Catorce años después de abierto el debate sobre formación de un cirujano torácico general certificado / Fourteen Years following the Discussion about Training a Certified General Thoracic Surgeon

Introducción: En Cuba existen numerosos cirujanos que han dedicado una gran parte de su vida profesional a la cirugía del tórax no cardiovascular, pero solo ostentan el título de especialista de primer o segundo grado en cirugía general. Objetivo: Exponer los argumentos que demuestren la necesidad de crear e implementar la especialización de primer grado en cirugía torácica general o la maestría en cirugía del tórax. Métodos: Se realizó una búsqueda documental a partir de los motores de búsqueda de información científica Google Académico y Highwire Press. De la Web of Science, PubMed, Lilacs y Scopus se seleccionaron 23 artículos relacionados directamente con el objetivo propuesto. Desarrollo: En 2008 el profesor Benito Saínz Menéndez publicó un artículo en el cual expuso la necesidad de crear un programa de posgrado sobre cirugía torácica general; sin embargo, después de 14 años, aún se mantiene el debate sobre este tema. En tal sentido, los reclamos de la comunidad quirúrgica cubana en la propuesta de un programa de maestría y en una tesis doctoral se han hecho sentir en varias reuniones académicas y en diversas publicaciones. La nueva solicitud se justifica desde distintas aristas. Conclusión: El desarrollo de la educación de posgrado y la necesidad de formar recursos humanos capacitados en cirugía general ha acumulado los suficientes preceptos para solicitar la cirugía torácica como una subespecialidad o la inserción de una maestría sobre este tema. Se recomienda que se evalúe la posibilidad de la creación e implementación de la especialización o maestría en cirugía de tórax no cardiovascular(AU)

Introduction: In Cuba, there are numerous surgeons who have dedicated a large part of their professional life to noncardiovascular thoracic surgery, but they only hold the title of first- or second-degree specialist in General Surgery. Objective: To present the fundamentals demonstrating the need to create and implement the first-degree residence for general thoracic surgery or a master's degree in thoracic surgery. Methods: A document search was carried out using the scientific information search engines Google Scholar and Highwire Press. From the Web of Science, PubMed, Lilacs and Scopus, 23 articles directly related to the proposed objective were selected. Development: In 2008, Professor Benito Saínz Menéndez published an article in which he presented the need to create a postgraduate curriculum for general thoracic surgery; however, after 14 years, the debate on this subject is still ongoing. In this respect, the claims of the Cuban surgical community concerning the proposal of a master's program and a doctoral dissertation have been felt in several academic meetings, as well as in several publications. The new request is justified from different points of view. Conclusion: Through the development of postgraduate education and the need to train skilled human resources in general surgery, enough principles have been accumulated for requesting that thoracic surgery be taught as a subspecialty, or the insertion of a master's degree on this subject. The assessment is recommended for the possibility of creating and implementing a specialization or a master's degree in noncardiovascular thoracic surgery(AU)

Core competency of doctors at tertiary public hospitals in regions of different income levels in China: a cross-sectional survey / 中华医院管理杂志

Objective:To explore the core competency of doctors in tertiary public hospitals in regions of different income levels in China, and provide reference for promoting such competency and related policy formulation.Methods:Using multi-stage stratified cluster sampling method, 195 tertiary public hospitals in 16 provinces of China were selected from November 2021 to March 2022. 200 doctors were sampled from each hospital. A self-designed questionnaire was used to investigate the status of doctors′ core competencies, as well as the status of their postgraduate medical education and continuing medical education. According to the per capita gross regional product of each province in China Statistical Yearbook 2022, each province was divided into high, middle and low income regions, and the questionnaire data were descriptively analyzed, while χ2 test was used to compare the differences between groups. Results:A total of 32 673 valid questionnaires were collected. There were 12 135 doctors (37.14%) in China who had received comprehensive education and training of core competency in all dimensions. Among the dimensions of self-rated core competency of the surveyed doctors, there were 10 019 doctors (30.66%) with insufficient teaching ability and 438 (1.34%) with insufficient professional quality, and there was no significant difference between regions ( P>0.05). There were 2 385 (27.08%), 2 528 (27.55%) and 3 646 (24.82%) doctors in high-, middle- and low-income regions with insufficient lifelong learning ability, respectively. The proportion of doctors in middle- and high-income regions was higher than that in low-income ones ( P<0.05). There were 1 317 (15.57%), 1 290 (14.06%) and 2 719 (18.51%) doctors with insufficient knowledge and skills in high-, middle- and low-income areas, respectively. The proportion of doctors in low-income regions was higher than that in middle- and high-income regions ( P<0.05). The proportion of doctors who did not receive any kind of postgraduate medical education or continuing medical education in low-income regions was 7.33% (1 077 people), higher than that in high-income and middle- income ones ( P<0.05); 50.44% (4 442 people) of surveyed doctors in high-income regions believed that for standardized training of resident physicians (hereinafter referred to as residential training), the clinical teachers were " overworked to take this job", which was higher than that in middle- and low-income regions ( P<0.001); In middle-income regions, 46.16% (4 235 people) and 43.46% (3 987 people) believed that the salary residents and specialized physicians in standardized training (hereinafter referred to as specialized training) was too low, while 42.47% (3 897 people) and 30.44% (2 793 people) believed that the clinical practice opportunities of students were limited, both of which were higher than those in high-income and low-income regions ( P<0.001); 34.91% (5 128 people) of surveyed doctors in low-income regions believed that the investment was insufficient for training bases of residential training, 27.81% (4 085 people) of those held that training bases for specialized training were unevenly distributed, and 33.19% (4 876 people) of those held that continuing medical education was plagued by " insufficient promotion coverage, and insufficient opportunities for primary doctors", all of which being higher than those in high- and middle-income regions ( P<0.001). Conclusions:There is an obvious need to improve the core competence of doctors in the teaching ability dimension of tertiary public hospitals in China, especially in middle- and high-income regions for lifelong learning, and in low-income regions for knowledge and skills; There are differences between postgraduate medical education and continuing medical education systems in regions of different income levels in China. It is necessary to improve the competency oriented postgraduate medical education and continuing medical education systems.

Comparison and enlightenment of cardiothoracic residency training between China and the United States / 中华医学教育探索杂志

Through the comparison of the residency training system between China and the United States in pre-training educational background, training policy and post-training career path, it is concluded that the cardiothoracic surgery residency training in the United States has a high admission threshold, long training cycle and high education cost, but it also has the advantages of professional management, outstanding specialty characteristics and perfect evaluation system, which are suitable for the training of cardiothoracic surgeons. However, the current residency training of cardiothoracic surgery in China needs to be further improved. Learning from the advantages of the United States residency training system, we can formulate a more reasonable and professional residency training program according to Chinese own characteristics, so as to train excellent cardiothoracic surgeons for our country.

Impact Of Communication Skills Training in Postgraduate Medical Education

Background: Effective communication is a key feature of optimal doctor-patient relationship. As the postgraduate curriculum lacks standardized teaching and assessment, this study aimed to assess effec-tiveness of training program on communication skills of postgraduate medical students. Materials and methods: A prospective, interventional study was conducted among first year postgrad-uate medical students from different clinical specialty. Training program included introduction to prin-ciples of communication with basics of doctor-patient relationship, administering informed consent, breaking bad news and counselling patients with HIV/cancer. Pre and post-test skill assessment by Fac-ulty and postgraduate (PG) self-rating was carried out using KEECC-A Assessment tool for seven core communication competencies. Perception of students on training program was collected via feedback questionnaire. Results: Forty-three postgraduate medical students participated. Statistically significant increase in communication skills scores was observed post training with mean post-test assessment scores of 24.26�94, p<0.001(rating by faculty), 25.19�76, p<0.001(PG self-rating) and high degree of internal consistency was found. Students perceived the training program as valuable and highlighted its im-portance as a part of curriculum. Conclusion: Training program significantly enhanced communication skills of postgraduate medical students. Integration of standardized teaching and assessment of communication skills is essential for better healthcare practice and optimal doctor-patient relationship.

Factors Influencing the Postgraduate Training Choices of Medical Interns and Junior Medical Officers at the Georgetown Public Hospital Corporation, Guyana

ABSTRACT Objective: To determine the specialty preferences and the reasons for those choices among medical interns and junior medical doctors at the Georgetown Public Hospital Corporation (GPHC), Guyana. Methods: A cross-sectional study of recent medical graduates at GPHC using anonymous self-administered questionnaires was used. Results: Of the study population of 66, 60 of the questionnaires that were filled were returned (response rate of 91.5%). The females comprised 60% of the respondents and 98% of the respondents were interested in Postgraduate Medical Education (PGME). Paediatrics was the most popular programme (25% of the respondents) followed by internal medicine (21%), and the main reason among the respondents for their choice of training programme was personal interest (69%). Gender differences occurred in paediatrics and ophthalmology where the females were predominant, and in orthopaedics and anaesthesia, where the males were predominant. Conclusion: To ensure an adequate and balanced medical specialists workforce for the future, information on medical graduates' perceptions and preferences of PGME and the factors influencing their choices is important to policy planners and medical educators and efforts must be made to correct any of the maldistributions noted.

Curso de Competencia Comunicativa Intercultural a través del inglés en la Educación Médica Posgraduada / Course of Intercultural Communicative Competence through English in Postgraduate Medical Education

Introducción: Se presenta el diseño de un curso para el desarrollo de la competencia comunicativa intercultural (CCI) a través del inglés en la Educación Médica Posgraduada. Objetivo: Valorar el diseño del curso, teniendo en cuenta principios de los enfoques histórico-cultural y comunicativo, en que se sustenta. Material y Métodos: La población y muestra varía según objetivos y métodos empleados, se consultaron informantes claves (especialista y director de postgrado, docentes de posgrado y profesionales de la salud que han cumplido misión en países de habla inglesa). Las indagaciones empíricas se realizaron a través de entrevistas a profundidad, encuestas, observación del desempeño y revisiones documentales. Para la interpretación de los resultados se emplearon el análisis y la síntesis, la inducción y la deducción. Resultados: Se muestra la pertinencia de los sustentos seleccionados como fundamentación teórica del curso, los objetivos, contenidos y metodología, en particular las tareas docentes que estimulan el aprendizaje significativo de los participantes. Se brindan indicadores de desarrollo de la CCI que fueron esenciales para la determinación de los contenidos. Conclusiones: El diseño del Curso: Competencia Comunicativa Intercultural a través del inglés en la Educación Médica Posgraduada, revela una relación lógica entre su fundamentación teórica y todos sus componentes didácticos, resaltando la importancia de las exigencias de las tareas docentes y sus potencialidades para desarrollar la Competencia Comunicativa Intercultural y responder a las necesidades de aprendizaje identificadas(AU)

Introduction: The design of a course for the development of intercultural communicative competence (ICC) through English in Postgraduate Medical Education is presented. Objective: To assess the design of the course taking into account the principles of the historical, cultural and communicative approaches on which it is based. Material and Methods: The population and sample varies according to the objectives and methods used. Key informants were consulted (one specialist and one postgraduate director, postgraduate teachers and health professionals who have fulfilled missions in English-speaking countries). Empirical inquiries were made through in-depth interviews, surveys, performance observation and documentary reviews. For the interpretation of results, analysis and synthesis, induction and deduction were used. Results: The relevance of the selected aspects as the theoretical foundation of the course, objectives, contents and methodology, particularly the teaching tasks that stimulate the significant learning of the participants are shown. ICC development indicators that were essential for content determination are provided. Conclusions: The course design related to Intercultural Communicative Competence through English in Postgraduate Medical Education reveals a logical relationship between its theoretical foundation and all its didactic components, highlighting the importance of the demands of teaching tasks and their potential to develop Intercultural Communicative Competence and respond to identified learning needs(AU)

Residency Evaluation and Adherence Design Study III: Ophthalmology residency training in India: Then and now朓mproving with time?

Purpose: To gauge the differences in ophthalmology residency training, academic, clinical and surgical, in the last three decades of the 20th century and the first decade of the 21st century. Methods: A survey was conducted by the Academic and Research Committee of the All India Ophthalmological Society, in 2014�16, using a prevalidated questionnaire, which was circulated to ophthalmologists to gauge the practicality of the teaching protocols of clinical and surgical skills during postgraduate residency program. Results: Of the 1005 respondents, 320 ophthalmologists who completed residency between 1967 and 2002 (20th century trained) and 531 who completed a residency in 2003�12 (21st century trained) fulfilled the inclusion criteria. The average age was 49.2 years (standard deviation [SD] 4) and 32.6 years (SD 4), respectively. Twenty-first century trained ophthalmologists rated their training significantly better than the 20th century trained ophthalmologists for slit lamp examination (P = 0.001), indirect ophthalmoscopy, gonioscopy, automated perimetry, optical coherence tomography, and fundus photography (all having P < 0.001), while the 20th century trained rated their teaching of refraction, synoptophore, diplopia charting better (all P < 0.001). The range of grading was 0� in all categories. The median number of surgeries performed independently by 20th century and 21st century trained (during their training period) were: intracapsular cataract extraction (ICCE) 10, 0; extracapsular cataract extraction (ECCE) 43, 18; small incision cataract surgery (SICS) 5, 55; phacoemulsification (Phaco) 0, 1; pterygium excision 20, 15; dacryocystectomy 11, 4; dacryocystorhinostomy 11, 2; chalazion 35, 30; trabeculectomies 5, 0; strabismus correction 0, 0; vitrectomy 0, 0; keratoplasty 0, 0; eyelid surgery 6, 2; and ocular emergencies 18, 20. Conclusion: Teaching of many clinical skills had improved over decades. Cataract surgery training has shifted from ICCE and ECCE to SICS and Phaco, but other surgeries were still taught sparingly. There was an enormous variation across the country in residency training which needs immediate attention.

Reconsideration on training of internal chief medical residency in post-graduate medical education system / 基础医学与临床

Under the backgroud of establishing a unified and standardized postgraduate medical education system in China,this article reviews the origination and current situation of chief resident of internal medicine. By comparing the difference of training in Sino-American,the chief residency of internal medicine should comply with the interna-tional medical education system,and flexible design the role and function of chief medical residents combining with the domestic medical and training needs.

<b>Postgraduate Japanese Medical Education in Kampo </b><b>Medicine</b> / 日本東洋医学雑誌

<p>Kampo medicine has been incorporated into Japan's medical curriculum nationwide. However, it has not been adopted into its postgraduate medical education. The present study assessed Kampo medicine educational needs for residents in Japanese postgraduate training programs. A questionnaire-based survey was conducted in residents at Japanese Red Cross Ishinomaki Hospital, regarding their experience in prescribing Kampo formulae and the Kampo medicine curriculum they expect in their postgraduate education. Twenty-one residents completed the questionnaires. Seventy-five percent of junior and all senior residents had used Kampo medications. They were mostly provided with on-the-job instruction by attending doctors, senior residents, and fellows during their residency rotations. All residents needed Kampo medicine education opportunities. They expected guidance with respect to the basics of Kampo medicine, and the treatment of common diseases with Kampo formulae. The results of our study demonstrates that residents believe Kampo medicine education should be provided in postgraduate training programs.</p>

Iran’s Postgraduate Medical Education Achievements over Last 35 Years.

Aims: This article provides important information on Iran clinical postgraduate education progresses over the last 35 years. This historical study focus is on post graduate education quantitative achievements and growth of admitted residents and graduated specialist and subspecialists and fellowships by gender since 1979 after the revolution in Iran. Study Design: This is a comprehensive national historical study. Place and Duration of Study: This national study was performed in Iranian Academy of medical science, between Apr. 2011 and may 2014. Methodology: The first hand data gathered from Iran health ministry of and also from Medical Council of IR Iran. Results: There are 28 specialty and 24 subspecialties disciplines in Iran’s postgraduate medical education programs. The numbers of resident’s admission in specialties increased from 385 in 1979 to 2500 in 2014, and respectively from zero to 269 in subspecialty fields. 55 percent of admitted residents in specialty programs and 30 percent of admitted specialists in subspecialty programs were female in last year. During the period of 1979-2013, number of Iranians medical specialists’ has more than 300 percentage increases, and the ratio of specialist per 100,000 Iranian Population has more than 110 percentage increases. Research is another important field in our medical education system. Iran has published more than 20,000 medical and health research articles last year and 0.44% of its studies are considered as the 1% best articles of the world. The country has also gained the first place in the Middle East regarding science production. Conclusion: Along with expansion Iran’s P.G.M.E. over the last 35 years, the number of Iranian female physicians significantly increased. Iran’s medical education system with great achievement in specialty/subspecialty training and related research is comparable with those of the most progressed countries in the world.

Culmina el primer ciclo de la formación de especialistas para la atención primaria y el sistema público de atención de salud: qué hacer en adelante? / Training program of specialists incorporated in the primary health care teams: at the end of the first six year cycle, which goals for the next stage?

El Programa de formación de especialistas para la atención primaria de salud y el sistema público, fue iniciado por el Ministerio de Salud de Chile en el año 2007 y se implementa en ocho facultades de Medicina. El Programa dura seis años; la mitad del período transcurre en centros de salud familiar. La primera cohorte de médicos se graduará a comienzos del año 2014. Participan 498 médicos jóvenes, estudiando en hospitales de nivel universitario y trabajando en 73 centros de salud que atienden una población de cerca de dos millones de usuarios potenciales. Actualmente hay suficiente evidencia de que las autoridades, los profesores de clínica, los residentes, las municipalidades y los evaluadores externos consideran que el Programa es necesario y efectivo. El Ministerio proporciona el financiamiento adecuado; pero todavía preocupa su estatus legal y organizacional. Las actividades se orientan a la consolidación de la gestión clínica, al fortalecimiento de las funciones de promoción y prevención en los centros de salud, al progreso en la equidad y efectividad del sistema y a la educación de los usuarios y de las comunidades. Durante la formación también se desarrolla un curso (diploma) de Salud Pública. Los objetivos de mayor alcance incluyen: la planificación de la cobertura a alcanzar durante el próximo ciclo de seis años, la definición de las condiciones deseables para ejecutar la atención primaria, y la evaluación del costo efectividad de las acciones, incluyendo el destino ulterior de los egresados.

The Training Program of specialists incorporated in the primary health care teams and in the public medical care system was started by the Ministry of Health of Chile in 2007 and is carried out in cooperation with eight Medical Faculties. The program lasts six years; half of the time is spent in primary care clinics. The fist cohort will graduate as specialists beginning of 2014. In all, 498 young physicians are now participating in the Program in 73 clinics that cover nearly 2 million potential users. It is generally agreed by all concerned – authorities, faculty, residents, municipalities, external evaluators - that the Program is necessary and effective. However, at this stage and in spite of the financial and administrative support so far provided, there is a concern regarding the legal and organizational status of the Program. Current efforts are being directed towards consolidating the clinical management of patients, strengthening promotion and prevention in the clinics, improving the equity and effectiveness of the system and educating the users and the communities. This is supported by a public health course delivered during the entire duration of the Program. Broader objectives include: planning the coverage to be attained during the next six-year cycle; defining the required type of PHC facilities, and evaluating the cost-effectiveness of the Program, including the subsequent destination of its graduates.

The nursing practice program in the new intern orientation / 医学教育

1) Yokohama City University Hospital has provided a 1-day nursing practice program during the orientation period for first-year interns since 2004. Here we report on the practice performed this year.2) After taking part in the practice, interns described the communication and consultation among the medical team as well as the nurse-patient and nurse-physician relationships. In addition, they recognized the professionalism of nursing.3) To assess the clinical outcome of this practice, we would use the attitude evaluation by head nurses of wards.

The Perception and Opinions for the 'Compulsory Clinical Training Program' of Postgraduate Medical Trainee / 가정의학회지

BACKGROUND: Nowadays 2-year 'Compulsory Clinical Training Program' is on issue. The perception and opinions for the new training system of residents and interns may be essential to establish ideal postgraduate medical education. METHODS: A questionnaire survey of postgraduate trainee from March to April 2008 was performed by person to person method. Gender, age, specialty, the location and the facility of the hospital, and 7 questions reflecting individual perception and opinions for the 'Compulsory Clinical Training Program' were reviewed. RESULTS: Among in 1,314, 1,284 subjects completed the survey fully. We divided 1,284 sujects into 4 groups; Intern; Resident of Family Medicine; Resident of Internal Medicine or Pediatrics; Resident of other than Family Medicine, Internal Medicine and Pediatrics. About the vision for independent clinical skills through the 'Compulsory Clinical Training Program', most were negative. They were afraid of 'prolongation of current Internship' or 'unclear quality of the training course'. In case of setting the 'Compulsory Clinical Training Program', most chose additional resident courses for specialty. The main opinion about the ideal model of a primary physician was medical doctors who obtained primary care specialty. CONCLUSION: Most of the residents and interns think that the specialists of family medicine, internal medicine or pediatrics are suitable for primary care. And on wishing the additional residency course even after 'Compulsory Clinical Training Program', they doubt about the efficacy of the new training system.

Self-evaluation by residents in ambulatory clinic practice at Fukuoka University Hospital / 医学教育

1) We have performed ambulatory clinic practice for first-year residents 3 times. Residents evaluated the practice program and their own examination skills using questionnaires after the practice.2) Most residents felt that this program was necessary and effective for clinical training. Self-evaluation scores for the last practice were slightly higher than those for the first practice in the cognitive, affective, and psychomotor domains.3) Residents recognized the importance of ambulatory clinic practice. This program was suggested to be effective for postgraduate clinical education.

The Present Condition and Problems of Postgraduate Medical Education in Bioethics at a University Hospital: Results of a Questionnaire Survey of Medical Staff / 医学教育

We have surveyed what physicians in our department think about postgraduate education in bioethics. Although 90% of physicians recognized the importance of bioethics education, 90% of physicians had not taught bioethics to residents and had not read any bioethics books in the last 2 years. Approximately 80% of physicians believed that discussions were needed to confirm residents' awareness of bioethics and life-and-death issues but that residents and physicians do not need to read relevant books and mandatory reports to deepen their awareness of bioethics. Because many physicians in our department have little motivation to improve their view of bioethics, postgraduate education in bioethics is needed for both residents and physicians.

Effect of Repeated Training in Physical Examination with a New Cardiology Simulator for 1st-year Medical Residents Shortly after Receiving Medical Licenses / 医学教育

We used a new cardiology simulator twice to train lst-year medical residents in physical examination with a specific behavioral objective shortly after they had received their medical licenses. The first training sessions were to teach residents to understand normal heart sounds and to perform physical examinations in the proper order; the second training sessions were to teach recognition of abnormal heart sounds and murmurs. After the first training sessions, all residents could perform physical examinations in the proper order with special attention to the jugular vein, differentiation of systole and diastole by palpating the carotid artery, splitting of S2, and the timing and transmission of heart murmurs. Just after the second training sessions, all residents thought that their physical examination skills and ability to recognize abnormal heart sounds and murmurs had improved. One year later, the residents were accustomed to performing physical examination in the proper order and could recognize gallop rhythms and murmurs of grade 3/6 or higher. Repeated training with specific behavioral objectives could motivate residents to understand both normal and abnormal heat sounds and murmurs.

Medical Interview under the Supervision of Senior Physicians in the Outpatient Department by Medical Trainees Who Have Just Received Their Medical License / 医学教育

All 11 1st-year medical trainees in 1999 participated in medical interview training in the outpatient department under the supervision of senior physicians. Interviews were to be done within 15 minutes. The training was completed when each trainee had interviewed an average of 10 patients. Approximately 70% of the chief complaints were common ones that the Japanese Society of Internal Medicine has recommended general internists master. Most trainees considered this training effective for learning to clarify the patient's reason for seeking care and for improving presentation skills. However, they considered the training ineffective for learning to judge the necessity of emergency care and for understanding the usefulness and limitations of laboratory data, electrocardiograms, and chest films.

Analysis of Medical Residents With Inappropriate Performance During the First 2 Years of Postgraduate Medical Education / 医学教育

Among the 55 medical residents who had completed the 2-year postgraduate medical training course at Tenri Hospital in the past 5 years, the postgraduate medical education committee analysed 9 residents whose clinical performance was considered inappropriate. The committee, composed of eight instructors, found that residents with initially poor medical knowledge were able to improve their medical performance and skills during their 2 years of training; however, other residents who lacked responsibility towards patients, communication skills, and medical ethics during training had great difficulty improving or altering their attitude or performance in the 2 years.

Training with Ultrasonography in Palpation of the Thyroid Gland for 1st-Year Medical Residents / 医学教育

We have attempted to train 1st-year medical residents who have just received their medical licenses in palpation of the thyroid gland. The residents were instructed to palpate goiters by an otolaryngologist responsible for the ultrasonography laboratory for thyroid disease, and palpation findings were compared with ultrasonography findings. Each resident examined an average of 6.0 patients with diffuse goiter and 4.6 patients with nodular goiter. One year later, 75% of the residents had confidence in palpation of the thyroid gland, and every resident had palpated the thyroid gland as a part of the physical examination for all inpatients, but not for outpatients. This training was useful for familiarizing medical residents with palpation of the thyroid gland in routine physical examination.

Bedside Teaching in Heart Disease for 1st-Year Medical Trainees by Specialized 2nd-Year Medical Trainees / 医学教育

In the past 2 years, all 1st-year medical trainees have been instructed in physical examination of patients with heart disease in the general ward of Tenri Hospital by two or three 2nd-year medical trainees who had received special training in physical examination for heart disease. After 1 year of training, all 1st-year medical trainees became confident in making a proper physical examination and in detecting an S3 gallop but were not confident in detecting other abnormal physical findings. On the other hand, the 2nd-year medical trainees thought that they were able to organize their own medical knowledge by teaching 1st-year medical trainees.