Family Involvement by Japanese Family Physicians in Their Clinics: The Second Report of a Focus Group Discussion / 日本プライマリ・ケア連合学会誌

Objective: To clarify the involvement of Japanese family physicians with patients and their families in their daily practice.Methods: Participants were Japanese family physicians with over one year of experience of full-time work in their clinics, and who were able to join the focus group discussions (FGD) and member checks. The study employed a qualitative research design with semi-structured FGD. Two analysts examined video recordings of the FGD, and the results were verified through member checks and external checks.Results: Eight physicians participated at first, but five of them dropped out because of job commitments or death. The involvement by Japanese family physicians consisted of three stages. The first stage was "the approach of repeated hypothesis testing and normalizing" as safety interventions. The second stage was "reevaluation of the family" utilizing family genograms, family conferences, and others. After exhausting all other efforts, they engaged in "accepting the one who comes to them" in collaboration with the patient and families. The outcomes included awareness of patients, their smiles due to feeling accepted, and their expressed emotions. They did not explicitly boast that they were able to engage with family members. In addition, they also needed case studies of instances of "failure." Conclusion: Japanese family physicians engaged in three-stage involvement with families.

Future Roles of Physicians in Medical Education / 医学教育

Changing societal environments are forcing us to prepare to assume new roles as physicians. The resulting changes coming to the practice of medicine require significant medical education reforms. Specifically, there are nine factors that impact this need for change. Those factors are: 1) expanding medical knowledge, 2) introduction of various new technologies into medicine, 3) easy accessibility to medical knowledge by patients and their family members, 4) an aging population, 5) rapid development of information and communication technology, 6) the imminent arrival of artificial intelligence, 7) specialization of physicians, 8) variety of health professionals, and 9) globalization-.

How and When Do Japanese Family Physicians Assess Family in Their Clinics?: A Preliminary Initial Report from a Focus Group Discussion / 日本プライマリ・ケア連合学会誌

Objective: To clarify how and when Japanese family physicians assess families in their daily practice.Methods: Participants were Japanese family physicians with over one year of experience of full-time work in their clinics, and who were able to join the focus group discussions (FGD) and member checking. The study employed a qualitative research design with semi-structured FGD. Two analysts examined video recordings of the FGD, and the results were verified through member checking and the checking by external members.Results: Physicians assessed families naturally while examining patients for common cold, during vaccination, and during registration in the Japanese care insurance system.Additionally, the physicians assessed the families when they observed or suspected something strange regarding the patient and/or the family.Families were assessed based on how they spent their time during special Japanese events that the family members attended together (e.g., Bon festival or Japanese style New Year holidays), the patient's illness behavior in non-reserved outpatient clinics, and their communication patterns. Furthermore, the family photograph technique for family therapy was also used for assessment.Conclusion: Participants utilized skills of family therapy such as communication patterns and family photographs. They also employed unique skills such as assessment of the families' sharing time during traditional events, assessment of the patient's illness behavior, and general assessments regarding the Japanese care insurance system.

What are the benefits of simulation training with simulated patients? / 医学教育

Introduction: Consultation simulation with simulated patients has rarely been done as a training program.<br>Method: Fifth-year medical students in 2 neighboring universities attended the same training program at each site. The students’ performance was evaluated.<br>Result: Most medical students thought that this training program was valuable and that they require more opportunity to practice. Students evaluated their own performance in both medical procedures and differential diagnosis as being poor. However, about 50% of students felt that they paid careful attention to the simulated patient during physical examination. Students thought that the consultation was extremely realistic and that the series of medical procedures they performed at the first attempt was extremely difficult but increased their motivation. They thought that the feedback they received from simulated patients was beneficial.<br>Discussion: This education program is highly regarded by students and is suggested to be versatile.

Knowing the Patient Better : How Facilitated Sharing of Diabetes Patients' Life Stories Enhances Patient-Physician Relationships but not Metabolic Control / General Medicine

<b>BACKGROUND</b>: The patient-physician relationship and patient self-management are important in controlling diabetes mellitus. This pilot study assessed the value of patients sharing their stories with physicians.<br><b>METHOD</b>: Twelve patients and two physicians participated. Patients told their life stories to a co-medical interviewer, and these were transcribed and summarized in their medical charts. The physicians read the transcripts. The intervention was evaluated by questionnaire and interviews with the patients and physicians. Two coders qualitatively analyzed the interviews. Glycated haemoglobin (HbA1c) and body weight were examined before and six months after the intervention.<br><b>RESULTS</b>: 75% of patients felt an improvement in the physician's empathy, advice and ability to share the patient's problems. Physicians reported an improved relationship with 40% of the patients. The patient interview identified: 1) facilitated self-reflection; 2) encouraged self-efficacy; 3) changed perceptions about health-care related behavior; and, 4) difficulties in changing behavior. However, improvement in HbA1c levels and body weight was not significant.<br><b>CONCLUSIONS</b>: The patients were satisfied that sharing their stories improved self-reflection and self-efficacy, but found it difficult to adopt healthier options for managing their diabetes. Long-term study of whether improved physician communication skills will enhance outcomes is needed.

Knowing the Patient Better: How Facilitated Sharing of Diabetes Patients' Life Stories Enhances Patient-Physician Relationships but not Metabolic Control / General Medicine

<b>BACKGROUND</b>: The patient-physician relationship and patient self-management are important in controlling diabetes mellitus. This pilot study assessed the value of patients sharing their stories with physicians.<br><b>METHOD</b>: Twelve patients and two physicians participated. Patients told their life stories to a co-medical interviewer, and these were transcribed and summarized in their medical charts. The physicians read the transcripts. The intervention was evaluated by questionnaire and interviews with the patients and physicians. Two coders qualitatively analyzed the interviews. Glycated haemoglobin (HbA1c) and body weight were examined before and six months after the intervention.<br><b>RESULTS</b>: 75% of patients felt an improvement in the physician's empathy, advice and ability to share the patient's problems. Physicians reported an improved relationship with 40% of the patients. The patient interview identified: 1) facilitated self-reflection; 2) encouraged self-efficacy; 3) changed perceptions about health-care related behavior; and, 4) difficulties in changing behavior. However, improvement in HbA1c levels and body weight was not significant.<br><b>CONCLUSIONS</b>: The patients were satisfied that sharing their stories improved self-reflection and self-efficacy, but found it difficult to adopt healthier options for managing their diabetes. Long-term study of whether improved physician communication skills will enhance outcomes is needed.

Community-Oriented Undergraduate Medical Education / 医学教育

1) Many medical schools in Australia are adopting curricula that encourage medical students to understand the community and the importance of community-based medicine.<br>2) Flinders University has successfully created and implemented a curriculum in which medical students spend time in small community hospitals and clinics during their third year.<br>3) Although there are many types of community-oriented medical education, we must consider what kind of medical education would increase the quality of community medicine in Japan.

Effects of Medical Student Gender on Communication during Objective Structured Clinical Examination Medical Interviews / 医学教育

This study aimed to assess how the gender of medical students affects their communication styles and those of simulated patients (SPs) during objective structured clinical examination medical interviews in Japan. <br>1) Medical interviews conducted by 82 fourth-year medical students (53 male and 29 female) at Nagoya University School of Medicine were analyzed by means of the Roter Interaction Analysis System.<br>2) Compared with male medical students, female medical students engaged in significantly more emotionally focused talk, particularly empathy, and asked more open-ended questions. <br>3) With female medical students, SPs engaged in significantly more social talk (personal remarks), gave more biomedical information, and made more total utterances than they did with male medical students.<br>4) The gender of medical students significantly affected their communication styles and those of SPs. (127 words)

Three essential conditions to cultivate physician scientists / 医学教育

1) We conducted a workshop to discuss the definition of the term "physician scientist", what thought processes and competencies are expected, and how to better help physician scientists develop through medical schools.2) The definition of a physician-scientist is a physician who both provides patient care and approaches unsolved questions in understanding the mechanisms of diseases and developing new treatments.3) Essential conditions for a medical school to cultivate physician scientists include providing good role models for physician scientists, making efforts to stimulate students' motivation, and supporting collaboration among physicians and scientists on the faculty.

Future use of skills laboratories at Medical Schools in Japan: how to transform these into effective educational departments? / 医学教育

1)Leaders of skillslabs at Japanese medical schools are concerned about the future of skillslabs.2)The way skillslabs are presently used in Japan is not in accordance with current evidence on teaching skills.3)We present a stepwise process to bring Japanese skillslabs in line with the standards of 2009.

Activities and attitudes of standardized patients in the objective structured clinical examination: The second report of a nationwide survey / 医学教育

The role of standardized patients (SPs) has developed rapidly over the last10years because of medical education curriculum reform and the introduction of the objective structured clinical examination (OSCE). As the participation of SPs in medical education has increased, the anxieties and frustrations of SPs have also increased. We believe that an understanding of the attitudes of SPs would improve the quality of their activities. The purpose of this survey was to study the activities and psychological needs of Japanese SPs in the OSCE.<BR>1) The response rate to the nationwide survey was62% (332of532SPs).<BR>2) Role-playing and group discussion were the most common training methods, and the length of training varied from 0 to 40 hours.<BR>3) The factors that SPs felt difficult were judging how much to respond in their performances (73%) and maintaining consistent standards in evaluating examinees (66%).<BR>4) Our results suggest that SPs require more training and that the number of SP educators should be increased.

Demographic characteristics of standardized patients (SPs) and their satisfaction and burdensome in Japan: The first report of a nationwide survey / 医学教育

SPs have made a dramatic development in medical education over 10 years, due to the influence of medical education curriculum reform and the introduction of the Objective Structured Clinical Examination. However the quality of SPs' activities varies. In order to increase the quality it is necessary to analyze the psychological needs of SPs. The purpose of this survey is to explore SPs' personal characteristics and how they feel during their activities.<BR>1) In a nationwide survey of Japanese SPs, 332 SPs (62%) out of 532 responded.<BR>2) Sixty percent of SPs were between the ages of 50 and 69 years and the ratio of male to female SPs was 1: 4. The ratio of workers and non-workers was 1: 2.<BR>3) A qualitative analysis found that SP motivations were derived mainly from making a contribution to society and self-improvement. Ninety six percent of SPs were satisfied with being an SP, especially when they saw improvements in the students.<BR>4) However, 67% of SPs expressed difficulty with the three core skills of feedback, evaluation and performance.

A Pilot Study of Medical Students' Medical Interview and Physical Examination Practice with Simulated Patients / 医学教育

Objectives: To investigate future directions of medical interview and physical examination practice (MIPEP) with simulated patients and to clarify its educational meaning for medical students. Design: Qualitative design using 8 focus groups before and after MIPEP with simulated patients (4 pre-MIPEP and 4 post-MIPEP). Methods: Nine simulated patients and 10 medical students participated. Four physicians served as facilitators. Each student practiced consultation, including two medical interviews and physical examinations (of one male and one female simulated patient), for 15 minutes. After every consultation, students had a 15-minute feedback session with a simulated patient and a facilitator. All simulated patients and students participated in both the pre-MIPEP and post-MIPEP focus groups. Results: Through pre-MIPEP and post-MIPEP focus groups, medical students realized that an appropriate disposition and talking with patients during physical examination are helpful. MIPEP with simulated patients helps students to gain confidence before clinical practice. Simulated patients found that the value of MIPEP with simulated patients for medical students was increased by thorough course preparation and by the simulated patient's training and motivation, which was affected by the students' attitudes to MIPEP with simulated patients. Conclusion: MIPEP with simulated patients is valuable for teaching the appropriate disposition towards patients, including making physical contact and talking with patients as fellow human beings. When the students' attitudes satisfy the simulated patients, MIPEP with simulated patients can become a powerful educational method.

Qualitative Analysis of How Simulated Patients Perceive Physical Examinations / 医学教育

Objectives: To investigate how simulated patients perceive physical examinations. Methods: Simulated patients, who were members of the Nagoya University Simulated Patient Society, were divided into two groups according to age, one group in their 40s and one in their 60s, and interviewed about their perceptions of physical examinations. A coding scheme was used to organize the data in thematic categories and extracted concepts. Results: Both groups believed that: 1) training in physical examination is essential for medical students and 2) communication between a patient and a physician during physical examination is important. The 60s group had positive “attitudes” and less “hesitation” in terms of physical examination, whereas the opposite was true for the 40s group. As for “acceptable body parts, ” there was a greater degree of acceptance among the 60s group, whereas the “students' sex” affected the 40s group but not the 60s group. Conclusion: The results suggest that simulated patients can participate in physical examination education, providing each simulated patient's preferences are considered.

Desirable Educational Environment for the Better Clinical Clerkship / 医学教育

In order to implement, or enhance the quality of clinical clerkship, it is necessary to develop good educational environment which will be appropriate to allow medical students participate in medical team services. Important things to be considered will be, (1) Systematic management of the individual department's program by the faculty of medicine, (2) Developing educational competency within the medical care team function, and (3) Nurturing students' awareness forself-diected learning and cooperative team work, and teaching- and medical staffs' awareness of their educational responsibilities. In this paper, to develop better educational environment for clinical clerkship, we propose a desirable situation of the educational organization, dividedly describing on the roles of dean, faculties, board of education, department of medical education, clerkship director, teaching physicians, residents and medical students.

Evaluation of the Model Core Curriculum for Clinical Clerkship / 医学教育

In March 2001, Research and Development Project Committee for Medical Educational Programs proposed a model core curriculum for undergraduate medical education. In this curriculum, implementation of the clinical clerkship is strongly recommended. Two similar curriculum models were later presented by other organizations, and some differences were observed among them. We, Undergraduate Medical Education Committee, have evaluated and compared themodel core curriculum 2001 with the Japanese newer proposals as well as those of USA and UK. Here is reported our proposals for a better rewriting of the learning objectives in the model core curriculum 2001, with some emphasis on the nurture of the competence of the case presentation and decision making process.

Developing a General Medicine Residency Curriculum: Lessons Learned from Family Practice Residency Training in the United States / 医学教育

Systematic residency education curricula can provide students and residents opportunities to learn a broad range of clinical skills. One curricular model for Japanese general medicine departments <I>(sogoshinryo-bu)</I> is family-practice residencies in the United States. The values of family practice include first-contact care, continuity, comprehensiveness, coordination, community health, and care of the person. The precepting system is the pillar of resident education and provides the structure for physician-teachers to guide a medical school graduate to become a competent family physician by the end of 3 years of clinical training. Family-practice centers, community-based clinics where university faculty and residents provide care, have a proven record in the United States as clinical classrooms for teaching the values and skills needed for high-quality primary care and could greatly facilitate practice-focused training in Japan.

Opinions of the Medical Faculty on Student Evaluations of Faculty Teaching / 医学教育

Medical students in the second to fifth years evaluated all classroom lectures and laboratories in 1998. To clarify the faculty's opinions on student evaluations, in 2000 a questionnaire survey was given to 420 members of the teaching staff, of whom 137 (33%) responded. One hundred three (81.1%) instructors immediately checked the questionnaires after the classroom lecture or laboratory session, of whom 100 reported that the questionnaires were helpful for preparing subsequent lectures. One hundred nine faculty members replied that student evaluations of faculty teaching were meaningful, and 109 supported similar surveys in the future. Although conducting surveys of many students requires considerable time and cost, an effective feedback system plays an important role for both faculty and students.

Experiences, Strategies, and Principles of Clinical Clerkships: Comparisons and Observations about the United States and Japan / 医学教育

The Ministry of Education, Sports and Culture has taken increasing interest in the usefulness and importance of clinical clerkships for 5th-and 6th-year medical students. This paper is the product of a symposium at the Nagoya University School of Medicine which was convened to examine the role of clinical rotations for medical students in the United States and Japan. This paper contains: an overview of medical education and the role of medical student clinical rotations in the United States; observations on being a clinical clerk in the United States; observations on being a clinical clerk in Japan and experiences of Japanese medical students in the United States; an integrated summary of the problems of clinical rotations in the United States; and experiences of Japanese medical students in clinical rotations in the United States. Clinical clerkship for 5th-and 6th-year medical students can only be developed and implemented with careful thought, significant time, and adjustment to new systems. Nevertheless, adoption of clinical clerkship in Japan has great potential for improving the quality of medical education in Japan.

A Trial of Medical Students Playing Standardized Patients During an Objective Structured Clinical Examination / 医学教育

This study explored the value of using medical students as standardized patients (SPs) during objective structured clinical examinations for the medical interview. Evaluations by both examiners and examinees revealed that the performance of medical students as SPs provided sufficient reality and reproducibility for the objective evaluation of interview skills. The experience also offered medical students playing SPs the opportunity to learn the importance to patients of eye contact and of a sympathetic and reliable attitude on the part of physicians toward their patients during the medical interview. In conclusion, training medical students to serve as SPs for evaluating interviewing skills in the context of an objective structured clinical examination is beneficial to both the person being evaluated and to the medical student serving as the SP.