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Title: http://jpsmodel.umin.jp/


1
??????????! ???????? ???????????? ???????????????
???? http//jpsmodel.umin.jp/
?????????? ?????????????? ???????
2
??????
3
????????
(??55???????859?)
(??????? ????????????????????????(???????????)????
??????????????????2004)
4
???????????
???????2005
???????????(?)(????)
?? ??? ???? ??? ????
20? 68.2 814 15.9
30? 62.9 1446 13.2
40? 58.9 1241 12.5
50? 52.5 664 11.3
60? 46.9 122 8.6
70? 46.0 23 13.8
80? 40.0 1 .
?? 60.6 4325 14.3
5
????????????2006
???????
??? ??? ????????????????
(?????)
6
????????????2006
???????
????????? NIOSH?????????
??????948????????QOL????????

(?????)
7
????????????2006
???????
???????????
NIOSH?????????
(?????)
8
???????????
???????2005
???????????? -????????-
N1,224
???????????????????
(????)
9
????????????????????? ?????????????(???)
?????????????primary care ????????????????????????
????????????????????????? ????????????
(?????????????????(???????????) ?????????????????
?????2004)
10
???????????????(???)
??????10??????????????????10???????????????30?????
?????????????
(?????????????????(???????????) ?????????????????
?????2004)
11
???????????
???????2005
?-1-6. ?????????????100???????????????????????????
??????????
12
??????
1)    ??????????????????? ?????????????????? ??
?????????????(?????)?????? 2)   
?????????????????????????????? ?????????? 3)  
?????????????????????????????? ?????? 4)
???????????????????????????????????????
13
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    ????
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14
???????????
??????????
???????2005
1??????? ??? ?
1? 284
2? 238
3? 158
4? 99
5? 74
6? 45
7? 46
8? 20
9? 16
10?- 41
15?- 30
20?- 18
?? 1069
49 !
16!
????????????????????????
15
?????????
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?? ??
?? 5,900?? 1?2,700??
????????? 204?? 3528??
??????????? 20.8? 1.8?
?????????? ??? 75,000? 29?? 5,000? 3.6??
16
1??????????? -??????
? ????????????????
????????????????????????????????
???????????????
17
?????? ????
?????
???????4??
??1,663km2 ??107??(??24??) ???????? ????????20
-30??? ??????(???25???)
18
?????????????????????? ?1?????????????????????
????????
1.??????????????????????? 2.??????????????????????
? ?????????????????????????
19
  • ????????????????2004???????
  • ??????3??????
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  • (?)??????????????
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  • (?)????????24???365??????????
  • ???????
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  • 3.???????????????????????????
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20
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    ??????????????????????????????????????????????????
    ???????????????????????

21
??
??
22
????????????????
?????? ????????? ???
???on call
on call
2
3 8
on call
???on call
on call
4 10 ??
???on call
2 5
2
2
14 50 ?? NICU
6 15 ?? NICU
??(??)2?
??1?
2
2 5
4 10 ??
2
on call
???on call
??
on call
2 5
2
on call
???on call
?? ??7? 58?
????? ??(??)2? 50?
23
????????????????
?????????? ??????????
2?
?????
on call?? 54? ???????? 30? ????????
2?
on call?? 60? ?????? 37? ??????
2?
1??????
on call?? 63? ?????? 36? ??????
14? 50? 2??? NICU
?????????
2?
on call?? 50? ????? 29? ????????
????23? 55? ?? 1? 48? ?? 1? ????? 3? ???????
??? 4? ?????????? 5? ???? 6?
2?
on call?? 65? ?????? 27? ????????
on call?? 55? ????? 28? ????????
2?
24
??????????????
  1. ???????????????????????????????(2004?3?)
  2. 47??????(?????)?????????????(2004?4?)??????
  3. ???????????????????????
  4. 36?????????(2006?3???)
  5. ?????????????(2007?1?)
  6. ????????????60???????????

25
?????????????
????????????????????????
2004?3? ?????????????????????? 2004?6? ???????????
?????? ???????????????????????
???????????????????? ?????????
??? 2004?6? ????????????? ??(2006?3?) ??URL
http//jpsmodel.umin.jp ????????????????? 2005? ?
??????????????????? ??????? 4??9???????????????
2006?3??? 36???????????????? ????
26
????????????????? ???????
?????? ??1-2??????????????(?)
27
????????????????? ???????
?????? ??2-2????????????????????(?)
28
????????????????? ???????
???????????(??1)??18?3????
??1??? ???? ???????????
??1,2?????????? 36 ???? 36 ????
??? 78?? 262??
?????? 3717 ? 7916 ?
(?????) (47.6 ?) (30.2 ?)
???????? 156 ? 207 ?
(?????) (2.0 ?) (0.8 ?)
NICU??????? 530 ? 1096 ?
(?????) (6.8 ?) (4.1 ?)
??????????? 899 ? 2448 ?
??????? ??????? 1108 ? 1764 ?
??????? 290 ? 422 ?
?????? 119 ? 67 ?
?????? ????? 348 ?? 559 ??
????? 3288 ? 4316 ?
????? 960 ? 1097 ?
????? 75 ?? 185 ??
????? 455 ? 789 ?
????? 159 ? 310 ?
29
??1(???????????????)???
47????
8,200?
30
????????????????? ???????
???????????????????
??
31
????????????????? ???????
????????????????
??
????????????????15002000
32
???????????
???????
???????????????(????)
??
N982
???
???
33
????????????
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???????????????(????)
??????????
N910
???
???????????
??????
???
34
  • ??17?12?22?
  • ???????????????????????
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  • ????????????????????????????
  •  ? ??????????????????????????????
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    ??????????????????????????????????????????????????
    ??

35
??????? H19?1???
???????
36
????????????????
???????????????
37
??????????
38
????????
  1. ??????????????????????????????????????????????????
    ??????????????????????????
  2. ???????????????????????????? ????????????????????
    ??????????????????????????????????????????????????

39
????????????????????? ??????? UK, EU
source Royal College of Paediatrics and Child
Health 2003 THE WORKING TIME DIRECTIVES
(AMENDMENT) REGULATIONS 2003 - DEROGATION   The
provisions of the Working Time (Amendment)
Regulations 2003 Working Time Limits From 1
August 2004, doctors in training will be subject
to weekly working time limits, which will be
phased in as follows 58 hours from 1 August
2004 to 31 July 2007. 56 hours from 1 August
2007 to 31 July 2009. 48 hours from 1 August
2009.
40
  • NY Resident, USA
  • Our Work Rules and the ACGME
  • Hard Rules
  •  
  • 80 hours/wk
  • 17 days off averaged over the block
  • 30 hour duty limit, no admits after 24 hours
  • 10 hours between shifts
  •   Accredited Council for Graduate Medical
    Education

41
????????????? (??19???(??)????) ?????????????????
????????????????????????????????????60????????????
???????? ??????????????????????????????
42
???????????????
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?????????? ????????? ???????
??????-??-?? ?????? ??????????????????
?????????? ??????????? ?????????????????
????? ???????? ?????????
43
?????????????
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  • ???????????????????????(?????)
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44
?????????(???)
??????????? / ????????????????? ????????????????
(????)??????????????????????????20???????????????
????????
(?????????????????(???????????) ?????????????????
?????2004)
45
  • ???????????????(?)
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  • ????????????????????????
  • ???????????????????????????????

46
????????????? ???? ?????????????????????????????
????
(?????????????????????ICU???????)
47
????????????? ??????????????????
?????????????? ??????????? 5,000-6,500? NICU
9,000? ????????(200???)?????????
(?????????????????????????DPC????? ?????)
48
  • ??????????
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  • ?????????????????????????????
  • ???????????????????????????????????????????
  • ??????????????????????????????????????????????????
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