(3)県全体の産科実態調査に基づく医療崩壊回避,および充実した卒前・卒後教育への取り組み(<特集>第60回学術講演会シンポジウム4「産婦人科医不足の解消を目指して」)

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To avoid the loss of regional medical services, it is important that we investigate the present conditions of medical practice and accurately inform all local residents regarding this critical situation. Likewise it is important to construct a cooperative organization mainly around secondary medical care. We restructured the secondary perinatal medical care region as a result of our investigation into emergency transportation. We also identified certain key hospitals at which the posting of obstetricians should be heavily encouraged for a while. Below we report one experience with cooperative practices. A healthcare crisis occurred in a secondary medical care in the south area of Nagano prefecture responsible for 1,800 annual deliveries; the number of birthing facilities dropped from six to three in half a year. However, it maintained its secondary medical care and successfully handled all the deliveries of regional residents despite a doubling of the annual number of births from 500 to 1,000 at key hospital. This success was due to the development of semi-open system of obstetric care based on designated key hospital, the sharing of consultation functions with neighboring clinics, and government support. The number of outpatients and emergency transfers of pregnant women declined in key hospital, and although the number of deliveries increased, the majorities were uncomplicated deliveries. Thus, obstetricians felt that their work burden remained unchanged or was even alleviated. However, a portion of the residents opposed the new system. A survey on puerperal women who experienced the system revealed that satisfaction rate of prenatal care in local residents was lower than in returning home pregnant women. However, in six months, the proportion of positive responses increased. Satisfaction rate of childbirth in both groups were high. In addition, administrative structures within local governments (cities, towns and villages) should facilitate medical cooperation in obstetrics and are develop a policy of providing economic assistance to young doctors working at key hospitals. It is impossible to maintain adequate levels of regional medical care unless the number of new doctors who work at a university dispatching doctors is increased. Therefore, substantiality of the pregraduate and postgraduate education is most important. In our experience, students and residents require the ability to assist the radiologist in obtaining preoperative imaging as well as adequate training to achieve self-sufficiency in checking histopathology specimens. It is important that obstetricians and gynecologists provide guidance with enthusiasm and that the education provided be equivalent to that at university.
社団法人日本産科婦人科学会の論文
2008-12-01

(3)県全体の産科実態調査に基づく医療崩壊回避,および充実した卒前・卒後教育への取り組み(<特集>第60回学術講演会シンポジウム4「産婦人科医不足の解消を目指して」)

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