医療教育における臨床推論を促進する「考えるOSCE-R」の開発

Abstract

藍野大学医療保健学部理学療法学科では，2007年度より理学療法版の客観的臨床能力試験（OSCE）を作成し，これに，映像によるグループリフレクションを組み込んだ「OSCEリフレクション法（OSCE–Reflection Method：OSCE-R）」を開発・実施してきた。本研究の目的は，臨床推論を求めるOSCE-R ver.2（「考えるOSCE-R」）が学生の学びに与える影響について検討することである。理学療法学科の3年生77名を対象に新しい課題でOSCE-Rを行い，グループリフレクション前後のOSCE評価得点の比較，リフレクションシート分析，アンケート調査およびインタビュー調査を行った。その結果，OSCE-R ver.2では，臨床現場に近い状況の臨床推論が促され，それによって理学療法過程をたどりながら，深く思考することが可能になるということが確認された。Based on our previously created version of an objective structured clinical examination (OSCE) for nurturing physical therapists, we developed a revised method called OSCE-Reflection method (OSCE-R) by integrating visual group reflection into the above OSCE, which has been implemented since FY2007． The purpose of this study was to investigate the effects of OSCE-R ver. 2 , i．e．an OSCE-R version with revised OSCE tasks, on the learning of students． In this study, seventy seven third-grade students of the physical therapy department were subjected to OSCE-R with the revised tasks in order to compare their OSCE scores obtained before and after their group reflection and analyze the reflection sheets, questionnaires and interview surveys that were conducted with them．The results demonstrated that the newly adopted “OSCE-R ver. 2” allowed for simulating the settings as close as possible to those in clinical practice thanks to the revision of tasks． We also found that OSCE-R allows students to think deeply and makes them follow a course of physical therapy assessment which includes clinical reasoning that is compatible with clinical practice.