Reducing mental health stigma among nursing students through an educational intervention.

BACKGROUND: Patient-centred care must consider service consumers' needs and improve their health and well-being as well as their satisfaction and the quality of their healthcare assistance. However, individuals experiencing mental illness often struggle with barriers and misunderstandings by health care professionals. Nursing Faculties are uniquely positioned to reduce stigmatising attitudes via new educational interventions that could align nursing curricula and individuals with mental illness needs. However, there are few studies about the stigma toward mental illness among nursing students in Spain. OBJECTIVES: The present study aimed to analyse the effect of a 9-month educational intervention on the level of stigma in nursing students. DESIGN: a one-group pre-postintervention design with no control group was conducted. METHODS: A total of 194 nursing students completed the EVEPEM scale before and after the intervention. The intervention comprised 55 hours of campus sessions and 150 h practicum in mental health settings. RESULTS: A destigmatising tendency was captured by a large main effect and a statistically significant stigma reduction. CONCLUSIONS: The educational 9-month intervention was effective in reducing students' stigma by providing theoretical education, personal contact with mental health service consumers, and critical reflection activities.

A comprehensive study of modified three-month pediatrics training curriculum at Shahid Beheshti University of Medical Sciences and its impact on student satisfaction.

OBJECTIVES: Continuous curriculum improvements reveal the dedication of policy-makers to raising the quality of education and student learning. This study aims to report the impact of curriculum changes to the three-month pediatric course curriculum at Shahid Beheshti University of Medical Sciences (SBMU) on the satisfaction levels of medical students. METHODS: One hundred eighteen 4th-5th years medical students, who had completed their pediatric clinical rotation in SBMU-affiliated teaching hospitals including Mofid Children Hospital, Loghman Hakim Hospital, Shohada-e-Tajrish Hospital, and Imam Hossein Hospital from January to December 2022 were included in this cross-sectional study. After obtaining informed consent, a questionnaire was sent out to all participants, that included 27 statements about the impact of the modified curriculum on their satisfaction with their learning and performance. SPSS version 22 was used to analyze the data. RESULTS: The level of satisfaction of trainees from attending clinics was 82-56%, prior introduction to the course was about 82%, and attending general hospitals (all hospitals except Mofid Children hospital, which is the only children hospital affiliated to SBMU) was 82-97%. The quality of patients-based learning was reported in terms of attendance at morning report sessions which was 92.3%, attendance at ward rounds, which was 71.8%, and attendance at clinics, which was 62.4%. The satisfaction rate from the senior attending mentor was 96.5%. The satisfaction rate of the pathology course was 67.2%, and the radiology was 82.4%. The satisfaction level of medical students from the infectious disease department was 70% and the gastroenterology department was 83.8%. The level of satisfaction with the implementation of the twelve-week program was 68.7%, with the expressiveness and usability of the presentation of materials was 53.9%, with the compatibility of the exams with the presented materials was 92%, and withholding weekly exams was 86.8%. The satisfaction rate of using the materials presented in the final exam in the digestive department and the infectious department was 85% and 68%, respectively. The overall satisfaction rate of the training course was 76.66%. CONCLUSION: The results provide vital insights for improving medical education. According to this study, medical student satisfaction with the pediatric curriculum after its recent revisions was in a satisfactory range. Attendance at clinics, information sharing, patient-based learning, practical training, attending mentorship, curriculum clarity, and alignment with student expectations all contributed to participants' high levels of satisfaction.

Pediatric Cardiology Condolence Letter Writing: Does a Fellowship Curriculum Impact Practice?

CONTEXT: Condolence letter (CL) writing after the death of a child is an important opportunity for humanism. Pediatric cardiology fellowship training now recognizes the importance of palliative care, but rarely includes CL education, despite its fragile patient population. OBJECTIVES: To address this professionalism gap, a formal CL writing curriculum was created and implemented in a pediatric cardiology fellowship. This study investigated the impact of the curriculum on pediatric cardiology CL writing, and broader CL practices and beliefs. METHODS: Pediatric cardiology fellows at a high volume urban academic program from 2000 to 2022 were divided into two cohorts (exposure to CL curriculum [2014-2022] vs. no exposure [2000-2013]) and responded by anonymous electronic multiple choice and open ended survey to assess the CL curriculum and describe current CL practices and beliefs. Impact of curriculum elements was determined by ordinal ranking. A 5-point Likert scale was used to report physician behaviors. Chi-square tests of independence were utilized for group comparisons. RESULTS: The overall survey response rate was 59% (63/107). Cardiologists who participated in the curriculum (64%, 35/55) were more likely to report writing CLs (80% vs. 40%; P < 0.01). Impactful curriculum elements included the opportunity for all fellows to contribute to a CL (78%) and identifying a primary fellow to write the CL (66%). A majority (>75%) of curriculum participants agreed that formal teaching increased their frequency, ability, and comfort in writing CLs. CONCLUSION: Development of condolence expression educational programs in pediatric cardiology training should be expanded.

Rapid Development and Testing of a COVID-19 Vaccine Curriculum for Pediatricians.

BACKGROUND AND OBJECTIVES: As the coronavirus disease 2019 (COVID-19) pandemic evolves and vaccines become available to children, pediatricians must navigate vaccination discussions in the setting of rapidly changing vaccine recommendations and approvals. We developed and evaluated an educational curriculum for pediatricians to improve their knowledge about COVID-19 vaccines and confidence in communicating with patients and families about COVID-19 vaccines. METHODS: Five institutions collaborated to develop an online educational curriculum. Utilizing the collaboration's multidisciplinary expertise, we developed a 3-module curriculum focused on the SARS-CoV-2 virus and vaccine basics, logistics and administration of COVID-19 vaccine, and COVID-19 vaccine communication principles. Surveys administered to clinician participants before and after completion of the curriculum assessed knowledge and confidence; a follow-up survey 1 month after the post-survey assessed persistence of initial findings. RESULTS: A total of 152 pediatric providers participated; 72 completed both pre- and post-surveys. The median knowledge score improved from the pre-survey to the post-survey (79%-93%, P < .001). There was an increase in providers' confidence after completing the curriculum, which persisted in the follow-up survey. In the post-survey, 98% of participants had had the opportunity to discuss the COVID-19 vaccine with patients, and most clinicians reported that the modules decreased apprehension some or significantly. CONCLUSIONS: This project demonstrates rapid and feasible deployment of a curriculum providing up-to-date information to front-line clinicians responsible for having complex conversations about COVID-19 vaccine decision-making. Clinicians who completed this curriculum had sustained increased confidence and decreased levels of apprehension when discussing the COVID-19 vaccine.

Improving interprofessional communication: Conceptualizing, operationalizing and testing a healthcare improvisation communication workshop.

BACKGROUND: Communication errors are a leading cause of adverse events in the acute and ambulatory healthcare setting. We now understand that communication within and across professions and patients is a complex achievement with numerous barriers, including cultural, educational, and structural hurdles. Improvisation has been identified as an approach with great potential to develop communication skills for multi-disciplinary healthcare students. OBJECTIVE: We report on the interdisciplinary conceptualization, operationalization, and effectiveness testing of a novel educational healthcare improvisation communication workshop. DESIGN: Prospective pre-post test experimental. SETTING: University of California, Irvine. PARTICIPANTS: Total of 158 nursing, medicine, and population health students. METHODS: We conceptualized improvisation through the constructs of presence, trust, and acceptance to develop workshop activities, then used the Kirkpatrick Learning Framework to test the workshop's feasibility, learning outcomes, and preliminary behavior changes. RESULTS: Participants rated the feasibility of the workshop highly. Pre-post workshop effectiveness testing showed significant increases in communication and collaboration competencies. Qualitative data suggested workshop activities were powerful learning modality because they were premised by introducing their conceptual underpinning and providing tangible examples via the video and debrief. Qualitative data also suggested preliminary behavior changes post workshop. CONCLUSIONS: We have developed and tested a communication teaching modality with strong conceptual grounding and empirical evidence of its efficacy in engaging healthcare students in collaborative communication, with documented evidence of learning that health educators can use in their courses. Future research is needed (and currently underway) to generate the evidence that the workshop can be adopted and sustained within a multi-school curriculum, which includes testing the feasibility of cross-school curriculum logistics (i.e. cross-listing the course to meet different school registrar policies, teaching workload sharing across faculty, etc.), as well as continued effectiveness testing.

Preliminary Evaluation of a Citizen Scientist Educational Curriculum Aimed at Engaging Black Men in Lung Cancer Early Detection Screening.

This article describes an educational program to engage African American men as citizen scientists (CSs) and future research partners in a lung cancer screening project. We provide an overview of the curriculum used, the structure and format of the educational sessions, and associated educational outcomes. Furthermore, we describe lessons learned in the engagement of African American men as CS in community-based lung-health equity research. The CS educational program included five group-based sessions delivered through zoom. The educational curriculum was adapted from the University of Florida Citizen Scientist program and tailored to address lung health and the contextual experiences of African American men. Each session lasted 90 minutes. Pre- and post-test measures were collected to examine changes in knowledge, comfort, health literacy, research interests, and medical mistrust. Eight African American men completed the CS educational program. Attendance rates were high for each session (100%). Seven participants completed additional human subject research certification. Improvements were observed from pre- to post-test in participants' level of knowledge, comfort, and health literacy but not medical mistrust. CS reported the most interest in participating in research aimed to identify important community strengths and problems. Study findings suggest that it was feasible to deliver an online citizen scientist educational program designed to prepare participants to serve as partners in a lung cancer screening intervention for African American men. Results suggest the educational program has the potential to improve key outcomes including completion of regulatory training and increased research-related knowledge, comfort, and health literacy.

Family Medicine Education at a Rural Hospital in Japan: Impact on Institution and Trainees.

Family medicine is vital in Japan as its society ages, especially in rural areas. However, the implementation of family medicine educational systems has an impact on medical institutions and requires effective communication with stakeholders. This research-based on a mixed-method study-clarifies the changes in a rural hospital and its medical trainees achieved by implementing the family medicine educational curriculum. The quantitative aspect measured the scope of practice and the change in the clinical performance of family medicine trainees through their experience of cases-categorized according to the 10th revision of the International Statistical Classification of Disease and Related Health Problems. During the one-year training program, the trainees' scope of practice expanded significantly in both outpatient and inpatient departments. The qualitative aspect used the grounded theory approach-observations, a focus group, and one-on-one interviews. Three themes emerged during the analysis-conflicts with the past, driving unlearning, and organizational change. Implementing family medicine education in rural community hospitals can improve trainees' experiences as family physicians. To ensure the continuity of family medicine education, and to overcome conflicts caused by system and culture changes, methods for the moderation of conflicts and effective unlearning should be promoted in community hospitals.

A mapping review of clinical nurse leader and nurse educator transitional care skills and competencies.

BACKGROUND: Little is known about how nurses are prepared to participate or lead teams in conducting safe and effective care transitions, despite being a complex process in which the nurse has an integral role. PURPOSE: To conduct mapping review to identify and synthesize key recommendations regarding curriculum content needed to increase Clinical Nurse Leader and Nurse Educator student knowledge and skills regarding transitional care. METHOD: Guidelines for developing the transitional care nurse role published by national accrediting bodies and certification organizations were reviewed to identify the required competencies. FINDINGS: Components identified included: communication; teamwork and collaboration; education and engagement of patient and family; promoting and support for self-management; and assessing/ managing risks/symptoms. CONCLUSION: Research evidence is needed to support academic preparation of nurses as leaders in care transition. The core transitional components identified can be used to develop competencies to assist training efforts of nurses in practice and educational settings.

A multidisciplinary, video-based, curriculum for management of the intubated and surgical airway patient for a pediatric hospital in El Salvador.

OBJECTIVE: Primary objective is to determine the rate of intubation with inappropriately sized endotracheal tubes (ETTs) in a pediatric intensive care unit (PICU) in El Salvador. Secondary objective is to determine effectiveness of a video-based curriculum to teach local providers on pediatric advanced airway management and surgical approach to patients requiring airway reconstruction. METHODS: Data for 296 intubated pediatric patients was collected over a six month period in a 16-bed PICU in El Salvador. Results of a learning behavior assessment survey completed by local healthcare workers informed a curriculum to complement on-site education during annual surgical airway mission trips. The video-based curriculum addressed proper sizing and use of cuffed endotracheal tubes, care of the intubated child and perioperative considerations of the surgical airway patient. Providers completed pre and post-curriculum quizzes to measure knowledge acquisition. RESULTS: Over 6-months, 281 patients were intubated. Sixty-three percent had improperly sized ETTs. Thirty-one percent had a failed or accidental extubation. All-cause mortality was 24%. One hundred and fifty-nine Salvadorian providers completed a learning behavior survey informing a video-based curriculum. Sixty-four providers completed the curriculum. Post-curriculum quiz scores increased by 18.7%. Surgeons, anesthesiologist, intensivists and speech pathologists demonstrated significant improvement (p < 0.05). CONCLUSION: Nearly two-thirds of intubated patients in a PICU in El Salvador have improperly sized ETTs and one-third require reintubation following planned or accidental extubation. The development of this first of its kind video-based curriculum for critical care and surgical training regarding how to properly care for the intubated child is coupled with the development of a longitudinal database to record pediatric airway related morbidity and mortality in the largest pediatric hospital in El Salvador. This model and system can be used to track the reduction in airway related morbidity and mortality directly related to a systems based intervention both in El Salvador and then elsewhere.

A Proposal for Educational Curriculum on Conflicts of Interest from Undergraduate through Postgraduate and Continuing Health Professions Education / 医学教育

To ensure public trust in health professions, it is imperative for health professionals to understand the concept of conflict of interest (COI) in health professions education and manage it appropriately. However, there are not enough formal curricula on COI in health professions education in Japan. We propose an educational curriculum on COI in health professions education which focuses on relationship between physicians and for-profit corporations. We hope that this proposed curriculum stimulates educational activities on the ground while taking context into account. We also hope the proposed curriculum leads to the formal incorporation of COI in health professions education and educational policies nationwide.

Pediatric Respiratory Therapists Lack a Standard Mental Model for Managing the Patient Who Is Difficult to Ventilate: A Video Review.

BACKGROUND: All health-care providers who care for infants and children should be able to effectively provide ventilation with a bag and a mask. Respiratory therapists (RTs'), as part of rapid response teams, need to quickly identify the need for airway support and use adjunct airway interventions when subjects are difficult to mask ventilate. Before implementation of an educational curriculum for airway management, we assessed whether pediatric RTs' who enter the room of a simulated infant mannequin in severe respiratory distress are able to apply bag-mask ventilation within 60 s and implement 2 adjunct airway maneuvers in a patient who is difficult to ventilate. METHODS: All pediatric RTs' were required to attend one high-fidelity simulation at the Johns Hopkins Medicine Simulation Center. The sessions were reviewed to evaluate whether the therapists would implement adjunct maneuvers to a patient who was in respiratory distress and was difficult to ventilate. RESULTS: Twenty-eight therapists participated in the baseline skills assessment session, and 26 (72% of eligible therapists) were evaluable with video clips. Only 3 of 26 (12%) attempted bag-mask ventilation within 60 s. Although all the therapists attempted one airway maneuver, only 65% were able to implement ≥2 airway maneuvers and achieve effective ventilation, with a wide range of time (98-298 s). There was no pattern regarding which intervention was implemented first, second, and so forth. CONCLUSIONS: Our team of pediatric RTs' did not share a standard mental model for initiating bag-mask ventilation during impending respiratory failure or implementing airway adjuncts. This may place children who are critically ill at risk of suboptimal management and threaten clinical outcomes. Therapist performance indicated that no established care algorithm had been effectively implemented or that skill retention was poor. A change in the content and delivery method of bag-mask ventilation training is warranted to improve the time to performance of key interventions and to establish a clear cognitive framework of difficult mask ventilation management.

The implementation of a longitudinal POCUS curriculum for physicians working at rural outpatient clinics in Chiapas, Mexico.

BACKGROUND: Medical care in resource limited settings is challenging, particularly with limited access to diagnostic and imaging studies. The most portable and cost effective diagnostic imaging in these areas is ultrasound. Ultrasound is a very teachable skill with a short, single intensive training course and hands-on teaching; however, there are limited data on a longitudinal point-of-care ultrasound (POCUS) curriculum in resource limited settings. The goal of this intervention is to develop an effective longitudinal POCUS curriculum for local physicians working in rural clinics in the state of Chiapas, Mexico, and evaluate its effectiveness on patient care. METHODS: This is a 12-month longitudinal ultrasound educational curriculum for local supervising physicians working in rural clinics in Chiapas, Mexico. The 10 clinics are a collaboration of the Mexican government and Compañeros En Salud with limited access to any diagnostic imaging or laboratory studies. The investigators assisted in obtaining four portable ultrasound machines for use in the clinics. Next, they organized four point-of-care ultrasound (POCUS) teaching sessions over a year, each session focusing on several distinct concepts. The sessions included lectures and hands-on teaching with both healthy volunteers and with patients in the various communities. Over the 12 months, the POCUS were logged and the majority of images saved. The logs were analyzed to determine if POCUS affected the medical management of the patients. The primary investigator reviewed 35.2% of the total ultrasounds completed, which was 52.2% of the save images, for quality assurance and feedback. RESULTS: Over the 12 months, there were 584 ultrasound studies documented. The most common study was a transabdominal obstetric examination (45.5%) followed by abdomen/pelvis (26.6%) and musculoskeletal (5.7%) and skin and soft tissue (5.7%). The use of POCUS changed the patient diagnosis after 194 scans (34%) and changed the clinical management for the patient encounter in 171 (30%) scans. In the 194 scans in which POCUS changed the diagnosis, the clinical management was changed, as a direct result of the scan results, in 152 (78.4%) of those patient encounters. CONCLUSION: A longitudinal POCUS educational curriculum is an effective way to equip local physicians in resource limited countries with a tool to improve their clinical management of patients.

Engaging the Front Line: Tapping into Hospital-Wide Quality and Safety Initiatives.

Healthcare increasingly is moving from volume- to value-based care, with an emphasis on linking a larger percentage of payments to the quality of care provided. There is a renewed interest in designing a focused, strategic approach to quality and safety education and engagement of trainees in hospital-wide quality, safety, and patient experience initiatives. Hospitals, trainees, and patients benefit as a result of engaging frontline learners in these activities. Hospitals can leverage the intelligence from the front line to contribute to improved hospital safety, increased employee and patient engagement, and better identification of vulnerable areas of safety risks. Trainees benefit from increased engagement by acquiring fundamentals in quality and safety; are able to satisfy Clinical Learning Environment Review recommendations; have an opportunity to practice a number of skill sets (leadership, communication, collaboration); and complete quality and safety hands-on projects. Patients benefit from a more engaged work force, safer environment for their healthcare, and an improved overall experience. In this article, the current state of the Johns Hopkins Department of Anesthesiology and Critical Care Medicine's efforts to engage its front line in quality, safety, and patient experience initiatives that are in evolutionary phases of implementation is presented. Evolutionary concepts relate to the Johns Hopkins Health System and the aim of its training program to continuously improve and innovate.

Developing Interactive Antimicrobial Stewardship and Infection Prevention Curricula for Diverse Learners: A Tailored Approach.

BACKGROUND: To impart principles of antimicrobial stewardship (AS) and infection prevention and control (IPC), we developed a curriculum tailored to the diverse aptitudes of learners at our medical center. METHODS: We integrated case-based modules, group learning activities, smartphone applications (apps), decision support tools, and prescription audit and feedback into curricula of the medical school, medicine residency program, infectious diseases (ID) fellowship program, and hospital medicine program operations. Interventions were implemented in 2012-2016 using a quasi-experimental before-and-after study design, and this was assessed using pre- and postintervention surveys or audit of antibiotic prescriptions. RESULTS: Over 180 medical students participated in the AS and IPC seminars. After smartphone app introduction, 69% reported using the app as their preferred source of antibiotic information. Approximately 70% of students felt comfortable prescribing antibiotics for a known infection compared with 40% at baseline (P = .02), and approximately 83% were able to identify the appropriate personal protective equipment for specific scenarios. Approximately 99% agreed that they have a role in promoting patient safety and preventing healthcare-associated infections as medical students. At 20 months, appropriateness of trainee antibiotic prescriptions increased by 20% (P < .01). Almost all ID fellows indicated that the AS and IPC seminar was a vital training supplement. Uptake of internist antibiotic recommendations using AS decision support tools was approximately 70%. CONCLUSIONS: All 5 interventions addressed learning objectives and knowledge gaps and are applicable across a range of environments. Evaluating long-term impact of our curriculum is the focus of future study.

Do Therapists Google Their Patients? A Survey Among Psychotherapists.

BACKGROUND: The increasing use of the Internet and its array of social networks brings new ways for psychotherapists to find out information about their patients, often referred to as patient-targeted googling (PTG). However, this topic has been subject to little empirical research; there has been hardly any attention given to it in Germany and the rest of Europe and it has not been included in ethical guidelines for psychotherapy despite the complex ethical issues it raises. OBJECTIVE: This study explored German psychotherapists' behavior and experiences related to PTG, investigated how these vary with sociodemographic factors and therapeutic background, and explored the circumstances in which psychotherapists considered PTG to be appropriate or not. METHODS: A total of 207 psychotherapists responded to a newly developed questionnaire that assessed their experience of and views on PTG. The study sample was a nonrepresentative convenience sample recruited online via several German-speaking professional therapy platforms. RESULTS: Most therapists (84.5%, 174/207) stated that they had not actively considered the topic of PTG. However, 39.6% (82/207) said that they had already looked for patient information online (eg, when they suspected a patient may have been lying) and 39.3% (81/207) knew colleagues or supervisors who had done so. Only 2.4% (5/207) of therapists had come across PTG during their education and training. CONCLUSIONS: It is essential to provide PTG as a part of therapists' education and training. Furthermore, the complex problems concerning PTG should be introduced into codes of ethics to provide explicit guidance for psychotherapists in practice. This report provides initial suggestions to open up debate on this topic.

Evaluation of a sequential structured educational curriculum for emergency medical technicians in airway management.

BACKGROUND AND AIMS: Emergency medical technician (EMT) training programs for certification vary greatly from course to course, but it is necessary that each course at least meets local and national requirements. It is reasonable to expect that EMTs' performance should improve after a structured educational curriculum. We hypothesized that EMTs' performance in airway management would improve after a sequential structured educational curriculum involving airway, followed by cardiopulmonary resuscitation (CPR) modules, beyond what is achieved after only the airway module. MATERIALS AND METHODS: To evaluate this, 76 EMTs were assigned to a 2-week airway module with a structured curriculum. This was followed by the 2-week CPR module, and the EMTs were tested before (preCPR test) and after (postCPR test) the CPR modules for improvement in their airway skills. EMTs also completed a questionnaire to evaluate the curriculum. RESULTS: PostCPR test mean scores were higher than those of the preCPR test (P < 0.05) except for the bag valve mask domain. EMTs evaluated the curriculum and gave a score of 3.7/5 for perceived achievement of goals of the syllabus for improving their airway skills. CONCLUSION: Thus, a sequential, structured curriculum in airway management followed by CPR, improves EMTs' performance levels above what they achieved after only the airway module, except for bag valve mask ventilation.

Fundamentals of robotic surgery: a course of basic robotic surgery skills based upon a 14-society consensus template of outcomes measures and curriculum development.

BACKGROUND: There is a need for a standardized curriculum for training and assessment of robotic surgeons to proficiency, followed by high-stakes testing (HST) for certification. METHODS: To standardize the curriculum and certification of robotic surgeons, a series of consensus conferences attended by 14 leading international surgical societies have been used to compile the outcomes measures and curriculum that should form the basis for a Fundamentals of Robotic Surgery (FRS) programme. RESULTS: A set of 25 outcomes measures and a curriculum for teaching the skills needed to safely use current generation surgical robotic systems has been developed and accepted by a committee of experienced robotic surgeons across 14 specialties. CONCLUSIONS: A standardized process for certifying the skills of a robotic surgeon has begun to emerge. The work described here documents both the processes used for developing educational material and the educational content of a robotic curriculum.

Graduate Education Programs in Health Policy and Management at the Harvard School of Public Health: Implications for Program Development in Japan / 医学教育

The goals of this article are to provide an overview of the master's degree programs offered by the Department of Health Policy and Management at the Harvard School of Public Health and to examine the program's implications for the development of educational programs for health-services administration in Japan. Three program features were identified: 1) a highly interdisciplinary approach, 2) a comprehensive curriculum, and 3) a community-based partnership. The large number of medical and academic institutions in Boston, where the school is located, provides significant advantages to the programs in terms of faculty recruitment and program development. However, future improvements are anticipated in determining the definition and scope of the programs and in assessing the potential differences between practice settings and academic training programs.

Advocacy by Students in Medical Education / 医学教育

A special Students' Committee on Medical Education was established by the Student Union of Nippon Medical School. The members of this committee are all volunteers and have carried out several plans to improve the educational environment at our school. In 1999, the Students' Committee on Medical Education proposed holding joint meetings with the Education Committee of Nippon Medical School. The meeting was to allow communication between students and teachers for improving the curriculum. The volunteer faculty members of the Education Committee and students have held joint meetings seven times from November 1999 through February 2001. Discussions between students and teachers have changed ideas on both sides and have led to improvements in some educational programs, such as clinical internship during the summer vacation.