Details of a Researcher - Haruta, Junji

Papers - Haruta, Junji

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Development of a validated assessment tool for medical students using simulated patients: an 8-year panel survey

J Haruta, R Nakajima, T Monkawa

BMC Medical Education 24 (1), 1-8 (BMC Medical Education) 24 ( 1 ) 399 2024.12

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

Hirohisa Fujikawa, Takuya Aoki, Takayuki Ando, Junji Haruta

BMC Medical Education (Springer Science and Business Media LLC) 24 ( 1 ) 660 2024.12

Abstract

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 2024.06

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)

Impact of University Hospital Clinical Clerkship on Medical Students' Understanding of the Specialties in General Medicine

Ando Takayuki, Hyakutake Misa, Haruta Junji, Fujikawa Hirohisa, Hirahashi Junichi, Fujishima Seitaro

An Official Journal of the Japan Primary Care Association (JAPAN PRIMARY CARE ASSOCIATION) 47 ( 2 ) 63 - 66 2024.06

ISSN 2185-2928

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．

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

T Ando, T Sasaki, Y Abe, Y Nishimoto, T Hirata, T Tajima, Y Oguma, ...

BJGP open 2024.04

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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 2024.03

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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 2024.02

ISSN 09150552

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

Osawa Gakuji, Haruta Junji, Matsuura Miyuki, Ueno Akika, Den Naoko

Palliative Care Research (Japanese Society for Palliative Medicine) 19 ( 1 ) 7 - 12 2024

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.

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

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

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

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 Katsunori, Sakashita Masafumi, Ogawa Yasushi, Inomata Takenori, Kainuma Keigo, Kan-o Keiko, Sato Sakura, Tamari Mayumi, Nakajima Saeko, Morita Hideaki, Kurashima Yosuke, Futamura Masaki, Takahashi Koichiro, Haruta Junji, Hyakutake Misa, Monkawa Toshiaki, Ishizuka Tamotsu, Imoto Yoshimasa, Oyama Noritaka, Kanzaki Sho, Kidoguchi Masanori, Fukushima Atsuki, Fukunaga Koichi, Fujieda Shigeharu, Yasutomi Motoko, Adachi Takeya

Japanese Journal of Allergology (Japanese Society of Allergology) 73 ( 4 ) 329 - 339 2024

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

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

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

Journal of Interprofessional Care, 1-8 1 - 8 2024

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

F Kent, J Haruta

Medical Education 2024

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

Igaku Kyoiku / Medical Education (Japan) (Japan Society for Medical Education) 54 ( 6 ) 601 - 603 2023.12

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

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

BMC Medical Education 23 (1), 1-9 (BMC Medical Education) 23 ( 1 ) 332 2023.12

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?

Junji Haruta, Takayuki Ando, Seitaro Fujishima

BMC medical education (BMC Medical Education) 23 ( 1 ) 15 - 15 2023.12

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 2023.11

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

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

Public Health 224, 152-158 (Public Health) 224 152 - 158 2023.11

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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Copper deficiency: An overlooked diagnosis

H Fujikawa, J Haruta

Cureus 15 (11) 15 ( 11 ) e49139 2023.11

ISSN 2168-8184

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Precision engineered peptide targeting leukocyte extracellular traps mitigate acute kidney injury in Crush syndrome

K Okubo, K Takayama, H Kawakami, K Iida, H Miyauchi, Y Roppongi, ...

Biochemical and Biophysical Research Communications (Biochemical and Biophysical Research Communications) 671 173 - 182 2023.09

ISSN 0006291X

Crush syndrome induced by skeletal muscle compression causes fatal rhabdomyolysis-induced acute kidney injury (RIAKI) that requires intensive care, including hemodialysis. However, access to crucial medical supplies is highly limited while treating earthquake victims trapped under fallen buildings, lowering their chances of survival. Developing a compact, portable, and simple treatment method for RIAKI remains an important challenge. Based on our previous finding that RIAKI depends on leukocyte extracellular traps (ETs), we aimed to develop a novel medium-molecular-weight peptide to provide clinical treatment of Crush syndrome. We conducted a structure-activity relationship study to develop a new therapeutic peptide. Using human peripheral polymorphonuclear neutrophils, we identified a 12-amino acid peptide sequence (FK-12) that strongly inhibited neutrophil extracellular trap (NET) release in vitro and further modified it by alanine scanning to construct multiple peptide analogs that were screened for their NET inhibition ability. The clinical applicability and renal-protective effects of these analogs were evaluated in vivo using the rhabdomyolysis-induced AKI mouse model. One candidate drug [M10Hse(Me)], wherein the sulfur of Met10 is substituted by oxygen, exhibited excellent renal-protective effects and completely inhibited fatality in the RIAKI mouse model. Furthermore, we observed that both therapeutic and prophylactic administration of M10Hse(Me) markedly protected the renal function during the acute and chronic phases of RIAKI. In conclusion, we developed a novel medium-molecular-weight peptide that could potentially treat patients with rhabdomyolysis and protect their renal function, thereby increasing the survival rate of victims affected by Crush syndrome.

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Association between family caregivers' primary care experience when they report as patients and their stress related to caregiving: A pilot cross-sectional study

Nakayama G., Masumoto S., Haruta J., Maeno T.

Journal of General and Family Medicine (Journal of General and Family Medicine) 24 ( 4 ) 231 - 239 2023.07

ISSN 2189-6577

Background: Few studies have examined whether family caregivers' own primary care providers can affect caregiving-specific well-being, such as caregiver stress. In this pilot study, we explored whether primary care experiences when family caregivers report as patients were associated with the stress of caregiving. Methods: We used cross-sectional data from a survey conducted in Japan between November and December 2020. We recruited family caregivers aged 40–74 years who were caring for community-dwelling adults with chronic conditions. We assessed primary care experience using the Japanese version of the Primary Care Assessment Tool Short Form (JPCAT-SF) and caregiver stress using the Japanese short version of the Zarit Caregiver Burden Interview. Results: In total, 406 family caregivers were included in the analysis. The mean JPCAT-SF total score was 42.1 out of 100 points. The proportion of caregivers who had higher caregiver stress was 48.8%. After adjusting for possible confounders, the JPCAT-SF score was found to be significantly associated with caregiver stress (lower stress = 0 vs. higher stress = 1; adjusted prevalence ratio per 1 SD increase in JPCAT-SF score = 0.89; 95% CI 0.80–0.98). Among the subscales of the JPCAT-SF, longitudinality, and comprehensiveness (services available) were associated with caregiver stress. Conclusions: Better primary care experiences when family caregivers reported as patients were associated with lower caregiver stress. Longitudinality, which includes focusing attention on the individual as a whole person, and comprehensiveness in the context of building provider-patient relationships that make consultation easier when needed, were associated with lower stress.

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Association between experience of interprofessional care and self-medication among family caregivers: A cross-sectional study.

Shoichi Masumoto, Gen Nakayama, Junji Haruta, Tetsuhiro Maeno

Research in social & administrative pharmacy : RSAP (Research in Social and Administrative Pharmacy) 19 ( 5 ) 773 - 777 2023.05

ISSN 15517411

BACKGROUND: Although healthcare professionals pay attention to the drugs prescribed by physicians, few studies have assessed self-medication by family caregivers. Family caregivers' experience of interprofessional care in the care of patients can influence caregivers' health behaviors. OBJECTIVES: This study aimed to describe self-medication among family caregivers of community-dwelling adult patients, and to assess association between family caregivers' experience of interprofessional care and their self-medication, adjusting for possible confounding factors. METHODS: We conducted a cross-sectional survey from November to December 2020 in Ibaraki Prefecture, Japan. Family caregivers between 40 and 74 years old and caring for community-dwelling adult patients with chronic conditions were recruited. The use of any self-medication in the last 2 weeks by family caregivers was the outcome variable. The explanatory variable was family caregivers' experience of interprofessional care in the care of patients, using the Japanese version of the Caregivers' Experience Instrument (J-IEXPAC CAREGIVERS). Adjusted covariates were age, gender, educational attainment, annual household income, self-rated health, and caregiving time of family caregivers. RESULTS: Of 1091 recruited family caregivers, 750 were included in the analysis. A total of 258 (34.4%) family caregivers reported having used self-medication in the past 2 weeks. Logistic regression analysis showed that having a higher score on the J-IEXPAC CAREGIVERS (odds ratio 0.80 per 1 standard deviation increase) was associated with less use of self-medication by caregivers. CONCLUSIONS: This study revealed that about one-third of family caregivers self-medicate, and this practice is associated with a less positive experience of interprofessional care. These results suggest that it is important for healthcare professionals to be aware of the health condition of family caregivers and to provide appropriate advice regarding self-medication.

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在宅医はどのように処方薬を評価し,どのような処方行動をとるのか?　質的帰納的研究

舛本祥一, 春田淳志

日本在宅医療連合学会誌 ((一社)日本在宅医療連合学会) 4 ( 2 ) 40 - 48 2023.05

在宅医が在宅患者の処方薬をどのような視点で評価し,どのような処方行動がなされていくのか明らかにするため,個人インタビューを用いた質的帰納的研究を実施した.在宅医療に従事する医師17名に対し,半構造化個別インタビュー調査を行い,録音データを逐語録化し,テーマ分析を行った.在宅医は,薬剤の身体的影響,患者の予後やQOL,患者・家族との関係性などを考慮しつつ,多職種とのやり取りを含めた在宅医療特有の様々な要因を考慮して,処方行動の判断を行っていることが明らかとなった.処方薬変更のプロセスの見える化,多職種間での処方行動への共通理解が進むことで,在宅医療における処方の質向上につながると期待される.(著者抄録)

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

Haruta Junji, Ando Takayuki, Endo Amane, Kaneko Makoto, Shikino Kiyoshi, Nagamine Yuiko, Nishigori Hiroshi, Fujikawa Hirohisa, Yamanashi Hirotomo

Igaku Kyoiku / Medical Education (Japan) (Japan Society for Medical Education) 54 ( 2 ) 142 - 148 2023.04

ISSN 03869644

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)

Matsushima Kayoko, Asada Yoshikazu, Nomura Osamu, Haruta Junji, Yamaguchi Kumiko, Kondo Takeshi, Nishigori Hiroshi, Konishi Yasuhiko

Igaku Kyoiku / Medical Education (Japan) (Japan Society for Medical Education) 54 ( 2 ) 177 - 181 2023.04

ISSN 03869644

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.

【Making of医学教育モデル・コア・カリキュラム】資質・能力に新設された総合的に患者・生活者をみる姿勢について

春田淳志, 安藤崇之, 遠藤周, 金子惇, 鋪野紀好, 長嶺由衣子, 錦織宏, 藤川裕恭, 山梨啓友

医学教育 ((一社)日本医学教育学会) 54 ( 2 ) 142 - 148 2023.04

ISSN 0386-9644

少子高齢化社会の背景と令和2年度からの調査を踏まえ,患者の抱える問題を臓器横断的に捉えた上で,心理社会的背景も踏まえた総合的な視点とアプローチの必要性が示され,医学教育モデル・コア・カリキュラム(令和4年改訂版)に総合的に患者・生活者をみる姿勢が資質・能力に新設された.下位目標として「全人的な視点とアプローチ」「地域の視点とアプローチ」「人生の視点とアプローチ」「社会の視点とアプローチ」が位置づけられた.抽象と具体,概念と経験,自己と他者等の視点を統合し,自己の在り方を省察できるような複数の学習理論を踏まえた教育方法が提案された.このような医学教育を通じて,患者・生活者のウェルビーイングが向上することを期待する.(著者抄録)

【Making of医学教育モデル・コア・カリキュラム】資質・能力に新設された総合的に患者・生活者をみる姿勢について

春田淳志, 安藤崇之, 遠藤周, 金子惇, 鋪野紀好, 長嶺由衣子, 錦織宏, 藤川裕恭, 山梨啓友

医学教育 ((一社)日本医学教育学会) 54 ( 2 ) 142 - 148 2023.04

ISSN 0386-9644

What kinds of work do Japanese primary care physicians who derive greater positive meaning from work engage in? A cross-sectional study.

Yu Yamamoto, Junji Haruta, Ryohei Goto, Tetsuhiro Maeno

Journal of general and family medicine (Journal of General and Family Medicine) 24 ( 2 ) 94 - 101 2023.03

ISSN 2189-6577

BACKGROUND: Despite the increasing need for primary care physicians (PCPs) around the world, few physicians choose it as a career. PCPs who can find meaning and enjoyment in their work can be role models for medical students and professionals, which may encourage more physicians to specialize in primary care. We aimed to compare the kinds of work that Japanese PCPs who derive greater positive meaning from work engage in versus those who derive less positive meaning from work. METHODS: This was a cross-sectional study that used self-administered questionnaires to ask Japanese PCPs about their basic characteristics and engagement in and enthusiasm for various types of work. The outcomes of the Japanese version of the work as meaning inventory (J-WAMI) were also assessed. Participants were divided into high- and low-scoring groups according to the median J-WAMI score, and logistic regression analysis was performed to identify factors related to the high J-WAMI-scoring group. RESULTS: A total of 268 out of 330 participants were included in the analysis. Males comprised 74.3%, and participants' average experience as a physician was 20.2 years. The median overall J-WAMI score was 38. Factors associated with the high J-WAMI scoring group were enthusiasm for outpatient care (OR: 1.04, 95% CI: 1.02-1.06) and engagement in research (OR: 2.74, 95% CI 1.33-5.66). CONCLUSIONS: Enthusiasm for outpatient care and engagement in research are associated with greater positive meaning of work among PCPs. Supporting these types of work may enhance PCPs' value of their work.

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Family caregivers' experience with healthcare and social care professionals and their participation in health checkups: A cross sectional study in Japan.

Gen Nakayama, Shoichi Masumoto, Junji Haruta, Tetsuhiro Maeno

Journal of general and family medicine (Journal of General and Family Medicine) 24 ( 2 ) 110 - 118 2023.03

ISSN 2189-6577

BACKGROUND: For family caregivers, who are generally regarded as a vulnerable population, having regular checkups is a desirable health behavior. This study examined family caregivers' habit of having regular checkups prior to becoming involved with professionals who care for patients, and whether they had had recent checkups. We then examined the association between family caregivers' experience with professionals and their participation in checkups after adjusting for the past habit. METHODS: We conducted a cross sectional survey in Japan between November and December 2020. We recruited family caregivers who were aged 40-74 years and caring for community-dwelling adult patients. The outcome variable was whether family caregivers had undergone any health checkups since April 2019. We assessed family caregivers' experience using the Japanese version of the Caregivers' Experience Instrument (J-IEXPAC CAREGIVERS). RESULTS: Of the 1091 recruited family caregivers, 629 were included in the analysis. Of these, 358 had previously undergone regular checkups, and 158 had no checkups or selected the option "unknown." Outcome rates in each group were 74.6% and 43.0%, respectively, and 62.0% for all 629 caregivers. Multivariate modified Poisson regression analysis revealed that among the J-IEXPAC CAREGIVERS scores, only the domain score for attention for the caregiver was significantly associated with family caregivers' participation in checkups (adjusted prevalence ratio per 1 SD increase = 1.07; 95% CI 1.01-1.14). CONCLUSIONS: Among family caregivers' experience with professionals, the factor that focused on caregivers themselves was significantly associated with their participation in checkups. This finding underscores the significance of caregiver-focused care.

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Current status of interprofessional competency among healthcare professions in Japan: A cross-sectional web-based survey.

Ryohei Goto, Junji Haruta

Journal of general and family medicine (Journal of General and Family Medicine) 24 ( 2 ) 119 - 125 2023.03

ISSN 2189-6577

BACKGROUND: Self-assessment of professionals' interprofessional competency is meaningful for benchmarking oneself and helping to identify training needs. We aimed to clarify differences in self-assessment of interprofessional competency in Japan by profession and type of facility. METHODS: We conducted a cross-sectional study using a web survey among primary healthcare providers in Japan, especially members of the Japan Primary Care Association, between June and October 2020. After sampling using the e-mail list, we used an exponential nondiscriminative snowball method as purposive sampling through key professional informants between November 2020 and February 2021. The questionnaire covered items including participant demographics (age, gender, years of experience as professionals, years of experience working at the current institution, attendance type (regular or part-time work), administrative experience, profession, and facility type) and included the Japanese version of the Self-assessment Scale of Interprofessional Competency (JASSIC). Differences between healthcare professions (physician, nurse, pharmacist, rehabilitation therapist, and social worker) and between types of facility (university hospital, medium-sized hospital, small hospital, and clinics) were compared using the Kruskal-Wallis test. RESULTS: A total of 593 people responded to the survey. Their mean age was 41.2 ± 11.3 years, and 312 (52.6%) were female. JASSIC scores of physicians and social workers were significantly higher than those of rehabilitation therapists (p < 0.01). Concerning facilities, professionals working in clinics rated themselves higher than those in medium-sized hospitals (p < 0.01). CONCLUSIONS: We revealed that self-assessment of interprofessional competency in Japan varied by profession and type of facility.

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<Report> What experiences have medical professionals had with COVID-19 in primary care settings?: A report on the first half of 2020

キムラ, シュウヘイ, オゾネ, サチコ, ゴトウ, リョウヘイ, テルヤマ, ジュンコ

History and Anthropology50 (筑波大学大学院人文社会ビジネス科学学術院人文社会科学研究群人文学学位プログラム歴史・人類学サブプログラム) 51 45 - 90 2023.02

ISSN 0385-4795

Association Between Varicella-Zoster Virus Vaccination and Patient Experience in Elderly Japanese Outpatients: A Case-Control Study

T Inaba, J Haruta, R Goto, T Maeno

Journal of Primary Care & Community Health 14, 21501319231192760 (Journal of Primary Care and Community Health) 14 21501319231192760 2023.01

ISSN 21501319

Background: This study examined the association between patient experience (PX, events experienced by patients during primary care that are an indicator of patient-centered quality) of primary care and varicella-zoster virus (VZV) vaccine uptake in older adults. Methods: A case-control study of VZV vaccination was conducted at a community hospital in Ibaraki, Japan. Patients aged 65 years or older who had continuously been patients of the hospital between April 2018 and April 2021 were included in the study. The vaccinated group consisted of 166 VZV-vaccinated patients. The controls consisted of 29 age- and sex-matched patients who did not receive VZV vaccination. A self-administered questionnaire was distributed between August and September 2021. It included the Japanese version of the Primary Care Assessment Tool Short Form (JPCAT-SF) to evaluate PX and included questions about recommendations for VZV vaccination by a physician and the vaccination history of relatives. Multivariable and intermediate factor analyses were used to assess whether there was an association between VZV vaccination and PX. Results: Questionnaires were sent to 457 subjects. Responses from 228 (116 in the vaccination group and 112 in the non-vaccinated group) were included in the analysis. Multivariable analysis, which excluded physician recommendation for VZV vaccination as a variable because it was an intermediate factor in the analysis, showed an association between PX and VZV vaccination (odds ratio, 1.38; 95% confidence interval, 1.00-1.92; P =.049). Conclusions: PX was associated with past VZV vaccination. Physician recommendation for VZV vaccination was an intermediate factor between PX and VZV vaccination.

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日本のプライマリ・ケア医のコロナワクチン接種の実践についての文化人類学的考察——スケーラビリティとノンスケーラビリティのはざまで

木村木村周平，堀口堀口佐知子，後藤後藤亮平，飯田飯田淳子， ...

F1000Research 11, 1268 2023

How do home physicians evaluate prescriptions and what prescribing behaviors do they take ？ : a qualitative study

Masumoto Shoichi, Haruta Junji

Journal of Japanese Association for Home Care Medicine (Japanese association for home care medicine) 4 ( 2 ) 40 - 48 2023

A qualitative inductive study using individual interviews was conducted to clarify the perspectives from which home physicians evaluate prescriptions for home care patients and how they decide prescription. A semi-structured individual interview was conducted with 17 physicians engaged in home medical care. We found that home physicians made prescribing decisions based on a variety of factors ; the physical effects of drugs, the patient's prognosis and quality of life, their relationship with the patient and family, and their interactions with various professions. Visualization of the prescription changing process and a common understanding of prescribing behavior among healthcare professionals are expected to improve the quality of prescribing in-home medical care.

What kinds of work do Japanese primary care physicians who derive greater positive meaning from work engage in? A cross‐sectional study

Y Yamamoto, J Haruta, R Goto, T Maeno

Journal of General and Family Medicine 24 (2), 94-101 2023

Has novel coronavirus infection affected the professional identity recognised by medical students?-A historical cohort study.

J Haruta, A Takayashiki, R Goto, T Maeno, S Ozone, T Maeno

Asia Pacific Scholar 8 (1) (Asia Pacific Scholar) 8 ( 1 ) 3 - 12 2023

ISSN 24249335

Introduction: The pandemic caused by the novel coronavirus (COVID-19) has produced dramatic changes in the learning environment for clinical practice in medical education, and the impact on medical students has been significant. However, few program evaluation studies involving professional identity, now emphasised in medical education, have compared current with pre-COVID-19 programs. Here, we compared the professional identity recognised by medical students in the years before and during COVID-19. Methods: Medical students who participated in clinical practice were evaluated using the Japanese version of the Professional Self-Identity Questionnaire (PSIQ), a 9-item inventory rated using 7-point Likert scales. They answered on the first day of a 4-week clinical practice module within a community-based medical education (CBME) program and at graduation in 2018-2019 (pre-COVID-19 pandemic) and in 2019-2020 (during-COVID-19 pandemic). We compared the mean difference in total PSIQ score of the 2019-2020 students to those of the 2018-2019 students as a historical cohort using an unpaired t-test. Results: Participants were 104 medical students in the 2018-2019 academic year and 92 in the 2019-2020 academic year. PSIQ was increased at graduation. Mean difference in total PSIQ score was statistically higher for the 2019-2020 students (13.5 ± 9.4) than for the 2018-2019 students (10.3 ± 8.1) (t =2.6, df =195, p = 0.01). Conclusion: Although clinical practice was restricted by COVID-19, this had some positive impact on the strengthening of professional identity recognised by medical students. This finding may have been influenced by the imprinting of professional norms and changes in society.

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Factors associated with interprofessional competencies among healthcare professionals in Japan.

Junji Haruta, Ryohei Goto

Journal of interprofessional care (Journal of Interprofessional Care) 37 ( 3 ) 473 - 479 2023

ISSN 13561820

We aimed to explore factors associated with interprofessional competencies among healthcare professionals in Japan. From June to October 2020, we conducted a cross-sectional survey via a validated self-administered web-based questionnaire using the Japanese version of the Self-assessment Scale of Interprofessional Competency (JASSIC). We recruited participants from an e-mail list. The questionnaire asked about JASSIC, basic demographic information, whether they had undertaken pre- and post-licensure interprofessional education (IPE), and administrative experience; as well as an organizational climate scale, including "Plan, Do, See" factor for management (PDS factor), and the "Do" factor in a leader-centered direction for people who work unwillingly. Factors associated with the total JASSIC score as interprofessional competencies were determined using multiple regression analysis. We analyzed data from 560 participants with an average age of 41.0 years, comprising 132 nurses, 127 doctors, and 120 social workers. The median of the total JASSIC score was 72/90 (range: 66-78). On multiple regression analysis, total JASSIC score was significantly associated with age, PDS factor, administrative experience, pre-licensure IPE, and pos-licensure IPE. These findings emphasize the importance of pre- and post-licensure IPE, and administrative experience for improving interprofessional competencies in Japan.

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Current status of interprofessional competency among healthcare professions in Japan: A cross‐sectional web‐based survey

R Goto, J Haruta

Journal of General and Family Medicine 24 (2), 119-125 2023

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

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

Journal of General and Family Medicine 24 (6), 343-349 2023

Identification of Chronic Conditions Associated with Fragmentation of Care in the Very Old Population in Japan.

T Ando, T Sasaki, J Haruta, Y Arai

The Annals of Family Medicine 21 (Supplement 3) 2023

Exploring patterns of collaboration among professionals, organisations, patients and communities that meet complex challenges and promote patient well-being

J Haruta

Impact 2023 (3), 26-28 2023

Association between family caregivers' primary care experience when they report as patients and their stress related to caregiving: A pilot cross‐sectional study

G Nakayama, S Masumoto, J Haruta, T Maeno

Journal of General and Family Medicine 24 (4), 231-239 2023

Overhead View in the Research of Interprofessional Education and Collaboration

春田淳志

The Journal of Interprofessional Collaboration in Health and Social Care (Japan Association for Interprofessional Education) 16 ( 2 ) 76 - 83 2023

ISSN 18836380

保健医療福祉領域における多職種連携教育や複雑な課題を解決するためには，効果的な協働とそれを
支える研究の知見が重要である。しかし，この分野の研究は複雑であるため，視座・視点・対象をよ
り意識する必要がある。そのため，本論文では，視座としてのミクロ・メゾ・マクロへの影響，研究
の視点の補助線となる学習理論や組織理論などを使用し，個人から地域まで幅広い対象の健康やQOL
などの指標を用いて評価する方法論を整理した俯瞰図を提案する。この俯瞰図に基づき，多職種連携
コンピテンシーを理論的枠組みとした具体的な研究を例に，視座・視点・対象・研究デザイン・方法
論について紹介する。また，医学・歯学・薬学教育のモデル・コア・カリキュラムにおいて，多職種
連携能力が資質・能力に組み込まれたことを皮切りに，今後の多職種連携教育・協働の研究の種を共
有する。

保健医療福祉の複雑化したニーズに合わせた連携の複雑性と未来への挑戦

春田淳志

The Journal of Interprofessional Collaboration in Health and Social Care (Japan Association for Interprofessional Education) 16 ( 2 ) 75 - 75 2023

ISSN 18836380

J-STAGE ダウンロード数　年間トップ20 (2021年9月～2022年8月) 掲載

武田裕子, 日高優, 三苫博, 安川康介, 里光やよい, 春田淳志, 宮田靖志, 諸井陽子, 石川和信

Igaku Kyoiku / Medical Education (Japan) (Japan Society for Medical Education) 53 ( 6 ) 538 - 555 2022.12

ISSN 03869644

学会和文誌新編集長からの挨拶

春田淳志

An Official Journal of the Japan Primary Care Association (JAPAN PRIMARY CARE ASSOCIATION) 45 ( 4 ) 107 - 107 2022.12

ISSN 21852928

What role expectations do primary care physicians hold for physical therapists regarding primary care?

Goto R, Haruta J, Ozone S

Journal of Primary Care & Community Health 2022.11

Research paper (scientific journal), Joint Work, Accepted

Design, Synthesis, and Monoamine Oxidase B Selective Inhibitory Activity of N-Arylated Heliamine Analogues.

Yamada M, Hirose Y, Lin B, Fumimoto M, Nunomura K, Natchanun S, Takahashi N, Ohki Y, Sako M, Murai K, Harada K, Arai M, Suzuki S, Nakamura T, Haruta J, Arisawa M

ACS medicinal chemistry letters 13 ( 10 ) 1582 - 1590 2022.10

ISSN 1948-5875

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Analyzing annual changes in network structures of a social media application-based information-sharing system in a Japanese community

Haruta, J., Tsugawa, S., Ogura, K

BMC Health Services Research (BMC health services research) 22 ( 1107 ) 1107 - 1107 2022.08

Research paper (scientific journal), Joint Work, Lead author, Accepted

BACKGROUND: Understanding the evolution of social network services (SNSs) can provide insights into the functions of interprofessional information-sharing systems. Using social network analysis, we aimed to analyze annual changes in the network structure of SNS-based information sharing among healthcare professionals over a 3-year period in Japan. METHODS: We analyzed data on SNS-based information sharing networks with online message boards for healthcare professionals for 2018, 2019, and 2020 in a Japanese community. These networks were created for each patient so that healthcare professionals could post and view messages on the web platform. In the social network analysis (SNA), healthcare professionals registered with a patient group were represented as nodes, and message posting and viewing relationships were represented as links. We investigated the structural characteristics of the networks using several measures for SNA, including reciprocity, assortativity and betweenness centrality, which reflect interrelational links, the prevalence of similar nodes with neighbors, and the mediating roles of other nodes, respectively. Next, to compare year-to-year trends in networks of patients overall, and between receiving nursing care levels 1-3 (lighter care requirement) and levels 4-5 (heavier care requirement), we described the annual structural differences and analyzed each measure for SNA using the Steel-Dwass test. RESULTS: Among 844, 940, and 1063 groups in each year, groups for analysis in care levels 1-3/4-5 were identified as 106/135, 79/89, and 57/57, respectively. The overall annual assessment showed a trend toward increased diameter and decreased density, but the differences were not significant. For those requiring care levels 1-3, assortativity decreased significantly, while for those requiring care levels 4-5, reciprocity decreased and betweenness centrality increased significantly. No significant differences were found in the other items. DISCUSSION: This study revealed that the network of patients with a lighter care requirement had more connections consisting of nodes with different links, whereas the network of patients with a heavier care requirement had more fixed intermediary roles and weaker interrelationships among healthcare professionals. Clarifying interprofessional collaborative mechanisms underlying development patterns among healthcare professionals can contribute to future clinical quality improvement.

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Factors associated with interprofessional competencies among healthcare professionals in Japan. Journal of Interprofessional Care

Haruta J, Goto R

Journal of Interprofessional Care 1 - 7 2022.07

Research paper (scientific journal), Joint Work, Lead author, Accepted

Verification of a Sense of Community Scale for Hospitals in Japan

Goto R, Haruta J, Ozone S.

Journal of Primary Care & Community Health (Journal of Primary Care and Community Health) 13 21501319221107317 - 21501319221107317 2022.06

Research paper (scientific journal), Joint Work, Accepted, ISSN 21501319

INTRODUCTION/OBJECTIVES: We aimed to verify whether a sense of community scale developed for hospital wards can be applied to hospitals. METHODS: A cross-sectional study was conducted using a self-administered questionnaire between July and October 2018 in 3 hospitals in Japan. The subjects were staff members working in these hospitals who provide direct medical or administrative services to patients and their families. The questionnaire inquired about the participants' basic attributes and workplace satisfaction, and included the sense of community scale and the Japanese version of the Assessment of Interprofessional Team Collaboration Scale-II. We evaluated the scale's structural validity, internal consistency, and hypothesis testing for construct validity. RESULTS: Of 826 eligible staff members, 539 were included in the analysis. Mean age was 40.4 years and 77.4% were female. Exploratory factor analysis showed that 24 of the 28 items in the sense of community scale could be categorized under 3 factors. Confirmatory factor analysis demonstrated a goodness of fit index of 0.794, adjusted goodness of fit index of 0.752, comparative fit index of 0.885 and root mean square error of approximation of 0.092. Cronbach's α for score in the sense of community scale was high (.96). Participants who reported high workplace satisfaction had significantly higher scores in the sense of community scale than those who indicated low workplace satisfaction (P < .001). CONCLUSIONS: We verified the reliability and validity of the Japanese version of the sense of community scale, which was originally developed for hospital wards, for the community in hospitals. With further verification, we hope the scale will be useful for evaluating the sense of community in hospitals.

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How do medical students learn about SDH in the community? A qualitative study with a realist approach.

Junji Haruta, Ayumi Takayashiki, Sachiko Ozone, Takami Maeno, Tetsuhiro Maeno

Medical teacher (Medical Teacher) 44 ( 10 ) 1 - 8 2022.05

ISSN 0142-159X

INTRODUCTION: The need to learn social determinants of health (SDH) is increasing in disparate societies, but educational interventions are complex and learning mechanisms are unclear. Therefore, this study used a realist approach to identify SDH learning patterns, namely context (C), mechanism (M), and outcomes (O) in communities. METHODS: A 4-week clinical practice program was conducted for 5th- and 6th-year medical students in Japan. The program included SDH lectures and group activities to explore cases linked to SDH in the community. The medical students' structural reflection reports for learning SDH were thematically analyzed through CMO perspectives. RESULTS: First, medical students anticipated the concept of SDH and participated in a community in which a social model was central. They then transformed their perspective through observational learning and explanations from role models. Second, medical students' confrontation of contradictions in the medical model triggered integrated explanations of solid facts. Third, conceptual understanding of SDH was deepened through comparison and verbalization of concrete experiences in multiple regions. Fourth, empathy for lay people was fostered by participating from a non-authoritative position, which differed from that in medical settings. CONCLUSION: Medical students can learn about the connections between society and medicine through four types of SDH learning patterns.

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特集ジェネラリストの羅針盤-医学部では教わらなかった28のクエスチョン知りたい!　仕事とキャリアの話多職種とどうタスクシェア・シフトすればいいの?

春田淳志

medicina (株式会社医学書院) 59 ( 6 ) 904 - 911 2022.05

ISSN 0025-7699

Japan's General Practitioners' Responses to COVID-19

Kimura Shuhei, Iida Junko, Teruyama Junko, Horiguchi Sachiko, Miyachi Junichiro, Hama Yusuke, Haruta Junji, Ozone Sachiko, Kaneko Makoto, Goto Ryohei

Japanese Journal of Cultural Anthropology (Japanese Society of Cultural Anthropology) 86 ( 4 ) 674 - 685 2022.03

ISSN 13490648

Since early 2020, the COVID-19 pandemic has been a pervasive global issue eliciting various responses at the local level. Drawing upon anthropologist Yanai Tadashi's concept “body social,” this article aims to discuss what Japanese general practitioners have attempted to protect from the uncontrollable “waves” of the pandemic. Based on the vivid narratives about their shifting patterns of responses from July 2020（the beginning of the so-called “second wave”） to February 2021（the end of the “third wave”）, it elucidates how the general practitioners' imaginings of the “body social” to be protected were flexibly transformed according to their perceptions of the pandemic situations in their immediate surroundings, from their physical bodies to their medical institutions, to their chiiki （communities）．Their engagements in expanding cooperation with other medical and non-medical actors to protect their chiiki as “body social” pose valuable lessons for anthropologists of infectious diseases and disasters beyond the realm of medicine.

総合診療医が守るもの─COVID-19への対応と社会身体

3．木村周平; 飯田淳子; 照山絢子; 堀口佐知子; 宮地純一郎; 濱雄亮; 春田淳志; 小曽根早知子; 金子惇; 後藤亮平

文化人類学 88 ( 4 ) 674 2022.03

Research paper (scientific journal), Joint Work, Accepted

訪問看護サービス利用の有無と，家族介護者からみた多職種によるケアの質評価との関連

中山元、舛本祥一、春田淳志、前野哲博

日本老年医学界雑誌 ((一社)日本老年医学会) 59 ( 2 ) 209 - 218 2022.02

Research paper (scientific journal), Joint Work, Accepted, ISSN 0300-9173

目的:家族介護者からみた医療介護福祉職らによるケアのプロセス評価に,訪問看護サービス利用の有無という違いが影響するかを検討するために,両者の関連性について横断的に検証した.方法:対象者はA県3自治体で介護認定を受けて1年以上になり,慢性症状を抱え在宅療養している人を介護する40～74歳の家族介護者で,2020年11～12月に介護支援専門員を通じて質問票を配布した.アウトカムは,慢性症状を抱える人とその家族介護者に対する多職種ケアのプロセスを,家族介護者が定量的に評価する日本語版IEXPAC CAREGIVERS(以下,当尺度)の総合得点と各下位尺度得点とした.当尺度は評価対象を多職種とし,家族介護者が多職種とかかわるなかで経験した具体的事象を量的に測定する.下位尺度は「患者に焦点」と「介護者に焦点」である.要因を訪問看護の利用の有無,共変量を家族介護者の社会経済的要因や訪問診療の有無等とした.当尺度得点を中央値で2群化し,2項ロジスティック回帰分析で解析した.結果:解析対象者は566人で,家族介護者の年齢中央値62歳,女性73.3%であった.訪問看護サービスの利用があったのは86ケース(15.2%)であった.ロジスティック回帰分析の結果,訪問看護サービス利用の有無(なし=参照)と当尺度の総合得点の高低(低群=0,高群=1)とは有意に関連した(オッズ比3.02;95%信頼区間1.54～5.91).各下位尺度得点では,「患者に焦点」では有意差を認めた一方,「介護者に焦点」では有意差を認めなかった.結論:訪問看護サービスが導入された家族介護者は,導入していない家族介護者と比べて当尺度の総合得点ならびに下位尺度の「患者に焦点」得点が有意に高かった.この結果は,訪問看護師が在宅療養する患者のケアにかかわる多職種協働の中核として,その役割期待に応えている可能性を示唆した.(著者抄録)

Factors associated with self-medication among family caregivers: A cross-sectional study

S Masumoto, G Nakayama, J Haruta, T Maeno

2022

Disparities in co-payments for influenza vaccine among the elderly, during the COVID-19 pandemic in Japan

T Ando, T Maruyama, A Tamai, T Murakami, Y Kido, T Ishida, H Taya, ...

Journal of Infection and Chemotherapy (Journal of Infection and Chemotherapy) 28 ( 7 ) 896 - 901 2022

ISSN 1341321X

INTRODUCTION: Seasonal influenza vaccination for the elderly is highly recommended during the COVID-19 pandemic. In Japan, the amount of subsidy for influenza differs among municipalities. Thus, we investigated the amount of and variation in subsidy for influenza vaccination for the elderly in 2020. METHODS: This was an ecological study of 1,922 municipalities in Japan. The amount of subsidy for influenza vaccines for the elderly in each municipality was surveyed through websites or via telephone. Geographic and financial data for municipalities and prefectures were obtained from the open data. The amount of co-payment for the influenza vaccine and the geographical and financial status of each municipality were compared, according to the aging rate. Univariate logistic regression analysis was performed to explore factors related to the free influenza vaccine. RESULTS: Municipalities with higher aging rates tended to have higher median co-payments for vaccines in 2020. (0 yen vs 1000 yen, p < 0.001) In addition, they tended to have worse financial conditions and lower per capita incomes. A similar trend was observed in the analysis by prefecture, i.e., a higher influenza mortality rate in prefectures with a higher aging rate. Despite having lower incomes, municipalities and prefectures with higher aging populations had higher mortality rates from influenza and higher co-payments for influenza vaccination. CONCLUSIONS: In Japan, there is a disparity among elderly people; areas with an aging population have higher co-payments for influenza vaccines despite lower incomes, suggesting that the government needs to implement corrective measures to reduce this disparity.

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How have Japanese primary care physicians carried out vaccinations against COVID-19? : Attempts at making the non-scalable ‘scalable’

Shuhei Kimura, Sachiko Horiguchi, Ryohei Goto, Junko Iida, Sachiko Ozone, Makoto Kaneko, Junko Teruyama, Yusuke Hama, Junji Haruta, Junichiro Miyachi

F1000Research (F1000 Research Ltd) 11 1268 - 1268 2022

Research paper (scientific journal), Joint Work, Last author, Accepted

Vaccine rollouts have been underway to combat the COVID-19 pandemic globally. Based on ongoing interviews with ten primary care physicians ‘in the field’, this paper elucidates how in practice the vaccinations were carried out in Japan in 2021. We examine what the primary care physicians did to prepare for the rollouts, what problems they faced, and how they responded to these problems. Large-scale vaccination projects are supposed to proceed smoothly and quickly, or to have what Anna Tsing calls ‘scalability’. In practice, however, they required a variety of tasks for coordination, information sharing, and promotion. Despite feeling stressed by the lack of information and exhausted by the work overload, the primary care physicians carried out the vaccinations as an important service to their patients and communities. The findings of this paper will provide valuable materials for improving future vaccine rollouts.

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What kinds of work do Japanese primary care physicians who derive greater positive meaning from work engage in?

Yamamoto Y, Haruta J, Goto R, Maeno T

Journal of General and Family Medicine 2022

Research paper (scientific journal), Joint Work, Accepted

Family caregivers’ experience with healthcare and social care professionals and their participation in health checkups

Nakayama G, Masumoto S, Haruta J, Maeno T

Journal of General and Family Medicine 2022

Research paper (scientific journal), Joint Work, Accepted

【私のIPE体験】慶應義塾大学

尾崎真友, 春田淳志

The Journal of Interprofessional Collaboration in Health and Social Care (Japan Association for Interprofessional Education) 15 ( 2 ) 114 - 115 2022

ISSN 18836380

What Role Expectations Do Primary Care Physicians in Japan Hold for Physical Therapists Regarding Primary Care?

Ryohei Goto, Junji Haruta, Sachiko Ozone

Journal of primary care & community health (Journal of Primary Care and Community Health) 13 21501319221124316 - 21501319221124316 2022

ISSN 21501319

INTRODUCTION/OBJECTIVES: This study aimed to clarify what primary care physicians (PCPs) in Japan understand of the role of physical therapists (PTs) through the experience of working with PTs in hospitals, and what roles PCPs expect for PTs in future primary care. METHODS: Semi-structured interviews were conducted individually with 9 purposively sampled PCPs with sufficient experience of collaboration with PTs. Interview data were analyzed by theme analysis focusing on "What does the PCP understand about the role of PTs through the experience of working with PTs in hospitals?" and "What roles and purposes does the PCP wish for PTs in primary care settings?" RESULTS: PCPs viewed PTs as providers of rehabilitation in the traditional medical model, and understood their role as an occupation having a mono-causal viewpoint, namely a specific and well-defined outcome for individual patients, and intervening with patients within a short clinical course with the aim of improvement or maintenance of the patient's condition. With regard to future primary care, PCPs expected that PTs would interpret various factors related to patient lives from the viewpoint of causal interactions; become important stakeholders in the community; and respond flexibly to patients and the environmental factors around them with continued support to the individual. CONCLUSIONS: PCPs understood the role of PTs in hospitals as "Rehabilitation in the traditional medical model," and expected the future role of PTs in primary care as "Rehabilitation in integrated community care."

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[Relationship between the use of home-visit nursing services and family caregivers' experience of interprofessional care].

Gen Nakayama, Shoichi Masumoto, Junji Haruta, Tetsuhiro Maeno

Nihon Ronen Igakkai zasshi. Japanese journal of geriatrics (The Japan Geriatrics Society) 59 ( 2 ) 209 - 218 2022

ISSN 03009173

AIM: To examine the relationship between the use of home-visit nursing services (VNS) for patients and their family caregivers' experience of interprofessional care, which is an indicator of the care process. METHODS: We used data from a cross-sectional survey in Japan, 2020. Family caregivers 40-74 years old and caring for community-dwelling patients with chronic conditions were recruited. The outcome variable was family caregivers' experience, reflecting the quality of interprofessional care for patients and their caregivers. We used the Japanese version of the Caregivers' Experience Instrument (J-IEXPAC CAREGIVERS), which includes two domains: attention for the patient and attention for the caregiver. The main factor was the use of VNS, and covariates were socioeconomic factors of the caregivers and the use of other health and social care services. J-IEXPAC CAREGIVERS scores were divided into two groups by median values and analyzed by multivariate logistic regression analyses. RESULTS: A total of 566 caregivers were included in the analysis. The median age was 62 years old. VNS was used in 86 cases (15.2%). Logistic regression analyses revealed that the use of VNS was significantly associated with a higher total score group for J-IEXPAC CAREGIVERS (odds ratio = 3.02; 95% confidence interval 1.54-5.91). Of the J-IEXPAC CAREGIVERS domains, attention for the patient was significant. CONCLUSIONS: We found that the use of VNS was likely to provide a better experience among family caregivers. Our findings suggest that visiting nurses fulfill their expected role as core members of a multidisciplinary team.

Japan's General Practitioners' Responses to COVID-19 Transformations of the" Body Social" in Between Pandemic Waves

S Kimura, J Iida, J Teruyama, S Horiguchi, J Miyachi, Y Hama, J Haruta, ...

Japanese Review of Cultural Anthropology 23 (1), 337-342 2022

Japan's General Practitioners' Responses to COVID-19

Kimura Shuhei, Iida Junko, Teruyama Junko, Horiguchi Sachiko, Miyachi Junichiro, Hama Yusuke, Haruta Junji, Ozone Sachiko, Kaneko Makoto, Goto Ryohei

Japanese Review of Cultural Anthropology (Japanese Society of Cultural Anthropology) 23 ( 1 ) 337 - 342 2022

ISSN 24325112

[How have Japanese primary care physicians carried out vaccinations against COVID-19? : Attempts at making the non-scalable 'scalable'].

Kimura S, Horiguchi S, Goto R, Iida J, Ozone S, Kaneko M, Teruyama J, Hama Y, Haruta J, Miyachi J

F1000Research 11 1268 2022

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How have Japanese primary care physicians carried out vaccinations against COVID-19?: Attempts at making the non-scalable'scalable'

S Kimura, S Horiguchi, R Goto, J Iida, S Ozone, M Kaneko, J Teruyama, ...

F1000Research 11, 1268-1268 (F1000Research) 11 2022

Vaccine rollouts have been underway to combat the COVID-19 pandemic globally. Based on ongoing interviews with ten primary care physicians 'in the field', this paper elucidates how in practice the vaccinations were carried out in Japan in 2021 from a cultural anthropological perspective. We examine what the primary care physicians did to prepare for the rollouts, what problems they faced, and how they responded to these problems. Large-scale vaccination projects are supposed to proceed smoothly and quickly, or to have what Anna Tsing calls 'scalability'. In practice, however, they required a variety of tasks for coordination, information sharing, and promotion. Despite feeling stressed by the lack of information and exhausted by the work overload, the primary care physicians carried out the vaccinations as an important service to their patients and communities. The findings of this paper will provide valuable materials for improving future vaccine rollouts.

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文化人類学にとっての医学教育モデル·コア·カリキュラム改訂の意義

医療者向け人類学教育連携委員会, 木村周平, 飯田淳子, 伊藤泰信, 倉田誠, 錦織宏, 浜田明範, 春田淳志, 星野晋

Japanese Journal of Cultural Anthropology (Japanese Society of Cultural Anthropology) 86 ( 3 ) 511 - 514 2021.12

Accepted, ISSN 1349-0648

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

The 21st - Term Interprofessional Education Committee, Goto Ryohei, Maeno Takami, Haruta Junji, Ino Miyuki, Ishikawa Satoko, Uchiyama Yasushi, Ohtsuki Masatsugu, Kato Hirotaka, Goto Michiko, Naito Chisako, Norose Takahiko, Yoshimi Kenji, Yasui Hiroki

Igaku Kyoiku / Medical Education (Japan) (Japan Society for Medical Education) 52 ( 6 ) 557 - 563 2021.12

ISSN 0386-9644

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)

The 21st - Term Interprofessional Education Committee, Maeno Takami, Goto Ryohei, Haruta Junji, Ino Miyuki, Ishikawa Satoko, Uchiyama Yasushi, Ohtsuki Masatsugu, Kato Hirotaka, Goto Michiko, Naito Chisako, Norose Takahiko, Yoshimi Kenji, Yasui Hiroki

Igaku Kyoiku / Medical Education (Japan) (Japan Society for Medical Education) 52 ( 6 ) 565 - 570 2021.12

ISSN 0386-9644

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.

What types of networks do professionals build, and how are they affected by the results of network evaluation?

J Haruta, S Tsugawa Phd

Frontiers in Public Health, 1878 (Frontiers in Public Health) 9 758809 - 758809 2021.11

Background: We aimed to explore what kind of social networks characterizable as "consult/be consulted" are built among healthcare professionals in a community and the impact of providing the professionals with these findings. Methods: We adopted mixed methods exploratory study using social network analysis (SNA) and content analysis. SNA can visualize social network structures such as relationships between individuals. The healthcare professionals were asked about the key persons they consulted and were consulted by concerning these healthcare issues: (1) daily work; (2) a person with acute back pain; (3) a garbage-filled house reported by a neighbor; (4) a person with dementia; and (5) a study meeting. We identified the key roles depending on the issues using SNA. After analysis, the analytical findings were shared with the participants. To explore their cognitive responses, an open-ended questionnaire was delivered and a content analysis was implemented. Results: Of 54 healthcare professional participants, the data of 52 were available for analysis. The findings (in the respective order of the five topics above) were as follows: the number of nodes was 165, 95, 85, 82, and 68; clustering coefficient was 0.19, 0.03, 0.02, 0.11, and 0.23; assortativity was -0.043, -0.11, -0.23, -0.17, and -0.23; reciprocity was 0.35, 0.31, 0.39, 0.29, and 0.48. The top three centralities included nurses. Eighty-seven free comments were received, of which 39 were categorized as descriptive, 10 as analytical, and 38 as critical. Discussion: The structure of "consult/be consulted" networks differed by topic. SNA is available to detect the healthcare resources network and it may have helped them to reflect on their own networks.

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Validation of the professional self-identity questionnaire for medical students during clinical practice in Japan

J Haruta, T Maeno, A Takayashiki, R Goto, S Ozone, T Maeno

International Journal of Medical Education 12, 160-165 (International journal of medical education) 12 160 - 165 2021.08

Joint Work, ISSN 2042-6372

Objectives: To validate the Professional Self Identity Questionnaire (PSIQ) for medical students during clinical practice. Methods: We conducted a single-year longitudinal questionnaire study using the PSIQ. The PSIQ rates the nine items of "teamwork", "communication", "conducting assessment", "cultural awareness", "ethical awareness", "using records", "dealing with emergencies", "reflection", and "teaching" on a scale of 1-7 points. The study participants consisted of 118 fifth- and sixth-grade medical students who completed a mandatory 4-week clinical practice in a community-based medical education (CBME) curriculum. The data were collected before and after the CBME curriculum and after clinical practice at the time of graduation. To validate the internal structure of the PSIQ, we calculated Cronbach's alpha in the three phases. Additionally, to assess construct validity, we analyzed the trends and differences in each of the nine items of the PSIQ using repeated measures analysis of variance (ANOVA). We also showed the differences in effect size before and after the CBME curriculum. Results: The data of 105 medical students were analyzed. Cronbach's alpha in the three phases was 0.932, 0.936, and 0.939, respectively. PSIQ scores increased progressively for all items, and the F-test for repeated measures ANOVA of nine items' average score across the three phases showed a significant difference F(2,208) = 63.59, p<0.001. The effect size for professional identity of cultural awareness before and after the CBME curriculum was 0.67, or medium. Conclusions: We validated the PSIQ for medical students during clinical practice. Reflecting on professional identity may provide an opportunity for meaningful feedback on readiness to become a doctor.

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医学教育に社会科学を活かすために

飯田淳子, 木村周平, 伊藤泰信, 倉田誠, 浜田明範, 星野晋, 春田淳志, 錦織宏

Igaku Kyoiku / Medical Education (Japan) (Japan Society for Medical Education) 52 ( 4 ) 342 - 344 2021.08

Accepted, ISSN 0386-9644

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

Komori Satoko, Ozone Sachiko, Goto Ryohei, Haruta Junji

An Official Journal of the Japan Primary Care Association (JAPAN PRIMARY CARE ASSOCIATION) 44 ( 1 ) 11 - 16 2021.03

Joint Work, ISSN 2185-2928

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.

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「ソーシャルディスタンス」の時代のエスノグラフィー：デジタルプラットフォームを活用した調査を事例として

4．照山絢子; 飯田淳子; 木村周平; 堀口佐知子; 春田淳志; 濱雄亮; 金子惇; 宮地純一郎; 小曽根早知子; 後藤亮平

白山人類学 24 101 - 114 2021.03

Research paper (scientific journal), Joint Work, Accepted

Ethnography in the Age of “Social Distancing”: A Case of a Project Utilizing Digital Platforms

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

白山人類学 = Hakusan Review of Anthropology (白山人類学研究会) 24 101 - 114 2021.03

Accepted, ISSN 1341-5980

The influence of family caregivers’ experience of interprofessional care on their participation in health checkups as preventive health behavior in Japan—a cross-sectional analysis

Nakayama G, Masumoto S, Haruta J, Maeno T

International Journal of Environmental Research and Public Health (International Journal of Environmental Research and Public Health) 18 ( 1 ) 1 - 12 2021.01

Joint Work, ISSN 16617827

Background: The role of family caregivers has been vital, especially in superaging societies like Japan’s. The caregivers’ experience of interprofessional care is a key aspect in their evaluation of the quality of integrated care. We sought to explore whether family caregivers’ experience of interprofessional care is associated with their own participation in health checkups as preventive health behaviors. Methods: We used cross-sectional data obtained during the development of the Japanese version of the Caregivers’ Experience Instrument (J-IEXPAC CAREGIVERS). Participants who had provided care for at least one year were surveyed (n = 251). We assessed family caregivers’ experience of interprofessional care using J-IEXPAC CAREGIVERS and their participation in health checkups. Results: Multivariate logistic regression analysis revealed that the J-IEXPAC CAREGIVERS total score was significantly associated with the caregivers’ participation in health checkups [odds ratio per 1-point increase = 1.05; 95% confidence interval 1.01–1.09]. Two domain scores (attention for the patient and attention for the caregiver) of J-IEXPAC CAREGIVERS were significantly associated with the outcome. Conclusions: Family caregivers with more positive experiences of interprofessional care were more likely to participate in health checkups. These results support the significance of family caregivers’ experience of care, which may promote preventive health behaviors.

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Impact of Early Exposure to Simulation Program on Undergraduate Medical Students’ Interest in Urology

T Kimura, K Kojo, M Shiga, I Chihara, A Ikeda, S Kandori, T Kojima, ...

Journal of Medical Education and Curricular Development 8, 23821205211020750 8 23821205211020750 2021.01

Joint Work

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What Role Conceptions Do Multi-Healthcare Professionals Have of Physicians and What Role Expectation Do They Have of Physicians in a Community?

J Haruta, R Goto, S Ozone, T Maeno

BMC Family Practice (BMC Family Practice) 22 ( 1 ) 217 2021

Joint Work

Background: To create an effective community-based integrated care system, interprofessional collaboration based on healthcare professionals’ mutual understanding of their respective roles must be promoted. This study aimed to identify the role conception and role expectation that other healthcare professionals have towards physicians in the context of a community-based integrated care system. Methods: We organized focus groups and adopted ‘Role Theory’ as a theoretical framework. We collected data from healthcare professionals attending a conference on community-based integrated care systems in Japan. Fifty-four non-physician healthcare professionals consented to participate in 7 focus groups. Theme analysis based on the verbatim recorded transcripts was conducted in accordance with the framework of “Role Theory”. Results: The role conception of physicians is as a figure of intellectual authority positioned at the top of a traditional hierarchy, with a personal character of criticism/autonomy/closedness, not accommodative of interference from others, and upholding the Biomedical Model as an absolute standard. In response to this, the role expectation of physicians in the community is that they undertake actions that only physicians can undertake to ensure that a flat organization functions properly in providing medical explanations during patient transitions, and to offer healthcare support for patients who are difficult to access. This role expectation also includes the perception of patients as human beings, with physicians adapting to the Bio-Psycho-Social Model, explaining to patients about their disease as an authoritative voice based on an understanding of psychosocial circumstances, and sharing the prognosis of disease or disability. The expected personal character is a person with an open mind who allows others to seek advice, as well as a sense of approachableness which facilitates such seeking of advice. Conclusion: In the context of a community-based integrated care system, physicians should consider the understanding of their role conception and role expectation that other professionals have of them, and endeavor to create an open relationship with all healthcare professionals while giving careful consideration to their own role.

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Primary care physicians’ narratives on COVID‐19 responses in Japan: Professional roles evoked under a pandemic

J Haruta, S Horiguchi, J Miyachi, J Teruyama, S Kimura, J Iida, S Ozone, ...

Journal of General and Family Medicine 2021

Joint Work

Primary care physicians’ narratives on COVID-19 responses in Japan: Professional roles evoked under a pandemic

Haruta J, Horiguchi S, Miyachi J, Teruyama J, Kimura S, Iida J, Ozone S, Goto R, Kaneko M, Hama Y

Journal of General and Family Medicine (Journal of General and Family Medicine) 22 ( 6 ) 316 - 326 2021

Joint Work, ISSN 2189-7948

Background: Within the vague system of primary care and COVID-19 infection control in Japan, we explored how primary care (PC) physicians exhibited adaptive performance in their institutions and communities to cope with the COVID-19 pandemic from January to May 2020. Methods: Narrative analysis conducted by a team of medical professionals and anthropologists. We purposefully selected 10 PC physicians in community-based hospitals and clinics and conducted a total of 17 individual and group interviews. The verbatim transcript data were analyzed using the conceptual framework of adaptive performance. Results: We identified three “phases” of the time period (January–May 2020). In Phase 1, PC physicians initially perceived the disease as a problem unrelated to them. In Phase 2, the Diamond Princess outbreak triggered adaptive performance of the physicians, who began to deal with medical issues related to COVID-19 by using social networking services and applying the collected information to their organization and/or communities. Following this, in Phase 3, the PC physicians’ adaptive performance in their own communities and institutions emerged in the face of the pandemic. Reflecting their sensitivity to local context, the PC physicians were seen to exhibit adaptive performance through dealing with context-dependent problems and relationships. Conclusions: PC physicians exhibited adaptive performance in the course of coping with the realities of COVID-19 in shifting phases and in differing localities in the early stages of the pandemic. The trajectories of adaptive performance in later stages of the pandemic remain to be seen.

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

J Haruta, R Goto

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

Joint Work, ISSN 13561820

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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Committee report (Practice Article1) : Online Interprofessional Education

Interprofessional Education Committee, Kato Hirotaka, Goto Ryohei, Naito Chisako, Maeno Takami, Yoshimi Kenji, Yasui Hiroki, Haruta Junji, Goto Michiko, Norose Takahiko, Muraoka Chikusa, Ino Miyuki, Ishikawa Satoko, Uchiyama Yasushi, Ohtsuki Masatsugu

Igaku Kyoiku / Medical Education (Japan) (Japan Society for Medical Education) 52 ( 1 ) 53 - 57 2021

ISSN 0386-9644

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.

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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

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

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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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

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

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

Sachiko Ozone, Junji Haruta, Ayumi Takayashiki, Takami Maeno, Tetsuhiro Maeno

BMC Medical Education 20 (1), 1-8 (BMC Medical Education) 20 ( 470 ) 470 2020.11

Research paper (scientific journal), Joint Work, Accepted

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

R Goto, J Haruta

Family Medicine and Community Health 8 (4) (Family Medicine and Community Health) 8 ( 4 ) 2020.11

Joint Work, ISSN 23056983

© 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

Junji Haruta, Sho Tsugawa, Kazunari Ogura

Family Medicine and Community Health (Family Medicine and Community Health) 8 ( 4 ) e000396 2020.09

Research paper (scientific journal), Joint Work, Accepted, ISSN 23056983

© 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 and Internal Medicine (Journal of General Internal Medicine) 35 ( 12 ) 3485 - 3491 2020.09

Research paper (scientific journal), Joint Work, Accepted, ISSN 08848734

© 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 2020.07

Research paper (scientific journal), Joint Work, Accepted, ISSN 2044-6055

© 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 2020.06

Research paper (scientific journal), Joint Work, Accepted, ISSN 0263-2136

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 2020.03

Research paper (bulletin of university, research institution), Joint Work

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

Haruta Junji., Yamamoto Yu.

Medical Teacher (Medical Teacher) 42 ( 1 ) 101 - 110 2020.01

Research paper (scientific journal), Joint Work, Accepted, ISSN 0142159X

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 2020.01

Research paper (scientific journal), Joint Work, Accepted, ISSN 24249335

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 2020.01

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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13-1　 Online Interprofessional Education Program in the Master Course of Health Professions Education

Haruta Junji, Kawakami Chihiro, Hayakawa Kaho

Igaku Kyoiku / Medical Education (Japan) (Japan Society for Medical Education) 51 ( 3 ) 344 - 347 2020

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

Joint Work

【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

Kimura Shuhei, Miyaji Junichiro, Haruta Junji, Iida Junko, Ozone Sachiko, Kaneko Makoto, Goto Ryohei, Teruyama Junko, Hama Yusuke, Horiguchi Sachiko

Japanese Journal of Cultural Anthropology (Japanese Society of Cultural Anthropology) 85 ( 3 ) 566 - 569 2020

Joint Work, ISSN 1349-0648

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パンデミック下の医学教育-現在進行形の実践報告-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

J HARUTA, C KAWAKAMI, K HAYAKAWA

医学教育 51 (3), 344-347 2020

A comprehensive view to reflection on the palliative care approach for family medicine residents: A modified Delphi method

Jun Hamano, Junji Haruta, Naoto Ishimaru, Takahiro Otsuka, Naoko Den, Keiichiro Sakato, Takuma Kimura, Ryo Yamamoto

Cogent Medicine 6 ( 1 ) 2019.12

Research paper (scientific journal), Joint Work, Accepted

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Factors for self-assessment score of interprofessional team collaboration in community hospitals in Japan

Haruta Junji., Ozone Sachiko., Goto Rryohei.

Family Medicine and Community Health (Family Medicine and Community Health) 7 ( 4 ) e000202 2019.11

Research paper (scientific journal), Joint Work, Accepted, ISSN 23056983

Interprofessional collaboration is considered an important strategy in overcoming the complex issues associated with healthcare outcomes. A nationwide, community-based integrated care system developed for the care of older people in individual communities in Japan requires community hospitals to deliver integrated care to coordinate efforts for creating effective environments for health. This study aimed to explore the factors associated with the self-assessment score of interprofessional collaboration in community hospitals. Design Cross-sectional study using the Assessment of Interprofessional Team Collaboration Scale (AITCS). Setting This study was conducted in three small community hospitals in Japan. Participants All healthcare staff in the hospitals via research collaborators were asked to complete the anonymous self-administered questionnaire of the AITCS comprising questions related to individual factors (age, gender, profession), hospital to which they belonged, relationships with neighbouring facilities, job burden and job satisfaction from July to October 2018. The association between the questionnaire items as explanatory variables and AITCS score as an objective variable was determined using univariate followed by multiple regression analyses. Results The data from 325 of 630 participants were analysed, of whom 252 were female (77.5%) and 240 were nurses (73.8%). The mean of the total AITCS score was 117.6 (range 37-185), and the Visual Analogue Scale for relationships with neighbouring facilities, job satisfaction and job burden was 53.0 mm (0-100), 46.1 mm (0-100) and 64.3 mm (0-100), respectively. In univariate analyses of the association with AITCS score, explanatory variables with a significance level of <0.05 were relationships with neighbouring facilities, job satisfaction and job burden. On multiple regression analysis, the total AITCS score was independently associated with age, profession (nurse/non-nurse), relationships with neighbouring facilities and job satisfaction. Conclusions Better self-assessment score of interprofessional collaboration is more strongly associated with younger age, a nursing profession, better relationships with neighbouring facilities and greater job satisfaction than with the hospital to which the participant belonged. These findings may help community hospitals enhance the integration of service delivery and benefit to the community through interprofessional collaboration.

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Effectiveness of an interprofessional education program using team-based learning for medical students: Randomized control trial

Hamada Shuhei, Haruta Junji, Maeno Takami, Maeno Tetsuhiro, Suzuki H, Takayashiki A, Inada H, Naito T, Tomita M, Kano N, Baba T

Journal of General and Family Medicine 3 ( 21(1) ) 2 - 9 2019.11

Research paper (scientific journal), Joint Work, Accepted

Translation and cross-cultural adaptation of the Japanese version of the Assessment of Interprofessional Team Collaboration Scale-II(J-AITCS-II)

Yu Yamamot, Junji Haruta

MedEdPublish 8 ( 3 ) 46 2019.10

Research paper (scientific journal), Joint Work, Accepted

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保健医療福祉専門職の関係性や問題の認識は対話を通じてどう変わっていくのか？：複雑性の理論的枠組みを用いた医療過疎地の在宅医療推進プロセスを探索する質的記述的研究

細井崇弘, 春田淳志, 阪本直人, 前野哲博

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) 42 ( 2 ) 103 - 109 2019.06

Research paper (scientific journal), Joint Work, Accepted, ISSN 2185-2928

目的:医療資源の限られた地域で働く多職種は、どのような関係性の認識の中で在宅医療の問題をどのように認識しているか、そしてそれがどのように変容するかを明らかにする。方法:茨城県K市で働く多職種が在宅医療について主体的に話し合う場を提供し、その会議内容を逐語録化しテーマ分析を行った。結果:多職種は互いの関係性を階層構造の中で捉えるフェーズから、対話を通じて相互理解が深化する関係、ホラクラシーを理想とする考えが共有できる関係と変容する中で、在宅医療の問題を他人事の問題から自分事、地域全体の問題へと考えるようになった。結論:在宅医療推進に関わる問題は複雑であり、課題の共有や解決策を模索するだけでなく、問題に関わる多職種の関係性の変容が必要である。対話を通じて各専門職の関係性が変わることで、在宅医療不足の問題を自らの地域の問題として捉え、主体的に解決策を模索するようになることが明らかになった。(著者抄録)

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保健医療福祉専門職の関係性や問題の認識は対話を通じてどう変わっていくのか?　複雑性の理論的枠組みを用いた医療過疎地の在宅医療推進プロセスを探索する質的記述的研究

細井崇弘, 阪本直人, 春田淳志, 前野哲博

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) 42 ( 2 ) 103 - 109 2019.06

ISSN 2185-2928

医学部医学科におけるシミュレーションに関する大学教員研修についての全国調査報告

志賀隆, 藤崎和彦, 小松弘幸, 前野貴美, 阿部恵子, 春田淳志, 栩野吉弘, 竹本恭彦, 石川和信, 首藤太一

医学教育 ((一社)日本医学教育学会) 50 ( 3 ) 245 - 250 2019.06

ISSN 0386-9644

日本のシミュレーション教育に関する大学教員研修についての全国調査を行った。シミュレーションFDを実施している大学は47校(68%)であった。OSCE関連の項目の実施率が高く、インストラクショナルデザイン、テクノロジー、プログラム評価、総括的評価、などの項目の実施率は低かった。特に、省察的実践、論文執筆の指導については15%に満たなかった。また障壁としては、学生の要因は少なく、シミュレーション教育にかかわる指導者の多忙が90%と最も多かった。(著者抄録)

Legitimate peripheral participation in a research education program for primary care residents: a case study of educational research

Sachiko Ozone, Ryohei Goto, Junji Haruta

MedEdPublish 8 ( 2 ) 37 2019.05

Research paper (scientific journal), Joint Work, Accepted

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Associated factors for discussing advance directives with family physicians by noncancer outpatients in Japan. Journal of General and Family Medicine

Hamada Shuhei, Haruta Junji, Hamano Jun, Maeno Tetsuhiro, Maeno Takami

Journal of General and Family Medicine (Journal of General and Family Medicine) 20 ( 3 ) 82 - 92 2019.05

Research paper (scientific journal), Joint Work, Accepted, ISSN 2189-6577

© 2019 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association. Background: Advance directives (ADs) are seldom discussed between primary care physicians (PCPs) and their patients, especially those with noncancer diseases. The aim was to identify the factors associated with discussing AD by noncancer patients with their physicians. Methods: This cross-sectional study was conducted in a hospital or clinic from October to December 2017. Physicians chose eligible noncancer patients aged 20 years or older to respond to an anonymous self-completed questionnaire inquiring about the objective variable “I want to discuss AD with my doctor,” as well as basic characteristics, and facilitators and barriers to discussing AD identified in previous studies. The physicians responded to a survey comprising the Palliative Performance Scale (PPS) and inquiring about the disease category for each patient. Data were analyzed using binomial logistic regression analysis. Results: A total of 270 patients (valid response rate, 79.6%) were included. Multivariate analysis identified a period of visit to the study site ≥ 3 years (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.05-4.10), physicians who are very good at taking care of patients’ disease (OR, 12.68; 95% CI, 1.12-143.22), and patients’ worry about their quality of life (QOL) in the future (OR, 2.69; 95% CI, 1.30-5.57) as facilitators for discussing AD with physicians, and PPS ≤ 90 (OR, 0.51; 95% CI, 0.26-0.98) as a barrier. Conclusions: Our study indicates that patients’ future QOL concerns, a long period of visit to a hospital, and the presence of physical symptoms were associated with the willingness of noncancer patients to discuss AD with PCPs.

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かぜに対する認識と受診信念に関連する要因の探索～健診受診者を対象にしたアンケート調査より～

阪本直人, 堤円, 釋文雄, 春田淳志, 後藤亮平, 前野哲博

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) 42 ( 1 ) 2 - 8 2019.03

Research paper (scientific journal), Joint Work, ISSN 2185-2928

目的:健診受診者を対象に、かぜに対する認識の現状と受診信念との関連を明らかにすべく調査した。方法:2012年8月〜9月、茨城県X市健診受診者に対し、かぜに対する認識や対処行動について無記名自記式質問紙で調査した。結果:1079名(有効回答率74.5%)が調査対象となり、かぜをひいたら「点滴や注射を受けると早く治る」に75.9%が賛成し、42.0%が「ウイルスが原因のかぜは抗生物質が効かない」に反対した。また、同項目で28.6%が「分からない」と回答。また「かぜ薬を早めに飲むと早く治る(OR:1.61)と「点滴や注射を受けると早く治る(OR:1.86)」が受診信念に関連する要因であった。結論:かぜに対する認識、そして、抗生物質の効果や医療機関で行われる治療に対する理解が不十分なことが分かった。また、かぜ薬や点滴・注射が治癒期間を短縮するという認識が、受診信念と関連することが示された。(著者抄録)

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Validity Evidence for Interprofessional Performance Scale in Conference (IPSC) in Japan'

Haruta J, Yamamoto Y, Goto R, Maeno T

MedEdPublish 8 ( 1 ) 54 2019.03

Research paper (scientific journal), Joint Work, Accepted

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かぜに対する認識と受診信念に関連する要因の探索　健診受診者を対象にしたアンケート調査より

阪本直人, 釋文雄, 堤円香, 春田淳志, 後藤亮平, 前野哲博

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) 42 ( 1 ) 2 - 8 2019.03

ISSN 2185-2928

Interprofessional education in medical schools in Japan

Maeno T, Haruta J, Takayashiki A, Yoshimoto H, Goto R, Maeno T

PLoS ONE (PLoS ONE) 14 ( 1 ) e0210912 2019.01

Joint Work

© 2019 Maeno et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Interprofessional education (IPE) for medical students is becoming increasingly important, as reflected in the increasing number of medical schools adopting IPE. However, the current status of and barriers to pre-registration IPE implementation in Japanese medical schools remain unknown. The purpose of this study was to clarify the status and barriers of IPE implementation in medical schools in Japan. We conducted a curriculum survey from September to December 2016 of all 81 medical schools in Japan. We mailed the questionnaire and asked the schools’ undergraduate education staff to respond. The survey items were the IPE implementation status and barriers to program implementation. Sixty-four of the 81 schools responded (response rate 79.0%), of which 46 (71.9%) had implemented IPE, 42 (89.1%) as compulsory programs. Half of IPE programs were implemented in the first 2 years, while less than 10% were implemented in the latter years of medical programs. As part of the IPE programs, medical students collaborated with a wide range of professional student groups. The most common learning strategy was lectures. However, one-third of IPE programs used didactic lectures without interaction between multi-professional students. The most common perceived major barrier to implementing IPE was adjustment of the academic calendar and schedule (82.8%), followed by insufficient staff numbers (73.4%). Our findings indicate that IPE is being promoted in undergraduate education at medical schools in Japan. IPE programs differed according to the circumstances of each school. Barriers to IPE may be resolved by improving learning methods, introducing group discussions between multi-professional students in lectures or introducing IPE programs using team-based learning. In summary, we demonstrated the current status and barriers of IPE implementation in Japanese medical schools. Our findings will likely lead to the promotion of IPE programs in Japan.

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Realist Approach: How to Evaluate Complex Interventions and Educational Programs Based on Scientific Methodology

J HARUTA, S OZONE, R GOTO

An Official Journal of the Japan Primary Care Association, 167-173 2019

Joint Work

How do Health Care Professionals Change the Recognition of Relationships and Problems Among Them Through Dialogue? Qualitative Descriptive Research Exploring the Process of …

T HOSOI, N SAKAMOTO, J HARUTA, T MAENO

An Official Journal of the Japan Primary Care Association, 103-109 2019

Joint Work

Factors Associated with Knowledge of the Common Cold and Desire for Medical Treatment: A Cross-sectional Study of Citizens Undergoing Health Checkups

N SAKAMOTO, F SHAKU, M TSUTSUMI, J HARUTA, R GOTO, T MAENO

An Official Journal of the Japan Primary Care Association, 2-8 2019

Joint Work

A Nationwide Survey on the Faculty Development for Simulation-Based Medical Education in Japan

T SHIGA, K FUJISAKI, H KOMATSU, T MAENO, K ABE, J HARUTA, ...

Medical Education, 245-250 2019

Joint Work

Development of an interprofessional competency framework for collaborative practice in Japan

Haruta J, Yoshida K, Goto M, Yoshimoto H, Ichikawa S, Mori Y, Yoshimi K, Otsuka M

Journal of Interprofessional Care (Journal of Interprofessional Care) 32 ( 4 ) 436 - 443 2018.07

Research paper (scientific journal), Joint Work, ISSN 13561820

© 2018, © 2018 Taylor & Francis. Rapid aging of the population necessitates improved collaboration among healthcare professionals. Unfortunately, interprofessional collaboration has yet to be implemented effectively in Japan. Therefore, we aimed to develop an interprofessional competency framework for Japanese healthcare professionals. The project was conducted as a four-step process, starting with initial categorization of potential competency domains, followed by guiding principle and prototype development, feedback on the prototype, and final consensus. First, authors (JH and MO) collected opinions about competency in interprofessional collaboration at two academic meetings of the Japan Association for Interprofessional Education (JAIPE) and then analyzed the data thematically. Second, a project team consisting of JAIPE and University representatives extracted the domains and statements as prototype 1. Third, seven representatives from professional organizations joined the project team and developed prototype 2. We then called for feedback on the revised prototype 2 at both an open symposium and via public comments. Following revision of prototype 2, a new project team including 20 university, professional organization and health practitioner representatives finally discussed prototype 3, developed the final draft and reached a consensus. In analysis after collecting the data, we extracted 11 themes. We developed four key principles which applied to six domains as prototype 1–3. Finally, our competency framework included two core domains of “Patient-/client-/family-/community-centered” and “Interprofessional communication”, and four peripheral domains of “Role contribution”, “Facilitation of relationships”, “Reflection” and “Understanding of others”. We developed an interprofessional competency framework in Japan which consists of two core and four peripheral domains. The interprofessional competency framework is likely to affect the understanding of “high-context” and “relationalism” in Japanese healthcare. We hope that our interprofessional competency framework will encourage the systematic implementation of interprofessional education and collaboration in Japan.

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Internet Survey Regarding Knowledge About the Common Cold in Japan

Sakamoto, N., Haruta, J., Goto, Ryohei., Yokoya, S., Madoka, T., Takayashiki, A., Maeno, T., Maeno, T.

Clinical Infection and Immunity 3 ( 2 ) 37 - 44 2018.06

Research paper (scientific journal), Joint Work, Accepted

Translation and cultural adaptation of the Japanese version of the interprofessional facilitation scale

Haruta J, Breugelmans R, Nishigori H

Journal of Interprofessional Care (Journal of Interprofessional Care) 32 ( 3 ) 321 - 328 2018.05

Research paper (scientific journal), Joint Work, ISSN 13561820

© 2018 Taylor & Francis. Effective interaction in interprofessional collaboration requires skills in interprofessional facilitation. The need for interprofessional learning and practice in Japan is highlighted by Japan’s status as one of the most rapidly aging societies because good care for elderly people with complex needs requires effective collaboration between different professional groups. The development of interprofessional facilitation skills (including management of the additional complexities) among learners or professionals enhances interprofessional learning and consensus building and empowers them to make appropriate commitments when faced with difficult challenges. The 18-item interprofessional facilitation scale (IPFS) can be used to enhance interprofessional facilitation skills. Here, we aimed to develop a Japanese adapted version of the IPFS and to validate it for use with Japanese healthcare professionals. Consistent with guidelines for cross-cultural adaptation, three translators translated the original IPFS from English into Japanese, and an expert and all authors confirmed its face and content validity. The translated items were amended during backtranslation and expert reviews. Exploratory factor analysis was performed with 167 healthcare professionals to explore the underlying structure of the items. This analysis revealed two factors with good internal consistency (Cronbach’s alpha > 0.8), which were labelled as: (1) encouraging interprofessional interaction and (2) respect for each professional. The original factor ‘Encouraging interprofessional interaction’ was divided into two factors in the study. One reason for this division might be related to the behaviour of Japanese health professionals, that is, most Japanese might understand that ‘facilitation’ encourages relationships as contextual belonging that are distinct from relationships based on respect for others. This mindset is likely based on the notion of ‘relationalism’, which is fundamental in Japanese culture. Further investigation of this Japanese version of the IPFS will strengthen factor construction and improve scrutiny of the relationships between factors.

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A cross-sectional survey of interprofessional education across 13 healthcare

Goto Michiko., Haruta Junji., Oishi, Ai., Yoshida Kazue., Yoshimi Kenji, Yoshimoto Hisashi.

The Asia Pacific Scholar medical and healthcare professions education 3 ( 2 ) 38 - 46 2018.05

Research paper (scientific journal), Joint Work, Accepted

Background: With the rapid aging of the population, collaboration among the various medical professions throughout the country is becoming increasingly indispensable in Japan. To promote collaboration in medical care, it is necessary to introduce the concept of collaboration to students at an early stage of their professional education. Despite this need, there are no core medical, healthcare and welfare education curricula in Japan that include interprofessional education (IPE). Therefore, the status of IPE in Japanese schools of medicine and other healthcare-related services is unclear.
Methods: We sent 3,430 questionnaires to 13 schools of medicine and related healthcare providers: doctors, nurses, physical therapists, registered dieticians, dentists, dental hygienists, social workers, pharmacists, occupational therapists, clinical psychologists, medical administrators, certified care workers, and speech therapists. The items addressed implementation rate of IPE, teaching methods and grading methods.
Results: Of the 3,430 surveys distributed, 572 completed surveys were returned (response rate 17%). Of the completed surveys, 493 qualified as valid, resulting in a final response rate of 14%. Only 19% (n = 93) of the analysed medical educational institutions included IPE instruction in their curricula.
Conclusion: While many educational institutions were conducting IPE, there were important inter-institutional differences with respect to attitudes towards IPE, teaching methods, and evaluation methods. This study was unprecedented in scale, and provides important basic information for the future development of IPE in Japan.

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Identification of prognostic factors for activities of daily living in elderly patients after hospitalization for acute infectious disease in Japan: A 6-month follow-up study

Goto R, Watanabe H, Haruta J, Tsutsumi M, Yokoya S, Maeno T

Geriatrics and Gerontology International (Geriatrics and Gerontology International) 18 ( 4 ) 615 - 622 2018.04

Joint Work, ISSN 14441586

© 2017 Japan Geriatrics Society Aim: We investigated factors that predict the prognosis of activities of daily living (ADL) in elderly patients who had undergone rehabilitation during hospitalization for acute infectious disease. Methods: The present prospective cohort study included 131 patients who were hospitalized due to acute infectious disease and who had undergone rehabilitation during hospitalization. Patient characteristics collected from medical records included age, sex and comorbidity score. The level of ADL 2 weeks before admission was assessed by interview at the start of rehabilitation. Grip strength testing, Short Physical Performance Battery as an assessment of lower limb function and the Mini-Mental State Examination as an assessment of cognitive status were carried out at the time of hospital discharge. The level of ADL at 6 months after discharge was assessed by telephone interview. Multivariate logistic regression analysis was used to identify factors that independently predict ADL dependence (defined as being dependent in one or more ADL items at 6 months after discharge). Results: The average age of participants was 81.5 years, and 52.7% were women. A total of 22.1% of patients showed dependence in an ADL at 6-month follow-up. Factors that predicted an ADL dependence were comorbidity score (OR 4.19, 95% CI 1.19–14.69) and lower limb function (OR 0.51, 95% CI 0.36–0.72) at discharge. Conclusions: The present findings have implications for the healthcare planning and well-being of elderly patients during hospitalization and after discharge. Geriatr Gerontol Int 2018; 18: 615–622.

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退院後のADLに関連する予測因子の探索急性感染症で入院した高齢患者を対象にした前向き観察研究

後藤亮平, 春田淳志, 前野哲博

高齢者ケアリング学研究会誌 (日本高齢者ケアリング学研究会) 8 ( 2 ) 1 - 10 2018.01

Research paper (scientific journal), Joint Work, Accepted, ISSN 2185-6753

【目的】急性感染症で入院した高齢患者を対象に退院後のADL予後予測要因を明らかにすることを目的とした。【方法】急性感染症で入院した65歳以上の患者のうち、入院2週間前と比較して退院時にADL低下を認めた者を解析対象とした。データ収集は、リハビリテーション開始時(基本情報・入院前ADL等の収集)・退院時(身体機能等の評価)・退院後6ヵ月時(生活状況等の収集)の3時点で行った。対象者のうち、退院後6ヵ月時点のADLが、入院2週間前と同等まで回復した場合を「ADL回復群」、そうでない場合を「ADL低下群」と定義し、ADL回復を予測する要因を検討した。【結果】対象者(74例)の平均年齢は83.4±6.0歳、女性が43例(58.1%)であった。また、74例のうち40例(54.1%)が「ADL回復群」であり、その予測要因は、「退院時の下肢機能が高い」であった。【結論】退院時の下肢機能が高く保たれていることは、退院後のADL自立度に影響する可能性が考えられた。(著者抄録)

A cross-sectional survey of interprofessional education across 13 healthcare professions in Japan

M Goto, J Haruta, A Oishi, K Yoshida, K Yoshimi, Y Takemura, ...

The Asia Pacific Scholar 3, 37-45 2018

Improving the workflow of nursing assistants at a general hospital in Japan

Isono Hiroki, Suzuki Sayuri, Ogura Jun, Haruta Junji, Maeno Tetsuhiro

BMJ Open Qual 6 ( 2 ) e000106 2017.11

Research paper (scientific journal), Joint Work, Accepted

Transferring non-specialised tasks from registered nurses to nursing assistants may help registered nurses focus on specialised tasks. Optimising the workflow of nursing assistants by making their tasks more efficient may improve problems associated with the shortage of registered nurses. The nursing assistants at our hospital were stressed about referring inpatients to outpatient specialty clinics. Therefore, we initiated a project to optimise the referral process and reduce the time spent by nursing assistants on this task, with the collaboration of physicians, registered nurses and administrative assistants. The Training for Effective & Efficient Action in Medical Service–Better Process (TEAMS-BP) method, which was developed by modifying the Japanese Training Within Industry–Job Method, was used for the optimisation process. TEAMS-BP teaches users how to break each task down into its individual components, to scrutinise the details, and then to develop new processes by eliminating, combining, rearranging and simplifying tasks. At baseline, each referral took 10 min and was performed 39 times over 10 days in six wards. The first TEAMS-BP cycle did not yield satisfactory results for the nursing assistants. In the second TEAMS-BP cycle, participants included inpatient and outpatient physicians, registered nurses and administrative assistants. As a result, we changed the referral process from paper to electronic records and streamlined referrals that were ordered by inpatient physicians to outpatient physicians. The use of this method saved the equivalent of 175 hours of nursing assistants’ time per year at no additional cost. If we had been able to define the referral process as an interdisciplinary task and show the merits to each department from the beginning, we may have been able to form the interprofessional team in the first TEAMS-BP. Improving the efficiency of nursing assistants can allow other professionals to focus on their specialised tasks more effectively.

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How do healthcare professionals and lay people learn interactively? A case of transprofessional education.

Haruta Junji, Nishigori Hiroshi, Kitamura Kiyoshi,

The Asia Pacific Scholar medical and healthcare professions education. 2 ( 3 ) 1 - 7 2017.09

Research paper (scientific journal), Joint Work, Accepted

Lay people without a body of specialty knowledge, like the professionals, have not been able to partake in interprofessional education (IPE). Transprofessional education (TPE), which was defined as IPE with non-professionals /lay people, is an important extension of (IPE). A TPE programme was developed to explore how health professionals and lay people learn with, from and about each other in a Japanese community. The present study was conducted in a hospital and the surrounding community in Japan. An ethnographic study design was adopted, and the study participants were six lay individuals from the community and five professionals working in the community-based hospital. During the health education classes, the first author acted as a facilitator and an observer. On reviewing interview data and field notes using a thematic analysis approach, findings showed that healthcare professionals and lay participants progressed through uniprofessional and interprofessional before achieving transprofessional learning. Both type of participants became to transcend boundaries after sharing their viewpoints in a series of classes and recognized that they were important partners in their local community step by step, which increased their sense of belonging to the community. The transformation was driven by dynamic interaction of the following four factors: reflection, dialogue, reinforcement of ties, and expanding roles. We believe this process led both groups to come to feel collective efficacy and inspire healthcare professionals to reflect on their transprofessional learning. We clarified how healthcare professionals and lay people achieved transprofessional learning in a TPE programme where participants advanced through uniprofessional, interprofessional stage before achieving transprofessional learning.

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Validity of medical history taken by pharmacists using a medical history taking tool

Matsushita Aya, Haruta Junji, Tsutumi Madoka, Sato Takuya, Maeno Tetsuhiro.

Journal of General and Family Medicine 18 ( 6 ) 403 - 408 2017.06

Research paper (scientific journal), Joint Work, Accepted

Background
The progress in aging and the shortage of physicians is a significant problem in Japan. Hence, healthcare professionals including pharmacists should cooperate to provide medical services with limited resources. However, pharmacists might have inadequate skills in taking medical histories. Therefore, we developed an interview tool to collect accurate medical history. In this study, we aimed to validate the contents of medical histories taken by a pharmacist using the interview tool and investigate physician consultation length.
Methods
Setting intervention days alternately, adult outpatients of the Kitaibaraki Center for Family Medicine who had new symptoms had their medical histories taken by one of two pharmacists before their physician visit during the study period. The contents of the medical history taken by a pharmacist using text analysis were validated on other four days. All sentences collected by a pharmacist or five physicians were divided into segments, and six other physicians assessed each segment. Differences in length of the physician consultation between those with and without (intervention and control groups, respectively) medical history taken by a pharmacist were investigated.
Results
Of 23 patients’ medical histories taken by a pharmacist using the interview tool, 84.4% of segments were related to the clinical diagnosis. The mean consultation length was 10.1±8.4 minutes in the intervention group (n=104) and 13.0±10.4 minutes in the control group (n=96) (p=0.048).
Conclusions
Medical histories taken by a pharmacist using the interview tool had high content validity and might reduce physician consultation length.

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Cross-cultural adaptation of the professional version of the Readiness for Interprofessional Learning Scale (RIPLS) in Japanese

Oishi Ai., Haruta Junji., Yoshimi Kenji., Goto Michiko., Yoshida Kazue, Yoshimoto Hisashi

Journal of Interprofessional Care (Taylor & Francis) 31 ( 1 ) 85 - 90 2016.12

Research paper (scientific journal), Joint Work, Accepted

Interprofessional education (IPE) for healthcare professionals is important in Japan because of its rapidlyaging population and increasingly complex healthcare needs. However, no tools have been validated inthe Japanese context to evaluate healthcare professionals’attitudes towards, or readiness for, IPE. Theprofessional version of the Readiness for Interprofessional Learning Scale (RIPLS) with 23 items wasselected for cross-cultural adaptation because it has been widely used internationally and a Japaneseedition of the student version has already been developed. We followed a guideline for cross-culturaladaptation and subsequently conducted factor analysis with 368 responses from over 16 professions.Face and content validity was confirmed through the translation process. We obtained four factors withgood internal consistency (Cronbach’s alpha > 0.7). These results were similar to those of the original UKstudy, apart from one factor being divided into two different factors in this study. Studies are required tofurther confirm the rigor and generalisability of the results; however, the Japanese RIPLS can be used toevaluate healthcare professionals’attitudes towards IPE, which can eventually lead to a better IPEdevelopment for healthcare professionals in Japan.

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Development of an interprofessional competency framework in Japan

Haruta Junji., Sakai Ikuko, Otsuka Mariko., Yoshimoto Hisashi, Yoshida Kazue, Goto Michiko, Shimoi Toshimichi

Journal of Interprofessional Care 30 ( 5 ) 675 - 677 2016.09

Research paper (scientific journal), Joint Work, Accepted

This article presents a project that aimed to identify a set of competencies (domains and statements) to prepare Japanese students and healthcare practitioners for collaborative practice. The Japan Association for Interprofessional Education (JAIPE) has started a government-funded project to formulate its interprofessional competency framework, in cooperation with professional organisations (e.g. Japan Society for Medical Education) in healthcare and social sciences. This three-year project is underway as part of the Initiative to Build up the Core Healthcare Personnel programme of Mie University. This project consists of five stages: literature review, data collection, prototype development, consensus formation, and finalisation. Our efforts will culminate in Japan's first interprofessional competency framework, with consensus from relevant academic societies and other stakeholders. We hope that the involvement of stakeholder participation will improve the usability of the final interprofessional competency framework.

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専門職連携コンピテンシー 1. 多職種連携コンピテンシーの国際比較

J HARUTA

保健医療福祉連携 9 (2), 106-115 2016

Relationship between Nurses'“Social Skills” and the Degree of Knowledge Regarding the Professions of other Co-medicals, in Japan: 68

K Yoshida, M Goto, J Haruta, A Oishi, K Yoshimi, H Yoshimoto

Medical Education 49 2015

A Survey of Interprofessional Education in Japan: A Cross Sectional Study of Schools of Medicine and Other Health Care Services: 66

M Goto, A Oishi, J Haruta, K Yoshida, K Yoshimi, H Yoshimoto

Medical Education 49 2015

第4回日本プライマリ・ケア連合学会ワークショップ『ジェネラリストに必要な緩和ケアのスキルとは？』報告

大石愛, 浜野淳, 春田淳志, 木村洋輔, 菅野哲也, 田中久也

日本プライマリ・ケア連合学会誌 37 ( 4 ) 366 - 368 2014.12

Research paper (scientific journal), Accepted

医療専門職の多職種連携に関する理論について

春田淳志、錦織宏

医学教育 45 ( 3 ) 121 - 134 2014.05

Research paper (scientific journal), Accepted

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�T An overview of theories about interprofessional education and work

J Haruta, H Nishigori

Medical Education 45 (3), 121-134 2014

�T 医療専門職の多職種連携に関する理論について

春田淳志，錦織宏

医学教育 45 (3), 121-134 2014

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