MA Clinical Education 2007/08 における一学生としての経験

抄録

山梨医科大を 97 年に卒業し、亀田総合病院にて 1 ヶ月のハワイでのエクスターンシ

ップを含む 2 年間のスーパーローテーションプログラムの初期研修、九州大学心療
内科での後期研修、麻生飯塚病院での心療内科医としての診療の後、英国 Imperial
College London にて精神神経免疫学の博士課程を取得した後に University of London の
Institute of Education と London NHS Deanery が協働で始めた MA in Clinical Education
（臨床教育における修士課程）を体験した経験を、課程に参加している一人の学生
としての立場から、その課程への参加前の期待と実際の課程の内容・体験と印象、
そして現在までの足跡を紹介させて頂きます。

PPT presentation (560KB) http://homepage2.nifty.com/akira_naito/MAsofar.ppt

1. 修士課程を履修する前の期待について

臨床教育という修士課程の名や生涯学習教室との協力があるとのこと、またはじめ
に提示された MA の全体像を俯瞰する三角形の図から、学術的な背景の学習や臨床
現場での臨床実践内での学び・教育と学術的な理論展開を継ぐような概念の理解や
実践テクニックやティップスが学べるのではないかという期待を持ち課程を履修す
ることにしました。履修課程の中で仕事現場における学び（Workplace learning）と
いう概念が学術的にも存在することを知り、その概念を学びたいという興味と意欲
をましました

2. 実際に課程内の二つの必須のモジュールを経験した中での内容と他の履修学生に
対する印象

非常に多岐にわたる分野をそれぞれ指定文献の予習の元、約 3 時間くらいでまとめ
る授業を受けました。それぞれの講義ごとの専門の講師による授業で、両モジュー
ル共に招待講師を多く招いて行われましたが Contemporary issues in clinical education
での講演の方が、招待講師の数は多かった印象でした。Contemporary issue の方では
Swanwick 先生が全ての講義に出席していたり、Learning and Teaching の方では 3 人
の Module tutors がチームとして生徒と相対する形を見せたりすることで、一貫性を
保つような試みをしているように感じられました。内容的には、Teaching skills やテ
ィップスという側面はあまり体験できませんでしたが、理論体系としての学術背景
への考察の為の文献資料やハンドアウト、グループディスカッションはふんだんに
用意されていたように感じます。

コアモジュール二つを体験して

現在の医学教育における多岐にわたる領域の個々の側面をひとつひとつの講義の中
で俯瞰でき、その後自己学習を始めるきっかけ作りとして、各々の領域の要点と現
在の論点などが明確になるような講義やグループディスカッションを体験できたと
いう感想です。同時に受講していた他の生徒たちのコメントなどは、非常に色々な、

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特に教育職として現職で働いている立場としてのインプットが多く聞けたり、ブレ
イクでの会話の中で少し情報を提供しあったりすることができたことは学びになっ
ています。参加者（学生）同士の講義以外での個人的な勉強会や繋がりなどへの発
展は散見されるものの、それほど多くない印象でした。

評価課題としてのエッセイの作文に関して

多岐にわたる色々な領域の中から自分の興味や経験に基づいた焦点を絞り、文献・
図書の検索、読書、そして論文作成の過程を通し、その興味ある領域とその周辺の
更なる学びを深める機会となりました。エッセイのタイトルの選択やその後の査読
などの機会（エッセイスーバイザーと面と向かって話し合う時間として最高 1 時間
は保証され、IoE として CAPLIS などの論文作成そのものの指導の補助のシステム）
などは整備されている印象でした。

Experience of one student in MA Clinical Education 2007/08

Akira Naito

1. Expectation before taking the MA – from the title and the triangle diagram

The title of clinical education and the name of the department at IoE of the lifelong learning
encouraged me to think that the course will provide an academic framework and practical
connections between academia and clinical practice. The concept of workplace learning
came to me later in the course and it boosted my interests and the expectation.
The triangle diagram gave me impression that the MA course covers both theoretical
backgrounds for understanding pedagogical frameworks and practical hands-on skills in
actual teaching.

2. Impression of the contents in the two core modules and of fellow students

1) The list of session titles:

a) Contemporary Issues in Clinical Education module
 Clinical education in today’s health
 Curriculum design and development
 Clinical education and the patient
 Selection for clinical education and training
 Professionalism and the development of expertise
 Inter-professional education
 Simulation in clinical education
 The pedagogy of the one-to-one
 Challenges in assessment for clinical educators
 Continuing professional development
b) Learning and Teaching for Adults module

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  Nature of teachers’ work and pedagogical traditions in further, adult, higher and
professional education- teacher/teaching, learner/learning and knowledge/knowing
 Models of teaching and professional practice – competence, capability,
connoisseurship and reflective practice
 Models and theories of learning and teaching
 Approaches to and conceptions of learning and teaching, learning styles and learning
and understanding
 Enhancing learns’ motivation – emotion and learning
 Pedagogy of workplace- learning a participation and apprenticeship, restrictive and
expansive learning environments
 Pedagogy of workplace – organizations as activity systems – the clash between
managerial and professional objectives and cultures
 Assessment and learning – the tensions between instrumental assessment and
learning on some qualifications and learning cultures, the alternatives of using
formative assessment to foster sustainable and deep learning
 Student presentations on an aspect of practice in teaching, learning and/or
assessment drawn from the contents in which they work or study based on the
chosen assignment topic

2) Impression after attending the module

Well-covered overview of current clinical (medical) education, and individual contents gave
me a sense of what could be explored further in each area of the field.

3) Difficulties faced by me as a medically trained doctor with a natural science background

The challenge of moving from a 'clinical' way of thinking about issues to an 'educational' way
of thinking about them for me was viewed as a shift of way of thinking from the manner in
“problem-solving in order to find a solution (by myself from ‘my’ familiar perspectives)” to
the manner in “careful observation in order to check one’s own standpoint of the
perspective.” That is, I have come to think in the way that what background
(experience/knowledge) made him/her to behave this course of actions (or state this
discourse in a document). The experiences supported me to make the shift happened was
the exposure to many educational discourses, particularly of the socio-constructivists and
the experience of discussions amongst fellow colleagues in the modules.

The other point to mention that was unique and different from that of natural scientific
articles was the style and manner/construction of the literatures. It seems to me that
rationales to support one’s analysis can be more qualitative or narrative, which normally
contains a lot of background histories of arguments. This gives me an impression that I have
to read lots of previous literatures where the arguments were based upon to introduce the
notions which I was interested in. This means that evidence to use in a paper/essay can be a
historical document or a documented episode as long as it explains the origin and following
path of understanding of the argument may make sense. Hence, until I feel like I have come
across all the names of the notions (or original/influential authors of the notion) at least
once before, I was frustrated to find a ‘new’ notion or dimension/perspective at the same

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time I felt excited, i.e. I had been overwhelmed by the amount of ‘not-knowing’ how far
should I be in a dark to find out the way out.

The ‘turning point' that helped my understanding of the field, shall I say, was therefore that
I came across the same concept/notion from different modules and I could find myself the
argument given to me the second time (sometime from a different angle/perspective but
the same topic) was familiar to some extend. That is to say, the turning point was the time I
felt confident about at least what was told in the name.
The struggle I felt at most was the time I could not know (not manage to find out) what I
should ask to teacher(s)/supervisor(s) since I was a novice and felt like that I need to
prepare reading much more than required before coming to him/her to ask anything in
order to have a fruitful meeting with him/her, (i.e. I felt like that I knew that what can be
told at that stage was to ponder more or mull over (with readings) the purpose and reason
why I want to discuss/argue the particular topic).

The list of books I found empowering and helpful is following:

***
Experiential Learning: Experience as the Source of Learning and Development by David A.
Kolb
http://www.amazon.co.uk/dp/0132952610/

Educating the Reflective Practitioner: Toward a New Design for Teaching and Learning (The
Jossey-Bass Higher Education Series) by Donald A. Schon
http://www.amazon.co.uk/dp/1555422209/

Mind in Society: Development of Higher Psychological Processes by LS Vygotsky

http://www.amazon.co.uk/dp/0674576292/

Situated Learning: Legitimate Peripheral Participation by Jean Lave and Etienne Wenger
http://www.amazon.co.jp/dp/4782800843/
Communities of Practice: Learning, Meaning, and Identity by Etienne Wenger
http://www.amazon.co.uk/dp/0521663636/

The Culture of Education by J Bruner

http://www.amazon.co.uk/dp/0674179536/

Personal Knowledge: Towards a Post-critical Philosophy by Michael Polanyi

http://www.amazon.co.uk/dp/0226672883/

Conjectures and Refutations: The Growth of Scientific Knowledge by Karl R. Popper

http://www.amazon.co.uk/dp/0415285941/

Developing Professional Knowledge and Competence by Michael Eraut

http://www.amazon.co.uk/dp/075070330X/

インストラクショナルデザインの原理 R.M.ガニェ

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 http://www.amazon.co.jp/dp/4762825735/

Adult Education and Lifelong Learning: Theory and Practice by Peter Jarvis
http://www.amazon.co.uk/dp/0415314933/

A Practical Guide for Medical Teachers by John Dent and Ronald Harden
http://www.amazon.co.uk/dp/0443100837/

Workplace Learning in Context by Anne Munro, Helen Rainbird, and Alison Fuller
http://www.amazon.co.uk/dp/0415316316/
***

4) Writing an essay

Good opportunities to engage myself into thinking deeply in a particular area of the field
which I could choose from the vast range of topics

3. My achievements so far
1) Contemporary Issues in Clinical Education module
Log notes:
(http://homepage2.nifty.com/akira_naito/contemporaryissuesinclinicaldducation.pdf)

Assignment:
A total of 4181 words essay regarding ‘supervision’ examining current guidelines
with arguing a hypothesis that effective supervision not only improves
supervisees’ performance but it also enables medical professionals to develop
their own expertise, so as to attain better patient-care and safety
http://www.scribd.com/doc/4007874/

Result: grade B

2) Learning and Teaching for Adults module

Assignment:
A total of 4893 words essay regarding ‘medical professionalism and assessment’
examining related contemporary documents (particularly of the Doctors-in-
society) in relation with current discourses and templates of the assessment in
place of medical practice/trainings.
http://www.scribd.com/doc/14156700/

Result: grade A

3) Education for the Professionals module

Log notes:
(http://homepage2.nifty.com/akira_naito/educationfortheprofessionals.pdf)

Assignment:

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 A total of 4518 words essay regarding ‘tacit knowledge’ examining the process of
becoming a professional, operating within the regulations and practical limitations
reviews concepts relevant to tacit learning in the workplace using Polanyi’s
classification, and it argues that tacit process is manifested in the clinical
workplace and contributes to the development of expertise and identity.
http://www.scribd.com/doc/4007743/

Result: grade B