ABSTRACT
BACKGROUND: Japanese family physicians have limited psychiatric training, see a large volume of patients, and would benefit from the use of a mental-health screening tool. This study was an initial investigation into the feasibility and validity of using the Patient Health Questionnaire (PHQ) in the primary care setting in Japan.<BR>METHODS: Feasibility was determined by surveying 149 patients from three primary care practices. Of this sample, a Japanese psychiatrist interviewed 98 participants to assess the validity of the PHQ. Based on the psychiatrist's results, sensitivity, specificity, positive predictive value, kappa statistic and the Likelihood Ratio were examined.<BR>RESULTS: Some 83% of patients reported being “comfortable” in filling out the PHQ. Physicians (82%) reported that the information provided was “valuable” in understanding and treating the patient. The sensitivity of the PHQ in detecting any mental diagnosis was 93%, specificity was 81%, and the positive predictive value was 47%. In subjects with mood disorders, sensitivity was 75%, specificity was 88%, and the positive predictive value was 47%. The kappa reliability coefficients between the PHQ and psychiatrist diagnoses were 0.53 for any mental disorder and 0.51 for any mood disorder. In the case of any mental disorder, the Likelihood Ratio of a positive test (LR+) for the PHQ was 4.8. In the case of any mood disorder, the LR+ for the PHQ was 6.5.<BR>CONCLUSIONS: The Japanese version of the PHQ was useful for detecting mental and mood disorders.
ABSTRACT
Objective: To investigate whether postgraduate education through evidence-based medicine can affect the knowledge and behavior of residents.<BR>Design: Self-controlled and externally controlled trial.<BR>Setting: University hospital.<BR>Participants: Fifteen residents specializing in family medicine.<BR>Intervention: Four 2-hour seminars and weekly evidence-based medicine-style journal club meetings.<BR>Main outcome measures: Scores from a test of knowledge of evidence-based medicine and the number of MEDLINE searches conducted each month.<BR>Results: All residents improved their knowledge of evidence-based medicine and conducted more MEDLINE searches each month than did other medical residents or residents of our department last year.<BR>Conclusion: Postgraduate education through evidence-based medicine is effective in improving residents' knowledge and behavior.
ABSTRACT
In 1994, a basic diagnosis training course was introduced for 2nd-year medical students at Jichi Medical School (JMS) to teach basic interview and physical examination skills with an emphasis on diagnostic processes and principles. In planning and preparing the course, instructors at JMS frequently held discussions to determine learning objectives and activities. We used a comprehensive manual for small-group teaching to standardize lectures as much as possible. In all sessions of the basic physical examination, students were taught in small groups. We also constructed original models to teach palpation and percussion. These models allowed students to participate actively and helped them understand the principles, skills, and findings of palpation and percussion. Instructors at JMS concluded that the models were useful training tools.
ABSTRACT
The Jichi Medical School has trained doctors for work in community health care for over 20 years.Students learn medical communication skills by role-play. In this role-play, doctors and patients areplayed by students. Discussions are also held by students. The teaching staff give additional explanations, suggestions and demonstrations. By themselves, students learn about 1) general practice, 2) theprocess of consultation, 3) medical communication and 4) patients' emotions. We plan to develop othereducational resources such as trained simulated patients.