Committee report (Practice Article1) : Online Interprofessional Education / 医学教育

It is difficult to implement interprofessional education (IPE) in the classroom due to COVID-19. To share our knowledge of online IPE, we report on how we provided IPE for first-year students at two universities. At Mie University, a class was implemented to use Zoom. Quizzes and chats promoted interactions between instructors and students. At Hokkaido University of Science, an online team medical experience game was conducted via Zoom and a Learning Management System (LMS). The activity promoted interaction between students through gameplay and clear instructions. In both cases, students could successfully develop online IPE based on existing learning methods. Through their experience, it was clear that students are able to understand other professionals’ roles. They were also to commit to membership and/or teamship. On the other hand, students faced challenges with faculty familiarity and time allocation.

Working Group Report (Practice article 2) : Online Interprofessional Education Stepwise Interprofessional Education through Inter-University Collaboration at the University of Tsukuba (2) / 医学教育

@#In the second part of the second report, we introduce the Care Colloquium, an inter-university collaborative educational program between the University of Tsukuba and the Tokyo University of Science. The Care Colloquium is an interprofessional education program that uses PBL (Problem-based learning). In response to the COVID-19 pandemic, this program was implemented online using Microsoft Teams, with advance preparation including manual maintenance and communication testing. The same learning outcomes were achieved as the face-to-face implementation. Undergraduate interprofessional education tends to be a large-scale program, and the shortage of faculty and classrooms is challenging, but online education could overcome these obstacles. The development of hybrid programs that use the merits of both face-to-face and online education may lead to the promotion of interprofessional education in the future.

Working Group Report (Practice article 2) : Online Interprofessional Education Stepwise Interprofessional Education through Inter-University Collaboration at the University of Tsukuba (1) / 医学教育

For this second report, we divided the efforts of the University of Tsukuba into two parts. In the first part, we introduced the Interprofessional program, an inter-university collaborative educational program between the University of Tsukuba and Ibaraki Prefectural University of Health Sciences. Before the COVID-19 pandemic, this program was conducted using TBL (Team-based learning) in a large conference room. After the pandemic, this was conducted online (using Zoom). The main changes due to the online implementation were the following five points; (1) online faculty meetings, (2) advance distribution of materials, (3) testing using Google Forms, (4) group work using the breakout function, and (5) simultaneous editing using Google Docs. In the future, we would like to examine the possibility of new educational methods while creating innovations that are possible only through online interprofessional educational programs.

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%).

Survey of Formal Undergraduate Medical Curricula in Japan for Education on Drug Promotion / 医学教育

Introduction: Attention to undergraduate medical education on the relationship between physicians and the pharmaceutical industry has been increasing in North America and Europe. There are no reports, however, regarding this relationship in Japanese medical education.Methods: We conducted a cross-sectional survey using a self-administered questionnaire to investigate formal undergraduate curricula on the relationship between physicians and the pharmaceutical industry.Results: Forty-four of 80 medical schools approved participation in the study, with 16 (36.0%) reporting having a formal curriculum on drug promotion. Many of the themes included in the programs were related to research ethics or conflict of interest in research, with drug promotion covered in only a few programs.Discussion: More discussion and investigation into undergraduate education on the relationship between physicians and the pharmaceutical industry, especially on drug promotion, is warranted.

Survey of Formal Undergraduate Medical Curricula in Japan for Education on Drug Promotion / 医学教育

Introduction: Attention to undergraduate medical education on the relationship between physicians and the pharmaceutical industry has been increasing in North America and Europe. There are no reports, however, regarding this relationship in Japanese medical education.Methods: We conducted a cross-sectional survey using a self-administered questionnaire to investigate formal undergraduate curricula on the relationship between physicians and the pharmaceutical industry.Results: Forty-four of 80 medical schools approved participation in the study, with 16 (36.0%) reporting having a formal curriculum on drug promotion. Many of the themes included in the programs were related to research ethics or conflict of interest in research, with drug promotion covered in only a few programs.Discussion: More discussion and investigation into undergraduate education on the relationship between physicians and the pharmaceutical industry, especially on drug promotion, is warranted.

Comparative analysis of the depressive state, stressor, and stress-relieving factors of novice first year residents and established residents in Japan / 医学教育

Aim: We sought to compare the depression state of first-year residents, who were new to the system of clinical resident training, with those who had become completely familiar with the system.Method: A questionnaire-based survey on stress reaction was distributed to 250 resident training hospitals in Japan. The survey was taken by 1,753 first year residents who started postgraduate clinical training in 2011. The survey was given to the students once before the training and-again months after the training had started. The results were compared with those from a similar survey in 2004.Result: 3 months after the training had started, 30.5% of residents suffered from a depressive state. At that time, the prevalence of residents with newly developed symptoms of depression, who had no depressive state before the training, significantly decreased compared to those in 2004 (19.6 vs. 25.2%, p<0.001). The decrease of depressive state in 2011 may be due to the decrease of working hours, the improvement of stressor and stress-relieving factors.Discussion: Many residents still experienced a stress reaction. Further improvement of the training environment should be considered.

Medical Students Learning from a Problem Based Learning (PBL) Style In-home Care Course: A Qualitative Analysis of the Reports / 日本プライマリ・ケア連合学会誌

<p><b>Introduction: </b>The University of Tsukuba has a one-week in-home care course combining a problem-based learning style tutorial and lectures in the comprehensive community-based learning curriculum for 2^nd year students. This study aimed to investigate what medical students are learning concretely from this course.</p><p><b>Methods: </b>We performed a qualitative date analysis of the contents of all 111 student course reports written in the free description using a modified Steps Coding and Theorization method employing the framework of patient-centered clinical method (PCCM).</p><p><b>Results: </b>Medical students learned with keen interest based on their experiences and in the framework of PCCM such as 'Exploring health, disease and the illness experience', 'Understanding the whole person'. These processes led to the awareness of responsibility as a physician.</p><p><b>Conclusion: </b>The in-home care course in the classroom may provide medical students with an opportunity to become aware of their responsibility as a physician.</p>

The Interprofessional Education Programs of the University of Tsukuba: / 医学教育

　In the medical education curriculum of the School of Medicine, University of Tsukuba, an interprofessional education （IPE） program has been implemented from the first through fifth academic years as the core program in the “Essentials for Medical Professionals” course. From immediately after admission to the start of clinical training in the senior year, students have many opportunities to interact with a variety of health professionals and to systematically develop competence for interprofessional work.<br>　The School of Medicine and Medical Sciences, University of Tsukuba, consists of the School of Medicine, the School of Nursing, and the School of Medical Sciences. We have step-by-step IPE programs: students from 2 or more professions learn with, from, and about each other. In the first academic year early exposure to IPE is provided by team discussions of students from the 3 schools. In the second academic year the IPE program uses team-based learning （TBL）. In the third academic year, the Care Colloquium （a teamwork training course） is provided. The TBL program and the Care Colloquium are conducted though interuniversity collaboration with the Ibaraki Prefectural University of Health Sciences and with the Tokyo University of Science, respectively. One strategy to improve the effectiveness of the IPE program is interuniversity collaboration with the participation of a larger number of professions.

Patients' impressions about physicians working short-term in community clinics : A qualitative analysis of individual patient interviews / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : To reveal patients' impressions of physicians working short-term in community clinics, and to explore methods for physicians to work short-term in community clinics.<br><b>Methods</b> : We conducted a qualitative analysis of recordings of individual interviews performed on patients in community clinics using a partially revised SCAT (Steps for Coding and Theorization) method.<br><b>Results</b> : Patients indicated that they felt reassured by the constant presence of a chief physician at community clinics. They expected care within the scope of primary care, but were not expecting every element within this scope to be met. Patients had the attitude of accepting the current situation and were selecting how to receive medical care from the available options based on their personal priorities.<br><b>Conclusion</b> : Physicians working short-term in community clinics were satisfying a portion of the patients' needs. Providing care within the scope of primary care and taking the initiative in getting to know patients are essential elements for physicians working short-term in community clinics.

Association between smoking prevention education for elementary and junior high school students and modification of their parents' smoking behavior<br>- Can children's talk change parents' behavior? / 日本プライマリ・ケア連合学会誌

Association between smoking prevention education for elementary and junior high school students and the modification of their parents' smoking behavior — Can child education change parental behavior?<br><b>Introduction</b> : This study aimed to investigate an association between a smoking prevention education program for elementary and junior high school students, and the subsequent behavior modifications of their parents.<br><b>Methods</b> : Preventative education programs for smoking were provided to four elementary and three junior high schools in Kamisu City, Ibaraki Prefecture, Japan. We encouraged participating students to discuss the knowledge derived from the education sessions with their families. One month after completing the program, questionnaires were distributed to the parents of the students to investigate whether they had modified their smoking behavior as a result of what they had learnt from their children.<br><b>Results</b> : Two questionnaires were distributed to each of 1109 families, and 1427 valid responses were received. Analysis showed that 794 parents had been informed about tobacco use from their children (55.6%) and 271 parents had modified their smoking behavior (19.0%) as a consequence. This included smoking cessation, decreasing tobacco consumption, and smoking avoidance in the presence of their children. Behavior modification was significantly correlated with the knowledge they had derived from their children based on the preventative smoking education program (odds ratio = 3.3 ; 95% CI : 2.4-4.6).<br><b>Conclusion</b> : Implementation of an education program for smoking prevention focused on elementary and junior high school students can lead to modification of smoking behavior in both students and their parents, respectively.

Diagnostic Characteristics of Symptom Combinations over Time in Meningitis Patients / General Medicine

<b>Objective:</b> The aim of this study was to investigate diagnostic characteristics to distinguish bacterial meningitis (BM) from aseptic meningitis (AM) in meningitis patients. Indicators from the initial consultation were combined with a measure of time since the onset of fever.<br><b>Methods:</b> This was a retrospective chart review. We examined the sensitivity and specificity of the clinical information for BM. The diagnostic characteristics for BM were analyzed by considering the duration of fever for each patient at consultation, together with the presence or absence of changes in their mental status.The study examined 117 inpatients diagnosed with meningitis in their clinical record at the time of admission. The patients were admitted into two emergency hospitals in Japan between 2001 and 2011. Meningitis was defined as the presence of five or more cells per mm³ of CSF.<br><b>Results:</b> Twenty-five patients were diagnosed with BM and 92 patients with AM. There was no single clinical symptom that could distinguish BM from AM in patients suspected of meningitis. The sensitivity and specificity of the clinical information for fever duration and disturbance of consciousness at consultation were 95.0% and 40.3%, respectively, for BM patients with disturbance of consciousness or with duration of fever less than three days. Thus, the proportion of BM patients without disturbance of consciousness for three or more days after fever onset was only 5%.<br><b>Conclusions:</b> Patients without disturbance of consciousness for three or more days after fever onset are rarely suffering from BM.

Influence of parental smoking on junior high school students' perceptions of smoking / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : This study aimed to clarify any associations between familial smoking, especially parental smoking, and high school students' perceptions of smoking.<br><b>Methods</b> : Questionnaires on familial smoking and the Kano Test for Social Nicotine Dependence (KTSND) were distributed to junior high school students. The KTSND is a tool to evaluate positive perceptions of smoking. We analyzed the relationship between the total KTSND score and school grade, gender, familial smoking, paternal smoking, and maternal smoking.<br><b>Results</b> : We received 761 valid responses (valid response rate : 90.4%). Five hundred forty-three students had family members who smoked (71.4%), 394 had smoking fathers (51.8%), and 214, smoking mothers (28.1%). The total KTSND score correlated with familial smoking (10.55 vs 9.46, <italic>p</italic>=0.009) and maternal smoking (11.18 vs 9.87, <italic>p</italic>=0.002).<br><b>Conclusion</b> : Familial smoking, especially maternal smoking, correlated with positive perceptions of high school students towards smoking. Promoting smoking cessation in women with children may be effective in preventing tobacco use among children.

Prevalence of Sleep Apnea Syndrome in Japanese Patients with Persistent Fatigue / General Medicine

<b>Background:</b> Sleep apnea syndrome (SAS) is a common medical condition with significant adverse effects; however, it remains undiagnosed in many individuals. This study was conducted to assess the prevalence of SAS in fatigued subjects and to elucidate the factors associated with SAS.<br><b>Methods:</b> From March 2008 to March 2011, a cross-sectional, observational study was conducted in patients with persistent (≥1 month) fatigue. Patients with known causes of persistent fatigue were excluded. Data on patient characteristics (e. g., blood pressure, neck circumference, etc.) and overnight pulse oximetry were collected. SAS was defined as a 3% oxygen desaturation index (ODI) of 15 or more.<br><b>Results:</b> Among 46 subjects, the prevalence of SAS was 6.5% (95% CI, 1.4-17.9%). SAS was significantly more prevalent in patients with high systolic blood pressure (≥140 mmHg) than in patients with normal systolic blood pressure (<140 mmHg) (33.3% vs. 2.8%, P=0.049). Even after adjustment for age and sex, high systolic blood pressure showed a statistically significant association with SAS.<br><b>Conclusions:</b> Promoting awareness about SAS could be necessary in patients with persistent fatigue, especially in patients with high systolic blood pressure.

Resident stress in the new postgraduate clinical training system / 医学教育

Postgraduate residents face formidable stress. Unfortunately, many residents withdraw from training programs because of reactions to stress, such as depression. We performed a comprehensive study to examine the working conditions and stress of residents to improve the conditions of resident-training programs and reduce levels of stress.<BR>1) The study examined 548 first-year residents starting postgraduate clinical training at 41 hospitals in Japan. A selfadministered questionnaire, which included questions about working conditions, job stressors, buffer factors, and stress reactions, was answered before and 2 months after the start of training.<BR>2) A total of 318 subjects completed the survey.Of these subjects, 80 (25.2%) had depression after the start of training.<BR>3) Job stress patterns of residents were characterized by high workload and extremely low “reward from work” and “Job control.”<BR>4) Many residents had depression after the start of training.To improve residency programs, program directors should recognize the specific characteristics of residents' job stress and focus on buffer factors.