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Objective:To explore the effect of early clinical clerkship training in the early exposure to clinical practice of eight-year program medical students.Methods:Experimental control method was used in this study. A total of 120 eight-year program medical students in the third year of Batch 2014 to 2016 from the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were selected as the research objects. The students of each grade were randomly selected by computer and divided into experimental group and control group, with 20 students in each group. Before early clinical exposure, the experimental group received 16 class hours of early clinical clerkship training, while the control group did not receive early clinical clerkship training. After the early clinical exposure, the clinical diagnosis and treatment ability of the two groups of students was compared. SPSS 24.0 software was used for t test. Results:The scores of medical history inquiry of experimental group and control group were [(17.45±1.96) points and (15.95±1.93) points; (18.30±1.03) points and (16.75±1.86) points; (17.95±1.36) points and (16.40±1.60) points, respectively]. The physical examination scores were [(17.75±1.65) points and (16.05±1.64) points; (17.85±1.18) points and (16.80±1.47) points; (18.25±1.16) points and (16.85±1.63) points, respectively]. The clinical judgment scores were [(18.15±1.42) points and (16.35±2.41) points; (18.20±1.24) points and (16.65±1.53) points; (18.35±1.35) points and (16.25±1.83) points, respectively]. Diagnosis and treatment scheme scores were [(17.15±1.57) points and (14.55±2.56) points; (17.30±1.42) points and (15.90±1.48) points; (17.80±1.06) points and (16.35±1.87) points, respectively]. The scores of communication skills were [(17.95±1.15) points and (17.00±1.19) points; (18.55±0.83) points and (17.45±1.50) points; (18.45±1.00) points and (17.45±1.23) points, respectively], with statistically significant differences (all P<0.05). Conclusion:The application of early clinical clerkship training in the early exposure to clinical practice of eight-year program medical students can improve the quality of students' clerkship.
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Students in all years, including those in lower years, were prohibited from coming to campus because of COVID-19, which began to spread in January 2020. However, we believed that a hospital tour and observership would be important practical training for first and second year medical students as part of the early exposure program, which aims to increase student motivation. Thus, we decided to conduct a virtual hospital tour and a virtual observation of medical doctors’ work. We used Zoom to conduct a virtual hospital tour for first-year students in June, and a virtual observation of physicians’ work for second-year students in December. Although this offered less of an opportunity to experience the reality of the clinic, there have been benefits in terms of increased learning content, fairness of learning opportunities delivered, and the promotion of independent learning. With regard to a “Hospital Tour” and the “Observation of Medical Doctors’ Work” , we believe that hybrid forms, which are able to skillfully combine the strengths of the two methods, would be effective.
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At Showa University, which consists of the Schools of Medicine, Dentistry, Pharmacy, and Nursing and Rehabilitation Sciences, systematic interprofessional education for the purpose of training staff who can contribute to the medical team has been introduced with the cooperation of all 4 schools and through all undergraduate years. In the lower years, students study the basics of medical team care through a 4-school joint curriculum of experiential learning （such as early exposure） and problem-based learning inside and outside of the university. In the upper years, to acquire practical skills, students study the practice of medical team care through a joint curriculum of participatory learning in hospitals and the community. Through this curriculum, I expect that the medical staff to promote patient-centered team medical care in a variety of medical fields will grow in the future.
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This paper introduced the teaching reform in the integrated course of introduction to clinical medicine in China medical university.According to the capacity and quality in the global minimum essential requirements in medical education (GMER) proposed by the Institute for International Medical Education (IIME),we carried out the teaching reform of ‘early exposure to clinic’ in the integrated course of introduction to clinical medicine based on the theory of competency-based education (CBE) and took capacity-building as the teaching objective.We achieved good teaching effect and appraisal by students.
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In Japan, community–based education remains uncommon in undergraduate programs for students in schools of health sciences. The purpose of this study was to examine how students are affected by their participation in off–campus classes, which are considered as a main course of community–based education at the School of Health Sciences, Gunma University.<br>1)Reports submitted by students after participating in off–campus classes were broken down into sentences (with care being taken that each sentence made sense). The extracted sentences were carefully consolidated by means of the Kawakita Jiro method (affinity diagram).<br>2)A total of 972 sentences were extracted and were categorized into 3 categories: "enjoy going out to the community," "increased activity through experiences," "awareness of what one wants to be and one's insufficient abilities." Five middle–sized categories and 10 small categories were obtained.<br>3)Experiences in off–campus classes are expected to increase the activity of students and to have synergic effects with on–campus classes.<br>4)Community–based education might be effectively included in undergraduate programs for students in schools of health sciences.
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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.
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1) We performed a questionnaire survey of educational effectiveness and student satisfaction in regards to early exposure training programs.<br>2) The most effective educational training programs were, in descending order, "outpatient escort practice," "nursery practice," and "ward nursing practice." The programs with the highest levels of student satisfaction were, in descending order, "nursery practice," "severely mentally disabled patients' care practice," and "experimental learning practice of wheelchair activity." Because we found a large discrepancy between educational effectiveness and student satisfaction, we searched for factors influencing student satisfaction by analyzing the comments students made about each training program.<br>3) Factors that significantly affected both student satisfaction and educational effectiveness were "useful experience for future medical practice," "feeling of being able to help others," and "a sense of achievement."
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1) We conducted a workshop to discuss the definition of the term "physician scientist", what thought processes and competencies are expected, and how to better help physician scientists develop through medical schools.2) The definition of a physician-scientist is a physician who both provides patient care and approaches unsolved questions in understanding the mechanisms of diseases and developing new treatments.3) Essential conditions for a medical school to cultivate physician scientists include providing good role models for physician scientists, making efforts to stimulate students' motivation, and supporting collaboration among physicians and scientists on the faculty.
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The Society of Associate and Assistant Professors, Shinshu University School of Medicine, voluntarily held a miniworkshop for medical education in December 2006.Subjects were students' motivation, integrated clinical lecture, early exposure and research experience program.Based on the proposals from this meeting, following changes/additions were made to the 2007 curriculum.<BR>1) Clinical case presentation lectures for a combination of 5th and 6th grades students to raise the level of students' awareness and motivation.<BR>2) Lectures on doctors'career development for women to nourish professionalism.<BR>3) Doctors'office or hospital Visiting programs for freshmen to provide a chance to encounter the role model.
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We conduct an outpatient escort program as a part of our early exposure curriculum for first-year medical students. Each student escorts one patient at the University of Tsukuba Hospital throughout his or her first visit. We evaluated this program from the points of view of both students and patients.<BR>1) A questionnaire was distributed to all participating patients and students in 2006.<BR>2) In their questionnaires, many students commented on the long waiting time, the structural problems of the hospital, and the attitudes of physicians.<BR>3) Results of the questionnaire showed that both students and patients rated this program highly.<BR>4) No significant differences were noted between the comments of the students and those of the patients. The patients tended to rate this program more highly than did the students. One patient, however, commented that being constantly accompanied by a stranger was somewhat stressful.<BR>5) We conclude that this program can be efficiently carried out without being too much of a burden to patients and is a valuable part of an early exposure program for first-year medical students.
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We conducted an outpatient escort program as a part of our early exposure curriculum for first-year medical students. Each student escorted one patient at the University of Tsukuba Hospital throughout his or her first visit. This program enabled the students to experience and think about the system of a university hospital from a patient's point of view. We believe that this program is useful to motivate first-year medical students in their future studies.
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The early exposure of cover screws is a common complication of 2-stage implant technique. The exposure of cover screws between stage I and II surgery may cause inflammation in the soft tissues surrounding the implants, and lead to peri-implantitis or marginal bone loss. The purpose of this study was to evaluate the effect of the early exposure of cover screws on implants placed using 2-stage technique. Two hundred and nineteen implants in 77 patients were examined for cumulative survival rate, radiographic marginal bone level change, cause and frequency of the early exposure. The results were as follows: 1. Twenty-five implants showed early exposure of cover screws with a frequency of 11.4%. 2. Cumulative survival rate of the implants with early cover screw exposure was 88.0%, and that of the implants without cover screw exposure was 96.9%. 3. At the time of stage II surgery and 1 year after loading, the marginal bone loss was greater around the implants with early exposure of cover screws than around the implants without cover screw exposure(p 0.05).
Subject(s)
Humans , Inflammation , Peri-Implantitis , Survival RateABSTRACT
The purpose of this study was to investigate differences between first-year (n=97) and second-year medical students (n=102) in their reactions to a community-based early clinical exposure program. Questionnaires completed after their participation in the program showed that first-and second-year students did not differ in their interest in practical training in nursing homes and wards of the university hospital or in a presentation given by a family member of a cancer patient who had died in the hospital (Chi square test, p<0.05). However, second-year students were more likely to report that they understood the family's presentation well, whereas first-year students were more likely to report they could communicate with elderly or disabled persons. Several facilities in the community criticized the students' attitudes toward practical training. We believe the reason for the criticism was insufficient advance preparation.
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A program for early-exposure of first-year medical students to nursing and patient care was started at Osaka City University in 1994. Eighty students completed the program in the 2002 academic year. To improve methods of teaching and evaluation, we analyzed the responses of students and nursing instructors to questionnaires about satisfaction with the program after each practice session. Students were randomized to four settings (university hospital, general hospital, general emergency hospital, and general geriatric hospital). Responses of students and instructors did not differ between settings suggest that early exposure was uniform. Medical students gave higher scores for interest in and significance of early exposure, although nursing instructors did not. The success of the program of early exposure of medical students to nursing care will be used to further improve the curriculum.
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In 1996 we started an early exposure program of nursing and care for medical school freshmen at University of Tsukuba. The program consisted of out-of-hospital practice and in-hospital practice; 195 medical students completed the program in the 1999-2000 academic year. We analyzed students' questionnaires about satisfaction with the program after each practice and studied better settings for early exposure. Students were randomized to three out-ofhospital settings (nursing home, facilities for the elderly, and home-visit nursing) and also randomized the order of the practice (in-hospital or out-of-hospital first). The mean satisfaction score for setting was the highest for the home-visit nursing and lowest for nursing homes. The mean satisfaction score for order of practice was higher when in-hospital practice was done first.
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We investigated the effects on medical education of early exposure of undergraduate students to a summer camp for children with asthma. An objective evaluation by the editorial staff found final improvements in the following areas (in descending order of frequency): learning of basic medical behavior (91% of students); cooperative attitude of medical staff in general treatment with the patient and the patient's family (88%); understanding of childhood growth and development (80%); knowledge of childhood asthma (69%); and mastery of basic techniques for therapy and examination (41%). The differences in the ratio of improvement (%) before and after visiting the camp, were (in descending order of frequency): cooperative attitude of medical care staff in general medical treatment with the patient and the patient's family (47%); understanding of childhood growth and development (45%); knowledge of childhood asthma (38%); learning of basic medical manner (34%); and mastery of basic techniques for therapy and examination (25%). These findings suggest that a summer camp is useful for exposing undergraduate medical students to children with asthma and is effective for helping them understand patients and family-oriented pediatric medicine.
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A course in the Igakugairon for 1st-year students to develop an active learning attitude has been conducted since 1992 at the Shiga University of Medical Science. On the basis of observations of educational results during this period, the course's length, contents, and scheduling were improved. It has become a full-year course for 1st-year students. Lecture classes were decreased and classes in which students participate in discussions and role playing were increased. In particular, classes focusing on an “early exposure” program at medical and welfare facilities have provided an important opportunity for changes in learning attitudes among students. Although class attendance is not mandatory, it is more than 80% in every class, and students actively take part in discussions. From the attitudes of the students in the class and their evaluations of the course, we have concluded that this course is effective in developing an active learning attitude among students.
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The innovation of the University Chartering Standards Law in 1991 triggered changes in general education in almost all medical schools in Japan. These changes include: 1) frequent abolition of the department of general education; 2) an expansion in the offerings of specialty subject; and 3) increase in early exposure programs. The Model of general education has, in general, changed from the liberal arts model to the one that emphasizes the development of physicians. One remaining problem is that, although the system of general education has changed, the traditional pedagogy has generally persisted. These are at least two possible forms that general education can take in the future. The first one comes from the U.S., in which students enter medical schools after finishing their general college education. The other one stems from an European model in which high school provide students with part of their general education, and medical schools provide them with intensive basic and humanity education that is necessary for physicians. Medical schools in Japan now face three major challenges for the future: 1) seeking how to teach ways of thinking other than medical one; 2) establishing an education system corresponding with recent changes in young people; 3) establishing divisions which comprehensively organize and supervise general education.
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Recent changes in social needs and the health care system have prompted the development of new teaching strategies and methods in which active learning by students in small groups is emphasized. We created an “early exposure” training program to enable freshman medical students to obtain practical experience at medical and welfare institutions. This program was designed with the following features 1) student-centered and self-directed learning, 2) integrated education for knowledge, skills, attitude and ethics, 3) training in communication skills, and 4) tutor-assisted and small-group discussion. Tutors were recruited from basic medical science departments. In a self-evaluation survey, 92% of students found this early exposure training to be excellent or good. Most students achieved improvement in communication skills, attitude and ethics among the educational objectives. However, a few students did not fulfill any objectives, and thus we should consider further improvements in the tutorial system.