Decision-making Support and Patients’ Care Progress in a Palliative Care Outpatient Clinic at a Community Hospital

Purpose: This study aimed to investigate the decision-making support and patients’ care progress in a palliative care outpatient clinic at a community hospital. Methods: We conducted a retrospective examination of patients who visited our palliative care outpatient clinic and subsequently died between January 2020 and December 2021. The clinic, staffed by two palliative care physicians, operated twice weekly and accepted patients irrespective of their treatment status. Result: 93 patients were included in the analysis. At the onset of the outpatient clinic, 72 patients were asked about their preferred location for end-of-life care should their condition deteriorate. Of these, 25 patients preferred to receive end-of-life care in a palliative care unit (“PCU” group). Another 25 patients initially sought medical treatment at home through home-visits but later expressed a preference for care in a palliative care unit as their condition worsened (“home-visit→PCU” group). Additionally, 17 patients preferred home care from the end-of-life until death (“home-visit” group). Among the “PCU” patients, 96% received care in a palliative care unit, and 84% passed away in the same unit. In the “home-visit→PCU” group, 76% received care through home visit, and 80% passed away in a palliative care unit. In the “home-visit” group, 76% of patients received care at home, and 47% passed away in their own homes. Conclusion: These findings suggest that delivering end-of-life care in patients’ preferred locations is feasible with continuous decision-making support provided in the palliative care outpatient clinic.

2. A Newly Established Quality/Competency "Taking a Multi-Systemic View towards a Patient as a Living Person" / 医学教育

Based on the social context of an aging society and surveys conducted since 2020, the need for comprehensive perspectives and approaches that consider patients'psychosocial background and a cross-organ perspective has been identified. As a result, a new quality and ability, namely comprehensive attitudes toward patients, has been established as part of the core curriculum for medical education in FY2022. Specific learning objectives include "holistic perspectives and approaches," "community perspectives and approaches," "life perspectives and approaches," and "social perspectives and approaches". An educational design that draws on multiple learning theories to enable reflection on one's own way of being has been proposed to integrate abstract and concrete, conceptual and experiential, and self and others perspectives. It is expected that this medical education will lead to improvement in the well-being of individuals, families, and communities.

7. Educational Strategies and Good Practice (1) / 医学教育

In the 2022 revision of the Model Core Curriculum, a new "Educational Strategies and Assessment" section was added as a further development in outcome-based education. By adding a chapter on strategies and evaluation, which is an important element of the curriculum, and linking it to qualities and abilities, we have devised a way for learners and instructors to make use of the Core Curriculum more easily. In addition, 11 example of strategy and assessment cases are included as Good Practice to encourage practical application. However, since these are only examples, we hope this chapter will be further developed as universities create strategies and evaluations that make the most of their unique characteristics.

Committee report (Practice Article1) : Online Interprofessional Education / 医学教育

It is difficult to implement interprofessional education (IPE) in the classroom due to COVID-19. To share our knowledge of online IPE, we report on how we provided IPE for first-year students at two universities. At Mie University, a class was implemented to use Zoom. Quizzes and chats promoted interactions between instructors and students. At Hokkaido University of Science, an online team medical experience game was conducted via Zoom and a Learning Management System (LMS). The activity promoted interaction between students through gameplay and clear instructions. In both cases, students could successfully develop online IPE based on existing learning methods. Through their experience, it was clear that students are able to understand other professionals’ roles. They were also to commit to membership and/or teamship. On the other hand, students faced challenges with faculty familiarity and time allocation.

Comparison of Interprofessional Collaboration, Work Burden, Workplace Satisfaction, and Relationship with Neighboring Facilities between Clinic/Small Hospital Staff and those at Regional Core Hospitals / 日本プライマリ・ケア連合学会誌

Introduction: This study compared perceptions of interprofessional collaboration and recognition of work between clinic/small hospital staff and those at regional core hospitals.Methods: An anonymous, self-administered questionnaire was administered to the staff at 4 clinics/small hospital and those at 3 regional core hospitals responsible for regional medical care. The following items were compared between the 2 groups: Assessment of Interprofessional Team Collaboration (AITCS) Japanese version, Readiness for Interprofessional Learning Scale (RIPLS) Japanese version, workplace satisfaction, and relationship with neighboring facilities.Results: The subjects were 74 staff members at clinics and small hospital and 576 staff members at regional core hospitals; their average ages were 41.9 years and 40.6 years, respectively. Compared to staff at regional core hospitals, those at the clinics and small hospitals had significantly higher AITCS scores, RIPLS scores, and workplace satisfaction, and they also considered their institutions to have better relationship with neighboring facilities.Conclusion: The staff of clinics and small hospital were more aware of interprofessional collaboration than hospital staff, and were more satisfied with their workplaces. Understanding the underlying organizational differences may facilitate vertical integration in community-based integrated care systems.

Working Group Report (Practice article 2) : Online Interprofessional Education Stepwise Interprofessional Education through Inter-University Collaboration at the University of Tsukuba (1) / 医学教育

For this second report, we divided the efforts of the University of Tsukuba into two parts. In the first part, we introduced the Interprofessional program, an inter-university collaborative educational program between the University of Tsukuba and Ibaraki Prefectural University of Health Sciences. Before the COVID-19 pandemic, this program was conducted using TBL (Team-based learning) in a large conference room. After the pandemic, this was conducted online (using Zoom). The main changes due to the online implementation were the following five points; (1) online faculty meetings, (2) advance distribution of materials, (3) testing using Google Forms, (4) group work using the breakout function, and (5) simultaneous editing using Google Docs. In the future, we would like to examine the possibility of new educational methods while creating innovations that are possible only through online interprofessional educational programs.

Working Group Report (Practice article 2) : Online Interprofessional Education Stepwise Interprofessional Education through Inter-University Collaboration at the University of Tsukuba (2) / 医学教育

@#In the second part of the second report, we introduce the Care Colloquium, an inter-university collaborative educational program between the University of Tsukuba and the Tokyo University of Science. The Care Colloquium is an interprofessional education program that uses PBL (Problem-based learning). In response to the COVID-19 pandemic, this program was implemented online using Microsoft Teams, with advance preparation including manual maintenance and communication testing. The same learning outcomes were achieved as the face-to-face implementation. Undergraduate interprofessional education tends to be a large-scale program, and the shortage of faculty and classrooms is challenging, but online education could overcome these obstacles. The development of hybrid programs that use the merits of both face-to-face and online education may lead to the promotion of interprofessional education in the future.

Factors Associated with Knowledge of the Common Cold and Desire for Medical Treatment: A Cross-sectional Study of Citizens Undergoing Health Checkups / 日本プライマリ・ケア連合学会誌

Introduction: We investigated the relationship between knowledge of the common cold and desire for medical treatment.Methods: We administered an anonymous self-questionnaire about the common cold to citizens receiving health checkups in City X, Ibaraki Prefecture, between August and September 2012. We assessed citizens' knowledge about the common cold and whether they sought medical treatment for it, in addition to their demographic attributes.Results: We included 1079 citizens (response rate, 74.5%) in the analysis. The majority of participants believed that receiving intravenous (IV) infusions or injections for the common cold led to faster recovery times (75.9%). Roughly half of the participants (42.0%) did not believe that antibiotics are not effective against virus-based colds, while 28.6% were unsure. Finally, endorsement of the questionnaire items "taking cold medications early leads to faster recovery" (OR: 1.61) and "IV infusions or injections lead to faster recovery times" (OR: 1.86) were associated with a desire for medical treatment.Conclusion: Our results indicate that patients' knowledge about the common cold and their understanding of treatment options available at medical institutions were inadequate. Furthermore, we found that an awareness of how cold medicines, IV infusions, or injections may shorten treatment duration was associated with a desire for treatment.

How do Health Care Professionals Change the Recognition of Relationships and Problems Among Them Through Dialogue? Qualitative Descriptive Research Exploring the Process of Home Health Care Promotion in Areas Where Medical Resources are Insufficient Using the Theoretical Framework of Complexity / 日本プライマリ・ケア連合学会誌

Introduction: The Japanese government implemented a community-based integrated care system that provides community healthcare resources for elderly people focusing on home health care in particular. To achieve this, interprofessional teams in the community need to function seamlessly. Thus, we explored the process by which healthcare professionals change their recognition of the relationships and problems among them through the dialogue of home health care promotion.Methods: We held the World Cafe to discuss with healthcare professionals about home health care in a city in Ibaraki Prefecture. All dialogues were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.Results: Although healthcare professionals had strongly recognized the hierarchical relationship, they deepened their mutual understanding by sharing their background and values. While sharing the hope to make equitable relationships, they changed their recognition as follows: home health care was not "someone else's problem" but "their own problem" and "their own community's problem".Conclusion: It is necessary for healthcare professionals to share issues and explore methods to solve them in the community, and to change the relationships among stakeholders because problems related to home health care promotion are complex. This study clarified that healthcare professionals are motivated to seek solutions to problems proactively via their relationships in interprofessional teams in the community.

Realist Approach: How to Evaluate Complex Interventions and Educational Programs Based on Scientific Methodology / 日本プライマリ・ケア連合学会誌

The realist approach aims to evaluate the process of complex interventions and educational programs that are required in primary care. This is one research method focusing on the clarification of "how and why it works", which has been unclear thus far, and to make it possible to reflect on interventions and processes based on reality. In the realist approach, with realism as a paradigm, researchers collect quantitative and qualitative data, and create an integrated series of context, mechanism and outcome based on the concept of constructive alignment. In this report, the authors introduce an outline of the realist approach using an inter-professional shadowing program evaluation conducted for medical students at a community hospital as an example. It is the authors' goal that scientific evaluation applying realist principles be employed in the field of primary care.

A Nationwide Survey on the Faculty Development for Simulation-Based Medical Education in Japan / 医学教育

We have conducted a nationwide survey on faculty development for simulation-based medical education in Japan. The response rate was 90%. Forty-seven (68%) schools have implemented faculty development programs for simulation-based education. The most commonly implemented contents were standardized patient development, task trainer, high fidelity manikin operation, and student evaluation, which were related to objective structured clinical examination objective clinical skill assessment. Only 15 percent of medical schools implemented topics on reflective practice, and scientific writing. A constraint on faculty time was the most commonly perceived barrier to simulation use (mentioned by 62 schools; 90%).

Ⅰ An overview of theories about interprofessional education and work / 医学教育

　The theoretical framework for interprofessional education is drawn from a number of academic disciplines. To put theory into practice, it is necessary to analyze major theories and use metacognitive frameworks focusing on the micro, meso, and macro levels.<br>　As major theories, social constructivism and social capital were introduced. Social constructivism emphasizes the necessity of interaction with the social environment and proposes that persons play a large role in cognitive development. In social capital, people tend to share a common idea as “the social network has value.”<br>　On the basis of social welfare theory, we have described several theories focusing on the micro, meso, and macro levels. In micro-level analysis, successful application of adult learning theory, or andragogy, is a key mechanism for well-received interprofessional education. In addition, contact theory provides appropriate ways to reduce prejudice between members of a group, and social identity theory provides a concept for explaining intergroup behavior. In meso-level analysis, team learning, the theory of cooperation, activity theory, and Tuckman’s team development model were introduced. In macro-level analysis, we explained that healthcare professionals are socialized in complex systems focusing on organizational learning or practice.<br>　Finally, the literature for interprofessional education focusing on a metacognitive framework was introduced. We expect that, through multifaceted reflection over time, a theoretical framework for multidisciplinary cooperation will be developed.