議題In Pursuit of the Ideal Mix: the Medical Undergraduate Curriculum of Faculty of medicine, University of Colombo, Sri Lanka
Gominda Ponnamperuma, MBBS, MMEd, PhD
Senior Lecturer, Medical Education Development and Research Centre Faculty of Medicine, University of Colombo, Sri Lanka /
Project Associate Professor, IRCME, The University of Tokyo
概要Faculty of Medicine, University of Colombo, Sri Lanka is the second oldest medical school in South East Asia. For the most part of its 140-year history, the curriculum has been discipline-based, with didactic lectures being the predominant teaching and learning method. This was changed in a major curriculum reform in 1995.
The traditional, discipline-based curriculum was converted to a horizontally and vertically integrated curriculum with the introduction of course modules based on body systems. The curriculum was organised into five streams: introductory basic sciences stream; applied sciences stream; clinical sciences stream; community stream; and behavioural sciences stream. The largely teacher-centred lectures paved way to the more student-centred small group discussions and problembased learning. The curriculum resulted in greater student participation in active learning, and learning in context. Also the students were offered opportunities to hone their skills in hither to less addressed aspects such as communication skills, research skills, ethics, attitudes and professionalism. Both the organisation and implementation of teaching / learning and assessment methods in the curriculum constituted a paradigm shift in many ways. Both the students and the teachers had to learn new skills and educational techniques such as problem-based learning. The organisation of the curriculum meant that the teachers were no longer responsible for individual subjects. Rather all the teachers taught in the entire curriculum. The curriculum successfully overcame these initial hurdles.
However, the curriculum as it stands today is not without challenges. The streams that were developed to integrate the curriculum tend to function in isolation rather than in conjunction. The assessment needs to be streamlined more to achieve inter-stream integration and to reflect the curriculum outcomes in general. Hence, measures such as integrating the streams by using inter-stream activities, reorganising and integrating the assessment system, and the introduction of workplace-based assessment to counter the above challenges are currently being explored. How ideally these measures can be introduced and maintained to strike the ideal mix of educational strategies will be discussed during the session.


講師⼤⽣ 定義
概要⽇本医学教育学会・倫理・プロフェッショナリズム委員会での活動を中⼼に、情報提供を⾏い討論につなげたい。本講演では、最初に1)学会提⾔案の紹介 2)社会契約を基盤とする概念でわが国になじむものなのか、もっとなじみやすい考え⽅は︖を検討した、同委員会主催の11⽉シンポジューム概要の解説を⾏う。また、3)プロフェッショナリズムの評価についても2010年5⽉のオタワ会議のワーキンググループメンバーとして参加し、内容や討論の流れにも触れてみる。最後に演者の私⾒も交え、討論につなげたい。


議題Optimizing Resident Education: Strategies and Evidence
講師グレアム・マクマーン Graham McMahon, MD, MMSc
Division of Endocrinology, Diabetes & Hypertension, Brigham and Womenʼs Hospital Assistant Professor of Medicine, Harvard Medical School
Project Associate Professor, IRCME, The University of Tokyo
概要Changes in clinical practice have rendered inadequate the century-old,inpatient based education model. Financial pressures on teaching hospitals have intensified, encouraging the pursuit of clinical and grant revenue at the expense of trainee education. Patients who are hospitalized today aremore complex than previously, less representative of the diversity of diseases seen in the community, require greater involvement of specialists, and stay for a shorter time. These changes have increasingly limited the participation of trainees and affected their therapeutic relationships with their patients and their supervisors. In the United States, regulations limiting resident duty hours and patient load have had the unintended consequence of worsening this situation. In focus groups and surveys, our trainees sought to reverse this decline, and sought greater bedside teaching, more attending time and supervision, greater feedback, and a reduction in workload. An experiment that addressed these concerns on one service and compared it to a standard service demonstrated that attention to quality education improved both resident and attending satisfaction, but also positively impacted the quality and safety of patient care. Redesign of training programs is greatly needed. The changes should prioritize education over service; emphasize quality, patient safety, and systems-based practice; and provide graded and greater supervision of our trainees. In this session we will review how redesign of the structure and format of post-graduate clinical


議題Assessing Clinical Competence: Lessons from the USMLE Clinical Skills Examination
講師 グレアム・マクマーン Graham McMahon, MD, MMSc
Division of Endocrinology, Diabetes & Hypertension, Brigham and Womenʼs Hospital Assistant Professor of Medicine, Harvard Medical School
Project Associate Professor, The International Research Center for Medical Education, The University of Tokyo
概要The USMLE Step 2 Clinical Skills exam consists of a series of patient encounters in which the examinees must see 12 simulated patients over 8 hours of testing. All medical school graduates in the U.S., and all incoming foreign medical graduates must take the examination. Examinees take a history, do a physical examination, determine differential diagnoses, and then write a patient note based on their determinations. Examinees are expected to investigate the simulated patientʼs chief complaint, as well as obtain a thorough assessment of their past medical history, medications,allergies, social history, and family history. The introduction of the examination was very controversial, and many obstacles to the examination had to be overcome. Once introduced in 2004, the examination resulted in substantial changes to emphasis given to clinical skills in U.S. medical schools.
Gradual but meaningful changes in examinee performance were detected over time, but there continues to be controversy about the strengths, weaknesses and costs of the program. As the Japanese medical community works to enhance its own assessment systems, it is hoped that this session will illuminate some of the positive and negative lessons learned from the USMLE experience. We will discuss metrics of clinical competence, the establishment of validity and reliability, and how a summative assessment could be usefully developed in Japan.


議題Health Professions Teacher Education for clinicians in Toronto, Canada / From Traditional to Outcome-based Medical Education
Results of a Randomized Controlled Trial at the Ruhr-University Bochum, Germany / Teaching Modules in Pathology Education
講師Helen P. Batty ( カナダ トロント⼤学医学部地域家庭医学教授)
Thorsten Shaefer ( ドイツ ルール⼤学医学教育センター⻑)
Urs-Nikolaus Riede(ドイツ フライブルク⼤学 解剖学講座 教授)
資料ポスタースライド(Batty)スライド(Shaefer)スライド(Riede)、 講演ビデオ


講師中原 淳 (東京⼤学 ⼤学総合教育研究センター 准教授)
概要⼈の熟達化、技能形成は、職場における他者とのインタラクションと⽀援に、多⼤なる影響を受けています。 このセミナーでは、⺠間企業における「職場における学習」研究の中からわかってきたことをご紹介します。 医療現場の学習、医学教育にとって、すぐに直接役に⽴つ内容ではないと思いますが、その類似点、差異点を内省するきっかけを ご提供 できればと思います。


講師吉岡 俊正 (東京⼥⼦医科⼤学副理事⻑・同医学部医学教育学教授)
概要⽇本で2001年に導⼊された医学教育モデル・コア・カリキュラムの意義の ひとつは社会に対する教育の質保証であった。カリキュラムは教育の ⼀部であるが、運営組織・環境・⼈材を含む教育全体の質保証のために 機関認証評価制度がある。患者や医師が国家間を移動する時代となり、 他国の医師が診療に携わる際に、個々の医師の能⼒評価だけでなく、 医師の受けた教育の質が担保されることも必要となってきた。世界医学教育連盟は医育機関の国際的教育質保証基準として2003年に 基本(卒前)・卒後・⽣涯教育のグローバルスタンダードを提案し、 本年から「医師の役割」の国際基準の策定作業に⼊った。本セミナーでは世界医学教育連盟活動に基づく医学教育の国際的 質保証の動向について述べる。


講師鈴⽊ 克明 (熊本⼤学⼤学院社会⽂化科学研究科、 教授システム学専攻⻑・教授)
概要システム的な教育設計論として半世紀にわたって成⻑を遂げ各⽅⾯で 応⽤されているインストラクショナルデザイン(ID)の諸モデルをいくつか紹介し、医学教育の事例改善への応⽤を試みる。紹介するIDモデルは、 ガニェの9教授 事象、ケラーのARCSモデル、IDの5つの視点、eラーニングの質保証レイヤーモデル、IDの第⼀原理など。改善を試みる事例は、 東京⼤学医学教育国際協⼒研究センターが過去に⾏ったもの、 またはこれから⾏う予定のものを予定している。いわゆる「試し斬り」によって、 斬られる⿂(実践)のID的鮮度と斬る太⼑(道具)の切れ味が明らかに なってしまうという怖いもの⾒たさの企画です。


講師Arie Rotem (New South Wales⼤学名誉教授)
⼤⻄ 弘⾼ (東京⼤学医学教育国際協⼒研究センター講師)
日時2010年5⽉29⽇(⼟) 11時00分〜12時00分


講師北村 聖 (東京⼤学 医学教育国際協⼒研究センター教授)
概要平成15年秋に初めてのマッチングが⾏われ、平成16年度から新臨床研修制度が始まった。 その間⼤きな社会的問題にもなり、医師不⾜や医師の地域的偏在、診療科の偏在などの問題が明るみに出て、医師養成はどうあるべきかが議論されてきた。 この中で、東京⼤学付属病院はその使命から考えどのような研修を⽬指し、どのようなことが達成できたのか、あるいはどのような課題をかかえているのかなど、いまいちどまとめて⾒たい。