Staged Repair for Transposition of the Great Arteries in a Premature Triplet Weighing 1,336 g / 日本心臓血管外科学会雑誌

<p>Cardiac surgery for very-low-birth-weight infants is rarely reported, especially for a triplet. We herein report the successful staged repair of a premature triplet accompanied with transposition of the great arteries. During pregnancy, the fetuses were diagnosed as dichorionic diamniotic triplets, and the mother entered a hospital for maternal protection and health care from 25 weeks' gestation. The triplets were delivered by Caesarean section at 33 weeks and 5 days of gestation because of intrauterine growth retardation. One of the infants, weighing 1,336 g, was diagnosed with transposition of the great arteries (type II). Since he was deemed unable to endure an intracardiac repair, he received balloon atrial septostomy on the 27th day of life and then bilateral pulmonary artery banding on the 29th day of life. However, further balloon atrial septostomy on day 69 and left pulmonary arterial de-banding on day 73 post-birth were needed because of the progression of hypoxia. He received prolonged intubation and inotropic support after temporary cardiopulmonary stability, and we ultimately decided to perform arterial switch operation on day 110, when he weighed 1,838 g. The patient showed a good recovery. In the field of pediatric cardiac surgery, we occasionally select staged strategies for patients who cannot undergo radical operations all at once because of their general condition or low body weight. However, there are no established guidelines concerning the timing of palliative or radical operations in low-birth-weight infants. At present, we select medical strategies ourselves, on a case-by-case basis. In the present case, although our medical strategy had to be adapted, we still obtained a good recovery for this triplet with extremely low birth weight. We herein report this case with some references from the literature.</p>

Questionnaire survey about problem–based learning tutorial systems / 医学教育

  The implementation status of problem–based learning （PBL） tutorial systems was surveyed in 2008, 2011, and 2012. The 2008 survey showed that the content of PBL tutorial systems differed greatly among universities.<br>  In response to a question in the 2011 survey of whether the PBL tutorial system would last for 5 years or more, more than 80% of universities agreed that the systems would likely last that long.<br>  In response to a question of whether PBL tutorial system had been changed around 2012, more than 80% universities said the system had not been unchanged. Furthermore, regarding the evaluation of tutors, the motivation of tutors as a whole did not increase. In the future, the implementation status might not be changed.

The changes in students' consciousness about community medicine during our program / 医学教育

The collapse of community medicine has becomes a serious social problem in Japan, and a variety of measures have been implemented to counter it. In medical education, the model core curriculum has been revised, and many universities have started programs for community medical. We have had a community-based medical course at the Kinki University School of Medicine since 2005. This study examined the changes in students' consciousness about and affinity for community medicine during our program.<br>1)Questionnaires were completed by 494 students taking part in community-based medical training from April 2006 through July 2010. Results from before and after training were compared.<br>2)The questionnaire had 3 parts. The first part concerned medical activities with community residents. The second part concerned medical activities with housebound elderly persons. The third part concerned the students' future plans.<br>3)Many students gave themselves high scores for activities with community residents and housebound elderly persons. More students preferred hospitals in regional towns. A few students chose rural areas.<br>4)In an introduction to community medicine, it is important to first foster cordial relations with community residents. Cultivating problem-solving skills is the next challenge.<br>5)Community-based medical programs enhance medical students' understanding of and affinity for community medicine. Furthermore, some students will choose community-based medicine as a specialty.

Participation Report of the International Association of Medical Science Educators 14th Annual Meeting / 医学教育

1) We attended the 14th annual meeting of the International Association of Medical Science Educators. Findings of research in medical education were presented.<br>2) Topics of the meeting included: assessment, curriculum, instructional methods, professional development/student support, team-based learning and problem-based learning/clinical skills, and technology/e-learning.<br>3) Preconference workshops, concurrent focus sessions, poster discussions by category, and other events were cleverly integrated into the program of this meeting. We obtained useful and applicable information for the management of meetings on education.

Course to Researcher in Basic Medicine / 医学教育

1) For the future selection after 2-year primary clinical training program, most of the doctor do not desire to be a researcher in basic medicine as well as in public medicine.<BR>2) In order to educate medical students to experience the research with joy, curriculum for integrated laboratory practice and/or assignment to basic medical department may be a good candidate in poor situation.<BR>3) If a benefit to give favorable conditions to basic medical researcher may be legally provided, many residents assume attractive life in basic medicine.

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.

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.

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.

Evaluation of Remedial Education in Biology at Kinki University School of Medicine / 医学教育

Remedial education in the basic sciences (biology, physics, and chemistry) for medical students was introduced at Kinki University in 1993. The effects and problems of premedical education were examined on the basis of a questionnaire to students and of scores on biology examinations at the time of university entrance and at the end of the first academic year. From 1999 through 2002, the average percentage of incoming freshmen who had not taken a biology course in senior high school ranged from 45.8% to 61.6%. The average score of these students on biology examinations was 23.2 to 29 points higher at the end of the first academic year than at university entrance. Thus, we found that remedial education helped improve these results. However, according to the questionnaire 26.4% of students who received remedial education felt that it had had no effect. Even at the end of the first academic year, the difference in the average score between students who had studied biology in high school and those who had not was 17 points.

How should the Education of Basic Sciences Be Achieved in Accordance with the Model Core Curriculum? / 医学教育

Since the model core curriculum was shown in public, the discussion about the medical education is getting hot in every medical school. In the model core curriculum, the integrated course is designed with the basic sciences and the clinical medicine via pathophysiology, which will be educated by the PBL tutorial. Thus, the model core curriculum is suitable for growing up better clinician. The problem involved in the context is the lower recognition to the basic sciences and also the missing of the next generation in the teaching staff of the basic sciences. The introduction of the information technology to the medical education should be much progressive. The new integrated course with the structure and function should be designed with the information technology, which will fit to the new medical education in the 21st century.

A Tutorial System in Premedical Education / 医学教育

Eight years ago the problem-based learning tutorial system was introduced for premedical education at Kinki University School of Medicine. We evaluated this unique education system with questionnaires for students in 1997 and 2000. The suitability of the problem-based learning tutorial system for medical education was 72% in 1997 and 92% in 2000. Approximately 90% students were satisfied with the tutorial system in both years, indicating that this system was widely accepted by even first-year students. However, group differences and differences due to tutors were still observed in the activities of students or the achievement of general instructional objectives or both. The content of the tutorial system and tutor training should be continuously evaluated.

Evaluation by Questionnaire of a Tutorial System at Kinki University School of Medicine / 医学教育

A tutorial education system for medical students was introduced at Kinki University in 1998. To evaluate the efficacy and to identify problems of the system, questionnaires were given to both students and tutors. Many students (approximately 80%) enjoyed the system and felt that tutorial lectures were effective. Many students believed that their selflearning time had increased and that they had developed the ability to think scientifically. However, they also thought that the material for tutorials was insufficient and that some tutors lacked teaching ability. Tutors thought that students had developed motivation (52%), problem-solving ability (58%), and debating skills (77%). Tutors also pointed out several problems, e.g., that some students had not developed self-leaning ability. Also, some tutors were poorly motivated. These findings suggest that we need to improve tutorial materials and the quality of tutors as well as fostering the self-learning ability of students.

Questionnaire Survey of Clinical Clerkships for Students in the Sixth Academic Year / 医学教育

Kinki University School of Medicine introduced clerkships for undergraduate clinical training in 1999. Clinical clerkships are performed for the first 8 weeks of the sixth academic year. In 1999 and 2000 we conducted questionnaire surveys asking students about this system. The teaching staff encourages students to participate extensively in clinical situations, which reflects the consensus about this system. We also performed similar surveys of nurses and teaching staff. Clinical clerkships did not increase the incidence of problems between patients and medical staff. Many students felt their motivation to be a physician was increased. Although the findings of these questionnaire surveys indicate that our clerkship system works successfully, they also revealed some problems for sixth-year students. Although we recognize the significance of this system for undergraduate clinical training, further improvement is required.