A Workshop on Supporting Students with Developmental Disabilities 2023 / 医学教育

With the enactment of the amended Anti-Discrimination Act, which mandates the provision of reasonable accommodations, the urgent task for all health professional education institutions is to establish a support system for students with developmental disabilities. On the other hand, they are also required to fulfill their social accountability through quality assurance in education, such as the implementation of outcome-based education curriculum. In order to consider how to balance reasonable accommodations for students with developmental disabilities, quality assurance in education, and social accountability in undergraduate medical education, Professionalism Subcommittee held a workshop on April 22, 2023. The participants engaged in active discussions during the workshop.　Through a post-workshop survey, educational needs and challenges in supporting students with developmental disabilities were clarified, providing insights for future Subcommittee activities.

Online Symposium Held on June 10, 2023 / 医学教育

In the revised Core Curriculum, professionalism is listed as one of the basic qualities and abilities required of physicians. The definition of professionalism and related learning objectives (1. trust, 2. compassion, 3. liberal arts, and 4. bioethics) are also presented. However, the Core Curriculum does not explain why these objectives were listed. Therefore, some of them are difficult to understand or differ from what has been discussed in previous meetings of the current subcommittee (and previous committees). To properly and effectively advance professionalism education, it is necessary to confirm the contents of the revised Core Curriculum that are insufficient or inappropriate. It is also necessary to deepen the discussion for the next revision of the Core Curriculum. A symposium was held for this purpose. The main points of each lecture are presented within this report.

11. Dealing with Unprofessional Behavior / 医学教育

Dealing with unprofessional behavior may have stages of identification (definition), prevention, discovery, evaluation, remediation, and follow-up. What is an unprofessional behavior? How to avoid it. How to discover it. Why did the behavior occur and what effect did it have? How to remediate the behavior of unprofessional learners and healthcare provider. What happened to them and their behavior after that? Dealing with unprofessional behavior is complex. In addition, there are few opportunities to share concrete examples of dealing with unprofessional behavior, and it is difficult to share know-how on how to deal with it. For this reason, educators are sometimes even exhausted in dealing with unprofessional cases. It is very meaningful to share the response to unprofessional behavior even little by little.

A Proposal for Educational Curriculum on Conflicts of Interest from Undergraduate through Postgraduate and Continuing Health Professions Education / 医学教育

To ensure public trust in health professions, it is imperative for health professionals to understand the concept of conflict of interest (COI) in health professions education and manage it appropriately. However, there are not enough formal curricula on COI in health professions education in Japan. We propose an educational curriculum on COI in health professions education which focuses on relationship between physicians and for-profit corporations. We hope that this proposed curriculum stimulates educational activities on the ground while taking context into account. We also hope the proposed curriculum leads to the formal incorporation of COI in health professions education and educational policies nationwide.

Teaching the Fundamentals of Medical Professionalism / 医学教育

It is said that there is no universal and comprehensive definition of professionalism. This is because there are various factors to consider depending on age, social situation, and medical context. Another reason is that academics differ in how they think about professionalism. This situation has made it difficult to introduce professionalism education. However, it is thought that a certain educational effect can be obtained by promoting education while working with the learner to consider the concept and definition of professionalism based on the social contract that forms the basis of the concept of professionalism and the trust of society. We present examples of teaching the concept of professionalism through the use of concrete examples.

1. White Coat Ceremony Description of a White Coat Ceremony at Aichi Medical University School of Medicine / 医学教育

Abstract:　The first White Coat Ceremony was officially conducted by prof. Arnold P. Gold at Columbia University in 1993. The professor felt that medical students needed more humanism and professionalism. Therefore, he established the Gold Foundation, the sponsoring organization for the White Coat Ceremony. Since then, it has spread across the country. The aim of the White Coat Ceremony is for medical students to understand the meaning of the responsibility associated with wearing the white coats, and to be aware of humanism and professionalism. Although it has been recently introduced in many medical departments in Japan, implementation methods of the White Coat Ceremony.

Survey of Formal Undergraduate Medical Curricula in Japan for Education on Drug Promotion / 医学教育

Introduction: Attention to undergraduate medical education on the relationship between physicians and the pharmaceutical industry has been increasing in North America and Europe. There are no reports, however, regarding this relationship in Japanese medical education.Methods: We conducted a cross-sectional survey using a self-administered questionnaire to investigate formal undergraduate curricula on the relationship between physicians and the pharmaceutical industry.Results: Forty-four of 80 medical schools approved participation in the study, with 16 (36.0%) reporting having a formal curriculum on drug promotion. Many of the themes included in the programs were related to research ethics or conflict of interest in research, with drug promotion covered in only a few programs.Discussion: More discussion and investigation into undergraduate education on the relationship between physicians and the pharmaceutical industry, especially on drug promotion, is warranted.

Survey of Formal Undergraduate Medical Curricula in Japan for Education on Drug Promotion / 医学教育

Introduction: Attention to undergraduate medical education on the relationship between physicians and the pharmaceutical industry has been increasing in North America and Europe. There are no reports, however, regarding this relationship in Japanese medical education.Methods: We conducted a cross-sectional survey using a self-administered questionnaire to investigate formal undergraduate curricula on the relationship between physicians and the pharmaceutical industry.Results: Forty-four of 80 medical schools approved participation in the study, with 16 (36.0%) reporting having a formal curriculum on drug promotion. Many of the themes included in the programs were related to research ethics or conflict of interest in research, with drug promotion covered in only a few programs.Discussion: More discussion and investigation into undergraduate education on the relationship between physicians and the pharmaceutical industry, especially on drug promotion, is warranted.

3. Ten viewpoints regarding education on medical professionalism / 医学教育

<p>　There is no clear definition of medical professionalism, although it has long been discussed. However, it is inappropriate to be preoccupied with the details of its definition. It is more important to understand the basic concept of medical professionalism: a spirit of professionalism developed to gain the trust of patients and society, and implement education on professionalism.</p><p>　In the implementation of education on professionalism, it is important to: consider situation-dependent professionalism, focus on its relationships with society as well as individuals, and take into account the attributes of both professional and profession. Education on professionalism should encourage learners to reflect and establish their own identity as professionals, rather than placing an emphasis on education based on the norms, which are centered on lists of behaviors and competencies.</p>

9. Goals of a workshop / 医学教育

<p>　The paper reports a summary of the second session: "Educational strategies: Presentation of cases and SGD + group discussion" of the workshop: "Establishment of a consensus on education on professionalism" . The participants in the session set a goal as a milestone at each of the following stages of professionalism competence, presented educational strategies to accomplish them, and held discussions with each other: (1) Immediately following admission to the university, (2) Junior medical students, (3) Preclinical education, (4) Clinical clerkship, (5) Curriculum for students in multiple school years (for six years) , (6) Clinical training, (7) Life-long education.</p>

Coping with uncertainty and complexity of primary care practice / 日本プライマリ・ケア連合学会誌

Uncertainty and complexity remains prevalent throughout the practice of medicine. Primary care physicians often experience uncertainty and complexity in their practice because they encounter the wide variety of patients. Coping with uncertainty and complexity is one of the important competence of a physician, and it is one of the attributes of medical professionalism. Tackling uncertainty and complexity is a strong learning chance for physicians and it makes them grow. Using Cynefin framework and good doctor-patient communication with shared decision making are effective strategies for handling medical uncertainty and complexity.

Pharmaceutical industry support for junior residency education in Japan : a national survey of program directors / 医学教育

  To examine the status of pharmaceutical industry support for junior residency education in Japan, we performed a questionnaire survey of 445 residency program directors （response rate, 76%）.<br>1） Fifty-one percent of respondents thought that industry support was necessary for education, and 28% did not believe that industry support negatively affects residents’ prescribing behaviors.<br>2） Twelve percent said their institutions had a curriculum for physician-industry relationships. Ten percent prohibit residents from meeting with pharmaceutical representatives, and 30% ban gifts from industry.<br>3） Fifty-one percent reported that they had pharmaceutical industry-sponsored in-hospital educational events for residents, and 73% reported that they had industry-sponsored in-hospital educational events which residents were allowed to attend.<br>4） Program directors’ belief that industry support was necessary for education predicted that programs would receive such support.

A national survey of medical student–pharmaceutical industry relationships / 医学教育

1）Japanese medical students’ exposure to the pharmaceutical industry was surveyed in 2012 by means of a 15–item questionnaire.<br>2）Responses were received from 5431 students（1755 in the 4th year, 2222 in the 5th year, and 1454 in the 6th year）. The number of preclinical and clinical students in each year was 1755 and 0, respectively, in the 4th year, 853 and 1,369 in the 5th year, and 53 and 1401 in the 6th year.<br>3）A total of 20% to 37% of preclinical students and more than 95% of clinical students received small gifts, drug brochures, and box lunches while attending a pharmaceutical product seminar. Approximately 10% of preclinical students and 60% of clinical students received a taxi ticket to attend an educational event. In total, 8% of preclinical students and 40% of clinical students attended a dinner party after these educational events.<br>4）Therefore, the rate of exposure to the pharmaceutical industry was significantly higher for clinical students than for preclinical students.

Portfolio-based students learning about family and community in their community medicine clerkship: qualitative change in student learning resulting from use of a reflection sheet / 日本プライマリ・ケア連合学会誌

Introduction: Although community medicine clerkship has been introduced in many medical universities, no study of students’ learning during the clerkship has been conducted. Also, no evaluation of students’ learning about family and community has been carried out. <br>Methods: Sapporo Medical University fifth-grade students in the fiscal year 2006 to 2007 experienced two-week community medicine clerkships. They were obliged to record their clerkship experiences on a daily reflection sheet. We analyzed all the reflection sheets to understand what the students learned during their clerkships. We extracted all points considered to be examples of learning from the students’ descriptions, and classified these by content, and we also extracted examples of learning about family and community. <br>Results: The total number of points with learning content that were extracted was 2243 in 2006, and it was 3193 in 2007. Learning content about family and community averaged 5.2% and 3.7%, respectively, in 2006, and 10.7% and 7.9% in 2007. The total number of points of learning about family and community in 2007 increased significantly in comparison with the number in 2006. <br>Conclusion: By changing the viewpoint of learning by the introduction of a reflection sheet regarding family and community, even if the experience in community medicine clerkship was the same, students’ learning may have changed substantially. It was considered that the establishment of the framework of reflection was an important step.

Consensus Statement; Integrating professionalism education into undergraduate, postgraduate and continuing medical education / 医学教育

1)Professionalism should be explicitly introduced as a fundamental content into curricula/programs of undergraduate medical education, postgraduate clinical training, and of continuing medical education provided by professional societies and the Japan Medical Association.<br>2)We need to enhance our research activities on goals and objectives which should be accomplished through professionalism education, effective learning strategies, appropriate assessment methods, as well as the impact of informal and hidden curricula.<br>3)We propose that the medical profession should collaboratively develop various activities to win the trust of the general society in tandem with the introduction of professionalism education.

Curriculum development of medical professionalism in undergraduate medical education at Sapporo Medical University / 医学教育

1) Since the 2006 academic year, we have developed a 13-hour course in professionalism for fifth-year medical students at Sapporo Medical University.<br>2) The course included lectures and small-group discussions on the concept of medical professionalism, the definition of medical professionalism, clinical ethics, legal understanding, and the crisis of community medicine. At the end of the course, the students created their own student physician charter and recited it at the student physician charter ceremony.<br>3) Seventy-four percent of students evaluated the course positively, 18% pointed out positive and negative aspects of the course, and 8% evaluated the course negatively.

What do medical students learn from their community-medicine clerkships? / 医学教育

Many medical universities have developed community-medicine clerkships. However, few studies have examined what medical students have actually learned from these clerkships. <br>1) In 2006 students participated in a 2-week community-medicine clerkship, during which they were required to write about their experiences on a daily reflection sheet.<br>2) All reflection sheets were collected and analyzed. What students had learned from their clerkships was abstracted from the descriptions on their sheets, and the contents of students' learning were categorized.<br>3) The total number of abstracted learned items was 2243. The numbers of learned items for the areas of medical knowledge, communication, medical skills, clinical reasoning, clinical management, and patient management were 334, 232, 214, 111, 106, and 102, respectively. Learned items in these areas accounted for 49.0% of the total.<br>4) The numbers of learned items concerning the community and families were 84 (3.7%) and 117(5.2%), respectively, and were lower than the numbers for other categories.<br>5) A new strategy must be developed to enhance students' learning about the community and families.

Curriculum development of narrative-based medicine in undergraduate medical education: The narrative-based medicine course at Sapporo Medical University / 医学教育

1)In the 2008 academic year, we developed a new narrative-based medicine (NBM) curriculum at Sapporo Medical University. <br>2) The program includes lectures on the concept of NBM, the clinical practice of NBM, and the illness narratives of patients' families, and exercises in narrative competence (significant event analysis, parallel chart, and life story).<br>3) Although some students had negative attitudes about the program, most students evaluated the course positively. We need to continuously improve the curriculum to develop narrative competence in medical students.

Examination of opinions of patients regarding physicians and medical care after withdrawal of community hospital internists / 日本プライマリ・ケア連合学会誌

Introduction <br>This study aims to clarify how patients and local residents regard physicians and medical care in light of the ongoing nationwide tendency of internists to unexpectedly abandon their posts in local community hospitals. <br>Methods <br>The subjects of this study were citizens who chose to continue visiting a community hospital in X City after some of its internists recently left their posts in order to return to their previous hospitals. A questionnaire survey was conducted by focus-group interviews of two patient groups. <br>Results <br>Three hundred and ninety-nine responses were judged valid. The causative factors cited by the respondents for the internists’ abandonment of their jobs were: the college or university system (81%), the national institutions (79%), and the nation’ s hospital system (72%). Eighty-eight percent of the respondents observed that internists had done the best they could, while 88% pointed out that internists could not avoid changing their workplaces, 96% wanted internists to exert their utmost efforts for their patients, and 85% found internists trustworthy. <br>Conclusions <br>Patients affected by internists' job changes were actually inconvenienced by these, and considered it a matter of course that the results should have meant some loss of freedom for themselves. Moreover, it was suggested that that the physicians had lost their trust in the medical organizations, and the patients were left with very mixed emotions about the physicians. Many patients considered that the practice of medicine is a vocation, and, even though they experienced the physicians' withdrawals from their posts, they still expected a humane attitude in the doctors and communication with them, and they trusted them. However, there were some patients who regarded medicine as a service industry, so that it was suggested that there may be a change in the nature of the trust that patients have in doctors.

An internet survey of physicians' attitude towards gifts from drug companies / 医学教育

The relationship between physicians and drug companies has often been discussed. Maintaining trust by managing conflicts of interest is a requirement of medical professionalism. Maintaining an appropriate relationship is considered important in our medical education society. We conducted this survey to understand physicians' attitudes towards gifts offered by drug companies.1) Questionnaires were distributed to 1200 physicians who registered with an Internet survey company.2) After attending medical conference sponsored by drug companies, almost all physicians received ballpoint pens and note pads, and many physicians received, food, drink, taxi coupons, and booklets about clinical guidelines.3) Compared with young physicians, experienced physicians tend to receive more gifts from drug companies. Physicians who worked at clinics received gifts more frequently than did hospital physicians. Physicians who worked at public hospitals and university hospitals were offered travel and lodging expenses for attending clinical conferences.4) Most physicians received gifts from drug companies. The frequency of receiving such gifts differed with the number of years since graduation and the characteristics of their workplaces.5) The results of this survey are valuable fundamental data for discussing and teaching about the relationship between physicians and drug companies.