Introducing comprehensive community health care clerkships in depopulated areas

地域の医師不足,総合診療や地域包括ケアの重要性の高まりなどを背景に,医学教育における地域医療実習の拡充が求められている.山口大学医学部では医学科3年生を対象に,主に過疎地域やへき地の小規模病院あるいは診療所において2日間にわたる実習を行う｢地域包括医療修学実習｣を開始した.平成22年度より選択制で始め,平成24年度には必修化された.実習目的の明確化,自己紹介文の作成,患者や医療従事者へのインタビューの実施など,実習の効果を高める工夫を行った.また,関連する講義の実施や実習前の説明によって,学生のモチベーションと態度の向上を図った.平成26年度に行った学生への実習後アンケートでは,ほとんどの学生が,大学での学習意欲の向上,医師として働くことの動機づけ,ロールモデルの発見などに対して効果があったと回答した.本実習は,学生が地域医療を体験することで,期待された効果を得ることができた.ただし,山口県の医師確保などへの効果は明らかではなく,中長期的な効果の評価と継続的な内容の改善が今後の課題である.

Greater use of regional health care clerkships for medical students is needed to address the lack of physicians in rural areas and the increased importance of general medicine and comprehensive community health care. Yamaguchi University has introduced a comprehensive health care clerkship, in which third-year students study community health at small hospitals and clinics over a two-day period in depopulated and remote areas of Yamaguchi prefecture. The clerkships were introduced as a selective program in 2010 and became a compulsory subject in 2012. To make the program more effective, we set the purpose and objectives and asked students to write self-introductory letters and to interview patients and staff in the institutes. We also provided some related lectures and orientation to improve the students’ motivation and attitude. A survey of students who undertook the clerkship in 2014 demonstrated that almost all the students were better motivated to learn at university and to practice as physicians, and that they had found role models during the clerkship. The clerkship generated the expected outcomes by providing students with actual experience of community health care. However, it was not clear whether the clerkships were effective in increasing the numbers of physicians in Yamaguchi prefecture. Further research is needed to evaluate longer-term outcomes and to improve the content of the clerkships.

医学教育

地域医療教育

地域医療実習

地域包括ケア

過疎地域