Mobile medical services and experiential learning in community-based clinical clerkships enhancing medical students’ positive perceptions of community healthcare / Journal of Rural Medicine

Objective: Previous studies have investigated medical students’ interest in family medicine, as well as their intentions to work in rural areas after taking part in community-based clinical clerkships. Community-based clerkships are designed to teach medical students community healthcare and to increase the number of physicians working in rural communities following their graduation. However, few studies have examined which clerkship experiences, specifically, enhance medical students’ positive perceptions on community healthcare. This study aimed to examine the association between experiential learning in community-based clerkships and students’ positive perceptions on community healthcare.Patients and Methods: From 2015 to 2017, we conducted a questionnaire survey of 290 final year medical students, before and after completion of their community-based clerkships. The survey asked the students about their perceptions (categorized into “Worthwhile” and “Confident”) of community healthcare and experiential learning during their clerkships. We assessed 13 medical learning areas involving healthcare, medical care, welfare, and nursing care practice. Multivariable logistic regression was used to evaluate the factors associated with positive student perceptions.Results: Of the 290 students, 265 (91.3%) completed both the pre- and post-questionnaires. Of these, 124 (46.8%) were female, 67 (25.2%) were from small towns (of <100,000 people), and 87 (32.8%) selected clinical clerkships within depopulated areas. A total of 205 (73.3%) students reported positive perceptions on community healthcare. There was a significant association discovered between students’ positive perceptions on community-based healthcare and them taking part in experiential learning in mobile medical services (43 [16.2%] students experienced mobile medical services—adjusted odds ratio 6.65, 95%, confidence intervals 1.67–26.4, p = 0.007).Conclusion: Medical students’ positive perceptions on community healthcare were discovered to be associated with them taking part in experiential learning in mobile medical services during their community-based clerkships.

Primary care physician practices, recommendations, and barriers to the provision of routine and voluntary vaccinations in Japan / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : Recommendations from healthcare providers are considered by vaccinees and their parents when they decide whether to receive an immunization. However, in Japan, the attitudes of primary care physicians toward vaccination are unknown. We assessed some practices and recommendations of, and barriers to, primary care physicians regarding vaccinations in Japan.<br><b>Methods</b> : A self-administered questionnaire was mailed (in 2012) to 3000 randomly selected physician-members of the Japan Primary Care Association. Excluded were physicians within two years after graduation, living abroad or retired. We described respondent practices, recommendations, and barriers to the provision of routine and voluntary vaccinations.<br><b>Results</b> : The overall response rate was 25.8%. The rates at which physicians gave routine and voluntary vaccines in their own practices were 29.0-91.4% and 15.2-89.5%, respectively. The vaccine recommendation rates for routine and voluntary vaccines were 58.2-70.2% and 14.1-50.9%, respectively. The physicians reported that their barriers to recommendation of routine vaccines were vaccination schedule complexity (32.9%), opinions of vaccinees and parents (28.9%), and vaccine safety (27.7%). They also reported that perceived vaccine safety (62.1%), lack of understanding of vaccine-preventable diseases (55.7%), and complexity of vaccine schedules (44.4%) were reasons given by vaccinees and parents for noncompliance. Physicians' barriers to recommendation of voluntary vaccines were cost (45.3%), safety (35.1%), and lack of information (30.1%). They reported that vaccinees and parents expressed concern about cost (61.8%), safety (51.8%), and lack of vaccine information (50.7%).<br><b>Conclusion</b> : We clarified practices, recommendations, and barriers to primary care physicians regarding routine and voluntary vaccination in Japan.

A blended learning program providing core competency in clinical research / 医学教育

  In Japan, few health care professionals have a basic understanding（core competency）of the design of clinical research and statistical analysis. We developed a blended distance–learning program comprising face–to–face lectures with e–learning for busy health care professionals who work in the clinical settings to achieve core competency in clinical research. The purpose of this study was to examine the educational effects of this program.<br>1）Four months after the end of the program, 64％ of the participants had started to conduct clinical research.<br>2）This program may increase the number of research colleagues that can discuss clinical research.<br>3）This program could enhance the confidence（self–efficacy）of health care professionals in clinical research.

The Policy of Full Subsidy for Six Voluntary Vaccinations and Community Education in Horokanai Town ; Effects on Vaccine Coverage / 日本プライマリ・ケア連合学会誌

 In Horokanai town, Hokkaido, the policy of full subsidies for voluntary vaccinations against influenza, haemophilus influenzae type b (Hib), varicella, mumps, pneumococcal for children and human papillomavirus (HPV) was introduced between 2008 and 2010. A campaign for community education about vaccination was initiated.<br> Vaccination coverage improved after the subsidy as follows : influenza vaccination increased from 57.4% to 60.1%, Hib from 2.9% to 52.2%, varicella from 0% to 30.0%, mumps from 2.8% to 38.2%, pneumococcal for children from 1.3% to 50.6%, and HPV from 0% to 81.3%.