8. Learning Assessment and Good Practice (2) / 医学教育

In the 2022 Model Core Curriculum for Medical Education in Japan, "Chapter 3, Educational strategies and assessment" section II. "Learner Assessment," consists of three parts : II-1. Approaches to learner assessment, II-2. Assessment methods, and II-3. Questions about learner assessment. Based on the idea that "the way assessment is done varies from institution to institution," the answer to the "Question" is deliberately not included. We hope that readers will refer to this chapter when planning learning assessments in curriculum development while considering the curriculum's background and context.

Recent Trends of Medical Education Reforms in United Kingdom: / 医学教育

Background: Globalization urges us to discuss rationale and policy towards establishing a medical education accrediting body in Japan. Experience of General Medical Council （GMC） suggests us some useful lessons.<br>Method: Based on our visits and investigation into in GMC, we inquire how Quality Assurance （QA） was introduced in UK with what incentives and how QA has brought reforms in the medical schools in UK.<br>Result: Since 2003, GMC has changed its policy for QA from ‘inspection’ to ‘dialogue’. Dialogical QA asks a medical school to think critically of their education and consider vigorous actions for further improvements.<br>Discussion: Implications from the experience of GMC are: 1.QA process in GMC makes medical schools take robust steps towards changes, 2. Sharing the rational and policy for QA created the solid base for its effective implementation, 3. There are possible difficulties in establishing structure to do an enormous amount of coordinating work, which is necessary for constructing ‘dialogue with medical schools’.

Feedback for inappropriate behavior of medical students in early clinical exposure / 医学教育

<br>Background: Some early clinical exposure programs in the community have been implemented in our medical school from years 1 to 3: community service for the handicapped in year 1, care for severely handicapped children in year 2, and health care at home with district nurses in year 3. The directors of these programs informed us, in feedback reports, of the inappropriate behavior of medical students. We then provided feedback directly to the students. We investigated the changes in student behavior after feedback during the 3 years they participated in these programs.<br>Methods: We analyzed the feedback reports from these 3 early clinical exposure programs from 2009 to 2011. Inappropriate behavior of medical students and changes in behavior were recorded.<br>Results: Inappropriate behaviors reported were: 1） lack of essential learning behavior, 2） lack of positive attitude and acceptance of learning in the programs, and 3） lack of communication skills. The numbers of students who received feedback about inappropriate behaviors were 26 in year 1, 11 in year 2, and 2 in year 3. Feedback to students from early clinical exposure programs may lead to changes in their behavior.

What do medical students learn from home care practice? / 医学教育

Objectives: This study aimed to investigate what third–year students of the J University School of Medicine had learned in home care practice.<br>Methods: We analyzed the students’ reports and focused on the description of the learning for the practice. We extracted the category of learning using qualitative content analysis.<br>Results and Conclusion: The core categories we extracted from the analyses were: 1） characteristics of home healthcare, 2） patients, 3） families, 4） home–visiting nurses, 5） medical treatment teams, 6） frank remarks of medical students and physicians, and 7） necessities as a physician. The frank remarks of medical students and physicians included the distrust of physicians and the hopes of medical students. The students gained valuable experience from this practice. In particular, learning about the distrust of physicians and the hopes of medical students may be difficult without such practice.

Consideration of the validity of glycemic index using blood glucose and insulin levels and breath hydrogen excretion in healthy subjects

Although glycemic index [GI] is very important in choosing appropriate foods for patients with diabetes mellitus, GI itself does not provide sufficient information for choosing adequate foods. The validity of GI is considered by measurement of blood glucose and insulin levels, and breath hydrogen excretion, testing several cultivars in the same type food. Twelve females, 23.8 y participated in this within-subject, repeated-measures study. To clarify variations in GI in inter-cultivars of various foods, we examined four white rice and three potato cultivars and three noodle brands. Starchy-foods with a glucose equivalent of 50 g were repeatedly and randomly given to each subject. Blood and end-expiration were collected at selected periods. The significant difference of GI and insulinemic index [II] was not observed among the four white rice cultivars, though II of one cultivar were smaller than those of other three white rice cultivars. GI of three potato cultivars was relatively small, but the range of II was very large among three cultivars. Moreover, GI did not correspond to II among three noodle brands. AUC-3 h-glucose and ALJC-3 h-insulin scores of white rice and noodle were significantly larger than those for 2 h. The amount of breath hydrogen excretion showed a negative correlation to GI of tested foods. We should recognize that rare foods in which GI does not correspond to II exist in the cultivar of foods used for diet therapy of diabetes mellitus. We propose the addition of other information such as II and breath hydrogen excretion of selected foods

EFFECT OF REGULAR AEROBIC EXERCISE AND MENSTRUAL CYCLE ON CAROTID ARTERIAL STIFFNESS IN YOUNG FEMALE / 体力科学

Increased carotid arterial stiffness is associated with a risk factor of congestive heart failure. Thus factors that affect carotid arterial stiffness are of both physiological and clinical interest. The purpose of the present study was to examine the effects of regular aerobic exercise and menstrual cycle on carotid arterial stiffness in young female. The carotid β-stiffness index, an index of carotid arterial stiffness, was assessed in eight young female athletes (20.5 ± 0.4 years) and ten young female control subjects (21.3 ± 0.7 years). The carotid β-stiffness index was determined using ultrasound images of the common carotid artery with simultaneous recording of carotid arterial blood pressure by applanation tonometry. There was no difference in carotid β-stiffness index between the control and the athlete group both at the early follicular and the pre-ovulation phase of the menstrual cycle. On the other hand, the carotid β-stiffness index decreased from the early follicular phase to the pre-ovulation phase both in the control and the athlete group. These results suggest that carotid arterial stiffness in young females is not affected by regular aerobic exercise, but changes with the menstrual cycle, irrespective of exercise status.

Changes in Cardiac Autonomic Nervous Activity During Menstrual Cycle of Young Women / 体力科学

The purpose of this study was to evaluate the function of cardiac autonomic nervous activity and post-exercise vagal reaction during the menstrual cycle. The subjects were healthy young women (n=13, age 19.9±0.6 years) with normal menstrual cycles. Power spectral analysis of heart rate variability was used to examine cardiac autonomic nervous activity. In addition, the time con stant of heart rate decline for the first 30 sec (T<SUB>30</SUB>) after exercise was used to examine post-exercise vagal reactivation.<BR>Results show that the cardiac autonomic nervous activity changes during the menstrual cycle. Also, T<SUB>30</SUB> shows significant change during the menstrual cycle, especially T<SUB>30</SUB> retardation in the early luteal phase. These results suggest that an imbalance of estradiol and progesterone hormones may be responsible for these changes in cardiac autonomic nervous activity during the menstrual cycle.

Serum steroid hormone responses to acute resistance exercise / 体力科学

[Objective] The aim of this investigation was to evaluate serum steroid hormone responses to acute resistance exercise. [Methods] Subjects were young healthy males (n=6) and females (n=6) . Each group performed three sets of 10 leg press and 10 bench press exercises at an intensity of their individual 10-repetition maximum (1ORM), with 1 min rest between sets. Blood samples were collected before (Pre-Ex) and immediately following the exercise (P0), 30 mm (P30), 60 mm (P60), and 24 hours (P24h) after the exercise. Levels of blood lactate, serum testosterone, dehydroepian drosterone sulfate (DHEAS) and cortisol were determined. [Results] The levels of blood lactate in males and females significantly increased at P0 and P30 compared with Pre-Ex (p<0.05) . In males, the serum level of testosterone significantly increased at PO (p<0.05), whereas in females, it significantly decreased at P0, P30, P60, P 24 h. (p<0.05) . The level of DHEAS significantly increased at P0 in both males and females (p<0.05) . [Conclusion] The change in the level of testosterone was different between males and females, but that of DHEAS showed a similar pattern for both sexes. The data suggest that DHEAS could be a useful indicator for evaluating the anabolic status of acute resistance exercise in females.