Rural Medical Education Design in Minami-Hiyama / 医学教育

We are engaged in community medical education using Minami-Hiyama (14,000km<SUP>2</SUP>, population 23,000, aging rate 41.6%) in southern Hokkaido as a resource. The “rural(region)” concept has become more diverse in recent years, and a highly designed physician training program for rural doctors has become necessary. Therefore, we are attempting to design a rural medical education program based on the concept of “difference.” These “differences” can occur not only between urban and rural areas but also between different cultures. We hope that by connecting Minami-Hiyama and Sapporo with a telemedicine/education system, “differences” will be created and students who experience these differences will have a deeper understanding of rural medicine.

Utilization of and barriers to a telemedicine system at a rural general hospital in Japan: a mixed methods study / Journal of Rural Medicine

Objective: The initial and operational costs of telemedicine are major barriers to its adoption. We aimed to investigate and identify the barriers to adopting a telemedicine system in a Japanese rural general hospital without incurring setup and operational costs.Materials and Methods: Our study was conducted between May and August 2018, and included six general practitioners working at a rural general hospital. We extracted data collected from messages (date and time, sender and recipient, and counts and contents of messages) and conducted semi-structured interviews, which were then analyzed using quantitative and qualitative methods.Results: We quantitatively analyzed the total counted of the 179 messages. The total counts recorded for each physician were 56 (A), 20 (B), 3 (C), 74 (D), 5 (E), and 21 (F). The mean monthly counts were 2.17 (May), 8.50 (June), 11.50 (July), and 7.67 (August). Interview data from the six physicians yielded 13 codes that included various points of dissatisfaction acting as barriers to using our system, which we grouped into mental and physical barriers. Mental barriers included suspicion of carrying, feelings of isolation, and loss, whereas physical barriers included portability, user authentication, internet speed, group chat system, notice, search image, typing, chat system, print facility, and limited function.Conclusion: The representative barriers to introducing a telemedicine system at a rural general hospital in Japan without initial and running costs could be classified as feelings of isolation and suspicion of carrying (mental barriers); and notice, portability, and user authentication (physical barriers). Continued investigation in this area is warranted, and solutions to these barriers could improve the shortage of medical staff in the context of declining birth rates and aging populations in Japan.

Factors related to Japanese internal medicine doctors' retention or migration to rural areas: a nationwide retrospective cohort study

BACKGROUND@#Internal medicine (IM) doctors in Japan play the role of primary care physicians; however, the shortage of rural physicians continues. This study aims to elucidate the association of age, sex, board certification, type of work, and main clinical work with the retention or migration of IM doctors to rural areas.@*METHODS@#This retrospective cohort study included 82,363 IM doctors in 2010, extracted from the national census data of medical doctors. The explanatory variables were age, sex, type of work, primary clinical work, and changes in board certification status. The outcome was retention or migration to rural areas. The first tertile of population density (PD) of municipalities defined as rural area. After stratifying the baseline ruralities as rural or non-rural areas, the odds ratios (ORs) of the explanatory variables were calculated using generalized estimation equations. The analyses were also performed after age stratification (<39, 40-59, ≥60 years old).@*RESULTS@#Among the rural areas, women had a significantly higher OR for retention, but obtaining board certification of IM subspecialties had a significantly lower OR. Among the non-rural areas, physicians who answered that their main work was IM without specific subspecialty and general had a significantly higher OR, but obtaining and maintaining board certification for IM subspecialties had a significantly lower OR for migration to rural areas. After age stratification, the higher OR of women for rural retention was significant only among those aged 40-59 years. Those aged under 40 and 40-59 years in the non-rural areas, who answered that their main work was IM without specific subspecialty had a significantly higher OR for migration to rural areas, and those aged 40-59 years in the rural areas who answered the same had a higher OR for rural retention.@*CONCLUSIONS@#Obtaining and maintaining board certification of IM subspecialties are possible inhibiting factors for rural work, and IM doctors whose main work involves subspecialties tend to work in non-rural areas. Once rural work begins, more middle-aged female IM doctors continued rural work compared to male doctors.

Practical application of "dual-element and three-step" vocational college education model based on the modern apprenticeship / 中华医学教育探索杂志

This research implements the "dual-element and three-step" education model based on the modern apprenticeship system for rural medical students, establishes a complete teacher management system through the joint enrollment of schools and teaching hospitals, and strengthens the professional cognition stage, professional learning stage and professional practice stage. It has certain effects on promoting students' good sense of professional identity and responsibility, enhancing learning initiative and professional vocational ability, and cultivating skilled and service-oriented medical talents with "six-in-one" post competences in rural areas.

Assessment of clinical dehydration using point of care ultrasound for pediatric patients in rural Panama / 世界急诊医学杂志（英文）

BACKGROUND@# Dehydration and its associated symptoms are among the most common chief complaints of children in rural Panama. Previous studies have shown that intravascular volume correlates to the ratio of the diameters of the inferior vena cava (IVC) to the aorta (Ao). Our study aims to determine if medical students can detect pediatric dehydration using ultrasound on patients in rural Panama.@*METHODS@# This was a prospective, observational study conducted in the Bocas del Toro region of rural Panama. Children between the ages of 1 to 15 years presenting with diarrhea, vomiting, or parasitic infection were enrolled in the study. Ultrasound measurements of the diameters of the IVC and abdominal aorta were taken to assess for dehydration.@*RESULTS@# A total of 59 patients were enrolled in this study. Twenty-four patients were clinically diagnosed with dehydration and 35 were classified to have normal hydration status. Of the 24 patients with dehydration, half (n=12) of these patients had an IVC/Ao ratio below the American threshold of 0.8. Of the remaining asymptomatic subjects, about half (n=18) of these subjects also had an IVC/Ao ratio below the American threshold of 0.8.@*CONCLUSION@# Our study did not support previous literature showing that the IVC/Ao ratio is lower in children with dehydration. It is possible that the American standard for evaluating clinical dehydration is not compatible with the rural pediatric populations of Panama.

What do medical residents learn on a rural Japanese island? / Journal of Rural Medicine

Objective: Community-based medical education (CBME) serves as a complement to university medical education, and it is practiced in several urban undergraduate and postgraduate curriculums. However, there are few reports on CBME learning content in rural Japanese settings.Materials and Methods: This research aimed to clarify learning content through semi-structured interviews and qualitative analysis of second-year residents who studied on a remote, rural island located 400 km from the mainland of Okinawa, Japan. Analysis was based on Steps for Coding and Theorization (SCAT).Results: Fifteen concepts were extracted, and four categories were generated: a strong connection among the islanders, the necessary abilities for rural physicians, islander-centered care, and the differences between rural and hospital medicine. In contrast to hospital medicine, various kinds of learning occurred in deep relationships with the islanders.Conclusion: Through CBME on a remote island, the residents learned not only about medical aspects, but also the importance of community health through the social and cultural aspects, whole-person medical care in a remote location, and the importance of reflection in their self-directed learning.

Demonstration and application of remote medical information service platform based on the Internet of Things / 中国医学装备

Objective: To carry out telemedicine, remote teaching and conference, training and other activity by using remote medical information service platform based on Internet of Things so as to help primary hospital and clinic to achieve trans-regionally medical rescue and medically professional communication. Methods: Through relied on the modern communication technique and information technique to construct remote medical information service network platform that based on Internet of Things, and to link medical organization and patients of different regions so as to carry out relevant telemedicine activity. Results: Based on the remote medical information service platform, the project has realized the remote medical information system of high definition video conferencing. And its effect could really and naturally presented clearly and dynamically medical data. Therefore, it could quickly and efficiently enhanced the quality and effect of remote medical treatment, teaching and academic conferences. Conclusion: Telemedicine can overcome obstacles leaded by time and space in getting medical service, and telemedicine information service platform is a efficient way in modulating unbalance of medical resource distribution, expediting the construction of primary medical service system, promoting equalization of urban and rural medical service and alleviating problems when people get medical service.

Pneumonia as a trigger for atrial fibrillation / Journal of Rural Medicine

<p>In a rural mountainous region on a Friday, a 78-year-old man was seen in his physician’s office for leg edema and diagnosed with new onset atrial fibrillation. He was discharged home to start medications for atrial fibrillation and heart failure. He was hospitalized the next day with septic shock due to pneumococcal pneumonia. The new onset of atrial fibrillation requires a trigger acting on a vulnerable substrate. These triggers include acute conditions such as alcohol intoxication, myocardial infarction and pulmonary embolism. Pneumonia may act as a trigger causing the new onset of atrial fibrillation.</p>

Parsonage-Turner syndrome in a patient with bilateral shoulder pain: A case report / Journal of Rural Medicine

<p><b>Objective:</b> Parsonage-Turner syndrome is a peripheral neuropathy characterized by acute onset shoulder pain, myalgia, and sensory disturbances. The present report discusses a rare case of Parsonage-Turner syndrome and highlights the importance of accurate history recording and thorough physical examination for the diagnosis of the disease in rural areas.</p><p><b>Patient:</b> A 28-year-old woman presented to our clinic with acute bilateral shoulder pain and difficulty moving her right arm. A diagnosis of Parsonage-Turner syndrome was suspected based on the progression of symptoms, severity of pain, and lack of musculoskeletal inflammation. The diagnosis was confirmed by neurological specialists, and the patient was treated with methylprednisolone, after which her symptoms gradually improved.</p><p><b>Discussion:</b> The differential diagnosis of shoulder pain is complicated due to the wide variety of conditions sharing similar symptoms. Accurate history recording and thorough physical examination are required to differentiate among conditions involving the central nerves, peripheral nerves, and nerve plexuses.</p><p><b>Conclusion:</b> Although the symptoms of Parsonage-Turner syndrome vary based on disease progression and the location of impairment, proper diagnosis of acute shoulder pain without central neurological symptoms can be achieved in rural areas via thorough examination.</p>

Feasibility study of first-year medical students identifying cardiac anatomy using ultrasound in rural Panama / 世界急诊医学杂志（英文）

BACKGROUND: There are over 15 million children who have cardiac anomalies around the world, resulting in a significant morbidity and mortality. Early recognition and treatment can improve the outcomes and lengthen life-expectancy of these patients. The NIH and WHO have promoted guidelines for screening for congenital cardiac anomalies using ultrasound in rural environments. METHODS: Our study took place in Bocas Del Toro, Panama where a mobile clinic was established for community healthcare screening and ultrasonographic evaluation by medical student volunteers and volunteer clinical faculty. This was a non-blinded, investigational study utilizing a convenience sample of pediatric patients presenting for voluntary evaluation. Seven first-year medical students were recruited for the study. These students underwent a training program for advanced cardiac ultrasound instruction, termed "Pediatric Echocardiography Cardiac Screening (PECS)". RESULTS: Ten patients were enrolled in the study. Nine patients had adequate images as defined by the PECS criteria and were all classified as normal cardiac pathology by the medical students, resulting in a sensitivity and specificity of 100％. A single patient was identified by medical students as having a pathologic pulmonic stenosis. This was confirmed as correct by a blinded ultrasonographer. CONCLUSIONS: In this pilot study, the first-year medical students were able to correctly identify pediatric cardiac anatomy and pathology in rural Panama after undergoing a 12-hour ultrasound PECS training session. We believe that with this knowledge, minimally trained practitioners can be used to screen for cardiac anomalies in rural Panama using ultrasound.

Learning from Rural Physician Associate Program at the University of Minnesota / 医学教育

1)Rural Physician Associate Program (RPAP) at the University of Minnesota is a 9–month rural medicine program whose primary goal is to increase the supply of rural primary care physicians.<br>2)Over 40% of RPAP graduates practice in non–metropolitan areas and contribute significantly to the supply of physicians in rural areas.<br>3)In recent years, Japanese medical schools are admitting more students with a rural background. It is important to develop systematic and comprehensive rural medicine programs for students interested in rural medicine in order to increase the supply of rural physicians.

The Effectiveness of HIV/AIDS awareness intervention in a rural area of Cambodia: illiteracy, mobility, sexual behavior, and HIV/AIDS

<B>Objective:</B> To convey HIV⁄AIDS-related knowledge to people in rural Cambodia, we conducted an HIV⁄AIDS awareness intervention program and investigated its effectiveness, participants’ sexual behavior, HIV-related knowledge, and their attitude to HIV⁄AIDS.<br><B>Methods:</B> We conducted HIV⁄AIDS awareness intervention in a rural area of Cambodia from April to November 2007. We selected three villages (a total of 180 villagers) in Siem Reap Province. Our HIV⁄AIDS awareness intervention involved practical explanations by well-trained Cambodian staff using visual material and participatory activities in order to promote interest among illiterate participants. We implemented a cross-sectional study in each village after the HIV⁄AIDS awareness intervention using a questionnaire written in Khmer and assisted by a Cambodian NGO.<br><B>Results:</B> Two-thirds of the participants had not finished primary school and had difficulties reading and writing. A total of 77.8% of the people had obtained HIV⁄AIDS-related information from NGOs.<br><B>Conclusion:</B> The HIV⁄AIDS awareness intervention was welcomed by most of the villagers and positively influenced HIV⁄AIDS-related knowledge through the use of practical explanations. Rural areas are still more vulnerable to HIV⁄AIDS transmission, and at the same time more likely to be influenced by NGOs, than cities because of high rates of illiteracy and a lack of access to general HIV⁄AIDS-related information sources including television, books, newspapers, and the Internet. NGOs need to increase their efforts to educate the vulnerable populations in rural areas.