いまの初期研修って…
今週、楽しみにしていた地域医療研修で診療所の外来診療に入っています!
ずっと、医療過誤訴訟吹き荒れる中での研修医の保護もあり、決断・決定できな
い研修が続いていた中(野戦病院に行かなかったせいではあるけれど…)、気力
充実した昼の時間での外来診療はとても充実した学びがあって、嬉しさを感じる。
そんなときに気になる記事を見つけました。
日経メディカルオンライン
◆9.13 新臨床研修制度の光と影―医師953人の意見
http://cmad.nikkeibp.co.jp/?4_7799_134249_5
いろいろ生々しい典型的な意見が並び、いろいろ考えてしまいました。
そしてふと自分も今まで自分が今まで受けた中で最高だったなぁと感じた指導っ
てどんなものだったのかも、考えてみた。
で、マンガ「ヒカルの碁」のような世界があったな、と感じました。。
(そのマンガの大雑把なあらすじは、碁なんて知らない小学生に碁の神様のよう
な幽霊が取り付く。幽霊は石をもてないから、その小学生に手を動かしてもらう
ことで碁をうつ。そこで手を動かし、対局者たちの間で勝負を見ていたその男の
子は、急速に成長していく。というもの)
碁とか将棋とか、様々ある勝負の世界って、そこで戦っているひとにしか見えない
領域がある。
患者さんの病気と向き合う医療という勝負の現場も、やっぱりそうだと思う。い
ろいろ本を読んだりイメトレしたりしても到達できない領域が、(能力が届いて
いれば)現場に立ったときに見えてくる。きっとそれが、現場を経験する、症例
を経験する、ということなんだろう。
そして、一流の医師と一級の病気の勝負の間に研修医ながら立たせてもらえたと
き、一流の視野が見えてくることがあった。一流の医者の思考方法を、傍観では
なく、勝負の現場で体験させてもらえたとき、膨大な学びをさせてもらえること
があった。
研修医の成長のためには講義とか様々なことは必要なのだけれど、もっとも大き
く成長させてくれるのは、そんな一流の勝負、のはず。
スーパーローテートで研修をしていてとてもストレスなのは、そこまでとてもとて
も到達できないこと。
一流の勝負の間に立たせてもらえるにはそれなりの準備が必要。知識だけでなく、
上級医との個人的な関係や、その現場のシステムにどれだけ馴染んでいるか、な
どなどいろいろな準備が必要不可欠。不器用なぼくなどはそれがなかなかつくれ
ずあがいているうちにいつも、次の科に異動になる。
ただ手を動かしているだけ、傍観者であるだけ、のうちに次の科に異動になる。
1〜2ヶ月で異動して、異動先でカルチャーショックでふらふらになっていろい
ろ再構築しているうちにまた次の科、という繰り返しは消耗する。
もちろんそんなのは、不器用な一部の研修医のうめきに過ぎないところはあるだ
ろうけれど。
えらいひとたちや傍観する評価者たちが根本的に勘違いしていることがあると思
う。
スーパーローテートで小児・産婦含めいろいろな科をまわっても、研修医は、見
て回ったといううすっぺらい上っ面な「体験」をしても、永続的に身につく「経
験」は得ることはなかなかできない。上に書いたように短い期間じゃ経験するに
必要な準備はできないし、また、ストレート研修のときにあったようなその科の
学びで生きていくんだという覚悟もない。
だから、経験まで届かない。
研修終って身につかないのは研修医の責任なのか?
もちろん以前の研修にもたくさんの問題はあったけれど、でも深くも大きい弱点
を今の制度は持つ気がする。いまの制度は馴染んでいないということはあるだろ
うけれど。でもその大きな弱点が完全に克服される未来がくるのかな。でも、ど
んな仕組みも穴は消せないからしょうがないのかな。
ともあれ。
学びの多い勝負の視界を後輩にみせれるような先輩に、未来にはなりたいもので
す。努力せねば…。
コメント
新たな一歩が踏む出されたようで大変良かったですね!!
どうぞその調子で前向きに、どんな状況にも臆せず、頑張ってください♪
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