Objectives Understand purpose of Original Project Understand original

目的 Objectives �オリジナルプロジェクトの目的を理解するUnderstand purpose of Original Project �オリジナルプロジェクトのオプションを理解するUnderstand original project options �オリジナルプロジェクトのIMPSモデルを理解するUnderstand IMPS model for original projects

オリジナルプロジェクトの目的 Original Project Purpose �家庭医療修了要件としてRequirement for Family Medicine Certification �将来の家庭医療のリーダーとして、非臨床的問 題を解決するためにAs future family medicine leaders, others will look to you to solve non-clinical problems �オリジナルプロジェクトは個人的な報酬ですOriginal projects are personally rewarding �ミシガン大学では 15年の歴史があります 15 plus year history at UM

UFMとSFMの中核的活動としてのオリジナル プロジェクト Original Project as Core UFM and SFM activity �オリジナル学術プロジェクトは、ミシガン大学家庭医療科 における研修医教育の最重要ポイントである Original Scholarly Project is a highlight of residency training at the University of Michigan Department of Family Medicine �SFMでも中核的活動となり、あなた方を日本の他の研修 医から際立( )たせることになるでしょう Will become central at kiwada SFM and distinguish you from other residents in Japan �プライマリケア連合学会の必修科目requirement by primary care association

どのようにプロジェクトを選択するのか to pick a project? How �研修を通して、全ての研修医が家庭医療に関する個人 的あるいは自らの関心のあるトピックを見極める Over the course of training, all residents identify a topic of personal or professional interest relevant to family medicine.

何についてのプログラム？ about? What is the program �以下のことを助ける構造的枠組みを提供Program provides a structured framework to �厳格な学問的プロセスを用い、研修医が独自のプロジェク トを発展させたり、指導医メンターとの密な協力のもと、プロ ジェクトを改良、実行、評価する Help residents develop an original project using a rigorous academic process, work closely with faculty mentors to refine, carry out, and evaluate the project, and then summarize �学科のグランドラウンドや州レベルの家庭医療研究フォー ラムで研究結果を要約し報告する Present results at departmental grand rounds and at a statewide family medicine research forum.

どのような内容? What Content Areas? �研修医は自分達の研修や診療に関連すると思われる領 域や、研修中にあがった臨床的、教育的、政策的質問に 答える領域において、さらなる調査を行うことができる Residents can pursue advanced investigation in a subject area which they find relevant to their training and practice or which answers clinical, educational, or policy questions raised during training

プログラムの進行方法 How will it happen? �プログラムは、研修医がプロジェクトデザイン、評価、査定、 入門的統計学や研究における技術を学ぶことを手助け するカリキュラムを含んでいる Program includes curriculum to help resident learn skills in project design, evaluation, assessment, introductory statistics, and research

研修医プロジェクトの成果 Outcomes of Resident Projects? What are �UFM研修医は革新的かつ独創的プロジェクトを発展させ ている UFM residents have developed innovative and creative projects �多くの研修医が国内学会で自分のプロジェクトを発表し たり、査読審査のある学術誌において結果を出版してい る Many have gone on to present their projects at national meetings, publish results in peer -reviewed journals �家庭医療学科内のカリキュラムデザインに影響を与えた プロジェクトもあり、それらは現在と未来の研修医と指導 教員にとっての教育活動を変化させている Some projects influenced curriculum design within the department, and change educational activities for current and future residents and faculty

ミシガンでのプロジェクト例 Examples of UM Projects � Tammy Chang and Mikel Llanes � 妊婦に対する体重増加の認識および治療：質的研究Perception and treatment of weight gain by obstetrical practitioners- a qualitative study. � Holly Ross � 大学病院入院サービスへの診療の質のパターンとインパクトStaffing Patterns and Impact on Quality of Care for a University Family Medicine Inpatient Service � Caroline King � 妊婦健診：ミシガン大学での患者と医療者の行動Prenatal group visits: Patient and provider attitudes in the Department of Family Medicine � Hobart Lee � 患者安全性を改善する対話型ツールとしてのWebサインアウトElectronic Web Sign-out As an Interactive Tool to Improve Patient Safety � Scott Kelley and Ebony Parker-Featherstone � ミシガン大学での医師と 10代の若者、思春期の予防医療の会話Doctors Talking with Teens" or “Adolescent preventive care in the University of Michigan Dept. of Fam Med” � Jennifer Clem and Miranda Huffman � 死に至る患者のケアを学ぶ：緩和医療カリキュラムの評価とデザインLearning to Care for the Dying Patient: Evaluation and Design of a Palliative Medicine Curriculum

続き Examples of UM Projects � Marisyl de la Cruz and Alisa Young � 30－65歳のローリスク女性に対する子宮がん検診におけるHPVテストの 役割“Role of HPV testing in Cervical Cancer Screening in Low‑Risk Women ages 30‑ 65” � Beth Jones � 小児予防接種に対するクリニカル・リマインダーの役割"Clinical reminder system for childhood immunizations" � Jamie Szelagowski, Susie Ross � 栄養指導の改善：栄養に関してレジデント教育を改善するモジュールの 作成“Improved Education in Nutrition: nutrition” Creating an online nutrition module to improve resident education in � Jeffrey Kim, Kei Miyazaki � 成人入院医療カリキュラムのアセスメントおよび開発“Inpatient Adult Medicine Curriculum Assessment/Development” � Adaku Onyeji � イプシランティクリニックにおける禁煙プログラムの効果“Effectiveness of a Tobacco Cessation Program at the Ypsilanti Family Medicine Clinic” � Tom O’Neill – Expected Absence � レジデント診療報酬プロジェクト“Resident billing project”

自分の将来にどのように役に立つか。 How will it help my future? �以前のUFM 研修医は、オリジナル学術プロジェクトを完 了する過程が、キャリア形成や職業上の目標にとって重 要な類似のプロジェクトを自分たちが行うことを可能にし たと、報告している Former residents report that process of completing Original Scholarly Project allowed them to conduct similar projects important for career development and professional goals

ミシガン大学、静岡プログラムおよびオリジ ナルプロジェクトプログラムの使命 Mission of the University of Michigan, and SFM, Original Project Program � 未来の家庭医を募り、教育し、臨床診療や医学教育、 研究、公共政策やコミュニティー提唱において、地域や 国レベルで代表的存在になるよう鼓舞すること To recruit, educate and inspire future family physicians to serve as leaders in clinical practice, medical education, research, public policy and community advocacy on the local and national levels

オリジナルプロジェクトの重要性 How important is Original Project? �オリジナル学術プロジェクトは、我々SFMの使命の中心 的構成要素となっている The Original Scholarly Project fulfills a central component of our SFM mission.

家庭医療レジデントの オリジナル・プロジェクトの５ 種類 Five Types of Original Projects for Family Medicine Residents

IMPSとは？ IMPS what? ? ? �Investigative �Model of �Problem �Solving

IMPSの構成要素 Components of the IMPS �問題・疑問Problem/Question �予備情報の収集Gather preliminary information � 文献調査Literature review �ニーズ・アセスメントNeeds assessment �プロジェクト・介入の提案Propose project/intervention �介入を評価（そして修正する）Implement � Evaluate (and modify) intervention

臨床上のパラダイムとの比 較 Comparison with Clinical Paradigm 臨床CLINICAL 1) 主訴Chief Complaint 2) 情報収集Gather Information 3) アセスメントAssessment 4) 治療計画Treatment Plan 5) 計画の再評価と改訂 Reassess and Revise Plan 非臨床NON-CLINICAL 1)健康・マネジメント問題 Health/Management Problem 2)予備情報Preliminary Information 3)プロジェクト・介入の目的 Propose Project/Intervention 4) 提案Implement Proposal 5)再評価・修正Reassess and Modify

IMPSの手順 IMPS Procedures �オリジナル研究Original Research (OR) �持続的な品質改良（改善）Continuous Quality Improvement (CQI) �カリキュラム開発Curriculum Development (CD) �地域指向のプライマリケアCommunity-Oriented Primary Care �a. k. a, Population-Based Primary Care �臨床政策分析Clinical Policy Analysis (CPA)

オリジナル・リサーチ Original Research 1) 研究問題、リサーチ・クエスチョンを見つけるDevelop a Research Question 2)文献を調査する Assess Existing Literature 3) 研究調査をデザインするDesign a Research Study 4) リサーチの実行Implement a Research Study 5) データ分析行い、新たなリサーチを考えるAnalyze Data/ Propose New Research

地域指向のプライマリケ ア Community-Oriented Primary Care 1) 対象人口を定義し特徴づけるDefine and Characterize a Population 2) 健康の需要を分析し、資源を活用するAssess Health Needs/Available Resources 3)プログラムを企画し、計画を修正する Develop Program/Practice Modification 4) プログラムを実行し、計画を修正するImplement Program/Practice Modification 5)プログラムの 影響を分析し、介入を修正する Assess Impact/Modify Intervention

カリキュラム開発 Curriculum Development 1) パフォーマンスの欠如を見つけ出すIdentify Deficit in Performance 2) 現在の教育プログラムを分析するAssess Current Educational Efforts 3) カリキュラムを開発するDevelop a Curriculum 4) カリキュラムを実行するImplement Curriculum 5) インパクト・変更を評価するEvaluate Impact and Modify

改善：継続的な質の改善 Continuous Quality Improvement 1) 問題や意図しないアウトカムを見出す（日常診療や マネジメントに関して）Identify Problem/Unintended Outcome (clinical care or practice management) 2) 3) 4) 5) 要因を評価するAssess Factors Involved 代替戦略を開発するDevelop an Alternative Strategy 代替戦略を実行するImplement Alternative Strategy 影響を評価し修正するEvaluate Effects and Modify

臨床政策分析 Clinical Policy Analysis 1) 健康問題に関する政策（ガイドライン）を指摘する Identify Policy (guideline) addressing Health Issue 2) 3) 4) 5) 政策の作成を評価するAssess Development of the Policy 政策を分析するAnalyze the Policy 政策を実行するImplement the Policy 政策のインパクトを評価するEvaluate the Impact of the Policy

第一歩 First Steps �レジデントとして働く間に、問題点のリストを作っておく When working as resident, make a list of issues or problems that arise �指導医と自分の興味について話し合うDiscuss with faculty your interests �子宮摘出後の子宮がん検診の話題Pap after hysterectomy story Fetters MD, Fischer G, Reed BD. Effectiveness of vaginal Papanicolaou smear screening after total hysterectomy for benign disease. JAMA, 275(12): 940 -7, 1996.

北米での学会出席 �学会への参加 NAPCRG in Montreal（2009/11）, STFM in Vancouver（2010/4） �学会発表 STFMで”Prospects for Leadership, Education, Advocacy And The Patient-centered Medical Home In Asia. “の題でMain Presenterとして発表した。

リサーチメンター �リサーチメンター（アドバイザー）の役割 Role of Research Mentors �研修医の長期的ゴール設定と到達への計画を助けるHelp protégé identify and strategize to meet long-term goals �相談指導教育（メンタリング）とコラボレーションの違い between mentoring and collaboration Difference �メンター／メンティー関係は必ずうまく行くとは限らない Mentor/mentee relationship not guaranteed to work �メンターは助言や激励はできるが、望み通りの結果を約束できる わけではない desired outcome Mentor can provide expertise and encouragement but not ensure a �自分のメンティーを大事にしないメンターは、効果的である可能 性が低い Mentor who does not care about the protégé not likely to be effective 出典 Source: Katerndahl, et. al. “Issues Important to the Research Mentoring Relationship. ” Family Medicine. 43(3), March 2011

ディスカッション Discussion 指導医 �研究その他のプロジェクトにおける個人的経験 Personal experience in research or other projects �現在のプロジェクトやリサーチ・アイデアCurrent project or research ideas 研修医 �研究その他のプロジェクトにおける個人的経験 Personal experience in research or other projects �現在のプロジェクトやリサーチ・アイデアCurrent project or research ideas

可能なオリジナルプロジェクト �SFM家庭医療の後期研修一年目の包括的結果Content of a comprehensive family medicine internship (Arai) �SFMにおける産婦人科ガイドブックOB handbook (Arai) �家庭医療の後期研修性器模擬患者の可能性と壁Role of sexual organ SPI in FM resident education: Possibilities and Barriers (Nakane, Tsunawaki) �後期課程医療養成プログラムにおける目標と基準：発展 と実際かDevelopment and implementation of rotation-based goals and objectives (Arai) �家庭医療の基本となる知識、技能，と手技：SFM一年目 研修医の変化Change in Confidence in the essentials of family medicine: Outcomes of the first year of the SFM program (Nakane)

次なる段階 Next Steps �研修のタイムラインを作成する Establish a time line for training �発表のためのプロセスを形成する Establish process for presentation �国内学会の日程を考慮する Consider national program dates

今日のモルモットは 明日の指導者! Today’s guinea pigs are tomorrow’s leaders!

Publications Resulting from Resident Original Projects, 20042012 � Mirabelli M, Shehab R, Gorenflo D, Fetters MD. Pre-exercise stretching and sports related injuries: Knowledge, attitudes and practices. Clin J Sport Med. 2006; 16(3): 228 -31, � Gold KJ, Gorenflo DW, Schwenk TL, Bratton SL. Physician experience with family presence during cardiopulmonary resuscitation in children. Pediatric Critical Care Medicine. 2006; 7(5): 1 -6. � Phillips JP, Weismantel DP, Gold KJ, Schwenk TL. Medical student debt and primary care specialty intentions. Fam Med 2010; 42(9): 616 -22. � Khodaee M, Fetters MD, Gorenflo DW. Football (soccer) safety equipment use and parental attitudes toward safety equipment in a community youth sports program. Res Sports Med, 2011; 19(2): 129 -43. � Phillips JP, Weismantel DP, Gold KJ, Schwenk TL. How Do Medical Students View the Work Life of Primary Care and Specialty Physicians? Fam Med 2012; 44(1): 7 -13. � Riley M, Galang [Bettcher] S, Green LA. The Impact of Clinical Prompt on Prenatal Care. Fam Med 2011; 43(8): 560 -5. � Wallace J, Wu J, Weinstein J, Gorenflo D, Fetters M. Emergency Contraception: Knowledge and Attitudes of Family Medicine Providers. Fam Med 2004; 36(6) 417 -22

Other Publications by Residents, 2004 -2012 � Gold KJ, Barnes C, Lalley J, Schwenk TL. Case Report: Late-Onset Eclampsia Presents as Bilateral Cortical Blindness. American Family Physician. 2005; 71(5): 856, 858, 861. � Kim C, Fetters MD, Gorenflo DW. Residency education through the family medicine morbidity and mortality conference. Fam Med. 2006; Sep; 38(8): 550 -5. � Heidelbaugh, J, Bruderly, M. Cirrhosis and Chronic Liver Failure: Part 1. Diagnosis and Evaluation. Am Fam Physician 2006; 74: 756 -62 � Lewis CL, Kistler CE, Amick HR, Watson LC, Bynum DL, Walter LC, Pignone MP. Older adults' attitudes about continuing cancer screening later in life: a pilot study interviewing residents of two continuing care communities. BMC Geriatr. 2006; 6: 10. � Miyazaki K, Cooke JM, Fetters MD. Introduction of block month orientation (in Japanese). JAFM. 2009; 15(1): 32 -43. � Kirst NB. Quiet Moments. Hastings Center Report. 2009; 39(5): 8. � Kirst NB. Medical care that transcends words. New York Times, Jan 4, 2010. Accessed at http: //www. nytimes. com/2010/01/05/health/05 case. html? ref=health � Kirst NB. Other People’s Stories. Hastings Center Report. 2011; 41(5): 9 -10.

Oral Presentations and Posters by Residents, 2009 -2012 � � � � � Lee H, Heidelbaugh JJ, Campbell-Scherer D. Electronic Web Sign-out As an Interactive Tool to Improve Patient Safety. Society for Teachers of Family Medicine Annual Spring Conference, April 2009. Ross H, Forsch R, Sen A, Schwenk TL. Staffing patterns and impact on quality of care for a university family medicine inpatient service. Family Medicine Research Day XXXII, Brighton, MI, May 2009. Clem J, Huffman MM, Fonde K, Rodgers P. Learning to care for the dying patient: evaluation and design of a palliative medicine curriculum. Family Medicine Research Day XXXII, Brighton, MI, May 2009. Parker-Featherstone E, Kelley S, Green LA, Ruffin M. Adolescent preventive care in the University of Michigan family medicine residency. Family Medicine Research Day XXXII, Brighton, MI, May 2009. Mc. Laughlin E, Sheets K. Do physicians recognize medical jargon? Family Medicine Research Day XXXII, Brighton, MI, May 2009. Lee H, Heidelbaugh J, Campbell-Scherer DC. Family Medicine Research Day XXXII, Brighton, MI, May 2009. King C, Forsch R. Prenatal group visits in the department of family medicine: should we provide them? Family Medicine Research Day XXXII, Brighton, MI, May 2009. Distel L, Master-Hunter T. Intra-articular and soft tissue injections: development of a web-based teaching module for a family medicine residency curriculum. Family Medicine Research Day XXXII, Brighton, MI, May 2009. Chang T, Llanes M, Gold K, Fetters MD. Physician and nurse midwives’ approach to weight gain during pregnancy. Family Medicine Research Day XXXIII, Howell, MI, May 2010. Kay S, Bluhm B, Forsch R. University of Michigan family medicine resident clinic WIKI website. Family Medicine Research Day XXXIII, Howell, MI, May 2010. Lee H, Bluhm B; O'Neil T. Development of Resident Led Outpatient Morning Report as an Educational Model to Improve Resident Lectures. Society for Teachers of Family Medicine Annual Spring Conference, April 2010. Chang T, Llanes MT, Gold KJ, Fetters MD. Physicians’ and nurse-midwives’ approach to weight gain during pregnancy. North American Primary Care Research Group national meeting. Seattle, WA, Nov. 2010. Riley M, Bettcher S, Green LA. The Impact of Clinical Prompts on Prenatal Care. Society for Teachers of Family Medicine Annual Spring Conference, April 2011. Kim J, Miyazaki M, Randy Forsch, Rusty Chavey. University of Michigan Department of Family Medicine inpatient teaching curriculum improvement. Family Medicine Research Day, Howell, MI, May 2011. Ross SV, Szelagowski J, Amy Locke, Leslie Wimsatt. Nutrition fundamentals for clinicians: an educational module. Family Medicine Research Day, Howell, MI, May 2011. Jones EK, Nease DE. (Poster) Clinical reminders for childhood immunizations. Family Medicine Research Day, Howell, MI, May 2011. O’Neil T, Riley MA, Sen A, Heidelbaugh JJ. The Effects of a Virtual Paycheck on Resident Billing and Coding Patterns. Society for Teachers of Family Medicine Annual Spring Conference, April 2011 (poster) and Family Medicine Research Day, Howell, MI, May 2011 (oral presentation). Miyazaki K, Little SH, Fetters MD. Cultural Acceptability of Group OB Visits to Japanese Women in the United States. Society for Teachers of Family Medicine Annual Spring Conference, April 2011 (poster) and Family Medicine Research Day, Howell, MI, May 2011 (oral presentation). de la Cruz M, Onyeji A, Aikens JE, Gold KJ. Perceived Barriers and Potential Solutions In the Implementation of a Residency-Based Peer Evaluation System (poster). Society for Teachers of Family Medicine Annual Spring Conference, April 2011 and Family Medicine Research Day, Howell, MI, May 2011.