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都市部の総合診療医・家庭医に必要なコンピテンシーの検討

密山, 要用 東京大学 DOI:10.15083/0002005075

2022.06.22

概要

背景:近年、世界的な都市への人口集中により都市部におけるプライマリ・ケアの重要性が高まっている。都市部の総合診療医・家庭医(以下、GP/FPとする)の養成が不可欠だが、そのために必要な実践的能力としてのコンピテンシーに関する知見は限定的である。本論文は、都市部のGP/FPに必要なコピテンシーを明らかにすることを目的とする。

方法:第1の研究で、GP/FPを対象に半構造化面接法による個別インタビューと質的分析により、都市部と非都市部のコンピテンシーの共通と差異について検討する。第2の研究で、修正デルファイ法により内容妥当性が高く教育現場に実装できるコンピテンシーリストを明らかにする。

結果:第1の研究では、10名のGP/FPから42のテーマを抽出し、5つの領域に分類された。特に都市部のGP/FPのコンピテンシーとして10項目を明らかにした。第2の研究では、4つの属性の異なる集団の39名を集めデルファイ法で3ラウンドの調査を行い、18項目の都市部のGP/FPのコンピテンシーを明らかにした。

考察:得られたコンピテンシーについて検討し、都市部のコンテクストを理解し配慮したケアを提供できることが都市のGP/FPのコンピテンシーの中心的な概念枠組みであることを示すともに、既知のコンピテンシーである「多様性に配慮したケアを提供できること」に加えて、「患者を取り巻く複雑な医療・社会サービスと効果的に連携・調整・統合を行える能力」が都市のGP/FPにとって主要なコンピテンシーであることを新たに示した。

結論:これまで知見が限定的であった都市部のGP/FPのコンピテンシーについて検討し、内容妥当性に配慮した包括的なコンピテンシーリストを示すことができた。これらの知見を踏まえて今後、教育と臨床に実装するためのさらなる研究と教育実践を行う必要がある。

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