Implementation of a portfolio into clinical clerkship at a teaching hospital in Japan / 医学教育

1) We have implemented a portfolio as a learning and assessment tool into clinical clerkship rotation focusing on primary care medicine.<BR>2) We received favorable responses both from students and teachers.<BR>3) It is further required to promote the understanding of portfolio among teachers and students to enhance its utilization.

Changing Face of Medical Education in Korea / 医学教育

1) Korean medical education movement into Anglo-Saxon model is more rapid than the change in Japanese medical education. Health personnel licensing examinations have been sponsored by non-Governmental organization, NHPLEB (National Health Personnel Licensing Examination Board) instead of The Ministry of Health since 1994.<BR>2) Though governments in developing countries and former socialistic areas still actively lead medical education system, only a few developed countries stick to such an old system. In Japan, many stakeholders continue to hold consciousness since Edo period that government will determine most of the system. In Korea, the situation is opposite.<BR>3) Korean medical schools began to adopt a new graduate school system (4+4 in 2002; 10 out of 41 medical schools decided to introduce the new system. Such new curriculum structure is compatible with international standard.<BR>4) In Korean medical schools, the budget for human resources seems to be relatively much richer than that in Japan. Reform in Korean medical schools increased the number of professors in each department, though Japanese ones move toward cutback.<BR>5) The Korean Society of Medical Education was established in 1983. The Society holds two annual meetings a year. Spring meeting is similar to the one for the Association for American Medical Colleges and held in conjunction with Nationwide Dean's meeting, including various faculty development workshops and committee meetings as well.

Experience with 10 Seminars and Workshops for Medical Education / 医学教育

We have organized the Seminar and Workshop for Medical Education (SWME) 10 times from 2000 through 2003. More than 1, 200 persons have participated, including teachers, physicians, students, and simulated patients. The themes of the SWME have included a problem-based learning tutorial system, medical interview skills, objective structured clinical examinations, medical ethics, advanced cardiac life support/basic life support, evidence-based medicine, coaching technology, medical English education, and crisis management education. Invited lecturers from throughout the country organized most of these workshops. Advantages of the SWME are two-fold:(1) improving the medical teaching skills of each participant and (2) scouting for good young lecturers. Workshop reports are published in our annual monographs and other materials. The present paper is a historical review of the SWME and also describes the nationwide scope of faculty development.

Analyses of Scores of Examinations for Practical Training in Clinical Skills and for Clinical Training and Scores of Graduation Examinations in Undergraduate Medical Students / 医学教育

We analyzed the scores of objective structured clinical examinations (OSCEs) and written examinations administered to fourth-year medical students after practical training in clinical skills and to fifth-year medical students after clinical training and scores of graduation examinations taken by sixth-year medical students. Correlations were analyzed among the scores of 96 students who had taken all 3 examinations during a 3-year period. Mean scores on examinations in the fourth, fifth, and sixth years were compared between sixth-year students who did or did not graduate and between graduating students who did or did not pass the national examination for medical practitioners in Japan. Significant correlations in the scores were found between 1) OSCEs and written examinations for fourth-year students versus those for the fifth-year students; 2) OSCE and written examinations for fourth-year students versus graduation examination scores for the sixth-year students; and 3) OSCE and written examinations for fifth-year students versus graduation examination scores for sixth-year students. In addition, the mean scores in the fourth and fifth years were significantly higher for sixth-year students who graduated and passed the national examination than for students who did not graduate or who graduated but failed the national examination. These results suggest that the practical training in clinical skills given to fourth-year students and the clinical training given to fifth-year students strongly affect the overall evaluation of the ability of sixth-year students and success on the national examination.

Utility and Usefulness of the Skills Laboratory to Improve Practical Training in Clinical Skills / 医学教育

Medical students at Kurume University begin practical training in clinical skills in their fourth year. At that time, students use the skills laboratory to improve their clinical skills. Medical education resources in the skills laboratory include simulators for emergency resuscitation and heart diseases, wireless stethoscopes, and videotapes. All students use the skills laboratory for 2 months, and its usefulness was evaluated with questionnaires after practical training. More than 50 % of students approved of their practice in the skills laboratory. However, some students were unsatisfied because they were unable to make effective use of the simulators. In the future, an improved skills laboratory will be necessary to improve practical training in the clinical skills for medical students.

Consideration of Using a Home Page as a Teaching Aid / 医学教育

In this article, we describe the use of the home page of “Digestion” for self-learning and review by third-year students of our medical school. A home page should provide an overview of the site for easy navigation and present a briefexplanation of important or difficult terms. The page should minimize previously unseen information but should use multiple colors and animation to keep the student's attention. We propose that a nationwide collection of educational materials be established to avoid copyright problems.

Evaluation of the First Trial of a White Coat Ceremony as a Ceremony of Passage: A Method for Teaching Professionalism in Undergraduate Medical Education / 医学教育

Purposes: We performed a white coat ceremony for medical students, because there had not been a definite passage ceremony to create the desire to serve and the awareness of being physician. Opinions about the ceremony were with a questionnaire survey. Methods: The ceremony of white coat conferment was performed for the first time for 112 fourth-year medical students on January 11, 2001, just before the start of clinical training. A white coat and an identification badge with photograph were presented to the medical students, who were taking the first step to becoming a physician. A questionnaire survey was performed the next day to evaluate students' feelings. The questionnaire asked about student's 1) sense of responsibility to be engaged in medical practice, 2) feelings of kindness to patient, 3) love for of their school, 4) attachment to the white robe, 5) consciousness of being a professional, 6) sense of mission as a physician, 7) motivation to learn, 8) feelings of seriousness, and 9) desire to live ethically. A listening survey for the school staff and students was also included. Results: Clear improvements in consciousness were recognized in all items of the questionnaire (P>.0001). Approximately 80% of students approved of the ceremony being performed annually from the following year. The ceremony had had no established form, but many people acknowledged its significance. However, some students who did not realize the significance of the ceremony because it was performed in the middle of the semester. Conclusions: Although this was the first experience for us, many students and teaching staff were understanding and responded favorably to this passage ceremony. The ceremony to instill medical professionalism in student doctors will be improved with further efforts and experiences.

Bone mineral density in hypogonadal men remains low after long-term testosterone replacement / 亚洲男科学杂志(英文版)

<p><b>AIM</b>In 11 congenital hypogonadal men, the bone mineral density (BMD) values were determined to assess the effect of long-term androgen replacement therapy (ART) on skeletal integrity.</p><p><b>METHODS</b>Eleven congenital hypogonadal men, including 8 isolated gonadotropin deficiency patients, 2 Kallmann's syndrome and 1 vanishing testes syndrome were recruited and treated with 250 mg of testosterone enanthate intramuscularly every 4 weeks for 7-43 years (mean+/-SD: 21.5 +/-13 years). In these patients and a group of 10 healthy young men (controls), the whole and trabecular BMDs were examined at the distal end of radius by means of a peripheral quantitative computerized tomography device.</p><p><b>RESULTS</b>The whole radial BMD in hypogonadal men was significantly less in the patients than in the healthy men (498+/-115 and 725+/-134 mg/cm(3), respectively; P<0.01); the trabecular BMD was also lower in the hypogonadal men (199+/-80 and 375+/-89 mg/cm(3); P< 0.01). The whole radial BMD values in 10 of 11 hypogonadal men were at least 1 SD below the mean value for healthy young men; 2 hypogonadal men had BMD values more than 2.5 SD lower than the healthy mean. Additionally, the whole radial BMD showed a significant negative correlation with the patient's age at the initiation of ART (r = 0.748, P<0.01). The serum level of bone-specific alkaline phosphatase and the urinary level of deoxypyridinoline were not significantly different between the two groups.</p><p><b>CONCLUSION</b>Osteopenia persists in the hypogonadal men after long-term ART, suggesting that such patients have a persistent defect in bone development not alleviated by androgen replacement.</p>

Evaluation of Individual Care of Patients by Medical Students for Attitude Education / 医学教育

The usefulness of individual care of patients in the attitude education of undergraduates was evaluated with questionnaires completed by 4th-year medical students and patients. Ninety-eight percent of students finished performing patient care during a 2-week period. Seventy percent of patients completed questionnaires. The appearance, manner of greeting, and language of the students were considered good by 87% or more of the patients, and the students' consideration for the patients' safety, privacy, and communication was considered good by 86% or more of the patients. The practice was approved by 77% of the patients and was objected to by none. Ninety-nine percent of students completed questionnaires, and 79% of the respondents approved of the practice. Fourteen percent of the student respondents, many of whom had been treated as outpatients, objected to the practice. These results suggest that individual care of patients by medical students is useful for both patients and students.

A Case of Coronary Ostial Stenosis with Aortic Regurgitation Due to Syphilitic Aortitis / 日本心臓血管外科学会雑誌

A 50-year-old man was diagnosed as having aortic valve insufficiency, complete occlusion of the right coronary artery and 75% stenosis of the left main trunk due to syphilitic aortitis. Aortic valve replacement and coronary artery bypass grafting to three vessels were successfully performed. The selection of surgical procedures for the coronary lesion with syphilitic aortitis should be made carefully, since the progression of aortic root inflammation in the acute phase and the development of atherosclerotic changes are not preventable in the future. It is most important to select effective and safe surgical interventions, especially for patients with such a low cardiac function as our patient.

Intraoperative Autotransfusion during Abdominal Aortic Aneurysm Repair / 日本心臓血管外科学会雑誌

In a consecutive series of abdominal aortic aneurysm repairs, a non-washing autotransfusion unit system was used in 47 patients, and was not used in 25. In the 47 patients treated with the autotransfusion unit, the average amount of autotransfused blood was 1, 109±131ml in elective cases. The amount of banked blood transfusion was significantly smaller in autotransfused patients (mean; 712ml), compared to non-autotransfused patients (mean; 1, 405ml). Postoperative levels of serum bilirubin were higher in patients with greater autotransfused blood volumes than those with smaller volumes. The combination of preoperative autologous blood donation (2-3 units) and intraoperative autotransfusion is necessary to perform abdominal aortic aneurysm repair without homologous blood transfusion.