論文 - 春田　淳志

Polydoctoring and health outcomes among the very old population with multimorbidity: a retrospective cohort study in Japan

Ando T., Sasaki T., Fujikawa H., Haruta J., Arai Y.

Scientific Reports 15 （ 1 ） 32046 2025年12月

ISSN  2045-2322

　概要を見る

To assess the relationship between polydoctoring and patient outcomes, we conducted a retrospective cohort study using a Japanese population-based dataset from April 2014 to December 2022. Overall, 2,338,965 patients aged 75–89 years with at least two chronic conditions were included. Polydoctoring was assessed by the number of regularly visited facilities (RVFs). The primary outcome was all-cause mortality, with secondary outcomes being all-cause hospitalizations, hospitalizations for ambulatory care-sensitive conditions (ACSCs), and outpatient costs. During the study period, 14.5% of participants died, 52.2% were hospitalized, and 12.5% experienced ACSC-related hospitalizations. Patients without RVFs had the highest mortality risk (HR: 3.23, 95% CI: 3.14–3.33), while those with ≥ 5 RVFs had the lowest (HR: 0.67, 95% CI: 0.62–0.73). ACSC-related hospitalizations were U-shaped, with increased risk at ≥ 5 RVFs (HR: 1.13, 95% CI: 1.06–1.22). Outpatient costs increased 3.21 times for ≥ 5 RVFs compared to 1 RVF. Polydoctoring was associated with reduced mortality but higher hospitalization rates and costs, with an optimal RVF range of 2–3 which minimized ACSC-related admissions. These findings emphasize the need for strategies that balance the benefits and costs of polydoctoring to support sustainable healthcare through improved care coordination and resource management for aging populations.

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Medical Students' Views on Physician Working Hour Regulations in Japan—A Cross-Sectional Study

Fujikawa H., Haruta J.

Clinical Teacher 22 （ 5 ） e70182 2025年10月

ISSN  17434971

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Purpose: Many countries have introduced duty hour regulations for physicians. The perspectives of resident physicians and programme directors on working hour restrictions for physicians have been extensively studied. Conversely, the perspectives of medical students on this critical issue have been largely overlooked. Thus, we aimed to investigate perceptions of medical students regarding the scheduled implementation of physician work-hour regulation in Japan in April 2024. Methods: We conducted a multicentre, cross-sectional study in February 2024, focused on medical students in Japan. The participants completed a questionnaire that consisted of closed questions regarding the anticipated impact of work-hour restrictions and an open-ended question regarding their expectations/concerns about the restrictions. We analysed the data using descriptive statistics for the closed-ended questions and inductive content analysis for the open-ended question. Results: Three-hundred fifty-eight medical students responded to the survey. One hundred (27.9%) were not aware of the scheduled implementation of physician work-hour regulations. There was a discrepancy between responses to the closed-ended questions and that to the open-ended question; in the latter, more comments expressed concerns than expectations. A significant proportion of respondents were concerned about the increase in sabisu zangyo (unpaid work). Additionally, a considerable number were concerned about physicians' professional development and the system of limiting physicians' work hour. Conclusion: This study elucidated the perspectives of future physicians, a hitherto overlooked category of stakeholders. The findings will contribute to evidence-based policy-making regarding the restrictions and inform the development of concrete support measures to assist physicians in adapting to these changes.

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Integrating fixed norms and relational responsiveness in medical education: Redefining autonomy.

Haruta J, Miyachi J, Kato K, Kuwabara T, Imae A, Sase Y

Medical teacher    1 - 3 2025年07月

ISSN  0142-159X

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In this short communication, we reconceptualize autonomy in medical education, particularly within the context of professional identity formation (PIF). Traditionally, autonomy has been framed as independence and achievement based on ‘fixed norms’. However, identity is also shaped through ‘relational responsiveness’, which emphasizes mutual engagement and co-construction. Drawing on Asian cultural understandings of selfhood, we propose viewing autonomy as integrity enacted within a network of mutual responsibility. We argue that both fixed norms and relational responsiveness are essential, and we introduce a preliminary framework that highlights their complementary roles. While responsiveness fosters adaptability and connectedness, it can lead to identity diffusion if not grounded in internal standards. A blended model of both modes offers a more inclusive, culturally sensitive, and resilient approach to PIF in today’s complex medical landscape.

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Primary care experiences of family caregivers using the same medical facility as their care recipient or a different facility

Nakayama G., Masumoto S., Haruta J., Maeno T.

Journal of General and Family Medicine 26 （ 4 ） 297 - 304 2025年07月

ISSN  2189-6577

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Background: Family caregivers and care recipients do not always have the same usual source of care, which may create barriers to providing optimal care for caregivers. This study aimed to compare family caregivers' primary care experiences based on whether they used the same medical facility as their care recipient or a different facility. Methods: We used cross-sectional data from a survey conducted in Japan in 2020. Participants were family caregivers aged 40–74 years who cared for community-dwelling adults with chronic conditions. Caregivers' primary care experiences were assessed using the Japanese version of the Primary Care Assessment Tool Short Form (JPCAT-SF). Multivariable linear regression analyses were conducted to evaluate differences in JPCAT-SF scores between caregivers who used the same medical facility as their care recipient and those who used a different facility. Results: Of the 406 family caregivers analyzed, 216 (53.2%) used a different medical facility from their care recipient. After adjusting for possible confounders, JPCAT-SF total scores were significantly lower among family caregivers using a different facility compared with those using the same facility (adjusted mean difference −5.73, 95% confidence interval: −8.93 to −2.54). The JPCAT-SF subscale scores for longitudinality, comprehensiveness (services available), and community orientation were significantly lower in the different facility group than the same facility group. Conclusions: Family caregivers who used a different medical facility from their care recipient reported more negative primary care experiences than caregivers using the same facility. Greater efforts may be needed to provide patient-centered, family-oriented primary care for these caregivers.

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Do family physicians develop ambiguity tolerance as they gain experience? A multicenter cross-sectional study

Fujikawa H., Aoki T., Ando T., Haruta J.

Journal of General and Family Medicine （Wiley）  26 （ 3 ） 231 - 237 2025年05月

ISSN  2189-7948

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Background: Ambiguity tolerance is important because it contributes to both better patient care and physician well-being. Although a recent study showed that family physicians have greater ambiguity tolerance than non-family physicians, the question of when family physicians develop tolerance remains unanswered. Thus, the aim of this study was to examine the associations between the number of postgraduate years (PGYs) and ambiguity tolerance. Methods: This was a nationwide cross-sectional study involving family physicians in 14 residency programs throughout Japan. Ambiguity tolerance was assessed as the primary outcome using the Japanese version of the Tolerance for Ambiguity in Medical Students and Doctors scale. Secondary outcomes were burnout and work engagement, assessed using the Japanese version of the Burnout Assessment Tool and the ultra-short version of the Utrecht Work Engagement Scale, respectively. Results: 173 family physicians were included in the analysis. Physicians of PGY ≥7 had significantly greater ambiguity tolerance and lower burnout risk than those of PGY 3–6. Physicians of PGY 7–20 had significantly higher work engagement than those of PGY 3–6. Conclusions: Family medicine resident physicians may be vulnerable for the duration of the residency program, although they may develop ambiguity tolerance and improve well-being over the course of the program. Supervisors in family medicine residency programs should examine the learning environment of their program, considering the vulnerability of their trainees.

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Family physicians have greater ambiguity tolerance in the clinical context: A nationwide cross-sectional study

Fujikawa, H; Aoki, T; Ando, T; Haruta, J

JOURNAL OF GENERAL AND FAMILY MEDICINE 26 （ 2 ） 128 - 134 2025年03月

ISSN  2189-7948

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Family physicians have greater ambiguity tolerance in the clinical context: A nationwide cross-sectional study.

Fujikawa H, Aoki T, Ando T, Haruta J

Journal of general and family medicine 26 （ 2 ） 128 - 134 2025年03月

ISSN  2189-6577

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Family physicians have greater ambiguity tolerance in the clinical context: A nationwide cross-sectional study

Fujikawa H., Aoki T., Ando T., Haruta J.

Journal of General and Family Medicine 26 （ 2 ） 128 - 134 2025年03月

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Background: Ambiguity tolerance in the clinical context is increasingly recognized as essential for physicians to work as professionals. However, the relationship between specialty and ambiguity tolerance in the clinical context has been understudied. Here, we investigated the association between specialty and ambiguity tolerance in the clinical context, focusing on differences between family physicians (FPs) and non-FPs. Methods: We performed a nationwide cross-sectional study in Japan. We asked FPs from 14 family medicine residency programs across Japan and non-FPs from monitors of an internet survey company in Japan to participate in the study. We assessed their tolerance for ambiguity using the Japanese version of the Tolerance for Ambiguity in Medical Students and Doctors (J-TAMSAD) scale. Results: In total, 388 physicians (178 FPs and 210 non-FPs) completed our anonymous online survey and were included in the analysis. After adjustment for possible confounders (gender and postgraduate years), FPs had higher J-TAMSAD scale scores than internists/pediatricians, surgeons, and physicians with other specialties, meaning that FPs had greater ambiguity tolerance. Conclusions: This study reveals that FPs had greater tolerance for ambiguity in the clinical context than non-FPs. Our findings suggest that there may be a need to increase non-FP's tolerance for ambiguity specific to the clinical context through educational interventions, since ambiguity is inherent and growing in medicine today. FPs and non-FPs should work together to complement each other's strengths, rather than simply improving the training of non-FPs.

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Transformative learning in behavioral science education: A realist evaluation of medical students’ reflective engagement with cognitive behavioral therapy techniques, case …

J Haruta, T Kikuchi, J Kitanaka, M Kurata

2025年

Family physicians have greater ambiguity tolerance in the clinical context: A nationwide cross‐sectional study

H Fujikawa, T Aoki, T Ando, J Haruta

Journal of General and Family Medicine 26 (2), 128-134 2025年

Do family physicians develop ambiguity tolerance as they gain experience? A multicenter cross‐sectional study

H Fujikawa, T Aoki, T Ando, J Haruta

Journal of General and Family Medicine 26 (3), 231-237 2025年

A Simulated Interprofessional Team Conference Using Cross-Training for Junior Healthcare Students in Interprofessional Education: a Qualitative Content Analysis

Tomisaki E., Haruta J., Horiguchi T., Arahata T., Fukui R., Uno S., Ando T., Yoshino T., Ishikawa S., Suzuki S., Yamaura K., Monkawa T.

Advances in Medical Education and Practice 16   583 - 594 2025年

ISSN  1179-7258

　概要を見る

Purpose: In 2021, we introduced a new simulation-based learning program focusing on a roleplay conference before patient discharge. This study aimed to evaluate the program’s effectiveness and highlight the significance of cross-training in interprofessional education (IPE). Methods: In September 2023, the program included 346 students (98 medical, 110 nursing, and 138 pharmacy students). The students’ reflective writing was analyzed using inductive content analysis to describe their learning and perspectives. The original items, subcategories, and main categories were extracted. The simulation involved the students role-playing various healthcare professionals during a discharge-planning conference for a stroke patient. This allowed them to experience the challenges and dynamics of interprofessional collaboration. Results: Student feedback emphasized the importance of understanding what constitutes a good healthcare team. A total of 203 items were grouped into eight main categories and 17 subcategories, including patient-centered care (related to the importance of patient-centered care, supporting patient decision-making, communicating with patients during conferences, and facilitating decision-making processes), contrasts in patient and interprofessional communication, conference communication (challenge of building consensus, the way to proceed conferences, importance of conference preparation, and process of information aggregation and realization of outcomes), mutual recognition and role contribution, building relationships (importance of daily interprofessional communication), understanding one’s profession (reflection on one’s own profession, understanding the roles of different professions, and communication within one’s own professional context), recursion into learning (motivation for continuous learning and improvement), and understanding other professions (understanding the role and perspectives of other professions and recognizing professional differences). Specific feedback highlighted improved empathy and communication skills. Students recognized the value of each profession’s contribution to patient care. Moreover, students reported a deeper appreciation of patient-centered approaches and the complexities of coordinating care across different healthcare roles. Conclusion: Simulated interprofessional team conferences using cross-training effectively taught junior students to understand the essence of a good healthcare team and the importance of a patient-centered approach. Cross-training significantly enhanced students’ interprofessional competencies, communication skills, and empathy toward other professions. This case underscores the necessity of incorporating cross-training into IPE to prepare healthcare professionals for collaborative practice and improve patient outcomes. Future research should consider expanding the scope to include more diverse scenarios and longitudinal assessments to measure longterm impacts on professional practice.

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Medical Students' Views on Physician Working Hour Regulations in Japan—A Cross‐Sectional Study

H Fujikawa, J Haruta

The Clinical Teacher 22 (5), e70182 2025年

Development of a validated assessment tool for medical students using simulated patients: an 8-year panel survey

Haruta J., Nakajima R., Monkawa T.

BMC Medical Education （BMC Medical Education）  24 （ 1 ） 399 2024年12月

　概要を見る

Background: The use of simulated patients (SPs) to assess medical students’ clinical performance is gaining prominence, underscored by patient safety perspective. However, few reports have investigated the validity of such assessment. Here, we examined the validity and reliability of an assessment tool that serves as a standardized tool for SPs to assess medical students’ medical interview. Methods: This longitudinal survey was conducted at Keio University School of Medicine in Japan from 2014 to 2021. To establish content validity, the simulated patient assessment tool (SPAT) was developed by several medical education specialists from 2008 to 2013. A cohort of 36 SPs assessed the performance of 831 medical students in clinical practice medical interview sessions from April 2014 to December 2021. The assessment’s internal structure was analyzed using descriptive statistics (maximum, minimum, median, mean, and standard deviation) for the SPAT’s 13 item total scores. Structural validity was examined with exploratory factor analysis, and internal consistency with Cronbach’s alpha coefficients. The mean SPAT total scores across different SPs and scenarios were compared using one way analysis of variance (ANOVA). Convergent validity was determined by correlating SPAT with the post-clinical clerkship obstructive structured clinical examination (post-CC OSCE) total scores using Pearson’s correlation coefficient. Results: Of the 831 assessment sheets, 36 with missing values were excluded, leaving 795 for analysis. Thirty-five SPs, excluding one SP who quit in 2014, completed 795 assessments, for a response rate of 95.6%. Exploratory factor analysis revealed two factors, communication and physician performance. The overall Cronbach’s alpha coefficient was 0.929. Significant differences in SPAT total scores were observed across SPs and scenarios via one-way ANOVA. A moderate correlation (r =.212, p <.05) was found between SPAT and post-CC OSCE total scores, indicating convergent validity. Conclusions: Evidence for the validity of SPAT was examined. These findings may be useful in the standardization of SP assessment of the scenario-based clinical performance of medical students.

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Associations of clinical context-specific ambiguity tolerance with burnout and work engagement among Japanese physicians: a nationwide cross-sectional study

Fujikawa H., Aoki T., Ando T., Haruta J.

BMC Medical Education （Springer Science and Business Media LLC）  24 （ 1 ） 660 2024年12月

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Purpose: Ambiguity tolerance specific to the clinical context – in contrast to ambiguity tolerance as a personality trait – may vary with experience and has received considerable attention. Although this tolerance appears to be related to burnout and work engagement, few studies have examined this association among physicians. Thus, we aimed to examine the relationships between clinical context-specific ambiguity tolerance, burnout, and work engagement among physicians in Japan. Methods: We conducted a nationwide cross-sectional study in Japan. We invited family physicians from 14 family medicine residency programs and physicians with specialties other than family medicine from monitors of an Internet survey company to participate in the study. We measured ambiguity tolerance in the clinical context using the Japanese version of the Tolerance of Ambiguity in Medical Students and Doctors (J-TAMSAD) scale, burnout using the Japanese version of the Burnout Assessment Scale (BAT-J), and work engagement using the Utrecht Work Engagement Scale (UWES). We performed a multivariable linear regression analysis to determine whether the J-TAMSAD scale score was associated with the BAT-J and UWES scores. Results: 383 respondents were included in the analysis. After adjustment for possible confounders, clinical context-specific ambiguity tolerance showed a dose-dependent negative association with burnout (adjusted mean difference -0.39, 95% confidence interval (CI) -0.56 to -0.22 for the highest J-TAMSAD score quartile compared with the lowest). Ambiguity tolerance in the clinical context also showed a dose-dependent positive association with work engagement (adjusted mean difference 0.83, 95% CI 0.49 to 1.16 for the highest J-TAMSAD score quartile compared with the lowest). Conclusions: Our study showed that tolerance for ambiguity in the clinical context was negatively associated with burnout, and positively associated with work engagement. These findings will be useful in developing interventions aimed at preventing burnout and promoting work engagement among physicians.

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Determinants of polydoctoring among multimorbid older adults; a cross-sectional study in an urban area of Japan

Ando T., Sasaki T., Abe Y., Nishimoto Y., Hirata T., Haruta J., Arai Y.

Journal of General and Family Medicine 25 （ 6 ） 376 - 383 2024年11月

ISSN  2189-6577

　概要を見る

Background: Multimorbidity increases with age, leading to various adverse outcomes, including higher mortality, care dependency, hospitalizations, and healthcare costs. Polydoctoring, managing a patient with multimorbidity by multiple healthcare providers, can be a risk of fragmented care and increased healthcare expenditures. This study aims to identify patient-related factors contributing to polydoctoring in older adults with multimorbidity. Methods: This study is a cross-sectional study using baseline data from the Kawasaki Aging and Wellbeing Project. Participants were residents of Kawasaki City aged 85–89 years, without disability in basic activities of daily living, and being able to visit study site. The regularly visited facilities (RVF) index was employed to quantify polydoctoring. Polydoctoring was defined as having two or more RVFs. Poisson regression analysis was conducted to assess the association between polydoctoring and patient demographics, including types of chronic conditions and socioeconomic factors. Results: A total of, 968 participants with multimorbidity were analyzed. Increased RVF was significantly associated with eye diseases (rate ratio [RR] 1.27, 95% confidence interval [CI] 1.12–1.44), osteoporosis (RR 1.22, 95% CI 1.08–1.38), prostate diseases (RR 1.22, 95% CI 1.07–1.40), and osteoarthritis (RR 1.16, 95% CI 1.05–1.27). No significant correlation was found with educational status or financial hardship. Conclusion: The study indicated that certain chronic conditions are linked to increased polydoctoring among multimorbid older adults in Japan. However, most of those conditions are considered to be within a scope of family medicine/general practice. Training general practitioners to manage these conditions could reduce healthcare costs and the treatment burden, indicating a direction for future healthcare policy and medical education.

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Family physicians have greater ambiguity tolerance in the clinical context: A nationwide cross‐sectional study

Hirohisa Fujikawa, Takuya Aoki, Takayuki Ando, Junji Haruta

Journal of General and Family Medicine （Wiley）  2024年10月

ISSN  2189-7948

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Abstract

Background

Ambiguity tolerance in the clinical context is increasingly recognized as essential for physicians to work as professionals. However, the relationship between specialty and ambiguity tolerance in the clinical context has been understudied. Here, we investigated the association between specialty and ambiguity tolerance in the clinical context, focusing on differences between family physicians (FPs) and non‐FPs.

Methods

We performed a nationwide cross‐sectional study in Japan. We asked FPs from 14 family medicine residency programs across Japan and non‐FPs from monitors of an internet survey company in Japan to participate in the study. We assessed their tolerance for ambiguity using the Japanese version of the Tolerance for Ambiguity in Medical Students and Doctors (J‐TAMSAD) scale.

Results

In total, 388 physicians (178 FPs and 210 non‐FPs) completed our anonymous online survey and were included in the analysis. After adjustment for possible confounders (gender and postgraduate years), FPs had higher J‐TAMSAD scale scores than internists/pediatricians, surgeons, and physicians with other specialties, meaning that FPs had greater ambiguity tolerance.

Conclusions

This study reveals that FPs had greater tolerance for ambiguity in the clinical context than non‐FPs. Our findings suggest that there may be a need to increase non‐FP's tolerance for ambiguity specific to the clinical context through educational interventions, since ambiguity is inherent and growing in medicine today. FPs and non‐FPs should work together to complement each other's strengths, rather than simply improving the training of non‐FPs.

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増大号特集 続・Quality Indicatorの実装とその改善-日々の診療に役立つ診療評価指標 各論　プライマリ・ケア 多職種連携・協働の評価指標

春田 淳志

medicina （株式会社医学書院）  61 （ 11 ） 1820 - 1823 2024年10月

ISSN  00257699

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「パンデミックのドキュメンテーション」の記録

木村 周平, 飯田 淳子, 堀口 佐知子, 春田 淳志, 小曽根 早知子

文化人類学 （日本文化人類学会）  89 （ 2 ） 304 - 307 2024年09月

ISSN  13490648

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特集 今伝えたいクリニカル・パール-つくり方、使い方、活かし方 【総論】 ❶「クリニカル・パール」とは何か?　その臨床活用における注意点は?

春田 淳志

総合診療 （株式会社医学書院）  34 （ 9 ） 992 - 995 2024年09月

ISSN  21888051

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