7. Educational Strategies and Good Practice (1) / 医学教育

In the 2022 revision of the Model Core Curriculum, a new "Educational Strategies and Assessment" section was added as a further development in outcome-based education. By adding a chapter on strategies and evaluation, which is an important element of the curriculum, and linking it to qualities and abilities, we have devised a way for learners and instructors to make use of the Core Curriculum more easily. In addition, 11 example of strategy and assessment cases are included as Good Practice to encourage practical application. However, since these are only examples, we hope this chapter will be further developed as universities create strategies and evaluations that make the most of their unique characteristics.

5. The 2022 Revision of the Model Core Curriculum for Medical Education in Japan and the Common Achievement Test Being Made an Official Requirement / Participatory Clinical Clerkship / 医学教育

Following the revision of the structure and content of the Model Core Curriculum for Medical Education to be more outcome-based and the legal status of the medical practice performed by medical students in the clinical clerkship, we have revised the Guideline for Participatory Clinical Clerkship. The following items were revised or newly described : significance of enhancing the participatory clinical clerkship, scope of medical practice, confidentiality, patient consent, patient consultation and support service, objectives of the clinical clerkship, simulation education, departments where the clinical clerkship is conducted, assessment in the clinical practice setting, CC-EPOC, and entrustable professional activities. A foundation has been established to promote seamless undergraduate and postgraduate medical education. However, future work is needed to examine the specific level of performance expected at the end of the clinical clerkship and department-specific clinical practice goals and educational strategies.

Evaluation of triage checklist for mild COVID-19 outpatients in predicting subsequent emergency department visits and hospitalization during isolation period

Background and objectiveLimited evidence exists regarding the outcomes of patients with coronavirus disease 2019 (COVID-19) who are not hospitalized. This study aimed to assess the outcomes for mild COVID-19 patients in terms of emergency department (ED) visits and hospital admission given initial outpatient triage evaluation and to identify the triage factors affecting these outcomes. MethodsThis retrospective cohort study investigated adult COVID-19 Japanese patients who were triaged at Nagasaki University Hospital between April 1, 2021, and May 31, 2021. A triage checklist with 30 factors was used to identify patients requiring hospitalization. Patients recommended for isolation were followed up for later ED visit or hospital admission. ResultsOverall, 338 COVID-19 patients (mean age, 44.7; 45% women) visited the clinic at an average of 5.4 days after symptom onset. Thirty-six patients (10.6%) were hospitalized from triage, and the rest were recommended for isolation. Seventy-two non-hospitalized patients (23.8%) visited ED during their isolation period, and 30 (9.9%) were hospitalized after ED evaluation. The mean duration to ED visit and hospitalization after symptom onset were 8.8 and 9.7 days, respectively. Checklist factors associated with hospitalization during the isolation period were age > 50 years, obesity with BMI > 25, underlying hypertension, tachycardia with HR > 100/min or blood pressure >135 mmHg at triage, and >{square}3-day delay in hospital visit after symptom onset. ConclusionClinicians should be wary of COVID-19 patients with above risk factors and prompt them to seek follow-up assessment by a medical professional. SUMMARY AT A GLANCEOverall, 338 patients with mild COVID-19 were retrospectively followed up. Factors such as age >{square}50 years, BMI{square}> {square}25, underlying hypertension, high blood pressure and tachycardia at triage, and delayed visit after symptom onset were associated with emergency department visit and hospitalization during the isolation period.

Four Cases with Vulval Pain from Unknown Causes (Vulvodynia) Treated with Kampo Medicines, Mainly Shimotsuto / 日本東洋医学雑誌

We report 4 cases of vulvodynia, vulval pain from unknown causes that showed symptomatic improvements by administrating Kampo medicines. Modern medicines, such as analgesics, treatments for endometriosis or hormone replacement therapy, can't always be effective for vulvodynia and not a few patients go to see different hospitals without improving their pain. We diagnosed these 4 cases of vulvodynia were originated in kekkyo. We administered Kampo medicines, mainly shimotsuto with supporting ones, and the symptoms of vulvodynia improved.

The educational effect of a training program in ambulatory care for residents / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : We initiated an ambulatory care training program at five community hospitals in Nagasaki, including hospitals on remote islands, for the residents of Nagasaki University Hospital. We examined the educational effect of the ambulatory care training program in meeting the achievement targets for clinical training.<br><b>Methods</b> : The study included all residents (n=49) working in Nagasaki University Hospital in 2012. Following completion of the ambulatory care training program, the residents answered a questionnaire on the number of patients and their symptoms, inaddition to a self-assessment, and assessment by their supervisor.<br><b>Results</b> : The mean number of patients seen was 3.29 persons / training session. The number of symptoms to be encountered, which are established by Ministry of Health, Labour and Welfare, was positively correlated with the total number of patients seen. Although residents initially had a low rating of self-assessment on diagnosis or treatment, this rating tended to increase with time. The gap in levels on assessment of history taking, diagnosis, or treatment by residents versus those by the supervisors reduced with time in the program.<br><b>Conclusion</b> : Our ambulatory care training program is an effective program for meeting the achievement targets in clinical training for residents.

A theory–based trial for improving both economic growth and medical education in a university hospital / 医学教育

1）We instituted the “CHANGE Nagasaki University Hospital” project to improve both management and medical education and to boost the number of physicians recruited to this hospital.<br>2）We first identified the physicians’ problems and complaints via a questionnaire. Next, focusing on the most common complaints, we reduced secondary duties and methodically improved the educational environment by employing the a– b–c–d–strategy, which is based on the principles of medical education.<br>3）As a result, both, the hospital’s economic growth and the recruitment figures for resident physicians have increased continuously over the past 4 years.