History of Japanese medical education / 한국의학교육

Since medical education programs in Korea and Japan seem to mutually influence each other, this review article provides a history of Japanese medical education, focusing on the way in which it influenced and was influenced by Korean medical education. In the late 19th century, the University of Tokyo established the core medical school, disseminating its scholarship and system to other medical schools. In the early 20th century, the balance between the quality and quantity of medical education became a new issue; in response, Japan developed different levels of medical school, ranging from imperial universities to medical colleges and medical vocational schools. After World War II, all of Japan's medical schools became part of the university system, which was heavily regulated by the Ministry of Education (MOE) Standard for the Establishment of Universities. In 1991, MOE deregulated the Standard; since 2000, several new systems have been established to regulate medical schools. These new approaches have included the Model Core Curriculum, 2-year mandatory postgraduate training, and a medical education accreditation system. Currently, most medical schools are nervous, as a result of tighter regulatory systems that include an accreditation system for undergraduate education and a specialty training system for postgraduate education.

Survey on female physicians' life events and career support / 医学教育

<p>Introduction: In Japan, the number of female physicians is increasing rapidly. The importance of education focused on career development and the work-life balance is increasingly being recognized.</p><p>Methods: In February 2008, we sent a questionnaire regarding the working status and life events to 1,374 female physicians who graduated from Okayama University Medical School or who were working at university-affiliated hospitals and facilities at the time of the investigation.</p><p>Results: Of the 376 respondents (26.8% response rate), we analyzed 360 respondents whose specialty is clinical medicine. Among them, 75.9% (n=269) of female physicians have partners, 70.2% (n=233) have children, and most of the female physicians experience these life events from age of 25-29 years. Although 82.1% (n=216) regarded the timing of their marriage as appropriate, 65.2% (n=144) regarded it as appropriate about having first child. Of the 174 respondents who returned to clinical work, 32.2% (n=56) returned to the same position as a full-time worker, and 27.6% (n=48) changed their position from full-time to part-time. Important factors to return to work easily, 〈understanding from their supervisors〉, 〈support from their family〉, and an appropriate amount of work were the top three reasons.</p><p></p><p>Discussion: It is important to educate medical students about career development based on the life stage and work-life balance for gender equality in medicine.</p>

A study of the triage function of referrals in an urban clinic / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : To promote disease management in the community, general physicians should refer their patients to specialists in a timely and appropriate manner. In this study, we propose an indicator for evaluation of such referrals.<br><b>Methods</b> : We analyzed all referrals in an urban clinic from September 1, 2011 to August 31, 2012. Symptoms and diagnoses documented by general physicians were collected from medical records, and the final diagnoses by specialists were collected from their reports. The symptoms and diagnoses were classified using the International Classification of Primary Care second edition (ICPC-2). Referral rates, hospitalization rates, and place of referral were analyzed.<br><b>Results</b> : The average number of encounters in the candidate clinic was 1402 per month, and the mean number of referrals was 23 (1.6% of encounters). Of patients who received a referral, 6.75 (29.1%) were admitted to hospitals. The symptoms and diagnoses of the referred patients were distributed across all chapters (A to Z) of ICPC-2. Diagnoses of admitted patients included pneumonia (R81) (24%), urinary tract infection (U70 and U71) (9%), and acute gastroenteritis with dehydration (D73 with T11) (9%).<br><b>Conclusion</b> : We identified the referral rates, hospitalization rates, and distribution of referral patients as indicators of the triage function of primary care physicians. These should be evaluated further as potential indicators of “the quality of medical care.”

Rewarding, positive aspects and nursing characteristics of comprehensive community care practices by clinic nurses / 日本プライマリ・ケア連合学会誌

<b>Purpose</b> : The objective of this qualitative study was to clarify rewarding and positive aspects of comprehensive community care practices by clinic nurses.<br><b>Methods</b> : Semi-structured interviews were conducted for six nurses who had been working for more than five years at community-based clinics in the surrounding areas of Tokyo. Responses were analyzed using the Modified Grounded Theory Approach proposed by Kinoshita. Concept diagrams were drawn from the themes.<br><b>Results</b> : Nurses regarded the integrated care of individual patients, their family and community as meaningful and rewarding because they were able to provide truly holistic care. They were also satisfied with “value of individual experiences of nurses”, “frontier spirit of community nurses providing pathless integrated care”, “appropriate work-life balance”, “independent position in the clinic” and “community-based team approach including medicine, health and welfare”.<br><b>Conclusion</b> : Nurses felt easier providing their psychosocial intervention in a community-based clinic as part of a medical system. Nurses obtained rewards by using their holistic care ability. Since nurses and family physicians have similar perspectives with respect to patient-centered care, some nurses felt conflicts with their physicians, because patient-centeredness is not the only strength of such nurses.

The usefulness and necessity of postgraduate community-based training program in Saku Central Hospital : Impact of implementation of the New Postgraduate Training System for Physicians / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : The objective of this research was to evaluate and to seek out factors that affect the usefulness and necessity of postgraduate community-based training programs in Saku Central Hospital (SCH) after the implementation of the New Postgraduate Training System for Physicians (NPTSP) <br><b>Methods</b> : A questionnaire survey of physicians who entered the residency program of SCH between 1996 and 2007 was conducted.<br><b>Results</b> : The questionnaire was sent to 111 physicians, and responses were received from 73 (65.8%). Of the reasons for selecting SCH for residency training, three showed significant increases after the implementation of NPTSP : the training system, the general medicine department/general outpatient clinic, and the overall ambience of the SCH staff. The usefulness of the community-based training program showed a 3.77 times higher odds ratio (OR) in male residents (95% CI, 1.31-10.9). Necessity was decreased after the implementation of NPTSP, showing an OR (95% CI) of 2.99 (1.05-8.55).<br><b>Conclusion</b> : Of the reasons why residents selected SCH, the management system for the residency program and the environment for general practice in the hospital became more important after the implementation of NPTSP. The need for a community-based training program in SGH was decreased after NPTSP emphasized primary care.

Development Process of Medical Education Assets Library （MEAL） / 医学教育

  Committee for Information Infrastructure in the 16th term of JSME Board Members was newly created to edit Medical Education White Book issued every four years and to provide sooner and more comprehensive information infrastructure provision. MEAL was opened as a website for medical education information since August 2011. MEAL consists of glossary, articles, books and more resources using a system like Wiki or Blog on the Web. By such technological progress, not only one–way information provision from JSME but also bidirectional communication between JSME members and committees／board members became available. Internationally, similar websites are known, such as MedEdPORTAL by AAMC （Association of American Medical Colleges）, and expected to be new scholarly information added to journals.

Issues to conduct randomized controlled trials in medical education area / 医学教育

1) We conducted a randomized controlled trial in medical education area and explored practical issues through reflection on the processes.<br>2) In February 2007, 39 fourth-year medical students in Nippon Medical School listened to the lecture about how to ask key questions for the diagnosis. Shortly after they had medical interview with a standardized patient for measurement purpose. They were randomly allocated to study and control groups. The lecture content for the intervention group corresponded to the interview but the one for the control group did not correspond to the interview.<br>3) We identified the issues related with ethical review for research, how to mask the information of randomization out of assessors, and equity of educational intervention and assessment offered to both groups.

Improving the quality of physicians in Indonesia through a revised core curriculum and medical licensing system / 医学教育

The Indonesian government and authorities, moving rapidly in 2004 to rectify Indonesia's chronic shortage and regional imbalance in the number of physicians and to improve the standard of medical care, enacted the Medical Practice Act 2004 and established the Indonesian Medical Council (IMC). The IMC drew up a list of standard competencies to be acquired by all medical graduates; on the basis of this list, representatives from the Ministries of Health and National Education, medical school faculties, and the Indonesian Medical Association drew up the National Competency-Based Curriculum, which was subsequently approved by the IMC and adopted by all medical schools. This curriculum markedly improved Indonesia's core curricula for undergraduate medical education. By requiring that the medical competence of all physicians be evaluated before they receive a license to practice and requiring that all physicians renew their licenses every 5 years, the IMC has taken 2 major steps toward ensuring patient safety and improving the quality of medical services.

The transition from student to resident: A survey about abilities expected fo first-year residents / 医学教育

The interval between undergraduate medical education and graduate medical education causes residents to become disorganized when they start their first-year residency programs.This disorganized transition may be stressful for residents and preceptors and may cause resident to make medical errors.We performed a pilot study to examine the degree to which program directors agree about the abilities required for the start of the first of year residency.<BR>1) We asked the residency directors at university hospitals and residency hospitals nationwide (343 institutions) to indicate what abilities residents were expected to have at various stages of the residency program.The data received were then analyzed.<BR>2) A total of 134 residency directors (39%) returned the questionnaire.We calculated the percentage (expectation rate) of institutions that reported expected prerequisites at the start of the first year of residency and calculated the accumulated values (cumulative rate) of the percentages.<BR>3) Only 43 (30%) of 141 abilities upon the completion of residency-preparatory programs had a cumulative rate of more than 50%.<BR>4) Domains for which the expectation rate was more than 50% at the start of residency were medicine and related knowledge and practical skills for obtaining physical measurements.<BR>5) Physical examination and practical skills for which the cumulative rate was less than 50% on completion of residency-preparatory programs were those for the reproductive and urinary systems and pediatrics and the insertion and maintenance of intravenous lines and indwelling urinary catheters.<BR>6) Disparities are likely between the abilities of residents and the tasks expected of them upon entry into a residency program.This problem must be urgently addressed through medical education and graduate medical education.

The 12th Ottawa Conference / 医学教育

1) The International Ottawa Conference on Medical Education is one of three international conferences for medical education, along with the annual meetings of the Association for American Medical Colleges and the Association for Medical Education in Europe.<BR>2) Topics addressed at the 12th Ottawa Conference were interprofessional education, faculty development, reflective practice, standard settings for clinical skill assessment, key feature problems, and multisource (360 degree) feedback.

Increase in Knowledge of Ignorance During Problem-Based Learning Sessions: Possible Improvement of Metacognition / 医学教育

To seek longitudinal changes in metacognitive processes through problem-based learning (PBL), we analysed the contents of all comments written reflectively by the third-year students after they finished discussions in each PBL session. After dividing their comments into meaningful units, we focused on two major thematic categories and five sub-categories to be analysed.<BR>1) The number of units decreased significantly (chi-square: p=0.02).<BR>2) Only the proportion of units categorised as “comprehension” in “individual learning” showed significant increase (Bonferroni: p<0.001).<BR>3) Comments in this category stated that “I don't understand so-and-so.”<BR>4) The increase of “comprehension” as they experienced more PBL suggested that students' knowledge of ignorance as metacognition was fostered through sessions in medical PBL.

What Motivates Community Physicians to Participate in Office-based Education? / 医学教育

Increased emphasis on community-based education in medicine requires close collaboration with and cooperation from general practitioners. This study examined what motivates community physicians to participate in office-based education, to explore the most appropriate method for recognizing physicians' efforts and keeping them motivated with their precepting role. A large majority of respondents to a questionnaire survey thought that the opportunity to learn from their own teaching was an important reward. When the preceptors were asked what support would be most appropriate, a teaching certification plaque, continuing medical education courses, and a title were ranked highest, while financial reward was listed as the least important. Considered most essential by community preceptors were constructive feedback from students, medical-school instructors' understanding of the importance of community-based medicine, and the instructors' enthusiastic promotion of primary-care education.

Medical Education in Malaysia / 医学教育

1) Medical education in Malaysia is strongly affected by United Kingdom, which previously governed this area. Malaysia and UK have similarities in admission of high school graduates to medical schools, five-year curriculum emphasising primary care, and certifying graduation by internal and external examiners.<BR>2) Twinning programme is a general trend in Malaysia; offering medical degree from overseas after completing part of the partner school's curriculum in Malaysia.<BR>3) International Medical University, where the author had worked from 2003 to 2005, reveals strong enthusiasm in medical education because it sends students to undergraduate clinical education in 27 different partner medical schools in Western countries, provides hybrid curriculum with problem-based learning in preclinical years, moves towards outcome-based curriculum, and promotes several medical education research projects.<BR>4) Thus, medical education in Malaysia has made significant and innovative progress through severe competition with surrounding areas as well as western countries.

Evaluating an Undergraduate Curriculum for Communication Skills by Assessing Outpatient Satisfaction / 医学教育

A cross-sectional study was performed in the general medicine clinic of Saga Medical School Hospital to evaluate the humanistic quality of the clinical curriculum by assessing Patient satisfaction. The Patient Satisfaction Questionnaire (PSQ) developed by the American Board of Internal Medicine, was translated into Japanese, and 6 of 10 items were selected to evaluate the humanistic qualities of 123 fourth-year medical students who performed medical interviews of 442 patients. The patients rated each PSQ item with a 5-point scale from poor to excellent. The mean PSQ score was 3.38±0.66 (good to very good). The scores for “answering questions” and “giving clear explanations” were significantly lower than were scores for attitudinal aspects. The results suggest that the undergraduate curriculum at Saga Medical School for patient education skills requires further improvement.

Randomized Controlled Trial on "Cardiac Cycle: The First Step" Blinding the Students and the Rater / 医学教育

“Cardiac Cycle: The First Step, ” which discretely, non-ambiguously, and accurately presents basic essential information on the cardiac cycle, was compared with conventional material in terms of educational efficiency. Twenty-six first-year medical students were randomly assigned to either material. The conventional group was presented with a standard textbook with a typical figure and text. The students were blinded as to the origin of the materials. After self-study, the same quiz (30 two-item choice questions asking basic essential information) was given to both groups and was scored by a blinded rater. The number of correct answers was 25.7±3.7 (mean±SD) in the conventional group and 29.4±1.1 in the ‘first-step group’(p<0.01).

The Assessment of Undergraduate Curriculum of Communication Skills Evaluated by Performance Measurement Using Actual Outpatient Satisfaction / General Medicine

<B>OBJECTIVE</B>: To evaluate an undergraduate curriculum of communication skills by measuring satisfaction of outpatients whom final year students had examined.<BR><B>METHODS</B>: Cross-sectional surveys were conducted in General Medicine Clinic (GMC) of Saga Medical School (SMS) Hospital in 1999 and 2001. After the clinical clerkship in wards in fifth year, final year students experienced the two-week GMC clerkship, including seven hours of small group lecture in 1999, but partly converted into eight hours of small group discussion with a tutor in 2001. Six items in American Board of Internal Medicine Patient Satisfaction Questionnaire were selected as a validated instrument and incorporated into repeated measures ANOVA.<BR><B>RESULTS</B>: A total of 177 students were evaluated by 688 outpatients. Overall average score was 3.49+/-0.82. Average score in 2001 was significantly higher than that in 1999 (p<0.001; 3.58+ /-0.76vs 3.36+/-0.87) . The scores of“encouraging and answering questions”and“clear explanations”items were significantly lower than those of other items (3.21+/-0.98 and 3.37+/-0.92; Least Significant Difference) . The interaction between gender and years of curricula (1999 and 2001) was significant (p<0.001) ; female students showed remarkable improvement from 1999 to 2001 (Cohen's delta=0.67) .<BR><B>CONCLUSIONS</B>: Patient satisfaction scores indicated that undergraduate curriculum for communication skills in SMS improved from 1999 to 2001. Newly implemented small group discussion was a possible reason for the improvement, especially in female students. Further training for the skills of encouraging and answering questions and clear explanations will be the next step.

Humanistic Quality Ratings for Medical Students: an Association with Actual Patient Satisfaction in a Outpatient Clinic / General Medicine

PURPOSE: To determine whether faculty humanistic quality ratings for medical students in an Objective Structured Clinical Examination (OSCE) are associated with student OSCE scores and actual patient satisfaction in a university hospital outpatient (general internal medicine) clinic.<BR>METHODS: Our study was conducted on final-year (sixth grade) medical students in 1998. Forty medical students took the OSCE and were evaluated by faculty internists for humanistic qualities during OSCE sessions. Patient satisfaction ratings for students were also obtained in an outpatient clinic by using six items from the American Board of Internal Medicine Patient Satisfaction Questionnaire (PSQ) . A total of 40 students were evaluated by 117 patients. A multiple regression analysis was used for this study.<BR>RESULTS: In the OSCE, faculty humanistic quality ratings for students were associated with interview skills (p=0.004), but not with physical examination scores nor students' gender. However, patient satisfaction ratings were not statistically associated with faculty humanistic quality ratings for students, other OSCE scores nor with patients' demographic characteristics such as age, sex, occupation and education levels.<BR>CONCLUSIONS: Faculty humanistic quality ratings for medical students taking the OSCE were not significantly associated with patient satisfaction at the outpatient clinic in our study.

Objective Structured Clinical Examination for Essential Neurological Examination. Validation and Association Between the Score and the Learning Behaviors / 医学教育

Objective: To investigate the role and validity of the objective structured clinical examination (OSCE) for neurological screening (Neuro-OSCE) performed by medical students and to analyze the association between Neuro-OSCE score and student behavior for acquiring skills. Method: A 31-item Neuro-OSCE was created for systematic and time-saving screening of neurological findings. At Saga Medical School, 44 final-year students took a screening neurological examination course and performed Neuro-OSCE from August through October 1998. A questionnaire asked about self-educational behaviors, such as self-evaluation, mental concentration, and self-learning (knowlege-based), and self-practicing time. The relationship between Neuro-OSCE score and self-educational behaviors were analyzed. statistically. Results: Cronbach's coefficient alpha was 0.731, which indicated fair internal validity. The mean Neuro-OSCE score was 51.2± 6.6 (SD). Neuro-OSCE score was correlated with self-practicing time and mental concentration but not with self-learning time or self-evaluation. Conclusion: Our Neuro-OSCE has construct validity in the psychomotor domain from a taxonomic viewpoint because the Neuro-OSCE score was correlated with self-practicing time rather than self-learning time. Mental concentration was better a self-assessment method than was self-evaluation. However, setting self-educational goals for neurological examination is probably too difficult at the undergraduate level. Objective assessment by Neuro-OSCE is expected to foster relevant learning behavior.

The Role of On-Call Duty at the Tenri Hospital Emergency Department in Clinical Training in a General Outpatient Setting / 医学教育

Objective: To investigate the role of postgraduate clinical training at the emergency department of Tenri Hospital in teaching the diagnostic process in the general outpatient department.<BR>Method: Patients seen by 11 first-year residents at the emergency department were consecutively registered with summary sheets. Further information was added, and an analysis was performed of: 1) the distribution of chief complaints in the emergency and general outpatient departments and 2) initial diagnoses and the diagnostic process in the emergency department and the final diagnoses.<BR>Results: The distributions of chief complaints in 89 cases in the emergency department and in 183 cases in the general outpatient department were closely correlated (p=0.0016). Diagnoses in the emergency department were correct in 58% of cases. Treatment was incorrect in 3% of cases.<BR>Conclusion: The distributions of chief complaints in the emergency and general outpatient departments were similar. In our hospital the emergency department plays a major role in postgraduate clinical training by teaching the diagnostic process for the general outpatient department. Clinical management, including decision making for further tests and consultation, in the emergency department by first year residents did lead to any major adverse events.