The Seamless Transition of Medical Education from Pre- to Post-graduate Training: Approach from Outcome-based Education / 医学教育

In the past, pre-graduate medical education and clinical training have not been sufficiently discussed and consistent training of physicians has not been carried out because the entities that implement the studies are different. In order to realize high quality pre-graduate education and post-graduate clinical training, and to promote seamless training of physicians, it is necessary to establish a system of medical education. It is also necessary to consider the outcomes of pre-graduate medical education and clinical training to maintain consistency in the review of clinical training system for physicians in 2020. This paper discusses the Model Core Curriculum for Medical Education and clinical training from the perspective of outcome-based education for consistent physician training.

Three Policies in The Baccalaureate Degree Program and Outcome-Based Education / 医学教育

Educational reforms are required to achieve the "learning outcomes" expected in bachelor degree education programs. In executing reform, three policies of "diploma policy" , "curriculum policy" , and "admission policy" are clearly stated for each institution in order to facilitate integrated operation and practice. For the sake of quality assurance, outcome-based education (OBE), which emphasizes "learning outcomes" , has been introduced to medical education but it has not been adopted by all learning institutions. With the implementation of field-specific evaluations for medical education comes a need for all medical departments and medical colleges to introduce OBE as soon as possible. For this reason, an examination was conducted to find out how to formulate and operate the three policies under OBE.

Outcome-based medical specialty training: Can it bridge the gap between theory and clinical practice? / 医学教育

　The Japanese Medical Specialty Board has been established with the collaboration of medical and medical care organizations. It ensures the quality of medical specialists and achieves accountability to the people by certifying medical specialists and authorizing training programs. Outcome-based education is characterized by an emphasis on the quality assurance of trained physicians. Therefore, the new medical specialty training system could be constructed through outcome-based education. I give a brief overview of the new medical specialty training system, and it is discussed in the context of the guideline for medical specialty training system published recently.

1. Does the national examination for medical practitioners contribute to a seamless transition from under- to post-graduate medical education in Japan? / 医学教育

<p>　As medical safety attracts attention, it has become increasingly important to ensure the quality of medical education, and more emphasis has been placed on educational outcomes. An ideal form of training, in which medical students undergo medical education and then transfer to residency training seamlessly, can be conducted by setting general competencies required for all physicians as educational outcomes, as well as setting milestones in the process. Accomplishing competencies is the pillar of outcome-based education, and the assessment of students' achievements is important.<br>　The multilateral assessments of their competencies should be conducted, including written examinations, performance tests, observational assessments, and portfolios. In the existing national examination for medical practitioners, no such multilateral assessments are conducted. To promote seamless transition from under- to post-graduate education, it is important for the Faculty of Medicine and medical colleges to appropriately assess students' educational milestones as a condition of awarding them with degrees, in addition to the setting general competencies and such milestones.</p>

Implementation of outcome–based education at the Chiba University School of Medicine focusing on planning a sequential curriculum / 医学教育

1)We applied a spiral curriculum devised by Harden to plan a sequential curriculum in outcome–based medical education at the Chiba University School of Medicine.<br>2)To plan a sequential curriculum, Miller's pyramid was applied to create a model for developing the competencies of physicians.<br>3)Competence levels based on the developmental model were used to plan learning objectives for each unit, and students and teachers were encouraged to understand the relevance of each lesson to competencies.

Effectiveness of a training program using a mannequin-based simulator for central venous catheterization / 医学教育

Technical skills have traditionally been taught by "learning by doing". This teaching method is mainly associated with potential risks for patients. Teaching technical skills using simulators has emerged in recent years but their effectiveness has not been adequately tested. The objective of this study was to examine the effectiveness of a central venous catheterization (CVC) training program using a simulator.1) Twenty residents were randomized to either receive a training program using a simulator on CVC (simulator group, n=10) or not (non-simulator group, n=10). They were evaluated for their technical competence in performing CVC on patients and their personal concerns about their first experience of CVC.2) There was no difference between the two groups in resident and patient characteristics; however, the simulator group scored significantly higher in the 4-point performance score than the non-simulator group (2.80±0.33 versus 2.30±0.48, P=0.035).3) The completion rate of CVC was higher in the simulator group (90% versus 60%, P=0.12), and they required fewer attempts at needle insertions (1.67±0.71 versus 3.00±1.26, P=0.022).4) Residents in the simulator group noted the effectiveness of this program more frequently than those in the non-simulator group (86% versus 36%, P=0.057) and showed fewer concerns about their first experience of CVC on patients.5) The CVC training program using a simulator improved residents' skills and is likely to be effective to diminish the fears of residents about performing CVC on patients.

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.

Desirable Educational Environment for the Better Clinical Clerkship / 医学教育

In order to implement, or enhance the quality of clinical clerkship, it is necessary to develop good educational environment which will be appropriate to allow medical students participate in medical team services. Important things to be considered will be, (1) Systematic management of the individual department's program by the faculty of medicine, (2) Developing educational competency within the medical care team function, and (3) Nurturing students' awareness forself-diected learning and cooperative team work, and teaching- and medical staffs' awareness of their educational responsibilities. In this paper, to develop better educational environment for clinical clerkship, we propose a desirable situation of the educational organization, dividedly describing on the roles of dean, faculties, board of education, department of medical education, clerkship director, teaching physicians, residents and medical students.

Physical Examination Training and Gender of Japanese Medical Students: Analysis of a Questionnaire about Peer Training and Instructors / 医学教育

To assess the acceptance of peer physical examination training and the acquisition of professional attitudes as medical doctors, a questionnaire was given to 245 medical students (second, fourth, and sixth year) of Chiba University. All students recognized the value of peer physical examination training, and female students recognized the necessity of training with male examinees. Male students accepted roles of both examiner and examinee, but female students refused to be examined by male students or to be taught by male instructors. The genders of students and instructors must be considered when physical examination curricula are planned.

Evaluation of the Model Core Curriculum for Clinical Clerkship / 医学教育

In March 2001, Research and Development Project Committee for Medical Educational Programs proposed a model core curriculum for undergraduate medical education. In this curriculum, implementation of the clinical clerkship is strongly recommended. Two similar curriculum models were later presented by other organizations, and some differences were observed among them. We, Undergraduate Medical Education Committee, have evaluated and compared themodel core curriculum 2001 with the Japanese newer proposals as well as those of USA and UK. Here is reported our proposals for a better rewriting of the learning objectives in the model core curriculum 2001, with some emphasis on the nurture of the competence of the case presentation and decision making process.

Learning How to Suggest Changes in Health Behavior and to Inform Patients of Bad News with Simulated Patients in a Preclinical Clerkship Curriculum / 医学教育

In the fourth-year curriculum of the Chiba University School of Medicine, suggesting changes in health behavior and informing patients of bad news were studied through lectures and small-group role-playing with simulated patients as part of an advanced course in medical interviewing. We report on the contents of the curriculum and the results of an evaluation.

Promotion of Continuing Medical Education for Physicians by Using the Mailing List / 医学教育

Because new media have come onstage in the information technology period, also self-learning methods have been diversified. Recently, small group discussion such as clinical conference using the mailing list is lively performed among the primary care physicians, and it is considered to be useful for continuing medical education. To promote the mailing list for continuing medical education, we present as follows; 1) present situation: to show a good example of TFC-ML (total family care-mailing list), 2) usefulness: to know new medical knowledge, new medical information and literatures etc., to discuss clinical cases. 3) issues: a role of moderator, excess of information, correspondence with slander, 4) future: to reevaluate usefulness for continuing medical education. We would like to expect effectiveness of mailing list for continuing medical education.

Education in Multiprofessional Teamwork for Preclinical Medical Students Through Case-Oriented Problem-Solving / 医学教育

Teamwork is increasingly important for high-quality patient care, and education in multiprofessional or interdisciplinary teamwork has recently been proposed as an essential subject in the core curriculum of Japanese medical schools. We developed a course in teamwork in which medical students devised diagnostic, therapeutic, and support programs from a written patient scenario with the help of a multiprofessional staff, including subspecialty physicians and surgeons, nurses, a counselor, a social worker, and a dietician. The course promoted understanding of mutual roles and the ideal relationship between physicians and comedical staff. Active discussion is necessary for understanding interdisciplinary and transdisciplinary teamwork.

On a Report of the Questionaire Regarding Activities of Continuing Medical Education for the Primary Care Physicians in University Hospitals and Clinical Training Hospitals / 医学教育

The aim of this study is to clarify the present situation of activities of continuing medical education (CME) for the primary care physicians to whom the leading hospitals, such as universities and clinical trainee hospitals perform CME in their regions. A questionaire was designed for main 4 parts, as following: 1) On the purpose of CME for the physicians. 2) On the organization (office) managing CME in the hospitals. 3) On the strategies of CME. 4) On the evaluation of CME. Answers to a questionaire were replied from 234 institutions (58.1%). Analyzing the results, we recognized that the leading hospitals actively carried out CME for the primary care physicians in the community. Furthermore, conversion to experiential learning from passive learning and establishment of evaluation methods should be promoted in CME.

Clinical Tutorial System at Chiba University School of Medicine / 医学教育

Many institutions have applied a tutorial system to medical education since Tokyo Women's Medical College started doing so in 1990. Chiba University School of Medicine started a clinical tutorial system in April 1997 and has continued it for 4 years. Our system has employed problem-based learning using cases, with the goal of students' acquiring self-learning and problem-solving skills. This tutorial system has been positively evaluated by both students and instructors and is likely to be useful for clinical medical education.

Questionnaire Analysis of Early Postgraduate Clinical Training of 6th-Year Medical Students at Chiba University School of Medicine / 医学教育

A questionnaire analysis of early postgraduate clinical training of 6th-year medical students was conducted for 3 consecutive years. After graduation, 32% of the students wished to become family physicians, 58% wished to become specialists, and 9% wished to become other types of doctors. The type of postgraduate clinical training most often considered ideal was superrotation, followed by rotation and straight track. Superrotation should be introduced to junior residents during postgraduate clinical training as should a variety of subspecialty training courses for specialists, including family medicine for senior residents.

Evaluation by Students of Bedside Learning in the Department of Pediatric Surgery / 医学教育

We evaluated bedside learning in the department of pediatric surgery by conducting a questionnaire survey of senior medical students at Chiba University School of Medicine. We obtained responses from 70 of 95 students (74%). Although 84% of students responded by making lists of patients' problems. Many students indicated insufficient knowledge about diseases and insufficient technical skills for medical treatment as the reasons they could not solve these problems. This finding indicates that students do not have sufficient basic knowledge and clinical skills for bedside learning. These skills must be acquired and evaluated before bedside learning can be started.