Promotion of Continuing Medical Education for Physicians by Using the Mailing List / 医学教育

Because new media have come onstage in the information technology period, also self-learning methods have been diversified. Recently, small group discussion such as clinical conference using the mailing list is lively performed among the primary care physicians, and it is considered to be useful for continuing medical education. To promote the mailing list for continuing medical education, we present as follows; 1) present situation: to show a good example of TFC-ML (total family care-mailing list), 2) usefulness: to know new medical knowledge, new medical information and literatures etc., to discuss clinical cases. 3) issues: a role of moderator, excess of information, correspondence with slander, 4) future: to reevaluate usefulness for continuing medical education. We would like to expect effectiveness of mailing list for continuing medical education.

An Analysis of Conflicts Between Medical Residents and Nurses in a General Medicine Ward / 医学教育

Background and Method: To identify the cause of conflicts between medical residents and nurses during daily care practices in a general medicine ward, we observed and conducted interviews with 12 residents in their second postgraduate year. Results: We found three typical situations that are likely to lead to conflicts. 1) Both residents and nurses, especially when they are less experienced, are too occupied with their daily tasks to understand their counterpart's difficulties. 2) Nurses push residents to make quicker decisions beyond their discretion and ability. 3) The medical priority of making a precise diagnosis conflicts with the nursing priority of keeping patients comfortable.

On a Report of the Questionaire Regarding Activities of Continuing Medical Education for the Primary Care Physicians in University Hospitals and Clinical Training Hospitals / 医学教育

The aim of this study is to clarify the present situation of activities of continuing medical education (CME) for the primary care physicians to whom the leading hospitals, such as universities and clinical trainee hospitals perform CME in their regions. A questionaire was designed for main 4 parts, as following: 1) On the purpose of CME for the physicians. 2) On the organization (office) managing CME in the hospitals. 3) On the strategies of CME. 4) On the evaluation of CME. Answers to a questionaire were replied from 234 institutions (58.1%). Analyzing the results, we recognized that the leading hospitals actively carried out CME for the primary care physicians in the community. Furthermore, conversion to experiential learning from passive learning and establishment of evaluation methods should be promoted in CME.

Significance of General Medicine in Postgraduate Surgical Education / 医学教育

To evaluate whether general medicine training in our general ward has beneficial effects on postgraduate surgical training, questionnaires on general medicine training was sent to 30 doctors who had undergone initial training as residents in our hospital and were involved in surgical practice at the time of the survey. Twenty-two responses were obtained. Fifteen respondents had motivation for general practice at the beginning of their residency, and 20 attained their objectives during the 2-year training. Nineteen respondents appreciated their experiences in managing a variety of diseases encompassing the disciplines of internal medicine and surgery, although 12 complained of a shortage of teaching staff. From the viewpoint of its contribution to their present practice, their training in the general ward was evaluated by all respondents as having been beneficial. We conclude that general medicine training has beneficial effects on postgraduate surgical training that emphasizes comprehensive patient care.

Analysis of Medical Residents With Inappropriate Performance During the First 2 Years of Postgraduate Medical Education / 医学教育

Among the 55 medical residents who had completed the 2-year postgraduate medical training course at Tenri Hospital in the past 5 years, the postgraduate medical education committee analysed 9 residents whose clinical performance was considered inappropriate. The committee, composed of eight instructors, found that residents with initially poor medical knowledge were able to improve their medical performance and skills during their 2 years of training; however, other residents who lacked responsibility towards patients, communication skills, and medical ethics during training had great difficulty improving or altering their attitude or performance in the 2 years.

The Role of On-Call Duty at the Tenri Hospital Emergency Department in Clinical Training in a General Outpatient Setting / 医学教育

Objective: To investigate the role of postgraduate clinical training at the emergency department of Tenri Hospital in teaching the diagnostic process in the general outpatient department.<BR>Method: Patients seen by 11 first-year residents at the emergency department were consecutively registered with summary sheets. Further information was added, and an analysis was performed of: 1) the distribution of chief complaints in the emergency and general outpatient departments and 2) initial diagnoses and the diagnostic process in the emergency department and the final diagnoses.<BR>Results: The distributions of chief complaints in 89 cases in the emergency department and in 183 cases in the general outpatient department were closely correlated (p=0.0016). Diagnoses in the emergency department were correct in 58% of cases. Treatment was incorrect in 3% of cases.<BR>Conclusion: The distributions of chief complaints in the emergency and general outpatient departments were similar. In our hospital the emergency department plays a major role in postgraduate clinical training by teaching the diagnostic process for the general outpatient department. Clinical management, including decision making for further tests and consultation, in the emergency department by first year residents did lead to any major adverse events.

Bedside Teaching in Heart Disease for 1st-Year Medical Trainees by Specialized 2nd-Year Medical Trainees / 医学教育

In the past 2 years, all 1st-year medical trainees have been instructed in physical examination of patients with heart disease in the general ward of Tenri Hospital by two or three 2nd-year medical trainees who had received special training in physical examination for heart disease. After 1 year of training, all 1st-year medical trainees became confident in making a proper physical examination and in detecting an S3 gallop but were not confident in detecting other abnormal physical findings. On the other hand, the 2nd-year medical trainees thought that they were able to organize their own medical knowledge by teaching 1st-year medical trainees.

A Curriculum on the Undergraduate Education of General Medicine / 医学教育

The working group on the education of general medicine, Japan Society for Medical Education, has defined general medicine as a discipline which includes following three areas; 1) basic clinical skills which incorporate humane health care, 2) comprehensive community and family medicine and 3) general internal medicine which provides integrated services to solve clinical problems at any level. It has also issued a proposal on undergraduate education of general medicine at university hospitals. The working group now propose a detailed sample curriculum which describes the instruction in three areas mentioned above. Overview, General Instructional Objective (GTO), Specific Behavioral Objectives (SBOs), Learning Strategies (LS) and Evaluation are included in this sequence.

A Person-to-Person Training Method to Master the Physical Examination of the Heart for 1st-Year Medical Trainees / 医学教育

In the past 2 years, five 1st-year medical trainees with excellent knowledge and attitude trained with an instructor supervision in the physical examination of the heart with 4 to 5 patients a week. Despite their undergraduate medical education, these medical trainees could not detect abnormal physical findings of the heart. As much as 5 months of training was required before they could satisfactorily detect such abnormalities.

Medical education system. Introduction of the Clinical Professor System to Improve Clinical Competences of Medical Students / 医学教育

Japanese medical school graduates who have just been licensed cannot properly conduct historytaking and physical examination because of inadequate undergraduate clinical practical training. We propose that each medical school should recruit senior physicians in its affiliated teaching hospitals as clinical professors who clinically train medical students in their own hospitals, evaluate the clinical competences of the students, and also participate in improving the undergraduate clinical curriculum of the medical school. The students poorly evaluated by clinical professors should not be allowed to graduate, while the clinical professors are evaluated by students and the medical school for renewal of the professorship.

Results of our 6-months training of ECG diagnosis for the first-year postgraduate medical trainees / 医学教育

We have conducted weekly 40-minute training session of ECG diagnosis for lst-year postgraduate medical trainees for 6 months. Their abilities to read ECGs were tested before and after training sessions. Before training (just after graduation from medical school) they were able to diagnose typical ECGs if each tracing had only one abnormality and if enough time was given for interpretation. However, they frequently misdiagnosed even ECGs that they had correctly diagnosed on pre-tests if they were presented with many other ECGs and the time for interpretation was limited. Post-tests by students and teachers showed that our training of systematic and orderly reading of ECGs has enabled students to describe ECG findings fairly accurately but could not teach them to diagnose underlying cardiac disorders.

History Taking and Physical Examination for Patients with Common Cardiovascular Complaints in an Outpatient Clinic by Medical Residents Supervised by an Experienced Cardiologist / 医学教育

Eleven 2nd-year medical residents were given the opportunity to take histories and give physical examinations for patients whose complaints included chest pain, palpitations, dyspnea on exertion, fainting, asymptomatic electrocardiographic abnormalities, and hypertension. Each resident took part in this program in an instructor's outpatient clinic twice a week for 2 consecutive months; each resident saw an average of 19 patients. The instructor discussed with the residents how to make diagnoses logically and the necessity of emergency treatment. The residents learned that taking histories accurately is an extremely important diagnostic tool, that a systematic approach is important, and that clinical decisions are often influenced by nonmedical factors. Medical residents need to have experience with such patients to improve their ability to take histories and perform physical examinations; however, proper supervision by an instructor in more important.

A Method for Learning Surgical Knot-Tying Technique in a General Medicine Training Program / 医学教育

To evaluate the learning process in a general medicine training program for skills used in minor outpatient surgery, we introduced a new educational program for knot-tying technique. Eleven 1st year residents were enrolled in the program. The program consisted of initial instruction by senior surgeons through a video system, continuous training with a phantom at weekly surgical conferences, and practical application in the operating room. We objectively evaluated the effectiveness of this program with our unique scoring system for tying which includes speed, form, and securityof the knots. The scores after 4 months, especially the speed score, were significantly, better than those at the beginning of the program (P<0.05), and the scores for form and security tended to be higher than those of 2nd-year residents. We conclude that this unique program for knot tying is effective for teaching proper techniques for tying tight and secure knots and may be used as a part of general medicine training program.

Status Quo of General Medicine at Teaching Hospitals in Japan. Report by General Medicine Working Group of Japan Society for Medical Education / 医学教育

In April, 1995, 392 teaching hospitals were surveyed by questionnaire regarding status quo of general medicine in Japan. Independent department of general medicine was established in 11 university and 16 non-university teaching hospitals (11.6% of the respondents). There were another 23 hospitals-3 universtiy and 20 non-university hospitals-in which general medicine was practiced at other department. Therefore, 50 hospitals (21.5% of the respondents) had a group of physicians practicing general medicine in one way or another.<BR>Many problems surrounding general medicine, however, were raised, especially about conceptual gaps between generalist physicians and specialists or patients. It is mandatory for clinicians and educators in general medicine to make the concept of general medicine explicit in understandable words for other specialists and lay people. In addition, high quality practice, education and research products are essential to attract more doctors of younger generation.

A Trial of History Retaking by Medical Residents from Patients Having Chest Pain of Known Cause. Clinical Teaching in an Outpatient Department / 医学教育

To improve the ability of 1st-year medical residents to take histories from patients with chest pain we had residents re-interview patients in a senior cardiologist's outpatient department who had had chest pain of known origin. Three medical residents participated in this training program just after obtaining their licenses to practice medicine. Each resident took histories from approximately 25 consecutive patients during a 1-month period. Causes of chest pain included angina pectoris (38 cases), acute myocardial infarction (16 cases), pulmonary embolism (10 cases), and dissecting aortic aneurysm (4 cases).<BR>Each of the three residents stated that they recognized the importance of taking histories from patients with ischemic heart disease and became confident doing so after having interviewed about 15 patients. What they learned in this training program was considered useful when they interviewed new patients in an emergency room who complained of chest pain. One resident wished that this training had started several months after receiving his license because they had little experience taking histories from patients while in medical school. Four months after this training, the senior cardiologist tested the three residents by having them interview new patients with chest pain and found their abilities to be satisfactory.<BR>Twenty consecutive cases appears to be a satisfactory number for medical residents to become confident in taking histories from patients with ischemic heart disease. This training program should be started within 3 months after residents receive their medical licenses.

Evaluation of Postgraduate Clinical Training / 医学教育

Based on 20 years of experience with an unique postgraduate clinical training program, consisting of “g eneral wards ” and “inninr-residents in general medicine” at Tenri Hospital (Nara, Japan), we have identified the following points for the successful evaluation of residents: 1) unlike undergraduate teaching, item-based evaluations do not fit teaching in the clinical setting, 2) evaluation of residents' attitudes should be emphasized, 3) comprehensive evaluation in regular meetings by the teaching staff is practical and useful, 4) mechanisms to reflect patients' opinions should be included in the evaluation process.

Cardiology Case Conferences for Residents in Internal Medicine, with a Particular Focus on History Taking and Physical Examination / 医学教育

With the development of sophisticated medical technologies, there has been a tendency to belittle the taking of the “history and physical, ” even in the field of cardiology. We have been holding cardiology case conferences for general medical residents, with the main focus on history taking and physical examination since 1992, so that all residents are able to provide a certain level of primary care for patients with cardiac diseases regardless of his or her future sub-speciality. We present our methods and the educational effect of these conferences.

Report from Working Group on Postgraduate Medical School and Speciality Training. With a Special Emphasis on Clinical Course in Postgraduate Medical School / 医学教育

Discussions on the postgraduate medical school and the speciality training course after graduation had been conducted 2 times in 1994 among the members of the working group on postgraduate medical school and speciality training in Japanese Society for Medical Education. Results of the discussion are reported in this paper as a proposal for the improvement of the present state of education and training in the postgraduate medical schools in our country. In this report, several important proposals which need further discussions such as the shortening the clinical course in postgraduate medical school to 3 years from present 4 years and necessity of establishing the obligatory course for training the basic technology for life science research are presented. It is mandatory to have full time teaching staff as well as exclusive space for postgraduate course in each school to improve the of education of postgraduate medical schools.