A contemporary training concept in critical care cardiology.

Critical care cardiology (CCC) in the modern era is shaped by a multitude of innovative treatment options and an increasingly complex, ageing patient population. Generating high-quality evidence for novel interventions and devices in an intensive care setting is exceptionally challenging. As a result, formulating the best possible therapeutic approach continues to rely predominantly on expert opinion and local standard operating procedures. Fostering the full potential of CCC and the maturation of the next generation of decision-makers in this field calls for an updated training concept, that encompasses the extensive knowledge and skills required to care for critically ill cardiac patients while remaining adaptable to the trainee's individual career planning and existing educational programs. In the present manuscript, we suggest a standardized training phase in preparation of the first ICU rotation, propose a modular CCC core curriculum, and outline how training components could be conceptualized within three sub-specialization tracks for aspiring cardiac intensivists.

Online Core Curriculum and Mastery (OCCAM): A Behavioral Neurology & Neuropsychiatry (BNNP) Curricular Needs Assessment.

Behavioral neurology & neuropsychiatry (BNNP) fellowships are accredited by the United Council for Neurologic Subspecialties (UCNS). Programs cover the UCNS-recommended topics differently. A curriculum accessible to all fellowships would standardize education and identify gaps in topics that are less well covered across programs. The purpose of the present needs assessment was to inform the development of the Online Core Curriculum and Mastery: BNNP (OCCAM-BNNP), a website for all UCNS-accredited BNNP programs. Program directors and fellows were surveyed to learn how well topics are covered and identify educational gaps, or specific topics on the UCNS website that are less well represented among programs. Thirty-seven fellowship program directors listed on the UCNS website were invited to take the survey and forward it to both current fellows (graduating in 2021) and recent graduates (graduated from 2015 to 2020). There were 29 responses from 37 programs. Of the 34 topics that respondents rated on a 1-5 Likert scale (from "not covered" to "completely covered"), 15 of 34 (44%) were identified as having >40% of responses as mostly "not covered," "incompletely covered," or "partially covered." Ninety-seven percent of respondents affirmed that it would be useful to have a free web-based resource for BNNP education. Slightly under one-half of all BNNP topics were not well covered. A survey was undertaken to identify and fill the educational gaps indicated by fellowship directors and fellows, and the OCCAM-BNNP website was developed as a repository for relevant content, providing a resource that many BNNP clinicians would find useful.

[Now That Core Curriculum (Medicine, Dentistry, and Pharmacy) are Being Revised at the Same Time, How Should Pharmacy Education be?]

In recent years, the role of pharmacists has changed dramatically due to a combination of rapid developments in medicine, science and technology, along with a rapidly aging population and declining birthrate. Especially since the 1980s, these changes have been remarkable. Accordingly, in order to best prepare pharmacists, the duration of pharmacy education has been extended to six years. Further, the core curricula of all three medical faculties (medicine, dentistry, and pharmacy) will be revised concurrently, in a coordinated manner, in 2024. Pharmaceutical education should thus place more emphasis on clinical education to "know clinical practice, link what you have learned in clinical practice to drug discovery, and important to know the roles of each medical provider including patients and contribute to drug treatment and post-marketing drug development. We should be aware that pharmacy and medical care cannot be achieved through lectures alone." In designing a new pharmaceutical curriculum to meet these coming needs, it is important to have a vision looking 10 or 20 years into the future. It is necessary to know the world in which we live, as well as the role that should be played by pharmacists, to set a clear educational philosophy that includes goals to be achieved, and then to develop a curriculum to reach these, and a plan for steadily putting these goals into practice.

[Fostering Pharmacists to Succeed in a Drastically Changing Society].

In 2006, Japan's pharmaceutical science education was revised to a 6-year enrollment course, placing greater emphasis on cultivating practical clinical ability. Quality Assurance (QA) measures have been implemented including offering education based on a model core curriculum and third-party assessments. In August 2021, Ministry of Education, Culture, Sports, Science and Technology (MEXT) launched an investigative commission to review the above. For QA, the commission summarized a comprehensive report in August 2022 for items including: modality of selecting entrants; revising enrollment limits; securing education management; information disclosure; corresponding to pharmaceutical education assessments. For revising the model core curriculum, the commission is reviewing correspondence to: demographic changes due to decreasing birthrates, an ageing population, changes in the structure of diseases; rising and emerging infectious diseases; utilizing Big Data and artificial intelligence (AI). As Japan's ageing population is forecast to peak in 2040s, pharmacists must be fostered to provide safe and quality medicine towards a drastically changing future. Medical care is provided through the collaboration of various professions. In such changing demographics, team medicine is crucial to provide quality medical care. Moreover, towards all medical professions sharing the same vision, revisions to the model core curricula for medical and dental education are also being reviewed. The commission is now reviewing detailed curricula to foster pharmacists with competencies to: comprehensively assess patients and ordinary citizens; utilize information science and technology; professionalism. Towards securing quality pharmaceutical education, pharmaceutical departments at universities must also organize and implement an educational curriculum based on the Model Core Curriculum for Pharmaceutical Education. This paper will introduce the investigative commission's review.

Clinical Clerkships in General Medicine Enable Students to Acquire Basic Medical Competencies and Experience in Community-Based Integrated Care: A Descriptive Questionnaire-Based Study.

Background No previous research has targeted educators regarding educational practice and the achievements of students in terms of the learning objectives of clinical clerkships in university general medicine departments of Japan. We aimed to clarify the characteristics of clinical clerkships in Japanese general medicine departments using a questionnaire administered to chairpersons of university general medicine departments. Methods This was a descriptive questionnaire-based study using Google Forms (Google, Inc., Mountain View, CA, USA). We asked the chairpersons of general medicine departments in Japanese universities the following questions, with responses given on a 5-point Likert scale: Question 1: How well are primary symptoms in the national model core curriculum for undergraduate medical education taught in clinical clerkships in university general medicine departments? Question 2: How successfully can students achieve the learning objectives of the national model core curriculum for undergraduate medical education through clinical clerkships in general medicine departments of university hospitals? Question 3: How successfully can students achieve the learning objectives of the national model core curriculum for undergraduate medical education through clinical clerkships in other community clinics or hospitals? The results of the questionnaire responses are described as mean±standard deviation. Results Of the 71 Japanese universities with general medicine departments, 43 were included in the analysis. For Question 1, the symptoms and pathophysiologies with a mean score of 4 points or higher were fever, general malaise, anorexia, weight loss or gain, edema, abdominal pain, lymphadenopathy, and headache. All those symptoms require basic medical competencies. For Questions 2 and 3, the intramural clinical clerkship of general medicine departments had a higher mean score than the extramural clinical clerkship for diagnostic reasoning that emphasizes medical history and physical examination and a comprehensive approach to patients with multiple health problems. In contrast, the extramural clinical clerkship, in which medical students can build experience with community-integrated care, had a mean score of 3 points or higher for all items. Conclusions The clinical clerkship in general medicine departments of Japanese universities provides students with chances to acquire clinical competencies regarding primary symptoms and pathophysiologies. Additionally, the extramural clinical clerkship provides experience in community-based integrated care, including home medical care, collaboration, health and welfare, and long-term care.

Consensus on technical procedures for simulation-based training in thoracic surgery: an international needs assessment.

OBJECTIVES: To identify and prioritize technical procedures for simulation-based training to be integrated into the thoracic surgical curriculum. METHODS: A 3-round Delphi survey was conducted from February 2022 to June 2022 among 34 key opinion leaders in thoracic surgery from 14 countries worldwide. The 1st round was a brainstorming phase to identify technical procedures that a newly qualified thoracic surgeon should be able to perform. All the suggested procedures were categorized, qualitatively analysed and sent to the 2nd round. The second round investigated: the frequency of the identified procedure at each institution, the number of thoracic surgeons that should be able to perform these procedures, the degree of risk to the patient if the procedure is performed by a non-competent thoracic surgeon and the feasibility of simulation-based education. In the 3rd round, elimination and re-ranking of the procedures from the 2nd round were performed. RESULTS: Response rates in the 3 iterative rounds were 80% (28 out of 34), 89% (25 out of 28) and 100% (25 out of 25) in the 1st, 2nd and 3rd round, respectively. Seventeen technical procedures were included for simulation-based training in the final prioritized list. The top 5 procedures were Video-Assisted Thoracoscopic Surgery (VATS) lobectomy, VATS segmentectomy, VATS mediastinal lymph node dissection, diagnostic flexible bronchoscopy and robotic-assisted thoracic surgery port placement, robotic-assisted thoracic surgery docking and undocking. CONCLUSIONS: The prioritized list of procedures represents a consensus of key thoracic surgeons worldwide. These procedures are suitable for simulation-based training and should be integrated in the thoracic surgical curriculum.

Imaging Informatics Fellowship Curriculum: Building Consensus on the Most Critical Topics and the Future of the Informatics Fellowship.

The existing fellowship imaging informatics curriculum, established in 2004, has not undergone formal revision since its inception and inaccurately reflects present-day radiology infrastructure. It insufficiently equips trainees for today's informatics challenges as current practices require an understanding of advanced informatics processes and more complex system integration. We sought to address this issue by surveying imaging informatics fellowship program directors across the country to determine the components and cutline for essential topics in a standardized imaging informatics curriculum, the consensus on essential versus supplementary knowledge, and the factors individual programs may use to determine if a newly developed topic is an essential topic. We further identified typical program structural elements and sought fellowship director consensus on offering official graduate trainee certification to imaging informatics fellows. Here, we aim to provide an imaging informatics fellowship director consensus on topics considered essential while still providing a framework for informatics fellowship programs to customize their individual curricula.

Efforts to Promote the Comprehension of and Motivation for the Practice of Basic Life Support for Infants: A Novel Strategy for Pharmaceutical Education / 社会薬学

The mortality rate of pediatric out-of-hospital cardiac arrest is more than 80% in Japan, which is markedly higher than that in adults. Basic life support (BLS) by bystanders is essential for preventing sudden cardiac death. In the model core curriculum for pharmaceutical education in 2024, students must acquire the ability to ensure public health. As part of our educational policy, pharmacy students provide a workshop on infant BLS. This workshop is incorporated after the PUSH course, an authorized training program for BLS focused on chest compressions and AED use of people over elementary school age, for convenience. We herein investigated whether infant BLS training promoted the comprehension of and motivation to perform BLS for infants and assessed the educational relevance of pharmacy students serving as instructors of the BLS training course. Questionnaire responses were obtained from participants before and after the workshop. The majority of participants were college students and childcare workers. Knowledge of infant BLS by childcare workers was significantly more extensive than that by the other participants; however, overall understanding of infant BLS and the motivation to contribute to it increased irrespective of participant backgrounds. Overall improvement was also observed in the items necessary to implement BLS excluding artificial ventilation even though the instructions were given only by pharmacy students. The present results demonstrate that infant BLS training effectively enhanced public motivation to perform BLS for infants with cardiac arrest.

Online Symposium Held on June 10, 2023 / 医学教育

In the revised Core Curriculum, professionalism is listed as one of the basic qualities and abilities required of physicians. The definition of professionalism and related learning objectives (1. trust, 2. compassion, 3. liberal arts, and 4. bioethics) are also presented. However, the Core Curriculum does not explain why these objectives were listed. Therefore, some of them are difficult to understand or differ from what has been discussed in previous meetings of the current subcommittee (and previous committees). To properly and effectively advance professionalism education, it is necessary to confirm the contents of the revised Core Curriculum that are insufficient or inappropriate. It is also necessary to deepen the discussion for the next revision of the Core Curriculum. A symposium was held for this purpose. The main points of each lecture are presented within this report.

10. The 2022 Revision of the Model Core Curriculum for Medical Education in Japan for Healthcare Professionals and Global Trends in Health Professions Education / 医学教育

Globally, there are currently three major competency models for healthcare professions education: CanMEDS 2015 in Canada, Accreditation Council for Graduate Medical Education Six-Competency model in the United States, and Tomorrow's Doctors in the United Kingdom. An investigation by the Revision Committee for the Japanese National Model Core Curriculum revealed that these competency models had been utilized in seven countries. In each country investigated for revision, medical schools were allowed to implement these major competency models flexibly. Although each university has a high degree of freedom in curriculum design and educational delivery, each country is regulated by a quality assurance system that requires accreditation by the World Federation for Medical Education (WFME) and other organizations. The 2022 Revision of the Japanese National Model Core Curriculum has also been translated into English and released to the global audience in the field.

9. Digital Transformation of the 2022 Revision of the Model Core Curriculum for Medical Education in Japan / 医学教育

The Model Core Curriculum (Core Curriculum) is a "model" that systematically organizes the "core" parts of a university "curriculum," which all universities should work on in common. This section describes the part of the Core Curriculum revision that is related to digital transformation (DX). In order to disseminate the Core Curriculum, prepare for future changes, and support the collaborative work of many experts, the DX of the Core Curriculum included the introduction of data and the digitalization of the Core Curriculum work process. The digitization of the core curricula has made it possible to search for and browse through them on a website, distribute them in multiple formats such as Excel files and csv files, and link them to various software such as electronic syllabi and data analysis software. The digitalization of the work process has enabled multiple members to revise the core curricula in parallel. In the future, more personnel will need to support the introduction of such digital technology and a wider range of data.

8. Learning Assessment and Good Practice (2) / 医学教育

In the 2022 Model Core Curriculum for Medical Education in Japan, "Chapter 3, Educational strategies and assessment" section II. "Learner Assessment," consists of three parts : II-1. Approaches to learner assessment, II-2. Assessment methods, and II-3. Questions about learner assessment. Based on the idea that "the way assessment is done varies from institution to institution," the answer to the "Question" is deliberately not included. We hope that readers will refer to this chapter when planning learning assessments in curriculum development while considering the curriculum's background and context.

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.

4. Alignment of the 2022 Revision of the Model Core Curriculum for Medical Education in Japan with the‘Standards of the National Medical Practitioners Qualifying Examination' / 医学教育

In this revision, we have attempted to align the Model Core Curriculum for Medical Education competency, "problem-solving ability based on specialized knowledge," with the "Standards of National Examination for Medical Practitioners." The major diseases and syndromes in "Essential Fundamentals" correspond to the basic diseases in Table 1 of the Core Curriculum, symptoms, physical and laboratory examinations, and treatment in "General Medicine" correspond to the items in Table 2 of the Core Curriculum, and the diseases in "Medical Theory" correspond to the diseases in PS-02 of the Core Curriculum. The validity of the diseases in the Core Curriculum was verified using the evaluation results of the examination level classification of the "Research for Revision of National Examination Criteria." Approximately 690 diseases were conclusively selected. This revision mentions the number of diseases in the Core Curriculum for the first time. Hopefully, this will lead to a deeper examination of diseases that should be studied in medical schools in the future.

3. A Newly Established Quality and Competency "Making Use of Information, Science and Technology" / 医学教育

Due to the importance of developing physicians' competencies to utilize information, science, and technology, the 2022 revision of the Model Core Curriculum for Medical Education newly established guidelines for qualities and competencies, which it refers to as "Competencies to utilize information, science, and technology." The Model Core Curriculum outlines these qualities as "understanding the ever-developing information society and practicing medical research and treatment while utilizing information, science and technology such as artificial intelligence." The guidelines are organized by the three perspectives of "ethical viewpoints and rules for dealing with information, science and technology," "principles of information, science and technology necessary for medicine and its surrounding society," and "utilization of information, science and technology in the medical field." The objectives of the course were set from the three perspectives of "ethics and rules for dealing with information, science and technology," "principles of information, science and technology necessary for medicine and the society surrounding it," and "utilization of information, science and technology in medical practice." We looked back on the process of formulating these qualities and competencies, which will become increasingly important, and discussed their future prospects.

1. Outline of the 2022 Revision of the Model Core Curriculum for Medical Education in Japan / 医学教育

The basic policies of the 2022 revision of the Model Core Curriculum for Medical Education are : (1) revision of the basic qualities and abilities required of physicians in society in 2040 and beyond, (2) further development of outcome-based education (reorganization of learning objectives and the addition of a chapter on strategy and assessment), (3) consistency with legal and institutional changes in physician training, (4) streamlining and digitization of the document, (5) improvements to future researcher training and development, (6) evidence-based Model Core Curriculum content, and (7) Partial standardization with the core curricula of dentistry and pharmacy.　Major points of revision include the addition of "Generalism" and "Information Technology " to the list of qualities and abilities, reorganization of diseases are to be consistent with the national examination, description of infectious diseases are to based on actual clinical practice, and "basic departments/specialties for participatory clinical clerkship" following discussion with JACME.

[Reviewing the Model Core Curriculum for Pharmacy Education and Fundamental Capacities to Become a Pharmacist with a 20-year Perspective on Human Resources Development].

The model core curriculum for pharmacy education (core curriculum) specifies the basics of 6-year pharmacy education. Pharmacy education is currently being provided based on the revised version of the core curriculum created in 2013 (revised core curriculum), with the aim of training pharmacists with the ability to fulfill social needs. The revised core curriculum also defines the "fundamental capacities to become a pharmacist" that should be acquired by the time of graduation. As education based on the revised core curriculum has been progressing, various challenges of this version, which may also be related to the basis of 6-year pharmacy education, have been identified. Measures to address these challenges, including: clearly indicating the number of goals in each area and the relationship between basic and clinical pharmacy; demonstrating the basic ideas of 2 areas differing from those for knowledge acquisition, 〈basic items〉 and 〈pharmacological research〉; and defining 〈clinical pharmacy〉 and the 〈fundamental capacities to become a pharmacist〉 in the context of pharmacy education, should be discussed in the future. Students educated based on a new version of the core curriculum, which will be created during the next term, are supposed to be active in society as pharmacists 20 or 30 years later. With this taken into account, this paper discusses the revised core curriculum currently in use, and proposes improvement plans for the new version, such as specifying parameters to evaluate learning achievements and the hierarchical relationships among areas.