新興感染症の拡大など予測不能で、従来の対策では解決が困難な課題が増えている。医療機関においても、新たな解決策を創造する力や諦めず考え抜く力が強く求められている。そこで、VUCAの時代に不可欠な力を高めるため、現在取り組んでいる前例のない課題を素材にケースを作成し、これを使用したケースメソッド教育プログラムを開発した。
今年度作成したケースは、A病院がCOVID-19と医師の働き方改革に伴い直面している新たな課題5ケースである。ケース毎に教育テーマを定め、関係者へのインタビューと関連資料をもとに8～10頁のケースを作成した。ケース本文ならびに教育目的や設問などの授業計画書は、ケースメソッド教育の専門家とともに検討を行った。
教育プログラムは、①ケースの事前学習、②グループ討議(50分)、③クラス討議（60分）、④まとめ・補足講義で構成されている。全5回の研修会には、A病院看護師長14名、大学院生4名が参加した（2021年6月～2022年3月）。毎回、終了後に評価のためWEB調査を行い、クラス討議を録画し参加者の発言回数と発言時間をカウントし、音声を文字に起こして内容分析を行った。
クラス討論での参加者の発言総回数は回を重ねる毎に増加した（初回：18回、最終回：32回）。発言内容も初回は表層的な分析や部分的な解決策が目立ったが、次第に複数の要因間の作用の分析や、全体最適の視点や、根本解決策の提案が増えた。プログラムに参加したことにより鍛えられたと感じている力は「問題・要因構造をつかむ力」（84.3%）、「現状分析力」（66.0%）、「予測力（中長期的な視点）」(52.3%)だった。一方、「応用力」(12.5%)、「説得力」（6.5%）は低かった。初回は低かったが回を重ねる毎に高まったのは「解決策の提案力」(初回25%⇒最終回：54％)、「論理的思考力」(同25%⇒38%)、「意思決定力」（同6%⇒31%）であった。
今後は、「説得力」等の苦手だと感じている力に焦点をあてたケースを作成し、教育プログラム内容の改訂を行っていく。
There are many unforeseen and difficult-to-solve issues with conventional countermeasures, such as spreading new infectious diseases. Medical institutions are also in vital need of the ability to create new solutions and to think things through never giving up. Thus, to enhance these essential skills in the age of VUCA, we developed a case method educational program that uses cases created from unprecedented issues currently being addressed.
This year, the program was based on five new cases Hospital A faces with COVID-19 and physician work style reformation. We defined an educational theme for each case and developed an 8- to 10-page case based on interviews with relevant personnel and related materials. The text of the cases and the lesson plans, including educational objectives and questions, were reviewed with experts in case method education. We created an educational program consisting of (1) preparatory study of the cases, (2) group discussion (50 min.), (3) class discussion (60 min.), and (4) summary and supplementary lectures.
Fourteen head nurses from Hospital A and four graduate students participated in five training sessions under this program (June 2021 - March 2022). A web-based survey was conducted after each session for evaluation purposes. Class discussions were recorded, and the number of times participants spoke and the amount of time they spent speaking were counted. The recorded audio was then transcribed for content analysis.
The total number of comments made by participants in class discussions increased in each session (first session: 18, last session: 32). In the first session, most of the comments were superficial analyses and partial solutions. Gradually, however, analysis of the effects of multiple factors, the perspective of overall optimization, and proposals for fundamental solutions became more common.
According to the survey, the program developed "the ability to grasp the problem and factor structure" (84.3%), "the ability to analyze the current situation" (66.0%), and "the ability to forecast (medium- to long-term perspective)" (52.3%). On the other hand, those with fewer responses were "ability to apply" (12.5%) and "persuasiveness" (6.5%). The abilities that were low the first time but increased each time were "ability to propose solutions" (from 25% the first time to 54% the last time), "logical thinking" (from 25% to 38%), and "decision-making" (from 6% to 31%).
We will continue to revise the content of the educational program by creating cases focusing on "persuasiveness" and other abilities, for which not much improvement has been found.