 1 ) 2021年12月

出版者・発行元：BMC Pregnancy and Childbirth

Background: The adequate maternal sleep duration required for favorable obstetric outcomes is unknown. We evaluated the association between maternal sleep duration and low birth weight infants, small for gestational age infants, and macrosomia. Methods: Participants enrolled in the Japan Environment and Children’s Study, a nationwide birth cohort study, with singleton pregnancies after 22 weeks, who gave birth between 2011 and 2014 were enrolled and categorized into five groups according to maternal sleep duration during pregnancy: < 6.0 h, 6.0–7.9 h, 8.0–8.9 h, 9.0–9.9 h, and 10.0–12.0 h. We evaluated the association between maternal sleep duration and the incidence of low birth weight infants (< 2500 g), very low birth weight infants (< 1500 g), small for gestational age infants, and macrosomia (> 4000 g), with women with maternal sleep duration of 6.0–7.9 h as the reference, using a multiple logistic regression model. Results: In total, 82,171 participants were analyzed. The adjusted odds ratios (95% confidence intervals) for low birth weight infants in women with maternal sleep duration of 9.0–9.9 h and 10.0–12.0 h and for small for gestational age infants in women with maternal sleep duration of 9.0–9.9 h were 0.90 (0.83–0.99), 0.86 (0.76–0.99), and 0.91 (0.82–0.99), respectively, before adjusting for excessive gestational weight gain. No significant association was observed between maternal sleep duration and these outcomes after adjusting for excessive gestational weight gain. Among women with appropriate gestational weight gain, the adjusted odds ratios (95% confidence intervals) for low birth weight infants and for small for gestational age infants with sleep duration of 9.0–9.9 h were 0.88 (0.80–0.97) and 0.87 (0.78–0.97), respectively. Conclusions: Maternal sleep duration of 9.0–9.9 h was significantly associated with the decreased incidence of low birth weight infants and small for gestational age infants in pregnant women with appropriate gestational weight gain, compared with that of 6.0–7.9 h. Care providers should provide proper counseling regarding the association between maternal sleep duration and neonatal birth weight and suggest comprehensive maternal lifestyle modifications to prevent low birth weight and small for gestational age infants.

DOI： 10.1186/s12884-021-03670-3

Immunoglobulin E levels and pregnancy-induced hypertension: Japan Environment and Children’s Study Open Access

Kyozuka H., Murata T., Fukuda T., Endo Y., Yamaguchi A., Yasuda S., Kanno A., Sato A., Ogata Y., Hosoya M., Yasumura S., Hashimoto K., Nishigori H., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Iso H., Shima M., Kurozawa Y., Suganuma N., Kusuhara K., Katoh T.

Scientific Reports 11 巻 ( 1 ) 2021年12月

出版者・発行元：Scientific Reports

High serum immunoglobulin E (IgE) levels are associated with cardiovascular events. We aimed to evaluate the association between total IgE levels during the first trimester of pregnancy and pregnancy-induced hypertension (PIH) development in a large Japanese cohort. We analysed data pertaining to singleton primipara pregnancies recorded in the Japan Environment and Children’s Study involving births from 2011 to 2014. Serum IgE levels were determined using the immunonephelometric technique. High serum IgE was defined as level ≥ 170 IU/ml. Hypertensive disorders in pregnancy (HDP) were categorized into early onset (Eo) PIH (developed < 34 weeks) or late onset (Lo) PIH (developed ≧ 34 weeks). A multiple logistic regression model was used to estimate the risk of high serum IgE levels on PIH, Eo-PIH, and Lo-PIH. Overall, 32,518 participants were enrolled. The prevalence of total, Eo-, and Lo-PIH was 3.2%, 0.6%, and 2.3%, respectively. Patients with high serum IgE levels had an increased risk of Lo-HDP (adjusted odds ratio [aOR]:1.19, 95% confidence interval 1.01–1.40). No correlation was found with either PIH (total) or Eo-PIH. High serum IgE levels during the first trimester were associated with the risk of Lo-PIH. Our results could influence and shape further research regarding the pathogenesis of Lo hypertension.

DOI： 10.1038/s41598-021-88227-2

Maternal pre-pregnancy body mass index and foetal acidosis in vaginal and caesarean deliveries: The Japan Environment and Children’s Study Open Access

Murata T., Kyozuka H., Yamaguchi A., Fukuda T., Yasuda S., Sato A., Ogata Y., Shinoki K., Hosoya M., Yasumura S., Hashimoto K., Nishigori H., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Iso H., Shima M., Kurozawa Y., Suganuma N., Kusuhara K., Katoh T.

Scientific Reports 11 巻 ( 1 ) 2021年12月

出版者・発行元：Scientific Reports

A high maternal body mass index (BMI) is associated with increased risks of asphyxia-related neonatal morbidity. We evaluated the association between maternal pre-pregnancy BMI and foetal acidosis while accounting for the mode of delivery. Participants from the Japan Environment and Children’s Study with singleton pregnancies after 22 weeks of gestation who gave birth during 2011–2014 were included. The participants (n = 71,799) were categorised into five groups according to the pre-pregnancy BMI: G1 (BMI < 18.5 kg/m2), G2 (18.5 to < 20.0 kg/m2), G3 (20.0 to < 23.0 kg/m2), G4 (23.0 to < 25.0 kg/m2), and G5 (≥ 25.0 kg/m2). Foetal acidosis was defined as umbilical artery pH (UmA-pH) < 7.20 or < 7.10. Multiple logistic regression analyses were used to evaluate the effect of pre-pregnancy BMI on foetal acidosis risk, accounting for the mode of delivery. In Japanese women, pre-pregnancy BMI ≥ 25.0 kg/m2 significantly increased the likelihood of foetal acidosis in newborns delivered vaginally. We found no association between pre-pregnancy BMI and foetal acidosis in newborns delivered via caesarean section. Counselling for body weight control before pregnancy and adequate management and selection of the mode of delivery in pregnant women with a high BMI who are in labour may be essential to avoid foetal acidosis.

DOI： 10.1038/s41598-020-79178-1

Author Correction: Gestational weight gain and foetal acidosis in vaginal and caesarean deliveries: The Japan Environment and Children’s Study (Scientific Reports, (2020), 10, 1, (20389), 10.1038/s41598-020-77429-9) Open Access

Scientific Reports 11 巻 ( 1 ) 2021年12月

A collaborative clinical case conference model for teaching social and behavioral science in medicine: an action research study 査読有り Open Access

Miyachi, J; Iida, J; Shimazono, Y; Nishigori, H

BMC MEDICAL EDUCATION 21 巻 ( 1 ) 頁： 574 2021年11月

記述言語：英語出版者・発行元：BMC Medical Education

Background: Effective social and behavioral sciences teaching in medical education requires integration with clinical experience, as well as collaboration between social and behavioral sciences experts and clinical faculty. However, teaching models for achieving this integration have not been adequately established, nor has the collaboration process been described. This study aims to propose a collaborative clinical case conference model to integrate social and behavioral sciences and clinical experience. Additionally, we describe how social and behavioral science experts and clinical faculty collaborate during the development of the teaching method. Methods: A team of medical teachers and medical anthropologists planned for the development of a case conference based on action research methodology. The initial model was planned for a 3-h session, similar to a Clinicopathological Conference (CPC) structure. We evaluated each session based on field notes taken by medical anthropologists and post-session questionnaires that surveyed participants’ reactions and points of improvement. Based on the evaluation, a reflective meeting was held to discuss revisions for the next trial. We incorporated the development process into undergraduate medical curricula in clinical years and in a postgraduate and continuous professional development session for residents and certified family physicians in Japan. We repeated the plan-act-observe-reflection process more than 15 times between 2015 and 2018. Results: The development of the collaborative clinical case conference model is summarized in three phases: Quasi-CPC, Interactive, and Co-constructive with unique structures and underlying paradigms. The model successfully contributed to promoting the participants’ recognition of the clinical significance of social and behavioral sciences. The case preparation entailed unique and significant learning of how social and behavioral sciences inform clinical practice. The model development process promoted the mutual understanding between clinical faculty and anthropologists, which might function as faculty development for teachers involved in social and behavioral sciences teaching in medical education. Conclusions: The application of appropriate conference models and awareness of their underlying paradigms according to educational situations promotes the integration of social and behavioral sciences with clinical medicine education. Faculty development regarding social and behavioral sciences in medical education should focus on collaboration with scholars with different paradigmatic orientations.

DOI： 10.1186/s12909-021-03009-8

「医学教育研究室の抄読会から」 (第9回) 査読有り

及川沙耶佳, 木村武司, 錦織宏

医学教育 52 巻 ( 5 ) 頁： 443 - 445 2021年10月

「医学教育研究室の抄読会から」 (第8回) 査読有り

森下真理子, 木村武司, 錦織宏

医学教育 52 巻 ( 4 ) 頁： 337 - 341 2021年8月

医学教育に社会科学を活かすために査読有り

飯田淳子, 木村周平, 伊藤泰信, 倉田誠, 浜田明範, 星野晋, 春田淳志, 錦織宏

医学教育 52 巻 ( 4 ) 頁： 342 - 344 2021年8月

連載オンラインによる医療者教育はじめに査読有り

錦織宏

医学のあゆみ 278 巻 ( 7 ) 頁： 734 - 734 2021年8月

拘束からの解放査読有り

近藤猛, 錦織宏

医学教育 52 巻 ( 3 ) 頁： 263 - 269 2021年6月

記述言語：日本語出版者・発行元：日本医学教育学会

これまで臨床研修指導医講習会は原則として2泊3日の合宿形式で行われてきたが, コロナ禍のために完全オンライン形式で実施した. 長時間の同期型オンライン学習による参加者の負担を避ける目的で, 事前課題を課してそれに基づいたディスカッションを行う反転授業形式の非同期型オンライン学習も採用した. 同期型講習実施日の5週間前から事前課題を順次提示し, 同期型講習は2020年11月13日 (金) 17時から14日 (土) 18時まで, 参加者45名に対して行った. 全参加者が課題を全て提出し修了した. 事前課題を活用した反転授業型のオンライン指導医講習会は, 多忙な臨床医を拘束する時間を大幅に削減できる可能性がある.

DOI： 10.11307/mededjapan.52.3_263

5. まとめと提言 : 医学教育における行動科学・社会科学の将来査読有り

錦織宏

医学教育 52 巻 ( 2 ) 頁： 145 - 149 2021年4月

記述言語：日本語出版者・発行元：日本医学教育学会

JACMEによる医学教育分野別認証評価によって, 医学教育における行動科学・社会科学に関する議論が活発化してきている. 本特集における行動科学・社会科学・医療法学・医療倫理学に関する概念整理に加えて, 本稿では, 社会医学と社会科学の関係性を整理し, 米国や英国の医学教育における行動科学・社会科学の現況について記述する. また行動科学・社会科学において, なぜ, 心理学・人類学・社会学といった学問を基盤とするのかについて私見を述べ, 意見・異見・反論を求める.

DOI： 10.11307/mededjapan.52.2_145

「医学教育研究室の抄読会から」第7回査読有り

木村峻輔, 木村武司, 錦織宏

医学教育 52 巻 ( 2 ) 頁： 161 - 163 2021年4月

「医学教育研究室の抄読会から」 (第6回) 査読有り

木村武司, 錦織宏

医学教育 52 巻 ( 1 ) 頁： 58 - 60 2021年2月

医学教育サイバーシンポジウム開催報告査読有り

医学教育サイバーシンポジウム特別委員会, 田中淳一, 門川俊明, 村岡千種, 淺田義和, 木村武司, 清水郁夫, 錦織宏

医学教育 52 巻 ( 1 ) 頁： 47 - 51 2021年2月

記述言語：日本語出版者・発行元：日本医学教育学会

新型コロナウイルス感染症 (COVID-19) は, 医学教育に大きな影響を与え, 急速に変化する不確実な状況に対応する必要が生じた. また今年度の学術大会の誌上開催の決定を受け, 情報共有・ディスカッションを行う場が必要と考えた. そこで, 医学教育サイバーシンポジウム特別委員会が編成され, 2020年5月より2週間ごとに, 「これからの臨床実習」, 「試験」「卒後教育」「With Corona時代の医学教育」の題目でシンポジウムを計4回実施した. 本稿では, その概要と今後の考察を含めて報告する.

DOI： 10.11307/mededjapan.52.1_47

Gestational weight gain and foetal acidosis in vaginal and caesarean deliveries: The Japan Environment and Children’s Study Open Access

「医学教育研究室の抄読会から」 (第5回)

種村文孝, 木村武司, 錦織宏

医学教育 51 巻 ( 6 ) 頁： 700 - 701 2020年12月

Murata T., Kyozuka H., Yamaguchi A., Fukuda T., Yasuda S., Sato A., Ogata Y., Shinoki K., Hosoya M., Yasumura S., Hashimoto K., Nishigori H., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Nakayama T., Iso H., Shima M., Kurozawa Y., Suganuma N., Kusuhara K., Katoh T.

Scientific Reports 10 巻 ( 1 ) 2020年12月

出版者・発行元：Scientific Reports

Inappropriate gestational weight gain (GWG), either above or below the recommended values, has been associated with an increased risk of adverse obstetric outcomes. To evaluate the risks of GWG for foetal acidosis according to pre-pregnancy body mass index (BMI) and mode of delivery, we analysed women with singleton pregnancies between 2011 and 2014 in the Japan Environment and Children’s Study. Participants (n = 71,799) were categorised according to pre-pregnancy BMI. GWG was categorised into insufficient, appropriate, or excessive. Foetal acidosis was defined as umbilical artery pH (UmA-pH) < 7.20 or < 7.10. Multiple logistic regressions were performed for each BMI category to identify the risks of GWG for foetal acidosis, accounting for the mode of delivery. Excessive GWG was significantly associated with increased foetal acidosis in overweight women and in women whose pre-pregnancy BMI was 23.0–25.0 kg/m2 especially in those with vaginal deliveries. Conversely, excessive GWG was not significantly associated with increased foetal acidosis in obese women and in women whose pre-pregnancy BMI was ≥ 25.0 kg/m2.

DOI： 10.1038/s41598-020-77429-9

臨床研修指導医講習会における医学教育ケースカンファレンスの試み査読有り

木村武司, 種村文孝, 近藤猛, 錦織宏

医学教育 51 巻 ( 5 ) 頁： 591 - 595 2020年10月

記述言語：日本語出版者・発行元：日本医学教育学会

臨床研修指導医講習会において, 個別の教育実践ケースの発表から実際の教育現場で抱えている諸問題を議論する医学教育ケースカンファレンスを行った. 開催2カ月前から準備をし, 当日は4つのケースを扱った. 筆者らは, 教育現場の実践に医学教育学の言葉を付与し, 理論や概念的枠組みを結びつけ, 受講者に臨床研修の現場で起こっている事象の理解を深めるよう努めた. 本試みは教育実践を通じて医学教育学の知見を学ぶだけでなく, 診療科横断的な教育に関連する実践共同体の構築に寄与する可能性を示した. そこでは, 実践の背景や文脈を考慮しながら理論と適切につなぐ「通訳者」の存在が鍵となり, 今後はその人材育成も課題である.

DOI： 10.11307/mededjapan.51.5_591

医学教育研究室の抄読会から　第4回査読有り

木村武司, 錦織宏

医学教育 51 巻 ( 5 ) 頁： 615 - 617 2020年10月

医学教育研究室の抄読会から　第3回査読有り

佐野樹, 木村武司, 錦織宏

医学教育 51 巻 ( 4 ) 頁： 466 - 467 2020年8月

「医学とは何か」を問う教育の実態調査 : 中川米造の医学概論の観点から査読有り

外山尚吾, 青木杏奈, 藤崎和彦, 錦織宏

医学教育 51 巻 ( 4 ) 頁： 379 - 388 2020年8月

記述言語：日本語出版者・発行元：日本医学教育学会

背景 : 中川米造が医学概論という学問で探求した「医学とは何か」という問いに関する内容が, 現在の卒前医学教育でどのように取り扱われているかを調査した.　方法 : Web上でアクセス可能なシラバスを調査対象とした. 授業内容・授業時間数・教育方法・評価方法・教員について分析した.　結果 : 69校において, 「医学哲学・医療倫理学」「医療社会学・医療人類学」「医学史」の総授業時間数はそれぞれ1066時間20分, 213時間5分, 192時間5分であり, 該当授業全体に占める割合は72%, 14%, 13%だった.　考察 : 「医学概論」という言葉ではない形で, 「医学とは何か」という問いにつながる教育が散発的に行われていることも分かった.

DOI： 10.11307/mededjapan.51.4_379

5. 学会で出会ったある高齢男性医師の語り〈なぜ医学教育研究論文を書くのか? 〉査読有り

反転授業を活用した臨床研修指導医講習会の実施報告査読有り

近藤猛, 錦織宏

医学教育 51 巻 ( 2 ) 頁： 168 - 170 2020年4月

「医学教育研究室の抄読会から」　第2回

木村武司, 種村文孝, 錦織宏

医学教育 51 巻 ( 2 ) 頁： 166 - 167 2020年4月

錦織宏

医学教育 50 巻 ( 6 ) 頁： 559 - 562 2019年12月

記述言語：日本語出版者・発行元：日本医学教育学会

我々はなぜ医学教育研究の論文を書き, また学会などで発表するのだろうか? またなぜ医学教育研究の論文を読み, 学会での発表を聞くのだろうか? 医学教育の実践はしばしば講義室などの閉じられた空間で行われ, そこには, <教員・指導医>と<医学生・研修医>といった明確な権力勾配が存在する. 本稿では, 権力構造に着目した批判理論という認識論的立場に立ち, 医学教育研究における教育事例報告の意義についての論を展開する.

DOI： 10.11307/mededjapan.50.6_559

Incidence of Domestic Violence Against Pregnant Females after the Great East Japan Earthquake in Miyagi Prefecture: The Japan Environment and Children's Study

The Implications of Culture in the Education and Practice of Healthcare Professionals 査読有り Open Access

McKimm J., Nishigori H.

Asia Pacific Scholar 4 巻 ( 3 ) 頁： 1 - 2 2019年9月

Professional identity formation of female doctors in Japan - gap between the married and unmarried 査読有り Open Access

Matsui, T; Sato, M; Kato, Y; Nishigori, H

BMC MEDICAL EDUCATION 19 巻 ( 1 ) 頁： 55 2019年2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: During professional identity formation (PIF), medical students and young doctors enter the process of socialization in medicine with their preexisting personal identities. Here, the authors focused on how gender influences both the professional and personal identities of doctors. The authors' particular research question was how the professional and personal identities of female doctors are formed in Japan, a patriarchal and highly masculinized country, especially before and after marriage and childbirth. Methods: Narrative inquiry was used as the research methodology. The authors purposively sampled 10 unmarried and 15 married Japanese female physicians with varying lengths of full-time work experience and conducted individual semi-structured face-to-face interviews between July 2013 and February 2015. The authors recorded, transcribed and anonymized the narrative data and extracted themes and representative narratives related to the formation of professional and personal identities. Based on these, the authors developed the master narrative for the whole study. Results: The PIF process by which female physicians integrate personal and professional identities was profoundly affected by gender stereotypes. Further, participant narratives revealed the existence of conflict between married and unmarried female doctors, which created a considerable gap between them. Conclusions: Female physicians lived with conflicting emotions in a chain of gender stereotype reinforcement. To overcome these issues, we propose that it is necessary to depart from a culture that determines merit based on a fixed sense of values, and instead develop a cultural system and work environment which allows the cultivation of a professional vision that accepts a wide variety of professional and personal identities, and a similarly wide variety of methods by which the two can be integrated.

DOI： 10.1186/s12909-019-1479-0

Sakurai K., Nishigori H., Nishigori T., Mizuno S., Obara T., Iwama N., Watanabe Z., Ishikuro M., Tatsuta N., Nishijima I., Sugawara J., Fujiwara I., Arima T., Kuriyama S., Metoki H., Takahashi F., Nakai K., Yaegashi N., Saito H., Kishi R., Hashimoto K., Mori C., Hirahara F., Yamagata Z., Inadera H., Kamijima M., Konishi I., Iso H., Shima M., Ogawa T., Suganuma N., Kusuhara K., Katoh T.

Disaster Medicine and Public Health Preparedness 11 巻 ( 2 ) 頁： 216 - 226 2017年4月

出版者・発行元：Disaster Medicine and Public Health Preparedness

Objective: This study aimed to clarify the correlation between the 2011 Great East Japan Earthquake and domestic violence (DV) against pregnant females after the disaster in Miyagi Prefecture, an area damaged by the earthquake and tsunami. Methods: We analyzed 7600 pregnant females from June to December 2011. The incidence of physical and mental DV and the proportions in the inland, north coastal, and south coastal areas of Miyagi Prefecture and nationwide were calculated, and a chi-square test was conducted for comparison. The risk factors for DV were estimated with multivariate logistic regression analyses on a prefecture-wide basis. Results: The incidence levels for physical DV were found to be 5.9% in the north coastal area, which was significantly higher than in the inland area (1.3%, P=0.0007) and nationwide (1.5%, P<0.0001). There were no significant differences in the incidence of mental DV between the 3 areas in Miyagi Prefecture (inland 15.2%, north coast 15.7%, and south coast 18.8%) or nationwide (13.8%). Experiencing disease or injury in someone close and changes in the family structure were significantly associated with mental DV in Miyagi Prefecture. Conclusion Continuous monitoring and support for pregnant females may be necessary to address this issue in disaster-affected areas.

DOI： 10.1017/dmp.2016.109

Determinants of polyunsaturated fatty acid concentrations in erythrocytes of pregnant Japanese women from a birth cohort study: Study protocol and baseline findings of an adjunct study of the Japan environment & Children's study Open Access

Saito S., Kawabata T., Tatsuta N., Kimura F., Miyazawa T., Mizuno S., Nishigori H., Arima T., Kagawa Y., Yoshimasu K., Tsuno K., Ito Y., Kamijima M., Nakai K., Yaegashi N.

Environmental Health and Preventive Medicine 22 巻 ( 1 ) 2017年

出版者・発行元：Environmental Health and Preventive Medicine

Background: N-3 polyunsaturated fatty acids (n-3 PUFA) may have multiple beneficial effects on the outcome of pregnancy, maternal health and child development. The present study introduced the protocol of a birth cohort study to examine the beneficial effects of n-3 PUFA status in pregnant Japanese women as an adjunct study of the Japan Environment and Children's Study (JECS). Methods: The JECS participants in the coastal areas of Miyagi Prefecture were further invited to participate in this adjunct study, and 1,878 pregnant women were enrolled prior to delivery. Their n-3 PUFA status was evaluated with fatty acid profiles in erythrocytes of maternal blood collected from 1,623 mothers at 24-30 weeks of gestation and cord blood from 1,505 deliveries. Results: The baseline results, including comprehensive data on the fatty acid status and determinants affecting the PUFA status, were analyzed. In stepwise multivariate analyses, the cord blood docosahexaenoic acid (DHA) level was found to be significantly influenced by the DHA level in maternal blood, the child's sex, and the gestational period. The maternal DHA level was influenced by fish intake, maternal age, and the prepregnancy body mass index. While cord blood eicosapentaenoic acid (EPA) was influenced by maternal EPA, fish intake, and season at birth, additional factors such as maternal education, household income, and smoking habits affected the maternal EPA content. Conclusion: Further studies are warranted to clarify the nutritional impacts of n-3 PUFA in pregnant Japanese women of the cohort study.

DOI： 10.1186/s12199-017-0636-5

Fermented food consumption and psychological distress in pregnant women: A nationwide birth cohort study of the Japan environment and children’s study Open Access

Takahashi F., Nishigori H., Nishigori T., Mizuno S., Obara T., Metoki H., Sakurai K., Ishikuro M., Iwama N., Tatsuta N., Nishijima I., Fujiwara I., Arima T., Nakai K., Sugiyama T., Kuriyama S., Yaegashi N., Saito H., Kishi R., Hashimoto K., Mori C., Hirahara F., Yamagata Z., Inadera H., Kamijima M., Konishi I., Iso H., Shima M., Ogawa T., Suganuma N., Kusuhara K., Katoh T.

Tohoku Journal of Experimental Medicine 240 巻 ( 4 ) 頁： 309 - 321 2016年12月

出版者・発行元：Tohoku Journal of Experimental Medicine

Health benefits of fermented foods are attracting attention worldwide, and they have been traditionally eaten in Japan. Moreover, a recent study showed the association between the higher intake of yogurt and lower prevalence of depressive symptoms during pregnancy. Psychological problems, such as anxiety and depression, during pregnancy are serious health concerns and may increase the risk of adverse outcomes in children. In this study, we explored the association between fermented food consumption and psychological distress in 10,129 pregnant Japanese women, using the fixed data of the Japan Environment and Children’s Study (JECS), an ongoing nation-wide birth cohort study. Food consumption was assessed with a semi-quantitative food frequency questionnaire (FFQ), and the Kessler 6-item psychological distress scale (K6) was administered to eligible women during their second or third trimester to eliminate overlap with the period of hyperemesis gravidarum. The mean median gestation in the subjects was 24.8 weeks. In total, 9,030 subjects completed the K6 questionnaire and FFQ. Importantly, the prevalence of the K6 score of ≥ 13 was 3.1% (280 subjects). This value was lower compared to precedent studies, which may reflect that cooperative and health conscious subject participated in the survey. The multivariate logistic regression analysis indicates that the intake of yogurt, lactic acid beverages, cheese, Japanese pickles, miso soup, or fermented soybeans was not significantly associated with a K6 score of ≥ 13. In conclusion, the present cohort study shows no association between fermented food consumption and psychological distress symptoms during the second or third trimester of pregnancy.

DOI： 10.1620/tjem.240.309

委員会報告日本医学教育学会認定医学教育専門家資格制度創設への提言査読有り

藤崎和彦, 田川まさみ, 西城拓也, 井内康輝, 錦織宏, 渡邊洋子, 大谷尚, 守屋利佳, 吉岡俊正, 吉田素文, 鈴木康之

医学教育 43 巻頁： 221 - 231 2012年

日本医学教育学会認定医学教育専門家資格制度創設への提言査読有り

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

医学教育 43 巻 ( 3 ) 頁： 221 - 231 2012年

序章

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

医学教育 = Medical education 40 巻 ( 4 ) 頁： 235 - 236 2009年8月

医学・医療教育学の専門家養成に関するニーズ調査結果査読有り

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： 237 - 241 2009年

記述言語：日本語出版者・発行元：日本医学教育学会

1）日本医学教育学会マスターコース検討委員会は医学・医療教育専門家の教育に関するニーズ調査を実施した． 2) 医学・医療教育機関のリーダー，日本医学教育学会会員など1831名にアンケートを発送し，644名から回答を得た（回収率35.2%）．回答者の過半数は医学教育専門家が必要であると認識しており，求めるレベルとしては認定資格が最も多かったが，修士・博士等のニーズも存在した． 3) これらの結果は日本においても医学・医療教育学の専門家を育成するシステムの構築を進める必要性を支持するものである．

DOI： 10.11307/mededjapan.40.237

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

【地域医療実習・研修でなにを学ぶのか】実際に学ぶこと文化人類学的医療を学ぶ査読有り

総合的に患者・生活者をみるために必要なコンピテンシーとは医学教育モデル・コア・カリキュラムへの新設

藤川裕恭, 安藤崇之, 遠藤周, 金子惇, 鋪野紀好, 長嶺由衣子, 中山健夫, 錦織宏, 山梨啓友, 春田淳志

日本プライマリ・ケア連合学会学術大会 15回巻頁： 333 - 333 2024年6月

An "integration" of professional identity formation among rural physicians experiencing an interplay between their professional and personal identities 査読有り Open Access

Miyachi, J; Iwakuma, M; Nishigori, H

ADVANCES IN HEALTH SCIENCES EDUCATION 2024年5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：Advances in Health Sciences Education

The present understanding of professional identity formation is problematic since it underrepresents minority physicians and potentially excludes their professional identity formation experiences. Rural physicians are expected to have similar underrepresented aspects as minority physicians because of their specific sociocultural contexts and consequent private–professional intersection, which lead to ethical complexities. Therefore, to bridge this research gap, we interviewed 12 early- to mid-career Japanese physicians working in rural areas and explored their experiences. Through a narrative analysis guided by Figured Worlds theory, we analysed the data by focusing on the vocabulary, expressions, and metaphors participants used to describe their experiences. A central theme emerged concerning how the rural physicians configurated their personal versus professional participation in their local communities. Further, their identity narratives varied regarding how they constructed their identities, rural communities, and relationships as well as their identity formation ideals and strategies to achieve them. Informed by ‘Big Questions’ concerning worldview framework, we delineated four identity narratives as prototypes to describe how they participated in their communities. These identity narratives provide a preliminary understanding of how diverse identity formation is for rural physicians. In addition, our findings exposed the current professional identity formation framework as potentially biased towards single forms of participation in monolithic communities, overlooking complicated forms of participation in multiple communities. We argue that applying frameworks and concepts to capture these multiple forms of participation as well as revisiting the ‘discourse of integration’ are necessary steps to overcome the limitation of the current understanding of professional identity formation.

DOI： 10.1007/s10459-024-10337-z

その他リンク： https://link.springer.com/article/10.1007/s10459-024-10337-z/fulltext.html

宮地純一郎, 錦織宏

地域医学 37 巻 ( 9 ) 頁： 879 - 884 2023年9月

記述言語：日本語出版者・発行元：(公社)地域医療振興協会

＜POINT＞(1)文化人類学は現場に自分の生身の体を置くフィールドワーク,参与観察,文脈を踏まえた視点,自己相対化と自己変容を特徴とした学問である(2)文化人類学は,文脈にまつわる探究および医療者集団の価値体系と習慣に対する感受性と言語化を通じて臨床実践を変えうる(3)文化人類学の特徴を地域医療教育に加味することで,ただ現場に行くだけでは届かない深み・厚みが生まれうる(著者抄録)

教育実践報告航空業界の安全から医療安全を相対化するFaculty development

木村武司, 種村文孝, 清水郁夫, 錦織宏

医学教育 54 巻 ( Suppl. ) 頁： 199 - 199 2023年7月

職種横断的な内省を通して思いのすれ違いを連携に活かす "多職種連携モヤっと研究会"の取り組み査読有り

佐野樹, 森下真理子, 錦織宏

医学教育 54 巻 ( 3 ) 頁： 281 - 287 2023年6月

記述言語：日本語出版者・発行元：(一社)日本医学教育学会

専門職間で起こる思いのすれ違いを「モヤっと」と名づけ,それを医療/教育現場での連携に活かすため,2014年から研究会を立ち上げた.多施設の多職種で月1回1時間のオンライン研究会を行い,モヤっとした経験について内省を行った.本稿では研究会について振り返る中で,会の発足と歩み,会の中で起きている学習プロセスや根拠となっている理論について述べる.さらに研究会での実践とその変化について共有しつつ,多職種連携(教育)での内省には,専門領域内でする一次内省と,領域の外から自らの専門を見つめる二次内省の両輪が必要であることを示す.(著者抄録)

10. 医学教育モデル・コア・カリキュラム (令和4年度改訂版) 国際発信・医学教育先進国の動向査読有り

矢野晴美, 松山泰, 及川沙耶佳, 菊川誠, 清水郁夫, 野村理, 錦織宏

医学教育 54 巻 ( 2 ) 頁： 194 - 198 2023年4月

記述言語：日本語出版者・発行元：日本医学教育学会

世界で主流のコンピテンシーモデルとして, カナダのCanMEDS 2015, 米国卒後臨床研修諮問機関ACGMEモデル, 英国Tomorrow's Doctorsがある. 文部科学省医学教育モデル・コア・カリキュラム改訂では, 海外調査が実施された. 調査対象国の医学部では上記3つのいずれかが採用されており, これらのモデルの活用は, 柔軟であった. 各大学のカリキュラム・デザイン, 教育の提供の自由度は高いが, 質保証体制として, 各国は世界医学教育連盟 (WFME) などの認証が必要で, 規制されている. また令和4年度改訂版モデル・コア・カリキュラムは英訳され世界に情報発信されている.

DOI： 10.11307/mededjapan.54.2_194

8. 学修評価とGood Practice (2) 査読有り

伊藤彰一, 岡崎仁昭, 小松弘幸, 錦織宏, 松山泰, 山脇正永, 菊川誠, 清水郁夫, 中村真理子, 三谷昌平

医学教育 54 巻 ( 2 ) 頁： 182 - 186 2023年4月

記述言語：日本語出版者・発行元：日本医学教育学会

医学教育モデル・コア・カリキュラム (令和4年度改訂版) で新たに記載された「第3章学修方略・評価」の「II. 学修評価」は, 1. 学修評価の考え方, 2. 学修評価の方法, 3. 学修評価の問いの三部構成となっている. 3. 学修評価の問いでは, 「評価の在り方は教育機関によって異なる」という基本的な考え方にもとづいて, あえて「問い」に対する回答が記載されていない. カリキュラム開発において学修評価を計画する際には, 「 II . 学修評価」の記載を参考にしつつ, カリキュラムの背景や文脈をふまえて検討を重ねていただきたい.

DOI： 10.11307/mededjapan.54.2_182

【Making of医学教育モデル・コア・カリキュラム】資質・能力に新設された総合的に患者・生活者をみる姿勢について査読有り

【Making of医学教育モデル・コア・カリキュラム】資質・能力に新設された総合的に患者・生活者をみる姿勢について査読有り

春田淳志, 安藤崇之, 遠藤周, 金子惇, 鋪野紀好, 長嶺由衣子, 錦織宏, 藤川裕恭, 山梨啓友

医学教育 54 巻 ( 2 ) 頁： 142 - 148 2023年4月

記述言語：日本語出版者・発行元：(一社)日本医学教育学会

少子高齢化社会の背景と令和2年度からの調査を踏まえ,患者の抱える問題を臓器横断的に捉えた上で,心理社会的背景も踏まえた総合的な視点とアプローチの必要性が示され,医学教育モデル・コア・カリキュラム(令和4年改訂版)に総合的に患者・生活者をみる姿勢が資質・能力に新設された.下位目標として「全人的な視点とアプローチ」「地域の視点とアプローチ」「人生の視点とアプローチ」「社会の視点とアプローチ」が位置づけられた.抽象と具体,概念と経験,自己と他者等の視点を統合し,自己の在り方を省察できるような複数の学習理論を踏まえた教育方法が提案された.このような医学教育を通じて,患者・生活者のウェルビーイングが向上することを期待する.(著者抄録)

春田淳志, 安藤崇之, 遠藤周, 金子惇, 鋪野紀好, 長嶺由衣子, 錦織宏, 藤川裕恭, 山梨啓友

医学教育 54 巻 ( 2 ) 頁： 142 - 148 2023年4月

記述言語：日本語出版者・発行元：(一社)日本医学教育学会

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00050&link_issn=&doc_id=20230516210002&doc_link_id=10.11307%2Fmededjapan.54.2_142&url=https%3A%2F%2Fdoi.org%2F10.11307%2Fmededjapan.54.2_142&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Reconstructing the concept of empathy: an analysis of Japanese doctors' narratives of their experiences with illness 査読有り国際誌 Open Access

Morishita, M; Iida, J; Nishigori, H

ADVANCES IN HEALTH SCIENCES EDUCATION 28 巻 ( 1 ) 頁： 87 - 106 2023年3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：Advances in Health Sciences Education

The ability of doctors to empathise with patients is a crucial concern in establishing humanistic medicine. Therefore, the cultivation of this ability has been discussed extensively in medical education. One theory suggests that the experience of patienthood can increase empathy among doctors. This theory is supported by previous research that published doctors’ illness narratives. However, the concept of empathy has been ambiguously defined in academic fields, including medicine; therefore, analysing how doctors experience ‘empathy’ in their interactions with patients is difficult. Our research question is how doctors who became patients describe the relationship between their illness experiences and the interactions with patients after their illness. To this end, this paper initially tracks the debates on ‘empathy’ in medicine and other disciplines, to develop a lens for analysing doctors’ illness narratives. Next, we conduct a narrative analysis of illness stories from 18 Japanese medical doctors who became patients. Our analysis supports the traditional idea that an illness can enable a doctor to become more empathetic. However, this is overly simplistic; how doctors experience and subsequently process their illness is more complex. Moreover, this notion can disregard doctors’ suffering in these circumstances, and fail to represent the often-lengthy process of mastering ‘empathy’ based on their experiences. Therefore, our analysis deconstructed the concept of ‘empathy’, showing that it can appear in various ways. Further research is required to elucidate how empathy is cultivated during the process of transformation of doctors’ illnesses, focusing on their communities and practices.

DOI： 10.1007/s10459-022-10143-5

Psychological safety and Safety-II paradigm for faculty development 査読有り Open Access

Shimizu, I; Lee, SS; Findyartini, A; Shikino, K; Asada, Y; Nishigori, H

ASIA PACIFIC SCHOLAR 7 巻 ( 3 ) 頁： 60 - 62 2022年7月

Locally adapting generic rubrics for the implementation of outcome-based medical education: a mixed-methods approach 査読有り Open Access

Kondo, T; Nishigori, H; van der Vleuten, C

BMC MEDICAL EDUCATION 22 巻 ( 1 ) 頁： 262 2022年4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: Rubrics are frequently used to assess competencies in outcome-based medical education (OBE). The implementation of assessment systems using rubrics is usually realised through years of involvement in projects with various stakeholders. However, for countries or specialities new to OBE, faster and more simplified processes are required. In March 2019, Japan introduced nine competencies and generic rubrics of competencies for medical residents. We explored the local adaptation of these generic rubrics and its consequences for assessors. Methods: The study followed three steps. First, we locally adapted the generic rubrics. This was followed by conducting mixed-method research to explore the effect of the local adaptation. In step two, we examined the correlations between the scores in the locally adapted assessment sheets for supervising doctors and generic rubrics. In step three, we conducted interviews with supervising doctors. The study was conducted in the General Internal Medicine Department of Nagoya University, Japan. In the first step, doctors in the Medical Education Center and other medical departments, clerks, and residents participated. Supervising doctors in the General Internal Medicine Department participated in the second and third steps. Results: A locally adapted assessment system was developed and implemented in seven months. The scores of the generic rubrics and the adapted assessment tool completed by the supervising doctors showed good correlations in some items as opposed to others, assessed mainly with other tools. Participant interviews revealed that local adaptation decreased their cognitive load leading to consistent ratings, increased writing of comments, and promoting reflection on instruction. Conclusions: This adaptation process is a feasible way to begin the implementation of OBE. Local adaptation has advantages over direct use of generic rubrics.

DOI： 10.1186/s12909-022-03352-4

Cultivating cultural awareness among medical educators by integrating cultural anthropology in faculty development: an action research study 査読有り Open Access

Oikawa, S; Iida, J; Ito, Y; Nishigori, H

BMC MEDICAL EDUCATION 22 巻 ( 1 ) 頁： 196 2022年3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: In faculty development, understanding each participant’s cultural context is important. However, there is scarce evidence on how to improve cultural understanding in faculty development. Cultural anthropology is a discipline that focuses on developing cultural self-awareness by understanding different cultures. Professionals from this field can be crucial to the goal of cultivating cultural awareness among medical educators. The aims of this study are to 1) develop and modify cultural anthropology sessions in faculty development and 2) evaluate the effectiveness of these sessions, including their long-term impacts. Methods: The cultural anthropology sessions were organized as part of a longitudinal faculty development program—Foundation Course for Medical Education—at Kyoto University in Japan. The study included 47 medical educators participating in faculty development and three lecturers: two cultural anthropologists and a medical educator. We developed the cultural anthropology sessions and implemented them in the longitudinal faculty development program. In these sessions, cultural anthropologists used inquiry-guided reflection. An action research methodology was employed and repeated in four cycles from 2015 to 2018. Qualitative and quantitative data were collected during the action research cycles. The qualitative data were thematically analyzed. Results: The cultural anthropologists’ inquiries fostered learning during the sessions, and three themes—cultural relativism, attention to context, and reframing—were synthesized. As a long-term impact of the sessions, the learners reported becoming more aware of the cultural contexts in their daily educational and clinical activities. Conclusions: The cultural anthropology sessions in the faculty development program were shown to have enhanced the participants’ awareness of cultural contexts. The concept and format of these sessions may be used more widely in faculty development programs.

DOI： 10.1186/s12909-022-03260-7

その他リンク： https://link.springer.com/article/10.1186/s12909-022-03260-7/fulltext.html

Medical Students' and Trainees' Country-By-Gender Profiles: Hofstede's Cultural Dimensions Across Sixteen Diverse Countries 査読有り Open Access

Monrouxe, LV; Chandratilake, M; Chen, JL; Chhabra, S; Zheng, LB; Costa, PS; Lee, YM; Karnieli-Miller, O; Nishigori, H; Ogden, K; Pawlikowska, T; Riquelme, A; Sethi, A; Soemantri, D; Wearn, A; Wolvaardt, L; Yusoff, MSB; Yau, SY

FRONTIERS IN MEDICINE 8 巻頁： 746288 2022年2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：Frontiers in Medicine

Purpose: The global mobility of medical student and trainee populations has drawn researchers' attention to consider internationalization in medical education. Recently, researchers have focused on cultural diversity, predominately drawing on Hofstede's cross-cultural analysis of cultural dimensions from general population data to explain their findings. However, to date no research has been specifically undertaken to examine cultural dimensions within a medical student or trainee population. This is problematic as within-country differences between gender and professional groups have been identified within these dimensions. We address this gap by drawing on the theoretical concept of national context effects: specifically Hofstede's six-dimensional perspective. In doing so we examine medical students' and trainees' country profiles across dimensions, country-by-gender clustering, and differences between our data and Hofstede's general population data. Methods: We undertook a cross-cultural online questionnaire study (eight languages) containing Hofstede's 2013 Values Survey. Our questionnaire was live between 1st March to 19th Aug 2018, and December 2018 to mitigate country holiday periods. We recruited undergraduate medical students and trainees with at least 6-months' clinical training using school-specific methods including emails, announcements, and snowballing. Results: We received 2,529 responses. Sixteen countries were retained for analyses (n = 2,307, 91%): Australia, Chile, China, Hong Kong, India, Indonesia, Ireland, Israel, Japan, Malaysia, New Zealand, Pakistan, South Africa, South Korea, Sri-Lanka, Taiwan. Power distance and masculinity are homogenous across countries. Uncertainty avoidance shows the greatest diversity. We identified four country clusters. Masculinity and uncertainty are uncorrelated with Hofstede's general population data. Conclusions: Our medical student and trainee data provides medical education researchers with more appropriate cultural dimension profiles than those from general population data. Country cluster profiles stimulate useful hypotheses for further research, especially as patterning between clusters cuts across traditional Eastern-Western divides with national culture being stronger than gendered influences. The Uncertainty dimension with its complex pattern across clusters is a particularly fruitful avenue for further investigation.

DOI： 10.3389/fmed.2021.746288

Advancing the science of health professions education through a shared understanding of terminology: a content analysis of terms for "faculty" 査読有り Open Access

Teunissen, PW; Atherley, A; Cleland, JJ; Holmboe, E; Hu, WCY; Durning, SJ; Nishigori, H; Samarasekera, DD; Schuwirth, L; van Schalkwyk, S; Maggio, LA

PERSPECTIVES ON MEDICAL EDUCATION 11 巻 ( 1 ) 頁： 22 - 27 2022年1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：Perspectives on Medical Education

Introduction: Health professions educators risk misunderstandings where terms and concepts are not clearly defined, hampering the field’s progress. This risk is especially pronounced with ambiguity in describing roles. This study explores the variety of terms used by researchers and educators to describe “faculty”, with the aim to facilitate definitional clarity, and create a shared terminology and approach to describing this term. Methods: The authors analyzed journal article abstracts to identify the specific words and phrases used to describe individuals or groups of people referred to as faculty. To identify abstracts, PubMed articles indexed with the Medical Subject Heading “faculty” published between 2007 and 2017 were retrieved. Authors iteratively extracted data and used content analysis to identify patterns and themes. Results: A total of 5,436 citations were retrieved, of which 3,354 were deemed eligible. Based on a sample of 594 abstracts (17.7%), we found 279 unique terms. The most commonly used terms accounted for approximately one-third of the sample and included faculty or faculty member/s (n = 252; 26.4%); teacher/s (n = 59; 6.2%) and medical educator/s (n = 26; 2.7%) were also well represented. Content analysis highlighted that the different descriptors authors used referred to four role types: healthcare (e.g., doctor, physician), education (e.g., educator, teacher), academia (e.g., professor), and/or relationship to the learner (e.g., mentor). Discussion: Faculty are described using a wide variety of terms, which can be linked to four role descriptions. The authors propose a template for researchers and educators who want to refer to faculty in their papers. This is important to advance the field and increase readers’ assessment of transferability.

DOI： 10.1007/s40037-021-00683-8

その他リンク： https://link.springer.com/article/10.1007/s40037-021-00683-8/fulltext.html

A scoping review of clinical reasoning research with Asian healthcare professionals. 査読有り Open Access

Lee CY, Jenq CC, Chandratilake M, Chen J, Chen MM, Nishigori H, Wajid G, Yang PH, Yusoff MSB, Monrouxe L

Advances in health sciences education : theory and practice 26 巻 ( 5 ) 頁： 1555 - 1579 2021年12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：Advances in Health Sciences Education

Clinical reasoning is the thought process that guides practice. Although a plethora of clinical reasoning studies in healthcare professionals exists, the majority appear to originate from Western cultures. A scoping review was undertaken to examine clinical reasoning related research across Asian cultures. PubMed, SciVerse Scopus, Web of Science and Airiti Library databases were searched. Inclusion criteria included full-text articles published in Asian countries (2007 to 2019). Search terms included clinical reasoning, thinking process, differential diagnosis, decision making, problem-based learning, critical thinking, healthcare profession, institution, medical students and nursing students. After applying exclusion criteria, n = 240 were included in the review. The number of publications increased in 2012 (from 5%, n = 13 in 2011 to 9%, n = 22) with a steady increase onwards to 12% (n = 29) in 2016. South Korea published the most articles (19%, n = 46) followed by Iran (17%, n = 41). Nurse Education Today published 11% of the articles (n = 26), followed by BMC Medical Education (5%, n = 13). Nursing and Medical students account for the largest population groups studied. Analysis of the articles resulted in seven themes: Evaluation of existing courses (30%, n = 73) being the most frequently identified theme. Only seven comparative articles showed cultural implications, but none provided direct evidence of the impact of culture on clinical reasoning. We illuminate the potential necessity of further research in clinical reasoning, specifically with a focus on how clinical reasoning is affected by national culture. A better understanding of current clinical reasoning research in Asian cultures may assist curricula developers in establishing a culturally appropriate learning environment.

DOI： 10.1007/s10459-021-10060-z

【医学・医療者教育学を学ぶ我が国のプログラム】京大FCME(ふくみん) 現場で働く指導医のための医学教育学プログラム基礎編

その他リンク： https://link.springer.com/article/10.1007/s10459-021-10060-z/fulltext.html

錦織宏, 及川沙耶佳, 谷昇子, 木村武司, 種村文孝

医学教育 52 巻 ( 6 ) 頁： 515 - 523 2021年12月

記述言語：日本語出版者・発行元：(一社)日本医学教育学会

2015年に文部科学省の助成を受けて開講した京都大学の「現場で働く指導医のための医学教育学プログラム-基礎編」は対面型と遠隔型を組み合わせた形で医学教育学を体系的に学ぶプログラムである。1年間で約120時間学修することになる受講生は、課題に追われながらも12名の仲間と強固な学修コミュニティを形成していき、その様は講師が羨むほどである。また、プログラムに思想・哲学を掲げていること、そして文化人類学を重視したプログラムであることが特徴である。(著者抄録)

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00050&link_issn=&doc_id=20220112190004&doc_link_id=10.11307%2Fmededjapan.52.6_515&url=https%3A%2F%2Fdoi.org%2F10.11307%2Fmededjapan.52.6_515&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

52巻3号掲載「拘束からの解放―反転授業を活用した完全オンライン型臨床研修指導医講習会―」を読んで, への応答査読有り

近藤猛, 錦織宏

医学教育 52 巻 ( 5 ) 頁： 450 - 451 2021年10月

外科系医師はどのようにして医学教育のキャリアを形成していくのか? 臨床医から、臨床医の教育、そして医学教育学へ医学教育学を学ぶ産婦人科医として査読有り

磯部真倫, 榎本隆之, 錦織宏

医学教育 52 巻 ( Suppl. ) 頁： 37 - 37 2021年7月

Lists of potential diagnoses that final-year medical students need to consider: a modified Delphi study 査読有り Open Access

Urushibara-Miyachi, Y; Kikukawa, M; Ikusaka, M; Otaki, J; Nishigori, H

BMC MEDICAL EDUCATION 21 巻 ( 1 ) 頁： 234 2021年4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: Contrastive learning is known to be effective in teaching medical students how to generate diagnostic hypotheses in clinical reasoning. However, there is no international consensus on lists of diagnostic considerations across different medical disciplines regarding the common signs and symptoms that should be learned as part of the undergraduate medical curriculum. In Japan, the national model core curriculum for undergraduate medical education was revised in 2016, and lists of potential diagnoses for 37 common signs, symptoms, and pathophysiology were introduced into the curriculum. This study aimed to validate the list of items based on expert consensus. Methods: The authors used a modified Delphi method to develop consensus among a panel of 23 expert physician-teachers in clinical reasoning from across Japan. The panel evaluated the items on a 5-point Likert scale, based on whether a disease should be hypothesized by final-year medical students considering given signs, symptoms, or pathophysiology. They also added other diseases that should be hypothesized. A positive consensus was defined as both a 75% rate of panel agreement and a mean of 4 or higher with a standard deviation of less than 1 on the 5-point scale. The study was conducted between September 2017 and March 2018. Results: This modified Delphi study identified 275 basic and 67 essential other than basic items corresponding to the potential diagnoses for 37 common signs, symptoms, and pathophysiology that Japanese medical students should master before graduation. Conclusions: The lists developed in the study can be useful for teaching and learning how to generate initial hypotheses by encouraging students’ contrastive learning. Although they were focused on the Japanese educational context, the lists and process of validation are generalizable to other countries for building national consensus on the content of medical education curricula.

DOI： 10.1186/s12909-021-02652-5

その他リンク： https://link.springer.com/article/10.1186/s12909-021-02652-5/fulltext.html

A Collaborative Clinical Case Conference Model for Teaching Social and Behavioral Science in Medicine: An Action Research Study 査読有り

Junichiro Miyachi, Junko Iida, Yosuke Shimazono, Hiroshi Nishigori

2021年2月

出版者・発行元：Research Square Platform LLC

<title>Abstract</title>
<bold>Background: </bold>Effective social and behavioral sciences teaching in medical education requires integration with clinical experience, as well as collaboration with social and behavioral sciences experts and clinical faculties. However, teaching models for achieving this integration have not been adequately established, nor has the collaboration process been described. This study aims to propose a collaborative clinical case conference model to integrate social and behavioral sciences and clinical experience. Additionally, we describe how social and behavioral science experts and clinical faculties collaborate during the development of the teaching method.<bold>Methods:</bold> A team of clinical teachers and medical anthropologists planned for the development of a case conference based on action research methodology. The initial model planned for a 3-hour session, similar to the Clinicopathological Conference structure. We evaluated each session based on fieldnotes taken by medical anthropologists, and post-session questionnaires that surveyed participants’ reactions and points of improvements. Based on the evaluation, a reflective meeting was held to discuss revisions for the next trial. We incorporated the development process into undergraduate medical curricula in clinical years and in a postgraduate and continuous professional development session for residents and certified family physicians in Japan. We repeated the plan-act-observe-reflection process more than 15 times between 2015 and 2018.<bold>Results:</bold> The development of the collaborative clinical case conference model is summarized in three phases: Quasi-CPC, Interactive, and Co-constructive with unique structures and underlying paradigms. The model successfully contributed to promoting the participants’ recognition of the clinical significance of social and behavioral sciences. The case preparation entailed a unique, significant learning of how social and behavioral sciences inform clinical practice. The model development process promoted the mutual understanding between clinical faculties and anthropologists, which might function as faculty development for teachers involved in social and behavioral sciences teaching in medical education. <bold>Conclusions:</bold> The application of fitting conference models and awareness of their underlying paradigm according to educational situations could promote the integration of social and behavioral sciences with clinical medicine education. Faculty development in social and behavioral sciences in medical education should focus on collaboration with scholars with different paradigmatic orientations.

DOI： 10.21203/rs.3.rs-138564/v1

その他リンク： https://www.researchsquare.com/article/rs-138564/v1.html

Correlation between the number oflaparoscopy-qualifiedgynecologists and the proportion of laparoscopic surgeries for benign gynecological diseases in Japan: An ecological study 査読有り国際誌

Isobe, M; Kataoka, Y; Chikazawa, K; Hada, T; Nishigori, H; Takahashi, T; Enomoto, T

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH 47 巻 ( 1 ) 頁： 329 - 336 2021年1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：Journal of Obstetrics and Gynaecology Research

Aim: We aimed to evaluate regional disparities in the proportion of the three main laparoscopic surgeries for benign gynecological diseases among 47 prefectures in Japan and their correlation with the number of laparoscopy-qualified gynecologists per population. Methods: In this retrospective ecological study, we collected the data of patients from 47 prefectures in 2017 using “The National Database of Health Insurance Claims and Specific Health Checkups of Japan” Open Data from the Ministry of Health, Labor and Welfare in Japan. The primary outcome of the study was the proportion of laparoscopic surgeries conducted for benign gynecologic diseases (hysterectomy, myomectomy and surgery for the benign ovarian diseases). The main exposure was the number of laparoscopy-qualified gynecologists per 100 000 females. Results: The average proportion of laparoscopic hysterectomies, myomectomies and surgeries for the benign ovarian disease were 38% (standard deviation (SD) 16, range 12–74), 48% (SD 18, range 9–81) and 60% (SD 11, range 36–79), respectively. Multiple regression analysis showed a significant correlation between the number of laparoscopy-qualified gynecologists per 100 000 females and the proportion of the three main laparoscopic surgeries. Conclusion: There are obvious regional disparities in the proportion of the three main laparoscopic procedures for benign gynecological diseases among 47 prefectures. The number of laparoscopy-qualified gynecologists correlated significantly with these regional disparities. The academic society should monitor these regional disparities and make an effort to reduce these regional disparities by increasing laparoscopy-qualified gynecologists in areas where the widespread use of laparoscopic techniques is lagging.

DOI： 10.1111/jog.14528

Continuing medical education during pandemic waves of COVID-19: Consensus from medical faculties in Asia, Australia and Europe. 査読有り

Wong C, van den Broek W, Doody G, Fischer M, Leech M, De Ponti F, Gerbes A, Nishigori H, Lee YM, Frens M, Kasuya H, Bazzoli F, Hickel R, Lee HS, van Leeuwen JPTM, Mitchell C, Kadomatsu K, Atherton J, Chan F

MedEdPublish (2016) 10 巻 ( 1 ) 頁： 64 2021年

Development of entrustable professional activities for residents rotating nephrology department in a Japanese university hospital: a Delphi study 査読有り Open Access

Tanaka, A; Kondo, T; Urushibara-Miyachi, Y; Maruyama, S; Nishigori, H

BMJ OPEN 11 巻 ( 8 ) 頁： e047923 - e047923 2021年

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

Objectives Training strategies regarding entrustable professional activities (EPAs) vary from country to country; one such strategy is for residents. However, there are no reports of EPAs developed for residents who rotate to the nephrology departments. We aimed to construct such EPAs, which could be generalised to other institutions. Design Purposive design and a modified Delphi method to build consensus. Setting The department of nephrology in a university hospital in Aichi Prefecture, Japan. Participants Based on the attainment goals used in our department, an initial list was developed within the research group. The expert panel included 25 nephrologists from our affiliate hospital. Responses were based on a 5-point method and agreement was reached if both (A) and (B) were met: (A) mean≥4 with a SD <1; (B) more than 75% of respondents rated the item 4 or more. With agreement, the item was left for the next round. This round was repeated. Results An initial list of 11 items was developed; after three Delphi rounds and revisions, eight items remained that were then established as the final EPAs. These items can serve as a list of goals to be reached by residents who rotate to the department of nephrology. The results indicated that most of the experts believed residents should be able to perform tasks deemed necessary or urgent for all physicians, such as those that deal with hyperkalaemia and heart failure. Conclusions The concept of EPAs enabled us to develop goals and evaluation criteria for residents' training in nephrology. This study can serve as a springboard for future discussions and contribute to the development of resident education in nephrology.

DOI： 10.1136/bmjopen-2020-047923

Problem-Based Learning in Child and Adolescent Psychiatry: A Perspective from Japan 査読有り Open Access

Iwatsuki, J; Kondo, T; Takahashi, N; Takami, H; Nishigori, H; Bustos-Villalobos, I; Aleksic, B; Kasuya, H; Ban, NO; Yagi, T; Skokauskas, N

ADVANCES IN MEDICAL EDUCATION AND PRACTICE 12 巻頁： 1329 - 1335 2021年

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

Purpose: Japanese higher education institutions have long been striving for the globaliza-tion of medical education. Nagoya University (NU) adopted PBL as a means of enhancing intercultural awareness in globalizing medical education by working with the Norwegian University of Science and Technology (NTNU), Faculty of Medicine and Health Science, under the Trondheim NTNU-Nagoya (TroNa) partnership for mobility and internationaliza-tion of child and mental health studies. This study aims to assess students’ attitudes towards PBL and to suggest future developments in this form of education by introducing common PBL scenarios experienced at NTNU and NU. Methods: Two 90-minute PBL sessions were conducted at NU. Ten groups of medical students were formed, each consisting of up to 10 students, and students were asked to fill in a questionnaire developed to assess their understanding of, attitudes to and satisfaction with the classes. We investigated three different groups of questions on: NU medical students’ general impressions of PBL; their impressions of PBL in child and adolescent psychiatry (CAP); and their impressions of PBL in specific case scenarios. Correlations between each of the questions from the three groups were evaluated using multivariate analysis. Results: Overall, a majority of the NU medical students were satisfied with PBL, while a small number preferred traditional lecture-style learning (5%). More than half of the students agreed that PBL increased their understanding and interest in CAP (53%), although some male students felt that the amount of time spent was insufficient (20.3%). Correlations were seen for students who thought that PBL enhanced their understanding of and interest in CAP. Regarding case scenarios, most students (82.5%) agreed that PBL helped them to develop clinical problem-solving skills. Conclusion: The study found an overall positive attitude towards PBL, PBL in CAP and the specific PBL case scenario presented.

DOI： 10.2147/AMEP.S333958

Differential Diagnoses That Final-Year Medical Students Need to Consider: A Modified Delphi Study 査読有り

Yuka Urushibara-Miyachi, Makoto Kikukawa, Masatomi Ikusaka, Junji Otaki, Hiroshi Nishigori

BMC Medical Education 2020年12月

担当区分：最終著者記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Research Square

<title>Abstract</title>
<bold>Background</bold>: Contrastive learning is known to be effective in teaching medical students how to generate diagnostic hypotheses in clinical reasoning. However, there is no consensus on comprehensive lists of differential diagnoses across different medical disciplines regarding the common symptoms that should be learned as part of the undergraduate medical curriculum. In Japan, the national model core curriculum for undergraduate medical education was revised in 2016, and lists of differential diagnoses for 37 common symptoms were introduced into the curriculum. This study aimed to validate the list of items based on expert consensus for use as a reference worldwide.<bold>Methods</bold>: The authors used a modified Delphi method to develop consensus among a panel of 23 expert physician-teachers in clinical reasoning from across Japan. The panel evaluated the items on a 5-point Likert scale, based on whether a disease should be hypothesized by final-year medical students considering a given symptom. They also added other diseases that should be hypothesized. A positive consensus was defined as both a 75% rate of panel agreement and a mean of 4 or higher with a standard deviation of less than 1 on the 5-point scale. The study was conducted between September 2017 and March 2018. <bold>Results</bold>: This modified Delphi study identified 275 essential and 67 supplemental items corresponding to the differential diagnoses for 37 common symptoms that Japanese medical students should master before graduation. <bold>Conclusions</bold>: The lists developed in the study can be useful for teaching and learning how to generate initial hypotheses by encouraging students’ contrastive learning. Although the lists may be specific to the Japanese context, the lists and process of validation are generalizable to other countries for building national consensus on the content of medical education curricula.

DOI： 10.21203/rs.3.rs-127514/v1

その他リンク： https://www.researchsquare.com/article/rs-127514/v1.html

The number of overall hysterectomies per population with the perimenopausal status is increasing in Japan: A national representative cohort study 査読有り

Isobe, M; Kataoka, Y; Chikazawa, K; Nishigori, H; Takahashi, T; Enomoto, T

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH 46 巻 ( 12 ) 頁： 2651 - 2661 2020年12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：Journal of Obstetrics and Gynaecology Research

Aim: This study aimed to investigate the trends in overall hysterectomy and other alternative therapies for benign uterine diseases per population aged 40–54 years in Japan. Methods: We conducted a national representative cohort study in Japan. We obtained data from ‘The National Database of Health Insurance Claims and Specific Health Checkups of Japan’ Open Data. The primary outcome was the number of overall hysterectomies for benign gynecologic diseases per population aged 40–54 years, from 2014 to 2017 in Japan. The secondary outcome was the number of alternative surgical and drug therapies to hysterectomy per population. We also analyzed the correlation between the number of laparoscopy-qualified gynecologists and the number of overall hysterectomies per population among 47 prefectures in 2017. Results: The number of overall hysterectomies for benign gynecological diseases per 100 000 females aged 40–54 years gradually increased from 320 in 2014 to 344 in 2017 (7.5% increase overall). Moreover, there was a significant increase in the use of levonorgestrel intrauterine systems. We could not explain the reason for this increase in the rate of overall hysterectomies by summarizing the increase or decrease of alternative therapies to hysterectomy. Multiple regression analysis showed a significant correlation between the number of laparoscopy-qualified gynecologists and the number of overall hysterectomies among 47 prefectures. Conclusion: Despite the spread of alternative therapies to hysterectomy, there was an increasing trend for overall hysterectomies in Japan. The reason was not clear but may be related to the spread of laparoscopic hysterectomy.

DOI： 10.1111/jog.14517

Failure or adaptation? - Redefining PBL from the perspective of the Safety II paradigm 査読有り国際誌

Shimizu, I; Nishigori, H

MEDICAL TEACHER 42 巻 ( 9 ) 頁： 1076 - 1077 2020年9月

Admission policies and methods at crossroads: a review of medical school admission policies and methods in seven Asian countries. 査読有り国際誌 Open Access

Soemantri D, Karunathilake I, Yang JH, Chang SC, Lin CH, Nadarajah VD, Nishigori H, Samarasekera DD, Lee SS, Tanchoco LR, Ponnamperuma G

Korean journal of medical education 32 巻 ( 3 ) 頁： 243 - 256 2020年9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：Korean Journal of Medical Education

Selecting the right applicants is an important part of medical student admission. While one universally accepted selection criterion is academic capacity, there are other criteria such as communication skills and local criteria (e.g., socio-cultural values) that are no less important. This article reviews the policies and methods of selection to medical schools in seven countries with varying socio-economic conditions and healthcare systems. Senior academics involved in medical education in Indonesia, Japan, Malaysia, the Philippines, Singapore, Sri Lanka, and Taiwan completed a pre-agreed pro-forma per each country to describe the country's admission policies and methods. The details were then compared and contrasted. This review identifies tension between many of the policies and methods used in medical school admissions, such as between the need to assess non-cognitive abilities and widen access, and between the need for more medical professionals and the requirement to set high entry standards. Finding the right balance requires careful consideration of all variables, including the country's human resource needs; socio-economic status; graduates' expected competencies; and the school's vision, mission, and availability of resources.

DOI： 10.3946/kjme.2020.169

目標・方略・評価を基盤とした卒後・専門教育のあり方〜現状とあるべき姿〜産婦人科領域における臨床研修医教育、専攻医教育、サブスペシャリティ教育における現状と問題点査読有り

Entrustable professional activity(EPA)を用いた、腎臓内科を研修する初期臨床研修医の到達目標と評価基準の作成査読有り

田中章仁, 近藤猛, 宮地由佳, 丸山彰一, 錦織宏

日本腎臓学会誌 62 巻 ( 4 ) 頁： 375 - 375 2020年7月

磯部真倫, 錦織宏, 榎本隆之

医学教育 51 巻 ( Suppl. ) 頁： 42 - 42 2020年7月

EPAを用いた老年医学分野における初期臨床研修到達目標の開発査読有り

渡邊一久, 近藤猛, 葛谷雅文, 錦織宏

医学教育 51 巻 ( Suppl. ) 頁： 207 - 207 2020年7月

Faculty development in medical education: an environmental scan in countries within the Asia pacific region. 査読有り国際誌 Open Access

Samarasekera DD, Lee SS, Findyartini A, Mustika R, Nishigori H, Kimura S, Lee YM

Korean journal of medical education 32 巻 ( 2 ) 頁： 119 - 130 2020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：Korean Journal of Medical Education

Purpose: In recent years, faculty development (FD) research is more noticeable within an inter-professional context and in allied health education. However, there is a paucity of published literature on FD medical education programs in Asia. With the formation of the Asia Pacific Medical Education Network (APME-Net) in 2015, a scoping review of an environmental scan of FD medical education programs in main institutions in South East Asia and Australia in 2018 was conducted. Methods: A survey was developed to collect data on FD in medical education after several rounds of discussion with APME-Net members. The representatives from nine countries in Asia and Australia were invited to partner in this research project. They sent the questionnaire to the Dean of all different medical schools after ethical clearance. The data collected was analyzed using descriptive statistics. Results: Only institutions in four countries responded to the questionnaire. The medical/health professions education center/department/unit has been established in most educational institutions in these countries. These centers/departments/units mostly carry out FD programs to improve the teaching and learning skills of trained participants, particularly clinical teachers via workshops and seminars. Staffing issues and participant buy-in are the current key priorities of the center/department/unit in terms of FD. Lastly, research related FD program has not been well-supported in these countries, hence, the lack of publication in this area. Conclusion: Collaboration between countries to address key areas of interest and develop more standardized and productive FD medical education is required especially in research.

DOI： 10.3946/kjme.2020.160

Doctors' experience of becoming patients and its influence on their medical practice: A literature review.

Morishita M, Iida J, Nishigori H

Explore (New York, N.Y.) 16 巻 ( 3 ) 頁： 145 - 151 2020年5月

Doctors' experience of becoming patients and its influence on their medical practice: A literature review

Morishita Mariko, Iida Junko, Nishigori Hiroshi

EXPLORE-THE JOURNAL OF SCIENCE AND HEALING 16 巻 ( 3 ) 頁： 145-151 2020年

Current State and Future Opportunities for Continuing Medical Education in Japan. 査読有り国際誌

Sherman L, Nishigori H

Journal of European CME 9 巻 ( 1 ) 頁： 1729304 - 1729304 2020年

Doctors as objects of worship: Reconsidering doctors’ competency based on cultural context 査読有り Open Access

Morishita M., Nishigori H.

Asia Pacific Scholar 4 巻 ( 3 ) 頁： 99 - 101 2019年9月

A two-edged sword: Narrative inquiry into Japanese doctors’ intrinsic motivation 査読有り Open Access

H Nishigori, T Suzuki, T Matsui, J Busari, T Dornan

TAPS 4 巻 ( 3 ) 頁： 24 - 32 2019年9月

掲載種別：研究論文（学術雑誌）出版者・発行元：Asia Pacific Scholar

Introduction: Although retaining a healthy and motivated medical workforce is becoming an intractable problem, the intrinsic motivation that keeps doctors working for patients remains under-investigated. The 2011 Tōhoku earthquake and tsunami provided a unique opportunity for culturally situated research into doctors’ intrinsic motivation. The purpose of this study was to answer the research question: what motivates doctors to work for patients above and beyond expectations? Methods: This paper reports a qualitative inquiry informed by semi-structured individual interviews with 15 Japanese doctors who had joined disaster relief activities, which uses the Bushido virtue code as a conceptual framework. The authors read transcripts repeatedly and conducted a cross-case analysis to identify final themes and illustrative narratives. Results: A young doctor wanted to learn by testing out his capabilities. A senior doctor yearned to be of value to others. Other participants told how identifying with victims motivated them. There were negative as well as positive motivations, exemplified by a participant whose sense that well-educated people had a duty to help was coupled with a wish to avoid being blamed by others. Discussion: Volunteering met participants’ needs for self-esteem by restoring their relationships with patients to ones in which they had some measure of control. But avoiding being blamed or losing Meiyo (Honour) also motivated physicians to volunteer. Reinforcing the satisfaction of a job well done may help offset the lack of control, guilt, and shame that too easily results from the relentless pressures of workload and external accountability in today’s healthcare systems.

DOI： 10.29060/taps.2019-4-3/oa2063

医学教育分野の学術的国際交流に関する省察的記述文化進化主義から文化相対主義への変遷

Current status of medical education research in Japan: A meta-epidemiological investigation 査読有り

Yuki Kataoka, Hiraku Tsujimoto, Yasushi Tsujimoto, Yuka Urushibara-Miyachi, Yuda Miyamoto, Hideto Yasuda, Hiromitsu Yamashita, Ryohei Yamamoto, Hiroshi Nishigori

The Asia Pacific Scholar 4 巻 ( 2 ) 頁： 7 - 13 2019年5月

「将来構想に関する若手ワーキンググループ」の委員会報告について序文査読有り

鈴木康之, 錦織宏, 片岡裕貴, 宮地由佳, 蓮沼直子, 大槻眞嗣, 飯田淳子, 淺田義和

医学教育 50 巻 ( 1 ) 頁： 1 - 1 2019年

【医学教育における国際協力】タイ王国CPIRDのECMEにおける国際協働

錦織宏, 及川沙耶佳, 松山泰, 藤原広臨, 宮地由佳, 柴原真知子, 春田淳志, 宮地純一郎, 茂木恒俊, 加藤浩晃, 谷昇子, 伊藤和史, 西城卓也, 飯田淳子, 大谷尚, 小西靖彦, Arora Rajin, Sriruksa Kanokwan

医学教育 49 巻 ( 4 ) 頁： 283 - 287 2018年8月

【医学教育における国際協力】タイ王国CPIRDのECMEにおける国際協働査読有り

医学教育 49 巻 ( 4 ) 頁： 283 - 287 2018年8月

Translation and cultural adaptation of the Japanese version of the interprofessional facilitation scale. 査読有り国際誌

Haruta J, Breugelmans R, Nishigori H

Journal of interprofessional care 32 巻 ( 3 ) 頁： 321 - 328 2018年5月

National survey of international electives for global health in undergraduate medical education in Japan, 2011-2014. 査読有り

Suzuki T, Nishigori H

Nagoya journal of medical science 80 巻 ( 1 ) 頁： 79 - 90 2018年2月

臨床症例検討会を通じた文化人類学教育行動科学・社会科学教育の新しい形(その3) 査読有り

飯田淳子, 宮地純一郎, 島薗洋介, 錦織宏

医学教育 48 巻 ( Suppl. ) 頁： 156 - 156 2017年8月

How do healthcare professionals and lay people learn interactively? A case of transprofessional education. 査読有り

Haruta J, Kitamura K, Nishigori H

The Asia Pacific Scholar 2 巻 ( 3 ) 2017年

宮地純一郎, 錦織宏

医学教育 47 巻 ( Suppl. ) 頁： 192 - 192 2016年7月

A Potential Use for Manga in Medical Education. 査読有り国際誌

Hiroaki Kato, Hiroshi Nishigori

Academic medicine : journal of the Association of American Medical Colleges 91 巻 ( 3 ) 頁： 290 - 290 2016年3月

Physical Examination and the Physician-patient Relationship: A Literature Review. 査読有り

Iida J, Nishigori H

MedEdPublish 5 巻 ( 3 ) 頁： 14 2016年

Beyond work-hour restrictions: a qualitative study of residents' subjective workload. 査読有り国際誌

Hiroshi Nishigori, Gautam A Deshpande, Haruo Obara, Osamu Takahashi, Jamiu Busari, Tim Dornan

Perspectives on medical education 4 巻 ( 4 ) 頁： 176 - 80 2015年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Following the introduction of work-hour restrictions, residents' workload has become an important theme in postgraduate training. The efficacy of restrictions on workload, however, remains controversial, as most research has only examined objective workload. The purpose of this study was to explore the less clearly understood component of subjective workload and, in particular, the factors that influenced residents' subjective workload. METHOD: This study was conducted in Japan at three community teaching hospitals. We recruited a convenience sample of 31 junior residents in seven focus groups at the three sites. Audio-recorded and transcribed data were read iteratively and analyzed thematically, identifying, analyzing and reporting themes within the data and developing an interpretive synthesis of the topic. RESULTS: Seven factors influenced residents' subjective workload: (1) interaction within the professional community, (2) feedback from patients, (3) being in control, (4) professional development, (5) private life, (6) interest and (7) protected free time. DISCUSSION AND CONCLUSION: Our findings indicate that residents who have good interaction with colleagues and patients, are competent enough to control their work, experience personal development through working, have greater interest in their work, and have fulfilling private lives will have the least subjective workload.

DOI： 10.1007/s40037-015-0198-4

Why do students participate in medical education? 査読有り国際誌

Hirohisa Fujikawa, Jeffery Wong, Hiroki Kurihara, Kiyoshi Kitamura, Hiroshi Nishigori

The clinical teacher 12 巻 ( 1 ) 頁： 46 - 9 2015年2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：Blackwell Publishing Ltd

BACKGROUND: Medical student involvement in curriculum development is important; however, little is known about why medical students become engaged in this activity. The aim of this study was to understand what motivates medical students at one university to participate in the process of curriculum development and gain a wider perspective on student engagement in medical education. METHODS: Grounded theory methodology was the foundation of this study. We conducted semi-structured interviews with seven medical students from the University of Tokyo who developed and participated in a group whose aim was to actively contribute towards improving their medical education. The data from the interviews were analysed by thematic synthesis, with triangulation. RESULTS: Three themes emerged as potential explanations for motivating student behaviour: (1) extracurricular interaction with faculty members; (2) engaging with highly motivated peers; and (3) student values for serving the public. CONCLUSIONS: Students working to improve educational processes at their medical schools had the opportunity to communicate more with faculty members, enjoyed opportunities for networking with other highly motivated peers and enhanced aspects of their developing professionalism.

DOI： 10.1111/tct.12240

鑑別診断を考えながら行う身体診察(HDPE)の教材作成用オンラインシステムの開発

意見 : 非眼科医の眼科診察における学習目標に関しての考察

加藤浩晃, 錦織宏

医学教育 46 巻 ( 5 ) 頁： 436 - 437 2015年

記述言語：日本語出版者・発行元：日本医学教育学会

医学生, 初期研修医やプライマリ・ケア医の学習目標の指針である, 医学教育モデル・コア・カリキュラムや卒後臨床研修制度における臨床研修の到達目標, 日本プライマリ・ケア連合学会基本研修ハンドブックにおいて眼底診察の必要性が述べられているが, 眼底診察に比べると前眼部診察を行う機会が多く, 非眼科医の眼科診療における学習目標として眼底診察よりも, 角膜, 結膜, 水晶体, 眼瞼を診察する前眼部診察をより重視する必要があると考える.

DOI： 10.11307/mededjapan.46.5_436

アウトカム不在の学士入学制度におけるProfessional Identityの確立東京大学のケース査読有り

佐々木那津, 錦織宏

医学教育 45 巻 ( Suppl. ) 頁： 121 - 121 2014年7月

大滝純司, 錦織宏, 増田浩三, 菊川誠, 川島篤志

日本シミュレーション医療教育学会雑誌 2 巻頁： 81 - 81 2014年6月

Bushido and medical professionalism in Japan. 査読有り国際誌

Hiroshi Nishigori, Rebecca Harrison, Jamiu Busari, Tim Dornan

Academic medicine : journal of the Association of American Medical Colleges 89 巻 ( 4 ) 頁： 560 - 3 2014年4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：LIPPINCOTT WILLIAMS & WILKINS

Medical professionalism has become a core topic in medical education. As it has been considered mostly from a Western perspective, there is a need to examine how the same or similar concepts are reflected in a wider range of cultural contexts. To gain insights into medical professionalism concepts in Japanese culture, the authors compare the tenets of a frequently referenced Western guide to professionalism (the physician charter proposed by the American Board of Internal Medicine Foundation, American College of Physicians Foundation, and the European Federation of Internal Medicine) with the concepts of Bushido, a Japanese code of personal conduct originating from the ancient samurai warriors. The authors also present survey evidence about how a group of present-day Japanese doctors view the values of Bushido.Cultural scholars have demonstrated Bushido's continuing influence on Japanese people today. The authors explain the seven main virtues of Bushido (e.g., rectitude), describe the similarities and differences between Bushido and the physician charter, and speculate on factors that may account for the differences, including the influence of religion, how much the group versus the individual is emphasized in a culture, and what emphasis is given to virtue-based versus duty-based ethics.The authors suggest that for those who are teaching and practicing in Japan today, Bushido's virtues are applicable when considering medical professionalism and merit further study. They urge that there be a richer discussion, from the viewpoints of different cultures, on the meaning of professionalism in today's health care practice.

DOI： 10.1097/ACM.0000000000000176

英国卒前医学教育改革の動向 : General Medical Council における教育質保証の取り組み

ジャカルタ医学教育学会参加報告

宮地由佳, 錦織宏

医学教育 45 巻 ( 1 ) 頁： 43 - 44 2014年

記述言語：日本語出版者・発行元：日本医学教育学会

1．2013年12月にインドネシアで開催された第6回ジャカルタ医学教育学会に参加した． 2．インドネシアにおいても医学教育学への関心は高まりつつある．本邦も含めたアジアからの世界への研究成果の発信が望まれる．

DOI： 10.11307/mededjapan.45.1_43

文化人類学と医学／医療者教育招待有り査読有り

錦織宏, 道信良子

医学教育 44 巻 ( 5 ) 頁： 273 - 273 2013年10月

共用試験OSCEの学習評価項目に対応したHDPE実技試験評価の試み

松井智子, 錦織宏, 菊川誠, 大滝純司

医学教育 44 巻 ( Suppl. ) 頁： 83 - 83 2013年7月

鑑別診断を考えながら行う身体診察(HDPE)の教材作成用オンラインシステムの開発

大滝純司, 錦織宏, 増田浩三, 菊川誠, 川島篤志, 松井智子, 川畑秀伸

医学教育 44 巻 ( Suppl. ) 頁： 160 - 160 2013年7月

学士入学経験が男性医師のキャリア形成に与える影響東大医学部のケーススタディ査読有り

佐々木那津, 錦織宏, 大西弘高, 北村聖

医学教育 44 巻 ( Suppl. ) 頁： 101 - 101 2013年7月

柴原真知子, 錦織宏, 中村真理子, 鈴木俊哉, 武田裕子, 小西靖彦, 福島統, 奈良信雄

医学教育 = Medical education 44 巻 ( 2 ) 頁： 63 - 70 2013年4月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：日本医学教育学会

背景 : 医学部の国際認証の議論が進む中，日本における教育認証評価機関のあり方を具体的に検討することが求められている． 方法 : GMC（英国医事委員会）で教育質保証が導入された経緯と具体的なプロセスについて，英国調査をもとに明らかにする． 結果 : 2003年を境にGMCにおける教育質保証は，「点検型」から「対話型」へ移行した．現在では，各医学部がGMCと関わりながら，自らの教育改善・向上に継続的に取り組むことの促進が中軸となっている． 考察 : GMCの教育質保証は，(1)医学部が自らの教育の現状を理解し，改善・向上への強いインセンティブとなっている点，(2)「何のための教育質保証なのか」への共通認識を構築することがその基盤となっている点は，日本への積極的示唆となる．一方で，膨大なコーディネート業務を行う体制整備が課題となる．

DOI： 10.11307/mededjapan.44.63

CiNii Books

第48回医学教育セミナーとワークショップ in 京都大学

その他リンク： http://search.jamas.or.jp/link/ui/2013256048

鑑別診断を考えながら行う身体診察(HDPE)の教材作成用オンラインシステムの開発

大滝純司, 錦織宏, 増田浩三, 菊川誠, 川島篤志, 小林智子, Yudkowsky R., Bordage G.

日本内科学会雑誌 102 巻 ( Suppl. ) 頁： 245 - 245 2013年2月

鈴木康之, 錦織宏

医学教育 44 巻 ( 5 ) 頁： 368 - 369 2013年

Reformation of Medical Education for an Aging Society in Japan. 招待有り査読有り

Hiroshi Nishigori

Journal of Medical Research and Education. 1 巻 ( 2 ) 頁： 8 - 9 2012年12月

Minimum Requirementの身体診察法を網羅したHDPEモデル授業用シナリオの開発

小林智子, 錦織宏, 菊川誠, 大滝純司

医学教育 43 巻 ( Suppl. ) 頁： 184 - 184 2012年7月

東京大学医学部医学科における女性学士入学者のアイデンティティの変遷査読有り

佐々木那津, 錦織宏, 大西弘高, 北村聖

医学教育 43 巻 ( Suppl. ) 頁： 56 - 56 2012年7月

A global template for reforming residency without work-hours restrictions: decrease caseloads, increase education. Findings of the Japan Resident Workload Study Group. 査読有り国際誌

Gautam A Deshpande, Kumiko Soejima, Yasushi Ishida, Osamu Takahashi, Joshua L Jacobs, Brian S Heist, Haruo Obara, Hiroshi Nishigori, Tsuguya Fukui

Medical teacher 34 巻 ( 3 ) 頁： 232 - 9 2012年

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

BACKGROUND: Japanese physician training programs are currently not subject to rigorous national standardization. Despite residency restructuring in 2004, little is known about the current work allocation of residents in Japan. AIMS: We quantified the amount of time that Japanese junior residents spend in service versus education in the context of caseload, fatigue, and low-value administrative work. METHODS: In this prospective, time-and-motion study, the activity of 1st- and 2nd-year residents at three Japanese community hospitals was observed at 5-min intervals over 1 week, and categorized as patient care, academic, non-patient care, and personal. Self-reported sleep data and caseload information were simultaneously collected. Data were subanalyzed by gender, training level, hospital, and shift. RESULTS: A total of 64 participating residents spent substantially more time in patient care activities than education (59.5% vs. 6.8%), and little time on low-value, non-patient work (5.1%). Residents reported a median 5 h of sleep before shifts and excessive sleepiness (median Epworth score, 12). Large variations in caseload were reported (median 10 patients, range 0-60). CONCLUSIONS: New physicians in Japan deliver a large volume of high-value patient care, while receiving little structured education and enduring substantial sleep deprivation. In programs without work-hour restrictions, caseload limits may improve safety and quality.

DOI： 10.3109/0142159X.2012.652489

A national survey of international electives for medical students in Japan: 2009-2010. 査読有り国際誌

Hiroshi Nishigori, Osamu Takahashi, Naomi Sugimoto, Kiyoshi Kitamura, Graham T McMahon

Medical teacher 34 巻 ( 1 ) 頁： 71 - 3 2012年

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

BACKGROUND AND OBJECTIVES: International electives can provide experiences for medical students to learn about health systems and foster critical self-reflection. So far, little is known about the status of Japanese students' engagement in international electives. We sought to provide information about the internationalization of Japanese medical education by clarifying the current situations of international electives. METHOD: We undertook a cross-sectional national 17-item questionnaire survey of program officers in all medical schools in Japan in February 2010. RESULTS: Sixty-five (81.3%) of 80 Japanese medical schools responded to the questionnaire. 462 Japanese medical students (3% of all students in their clinical years) travelled to North America (45.5%), Asia (25.0%), or Western Europe (24.4%) to study abroad. The number of students who participated in international electives was significantly increased when academic credit was available (median 6 vs. 1, p < 0.001) and institutional affiliations were present (median 7 vs. 2 students, p < 0.001). Most students were evaluated by means of written assignment on return. DISCUSSION AND CONCLUSION: About 3% of Japanese medical students participate in international clinical exchanges. Academic credit and institutional affiliations appear to promote greater utilization of international exchange opportunities.

DOI： 10.3109/0142159X.2012.638014

東京大学医学部医学科学士入学制度の実態査読有り

佐々木那津, 錦織宏, 大西弘高, 北村聖

医学教育 42 巻 ( Suppl. ) 頁： 74 - 74 2011年7月

A model teaching session for the hypothesis-driven physical examination. 査読有り国際誌

Hiroshi Nishigori, Kozo Masuda, Makoto Kikukawa, Atsushi Kawashima, Rachel Yudkowsky, Georges Bordage, Junji Otaki

Medical teacher 33 巻 ( 5 ) 頁： 410 - 7 2011年

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

INTRODUCTION: The physical examination is an essential clinical competence for all physicians. Most medical schools have students who learn the physical examination maneuvers using a head-to-toe approach. However, this promotes a rote approach to the physical exam, and it is not uncommon for students later on to fail to appreciate the meaning of abnormal findings and their contribution to the diagnostic reasoning process. The purpose of the project was to develop a model teaching session for the hypothesis-driven physical examination (HDPE) approach in which students could practice the physical examination in the context of diagnostic reasoning. METHODS: We used an action research methodology to create this HDPE model by developing a teaching session, implementing it over 100 times with approximately 700 students, conducting internal reflection and external evaluations, and making adjustments as needed. RESULTS: A model nine-step HDPE teaching session was developed, including: (1) orientation, (2) anticipation, (3) preparation, (4) role play, (5) discussion-1, (6) answers, (7) discussion-2, (8) demonstration and (9) reflection. DISCUSSIONS AND CONCLUSIONS: A structured model HDPE teaching session and tutor guide were developed into a workable instructional intervention. Faculty members are invited to teach the physical examination using this model.

DOI： 10.3109/0142159X.2010.540269

Asian perspectives for reflection. 査読有り国際誌

Hiroshi Nishigori, Kanokwan Sriruksa

Medical teacher 33 巻 ( 7 ) 頁： 580 - 1 2011年

医学部学士編入学試験受験者の受験準備の現状査読有り

佐々木那津, 錦織宏, 大西弘高, 北村聖

医学教育 41 巻 ( Suppl. ) 頁： 97 - 97 2010年7月

ポートフォリオおよびショーケースポートフォリオとは査読有り

横林賢一, 大西弘高, 斉木啓子, 渡邉隆将, 錦織宏

家庭医療 15(2):32-43 15 巻 ( 2 ) 頁： 32 - 44 2010年

A hypothesis-driven physical examination learning and assessment procedure for medical students: initial validity evidence. 査読有り国際誌

Rachel Yudkowsky, Junji Otaki, Tali Lowenstein, Janet Riddle, Hiroshi Nishigori, Georges Bordage

Medical education 43 巻 ( 8 ) 頁： 729 - 40 2009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：WILEY-BLACKWELL PUBLISHING, INC

CONTEXT: Diagnostic accuracy is maximised by having clinical signs and diagnostic hypotheses in mind during the physical examination (PE). This diagnostic reasoning approach contrasts with the rote, hypothesis-free screening PE learned by many medical students. A hypothesis-driven PE (HDPE) learning and assessment procedure was developed to provide targeted practice and assessment in anticipating, eliciting and interpreting critical aspects of the PE in the context of diagnostic challenges. OBJECTIVES: This study was designed to obtain initial content validity evidence, performance and reliability estimates, and impact data for the HDPE procedure. METHODS: Nineteen clinical scenarios were developed, covering 160 PE manoeuvres. A total of 66 Year 3 medical students prepared for and encountered three clinical scenarios during required formative assessments. For each case, students listed anticipated positive PE findings for two plausible diagnoses before examining the patient; examined a standardised patient (SP) simulating one of the diagnoses; received immediate feedback from the SP, and documented their findings and working diagnosis. The same students later encountered some of the scenarios during their Year 4 clinical skills examination. RESULTS: On average, Year 3 students anticipated 65% of the positive findings, correctly performed 88% of the PE manoeuvres and documented 61% of the findings. Year 4 students anticipated and elicited fewer findings overall, but achieved proportionally more discriminating findings, thereby more efficiently achieving a diagnostic accuracy equivalent to that of students in Year 3. Year 4 students performed better on cases on which they had received feedback as Year 3 students. Twelve cases would provide a reliability of 0.80, based on discriminating checklist items only. CONCLUSIONS: The HDPE provided medical students with a thoughtful, deliberate approach to learning and assessing PE skills in a valid and reliable manner.

DOI： 10.1111/j.1365-2923.2009.03379.x

鑑別診断を考えながら行う身体診察(HDPE)の指導方法に関する教材開発の試み

大滝純司, 錦織宏, 増田浩三, 菊川誠, 川島篤志

医学教育 40 巻 ( Suppl. ) 頁： 145 - 145 2009年7月

DREEM, PHEEM, ATEEM and STEEM in Japanese. 査読有り国際誌

Hiroshi Nishigori, Makiko Nishigori, Hiroshi Yoshimura

Medical teacher 31 巻 ( 6 ) 頁： 560 - 560 2009年6月

I came, i saw, i reflected: A qualitative study into learning outcomes of international electives for Japanese and British medical students 査読有り国際誌 Open Access

Nishigori H., Otani T., Plint S., Uchino M., Ban N.

Medical Teacher 31 巻 ( 5 ) 頁： e196-201 - e201 2009年5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

Background and aim: Although medical students have increasingly more opportunities to participate in international electives, their experiences are usually unstructured and the literature referring to their learning outcomes, educational environment, and assessment is scanty. This study was undertaken to clarify qualitatively what students learn from their international electives. Methods: We carried out semi-structured individual interviews with 15 Japanese students studying clinical medicine in British medical schools and six British students studying in Japanese medical schools. The thematic synthesis method was used in analysing the transcribed data and triangulation by multiple researchers was used to achieve higher reliability. Results: The main learning outcomes identified were skills in history taking and physical examination with clinical reasoning and in management of diseases rarely seen in the students' own countries; awareness of clinical ethics and merits and demerits of different systems of healthcare and medical education; sensitivity to issues in doctorpatient relationships and work ethics; enhancement of cultural competence; and personal development. Conclusions: Most learning outcomes of international electives are culture- or system-dependent. Students achieved outcomes related closely to medical professionalism, mainly through reflection. International electives may give students opportunities to learn both professionalism and cultural competence. © 2009 Informa UK Ltd All.

DOI： 10.1080/01421590802516764