研究者詳細 - 春田　淳志

論文 - 春田　淳志

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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

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

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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アレルギー領域における診療科・職種横断的リカレント教育の重要性　「出前授業による教育の機会創出事業」参加者データの分析

正木克宜, 坂下雅文, 小川靖, 猪俣武範, 貝沼圭吾, 神尾敬子, 佐藤さくら, 玉利真由美, 中島沙恵子, 森田英明, 倉島洋介, 二村昌樹, 高橋浩一郎, 春田淳志, 百武美沙, 門川俊明, 石塚全, 意元義政, 尾山徳孝, 神崎晶, 木戸口正典, 福島敦樹, 福永興壱, 藤枝重治, 安冨素子, 足立剛也, 免疫アレルギー疾患研究10か年戦略次世代タスクフォース(ENGAGE-TF)

アレルギー（(一社)日本アレルギー学会） 73 （ 4 ） 329 - 339 2024年06月

ISSN 0021-4884

【背景】多職種・複数診療科が関与するアレルギー診療水準の向上には,専門医以外も対象とした教育の必要性が考えられるが,そのニーズ調査と方法に関する検討は不十分である.【目的・方法】免疫アレルギー疾患研究10か年戦略次世代タスクフォース(ENGAGE-TF)は学会支援下に慶應義塾大学,福井大学と連携した複数回のバーチャル教育企画「出前授業」を企画した.そのニーズと有用性を検証するため,SNSや各大学・医師会等を通じて周知し,メーリングリストを用いてアンケート調査を行った.【結果】のべ1139人・回より回答を得た.半数以上が専門医以外の医師であり,幅広い医療関連職種も参加した.7割が「とても満足」,6割以上が「ちょうどよい」難易度と回答した.自由記載の感想から,職種毎の学びの焦点,経験年数による学びのスタンスの違いが見られた.【考察・結語】9割を占める専門医以外の参加者のプライマリケアにおけるアレルギー疾患対応ニーズの高さと,経験11年以上の医療関連職種の遠隔教育・リカレント教育の有用性が示唆された.(著者抄録)

大学病院における総合診療科臨床実習が医学生の総合診療の専門性への理解に及ぼす影響

安藤崇之, 百武美沙, 春田淳志, 藤川裕恭, 平橋淳一, 藤島清太郎

日本プライマリ・ケア連合学会誌（(一社)日本プライマリ・ケア連合学会） 47 （ 2 ） 63 - 66 2024年06月

ISSN 2185-2928

<p>大学病院における総合診療科の臨床実習において医学生が総合診療の専門性をどのように理解しているのかを明らかにするために，実習前後の「総合診療の専門性とは？」というアンケートの自由記載に対して内容分析を行った．大学病院での臨床実習を通して，診断学だけではなく心理・社会的側面を踏まえた診療や健康維持なども総合診療の専門性であることが学生により獲得されていることが明らかになった．</p>

Association of polydoctoring and mortality among very old persons with multimorbidity: a prospective cohort study in Japan.

Ando T, Sasaki T, Abe Y, Nishimoto Y, Hirata T, Tajima T, Oguma Y, Haruta J, Arai Y

BJGP open 2024年04月

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Exploring factors associated with healthcare professionals' subjective perceptions of complex issues in primary care in Japan: a self-administered survey study on confidence, satisfaction and burden levels.

Haruta J, Goto R

BMJ open 14 （ 3 ） e081328 2024年03月

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特集総合理学療法総合的に患者・生活者をみる姿勢と多職種連携能力-モデル・コア・カリキュラムから紐解く

春田淳志

理学療法ジャーナル（株式会社医学書院） 58 （ 2 ） 166 - 171 2024年02月

ISSN 09150552

地域の一般病院の緩和ケア外来における療養支援と患者の療養経過

大澤岳史, 春田淳志, 松浦みゆき, 上野晶香, 田直子

Palliative Care Research （日本緩和医療学会） 19 （ 1 ） 7 - 12 2024年

<p>【目的】地域一般病院の緩和ケア外来で療養支援した患者の経過を検討した．【方法】当院緩和ケア外来を受診しその後死亡した患者を後ろ向きに調査した．外来は週2回，がん治療状況に依らず診療した．【結果】対象93例中，病状悪化時の療養希望は72例に聴取し，療養から看取りまで緩和ケア病棟を希望（緩和ケア病棟希望）が25例，訪問診療を受けつつ自宅療養を行い最期は緩和ケア病棟での看取りを希望（訪問診療→緩和ケア病棟希望）が25例，療養から看取りまで自宅を希望（訪問診療希望）が17例だった．緩和ケア病棟希望患者の96%が緩和ケア病棟を利用し，84%が緩和ケア病棟で看取り，訪問診療→緩和ケア病棟希望患者の76%が訪問診療を利用し，80%が緩和ケア病棟で看取り，訪問診療希望患者の76%が自宅療養し，47%が自宅で看取られた．【結論】緩和ケア外来の療養支援にて希望場所での療養・看取りの実現可能性が示唆された．</p>

Re: Letter to the Editor of Public Health in response to'Effect of influenza vaccine subsidies for older adults on vaccination coverage and mortality before and during the …

T Ando, Y Ibuka, R Goto, J Haruta, DD Le, S Fujishima

Public health, S0033-3506 (23) 00489-4 2024年

Exploring factors associated with healthcare professionals’ subjective perceptions of complex issues in primary care in Japan: a self-administered survey study on confidence …

J Haruta, R Goto

BMJ Open 14 (3), e081328 2024年

Author reply to the definition and evaluation of uncoordinated involvement of multiple healthcare providers;“Polydoctoring” as a component of care fragmentation among patients …

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

Journal of General and Family Medicine 25 (2), 116 2024年

RECURRENT AND VIRTUAL EDUCATION FOR ALL DISCIPLINES AND OCCUPATIONS IN THE ALLERGY REALM：A SURVEY OF THE PARTICIPANTS FROM THE INITIATIVE 'OUTREACH LECTURES' TO CREATE EDUCATIONAL OPPORTUNITIES

Masaki K., Sakashita M., Ogawa Y., Inomata T., Kainuma K., Kan-O K., Sato S., Tamari M., Nakajima S., Morita H., Kurashima Y., Futamura M., Takahashi K., Haruta J., Hyakutake M., Monkawa T., Ishizuka T., Imoto Y., Oyama N., Kanzaki S., Kidoguchi M., Fukushima A., Fukunaga K., Fujieda S., Yasutomi M., Adachi T.

Japanese Journal of Allergology （一般社団法人日本アレルギー学会） 73 （ 4 ） 329 - 339 2024年

ISSN 00214884

Background: In the enhancement of allergy care involving multidisciplinary and multiple medical departments, there is a perceived need for education that targets not only specialists but also non-specialists. However, research on the need for and methods of such education remains inadequate. Objective: To design a remote allergy care education program for all medical practitioners and to validate its necessity and utility. Methods: The Empowering Next Generation Allergist/immunologist toward Global Excellence Task Force (ENGAGE-TF), supported by the Japanese Society of Allergology, initiated a virtual educational program called 'Outreach Lectures' in collaboration with Keio University and Fukui University. This initiative was widely promoted through social media and various institutions, and a survey was conducted through its mailing list. Results: 1139 responses were obtained. More than half were physicians from non-allergy specialties, representing a diverse range of healthcare professions. Over 70% expressed being 'very satisfied, ' and over 60% found the difficulty level 'appropriate. ' Free-form feedback revealed differences in learning focus based on profession and learning approach based on years of experience. Conclusion: The high participation rate (90%) of non-specialist physicians underscores the demand for addressing allergic conditions in primary care. The effectiveness of virtual/recurrent education, particularly for healthcare professionals with over 11 years of experience, was implied. Further follow-up investigation focusing on quantitative and objective assessment of educational effectiveness is indispensable.

Re: Letter to the Editor of Public Health in response to ‘Effect of influenza vaccine subsidies for older adults on vaccination coverage and mortality before and during the …

T Ando, Y Ibuka, R Goto, J Haruta, DD Le, S Fujishima

Public Health 227, e3-e4 2024年

Interprofessional competency in clinical students: validating the Clinical student version of the Japanese Self-assessment Scale of Interprofessional Competency (C-JASSIC)

Haruta J., Tomizaki E., Horiguchi T., Nakamura T., Ishikawa S., Monkawa T.

Journal of Interprofessional Care 1 - 8 2024年

ISSN 13561820

In this study, we developed and validated the Clinical Student Version of the Japanese Interprofessional Competency Self-Assessment Scale (C-JASSIC) for healthcare students in their clinical practice phase. Data obtained from 331 students (medical, 98; nursing, 99; pharmacy, 134) during orientation for interprofessional education (pre-IPE) and from 319 students (medical, 94; nursing, 93; pharmacy, 132) within a week following IPE (post-IPE) were analyzed. Exploratory pre-IPE and Confirmatory post-IPE factor analyses revealed a consistent 6-factor structure aligning with the Japanese Interprofessional Competency domains. The scale exhibited strong internal consistency, with Cronbach’s α values exceeding 0.8 for all factors both pre- and post-IPE. Scores for overall competency and individual domains increased post-IPE in 234 matched cases. A notable significant pre vs post difference concerned “Understanding of Others,” indicating enhanced interprofessional comprehension after clinical practice. There was a weak but significant positive correlation between IPE satisfaction and difference in pre- and post-IPE scores. However, no significant differences were observed among medical, nursing, and pharmacy students. Despite its strengths, such as its competency-based design and cultural relevance to Japan, a limitation of the study may be potential self-reporting bias. Nonetheless, C-JASSIC represents a valuable tool for seamless competency evaluations from student to professional stages, with implications for broader Asian contexts.

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Culture and context in Interprofessional education: Expectations in Australia and Japan

Kent F., Haruta J.

Medical Education 2024年

ISSN 03080110

The attributes of collaborative practice in health care vary across contexts, necessitating the adaptation of interprofessional education curricula to prepare students for the collaborative practice expected in their respective health care systems. Culture, when conceptualised through an organisational lens, allows an analysis of the shared assumptions, beliefs and values, without seeking to reduce to a uniform construct. This article explores the differences in interprofessional education competencies between Australia and Japan and considers the systems and patient expectations, which underpin each. While collaborative competence exhibits some similarities across contexts, competency frameworks differ in emphasis, language and key terminology, which highlight multiple points of difference in the expectations of interprofessional collaborative practice across contexts. There are education and practice consequences of these different perspectives of collaborative practice, in an increasingly mobile international workforce.

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COVID-19パンデミックを契機に刷新した高齢社会の解像度をあげる早期臨床実習

百武美沙, 春田淳志

医学教育（日本医学教育学会） 54 （ 6 ） 601 - 603 2023年12月

ISSN 03869644

Three-year evaluation of a program teaching social determinants of health in community-based medical education: a general inductive approach for qualitative data analysis

Ozone S., Haruta J., Takayashiki A., Maeno T., Maeno T.

BMC Medical Education （BMC Medical Education） 23 （ 1 ） 332 2023年12月

Background: Social determinants of health (SDH) are intricately intertwined with various social and economic factors. Reflection is essential for learning about SDH. However, only a few reports have focused on reflection in SDH programs; most were cross-sectional studies. We aimed to longitudinally evaluate a SDH program in a community-based medical education (CBME) curriculum that we introduced in 2018 based on the level of reflection and content on SDH in students’ reports. Methods: Study design: General inductive approach for qualitative data analysis. Education program: A 4-week mandatory clinical clerkship in general medicine and primary care at the University of Tsukuba School of Medicine in Japan was provided to all fifth- and sixth-year medical students. Students underwent a 3-week rotation in community clinics and hospitals in suburban and rural areas of Ibaraki Prefecture. After a lecture on SDH on the first day, students were instructed to prepare a structural case description based on encounters during the curriculum. On the final day, students shared their experiences in a small group session and submitted a report on SDH. The program was continuously improved and faculty development was provided. Study participants: Students who completed the program during October 2018–June 2021. Analysis: Levels of reflection were categorized as reflective, analytical, or descriptive. The content was analyzed based on the Solid Facts framework. Results: We analyzed 118 reports from 2018–19, 101 reports from 2019–20, and 142 reports from 2020–21. There were 2 (1.7%), 6 (5.9%), and 7 (4.8%) reflective reports; 9 (7.6%), 24 (23.8%), and 52 (35.9%) analytical reports; and 36 (30.5%), 48 (47.5%), and 79 (54.5%) descriptive reports, respectively. The others were not evaluable. The number of Solid Facts framework items in reports were 2.0 ± 1.2, 2.6 ± 1.3, and 3.3 ± 1.4, respectively. Conclusions: Students’ understanding of SDH deepened as the SDH program in the CBME curriculum improved. Faculty development might have contributed to the results. Reflective understanding of SDH might require more faculty development and integrated education of social science and medicine.

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How do medical students learn in an online community diagnostics program?

Haruta J., Ando T., Fujishima S.

BMC Medical Education （BMC Medical Education） 23 （ 1 ） 15 - 15 2023年12月

Background: The need to engage medical students in understanding the social and environmental determinants of health in disparate communities is increasing. However, previous reviews have noted the limited community diagnosis programs and program evaluation. Given the feasibility of the programs, it is expected to be widely available online. Therefore, this study used a realist approach to identify learning patterns through an online community diagnosis program, namely context (C), mechanism (M), and outcomes (O) patterns. Methods: A 2-week general medicine clinical practice program was conducted for 4th- and 5th-year medical students at a medical university in Japan. The program included a one-hour zoom-based lecture, feedback for students on their presentations on community diagnosis, and a structural report on community diagnosis. We developed the program based on variation theory, which views discernment and variation in situations having time, space, and social dimensions as core learning. The students' reflections on their learning through the program were thematically analyzed through CMO perspectives. The realist approach used in the online diagnosis program evaluation allows us to explore, test, and refine what mechanisms work under what conditions (context) and with what interventions (including opportunities and resources), from which we can describe iteratively explainable results. Results: First, the medical students, who spent most of their time in the limited residential areas they lived in, discovered the characteristics of their own community by discovery learning and comparison among peers. Second, they increased their intrinsic interest in the community by discerning specific issues in their familiar community through community diagnosis. Third, they valued community diagnosis by identifying relationships between local data on health issues under their learning responsibility. Fourth, they become more flexible in their thinking and created new knowledge that would fit the local community, and their reflection on themselves was encouraged. Conclusion: In this online community diagnosis program, medical students learned about the community through four types of learning patterns. Medical students may develop an understanding of community with interest using variation theory as a program development perspective and cognitive flexibility theory surrounding the essential ambiguity and abstraction of community.

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Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross-sectional study in Japan

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

Journal of General and Family Medicine （Journal of General and Family Medicine） 24 （ 6 ） 343 - 349 2023年11月

ISSN 2189-6577

Background: Care fragmentation, characterized by the uncoordinated involvement of multiple healthcare providers, leads to inefficient and ineffective healthcare, posing a significant challenge in managing patients with multimorbidity. In this context, “polydoctoring,” where patients see multiple specialists, emerges as a crucial aspect of care fragmentation. This study seeks to develop an indicator to assess polydoctoring, which can subsequently enhance the management of multimorbidity. Methods: Baseline survey data from the Kawasaki Aging and Wellbeing Project (KAWP) involving independent community-dwelling older adults aged 85–89 were utilized in this cross-sectional study. Polydoctoring measure was defined as the number of regularly visited facilities (RVFs). The association of RVF with the Fragmentation of Care Index (FCI) and the outcome measures of polypharmacy and ambulatory care costs were examined as indicators of care fragmentation. Results: The analysis comprised 968 participants, with an average of 4.70 comorbid chronic conditions; 65.3% of the participants had two or more RVFs, indicating polydoctoring. A significant correlation between RVF and FCI was observed. Modified Poisson regression analyses revealed associations between higher RVF and increased prevalence ratio of polypharmacy. Likewise, a higher RVF was associated with higher outpatient medical costs. Conclusions: RVF was significantly correlated with FCI, polypharmacy, and higher outpatient medical costs. Unlike complex indices, RVF is simple and intuitively comprehensible. Further research is needed to evaluate the impact of care fragmentation on patient outcomes, considering factors such as RVF thresholds, patient multimorbidity, and social support. Understanding the influence of polydoctoring can enhance care quality and efficiency for patients with multimorbidity.

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Effect of influenza vaccine subsidies for older adults on vaccination coverage and mortality before and during the COVID-19 pandemic: an ecological study in Japan

Ando T., Ibuka Y., Goto R., Haruta J., Le D.D., Fujishima S.

Public Health （Public Health） 224 152 - 158 2023年11月

ISSN 00333506

Objective: We aimed to determine how municipal subsidies for seasonal influenza vaccines for the elderly affected vaccination coverage and health outcomes and how responses to vaccine prices changed during the COVID-19 pandemic. Study design and methods: This ecological study includes 1245 municipalities in Japan between 2019 and 2020. Fixed-effects regression analysis was performed to evaluate the effect of influenza vaccine cost subsidy for people aged 65 years or older on vaccination coverage, all-cause mortality, and influenza-related mortality. Results: The vaccination rate increased when patients' copayments decreased, and reducing the copayment by 1000 Japanese Yen (JPY) was estimated to increase the vaccination rate by 6.3% (95% confidence interval [CI] 4.5–8.2%) in the adjusted model. When examining the additional effect of a zero price compared to a nearly zero price, we found that a zero price increased the immunization rate by 6.4% (95% CI 1.4–11.5%). The effect of copayment on the increase in vaccination coverage was significantly lower during the pandemic than in the pre-pandemic period. The municipal and prefectural analyses found no association between influenza vaccine copayments and all-cause, influenza, or pneumonia mortality. Conclusion: Cost subsidies and the zero-price effect were shown to increase vaccination coverage but were not associated with relevant mortality measures. Although the impact was attenuated under pandemic conditions, cost subsidy effectively increases the vaccination rate.

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