Clinical Clerkship at the Tokyo Medical and Dental University / 医学教育

1) Clinical education at the Tokyo Medical and Dental University consists of three parts: the preclinical clerkship which prepares students for clerkship, short observatory or partially participatory clinical education, called the combination block, and long participatory clinical education, the clinical clerkship. The clinical clerkship consists of core-and elective-rotations, including ten four-week rotations and two two-week rotations.<br>2) In implementing clinical clerkship, we sent up to 100 faculty staff to and carefully studied the model used at the Harvard Medical School, and developed our own original one that fits the Japanese setting.<br>3) To successfully implement the clinical clerkship, we developed a demo movie clip showing students’ expectation and tips for teaching, handed each student a cell phone to carry, allowed students’ charting to the electronic medical record system under supervision, and distributed a handout describing clerkship to all medical and paramedical staff.

Team–Based Learning at the Duke–NUS Graduate Medical School Singapore / 医学教育

1)We visited the Duke–NUS Graduate Medical School Singapore to learn the administration and management of, and the theory behind, team–based learning (TBL), a candidate educational method to replace the problem–based learning tutorial.<br>2)TBL motivates students to prepare for and engage in discussion. The grading of performance in TBL, certain characteristics of assignments, and the use of peer evaluation all promote individual and group accountability for learning.<br>3)To obtain the maximum overall benefit from TBL and to exploit group dynamics for effective learning, well–designed assignments are the key.

Trial of a joint class for role–playing of informed consent with first–year students as patients and fifth–year students as physicians / 医学教育

1)The purpose of this study was to evaluate a role–playing class for informed consent with fifth–year students playing the role of physicians and first–year students playing the role of patients.<br>2)The first–year students were competent as simulated patients for the informed consent role–playing and were a worthy educational human resource.<br>3)This role–playing was effective for helping both first–year and fifth–year students understand informed consent and the mentality of patients and to motivate students to study informed consent. This joint class also allowed fifth–year students to review their progress over time and gave first–year students a chance to meet role models.

Continuum of learning objectives from undergraduate clinical clerkship to postgraduate residency / 医学教育

To establish a framework for clinical education as a continuum from undergraduate clinical clerkships to postgraduate residency programs is an enormous challenge for Japanese medical education. The purpose of this article is to compare learning objectives achieved by clinical clerkship students to those achieved by postgraduate residents.1) Eighty-seven clerkship students and 67 residents at our hospital were assessed with the Web-based Evaluation System of Postgraduate Clinical Training with 253 learning objectives established by the Ministry of Health, Labour and Welfare.2) Clerkship students achieved most attitudinal objectives and performed well on the medical interview, basic physical examinations, and physician's order sheet.3) Clerkship students could observe major symptoms and diseases.4) These findings indicate the need to establish a common template for learning objectives used in both clerkships and residency programs.

The transition from student to resident: A survey about abilities expected fo first-year residents / 医学教育

The interval between undergraduate medical education and graduate medical education causes residents to become disorganized when they start their first-year residency programs.This disorganized transition may be stressful for residents and preceptors and may cause resident to make medical errors.We performed a pilot study to examine the degree to which program directors agree about the abilities required for the start of the first of year residency.<BR>1) We asked the residency directors at university hospitals and residency hospitals nationwide (343 institutions) to indicate what abilities residents were expected to have at various stages of the residency program.The data received were then analyzed.<BR>2) A total of 134 residency directors (39%) returned the questionnaire.We calculated the percentage (expectation rate) of institutions that reported expected prerequisites at the start of the first year of residency and calculated the accumulated values (cumulative rate) of the percentages.<BR>3) Only 43 (30%) of 141 abilities upon the completion of residency-preparatory programs had a cumulative rate of more than 50%.<BR>4) Domains for which the expectation rate was more than 50% at the start of residency were medicine and related knowledge and practical skills for obtaining physical measurements.<BR>5) Physical examination and practical skills for which the cumulative rate was less than 50% on completion of residency-preparatory programs were those for the reproductive and urinary systems and pediatrics and the insertion and maintenance of intravenous lines and indwelling urinary catheters.<BR>6) Disparities are likely between the abilities of residents and the tasks expected of them upon entry into a residency program.This problem must be urgently addressed through medical education and graduate medical education.

Comparative Analysis of Faculty Development in Japanese Medical Schools from 2003 through 2005 / 医学教育

1) The faculty development at each medical school from 2003 through 2005 was analysed.<BR>2) The major themes in faculty development were problem based learning, tutorial, computer based testing, and clinical training.<BR>3) Faculty development is considered an effective way to enhance the contributions of faculty members to medical education.

The Attempt to Develop a "Model Program" on the Basis of the Objectives Established by the Ministry of Health, Labour and Welfare in the New Postgraduate Clinical Training System / 医学教育

Clinical training programs play an extremely important role in the new postgraduate clinical training system introduced in 2004 because facilities for clinical training now include various health-related institutions in addition to the university hospitals and special hospitals for clinical training used in the previous system. Although educational goals have been established by the Ministry of Health, Labour and Welfare, trainees may have difficulty achieving these goals, even under the guidance of staff at the various facilities. There are differences in the function and quality of health-related institutions in the community. For the practical and convenient application of educational goals, we have attempted develop a “model program” to supplement the objectives indicated by the learning goals with more specific objectives. These supplementary objectives can be modified by individual institutions. We hope that this “model program” contributes to the development of objectives for each institution and helps improve the quality of the postgraduate training system in Japan.

Evaluation of Faculty's Instructional Abilities by Students in a Clinical Introductory Program / 医学教育

In a clinical introductory program, each group of 9 fifth-year medical students rotated through 9 courses every 2 weeks. In each class, students evaluated the instructional abilities of the faculty. Eighty-two students answered 7 questions on a 5-point scale immediately after each class was completed. Because the questionnaire also served as a record of attendance, responses were obtained from all students who attended. Overall satisfaction was correlated most strongly with teaching skills, followed by contents of the class to achieve goals and the level of difficulty. The evaluation of faculty's instructional abilities by students can provide valuable information on areas to improve so that students can be educated more effbctively and with greater satisfaction.

Evaluation of Clinical Instructors by First-year Residents / 医学教育

<I>Objective: </I> In our postgraduate clinical training program, first-year residents are rotated among six subdivisions of internal medicine (cardiology, respiratory diseases, gastroenterology, and endocrinology plus either hematology, collagen diseases, or neurology) every 2 months. The residents are trained by clinical instructors (attending physicians or senior residents) on a one to-one basis. To evaluate training by instructors, a questionnaire survey of first-year residents was performed. <I>Methods: </I> Questionnaires were sent to all 14 first-year residents who took part in our training program in 1998. A questionnaire assessing the performance of 1st-year residents was also sent to 15 clinical instructors participating in the program. The instructors had an average of 7.5±3.9 years of professional expericence. All participants were confidentially informed of the results. <I>Results</I>: All 14 first-year residents responded. They rated experienced attendants more highly than senior residents. The survey revealed specific problems of certain attending physicians, such as communication difficulties and poor teaching skills. <I>Conclusion</I>: Evaluation by first-year residents of training by clinical instructors provides constructive criticism of the training program and of individual instructors.