基本情報
論文
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JMIR medical education 10 e53193 2024年7月19日To assess the utility of wearable cameras in medical examinations, we created a physician-view video-based examination question and explanation, and the survey results indicated that these cameras can enhance the evaluation and educational capabilities of medical examinations.
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JMIR medical education 10 e52207 2024年5月30日 査読有りBACKGROUND: The relationship between educational outcomes and the use of web-based clinical knowledge support systems in teaching hospitals remains unknown in Japan. A previous study on this topic could have been affected by recall bias because of the use of a self-reported questionnaire. OBJECTIVE: We aimed to explore the relationship between the use of the Wolters Kluwer UpToDate clinical knowledge support system in teaching hospitals and residents' General Medicine In-Training Examination (GM-ITE) scores. In this study, we objectively evaluated the relationship between the total number of UpToDate hospital use logs and the GM-ITE scores. METHODS: This nationwide cross-sectional study included postgraduate year-1 and -2 residents who had taken the examination in the 2020 academic year. Hospital-level information was obtained from published web pages, and UpToDate hospital use logs were provided by Wolters Kluwer. We evaluated the relationship between the total number of UpToDate hospital use logs and residents' GM-ITE scores. We analyzed 215 teaching hospitals with at least 5 GM-ITE examinees and hospital use logs from 2017 to 2019. RESULTS: The study population consisted of 3013 residents from 215 teaching hospitals with at least 5 GM-ITE examinees and web-based resource use log data from 2017 to 2019. High-use hospital residents had significantly higher GM-ITE scores than low-use hospital residents (mean 26.9, SD 2.0 vs mean 26.2, SD 2.3; P=.009; Cohen d=0.35, 95% CI 0.08-0.62). The GM-ITE scores were significantly correlated with the total number of hospital use logs (Pearson r=0.28; P<.001). The multilevel analysis revealed a positive association between the total number of logs divided by the number of hospital physicians and the GM-ITE scores (estimated coefficient=0.36, 95% CI 0.14-0.59; P=.001). CONCLUSIONS: The findings suggest that the development of residents' clinical reasoning abilities through UpToDate is associated with high GM-ITE scores. Thus, higher use of UpToDate may lead physicians and residents in high-use hospitals to increase the implementation of evidence-based medicine, leading to high educational outcomes.
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BMC medical education 24(1) 316-316 2024年3月20日 査読有りBACKGROUND: In Japan, postgraduate clinical training encompasses a 2-year residency program, including at least 24 weeks of internal medicine (IM) rotations. However, the fragmented structure of these rotations can compromise the training's quality and depth. For example, a resident might spend only a few weeks in cardiology before moving to endocrinology, without sufficient time to deepen their understanding or have clinical experience. This study examined current patterns and lengths of IM rotations within the Japanese postgraduate medical system. It scrutinized the piecemeal approach-whereby residents may engage in multiple short-term stints across various subspecialties without an overarching, integrated experience-and explored potential consequences for their clinical education. METHODS: This nationwide, multicenter, cross-sectional study used data from self-reported questionnaires completed by participants in the 2022 General Medicine In-Training Examination (GM-ITE). Data of 1,393 postgraduate year (PGY) one and two resident physicians who participated in the GM-ITE were included. We examined the IM rotation duration and number of IM subspecialties chosen by resident physicians during a 2-year rotation. RESULTS: Approximately half of the participants chose IM rotation periods of 32-40 weeks. A significant proportion of participants rotated in 5-7 internal medicine departments throughout the observation period. Notable variations in the distribution of rotations were observed, characterized by a common pattern where resident physicians typically spend 4 weeks in each department before moving to the next. This 4-week rotation is incrementally repeated across different subspecialties without a longer, continuous period in any single area. Notably, 39.7% of participants did not undertake general internal medicine rotations. These results suggest a narrowed exposure to medical conditions and patient care practices. CONCLUSIONS: Our study highlights the need to address the fragmented structure of IM rotations in Japan. We suggest that short, specialized learning periods may limit the opportunity to gain broad in-depth knowledge and practical experience. To improve the efficacy of postgraduate clinical education, we recommend fostering more sustained and comprehensive learning experiences.
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JMIR medical education 10 e54401 2024年2月29日 査読有りBACKGROUND: Medical students in Japan undergo a 2-year postgraduate residency program to acquire clinical knowledge and general medical skills. The General Medicine In-Training Examination (GM-ITE) assesses postgraduate residents' clinical knowledge. A clinical simulation video (CSV) may assess learners' interpersonal abilities. OBJECTIVE: This study aimed to evaluate the relationship between GM-ITE scores and resident physicians' diagnostic skills by having them watch a CSV and to explore resident physicians' perceptions of the CSV's realism, educational value, and impact on their motivation to learn. METHODS: The participants included 56 postgraduate medical residents who took the GM-ITE between January 21 and January 28, 2021; watched the CSV; and then provided a diagnosis. The CSV and GM-ITE scores were compared, and the validity of the simulations was examined using discrimination indices, wherein ≥0.20 indicated high discriminatory power and >0.40 indicated a very good measure of the subject's qualifications. Additionally, we administered an anonymous questionnaire to ascertain participants' views on the realism and educational value of the CSV and its impact on their motivation to learn. RESULTS: Of the 56 participants, 6 (11%) provided the correct diagnosis, and all were from the second postgraduate year. All domains indicated high discriminatory power. The (anonymous) follow-up responses indicated that the CSV format was more suitable than the conventional GM-ITE for assessing clinical competence. The anonymous survey revealed that 12 (52%) participants found the CSV format more suitable than the GM-ITE for assessing clinical competence, 18 (78%) affirmed the realism of the video simulation, and 17 (74%) indicated that the experience increased their motivation to learn. CONCLUSIONS: The findings indicated that CSV modules simulating real-world clinical examinations were successful in assessing examinees' clinical competence across multiple domains. The study demonstrated that the CSV not only augmented the assessment of diagnostic skills but also positively impacted learners' motivation, suggesting a multifaceted role for simulation in medical education.
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Scientific reports 14(1) 1481-1481 2024年1月17日 査読有りLong duty hours (DH) impair sleep and negatively affect residents' health and medical safety. This cross-sectional study investigated the association among residents' DH, sleep duration, insomnia, sleep impairment, depressive symptoms, and self-reported medical errors among 5579 residents in Japan who completed the General Medicine In-Training Examination (2021) and participated in the training-environment survey. Weekly DH was classified under seven categories. Sleep duration and insomnia symptoms, from the Athens Insomnia Scale, were analysed to determine sleep impairment; depressive symptoms and medical errors were self-reported. Among 5095 residents, 15.5% slept < 5 h/day, and 26.7% had insomnia. In multivariable analysis, compared with ≥ 60 and < 70, DH ≥ 90 h/week associated with shorter sleep duration and worsen insomnia symptoms. Shorter durations of sleep and more intense symptoms of insomnia were associated with increased depressive symptoms. Medical errors increased only among residents with insomnia, but were not associated with sleep duration. DH > 90 h/week could lead to shorter sleep duration, worsen insomnia symptoms, and negatively impact well-being and medical safety. There was no significant association between sleep duration and medical errors; however, insomnia conferred an increased risk of medical errors. Limiting DH for residents to avoid excessive workload can help improve resident sleep, enhance resident well-being, and potentially reduce insomnia-associated medical errors.
MISC
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Medicina 60(6) 894-898 2023年5月
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Medicina 60(6) 906-910 2023年5月
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医学教育 53(Suppl.) 46-46 2022年7月
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医学教育 53(Suppl.) 45-45 2022年7月
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診断と治療 108(5) 579-582 2020年5月
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関東リウマチ 53 97-99 2020年3月69歳男。受診の4週前に発熱・鼻根部の腫脹・咽頭痛が出現した。2週前に右眼の充血と右耳閉塞感が出現し、改善しないため受診し入院となった。入院時身体所見として右肩鎖・左肩・右第5MTP関節に圧痛を認めた。血液検査で白血球・リンパ球・赤血球・ヘモグロビンの低値とMCV・血沈の高値を認めた。生化学検査でクレアチニン・AST・ALT・フェリチンの高値、免疫学的検査でIgGの高値を認めた。これらの所見から再発性多発軟骨炎(RP)を疑った。経過中に左耳介の発赤・腫脹・熱感、左肩・左膝・左足関節の圧痛、四肢の隆起性紅斑が出現し、紅斑は全身に拡大した。Sweet病の診断基準に照らし合わせ、紅斑や好中球優位の浸潤像、自己免疫疾患の背景、各種炎症所見などからSweet病と診断した。プレドニゾロン65mgで治療開始し、発熱は速やかに改善した。鼻根部・耳介の腫脹も改善したが、白血球数は2000/μl台までしか上昇せず、MDSのマーカー(WT-1 mRNA)が陽性となったためMDSと診断した。最終診断は「Sweet病とMDSを合併したRP」となった。
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レジデントノート 21(11) 1927-1928 2019年10月
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Gノート 6(2) 308-314 2019年3月<Point>●診断推論プロセスには、結論へ向かって跳躍しようとする速い思考のsystem 1(直観的思考)と、段階的に手順を踏んで論理的に考えようとする遅い思考のsystem 2(分析的思考)とが存在します●system 1もsystem 2も短所と長所を有しており、どちらも診断精度については同等です●診断エラーはcommon medical problemであり、知識や技術の不足よりも、むしろ思考プロセスに影響を及ぼすシステム要因と認知心理的要因とが複雑に絡み合って生じるものです(著者抄録)
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レジデントノート 19(9) 1589-1595 2017年9月(1)生活習慣病治療の目的は異常値の是正ではなく、「元気に長生きできる」という真のエンドポイントにある(2)過ぎたるは猶及ばざるが如し。適切な治療目標を設定し、過剰治療を減らそう(3)必ずしも「新しい薬=よい薬」ではない。長く使われ、豊富なエビデンスがある薬剤に親しもう(著者抄録)
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薬局 68(9) 2981-2985 2017年8月<Key Points>下部消化管の主な生理的機能は、小腸が栄養素の吸収、大腸が水と電解質の吸収、直腸が便貯留と排便である。下部消化管切除後の晩期合併症では(1)切除腸管のもつ生理的機能障害の影響、(2)周辺組織の切除・損傷による影響、(3)開腹術自体の影響を考える。晩期合併症は必ずしも腹部症状で発症するものだけではない。長期間の栄養吸収障害による影響や、神経損傷に伴う患者自身が訴えにくい合併症を意識して問診する必要がある。(著者抄録)
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成人病と生活習慣病 47(1) 17-21 2017年1月若年者と同様に高齢者の初発頭痛でも一次性頭痛は多く、年齢が上昇するに従って片頭痛の頻度は低下し、緊張型頭痛の頻度が上昇する。また、若年者より割合が増える二次性頭痛を念頭に置いた診療が必要である。頭痛は身体疾患に起因するのみならず、うつ病に代表される精神疾患や、薬物有害反応が原因となり得る。特に後者では、安易に鎮痛薬処方が重ねられることでprescribing cascadeを引き起こし、ポリファーマシー状態の悪化を引き起こすという認識が重要である。(著者抄録)
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診断と治療 104(8) 1029-1033 2016年8月<Headline> 1 特発性浮腫は特に女性に多くみられ、頻度が高い疾患ではあるが、浮腫をきたす各疾患を除外することで診断可能である。2 両下肢浮腫を呈する患者の診療時には、重大な疾患を示唆する「レッド・フラッグサイン」に着目して病歴を確認することが重要である。3 患者の希望に応じて、特発性浮腫の症状改善目的に安易にループ利尿薬を長期間使用することは、結果的に浮腫の悪化を招くため原則として避けるべきである。(著者抄録)
共同研究・競争的資金等の研究課題
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日本学術振興会 科学研究費助成事業 2016年4月 - 2020年3月
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日本学術振興会 科学研究費助成事業 2012年4月 - 2015年3月