Torsion of the Gallbladder:A Case Report / 日本農村医学会雑誌

  A 86-year-old woman visited us, complaining about sharp abdominal pain she had very morning when she got up. Ultrasound and computer tomography scans of the abdomen revealed notable parietal hypertrophy and swelling of the gallbladder. The old woman was diagnosed with acute cholecystitis and immediately admitted to the hospital. Her condition did not improve on conservative management. Percutaneous transhepatic gallbladder drainage (PTGBD) was performed. The bile thus aspirated was bloody, which led us to suspect necrotizing cholecystitis. Emergency cholecystectomy was done. The abdominal operation found the gallbladder wandering with a torsion of 360 degrees around the gallbladder neck as the axis and the leakage of bile in the abdominal cavity from what could be presumed to be the area where the PTGBD was placed. After the torsion was corrected, the gallbladder was surgically removed. Neither gallstones nor tumors were found in it. There were signs of hemorrhagic necrosis in the mucus membrane. The patient made good progress after the operation and was discharged on the 15th hospital day. Torsion of the gallbladder is a comparatively rare entity and its symptoms are not always specific. Therefore, it defies preoperative diagnosis. In this paper, we report our experience with a case of this disease which presented characteristic radiographic images and discuss the treatment strategies including PTGBD.

Analyses of Scores of Examinations for Practical Training in Clinical Skills and for Clinical Training and Scores of Graduation Examinations in Undergraduate Medical Students / 医学教育

We analyzed the scores of objective structured clinical examinations (OSCEs) and written examinations administered to fourth-year medical students after practical training in clinical skills and to fifth-year medical students after clinical training and scores of graduation examinations taken by sixth-year medical students. Correlations were analyzed among the scores of 96 students who had taken all 3 examinations during a 3-year period. Mean scores on examinations in the fourth, fifth, and sixth years were compared between sixth-year students who did or did not graduate and between graduating students who did or did not pass the national examination for medical practitioners in Japan. Significant correlations in the scores were found between 1) OSCEs and written examinations for fourth-year students versus those for the fifth-year students; 2) OSCE and written examinations for fourth-year students versus graduation examination scores for the sixth-year students; and 3) OSCE and written examinations for fifth-year students versus graduation examination scores for sixth-year students. In addition, the mean scores in the fourth and fifth years were significantly higher for sixth-year students who graduated and passed the national examination than for students who did not graduate or who graduated but failed the national examination. These results suggest that the practical training in clinical skills given to fourth-year students and the clinical training given to fifth-year students strongly affect the overall evaluation of the ability of sixth-year students and success on the national examination.

Utility and Usefulness of the Skills Laboratory to Improve Practical Training in Clinical Skills / 医学教育

Medical students at Kurume University begin practical training in clinical skills in their fourth year. At that time, students use the skills laboratory to improve their clinical skills. Medical education resources in the skills laboratory include simulators for emergency resuscitation and heart diseases, wireless stethoscopes, and videotapes. All students use the skills laboratory for 2 months, and its usefulness was evaluated with questionnaires after practical training. More than 50 % of students approved of their practice in the skills laboratory. However, some students were unsatisfied because they were unable to make effective use of the simulators. In the future, an improved skills laboratory will be necessary to improve practical training in the clinical skills for medical students.

Evaluation of the First Trial of a White Coat Ceremony as a Ceremony of Passage: A Method for Teaching Professionalism in Undergraduate Medical Education / 医学教育

Purposes: We performed a white coat ceremony for medical students, because there had not been a definite passage ceremony to create the desire to serve and the awareness of being physician. Opinions about the ceremony were with a questionnaire survey. Methods: The ceremony of white coat conferment was performed for the first time for 112 fourth-year medical students on January 11, 2001, just before the start of clinical training. A white coat and an identification badge with photograph were presented to the medical students, who were taking the first step to becoming a physician. A questionnaire survey was performed the next day to evaluate students' feelings. The questionnaire asked about student's 1) sense of responsibility to be engaged in medical practice, 2) feelings of kindness to patient, 3) love for of their school, 4) attachment to the white robe, 5) consciousness of being a professional, 6) sense of mission as a physician, 7) motivation to learn, 8) feelings of seriousness, and 9) desire to live ethically. A listening survey for the school staff and students was also included. Results: Clear improvements in consciousness were recognized in all items of the questionnaire (P>.0001). Approximately 80% of students approved of the ceremony being performed annually from the following year. The ceremony had had no established form, but many people acknowledged its significance. However, some students who did not realize the significance of the ceremony because it was performed in the middle of the semester. Conclusions: Although this was the first experience for us, many students and teaching staff were understanding and responded favorably to this passage ceremony. The ceremony to instill medical professionalism in student doctors will be improved with further efforts and experiences.

Evaluation of Individual Care of Patients by Medical Students for Attitude Education / 医学教育

The usefulness of individual care of patients in the attitude education of undergraduates was evaluated with questionnaires completed by 4th-year medical students and patients. Ninety-eight percent of students finished performing patient care during a 2-week period. Seventy percent of patients completed questionnaires. The appearance, manner of greeting, and language of the students were considered good by 87% or more of the patients, and the students' consideration for the patients' safety, privacy, and communication was considered good by 86% or more of the patients. The practice was approved by 77% of the patients and was objected to by none. Ninety-nine percent of students completed questionnaires, and 79% of the respondents approved of the practice. Fourteen percent of the student respondents, many of whom had been treated as outpatients, objected to the practice. These results suggest that individual care of patients by medical students is useful for both patients and students.