The educational effect of a training program in ambulatory care for residents / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : We initiated an ambulatory care training program at five community hospitals in Nagasaki, including hospitals on remote islands, for the residents of Nagasaki University Hospital. We examined the educational effect of the ambulatory care training program in meeting the achievement targets for clinical training.<br><b>Methods</b> : The study included all residents (n=49) working in Nagasaki University Hospital in 2012. Following completion of the ambulatory care training program, the residents answered a questionnaire on the number of patients and their symptoms, inaddition to a self-assessment, and assessment by their supervisor.<br><b>Results</b> : The mean number of patients seen was 3.29 persons / training session. The number of symptoms to be encountered, which are established by Ministry of Health, Labour and Welfare, was positively correlated with the total number of patients seen. Although residents initially had a low rating of self-assessment on diagnosis or treatment, this rating tended to increase with time. The gap in levels on assessment of history taking, diagnosis, or treatment by residents versus those by the supervisors reduced with time in the program.<br><b>Conclusion</b> : Our ambulatory care training program is an effective program for meeting the achievement targets in clinical training for residents.

A theory–based trial for improving both economic growth and medical education in a university hospital / 医学教育

1）We instituted the “CHANGE Nagasaki University Hospital” project to improve both management and medical education and to boost the number of physicians recruited to this hospital.<br>2）We first identified the physicians’ problems and complaints via a questionnaire. Next, focusing on the most common complaints, we reduced secondary duties and methodically improved the educational environment by employing the a– b–c–d–strategy, which is based on the principles of medical education.<br>3）As a result, both, the hospital’s economic growth and the recruitment figures for resident physicians have increased continuously over the past 4 years.

Enforcement and analysis of the Objective Structured Teaching Evaluation / 医学教育

In Japan, awareness has increased in recent years of the importance of evaluating clinical educators. In Europe and North America, the Objective Structured Teaching Evaluation (OSTE), which employs standardized students, multiple stations, video recording, and scoring by multiple observers, is used to evaluate clinical educators. We report on the implementation of an OSTE in Japan.1) Ten clinician-educator physicians participated in the OSTE, which comprised 5 stations and included standardized residents. The stations were video-recorded, and the educators were assessed by 7 different evaluators.2) The educators were evaluated with a checklist and a 5-point scale. We assessed the reliability and validity of the checklist and analyzed the background characteristics of the clinician educators.3) The factors most closely associated with high ratings on the checklist and the 5-point scale were: having a history of attendance at a seminar for clinician-educators, having greater than 5 years experience as an educator, and not being an internist. There was no interobserver variability among the evaluators.4) The generalizability of the checklist was 0.81, and its reliability index was 0.83. The correlation coefficient between the total scale score and the checklist score was 0.8. 5) Although biases by participants were identified, our project suggests that the OSTE could be used in Japan to objectively evaluate the teaching skills of clinician-educators. Further research on the OSTE in Japan is warranted.

Working Conditions of Medical Residents in Ontario, Canada / 医学教育

1) In Canada, the working conditions of medical residents are negotiated on a province-by-province basis between provincial associations of residents and their respective employers. This paper focuses on the role of the Professional Association of Interns and Residents of Ontario (PAIRO).2) PAIRO negotiates working conditions with the Council of Academic Hospitals of Ontario and has obtained for its members a monthly salary of approximately 390,000 yen for first-year residents (the salary increases with each year of residency), a restriction of on-call duties to 7 of 28 days, and 4 weeks of paid vacation per year.3) In Japan, consideration should be given to the development of guidelines for the working conditions and salaries of residents based on the realities of each specialty and on local needs. To establish and enforce such guidelines, public funding and a third-party agency are necessary.

The Objective Structured Teaching Evaluation / 医学教育

1)With the implementation of mandatory clinical residency in Japan, resident evaluations have become an important part of clinical education. Recently, however, a greater emphasis has been placed on the evaluation of physician instructors. In the West, research examining the teaching skills of clinical physicians has been ongoing since the 1970s and is reviewed in this paper.<br>2)The Objective Structured Teaching Evaluation (OSTE), which uses standardized students, multiple stations, video recordings, and scoring by observers, was developed in the 1990s.<br>3)Unlike the Objective Structured Clinical Examination, which is an evaluation tool for medical students and residents, the OSTE is rarely used to evaluate individual performances or used as a part of certification exams. Instead, the OSTE serves as a tool for faculty development or as an outcome measure for the effectiveness of faculty development education initiatives.<br>4)If available in Japan, the OSTE would be an excellent resource for improving the teaching skills of physicians and would be a useful tool for training sessions for physician instructors. More research is needed to facilitate the introduction of the OSTE to Japan in the future.

Reformation of the clinical training system with educational theory: A trial in a clinical training hospital / 医学教育

1) We attempted to reform the medical education system for residents at the National Nagasaki Medical Center because the percentage of unmatched applicants in the new national residency training system has been increasing.2) We established a committee for residency training through leadership principles. We then classified problems of the training system and attempted to solve them through the concepts of the learning triangle in education and the educational cycle.3) Finally, we succeeded in improving the educational system for residents by establishing a new committee that individualizes the problems and solves them effectively.

A New Trend toward Interprofessional Education in Canada / 医学教育

1) The concept of interprofessionality, i. e., cohesive and cooperative practice between professionals, is necessary in North America because health professionals specializing in various fields work together on medical services.<BR>2) To introduce the concept of interprofessionality, interprofessional education, in which many kinds of health profes-sionals or students learn together, is extremely important. The Canadian government has been promoting and generously subsidizing interprofessional education as a way of improving public health and emphasizing patient-cen-tered medicine.<BR>3) In 2006, the University of Toronto established a new certificate course for future educational leaders who promote in-terprofessional education. We participated in this course and recommend that a course of this type be introduced toJapan.

Report on Ambulatory Teaching : A Japanese Look at the Canadian Educational System / General Medicine

BACKGROUND: Japanese medical education has undergone dramatic changes over the last 5 years. Clinical exercises and ambulatory-care training are now stressed to prepare medical students and residents for work in primary and continuing-care settings. For comparative purposes, we conducted a review of the undergraduate and residency training programs for ambulatory care at the University of Toronto in Canada. This report will examine the problems of training programs for ambulatory care in Japan by comparing the Canadian and Japanese models.<BR>METHOD: From December 2004 to March 2005, the first author observed the ambulatory training systems at the University of Toronto.<BR>OUTLINE OF CANADIAN AMBULATORY TRAINING PROGRAMS: There are three typical types of ambulatory training programs in Canada: community-office based programs for undergraduate students in family and community medicine; hospital/clinic based programs for junior residents in internal medicine; and consultation service programs for senior residents in internal medicine. Undergraduate and residency training programs are largely consistent with each other. The current trend in medical education is towards increased consolidation and efficiency in teacher and student training systems, with a reduction in the number of teaching hospitals and integration of teaching staff and curricula. Moreover, team-based training for ambulatory care appears effective.<BR>DISCUSSION: To improve the Japanese ambulatory training system, it is desirable to increase communication and contact between undergraduate-program educators and residency-training program educators in order to achieve integration and consistency between programs.

Self-Directed Learning and Community-Based Clinical Clerkships / 医学教育

Medical education programs in North America are often based on the adult education theory of self-directed learning (SDL). Many kinds of SDL have been introduced into preclerkship education, clerkships, residency training, and continuing medical education. The first goal of this paper was to review SDL in North American medical education. The second goal was to describe an example of community-based clerkship in which SDL was applied in the department of family and community medicine of the University of Toronto. A third goal was to give three recommendations for Japanese clinical clerkships. The first recommendation is the effect of the learning contract. The second is that the preceptor should give quick and frequent feedback to students and that a useful Japanese feedback device should be developed with information technology. The third recommendation is that a new curriculum combining community-based education for students with continuing medical education for doctors is necessary to improve Japanese medical education.