論文 - 春田　淳志

Development of a Japanese version of the Self-assessment Scale of Interprofessional Competency (JASSIC)

Haruta J., Goto R.

Journal of Interprofessional Care （Journal of Interprofessional Care）     1 - 8 2021年

共著,  ISSN  13561820

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This study aimed to develop a Japanese version of the Self-assessment Scale of Interprofessional Competency (JASSIC), which consists of six domains: Patient-/Client-/Family-/Community-Centered, Interprofessional Communication, Role Contribution, Facilitation Relationship, Reflection, and Understanding of Others. Validity of JASSIC was confirmed through a four-step process consisting of expert discussion, cognitive debriefing, feasibility, and statistical analysis. Confirmatory factor analysis (CFA) was performed by testing the correlation between the sum scores of JASSIC and the Assessment of Interprofessional Team Collaboration Scale-II(AITCS-II). First, 24 items were created through discussions among physicians, a nurse, a medical educator, and an information sociologist. Second, the items were modified by cognitive debriefing of a physician, nurse, pharmacist, occupational therapist, and social worker. Third, we provided the developed JASSIC for professionals at Hospital X (n = 139) and revised the wording and composition of the items. Finally, CFA among professionals at Hospital Y (n = 153) identified a 6-domain structure (GFI: 0.847, AGFI: 0.782, RMSEA: 0.088). Cronbach’s alpha was 0.92, and the correlation coefficient with AITCS-II was 0.72. Ongoing research into JASSIC will promote effective interprofessional collaborative practice not only in Japan but also other countries which share a similar culture and system.

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オンラインでの多職種連携教育実践報告　第1報　初年次学生を対象とした教育的なインタラクションを促すオンラインの工夫

多職種連携教育部会, 加藤 博孝, 後藤 亮平, 内藤 知佐子, 前野 貴美, 吉見 憲二, 安井 浩樹, 春田 淳志, 後藤 道子, 野呂瀬 崇彦, 村岡 千種, 伊野 美幸, 石川 さと子, 内山 靖, 大槻 眞嗣

医学教育 （日本医学教育学会）  52 （ 1 ） 53 - 57 2021年

ISSN  0386-9644

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<p>　教室での多職種連携教育はCOVID-19のため困難となった. オンラインでの多職種連携教育のノウハウを共有するため, 2大学で実施したオンラインの初年次学生を対象とした多職種連携教育の実践報告を行う. 三重大学ではZoomを用いた授業を実施し, クイズやチャットなどで教員と学生とのインタラクションを促す仕掛けが機能した. 北海道科学大学ではZoomとLearning Management System (LMS) を用いてチーム医療体験ゲームを行い, ゲーム性と明確な指示のもと学生間のインタラクションが促進された. どちらも既存の多職種連携教育をオンラインでうまく活用し, 学生の職種役割の理解やメンバーシップ/チームシップの理解は達成されたが, 教員の慣れや時間配分などの課題があった.</p>

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Comparison of Interprofessional Collaboration, Work Burden, Workplace Satisfaction, and Relationship with Neighboring Facilities between Clinic/Small Hospital Staff and those …

S KOMORI, S OZONE, R GOTO, J HARUTA

An Official Journal of the Japan Primary Care Association, 11-16 2021年

How do General Practitioners Handle Complexities? A Team Ethnographic Study in Japan

J Haruta, R Goto, O Sachiko, S Kimura, J Teruyama, Y Hama, T Maeno

BMC Primary Care （BMC Primary Care）  23 （ 1 ） 133 - 133 2021年

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Background: General practitioners (GPs) are often faced with complex problems, including patients with socio-economic and medical problems. However, the methods they use to approach these complexities are still not understood. We speculated that elucidating these methods using complex adaptive systems (CAS) methodology to comprehensively assess GPs’ daily activities would contribute to improving the professional development of GPs. This study aimed to clarify how expert GPs handle complex problems and adapt to their community context through the ethnography of GPs and other healthcare professionals in terms of CAS. Methods: We adopted the interdisciplinary team-ethnographic research approach. Five hospitals and four clinics in Japan which were considered to employ expert GPs were selected by purposive sampling. 62 individuals of various backgrounds working in these nine facilities were interviewed. Using field notes and interview data, the researchers iteratively discussed the adequacy of our interpretations. The first author (JH) prepared a draft report, which was reviewed by the GPs at the participating facilities. Through critical and iterative consideration of the different insights obtained, the final findings emerged together with representative data. Results: We identified four approaches used by GPs to deal with complexities. First, GPs treat patients with complex problems as a whole being and address their problems multi-directionally. Second, GPs build horizontal, trusting relationships with other healthcare professionals and stakeholders, and thereby reduce the degree of complexity of problems. Third, GPs change the learning climate while committing to their own growth based on societal needs and by acting as role models for other professionals through daily interpersonal facilitation. Fourth, GPs share community vision with multi-professionals and thereby act as a driving force for organizational change. These various interactions among GPs, healthcare professionals, organizations and communities resulted in systematization of the healthcare and welfare network in their community. Conclusions: Expert GPs developed interconnected multidimensional systems in their community health and welfare networks to adapt to fluctuating social realities using four approaches. GPs’ work environment may be considered as a complex adaptive system (CAS) and the approach of GPs to complexities is CAS-based. Our findings are expected to have practical applications for GPs.

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在宅における多職種協働に求められる俯瞰的視点：場と対象者の相互作用を踏まえた多職種連携コンピテンシー

春田 淳志

日本在宅ケア学会誌 （一般社団法人 日本在宅ケア学会）  24 （ 2 ） 11 - 16 2021年

ISSN  13469649

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Working Group Report (Practice article 2): Online Interprofessional Education Stepwise Interprofessional Education through Inter-University Collaboration at the University of …

T MAENO, R GOTO, J HARUTA, M INO, S ISHIKAWA, Y UCHIYAMA, ...

Medical Education, 565-570 2021年

Working Group Report (Practice article 2): Online Interprofessional Education Stepwise Interprofessional Education through Inter-University Collaboration at the University of …

R GOTO, T MAENO, J HARUTA, M INO, S ISHIKAWA, Y UCHIYAMA, ...

Medical Education, 557-563 2021年

Students’ understanding of social determinants of health in a community-based curriculum: a general inductive approach for qualitative data analysis

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

BMC Medical Education （BMC Medical Education）  20 （ 470 ） 470 2020年11月

研究論文（学術雑誌）, 共著, 査読有り

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Background: A community-based medical education (CBME) curriculum may provide opportunities to learn about the social determinants of health (SDH) by encouraging reflection on context, but the categories that students can learn about and their level of reflection are unclear. We aimed to analyze medical students’ understanding and level of reflection about SDH in a CBME curriculum. Methods: Study design: General inductive approach for qualitative data analysis. Education Program: All 5th-year and 6th-year medical students at the University of Tsukuba School of Medicine in Japan who completed a mandatory 4-week clinical clerkship in general medicine and primary care during October 2018 and May 2019 were included. The curriculum included 3 weeks of rotations in community clinics and hospitals in suburban and rural areas of Ibaraki Prefecture. On the first day, students learned about SDH through a lecture and a group activity. As an SDH assignment, they were instructed to prepare a structural case description using the Solid Facts framework based on encounters during the curriculum. On the final day, they submitted the structural reflection report. Analysis: Content analysis was based on the Solid Facts framework. Levels of reflection were categorized as reflective, analytical, or descriptive. Results: We analyzed 113 SDH case descriptions and 118 reports. On the SDH assignments, the students frequently reported on social support (85%), stress (75%), and food (58%), but less frequently on early life (15%), unemployment (14%), and social gradient (6%). Of the 118 reports, 2 were reflective, 9 were analytical, and 36 were descriptive. The others were not evaluable. Conclusions: The CBME curriculum enabled medical students to understand the factors of SDH to some extent. Further work is needed to deepen their levels of reflection.

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The process of transprofessional collaboration: How caregivers integrated the perspectives of rehabilitation through working with a physical therapist

Goto R., Haruta J.

Family Medicine and Community Health （Family Medicine and Community Health）  8 （ 4 ）  2020年11月

共著,  ISSN  23056983

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© Objectives To clarify the process of how caregivers in a nursing home integrate the perspectives of rehabilitation into their responsibilities through working with a physical therapist. Design This study was conducted under an action research approach. Setting The target facility was a nursing home located in Japan. The researcher, a physical therapist, worked at the nursing home once a week from April 2016 to March 2017. During the study period, he created field notes focused on the dialogue and action of caregivers regarding care, responses of caregivers to the physical therapist and reflections as a physical therapist. Caregivers were also given a short informal interview about their relationship with the nursing home residents. For data analysis, two researchers discussed the content based on the field notes, consolidating the findings. Participants The participants were caregivers who worked at the target facility. Thirty-eight caregivers agreed to participate. Average age was 39.6±11.1 years, 14 (37%) were male and average caregiver experience was 9.8 years. Results Two cycles of action research were conducted during the study period. There were four stages in the process of how caregivers in the nursing home integrated the perspectives of rehabilitation through their work with the physical therapist. First, caregivers resisted having the rehabilitation programme carried out in the unit because they perceived that rehabilitation performed by a physical therapist was a special process and not under their responsibility. However, the caregivers were given a shared perspective on rehabilitation by the physical therapist, which helped them to understand the meaning of care to adapt the residents' abilities to their daily life. They practised resident-centred care on a trial basis, although with a sense of conflict between their new and previous role, which emphasised the safety of residents' lives and personhood. The caregivers increased their self-efficacy as their knowledge and skills were supplemented by the physical therapist and his approval of their attempted care. They were then able to commit to their newly conceived specialty of care as a means of supporting the lives of residents. Conclusions The process of working with a physical therapist led to a change in caregivers' perception and behaviours, which occurred in four stages: resistance to incorporation, recapture of other perspectives, conflicts and trials in the role of caregiver and transformation to a resident-centred perspective.

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Exploring the structure of social media application-based information-sharing clinical networks in a community in Japan using a social network analysis approach

Haruta J., Tsugawa S., Ogura K.

Family Medicine and Community Health （Family Medicine and Community Health）  8 （ 4 ） e000396 2020年09月

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  23056983

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© Objective Currently, use of social networking services (SNSs) for interprofessional collaboration is increasing. However, few studies have reported on virtual interprofessional interactions in community healthcare services. Revealing such structural characteristics of the networks can provide insight into the functions of the interprofessional information-sharing network and lead to smoother collaboration. Thus, we aimed to explore the structure of SNS-based information-sharing clinical networks. Design Social network analysis (SNA). Setting We selected a community in City X in Japan. Data collection We analysed SNS-based information-sharing clinical network data linked to patients receiving home medical care or care services between January and December 2018. A network was created for each patient to allow healthcare professionals to post and view messages on the web platform. In the SNA, healthcare professions registered in a patient group were represented as nodes, and message posting/viewing relationships were represented as links in the patient network. We investigated the structural characteristics of the target networks using several measures for SNA, including indegree centrality and outdegree centrality, which reflect the number of incoming and outgoing links to/from a node, respectively. Additionally, the professions forming the most central nodes were investigated based on their ranking to identify those with a central role in the networks. Finally, to compare the networks of nursing care levels 1-3 (lighter care requirement) and those with nursing care levels 4-5 (heavier care requirement), we analysed the structural differences in the networks and investigated the roles of healthcare professionals using centrality measures of nodes. Results Among 844 groups, 247 groups with any nursing care level data were available for analysis. Increasing nursing care level showed higher density, reciprocity and lower centralisation. Healthcare professions with high indegree centrality (physicians, care workers and physical therapists) differed from those with high outdegree centrality (home care workers, physical therapists, and registered dieticians). Visiting nurses and nurses in the clinic played a central role, but visiting nurses tended to have higher indegree and outdegree centrality, while nurses in the clinic had higher closeness and betweenness centrality in networks with heavier care requirement. Conclusion The SNS-based information-sharing clinical network structure showed that different professions played some form of a central role. Associations between network structures and patient outcomes, cost effectiveness and other factors warrant further investigation.

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Better Patient Experience is Associated with Better Vaccine Uptake in Older Adults: Multicentered Cross-sectional Study

Kaneko M., Aoki T., Goto R., Ozone S., Haruta J.

Journal of General Internal Medicine （Journal of General Internal Medicine）  35 （ 12 ） 3485 - 3491 2020年09月

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  08848734

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© 2020, Society of General Internal Medicine. Background: Older adults’ uptake of influenza and pneumococcus vaccines is insufficient worldwide. Although patient experience of primary care is associated with vaccine uptake in children, this relationship remains unclear for older adults. Objective: This study examined the association between patient experience of primary care and influenza/pneumococcal vaccine uptake in older adults. Design and Methods: We conducted a multicentered cross-sectional survey involving 25 primary care institutions in urban and rural areas in Japan. Participants were outpatients aged ≥ 65 years who visited one of the participating institutions within the 1-week study period. We assessed patient experience of primary care using the Japanese version of the Primary Care Assessment Tool (JPCAT), which includes six domains: first contact (accessibility), longitudinality (continuity of care), coordination, comprehensiveness (services available), comprehensiveness (services provided), and community orientation. We used a generalized linear mixed-effects model to adjust for clustering within institutions and individual covariates. Key Results: One thousand participants were included in the analysis. After adjusting for clustering within institutions and other possible confounders, influenza and pneumococcal vaccine uptake was positively associated with JPCAT total scores (odds ratio per 1 standard deviation increase: 1.19, 95% confidence interval: 1.01–1.40 and odds ratio: 1.26, 95% confidence interval: 1.08–1.46, respectively). Of the JPCAT domains, coordination and community orientation were associated with influenza vaccine uptake and longitudinality, coordination, and comprehensiveness were associated with pneumococcal vaccine uptake. Conclusions: Influenza and pneumococcal vaccine uptake were positively associated with patient experience of primary care in older adults. Consideration of patient experience, particularly longitudinality, coordination, comprehensiveness, and community orientation, could improve vaccine uptake.

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Doctors' professional identity and socialisation from medical students to staff doctors in Japan: Narrative analysis in qualitative research from a family physician perspective

Haruta J., Ozone S., Hamano J.

BMJ Open （BMJ Open）  10 （ 7 ） e035300 2020年07月

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  2044-6055

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© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Objective Becoming a doctor involves transforming a lay person into a medical professional, which is known as professional socialisation. However, few studies have clarified differences in the professional socialisation process in detail. The aim of this study was to clarify the process of professional socialisation of medical students to residents to staff doctors. Design We used narrative analysis in qualitative research as a theoretical framework. Setting This study was conducted in Japan. Participants Participants were collected using a purposive sample of doctors with over 7 years of medical experience. We conducted semistructured interviews from September 2015 to December 2016, then used a structured approach to integrate the sequence of events into coherent configurations. Results Participants were 13 males and 8 females with medical careers ranging from 8 to 30 years. All participants began to seriously consider their own career and embodied their ideal image of a doctor through clinical practice. As residents, the participants adapted as a member of the organisation of doctors. Subsequently, doctors exhibited four patterns: first, they smoothly transitioned from peripheral' to full' participation in the organisation; second, they could no longer participate peripherally but developed a professional image from individual social interactions; third, they were affected by outsiders' perspectives and gradually participated peripherally; fourth, they could not regard the hospital as a legitimate organisation and could not participate fully. Conclusion The professional socialisation process comprises an institutional theory, professional persona, legitimate peripheral participation and threshold concepts. These findings may be useful in supporting professional development.

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Measuring family caregivers’ experience of interprofessional care for patients and families: development of the Japanese version of the Caregivers’ Experience Instrument

Nakayama Gen, Masumoto Shoichi, Haruta Junji, Maeno Tetsuhiro

Family Practice （Family Practice）  cmaa059 （ 6 ） 854 - 861 2020年06月

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  0263-2136

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Background: Improving individuals' experience of care is now a critical goal of health care systems. Although a number of instruments have been developed to measure experience of care, few instruments measure family caregivers' experience of interprofessional care for patients and families. Objective: To develop the Japanese version of the Caregivers' Experience Instrument (J-IEXPAC CAREGIVERS) and to investigate its validity in assessing quality of integrated care for both patients with chronic conditions and their family caregivers, from the caregivers' perspective, in Japan. Methods: We used a cross-sectional questionnaire survey to test the validity and internal consistency of J-IEXPAC CAREGIVERS. Four hundred family caregivers were recruited in three municipalities. We evaluated the feasibility, structural validity, internal consistency and hypothesis testing for construct validity of the scale. Results: A total of 274 (68.5%) questionnaires were analysed. Confirmatory factor analysis showed acceptable model fit for the hypothesized two-factor model according to fit indices, as identified for the original version: attention for the patient and attention for the caregiver. Cronbach's alpha for score in J-IEXPAC CAREGIVERS with 12 items was high (0.92). Spearman's rank correlation coefficient between overall caregiver satisfaction and J-IEXPAC CAREGIVERS score was 0.71. Family caregivers who experienced home-visit services had significantly (P = 0.001) higher total scores than those who did not. Conclusions: This pilot study showed that the J-IEXPAC CAREGIVERS is valid and reliable. This scale can be useful for evaluating quality of integrated care, with focus on family caregivers and patients with chronic conditions in Japan.

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医療者と文化人類学者の協働の試み 筑波での経験の報告

木村周平, 春田淳志, 照山絢子, 後藤亮平

歴史人類 48   66 - 48 2020年03月

研究論文（大学，研究機関等紀要）, 共著

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Realist approach to evaluating an interprofessional education program for medical students in clinical practice at a community hospital

Haruta J., Yamamoto Y.

Medical Teacher （Medical Teacher）  42 （ 1 ） 101 - 110 2020年01月

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  0142159X

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© 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis. Introduction: We examined the interrelationships between context, mechanism, and outcome using a realist approach following the introduction of interprofessional education (IPE) to clinical practice for medical students in the community. Methods: Through participant observation and interviews, a working hypothesis was developed. To evaluate IPE in clinical practice, medical students’ reports were thematically analyzed, and configuration on contexts, mechanisms, and outcomes were identified using a realist approach. Results: Influential contexts were medical students’ experience of clinical practice and learning characteristics, the capacity of other professionals, interprofessional relationships, and characteristics of the community hospital. One key mechanism was observational learning. Others were self-regulated learning, legitimate peripheral participation, experiential learning, contact hypotheses, awareness of social structure, and cognitive empathy. As faculties supported these key mechanisms, medical students became aware of the legitimacy of community-oriented primary care, noting the roles of physicians who support patients’ and/or their family’s life in collaboration with other professionals, and reflecting the necessity of shifting from physician-centered perspectives. As a result, medical students deepened their empathic understanding for other professionals. Conclusion: Faculties should develop IPE programs in clinical practice based on the ‘mechanism’, ‘context’, ‘outcome’ pattern and ‘context-mechanism-outcome’ configuration in primary care settings.

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How and what do laypeople learn about end-of-life care using narrative? A case study in educational research

Haruta Junji, Oishi Ai, Den Naoko

The Asia Pacific Scholar medical and healthcare professions education (TAPS) （Asia Pacific Scholar）  5 （ 1 ） 16 - 24 2020年01月

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  24249335

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Background: Studies have reported positive impacts from community engagement in end-of-life (EoL) care. However, few studies have used a narrative for health promotion. Thus, we examined how and what lay participants learned through an EoL care education program using narrative. Methods: A case study in educational research was implemented through qualitative process evaluation. The program was conducted in a hospital in Japan. Participants living in the surrounding community were recruited by convenience sampling. We conducted 90-minute focus groups with participants at two and eight months after the completion of the program. All data were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Result: We identified five themes. First, participants reconstructed the concept of EoL care using their own experience and new knowledge gained in the program. Second, the stories in the program stimulated participants to recall their feelings and emotions, which caused catharsis effects. Third, the stories evoked other perspectives through metacognition. Fourth, their experience inspired altruism towards patients and their families at the EoL. Fifth, they reflected on their own deaths as an extension of their relationship with others. This learning process was consistent with Kolb’s experiential learning. Their experience enabled lay participants to overcome the existential terror of death while using the narrative mode of thinking to perceive their relationship with others as a symbolic identity. Conclusion: The educational program using narrative deepened lay participants’ understanding of the concept of EoL care. Such programs have the potential to enhance community engagement in EoL care.

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Effectiveness of an interprofessional education program using team-based learning for medical students: A randomized controlled trial

Hamada S., Haruta J., Maeno T., Maeno T., Suzuki H., Takayashiki A., Inada H., Naito T., Tomita M., Kanou N., Baba T.

Journal of General and Family Medicine （Journal of General and Family Medicine）  21 （ 1 ） 2 - 9 2020年01月

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Background: To respond to increasingly complicated healthcare needs in primary care settings, all health and medical welfare professionals are required to collaborate with multiprofessionals, namely via “interprofessional work” (IPW). Interprofessional education (IPE) is essential for effective IPW, especially for medical students. This study aimed to determine whether participation in IPE can increase medical students’ readiness for interprofessional learning. Method: We examined the difference in readiness of medical students for interprofessional learning before and after an IPE program that used team-based learning (TBL). Each student was assigned to either a uniprofessional or multiprofessional group. They were evaluated using the Japanese version of the Readiness for Interprofessional Learning Scale (RIPLS). Program participants were 126 second-year medical students and 18 students of healthcare professions other than medical doctor who participated in a combined IPE program conducted by two universities. Medical students were allocated to 12 uniprofessional and nine multiprofessional groups at random. Results: One hundred and twelve medical students who replied to the questionnaire both before and after the program (valid response rate, 88.9%) were eligible for analysis. Of these, 42 were assigned to uniprofessional groups and 70 to multiprofessional groups. After the program, the RIPLS total score increased to a greater extent in the multiprofessional groups than in the uniprofessional groups (difference 3.17, 95% confidence interval 0.47-5.88, P =.022). Multiple regression analysis showed the same result. Conclusions: Learning in multiprofessional groups increased medical students’ readiness for interprofessional learning in an IPE program using TBL.

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医学教育修士課程における多職種連携教育オンラインプログラムの実践報告―オンラインに適したインタラクションの工夫―

春田 淳志, 川上 ちひろ, 早川 佳穂

医学教育 （日本医学教育学会）  51 （ 3 ） 344 - 347 2020年

ISSN  0386-9644

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Early exposure to hands-on surgical training encourages urological interest in undergraduate medical students

T Kimura, K Kojo, A Ikeda, S Kandori, T Kojima, J Haruta, H Nishiyama

2020年

共著

【教育・社会・研究活動】 COVID-19に向き合う医療者の経験のドキュメンテーション

木村 周平, 宮地 純一郎, 春田 淳志, 飯田 淳子, 小曽根 早知子, 金子 惇, 後藤 亮平, 照山 絢子, 濱 雄亮, 堀口 佐知子

文化人類学 （日本文化人類学会）  85 （ 3 ） 566 - 569 2020年

共著,  ISSN  1349-0648

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