A Nationwide Survey on the Faculty Development for Simulation-Based Medical Education in Japan / 医学教育

We have conducted a nationwide survey on faculty development for simulation-based medical education in Japan. The response rate was 90%. Forty-seven (68%) schools have implemented faculty development programs for simulation-based education. The most commonly implemented contents were standardized patient development, task trainer, high fidelity manikin operation, and student evaluation, which were related to objective structured clinical examination objective clinical skill assessment. Only 15 percent of medical schools implemented topics on reflective practice, and scientific writing. A constraint on faculty time was the most commonly perceived barrier to simulation use (mentioned by 62 schools; 90%).

Cooperative learning: the perceptions of University A's nursing students and factors influencing those perceptions / 医学教育

Background: To obtain suggestions regarding the methods of cooperative learning in basic nursing education, the nursing students' perceptions of cooperative learning and the relationship between such perceptions and their influencing factors were elucidated.Methods: Anonymous, self-administered questionnaires were conducted among 131 nursing students at University A in the Chubu region of Japan.Results: Binomial logistic regression confirmed that cooperative learning experiences in high school, learning satisfaction at University A, social support, styles of handling interpersonal conflicts, and undervaluing others in regard to assumed competence were significant influencing factors on the cooperative work recognition scale.Discussion: Factors, including professional identity, communication ability and students' past negative experiences, may have an effect on the recognition of cooperative work. This suggests the need for the continued investigation of the aspects of cooperative learning that take these factors into account.

A joint survey of medical students' self-assessment of competency after clinical clerkship and learning strategies among 9 universities in Japan / 医学教育

<p>Abstract:</p><p></p><p> This study examined the ability of medical students to self-assess basic clinical competence and learning strategies including simulation-based medical education for sixth-year medical students (n=903) at nine universities in Japan. About 40% of 27 procedures to achieve clinical skills in a model curriculum were taught using simulators with or without clinical training in hospitals. We noted that significant numbers of procedures were not practiced through any learning strategies. Higher self-assessment scores were observed among students in 4 schools who had more frequent learning opportunities through simulation-based education than among those with less frequent opportunities in 5 schools.</p>

Report of Workshop “Toward better care for sexual minorities” / 日本プライマリ・ケア連合学会誌

The concept of sexual minority contains lesbian, gay, bisexual, transgender (LGBT) and disorders of sex development. Despite many recent advances in rights for sexual minorities in the world, bias against them still exit. We held a workshop ‘toward better care for sexual minorities' on the 6th Annual Conference of Japan Primary Care Association 2015. Four lecturers talked about health disparities among sexual minority patients. We want this paper help reducing the readers' prejudice towards the sexual minorities and thus impact their future clinical practice.

Interprofessional education in home-care: Collaboration of medical and rehabilitation students / 医学教育

　In the coming ″Super-aging society″ , collaboration between medical professionals and health workers in home-care will be critical. Thus, undergraduate interprofessional education is important for the improvement of a collaborative attitude. We ran a 2-day IPE program for a medical and a rehabilitation student focused on collaboration for patients who have chronic diseases and problems in Activities of Daily Life (ADL) . As a result, one showed marked improvement in ADL while the other did not. Students learned not only roles and perceptions of other professionals but also a sense of worth and an appreciation of the difficulty of patient-centered home-care.

Medical Students' Simlympic Games 2014: / 医学教育

<p>　To encourage the broad use of simulation-based medical education and establish partnerships to promote objective structured clinical examinations after clinical clerkship among medical teachers, we hosted the first team-based clinical skills competition event for medical students in Japan, named ‘Medical Students' Simlympic Games 2014'. Thirty-six (12 teams of three) open-recruited 5th or 6th grade medical students participated in this event. Student teams performed clinical tasks at 6 stations, which actively utilized the strengths of simulators or simulated patients. Contents, composition, difficulty level, and validity were tested by trainee doctors and examined by committee members in advance. In this report, we describe our concept, executive committee formation, a variety of arrangements, the outline on the day of the event, and the results of a questionnaire targeting participants. (126 words)</p>

"Diabetes Education Class IPE" -Challenge to promote new IPE (interprofessional education) with real patients- / 医学教育

<p>　The WHO reported the importance of IPE (Interprofessional Education) in order to implement team-based medicine smoothly. Some Japanese medical educational institutes presented their IPE programs, which involved real patients, but most IPE programs used scenario-based or standardized patients. Moreover, few reports showed IPE programs for diabetic patient education. We created a new program, called the "Diabetes education class IPE" . Participants were 2 medical, 4 nursing, 4 pharmacy, and 3 dietician students. The students experienced the planning and management of and reflection on diabetes education classes. As a result of reflection, the "Diabetes education class IPE" was viewed as a useful IPE program.</p>

What are the benefits of simulation training with simulated patients? / 医学教育

Introduction: Consultation simulation with simulated patients has rarely been done as a training program.<br>Method: Fifth-year medical students in 2 neighboring universities attended the same training program at each site. The students’ performance was evaluated.<br>Result: Most medical students thought that this training program was valuable and that they require more opportunity to practice. Students evaluated their own performance in both medical procedures and differential diagnosis as being poor. However, about 50% of students felt that they paid careful attention to the simulated patient during physical examination. Students thought that the consultation was extremely realistic and that the series of medical procedures they performed at the first attempt was extremely difficult but increased their motivation. They thought that the feedback they received from simulated patients was beneficial.<br>Discussion: This education program is highly regarded by students and is suggested to be versatile.

Successful treatment for bladder hemorrhage with intravesical alum irrigation to one patient with moderate renal disfunction

We report a case of successful treatment for bladder hemorrhage with intravesical alum irrigation. A 60 s woman, who had renal pelvis carcinoma and moderate renal dysfunction（eGFR＝48 mL／min／1.73 m<SUP>2</SUP>）, was hospitalized to our palliative care unit, for pain control of her lumber metastasis. During hospitalization, the patient showed dysuria and a lot of intravesical blood coagulum, which was caused from bladder metastasis. After bladder flushing, continuous bladder irrigation with saline was started. However, when we reduced the irrigation speed, dysuria appeared again. Thus, we started intravesical alum irrigation. Six days after this irrigation has started, we stopped the irrigation because no gross hematuria was seen any more. On the blood test done ninth day after irrigation, serum alminium level was 0.4μg／dL（normal value＜0.8μg／dL）. Three months after discharge from the hospital, the patient died, however, no gross hematuria or anuria were seen up to that time. Serious adverse effects with intracesical alum irrigation were reported in patients with renal dysfunction. However, if the renal dysfunction was moderate, intravesical alum irrigation with reduced doses seem to be safe and effective.

Differences in medical students’ emotional intelligence and empathy according to academic year and sex / 医学教育

Objectives: To clarify differences in medical students’ emotional intelligence and empathy among 4 school years and sex.<br>Methods: A cross-sectional study of 370 medical students in years 1, 2, 4, and 6 was performed with Japanese versions of 2 self-reported questionnaires: the Trait Emotional Intelligence Questionnaire–Short Form （TEIQue-SF） and the Jefferson Scale of Physician Empathy–Student Version （JSPE-S）.<br>Results: Total scores of the TEIQue–SF tended to decrease in higher school years. However, the total score of the JSPE-S was significantly increased in year 6 but was decreased in year 4. Male students had higher TEIQue–SF scores, and female students had higher JSPE-S scores. Of the 4 factors of the TEIQue–SF compared （well-being, self-control, emotionality, and sociability）, only sociability was higher in males. No differences were found among school years. The scores of the TEIQue–SF and the JSPE-S showed a weak correlation. Of the factors of the TEIQue–SF, only self-control showed no correlation with the JSPE-S.<br>Discussion and Conclusion: These results suggest that the emotional intelligence of both male and female medical students tends to decline. The increase in JSPE-S scores in year 6 suggests that medical interview training is effective. Furthermore, training is important both to enhance emotional intelligence and to teach self-control skills.

Investigation of scenarios for healthcare education by multidisciplinary faculty / 医学教育

  In scenarios developed by a multidisciplinary faculty for interprofessional education, practical problems that emerged included: “medical incident” and “shortage of medical resources” from the perspective of patient and families,” and “information sharing,” “evaluation and feedback,” and “insufficient feeling of accomplishment” from the perspective of health-care professionals. Discussions identified “interprofessional collaboration,” “mutual understanding for professionalism,” and “embodiment of professional culture” as key words for problem solving. Finally, scenarios were developed in the hospital, home-care, nursing, or community care settings that referred to 2 themes, “end of life” and “dementia.” Pilot case studies performed with health care professionals demonstrated the utility of the scenarios and the effectiveness of interprofessional education.

The Medical Education Curricula for Students Selected by Nagoya University for Medically Underserved Areas / 医学教育

  To respond to the physician shortage, the capacity of medical schools has been increased through selective admission of student to practice in medically underserved areas; however, neither a system nor a curriculum for such students has been established. At Nagoya University, selected students have been admitted, and the division of Education for Community–Oriented Medicine was established in fiscal year 2009. We have introduced special curricula for these students, such as a seminar for community–oriented medicine, training for medical research, local hospital tours, and a special interprofessional education course. In fiscal year 2013, community medicine is expected to be implemented as a compulsory subject in the 4th year curriculum. For the education of students selected to practice in medically underserved areas, we believe that older students serving as role models and cooperation with other organizations and community are important.

A retrospective study of the factors tended to transfer to palliative home care from palliative care unit at a comprehensive cancer center in Japan

<b>Background</b>: The palliative care unit (PCU) at the National Cancer Center Hospital East changed the administrative policy to strengthen the transition to palliative home care. This study aimed to identify the factors tended to transfer to palliative home care in Japan. <b>Methods</b>: We reviewed the medical records of consecutive cancer patients admitted to our PCU during period from October 2010 until September 2011. Patients with performance status 4 and duplication were excluded in this study. We identified variables associated with the discharged group and the others group, using the univariate and multivariate analyses. <b>Results</b>: There were 223 patients (Pts) during periods, 63 Pts (28.3%) discharged to palliative home care and 160 Pts (71.7%) deceased in our PCU. Univariate and multivariate analysis identified: admission from their own home, a good PS of ≤ 2, good oxygen saturation, a good amount of oral intake, maintain of PS at day 15, no dyspnea and no abdominal distention as predictions of a transition to home from our PCU. <b>Conclusion</b>: Our study indicated the factors tended to transfer to palliative home care from PCU in Japan, however this study had some limitations. A prospective study is required to validate these factors.

Establishment of a clinical training system beyond the regions and the teaching hospitals / 医学教育

  Teaching hospitals play an increasingly important role in clinical training, and improvement of the education system is required. To effectively utilize limited human and material resources for clinical education and to enhance clinical education and medicine treatment throughout a region, cooperation between hospitals is essential. However, cooperation for clinical education training beyond prefectures or training hospitals cannot be said to be sufficient. The Kisogawa Medical Conference, a collaborative system of 5 training hospitals located around the Kiso River estuary, held medical lectures, hands–on seminars, and joint–hospital case conferences. Cooperation in medical education training and exchanges beyond prefectures and training hospitals is expected to lead to substantial improvements, not only in medical education training, but also in medical care throughout a region.

Validity and reliability of the Japanese versions of the Trait Emotional Intelligence Questionnaire-Short Form and the Jefferson Scale of Physician Empathy / 医学教育

  Emotional intelligence and empathy are crucial in patient–physician relationships and clinical outcomes. It has been reported that both emotional intelligence and empathy decrease as students advance through medical school. This study aimed to validate Japanese versions of the Trait Emotional Intelligence Questionnaire–Short Form （TEIQue–SF）, developed by Petrides and Furnham （2001）, and the Jefferson Scale of Physician Empathy （JSPE）, developed by Hojat et al. （2001）.<br>1）The TEIQue–SF and JSPE were translated and administered to 370 medical students. Valid responses were obtained from 321 students（88%）.<br>2）Cronbach’s alpha for internal reliability was high for both the TEIQue–SF （0.87） and the JSPE （0.89）. All item total score correlations were positive for both the TEIQue–SF （range, 0.29 to 0.64） and the JSPE （range, 0.27 to 0.72）.<br>3）Cronbach’s alpha was smaller if an item was deleted than if all items were included for both the TEIQue–SF （0.84–0.85） and the JSPE （0.81–0.86）.<br>4）Factor analysis of both the TEIQue–SF and the JSPE revealed that the Japanese versions had some structural differences from the original versions. However, criterion–related analysis showed that the TEIQue–SF and the JSPE were highly correlated with the NEO–Five Factor Inventory, a measure of the Big Five personality traits.<br>5）These findings provide support for the construct validity and reliability of the Japanese versions of the TEIQue–SF and the JSPE when used for medical students. Further investigation is needed.

Training Curriculum for Simulated and Standardized Patients: The 16th Medical Simulation Committee of the Japan Society for Medical Educatio / 医学教育

1．The basic training curriculum for simulated and standardized patients （SPs） was provided by the 16th Medical Simulation Committee based upon a nationwide field survey that was conducted by the committee in 2009 and other data.<br>2．The curriculum consists of 3 essential programs: interpersonal communication, medical education involving SPs, and the medical interview.<br>3．The medical interview program was composed of basic issues, comprehension of scenarios, acting role and performance, and feedback and assessment.<br>4．The training facilities or institutions were recommended to properly assess the performance quality of SPs in the educational setting by means of a specific and clearly defined evaluation method.

The effects of an administration policy of the palliative care unit of a cancer care hospital on the rate of region-based home death rate

The aim of this study was to explore the changes in the rates of discharge to home from the palliative care unit in the region where the regional palliative care intervention program, their home death rate, and their ratio to whole home death cancer patients in the region. During the study period, the palliative care unit changed an administrative policy actively end-of-life care to support patients at home. The rate of discharge to home from the palliative care unit increased 11% to 22% during the study period, and their home death rate increased 10% to 41%. The overall home death rate of cancer patients however remained 6.8% to 8.1%, and their ratio to whole home death cancer patients in the region was less than 10%. To establish health care system to support cancer patients at home, changing administrative policy of palliative care units is insufficient and increasing quality community palliative care resources seems to be essential.

A questionnaire survey about community medicine in residency programs in the Tohoku–Hokuriku region of Japan / 医学教育

In 2004 a program of community health and medicine was included in the national residency system. However, the contents and achievements of this program have not been adequately studied. We surveyed residents, program directors, and collaborating facilities for clinical training in community medicine in the Tohoku–Hokuriku region of Japan about the contents, practices, training period, curriculum development, and other aspects of the program.<br>1)We conducted a survey of 230 residents who had completed the program, 82 program managers, and 101 collaborating facilities.<br>2)The survey consisted of surveys of residents (survey 1), of program directors (survey 2), and of collaborating facilities (survey 3) and asked about the programs' consistency with the training objectives of the Ministry of Health, Labour and Welfare and satisfaction with community medicine.<br>3)Approximately 70% of residents, program managers, and collaborating facilities believed the training period for community medicine is appropriate.<br>4)Furthermore, 69.1% of residents, 65.5% of program directors, and 85.2% of facilities believed that the community medicine program in the national system was important or very important.<br>5)Training programs should be enhanced so that residents "understand and practice health care in outlying and rural areas" and to increase active involvement of program directors.

A workshop to promote interprofessional health care collaboration in the community / 医学教育

1)A workshop to promote interprofessional health–care collaboration in the community is reported.<br>2)The three topics discussed were: "the needs of an interprofessional network in the community," "barriers that can prevent the promotion of an interprofessional network in the community," and "strategies to overcome the barriers."<br>3)The critical issues identified were, communication, information sharing, and leadership. Working to improve the health–care system and clarifying and promoting the significance of an interprofessional network were also identified as critical issues.

A Survey on Training of Simulated and Standardized Patients(SP)and SP Program in Undergraduate Medical Education in Japan / 医学教育

A survey was conducted to better understand the current status of training of simulated and standardized patients (SP) in medical education and training protocol of SP training at each site, and to determine the future planning of the committee<br>1) Methods: A series of questions regarding the SP and SP training was sent to all 80 medical schools in Japan.<br>2) Results: Responses were received from 68 medical school (85%). According to the survey result, 43 medical schools (63%) trained their own SP. The total numbers of SP reported in this survey were 1,036 with ratio of male to female 1:3. The average numbers of SP at each medical school were 24 (range 5 to 87). SP training protocols were included basic training (88%) and to prepare common achievement test OSCE (84%), classes (74%) and advanced OSCE(60%). Only 6 medical school (14%) had the systematic curriculum for SP training.<br>3) Conclusion: To produce standardized, accurate SP training for medical education, the committee recommends to establish the standard curriculum and portrayal requirements for SP training.