Discussion Points for Developing Support System for Inclusion of Healthcare Students with Disabilities / 医学教育

The number of students with disabilities is increasing in healthcare and other fields. However, support systems have yet to progress, and faculty and staff often find it difficult in the field. About 10% of medical students in the United States report that they have a disability, and reasonable accommodation is provided in didactic, lab, and clinical setting. The government and others have indicated support policies for students with disabilities, and a large-scale survey of healthcare providers with disabilities has been conducted, and the issues have been clarified. This section introduces specific examples of support and reasonable accommodation for students with disabilities overseas. It is thought that the training of students with disabilities and their employment will facilitate diversity among healthcare professionals and improve the quality of healthcare. There is an urgent need to understand the overall picture of healthcare students with disabilities in Japan and to develop support systems for their inclusion.

3. Lectures at Tokyo Medical University / 医学教育

In 2015, Tokyo Medical University launched Medical Professionalism for 2nd, 3rd, and 4th year medical students to study professionalism in a sequential manner. The lecture for the 2nd year students was taught together with a representative of LGBTQ support groups. The lecture for the fourth-year students was taught together with a urologist who was a representative of a transgender support group. In summarizing the reports of the fourth-year students who took the lecture in 2021, many students thought that learning about LGBTQ was necessary from the early grades and wanted a more active learning experience. It is necessary to consider more effective learning by devising class content and methods.

Qualitative Analysis of The Usefulness of Patient Interview Videos as Educational Material for Junior Medical and Nursing Students / 医学教育

Introduction: This study aims to reveal the characteristics of patients' narrative videos and discuss the usability of video interviews with healthcare students.Methods: One hundred six medical students and 92 nursing students participated in this study. They watched an interview video of a breast cancer patient in class and wrote a description of their impressions. Student responses related to the interview video were qualitatively analyzed using Step for Coding And Theorization (SCAT).Results: The categories that emerged from the analyzed data were "useful for healthcare professionals to know about patients' feelings" , "useful for patients with the same diseases" , "the patient's own voice was realistic" , and "want to use before clinical training" .Discussion: The interview video was thought to be useful for students as it allowed them to feel the realism of the patients' narrative. The interview video was also convenient for lectures. For these reasons, it was concluded that interview videos of patients' narratives could be a useful educational material for healthcare students.

Early Improvement and Marriage Are Determinants of the 12-Month Treatment Outcome of Paroxetine in Outpatients with Panic Disorder

OBJECTIVE: In this study, we investigated the determinants of remission and discontinuation of paroxetine pharmacotherapy in outpatients with panic disorder (PD). METHODS: Subjects were 79 outpatients diagnosed with PD who took 10–40 mg/day of paroxetine for 12 months. The candidate therapeutic determinants included the serotonin transporter gene-linked polymorphic region and the −1019C/G promoter polymorphism of the serotonin receptor 1A as genetic factors, educational background and marital status as environmental factors, and early improvement (EI) at 2 weeks as a clinical factor were assessed. The Clinical Global Impression scale was used to assess the therapeutic effects of the pharmacotherapy. RESULTS: Cox proportional hazards regression was performed to investigate the significant predictive factors of remission and discontinuation. EI was only a significant predictive factor of remission. EI was a significant predictive factor of remission (hazard ratio [HR], 2.709; 95% confidence interval [CI], 1.177–6.235). Otherwise, EI and marital status were significant predictive factors of the discontinuation. EI (HR, 0.266; 95% CI, 0.115–0.617) and being married (HR, 0.437; 95% CI, 0.204–0.939) were considered to reduce the risk of treatment discontinuation. In married subjects, EI was a significant predictive factor of the discontinuation (HR, 0.160; 95% CI, 0.045–0.565). However, in unmarried subjects, EI was not a significantly predictive factor for the discontinuation. CONCLUSION: EI achievement appears to be a determinant of PD remission in paroxetine treatment. In married PD patients, EI achievement also appears to reduce a risk of discontinuation of paroxetine treatment.

Genetic Polymorphism of 1019C/G (rs6295) Promoter of Serotonin 1A Receptor and Catechol-O-Methyltransferase in Panic Disorder

OBJECTIVE: Family and twin studies have suggested genetic liability for panic disorder (PD) and therefore we sought to determine the role of noradrenergic and serotonergic candidate genes for susceptibility for PD in a Japanese population. METHODS: In this age- and gender-matched case-control study involving 119 PD patients and 119 healthy controls, we examined the genotype distributions and allele frequencies of the serotonin transporter gene linked polymorphic region (5-HTTLPR), −1019C/G (rs6295) promoter polymorphism of the serotonin receptor 1A (5-HT1A), and catechol-O-methyltransferase (COMT) gene polymorphism (rs4680) and their association with PD. RESULTS: No significant differences were evident in the allele frequencies or genotype distributions of the COMT (rs4680), 5-HTTLPR polymorphisms or the −1019C/G (rs6295) promoter polymorphism of 5-HT1A between PD patients and controls. Although there were no significant associations of these polymorphisms with in subgroups of PD patients differentiated by gender or in subgroup comorbid with agoraphobia (AP), significant difference was observed in genotype distributions of the −1019C/G (rs6295) promoter polymorphism of 5-HT1A between PD patients without AP and controls (p=0.047). CONCLUSION: In this association study, the 1019C/G (rs6295) promoter polymorphism of the 5-HT1A receptor G/G genotype was associated with PD without AP in a Japanese population.

Report of Workshop “Toward better care for sexual minorities” / 日本プライマリ・ケア連合学会誌

The concept of sexual minority contains lesbian, gay, bisexual, transgender (LGBT) and disorders of sex development. Despite many recent advances in rights for sexual minorities in the world, bias against them still exit. We held a workshop ‘toward better care for sexual minorities' on the 6th Annual Conference of Japan Primary Care Association 2015. Four lecturers talked about health disparities among sexual minority patients. We want this paper help reducing the readers' prejudice towards the sexual minorities and thus impact their future clinical practice.

Learning from a lecture about sexual minorities for first-year medical students / 医学教育

Objectives: The aim of this study was to explore the first-year medical students’ perception of their learning from a lecture about sexual minorities.<br>Methods: In September 2012, a physician and a gynecologist first lectured about sex differences, reproductive medicine, and sexually transmitted infections. Next, the representative of a support group for a sexual minority talked about the prejudice and discrimination toward sexual minorities. He showed a video about a high school student who had publicity revealed his sexual orientation. We analyzed the students’ reports by the qualitative data analysis method Step Coding and Theorization. The students’ descriptions were extracted, coded by contents, and then grouped into several categories.<br>Results: Many students were surprised at the percentage of persons belonging to a sexual minority. By watching the DVD they came to realize that homosexuals are just like other persons in most ways. They mentioned the need for correct knowledge about sexual minorities.<br>Conclusion: We believe that the educational session about sexual minorities is meaningful for and valued by medical students, and medical care for sexual minorities should be taught to medical students.

Relationships between self-efficacy on health behavior and patient's assessment of rheumatoid arthritis conditions / 日本プライマリ・ケア連合学会誌

<b>Objective</b> : The purpose of this study was to examine the relationships between levels of self-efficacy on health behavior of outpatients with rheumatoid arthritis (RA) and patient's assessment of RA conditions.<br><b>Methods</b> : A cross-sectional study was performed using a self-administered anonymous questionnaire between October and December 2010 on 406 RA outpatients who consecutively visited 3 urban hospitals in Japan. The following variables were investigated ; (1) the scale of self-efficacy on health behavior in chronic disease patients (CD-SES), which has 2 subscales : active coping behavior with disease (14 items) and controllability for health (10 items). (2) The demographic data ; age, gender, duration of disease, treatment. (3) patient's assessment of RA conditions : painful joint count, swollen joint count, serum C reactive protein (CRP), patient estimate of global status (PGS) which was measured on a 100-mm visual analogue scale (0=best score), functional disability according to Japanese version of modified Health Assessment Questionnaire.<br><b>Results</b> : CD-SES data were obtained from 191 patients. 80<b>%</b> was female with mean age 64.4 yr. Total CD-SES scores significantly correlated with age, PGS and functional disability. The scores of active coping behavior with disease correlated with age, and the scores of controllability for health correlated with PGS. The other variables such as painful joint counts, swollen joint counts, and serum CRP showed no relationship with the scores of self-efficacy.<br><b>Conclusion</b> : Self-efficacy on health behavior of RA patients related to PGS and functional disability. The longitudinal study is necessary to ascertain whether the psychological support enhances self-efficacy, and affects clinically important outcome measures such as PGS.

Preference for involvement in treatment decision-making for Japanese rheumatoid arthritis patients: A questionnaire survey / 日本プライマリ・ケア連合学会誌

Introduction: Recently, the significance of “shared decision-making” in which patients were actively involved in decision options for treatment on the basis of informed consent, has been recognized. However, few studies concerning this issue have been reported regarding rheumatoid arthritis (RA). We conducted a questionnaire survey on patient involvement in treatment decision-making. <br>Methods : Five hundred RA patients who attended the May 2009 annual meeting of the RA Patient Association in Japan were enrolled in this study. A questionnaire included disease activity and severity, and preferences regarding the extent of patient involvement in deciding on treatment options. Desired and actual roles were chosen from the following descriptions: #1: I prefer to leave all decisions regarding treatment to my doctor. #2: I prefer my doctor to make the final decision after showing me the best option. #3: I prefer that my doctor makes the final decision after showing me all possible therapeutic options. #4: I prefer that my doctor and I share responsibility for deciding which treatment is best for me. And #5: I prefer that the decision about which treatment I will receive should be made by myself. <br>Results: The questionnaire was returned by 76.4% of the patients, 91% of whom were women, and 71% were 60 years of age or older. While 54% of the patients selected “#4” as their desired role in the decision-making process, 44% of them indicated that “#3” was their actual role, indicating that they accepted the opinion of the attending physician. The desired role was concordant with the actual role in 45% of the patients, who were more satisfied with their medical care and relied on the physician more than those whose desired and actual roles were in conflict. <br>Conclusion: The physician should assess individual patient preferences and tailor care accordingly.

The nursing practice program in the new intern orientation / 医学教育

1) Yokohama City University Hospital has provided a 1-day nursing practice program during the orientation period for first-year interns since 2004. Here we report on the practice performed this year.2) After taking part in the practice, interns described the communication and consultation among the medical team as well as the nurse-patient and nurse-physician relationships. In addition, they recognized the professionalism of nursing.3) To assess the clinical outcome of this practice, we would use the attitude evaluation by head nurses of wards.

What is the difference between a <I>kenshui</I>, a resident, and an intern? / 医学教育

1) The Japanese term “<I>kenshui</I>”was officially defined in2004when the new postgraduate medical education system began.<BR>2) Although“<I>kenshui</I>”is often translated into English as “<I>resident</I>, ”it is best translated as “<I>intern</I>, ”because a kenshui rotates through many different departments.<BR>3) A United States-style residency is more akin to what is called “<I>koki-kenshu</I>” in Japanese.<BR>4) The “postgraduate year”naming system is the most precise way to describe the position of a physician in postgraduate training.

Practical Patient Safety Education for Medical Students at the Yokohama City University School of Medicine / 医学教育

In autumn 2005, a 15-hour patient-safety education program was incorporated into the core curriculum for fourth-year medical students at the Yokohama City University School of Medicine. Sixty students took part in the program. The goals of the curriculum are for students to understand the prevalence and origins of medical errors and to increase awareness of the physician's responsibility for patient safety. Because typical learning methods, such as didactic lectures, might not be effective, we developed an experimental or case-based learning method. Educational modalities included small-group discussion of medical errors, role-playing of medical error disclosure, and experience operating infusion pumps. In addition, to bridge the gap between educational systems and hospital systems, we collaborated with other healthcare workers, such as nurses and hospital pharmacists. Students evaluated the program favorably; most recommended continuing the curriculum for future medical student classes.

A Survey on Residents' Awareness of Patient Safety at the End of the First Year of Residency / 医学教育

A survey was performed to examine residents' awareness of patient safety. Sixty-two residents who had just finished their first year of residency participated in the study. Of the 62 residents, 30 were training at Yokohama City University Hospital and 32 were training at other hospitals. Although all residents knew about the serious medical mishap ( “surgical mix-up” ) that had occurred at Yokohama City University Hospital in 1999, only 53% knew about the judicial verdict in this case. The residents most often believed that the mishap was the fault of the hospital and its system (82%), followed by nurses (73%), supervising doctors (62%), and residents (45%). Seventy percent of the residents knew about the “Incident Reporting System, ” but only 20% had written an incident report. Incidents experienced or observed by residents were most often medication-related. No significant differences in the results of the survey were found between residents of Yokohama City University Hospital and those of other hospitals. In conclusion, although residents recognize the importance of patient safety at the end of the first year of their residency program, they still cannot deal properly with incidents.

Patient-Safety Curriculum for Medical Students in the United States / 医学教育

Since the publication of To <I>Err is Human</I> in 1999, medical schools around the worldhave been discussing ways to teach medical students about patient safety. To deepen the understanding of patient-safety curriculums used in the United States, Dr. Matthew Weinger, director of the San Diego Center for Patient Safety and a professor at the University of California, San Diego, School of Medicine (UCSD), was invited to participate in around-table discussion on “Patient Safety Curriculum for Medical Students” held at Yokohama City University. Althoughthere have been active discussions in journals and within medical school faculties, no discernable consensus has emerged in the United States, other than that patient safety should become part of the educational system. The patient-safety curriculum used at UCSD and the curriculums promoted by the Department of Veterans' Affairs National Center for Patient Safety are introduced.