Investigation of incidents and accidents related to guidance provided to residents / 医学教育

1) A total of 73 incidents and accidents related to guidance provided to residents obtained from data published by the Japan Council for Quality Health Care were investigated.2) These events can be divided into the following three categories: (1) Events that occurred during direct guidance to a resident by a supervising physician, (2) Events that occurred when a resident performed a procedure by himself or herself without the guidance of a supervising physician, although the supervising physician was near the resident, (3) Events that occurred when a resident performed a procedure by himself or herself while a supervising physician was absent.3) Regarding measures to prevent recurrence, the present results suggests that, in addition to the individual efforts of supervising physicians and residents, there is a need for system development through increased cooperation between the postgraduate clinical training center, each section/department and the department of medical safety management.

The investigation of incidents and accidents involving medical residents / 医学教育

1）We examined 111 cases of incidents and accidents involving medical residents which were identified in a search of the database of the Japan Council for Quality Health Care.<br>2）In each case we deduced the root causes, which were then classified into 8 categories.<br>3）To develop strategies to prevent such cases from recurring, we believe that it is essential to develop a variety of training facility systems and to establish collaborative multidisciplinary medical treatment teams. Our results also suggest that consistent undergraduate and postgraduate programs for medical safety education are necessary.

Study of Patient Safety Education for Undergraduates / 医学教育

1) The objective of this study was to investigate patient safety education for undergraduates in Japan.<BR>2) Our survey found that 87.5% of medical schools provided patient safety education for undergraduates.The topics covered were prevention of medical errors, communication, crisis management, and medical ethics.<BR>3) This study found several problems in measurement methods, learning strategies.and human resources of undergraduate medical education.

Re-evaluating the Final Goal in the New Postgraduate Clinical Training System / 医学教育

More than 2 years have passed since the new postgraduate clinical training program was instituted in 2004 to improve the clinical ability of Japanese physicians. However, there have already been discussions about whether the undergraduate curriculum and the postgraduate program should be improved.<BR>After the first physicians finished their training under the new program in the spring of 2006, questions were raised about whether the identical final goals of training could be achieved by transferring some items of postgraduate clinical training to the undergraduate period. Such a change might invigorate the undergraduate curriculum and enhance the effectiveness of the postgraduate program.<BR>1) Are-evaluation of the final goals of postgraduate clinical training might allow some items to be taught during the undergraduate period.<BR>2) Several questionnaires were sent to 211 supervising physicians and 184 first-year residents who had just completed the new internship program at 25 teaching hospitals (university hospitals and postgraduate training hospitals).<BR>3) Both trainees and supervising physicians reacted positively about and expressed a willingness to participate in training items, including noninvasive diagnostic procedures and laboratory studies not harmful to patients, during advanced courses in the undergraduate period.<BR>4) Both trainees and supervising physicians reacted negatively to participating in any invasive procedures that might affect a patient's welfare or sense of shame during the undergraduate period.<BR>5) In the future, training with simulated procedures before actual patients are encountered and enlisting enough supervising physicians are essential for unifying the undergraduate medical school curriculum and postgraduate clinical training programs.

The Primary Care Program of Undergraduate Medical Education / 医学教育

Primary care education is extremely important for undergraduate medical students. We evaluated a primary care program with fifth-or sixth-year medical students at the Hokkaido University School of Medicine from October 2002 through July 2003. The aim of this study was to examine differences in the medical situation between a university hospital and primary care clinics and to determine the importance of primary care. We assessed students' opinions about primary care on the basis of student reports. After completing this program, medical students (30.7%) believed primary care medicine was necessary, recognized the importance of the medical techniques, and were motivated to study primary care medicine (93.6%). The problems of this program were the short schedule and the cost of public transportation. We conclude that this primary care program is extremely effective for teaching undergraduate medical students about primary care medicine.

Combined Early Gastric Cancer with Abdominal Aortic Aneurysm: A Case Report / 日本心臓血管外科学会雑誌

A 70-year-old man was admitted with upper abdominal pain. Endoscopic examination demonstrated early gastric cancer, which computed tomography and ultrasonography showed a 6cm infrarenal abdominal aortic aneurysm and bilateral common iliac artery aneurysms. The patient underwent distal gastrectomy, then 33 days later repair of the abdominal aortic aneurysm and bilateral common iliac artery aneurysms with a Dacron graft via a retroperitoneal approach. The patient had a good postoperative course. There have been many reports on the management of combined gastrointestinal malignancy with abdominal aortic aneurysm. We recommend two-stage operation except in patients at high risk of cardiac or pulmonary complications because of the minimum risk of graft infection, and consider that a retroperitoneal approach is good for aortic surgery in cases with a history of previous transabdominal operations.

Temporary External Bypass during Abdominal Aortic Aneurysm Operation: Two Patients with Heart Failure of Aortic Dissection / 日本心臓血管外科学会雑誌

We report two cases of an abdominal aortic aneurysm, one with congestive heart failure, and the other with a dissecting aortic aneurysm (type IIIb), who underwent an aorto-bifemoral bypass operation under a temporary external axillofemoral bypass. In one patient (Case 1, a 74-year-old male), who had an abdominal aortic aneurysm with congestive heart failure due to aortic valve insufficiency and stenosis, perioperative transesophageal echocardiography demonstrated that, with a temporary external axillofemoral bypass, the regurgitant doppler signal was unchanged during the cross-clamping period of the abdominal aorta. In the other patient (Case 2, a 71-year-old male), who had a dissecting thoracoabdominal aortic aneurysm with the lower abdominal aorta having a true aneurysm formation, the transesophageal echocardiography demonstrated that, with a temporary external axillofemoral bypass, the false lumen of the dissecting thoracic aneurysm had no change in size during the cross-clamping period of the abdominal aorta. Thus, a temporary external axillofemoral bypass might avoid any unfavorable hemodynamic effect during and after the abdominal aortic clamping in patients suffering from an abdominal aortic aneurysm with cardiovascular complications.