{"id":7146,"date":"2020-07-01T09:00:11","date_gmt":"2020-07-01T00:00:11","guid":{"rendered":"https:\/\/wp.meccari.jp\/?p=7146"},"modified":"2023-12-27T15:39:52","modified_gmt":"2023-12-27T06:39:52","slug":"menu_16","status":"publish","type":"post","link":"https:\/\/wp.meccari.jp\/eigocafe\/menu_16\/","title":{"rendered":"Menu 16\u3000\u82f1\u8a9e\u3067\u306e\u533b\u7642\u9762\u63a5\u306e\u30b3\u30c4"},"content":{"rendered":"\"\"\r\n\r\n

\u3053\u3093\u306b\u3061\u306f\u3002\u300c\u533b\u5b66\u82f1\u8a9e\u30ab\u30d5\u30a7<\/strong><\/span>\u300d\u306b\u3088\u3046\u3053\u305d\uff01<\/span><\/p>\r\n\r\n

\u3053\u3053\u306f\u300c\u30b3\u30fc\u30d2\u30fc1\u676f\u5206\u300d\u306e\u6642\u9593\u3067\u3001\u533b\u5b66\u82f1\u8a9e\u306b\u307e\u3064\u308f\u308b\u8a71\u3092\u6c17\u8efd\u306b\u697d\u3057\u3093\u3067\u3044\u305f\u3060\u304f\u30b3\u30fc\u30ca\u30fc\u3067\u3059\u3002<\/span><\/p>\r\n\r\n

\u672c\u65e5\u306e\u30c6\u30fc\u30de\u306f\u300c\u82f1\u8a9e\u3067\u306e\u533b\u7642\u9762\u63a5\u306e\u30b3\u30c4<\/strong><\/span>\u300d\u3002<\/span><\/p>\r\n\r\n

\r\n\u533b\u5b66\u82f1\u8a9e\u6559\u80b2\u306b\u304a\u3044\u3066\u300c\u82f1\u8a9e\u3067\u306e\u533b\u7642\u9762\u63a5<\/strong>\u300d\u306f\u57fa\u672c\u7684\u306a\u5b66\u4fee\u9805\u76ee\u3067\u3042\u308a\u3001\u73fe\u5728\u591a\u304f\u306e\u533b\u5b66\u90e8\u3067\u53d6\u308a\u5165\u308c\u3089\u308c\u3066\u3044\u307e\u3059\u3002\u305d\u306e\u4e2d\u306b\u306f\u300c\u82f1\u8a9e\u3092\u8a71\u3059\u6a21\u64ec\u60a3\u8005\u3055\u3093\u3092\u4f7f\u3063\u305f\u533b\u7642\u9762\u63a5\u300d\u3084\u300c\u82f1\u8a9e\u3067\u306eOSCE\u300d\u306a\u3069\u3092\u5c0e\u5165\u3057\u3066\u3044\u308b\u5927\u5b66\u3082\u3042\u308a\u307e\u3059\u3002\u307e\u305f\u3001\u7c73\u56fd\u533b\u5e2b\u56fd\u5bb6\u8a66\u9a13 USMLE \u306b\u5408\u683c\u3057\u3066\u7c73\u56fd\u3067\u306e\u81e8\u5e8a\u7814\u4fee\u3092\u8003\u3048\u3066\u3044\u308b\u533b\u5b66\u751f\u306b\u3068\u3063\u3066\u306f\u3001\u5b9f\u6280\u8a66\u9a13\u3067\u3042\u308b USMLE Step 2 Clinical Skills (CS) \u306f\u65e5\u672c\u4eba\u306b\u306f\u6700\u3082\u30cf\u30fc\u30c9\u30eb\u304c\u9ad8\u3044\u8a66\u9a13\u3067\u3042\u308a\u3001\u305d\u306e\u5bfe\u7b56\u306b\u82e6\u52b4\u3057\u3066\u3044\u308b\u5b66\u751f\u3055\u3093\u3082\u6570\u591a\u304f\u3044\u307e\u3059\u3002\u79c1\u81ea\u8eab\u3001\u533b\u5b66\u82f1\u8a9e\u6559\u5e2b\u3068\u3057\u3066\u3053\u306e\u300c\u82f1\u8a9e\u3067\u306e\u533b\u7642\u9762\u63a5\u300d\u306f\u3001\u3053\u308c\u307e\u3067\u305a\u3063\u3068\u53d6\u308a\u7d44\u3093\u3067\u304d\u3066\u3044\u308b\u5927\u304d\u306a\u30c6\u30fc\u30de\u3067\u3082\u3042\u308a\u307e\u3059\u3002<\/span>
\r\n\u305d\u3053\u3067\u4eca\u6708\u306f\u3001\u73fe\u6642\u70b9\u3067\u79c1\u304c\u6700\u9069\u3068\u8003\u3048\u308b\u82f1\u8a9e\u3067\u306e\u533b\u7642\u9762\u63a5\u306e\u5b66\u3073\u65b9\u3068\u305d\u306e\u30b3\u30c4\u3092\u307e\u3068\u3081\u3066\u304a\u4f1d\u3048\u3057\u305f\u3044\u3068\u601d\u3044\u307e\u3059\u3002<\/span>\r\n<\/p>\r\n\r\n

\r\nTip 1\uff1a\u300c\u578b\u300d\u3092\u899a\u3048\u308b<\/span><\/strong><\/span>
\r\n\u65e5\u672c\u306e\u300c\u533b\u7642\u9762\u63a5\u300d\u306b\u76f8\u5f53\u3059\u308b\u82f1\u8a9e\u306e\u8868\u73fe\u306f medical interview<\/strong> \u3068\u306a\u308a\u307e\u3059\u304c\u3001\u4ed6\u306b\u3082 patient encounter<\/strong><\/span> \u3084 history taking<\/span><\/strong><\/span> \u306a\u3069\u306e\u8868\u73fe\u3082\u3042\u308a\u307e\u3059\u3002USMLE Step 2 CS \u3067\u306f patient encounter \u3068\u3057\u3066\u4e0b\u8a18\u306e\u9805\u76ee\u309215\u5206\u9593<\/strong>\u3067\u884c\u3046\u3053\u3068\u304c\u6c42\u3081\u3089\u308c\u307e\u3059\u3002<\/span>\r\n<\/p>\r\n\r\n

\r\nPatient Encounter<\/span><\/strong>
\r\n\u2022 Introduction<\/span>
\r\n\u2022 History Taking<\/span>
\r\n\u2022 Summary<\/span>
\r\n\u2022 Physical Examination<\/span>
\r\n\u2022 Closure<\/span>\r\n<\/p>\r\n\r\n

\r\n\u3053\u3053\u3067\u304a\u308f\u304b\u308a\u3044\u305f\u3060\u3051\u308b\u3088\u3046\u306b\u3001patient encounter<\/span><\/strong><\/span> \u3068\u306f\u300c\u75c5\u6b74\u8074\u53d6<\/strong>\u300dhistory taking<\/strong><\/span> \u3068\u3001\u300c\u8eab\u4f53\u8a3a\u5bdf<\/strong>\u300dphysical examination<\/strong><\/span> \u306a\u3069\u3092\u542b\u3081\u305f\u60a3\u8005\u3055\u3093<\/strong>\uff08\u7279\u306b\u5916\u6765\u60a3\u8005\u3055\u3093<\/strong>\uff09\u3068\u306e\u30b3\u30df\u30e5\u30cb\u30b1\u30fc\u30b7\u30e7\u30f3\u5168\u4f53<\/strong>\u306e\u3053\u3068\u3092\u8868\u3057\u307e\u3059\u3002<\/span>
\r\n\u3053\u3053\u3067\u306f\u300c\u533b\u7642\u9762\u63a5\u300d\u3068\u3057\u3066\u4e0a\u8a18\u306e physical examination \u3092\u9664\u3044\u305f introduction, history taking, summary, and closure \u306e4\u3064\u3092\u6271\u3044\u305f\u3044\u3068\u601d\u3044\u307e\u3059\u3002<\/span>\r\n<\/p>\r\n\r\n

\u82f1\u8a9e\u3067\u306e\u533b\u7642\u9762\u63a5\u3092\u5b66\u3076\u4e0a\u3067\u5927\u5207\u306a\u3053\u3068\u306f\u3001\u307e\u305a\u3053\u308c\u3089\u306e\u57fa\u672c\u69cb\u9020\u3068\u305d\u308c\u305e\u308c\u306e\u8cea\u554f\u8868\u73fe\u3092\u300c\u578b<\/strong>\u300d\u3068\u3057\u3066\u899a\u3048\u308b\u3053\u3068\u3067\u3059\u3002\u3053\u306e\u4e2d\u3067\u3082\u7279\u306b history taking \u306f\u4e0b\u8a18\u306e\u57fa\u672c\u69cb\u9020\u3092\u6301\u3063\u3066\u3044\u307e\u3059\u306e\u3067\u3001\u307e\u305a\u306f\u3053\u308c\u3092\u3057\u3063\u304b\u308a\u3068\u899a\u3048\u307e\u3057\u3087\u3046\u3002<\/span><\/p>\r\n\r\n

\r\n\u2022 Chief Complaint (CC)<\/span>
\r\n\u2022 History of Present illness (HPI)<\/span>
\r\n\u2022 Past Medical History (PMHx)<\/span>
\r\n\u2022 Past Surgical History (PSHx)<\/span>
\r\n\u2022 Medications (DHx)<\/span>
\r\n\u2022 Allergies<\/span>
\r\n\u2022 Family History (FHx)<\/span>
\r\n\u2022 Social History (SHx)<\/span>
\r\n\u2022 Review of Systems (ROS)<\/span>\r\n<\/p>\r\n\r\n

\u3053\u308c\u3089\u306f\u7686\u3055\u3093\u304c\u65e5\u672c\u306eOSCE\u3067\u5b66\u3093\u3060\u3082\u306e\u3068\u5c11\u3057\u7570\u306a\u308b\u304b\u3082\u3057\u308c\u307e\u305b\u3093\u304c\u3001\u4e0a\u8a18\u304c\u82f1\u8a9e\u570f\u3067\u306e history taking \u306e\u57fa\u672c\u69cb\u9020\u3068\u306a\u308a\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u305d\u3057\u3066\u3053\u308c\u3089\u306e\u9805\u76ee\u306b\u95a2\u3057\u3066\u3001\u305d\u308c\u305e\u308c\u306e\u8cea\u554f\u8868\u73fe\u3092\u300c\u578b\u300d\u3068\u3057\u3066\u6697\u8a18\u3057\u307e\u3059\u3002\u3082\u3061\u308d\u3093\u8cea\u554f\u8868\u73fe\u306f\u300c\u4e3b\u8a34\u300d chief complaint \u306b\u3088\u3063\u3066\u5909\u308f\u308a\u307e\u3059\u304c\u3001\u300c\u75db\u307f\u300d\u304c\u4e3b\u8a34\u306e\u5834\u5408\u306b\u4f7f\u3046\u82f1\u8a9e\u3067\u306e\u8cea\u554f\u8868\u73fe\u3092\u3053\u3061\u3089<\/span><\/a>\u306b\u307e\u3068\u3081\u3066\u304a\u304d\u307e\u3057\u305f\u306e\u3067\u3001\u307e\u305a\u306f\u3053\u308c\u3089\u306e\u8cea\u554f\u8868\u73fe\u3092\u3057\u3063\u304b\u308a\u3068\u300c\u578b\u300d\u3068\u3057\u3066\u6697\u8a18\u3057\u307e\u3057\u3087\u3046\u3002<\/span><\/p>\r\n\r\n

\r\nTip 2\uff1a\u300c\u73fe\u75c5\u6b74\u300d\u3067\u306f\u300c\u4f1a\u8a71\u300d\u3092\u3059\u308b<\/span><\/strong><\/span>
\r\n\u82f1\u8a9e\u3067\u306e\u533b\u7642\u9762\u63a5\u3092\u5b66\u3076\u5834\u5408\u3001\u591a\u304f\u306e\u5b66\u751f\u3055\u3093\u304c\u4e0a\u8a18\u306e\u300c\u578b\u3092\u899a\u3048\u308b\u300d\u3060\u3051\u3067\u7d42\u308f\u3063\u3066\u3057\u307e\u3044\u307e\u3059\u3002\u3057\u304b\u3057\u3001\u305f\u3060\u6c7a\u307e\u3063\u305f\u8cea\u554f\u3092\u3059\u308b\u3060\u3051\u306a\u3089\u82f1\u8a9e\u306e\u554f\u8a3a\u7968\u3067\u5341\u5206<\/strong>\u3067\u3059\u3002\u533b\u7642\u9762\u63a5\u306e\u6700\u5927\u306e\u76ee\u7684\u306f\u300c\u60a3\u8005\u3055\u3093\u3068\u30e9\u30dd\u30fc\u30eb<\/strong>\uff08\u77ed\u6642\u9593\u3067\u7bc9\u304f\u4fe1\u983c\u95a2\u4fc2<\/strong>\uff09\u3092\u5f62\u6210\u3059\u308b\u3053\u3068<\/strong>\u300d building a rapport with your patient<\/strong> \u3067\u3059\u3002\u305d\u306e\u305f\u3081\u306b\u306f\u60a3\u8005\u3055\u3093\u3068\u300c\u4f1a\u8a71\u300d\u3092\u3059\u308b\u3053\u3068\u304c\u91cd\u8981\u3067\u3059\u3002<\/span>\r\n<\/p>\r\n\r\n

\u3053\u306e\u300c\u4f1a\u8a71\u300d\u3092\u3059\u308b\u9805\u76ee\u3068\u3057\u3066\u6700\u3082\u91cd\u8981\u306a\u306e\u304c\u3001\u300c\u73fe\u75c5\u6b74<\/strong>\u300d history of present illness<\/strong> (HPI<\/strong>) <\/span>\u3067\u3059\u3002\u60a3\u8005\u3055\u3093\u306f\u300c\u4e3b\u8a34<\/strong>\u300d chief complaint<\/strong> (CC<\/strong>) \u304c\u539f\u56e0\u3067\u53d7\u8a3a\u3057\u3066\u3044\u308b\u308f\u3051\u3067\u3059\u304c\u3001\u305d\u306e CC \u3092\u8a73\u7d30\u306b\u5c0b\u306d\u3066\u3044\u304f\u306e\u304c HPI \u3067\u3059\u3002\u3067\u3059\u304b\u3089\u3053\u306e HPI \u304c\u60a3\u8005\u3055\u3093\u3068\u306e\u300c\u4f1a\u8a71\u300d\u306b\u304a\u3044\u3066\u6700\u3082\u91cd\u8981\u306b\u306a\u308b\u306e\u3067\u3059\u3002<\/span><\/p>\r\n\r\n

\u3053\u306e HPI \u306e\u5c0b\u306d\u65b9\u306b\u95a2\u3057\u3066\u306f\u3053\u3061\u3089<\/span><\/span><\/a>\u306b\u8a73\u3057\u304f\u307e\u3068\u3081\u3066\u3042\u308b\u306e\u3067\u8a73\u7d30\u306f\u7701\u304d\u307e\u3059\u304c\u3001\u57fa\u672c\u7684\u306b\u306f\u4ee5\u4e0b\u306e3\u3064\u306e\u30b9\u30c6\u30c3\u30d7\u3067\u30a2\u30d7\u30ed\u30fc\u30c1\u3057\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\r\n1. Open-ended questions<\/strong><\/span>: \u958b\u653e\u578b\u8cea\u554f\u3092\u4f7f\u3044\u300c\u767a\u75c7\u300d\u300c\u767a\u75c7\u524d\u300d\u300c\u767a\u75c7\u5f8c\u300d\u306e\u69d8\u5b50\u3092\u8a73\u7d30\u306b\u8a9e\u3063\u3066\u3082\u3089\u3046\u3002\u72b6\u6cc1\u306b\u5408\u308f\u305b\u3066\u8cea\u554f\u3092\u52a0\u3048\u3001\u9069\u5b9c\u8a71\u3092\u8981\u7d04\u3059\u308b\u3002<\/span>
\r\n2. Closed-ended questions<\/strong><\/span>: \u201cpain\u2019s OPQRST\u201d \u3084 \u201cSOCRATES\u201d \u306a\u3069\u3092\u30c1\u30a7\u30c3\u30af\u30ea\u30b9\u30c8\u3068\u3057\u3066\u4f7f\u3044\u3001 \u805e\u304d\u6f0f\u3089\u3057\u304c\u306a\u3044\u304b\u78ba\u8a8d\u3059\u308b\u3002<\/span>
\r\n3. Associated symptoms<\/strong><\/span>: \u9451\u5225\u75be\u60a3\u306b\u4f34\u3046\u95a2\u9023\u75c7\u72b6\u306e\u6709\u7121\u3092\u5c0b\u306d\u308b\u3002<\/span>\r\n<\/p>\r\n\r\n

\u6700\u521d\u306e\u6bb5\u968e\u3067\u306f\u3001\u300c\u60a3\u8005\u306e\u8a71\u306b\u5bfe\u5fdc\u3059\u308b<\/strong>\u300d responding to the patient\u2019s remarks<\/strong> \u3068\u3044\u3046\u3053\u3068\u304c\u4f55\u3088\u308a\u3082\u91cd\u8981\u306b\u306a\u308a\u307e\u3059\u3002\u81ea\u5206\u304c\u7528\u610f\u3057\u305f\u300c\u958b\u653e\u578b\u8cea\u554f\u300d\u3092\u7acb\u3066\u7d9a\u3051\u306b\u6d74\u3073\u305b\u308b\u306e\u3067\u306f\u306a\u304f\u3001\u60a3\u8005\u3055\u3093\u306e\u8a71\u306b\u6cbf\u3063\u3066\u81ea\u7136\u306a\u300c\u4f1a\u8a71\u300d\u3092\u3059\u308b\u3053\u3068\u304c\u5927\u5207\u306a\u306e\u3067\u3059\u3002\u5fc5\u8981\u306a\u3089\u3070 \u201cYou said the stomachache started after you had a breakfast. What did you have for the breakfast?\u201d \u3084 \u201cYou said you have been stressed out at work. Could you tell me more about your work?\u201d \u306e\u3088\u3046\u306b\u8cea\u554f\u3092\u91cd\u306d\u3066\u3044\u304f\u3053\u3068\u304c\u91cd\u8981\u3067\u3059\u3002\u305d\u3057\u3066\u3053\u306e\u4f1a\u8a71\u306e\u6700\u4e2d\u306b\u60a3\u8005\u3055\u3093\u306e\u8a71\u3092\u9069\u5b9c\u300c\u307e\u3068\u3081\u308b\u300dsummarize \u3053\u3068\u3092\u3057\u3066\u307f\u307e\u3057\u3087\u3046\u3002\u305d\u3046\u3059\u308b\u3053\u3068\u3067\u81ea\u5206\u304c\u4f55\u3092\u805e\u304d\u5fd8\u308c\u3066\u3044\u308b\u304b\u3001\u81ea\u7136\u306b\u601d\u3044\u3064\u304f\u3088\u3046\u306b\u306a\u308a\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u6b21\u306b\u73fe\u75c5\u6b74\u3092\u5c0b\u306d\u308b\u969b\u306b\u3088\u304f\u4f7f\u308f\u308c\u3066\u3044\u308b \u201cpain\u2019s OPQRST<\/strong>\u201d \u3084 \u201cSOCRATES<\/strong>\u201d \u306a\u3069\u3092\u30c1\u30a7\u30c3\u30af\u30ea\u30b9\u30c8\u3068\u3057\u3066\u4f7f\u3044\u3001\u805e\u304d\u6f0f\u3089\u3057\u304c\u306a\u3044\u304b\u3069\u3046\u304b\u3092\u78ba\u8a8d\u3057\u307e\u3059\u3002\u3053\u308c\u3089\u3092\u3044\u304d\u306a\u308a\u6a5f\u68b0\u7684\u306b\u5c0b\u306d\u3066\u3044\u304f\u3068\u3001\u60a3\u8005\u3055\u3093\u3068\u30e9\u30dd\u30fc\u30eb\u3092\u5f62\u6210\u3059\u308b\u3053\u3068\u304c\u96e3\u3057\u304f\u306a\u308b\u3070\u304b\u308a\u304b\u3001\u8a3a\u65ad\u306b\u5fc5\u8981\u306a\u5341\u5206\u306a\u60c5\u5831\u3092\u5f97\u308b\u3053\u3068\u3082\u3067\u304d\u306a\u304f\u306a\u308a\u307e\u3059\u3002\u3067\u3059\u304b\u3089\u3053\u308c\u3089\u306e\u8cea\u554f\u9805\u76ee\u306f\u3001\u300c\u767a\u75c7\u300d\u300c\u767a\u75c7\u524d\u300d\u300c\u767a\u75c7\u5f8c\u300d\u306b\u3064\u3044\u3066\u60a3\u8005\u3055\u3093\u81ea\u8eab\u304c\u5341\u5206\u306b\u8a9e\u308a\u3001\u3055\u3089\u306b\u7686\u3055\u3093\u81ea\u8eab\u304c\u8981\u7d04\u3057\u305f\u5f8c\u306b\u3001\u805e\u304d\u6f0f\u3089\u3057\u304c\u306a\u3044\u3088\u3046\u306b\u78ba\u8a8d\u3059\u308b\u30c1\u30a7\u30c3\u30af\u30ea\u30b9\u30c8\u3068\u3057\u3066\u4f7f\u3046\u3088\u3046\u306b\u3057\u3066\u304f\u3060\u3055\u3044\u3002<\/span><\/p>\r\n\r\n

\u73fe\u75c5\u6b74\u306e\u6700\u5f8c\u306f\u9451\u5225\u75be\u60a3\u306b\u4f34\u3046\u95a2\u9023\u75c7\u72b6\u306e\u6709\u7121\u3092\u5c0b\u306d\u307e\u3059\u3002\u3053\u306e\u95a2\u9023\u75c7\u72b6\u306b\u95a2\u3059\u308b\u8cea\u554f\u3092 review of systems (ROS) \u3068\u6df7\u540c\u3055\u308c\u308b\u65b9\u3082\u3044\u307e\u3059\u304c\u3001\u3053\u3053\u3067\u306f\u4e3b\u8a34\u304b\u3089\u8003\u3048\u3089\u308c\u308b\u9451\u5225\u75be\u60a3 differential diagnosis \u306b\u95a2\u9023\u3059\u308b\u75c7\u72b6\u306e\u6709\u7121\u3092\u5c0b\u306d\u3066\u3044\u304d\u307e\u3059\u3002\u5177\u4f53\u7684\u306b\u306f\u4e0b\u8a18\u306e6\u3064\u306e\u30d1\u30bf\u30fc\u30f3\u3092\u4f7f\u3048\u3070\u3001\u3069\u3093\u306a\u75c7\u72b6\u306b\u3064\u3044\u3066\u3082\u5c0b\u306d\u308b\u3053\u3068\u304c\u3067\u304d\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\r\n\u2022 Do you have (symptom: noun)?<\/span>
\r\n\u2022 Do you feel (symptom: adjective)?<\/span>
\r\n\u2022 Have you noticed any change in<\/strong> (habit<\/strong>)?<\/span>
\r\n\u2022 Has anyone you know noticed any change in (appearance)?<\/span>
\r\n\u2022 Have you been (verb)ing more than usual?<\/span>
\r\n\u2022 Sometimes patients with<\/strong> (chief complaint<\/strong>) have<\/strong> (symptom: noun<\/strong>). Has this happened to you?<\/strong><\/span>\r\n<\/p>\r\n\r\n

\u7279\u306b \u201cHave you noticed any change in<\/strong> (habit<\/strong>)?\u201d \u306f\u958b\u653e\u578b\u8cea\u554f\u3068\u306a\u308a\u3001\u60a3\u8005\u3055\u3093\u306b\u3068\u3063\u3066\u3082\u56de\u7b54\u306b\u304a\u3044\u3066\u81ea\u7531\u5ea6\u304c\u9ad8\u3044\u8cea\u554f\u8868\u73fe\u3068\u8a00\u3048\u307e\u3059\u3002\u307e\u305f\u300c\u52c3\u8d77\u4e0d\u5168\u300d erectile dysfunction \u3068\u3044\u3063\u305f\u5c0b\u306d\u306b\u304f\u3044\u3088\u3046\u306a\u75c7\u72b6\u306a\u3069\u3082\u3001 \u201cSometimes patients with high blood pressure have erectile dysfunction. Has this happened to you?<\/strong>\u201d \u306e\u3088\u3046\u306b\u9593\u63a5\u7684\u306b\u5c0b\u306d\u308b\u3068\u3001\u60a3\u8005\u3055\u3093\u306f\u56de\u7b54\u3057\u3084\u3059\u3044\u3068\u611f\u3058\u307e\u3059\u3002\u4e0a\u8a18\u306e6\u3064\u306e\u8cea\u554f\u8868\u73fe\u3092\u7d44\u307f\u5408\u308f\u305b\u3066\u3001\u81ea\u5206\u304c\u5c0b\u306d\u305f\u3044\u95a2\u9023\u75c7\u72b6\u306e\u6709\u7121\u3092\u5c0b\u306d\u3066\u307f\u308b\u3068\u826f\u3044\u3067\u3057\u3087\u3046\u3002<\/span><\/p>\r\n\r\n

\u3053\u306e\u3088\u3046\u306b history taking \u306b\u304a\u3044\u3066 HPI \u306f\u6975\u3081\u3066\u91cd\u8981\u306a\u90e8\u5206\u3067\u3059\u3002USMLE Step 2 CS \u3067\u306f physical examination \u3092\u9664\u3044\u305f patient encounter \u306b\u304a\u3088\u305d12\u5206\u9593\u3092\u4f7f\u3046\u3053\u3068\u304c\u3067\u304d\u307e\u3059\u3002\u3067\u3059\u304b\u3089\u3001\u82f1\u8a9e\u3067\u306e\u533b\u7642\u9762\u63a5\u3082\u57fa\u672c\u7684\u306b12\u5206\u9593\u3067\u7df4\u7fd2\u3059\u308b<\/strong><\/span>\u3053\u3068\u3092\u304a\u52e7\u3081\u3057\u307e\u3059\u304c\u3001\u305d\u306e\u969b\u306b\u306f12\u5206\u9593\u306e\u534a\u5206\u3067\u3042\u308b6\u5206\u9593\u3092\u3053\u306e HPI \u306b\u4f7f\u3046<\/strong><\/span>\u3053\u3068\u304c\u76ee\u5b89\u3068\u306a\u308a\u307e\u3059\u3002\u3082\u3057\u3053\u308c\u304b\u3089\u82f1\u8a9e\u3067\u306e\u533b\u7642\u9762\u63a5\u3092\u672c\u683c\u7684\u306b\u7df4\u7fd2\u3057\u305f\u3044\u3068\u8003\u3048\u3066\u3044\u308b\u65b9\u304c\u3044\u3089\u3063\u3057\u3083\u3044\u307e\u3057\u305f\u3089\u3001\u3069\u3093\u306a\u75c7\u72b6\u3067\u3082\u4e0a\u8a18\u306e3\u3064\u306e\u30b9\u30c6\u30c3\u30d7\u30926\u5206\u9593\u3067\u884c\u3048\u308b\u3088\u3046\u306b\u7df4\u7fd2<\/strong>\u3057\u3066\u307f\u3066\u304f\u3060\u3055\u3044\u3002<\/span><\/p>\r\n\r\n

\r\nTip 3\uff1a \u533b\u7642\u9762\u63a5\u306e\u5f8c\u534a\u306f\u5c0b\u554f\u5f62\u5f0f\u306b\u306a\u3089\u306a\u3044\u3088\u3046\u306b\u6c17\u3092\u3064\u3051\u308b<\/span><\/strong><\/span>
\r\n\u533b\u7642\u9762\u63a5\u3067\u6700\u3082\u91cd\u8981\u3068\u306a\u308b HPI \u306b\u3064\u3044\u3066\u5c0b\u306d\u7d42\u3048\u305f\u3089\u3001\u6b21\u306f past medical history \u304b\u3089 review of systems \u307e\u3067\u3092\u5c0b\u306d\u3066\u3044\u304d\u307e\u3059\u3002\u3053\u3053\u3067\u306f\u60a3\u8005\u3055\u3093\u306e\u4e3b\u8a34\u306b\u95a2\u308f\u3089\u305a\u3001\u3069\u3093\u306a\u4e3b\u8a34\u306b\u3082\u540c\u3058\u3088\u3046\u306a\u8cea\u554f\u3092\u3057\u3066\u3044\u304f\u3053\u3068\u304c\u6c42\u3081\u3089\u308c\u307e\u3059\u3002\u3067\u3059\u304b\u3089\u3001\u3053\u306e\u90e8\u5206\u3067\u306f\u6a5f\u68b0\u7684\u306a\u5c0b\u554f\u5f62\u5f0f\u306b\u306a\u3089\u306a\u3044\u3088\u3046\u306b\u7279\u306b\u6ce8\u610f\u3092\u3059\u308b\u3053\u3068\u304c\u5927\u5207\u3067\u3059\u3002<\/span>\r\n<\/p>\r\n\r\n

\u5177\u4f53\u7684\u306b\u306f\u60a3\u8005\u3055\u3093\u306e\u56de\u7b54\u306b\u5408\u308f\u305b\u3066\u8cea\u554f\u3092\u91cd\u306d\u305f\u308a\u3001\u8cea\u554f\u9805\u76ee\u306e\u9806\u756a\u3092\u5909\u3048\u308b\u3053\u3068\u304c\u6c42\u3081\u3089\u308c\u307e\u3059\u3002\u4f8b\u3048\u3070 past medical history \u3092\u5c0b\u306d\u3066\u3044\u3066\u60a3\u8005\u3055\u3093\u304c\u5185\u670d\u85ac\u306e\u8a71\u3092\u59cb\u3081\u305f\u3089\u3001\u305d\u3053\u3067 medications \u3084 allergies\u306e\u8cea\u554f\u3092\u91cd\u306d\u305f\u308a\u3001\u540c\u3058\u3088\u3046\u306a\u75c5\u6c17\u3092\u6301\u3063\u3066\u3044\u308b\u4eba\u304c\u5bb6\u65cf\u306b\u3044\u308b\u304b\u3069\u3046\u304b\u3092\u78ba\u8a8d\u3059\u308b\u305f\u3081\u306b\u3001 family history \u306e\u8cea\u554f\u3092\u3057\u307e\u3059\u3002\u3082\u3061\u308d\u3093\u3053\u308c\u3092\u3084\u308a\u904e\u304e\u308b\u3068\u3001\u4f55\u3092\u5c0b\u306d\u3066\u4f55\u3092\u5c0b\u306d\u3066\u3044\u306a\u3044\u306e\u304b\u3001\u308f\u304b\u3089\u306a\u304f\u306a\u3063\u3066\u3057\u307e\u3046\u5371\u967a\u6027\u3082\u3042\u308a\u307e\u3059\u304c\u3001\u60a3\u8005\u3055\u3093\u306e\u56de\u7b54\u306b\u5408\u308f\u305b\u3066\u81e8\u6a5f\u5fdc\u5909\u306b\u8a71\u984c\u3092\u5909\u3048\u308b\u3053\u3068\u3067\u3001\u3042\u308a\u304c\u3061\u306a\u5c0b\u554f\u5f62\u5f0f\u306e\u533b\u7642\u9762\u63a5\u3092\u56de\u907f\u3059\u308b\u3053\u3068\u304c\u3067\u304d\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u305d\u3046\u306f\u8a00\u3063\u3066\u3082 history taking \u306e\u6700\u5f8c\u306b\u5c0b\u306d\u308b review of systems<\/strong> (ROS<\/strong>) <\/span>\u3067\u306f\u305f\u304f\u3055\u3093\u306e\u8cea\u554f\u3092\u3059\u308b\u5fc5\u8981\u304c\u3042\u308a\u3001\u3069\u3046\u3057\u3066\u3082\u5c0b\u554f\u5f62\u5f0f\u306b\u306a\u308a\u304c\u3061\u3067\u3059\u3002\u305d\u3053\u3067\u3053\u306e ROS \u306e\u5c0b\u306d\u65b9\u306b\u95a2\u3057\u3066\u306f\u5c11\u3057\u4e01\u5be7\u306b\u89e3\u8aac\u3057\u305f\u3044\u3068\u601d\u3044\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u65e5\u672c\u8a9e\u3067\u306f\u300c\u30b7\u30b9\u30c6\u30e0\u30ec\u30d3\u30e5\u30fc<\/strong>\u300d\u3068\u3044\u3046\u8868\u73fe\u304c\u4e00\u822c\u7684\u3067\u306f\u3042\u308a\u307e\u3059\u304c\u3001\u82f1\u8a9e\u3067\u306f\u8a9e\u9806\u304c\u5909\u308f\u3063\u3066\u4e00\u822c\u7684\u306b review of systems<\/strong> (ROS<\/strong>) \u3068\u547c\u3070\u308c\u3066\u3044\u307e\u3059\u3002\u3053\u308c\u306f\u305d\u306e\u540d\u306e\u901a\u308a\u3001\u300c\u81d3\u5668\u7cfb\u7d71\u300d\u3067\u3042\u308b body systems \u3092\u300c\u632f\u308a\u8fd4\u308b\u300dreview \u3053\u3068\u3067\u3001\u60a3\u8005\u306e\u533b\u7642\u60c5\u5831\u3092\u5305\u62ec\u7684\u306b\u7406\u89e3\u3059\u308b\u8cea\u554f\u3067\u3059\u3002\u3053\u3053\u3067\u306f body systems \u3092\u5168\u3066\u5305\u62ec\u7684\u306b\u5c0b\u306d\u3066\u3044\u304f\u308f\u3051\u3067\u3059\u304b\u3089\u5f53\u7136\u6642\u9593\u3082\u304b\u304b\u308a\u3001\u5fd9\u3057\u3044\u65e5\u672c\u306e\u5916\u6765\u8a3a\u7642\u3067\u306f\u3042\u307e\u308a\u5c0b\u306d\u3089\u308c\u308b\u3053\u3068\u306f\u3042\u308a\u307e\u305b\u3093\u3002\u3057\u304b\u3057\u82f1\u8a9e\u570f\u306e history taking \u3067\u306f\u5fc5\u305a\u5c0b\u306d\u308b\u3053\u3068\u304c\u6c42\u3081\u3089\u308c\u3066\u3044\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u82f1\u8a9e\u306e\u533b\u7642\u9762\u63a5\u3067\u306f\u3001\u8a71\u984c\u3092\u5909\u3048\u308b\u969b\u306b transition<\/strong><\/span> \u3068\u547c\u3070\u308c\u308b\u4e00\u8a00\u3092\u4f1d\u3048\u307e\u3059\u3002\u3053\u308c\u306f\u300c\u3053\u308c\u304b\u3089\u301c\u3092\u5c0b\u306d\u307e\u3059\u300d\u3068\u3044\u3046\u3053\u3068\u3092\u4f1d\u3048\u308b\u8868\u73fe\u3067\u3001\u300c\u793e\u4f1a\u6b74\u300d social history \u3092\u5c0b\u306d\u308b\u969b\u306e transition \u3068\u3057\u3066\u306f \u201cNow I would like to ask about your lifestyle<\/strong><\/span>.\u201d \u306e\u3088\u3046\u306b\u4f1d\u3048\u307e\u3059\u3002ROS\u306e\u969b\u306b\u306f \u201cIn order to make sure we\u2019ve not missed anything, I\u2019d like to ask more broadly about your health<\/span>.<\/strong>\u201d \u306e\u3088\u3046\u306a\u8868\u73fe\u3092\u4f7f\u3044\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u5b9f\u969b\u306bROS\u3092\u5305\u62ec\u7684\u306b\u5c0b\u306d\u3088\u3046\u3068\u3057\u3066\u3082\u3001\u4f55\u3089\u304b\u306e\u52b9\u7387\u7684\u306a\u300c\u30b7\u30b9\u30c6\u30e0\u300d\u304c\u306a\u3044\u3068\u77ed\u3044\u6642\u9593\u3067\u5c0b\u306d\u308b\u306e\u306f\u96e3\u3057\u3044\u3068\u601d\u3044\u307e\u3059\u3002\u305d\u3053\u3067\u6700\u521d\u306b\u5c0b\u306d\u308bROS\u306e\u8cea\u554f\u9805\u76ee\u3068\u3057\u3066\u3001\u300c\u5168\u8eab\u75c7\u72b6<\/strong>\u300d\u300c\u7cbe\u795e\u75c7\u72b6<\/strong>\u300d\u300c\u982d\u9838\u90e8<\/strong>\u300d\u3092\u304a\u52e7\u3081\u3057\u307e\u3059\u3002\u300c\u5168\u8eab\u75c7\u72b6<\/strong>\u300d\u306f\u82f1\u8a9e\u3067\u306f general symptoms<\/strong><\/span> \u3084 systemic symptoms<\/strong><\/span> \u306e\u4ed6\u3001constitutional symptoms<\/strong><\/span> \u3068\u3082\u547c\u3070\u308c\u307e\u3059\u3002\u3053\u3053\u3067\u306f \u201cHave you noticed any change in your appetite<\/strong>\/weight<\/strong>\/sleeping?<\/strong><\/span>\u201d \u306e\u3088\u3046\u306b \u201cHave you noticed any change in your\u2026?<\/strong><\/span>\u201d \u3068\u3044\u3046\u958b\u653e\u578b\u8cea\u554f\u306e\u8868\u73fe\u304c\u5f79\u306b\u7acb\u3061\u307e\u3059\u3002\u300c\u7cbe\u795e\u75c7\u72b6<\/strong>\u300d mental symptoms<\/strong><\/span> \u3067\u306f\u3001\u30b9\u30af\u30ea\u30fc\u30cb\u30f3\u30b0\u3068\u3057\u3066\u300c\u6c17\u5206\u969c\u5bb3\u300d mood disorders \u306b\u95a2\u3059\u308b\u958b\u653e\u578b\u8cea\u554f\u306e \u201cHave you noticed any change in your mood?<\/strong><\/span>\u201d \u304c\u4fbf\u5229\u3067\u3059\u3002\u305d\u3057\u3066\u300c\u982d\u9838\u90e8<\/strong>\u300d\u3067\u3059\u304c\u3001\u3053\u308c\u306f\u82f1\u8a9e\u3067\u306f H<\/strong><\/span>ead, E<\/strong><\/span>yes, E<\/strong><\/span>ars, N<\/strong><\/span>ose, and T<\/strong><\/span>hroat \u306e\u982d\u6587\u5b57\u3092\u53d6\u3063\u305f HEENT<\/strong><\/span> \u3068\u547c\u3070\u308c\u3066\u3044\u307e\u3059\u3002\u767a\u97f3\u306f\u30a2\u30eb\u30d5\u30a1\u30d9\u30c3\u30c8\u3092\u305d\u306e\u307e\u307e\u4f7f\u3063\u3066\u300c\u30a8\u30a4\u30c1\u30fb\u30a4\u30fc\u30fb\u30a4\u30fc\u30fb\u30a8\u30cc\u30fb\u30c6\u30a3\u30fc\u300d\u306e\u3088\u3046\u306b\u306a\u308a\u307e\u3059\u3002\u3053\u3053\u3067\u306f \u201cDo you have any symptoms in your head<\/strong>\/eyes<\/strong>\/ears<\/strong>\/nose<\/strong>\/throat<\/strong>?<\/span>\u201d \u306e\u3088\u3046\u306b\u3001 \u201cDo you have any symptoms in your\u2026?<\/strong><\/span>\u201d \u3068\u3044\u3046\u958b\u653e\u578b\u8cea\u554f\u8868\u73fe\u304c\u6642\u9593\u77ed\u7e2e\u306b\u304a\u3044\u3066\u3082\u5f79\u306b\u7acb\u3061\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\r\n\u6b21\u306b\u5404 body systems \u3092\u52b9\u7387\u7684\u306b\u5c0b\u306d\u3066\u3044\u304d\u307e\u3059\u3002\u3068\u306f\u8a00\u3048body systems \u3092\u77ed\u3044\u6642\u9593\u306b\u5168\u3066\u601d\u3044\u51fa\u3059\u306e\u306f\u96e3\u3057\u3044\u306e\u3067\u3001\u899a\u3048\u3084\u3059\u3044\u300c\u8a9e\u5442<\/strong>\u300dmnemonics<\/strong> \u304c\u3042\u308b\u3068\u4fbf\u5229\u3067\u3059\u3002\u305d\u3053\u3067\u304a\u52e7\u3081\u3059\u308b\u306e\u304c \u201cMR DICE RUNS<\/strong><\/span>\u201d \u300c\u30b5\u30a4\u30b3\u30ed\u3055\u3093\u304c\u8d70\u308b<\/strong>\u300d\u3068\u3044\u3046\u3082\u306e\u3067\u3059\u3002<\/span>
\r\n\u3053\u308c\u306f M<\/strong><\/span>uscular system, R<\/strong><\/span>espiratory system, D<\/strong><\/span>igestive system, I<\/strong><\/span>ntegumentary system, C<\/strong><\/span>irculatory system, E<\/strong><\/span>ndocrine system, R<\/strong><\/span>eproductive system, U<\/strong><\/span>rinary system, N<\/strong><\/span>ervous system, and S<\/strong><\/span>keletal system \u306e\u982d\u6587\u5b57\u3092\u53d6\u3063\u305f\u3082\u306e\u3067\u3059\u3002\u3053\u306e\u4e2d\u3067\u3082Integumentary system \u306f\u898b\u6163\u308c\u306a\u3044\u65b9\u3082\u591a\u3044\u3068\u601d\u3044\u307e\u3059\u304c\u3001\u3053\u308c\u306f\u300c\u5916\u76ae\u7cfb<\/strong>\u300d\u3001\u3064\u307e\u308askin & hair \u306b\u95a2\u3059\u308b\u81d3\u5668\u7cfb\u7d71\u3092\u8868\u3057\u307e\u3059\u3002<\/span>
\r\n\u5b9f\u969b\u306b ROS \u3092\u5c0b\u306d\u3066\u3044\u304f\u969b\u306b\u306f\u3001\u3053\u306e \u201cMR DICE RUNS<\/strong>\u201d \u3092\u4f7f\u3063\u3066\u52b9\u7387\u826f\u304f\u8cea\u554f\u3092\u91cd\u306d\u3066\u3044\u304d\u307e\u3059\u3002\u305d\u3057\u3066\u3053\u308c\u3089\u306b\u3064\u3044\u3066\u5c0b\u306d\u3066\u3044\u304f\u969b\u306b\u306f \u3001\u201cDo you have diarrhea?\u201d \u306e\u3088\u3046\u306a\u9589\u9396\u578b\u8cea\u554f\u3092\u4f7f\u3046\u306e\u3067\u306f\u306a\u304f\u3001 \u201cHave you noticed any change in your\u2026?\u201d \u3084 \u201cDo you have any symptoms in your\u2026?\u201d \u3068\u3044\u3063\u305f\u958b\u653e\u578b\u8cea\u554f\u8868\u73fe\u3092\u4f7f\u3063\u3066\u3044\u304d\u307e\u3059\u3002\u3082\u3057\u305d\u3053\u3067\u60a3\u8005\u3055\u3093\u304c\u4f55\u3089\u304b\u306e\u75c7\u72b6\u3092\u8a8d\u3081\u305f\u306a\u3089\u3070\u3001\u305d\u3053\u304b\u3089\u5177\u4f53\u7684\u306a\u8cea\u554f\u3092\u91cd\u306d\u3066\u3044\u304d\u307e\u3059\u3002\u305d\u3046\u3059\u308b\u3053\u3068\u3067\u305f\u304f\u3055\u3093\u306e\u8cea\u554f\u304c\u5fc5\u8981\u306a ROS \u3067\u3082\u5c0b\u554f\u5f62\u5f0f\u3068\u306a\u308b\u3053\u3068\u3092\u907f\u3051\u308b\u3053\u3068\u304c\u3067\u304d\u307e\u3059\u3002<\/span>\r\n<\/p>\r\n\r\n

\u3053\u306e\u3088\u3046\u306b\u3001 transition, constitutional symptoms, mental symptoms, HEENT, and \u201cMR DICE RUN\u201d \u3068\u3044\u3046\u300c\u30b7\u30b9\u30c6\u30e0\u300d\u304c\u3042\u308b\u3060\u3051\u3067\u3082\u3001\u82f1\u8a9e\u3067 ROS \u3092\u5305\u62ec\u7684\u306b\u5c0b\u306d\u308b\u3053\u3068\u306f\u53ef\u80fd\u3067\u3059\u3002\u307e\u305f\u3069\u3046\u3057\u3066\u3082\u6642\u9593\u304c\u306a\u3044\u5834\u5408\u306b\u306f\u3001\u3053\u306e\u4e2d\u3067\u3082\u7279\u306b bowel movements, urinary habit, and menstruation \u3060\u3051\u3067\u3082\u805e\u304d\u9003\u3059\u3053\u3068\u304c\u306a\u3044\u3088\u3046\u306b\u5fc3\u304c\u3051\u307e\u3057\u3087\u3046\u3002<\/span><\/p>\r\n\r\n

\r\nTip 4\uff1a\u6700\u5f8c\u306b\u5fc5\u305a \u201cICE\u201d \u306e\u8cea\u554f\u3092\u3059\u308b<\/span><\/strong><\/span>
\r\nROS\u304c\u7d42\u308f\u308c\u3070\u60a3\u8005\u3055\u3093\u306b\u8cea\u554f\u304c\u306a\u3044\u304b\u3069\u3046\u304b\u3001\u305d\u3057\u3066\u81ea\u5206\u304c\u8a00\u3063\u305f\u3053\u3068\u304c\u4f1d\u308f\u3063\u305f\u304b\u3069\u3046\u304b\u3092\u78ba\u8a8d\u3057\u307e\u3059\u3002(\u201cDo you have any questions? Is there anything I said which you did not understand?\u201d)<\/span>
\r\n\u305d\u3057\u3066\u60a3\u8005\u3055\u3093\u306e\u8a71\u3092\u8981\u7d04\u3059\u308b\u306e\u3067\u3059\u304c\u3001\u8981\u7d04\u304c\u7d42\u308f\u3063\u305f\u5f8c\u306b\u3082\u305d\u308c\u304c\u6b63\u3057\u3044\u304b\u3069\u3046\u304b\u3001\u305d\u3057\u3066\u4ed6\u306b\u4ed8\u3051\u52a0\u3048\u308b\u3053\u3068\u304c\u306a\u3044\u304b\u3069\u3046\u304b\u3082\u78ba\u8a8d\u3057\u307e\u3059\u3002(\u201cIs that correct? Is there anything else you want to add?\u201d)<\/span>\r\n<\/p>\r\n\r\n

\u307e\u305f\u3001\u3053\u3053\u3067\u533b\u7642\u9762\u63a5\u3092\u7d42\u308f\u3089\u305b\u305a\u306b\u3001\u662f\u975e\u4e0b\u8a18\u306b\u3042\u308b \u201cICE<\/strong><\/span>\u201d \u306e\u8cea\u554f\u3092\u3059\u308b\u3088\u3046\u306b\u3057\u3066\u304f\u3060\u3055\u3044\u3002<\/span><\/p>\r\n\r\n

\r\n\u2022\u00a0I<\/strong>deas<\/span>\uff08\u60a3\u8005\u3055\u3093\u304c\u4e3b\u8a34\u306b\u3064\u3044\u3066\u3069\u3046\u8003\u3048\u3066\u3044\u308b\u304b\uff09<\/span>
\r\n\u201cDo you have any ideas<\/strong><\/span> about it yourself?\u201d<\/span>
\r\n\u2022\u00a0C<\/strong>oncerns<\/span>\uff08\u60a3\u8005\u3055\u3093\u304c\u4e3b\u8a34\u306b\u3064\u3044\u3066\u3069\u306e\u3088\u3046\u306a\u5fc3\u914d\u4e8b\u3092\u6301\u3063\u3066\u3044\u308b\u304b\uff09<\/span>
\r\n\u201cIs there anything particular that you are concerned<\/strong><\/span> about?\u201d<\/span>
\r\n\u2022\u00a0E<\/strong>xpectations<\/span>\uff08\u60a3\u8005\u3055\u3093\u304c\u533b\u5e2b\u3084\u75c5\u9662\u306b\u3069\u306e\u3088\u3046\u306a\u3053\u3068\u3092\u671f\u5f85\u3057\u3066\u3044\u308b\u304b\uff09<\/span>
\r\n\u201cWhat are your expectations<\/strong><\/span> about this visit today?\u201d<\/span>\r\n<\/p>\r\n\r\n

\u3053\u308c\u3089\u306f\u60a3\u8005\u3055\u3093\u306e\u300c\u89e3\u91c8\u30e2\u30c7\u30eb\u300d\u3092\u5c0b\u306d\u308b\u305f\u3081\u306b\u3068\u3066\u3082\u6709\u52b9\u306a\u8cea\u554f\u3067\u3059\u3002\u533b\u7642\u9762\u63a5\u306e\u6700\u5f8c\u306b\u306f\u5fc5\u305a\u3053\u306e \u201cICE\u201d \u306e\u8cea\u554f\u3092\u3057\u3066\u3001\u60a3\u8005\u3055\u3093\u304c\u3069\u306e\u3088\u3046\u306b\u89e3\u91c8\u3057\u3066\u3044\u308b\u306e\u304b\u3092\u78ba\u8a8d\u3059\u308b\u3088\u3046\u306b\u3057\u3066\u304f\u3060\u3055\u3044\u3002<\/span><\/p>\r\n\r\n

\r\nTip 5\uff1a\u60a3\u8005\u5f79\u306e\u7df4\u7fd2\u3092\u3059\u308b<\/span><\/strong><\/span>
\r\n\u4e0a\u8a18\u306e4\u3064\u304c\u82f1\u8a9e\u3067\u306e\u533b\u7642\u9762\u63a5\u306b\u304a\u3044\u3066\u5927\u5207\u306a\u7559\u610f\u70b9\u3067\u3059\u3002\u5f8c\u306f\u69d8\u3005\u306a\u75c7\u72b6\u306b\u5bfe\u3057\u3066\u3057\u3063\u304b\u308a\u3068\u533b\u7642\u9762\u63a5\u304c\u3067\u304d\u308b\u3088\u3046\u306b\u300c\u81e8\u5e8a\u63a8\u8ad6\u300d clinical reasoning\u306e\u30b9\u30ad\u30eb\u3092\u9ad8\u3081\u3066\u3044\u304f\u3053\u3068\u304c\u6c42\u3081\u3089\u308c\u307e\u3059\u3002<\/span>\r\n<\/p>\r\n\r\n

USMLE Step 2 CS \u3067\u306f\u5c0f\u5150\u79d1\u3084\u9055\u6cd5\u30c9\u30e9\u30c3\u30b0\u306a\u3069\u3082\u542b\u3081\u305f\u69d8\u3005\u306a\u75c7\u72b6\u304c\u4e3b\u8a34\u3068\u3057\u3066\u6271\u308f\u308c\u3066\u3044\u307e\u3057\u305f\u304c\u3001\u65e5\u672c\u306e\u533b\u5b66\u751f\u306b\u3068\u3063\u3066\u6700\u512a\u5148\u3059\u3079\u304d\u306f\u300c\u533b\u5b66\u6559\u80b2\u30e2\u30c7\u30eb\u30fb\u30b3\u30a2\u30fb\u30ab\u30ea\u30ad\u30e5\u30e9\u30e0<\/span><\/span><\/a>\u300d\u306b\u3042\u308b37\u306e\u75c7\u72b6\u3067\u3059\u3002\u3053\u306e\u4e2d\u3067\u5916\u6765\u60a3\u8005\u3055\u3093\u306e\u4e3b\u8a34\u3068\u306a\u308a\u306b\u304f\u3044\u300c\u30b7\u30e7\u30c3\u30af\u300d\u3068\u300c\u5fc3\u505c\u6b62\u300d\u3092\u9664\u3044\u305f35\u306e\u75c7\u72b6\u306b\u95a2\u3057\u3066\u3001\u3057\u3063\u304b\u308a\u3068\u81e8\u5e8a\u63a8\u8ad6\u304c\u3067\u304d\u308b\u3088\u3046\u306b\u6e96\u5099\u3092\u3057\u3066\u3044\u304f\u3053\u3068\u3092\u3001\u307e\u305a\u306f\u6c42\u3081\u3089\u308c\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u3082\u3061\u308d\u3093\u3053\u308c\u306f\u4e00\u671d\u4e00\u5915\u306b\u3067\u304d\u308b\u5bfe\u7b56\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u304c\u3001\u7c21\u5358\u306a\u65b9\u6cd5\u3068\u3057\u3066\u306f USMLE Step 2 CS \u306e\u69d8\u3005\u306a\u5bfe\u7b56\u672c\u3092\u4f7f\u3044\u3001\u5404\u75c7\u72b6\u306b\u5bfe\u3059\u308b\u30a2\u30d7\u30ed\u30fc\u30c1\u3092\u81ea\u5206\u306a\u308a\u306b\u307e\u3068\u3081\u3066\u3044\u304f\u3053\u3068\u304c\u6319\u3052\u3089\u308c\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u305d\u3057\u3066\u3053\u308c\u3089\u306e\u30a2\u30d7\u30ed\u30fc\u30c1\u3092\u307e\u3068\u3081\u3066\u3044\u304f\u4e2d\u3067\u3001\u662f\u975e\u5b9f\u8df5\u3057\u3066\u3044\u305f\u3060\u304d\u305f\u3044\u306e\u304c\u300c\u60a3\u8005\u5f79\u306e\u7df4\u7fd2\u3092\u3059\u308b<\/strong><\/span>\u300d\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002<\/span><\/p>\r\n\r\n

\u82f1\u8a9e\u3067\u306e\u533b\u7642\u9762\u63a5\u306b\u304a\u3051\u308b\u82f1\u8a9e\u529b\u3068\u3057\u3066\u91cd\u8981\u306a\u3053\u3068\u306f\u3001\u300c\u60a3\u8005\u3055\u3093\u304c\u4f55\u3092\u8a71\u3057\u3066\u3044\u308b\u306e\u304b\u7406\u89e3\u3067\u304d\u308b\u300d\u3068\u3044\u3046\u30ea\u30b9\u30cb\u30f3\u30b0\u529b\u3068\u3001\u60a3\u8005\u3055\u3093\u306e\u8a71\u306b\u67d4\u8edf\u306b\u5bfe\u5fdc\u3067\u304d\u308b\u30b9\u30d4\u30fc\u30ad\u30f3\u30b0\u529b\u3067\u3059\u3002\u3053\u308c\u3089\u306f\u3069\u3061\u3089\u3082\u7686\u3055\u3093\u306e\u300c\u82f1\u4f1a\u8a71\u30b9\u30ad\u30eb\u300d\u3068\u76f8\u95a2\u3057\u3066\u304a\u308a\u3001\u7c21\u5358\u306b\u5411\u4e0a\u3059\u308b\u3053\u3068\u306f\u3067\u304d\u307e\u305b\u3093\u3002<\/span><\/p>\r\n\r\n

\u3057\u304b\u3057\u533b\u7642\u9762\u63a5\u3068\u3044\u3046\u9650\u3089\u308c\u305f\u72b6\u6cc1\u306b\u304a\u3044\u3066\u306f\u3001\u3053\u306e\u30ea\u30b9\u30cb\u30f3\u30b0\u529b\u3068\u30b9\u30d4\u30fc\u30ad\u30f3\u30b0\u529b\u3092\u4e0a\u3052\u308b\u3053\u3068\u306f\u305d\u308c\u307b\u3069\u96e3\u3057\u3044\u3053\u3068\u3067\u306f\u3042\u308a\u307e\u305b\u3093\u3002\u305d\u3057\u3066\u305d\u308c\u3089\u3092\u52b9\u7387\u7684\u306b\u5411\u4e0a\u3055\u305b\u308b\u3053\u3068\u304c\u3067\u304d\u308b\u306e\u304c\u300c\u60a3\u8005\u5f79\u306e\u7df4\u7fd2\u3092\u3059\u308b\u300d\u3068\u3044\u3046\u3053\u3068\u3067\u3059\u3002<\/span><\/p>\r\n\r\n

\u5177\u4f53\u7684\u306b\u306f\u81ea\u5206\u304c\u6f14\u3058\u308b\u60a3\u8005\u3055\u3093\u306e\u300c\u75be\u60a3\u540d\u300d\u3092\u6c7a\u3081\u3001\u305d\u308c\u306b\u5408\u81f4\u3059\u308b\u3088\u3046\u306a\u30b7\u30ca\u30ea\u30aa\u3092\u82f1\u8a9e\u3067\u8003\u3048\u308b\u306e\u3067\u3059\u3002\u305d\u306e\u969b\u306b\u306f Web MD<\/span><\/span><\/a> \u3084 Mayo Clinic<\/span><\/span><\/a> \u3068\u3044\u3063\u305f\u82f1\u8a9e\u570f\u306e\u60a3\u8005\u3055\u3093\u304c\u53c2\u7167\u3059\u308b\u533b\u7642\u60c5\u5831\u30b5\u30a4\u30c8\u3084\u3001YouTube \u306a\u3069\u306e\u52d5\u753b\u3067\u305d\u308c\u305e\u308c\u306e\u75be\u60a3\u306e\u60a3\u8005\u3055\u3093\u304c\u81ea\u5206\u306e\u4f53\u9a13\u306a\u3069\u3092\u8a9e\u308b\u3082\u306e\u3092\u898b\u3066\u3001\u5b9f\u969b\u306e\u60a3\u8005\u3055\u3093\u304c\u3069\u306e\u3088\u3046\u306a\u82f1\u8a9e\u8868\u73fe\u3092\u4f7f\u3046\u306e\u304b<\/strong><\/span>\u3092\u53c2\u8003\u306b\u3057\u307e\u3059\u3002\u305d\u3057\u3066\u305d\u308c\u3089\u3092\u4f7f\u3063\u3066\u60a3\u8005\u5f79\u3092\u7df4\u7fd2\u3059\u308b\u306e\u3067\u3059\u3002<\/span><\/p>\r\n\r\n

\u307e\u305f\u3001\u7686\u3055\u3093\u306e\u5927\u5b66\u306b\u306f\u5fc5\u305a\u82f1\u8a9e\u306e\u6559\u54e1\u304c\u3044\u308b\u3068\u601d\u3044\u307e\u3059\u304c\u3001\u305d\u308c\u3089\u306e\u6559\u54e1\u306b\u306f\u300c\u60a3\u8005\u5f79\u3092\u6f14\u3058\u3066\u3082\u3089\u3046\u300d\u3088\u308a\u3082\u3001\u300c\u60a3\u8005\u5f79\u3092\u6f14\u3058\u308b\u305f\u3081\u306e\u53f0\u672c\u4f5c\u308a\u3092\u624b\u4f1d\u3063\u3066\u3082\u3089\u3046<\/strong><\/span>\u300d\u65b9\u304c\u306f\u308b\u304b\u306b\u52b9\u7387\u7684\u306b\u82f1\u8a9e\u306e\u6163\u7528\u8868\u73fe\u306a\u3069\u3092\u5b66\u3076\u3053\u3068\u304c\u3067\u304d\u308b\u306f\u305a\u3067\u3059\u3002<\/span><\/p>\r\n\r\n

\u3053\u308c\u307e\u3067\u306e\u79c1\u306e\u7d4c\u9a13\u304b\u3089\u8a00\u3063\u3066\u3082\u3001\u300c\u533b\u5e2b\u5f79\u306e\u7df4\u7fd2\u3092\u3059\u308b\u300d\u3088\u308a\u3082\u300c\u60a3\u8005\u5f79\u306e\u7df4\u7fd2\u3092\u3059\u308b\u300d\u65b9\u304c\u3001\u7d50\u679c\u3068\u3057\u3066\u533b\u5e2b\u5f79\u3068\u3057\u3066\u306e\u30b9\u30ad\u30eb\u3082\u5411\u4e0a\u3059\u308b\u3068\u611f\u3058\u3066\u3044\u307e\u3059\u3002\u662f\u975e35\u306e\u75c7\u72b6\u306b\u95a2\u3059\u308b\u6570\u591a\u304f\u306e\u75be\u60a3\u306e\u60a3\u8005\u5f79\u3092\u6e96\u5099\u3057\u3066\u3001\u533b\u7642\u9762\u63a5\u3067\u306e\u82f1\u8a9e\u30b9\u30ad\u30eb\u5411\u4e0a\u306b\u3064\u306a\u3052\u3066\u3044\u3063\u3066\u304f\u3060\u3055\u3044\u3002<\/span><\/p>\r\n\r\n

\u3055\u3066\u305d\u308d\u305d\u308d\u30ab\u30c3\u30d7\u306e\u30b3\u30fc\u30d2\u30fc\u3082\u6b8b\u308a\u308f\u305a\u304b\u3067\u3059\u3002\u6700\u5f8c\u306b\u672c\u65e5\u3054\u7d39\u4ecb\u3057\u305f\u30dd\u30a4\u30f3\u30c8\u3092\u307e\u3068\u3081\u3066\u304a\u304d\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\r\n\u2022 \u82f1\u8a9e\u306e\u533b\u7642\u9762\u63a5\u306e\u57fa\u672c\u8868\u73fe<\/span><\/span><\/a>\u3092\u6697\u8a18\u3059\u308b<\/span>
\r\n\u2022 \u300c\u73fe\u75c5\u6b74\u300d HPI<\/span><\/span><\/a> \u3067\u306f\u6700\u521d\u306b\u958b\u653e\u578b\u8cea\u554f\u3092\u4f7f\u3044\u3001\u300c\u767a\u75c7\u300d\u300c\u767a\u75c7\u524d\u300d\u300c\u767a\u75c7\u5f8c\u300d\u306e\u69d8\u5b50\u3092\u8a73\u7d30\u306b\u8a9e\u3063\u3066\u3082\u3089\u3046\u3002\u72b6\u6cc1\u306b\u5408\u308f\u305b\u3066\u8cea\u554f\u3092\u52a0\u3048\u3001\u9069\u5b9c\u8a71\u3092\u8981\u7d04\u3059\u308b<\/span>
\r\n\u2022 \u300c\u73fe\u75c5\u6b74\u300d HPI \u3067\u306e \u201cpain\u2019s OPQRST\u201d \u3084 \u201cSOCRATES\u201d \u306a\u3069\u306f\u805e\u304d\u6f0f\u3089\u3057\u304c\u306a\u3044\u304b\u78ba\u8a8d\u3059\u308b\u305f\u3081\u306e\u30c1\u30a7\u30c3\u30af\u30ea\u30b9\u30c8\u3068\u3057\u3066\u4f7f\u3046<\/span>
\r\n\u2022 \u300c\u73fe\u75c5\u6b74\u300d HPI \u306e\u6700\u5f8c\u306b\u306f\u9451\u5225\u75be\u60a3\u306b\u4f34\u3046\u95a2\u9023\u75c7\u72b6\u306e\u6709\u7121\u3082\u5c0b\u306d\u308b<\/span>
\r\n\u2022 \u82f1\u8a9e\u3067\u306e\u533b\u7642\u9762\u63a5\u306f USMLE Step 2 CS \u5bfe\u7b56\u3068\u3057\u306612\u5206\u9593\u3067\u7d42\u3048\u308b\u3088\u3046\u306b\u7df4\u7fd2\u3057\u3001\u305d\u306e\u3046\u3061\u534a\u5206\u306e6\u5206\u9593\u306f\u300c\u73fe\u75c5\u6b74\u300dHPI \u306b\u4f7f\u3046<\/span>
\r\n\u2022 \u300c\u73fe\u75c5\u6b74\u300dHPI \u4ee5\u5916\u306e\u9805\u76ee\u306f\u5c0b\u554f\u5f62\u5f0f\u306b\u306a\u3089\u306a\u3044\u3088\u3046\u306b\u3001\u60a3\u8005\u3055\u3093\u306e\u8a71\u306b\u5408\u308f\u305b\u3066\u8cea\u554f\u9805\u76ee\u306e\u9806\u756a\u3092\u9069\u5b9c\u5909\u66f4\u3059\u308b<\/span>
\r\n\u2022 \u300c\u30b7\u30b9\u30c6\u30e0\u30ec\u30d3\u30e5\u30fc\u300d\u306f transition, constitutional symptoms, mental symptoms, HEENT, and \u201cMR DICE RUN\u201d \u3068\u3044\u3046\u300c\u30b7\u30b9\u30c6\u30e0\u300d\u3092\u4f7f\u3063\u3066\u5c0b\u306d\u3001\u305d\u306e\u969b\u306b\u3082\u958b\u653e\u578b\u8cea\u554f\u3092\u591a\u7528\u3059\u308b<\/span>
\r\n\u2022 \u533b\u7642\u9762\u63a5\u306e\u6700\u5f8c\u306b\u306f\u5fc5\u305a\u60a3\u8005\u3055\u3093\u306e I<\/strong>deas, C<\/strong>oncerns, and E<\/strong>xpectations \u3092\u78ba\u8a8d\u3059\u308b \u201cICE\u201d \u306e\u8cea\u554f\u3092\u3059\u308b<\/span>
\r\n\u2022 \u300c\u533b\u5b66\u6559\u80b2\u30e2\u30c7\u30eb\u30fb\u30b3\u30a2\u30fb\u30ab\u30ea\u30ad\u30e5\u30e9\u30e0\u300d\u306b\u3042\u308b37\u306e\u75c7\u72b6\u306e\u3046\u3061\u3001\u30b7\u30e7\u30c3\u30af\u3068\u5fc3\u505c\u6b62\u3092\u9664\u3044\u305f35\u306e\u75c7\u72b6\u306e\u81e8\u5e8a\u63a8\u8ad6\u304c\u3067\u304d\u308b\u3088\u3046\u306b\u3059\u308b<\/span>
\r\n\u2022 \u7279\u5b9a\u306e\u75be\u60a3\u3092\u9078\u3073\u3001\u305d\u306e\u75be\u60a3\u306e\u60a3\u8005\u3055\u3093\u304c\u3069\u306e\u3088\u3046\u306a\u82f1\u8a9e\u8868\u73fe\u3092\u4f7f\u3046\u304b\u3092\u30a4\u30f3\u30bf\u30fc\u30cd\u30c3\u30c8\u3084\u82f1\u8a9e\u6559\u5e2b\u306e\u52a9\u3051\u3092\u501f\u308a\u3066\u8abf\u3079\u3001\u60a3\u8005\u5f79\u306e\u7df4\u7fd2\u3092\u3059\u308b<\/span>\r\n<\/p>\r\n\r\n

\u3067\u306f\u3001\u307e\u305f\u306e\u3054\u6765\u5e97\u3092\u304a\u5f85\u3061\u3057\u3066\u304a\u308a\u307e\u3059\u3002<\/span><\/p>\r\n\r\n

\u300cDr. \u62bc\u5473\u306e\u533b\u5b66\u82f1\u8a9e\u30ab\u30d5\u30a7\u300d\u3067\u306f\u7686\u3055\u3093\u304b\u3089\u6271\u3063\u3066\u6b32\u3057\u3044\u30c8\u30d4\u30c3\u30af\u3092\u52df\u96c6\u3044\u305f\u3057\u307e\u3059\u3002\u3053\u3061\u3089\u306e\u30ea\u30f3\u30af<\/strong><\/span><\/a>\u304b\u3089\u3053\u306e\u30ab\u30d5\u30a7\u3067\u6271\u3063\u3066\u6b32\u3057\u3044\u3068\u601d\u3046\u533b\u5b66\u82f1\u8a9e\u306e\u30c8\u30d4\u30c3\u30af\u3092\u3054\u81ea\u7531\u306b\u8a18\u8f09\u304f\u3060\u3055\u3044\u3002<\/span><\/p>\r\n

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