Revitalizing Postoperative Pain Management in Enhanced Recovery After Surgery via Inter-departmental Collaboration Toward Precision Medicine: A Narrative Review.

This narrative review explores the crucial aspects of postoperative pain management within the framework of Enhanced Recovery After Surgery (ERAS). It emphasizes the significance of effective and secure pain management, highlighting its impact on patient well-being, surgical outcomes, and hospital stays. The inadequacy of perioperative pain relief increases the risk of persistent postoperative pain, emphasizing the need to challenge the notion that pain is expected after surgery. The goals of postoperative pain management extend beyond mere relief, encompassing comfortable sleep, pain-free rest, and liberation from pain during initial recovery. Inadequate pain management can lead to complications such as heightened postoperative bleeding and an increased risk of thrombosis. The review delves into various analgesic methods, their complications, and safety measures. ERAS programs, focused on reducing complications and medical costs, emphasize the importance of judicious postoperative pain management and active rehabilitation. The review discusses complications associated with analgesic methods like opioids, epidural analgesia, and adjuvant analgesics. Collaboration within the perioperative management team is crucial for effective postoperative pain relief. Interdepartmental collaboration is essential for evaluating surgical procedures, analgesic methods, and crisis management strategies. The review concludes by integrating precision medicine into postoperative pain management, emphasizing the potential of genetic information in assessing pain sensitivity. It underscores the importance of inter-departmental collaboration and information gathering for the successful implementation of precision medicine tailored to each facility's perioperative management systems. Additionally, the impact of artificial intelligence (AI) on preoperative risk assessment and innovative monitoring techniques is discussed, paving the way for the advancement of precision medicine in postoperative pain management.

Significance of perioperative inter-departmental collaboration for obstetric emergency response: A mini-review.

This review underscores the crucial role of interdisciplinary collaboration in managing obstetric emergencies such as crisis bleeding. Prompt clinical judgment and coordinated interventions involving various departments are emphasized for the well-being of both the mother and newborn. The review explores the importance of emergency response infrastructure in obstetric facilities and delves into the 2022 Obstetric Crisis Bleeding Guidelines, emphasizing the relevance of a DIC score for severity assessment. The collaborative efforts within the operating room, involving different healthcare professionals, are detailed, stressing meticulous coordination during emergencies like massive bleeding. The necessity of interprofessional collaboration for building a responsive perioperative management team is discussed, with a focus on leadership, followership, and effective communication. The abstract also proposes simulation-based education for inter-departmental training, emphasizing a modified non-technical skill evaluation tool tailored to the unique characteristics of obstetric crisis management in the operating room. Continuous formative assessment of these factors is deemed essential for effective training in various obstetric emergency situations.

Survey on Medical Students' Attitudes Toward Medical Practice Just Before Clinical Clerkship in Japan.

INTRODUCTION: The present study examined the confidence in essential medical practices during clinical clerkship (CC) and performance in preparing education for medical students who are just starting CC at our university. METHODS: We conducted a survey using questionnaires with 105 fourth-year medical students just before starting CC. This questionnaire analysis consists of the confidence in objective structured clinical examination (OSCE) and computer-based testing (CBT) performance toward essential medical practice recommended in the "Report on Medical Practice during Clinical Clerkship" by the Japanese Ministry of Health, Labor, and Welfare and medical safety for CC. RESULTS: The response rate was 67.6% (71/105). As for the performance in each OSCE theme, the confidence in basic clinical technique was significantly smaller compared to chest or abdominal examination, medical interview, and emergency response (p<0.05 each). Medical interviews showed stronger confidence compared to gynecological, breast, or rectal examinations and prostate palpitation among medical examinations (p<0.05 each). In the basic technique during CC, skin disinfection showed stronger confidence compared to other techniques (p<0.05 each). On surgical technique during CC, surgical hand washing and gown technique significantly showed stronger confidence compared to skin suture, suture removal, bleeding control, and surgical assistant (p<0.05 each). CONCLUSION: Our results suggest that medical students just before CC have less confidence in invasive medical practice during CC. As medical practice by student doctors becomes public, further systematic basic skill training both before and during CC is warranted.

Comparison of attitudes toward community-based medicine between regional-quota and general-selected medical student in Japan.

Objective: This study compared the regional-quota and general-selected medical students' understanding, interest, and confidence in the community medicine practice and their attitudes toward the concept guidelines. Methods: We conducted a Web-based questionnaire survey regarding the understanding, interest, and confidence in future community medicine practice and attitudes toward concept guidelines among medical students of all grades (regional-quota and general-selected: n=82 and n=617, respectively). Results: The overall response rates were 68.5% (56/82) and 66.0% (409/617) in the regional-quota and general-selected groups, respectively. Although there was no significant difference between the groups in terms of understanding (P=0.998), interest and confidence in future practice were significantly higher in the regional-quota group (both P<0.001). There was no significant difference between the two groups for any of the six questions regarding community medicine guidelines. Conclusion: The understanding of community medicine or its conceptual guidelines did not significantly differ between the two groups; however, interest and confidence in future practice were significantly higher in the regional-quota group. These results suggest that the regional-quota system positively upregulates the interest in community medicine, which could be associated with confidence in future practice. Comprehensive and longitudinal improvements in the regional-quota system may be effective in cultivating community medicine.

Attitude toward career development in Japanese medical students: a questionnaire survey.

OBJECTIVES: The study aimed to evaluate attitudes of Japanese medical students toward career development, including the acquisition of medical specialty and doctorate degree qualifications. DESIGN: This involved a web-based questionnaire survey. SETTING: We asked medical students about attitudes toward career development after graduation. We also asked them about their intentions to acquire a medical specialty and a doctorate degree using a 5-point Likert scale. PARTICIPANTS: All 699 medical students (from first to sixth grade) in our medical school. RESULTS: The overall questionnaire response rate was 66.5% (465 of 699). Over 90.3% (420 of 465) of respondents desired the clinical discipline, while only 10 of 465 respondents (2.2%) did for basic research. Awareness of career development for ≥8 years after graduation was significantly lower compared with that for 1-2 years after graduation among fourth-sixth year students (fourth p=0.0023, fifth p<0.001, sixth p<0.001). Awareness of career development for 3-7 years after graduation was significantly lower compared with that for 1-2 years after graduation among third-sixth year students (third p<0.001, fourth p=0.003, fifth p<0.001, sixth p<0.001). In the sixth year medical students, only 10.3% showed strong awareness of career development for ≥8 years after graduation, while 39.7% of them did for 1-2 years after graduation. Intentions to acquire a doctorate degree were significantly weaker than those for a medical specialty in all years (p<0.001 in all grades). CONCLUSION: Most Japanese medical students concentrated on the 2-year initial training period immediately after graduation, with vague plans for the subsequent years. Intentions to acquire a doctoral degree were significantly lower than those for a medical specialty. Our findings underscore the necessity for a comprehensive, longitudinal and systematic career development programme.

Challenges for interprofessional simulation-based sedation training courses: Mini review.

Sedation for invasive procedures is given for various clinical purposes to patients of all ages worldwide. However, sedation is a continuum to general anesthesia and contains severe inherent risks leading to mortality. Providing a simulation-based sedation training course (SEDTC) to various medical staff could be an effective strategy to improve patient and medical safety associated with sedation. The SEDTC generally includes basic airway management such as upper airway obstruction release or rapid response action toward excessive sedation, utilizing problem-based learning or simulators. However, participation alone in the SEDTC can only achieve Level 1 (reaction) or 2 (learning) in the Kirkpatrick model. A patient safety improvement of Level 3 (transfer) or 4 (result) of the Kirkpatrick model can be achieved when all members related to sedation undergo experiential learning and reach a consensus. Accordingly, in-hospital interprofessional SEDTC focusing on a resilience approach is essential to achieve effective sedation patient safety in Level 3 or 4 of the Kirkpatrick model.

Learner-Centered Experience-Based Medical Education in an AI-Driven Society: A Literature Review.

This review proposes and explores the significance of "experience-based medical education" (EXPBME) in the context of an artificial intelligence (AI)-driven society. The rapid advancements in AI, particularly driven by deep learning, have revolutionized medical practices by replicating human cognitive functions, such as image analysis and data interpretation, significantly enhancing efficiency and precision across medical settings. The integration of AI into healthcare presents substantial potential, ranging from precise diagnostics to streamlined data management. However, non-technical skills, such as situational awareness on recognizing AI's fallibility or inherent risks, are critical for future healthcare professionals. EXPBME in a clinical or simulation environment plays a vital role, allowing medical practitioners to navigate AI failures through sufficient reflections. As AI continues to evolve, aligning educational frameworks to nurture these fundamental non-technical skills is paramount to adequately prepare healthcare professionals. Learner-centered EXPBME, combined with the AI literacy acquirement, stands as a key pillar in shaping the future of medical education.

Survey on digital dependency, writing by hand, and group learning as learning styles among Japanese medical students: Assessing correlations between various accomplishments.

BACKGROUND: Although digital learning devices have become increasingly more common in medical education settings, it remains unclear how they influence medical student learning styles and various outcome measures. This study aimed to assess student learning styles, specifically as they relate to digital dependency, writing habits, and group learning practices among current medical students. MATERIALS AND METHODS: This questionnaire study was approved by the Research Ethics Committee of Osaka Medical and Pharmaceutical University. We conducted a questionnaire survey of 109 medical students who were 5th year students during the 2021 school year. Medical students were asked about their level of digital dependency, writing by hand, and group learning practices. We also analyzed the correlation between student learning styles and their respective outcomes on several summative evaluations. RESULTS: Of the 109 students targeted, we received responses from 62 (response rate, 56.8%). Among the respondents, digital dependency was 83.4 ± 18.6%, while hand writing ratio 39.8 ± 29.9% and group learning ratio 33.5 ± 30.5%. We also assessed correlations between these learning styles and scores on the CBT, OSCE, CC, and CC Integrative Test. Only writing by hand showed a small positive correlation with CC Integrative Test scores. CONCLUSION: Our questionnaire survey assessed the rates of digital dependency, writing by hand, and group learning practices, and analyzed the correlations between these learning styles and respective outcomes. Current medical students exhibited high digital dependency which was not correlated with performance outcomes.

Simulation-Based Education in the Artificial Intelligence Era.

Simulation-based medical education (SBME) has been widely implemented in skill training in various clinical specialties. SBME has contributed not only to patient and medical safety but also to undergraduate and specialist education in the healthcare field. In this review, we discuss the challenges and future directions of SBME in the artificial intelligence (AI) era. While SBME fidelity or methods may become highly complicated in the AI era, the fact is that learners play a central role. As SBME and clinical education are complementary, mutual feedback and improvement are essential, especially in non-technical skill development. For the development of sustainable SBME in the clinical field in the AI era, continuous improvement is needed by academia, educators, and learners.

Comparison of Younger and Older medical student performance outcomes: A retrospective analysis in Japan.

The present study examined the impact of age on medical student repeat-year experience and performance outcomes on the objective structured clinical examination (OSCE), Clinical Clerkship (CC), and other relevant examinations in the Japanese medical school system. This retrospective analysis examined the number of students with repeat-years and the years required to graduate, stratifying students by the age they entered medical school (Younger: within 4 years of high school graduation; Older: 5 or more years after high school graduation). Scores of the Pre-CC OSCE, Computer-based testing (CBT), CC performance, CC integrative test, and graduation exams were compared among those graduating from our medical school between 2018 and 2020, and examined correlations between student age and performance outcomes. From 2018 to 2020, 328 medical students graduated. Of these, 283 had entered within 4 years of high school graduation (Younger), while 45 did so 5 or more years after high school graduation (Older). The number of repeat-years did not differ significantly between groups. The average number of years required to graduate was slightly higher for the Older group and the Younger group scored significantly higher on the CC integrative test. No significant differences were found for the remaining tests. These results suggest that older medical students in general show no significant inferiority in their performance of most clinical skills and competencies relative to younger students in Japan.

Gender differences in repeat-year experience, clinical clerkship performance, and related examinations in Japanese medical students.

While the number of female medical students is increasing in Japan, gender differences in medical school performance have not been studied extensively. This study aimed to compare gender differences in repeat-year experience, Clinical Clerkship (CC) performance, and related examinations in Japanese medical students. We retrospectively analyzed the number of repeat-year students and years to graduation for male and female medical students, and assessed gender differences in performance on computer-based testing (CBT) before CC, CC as evaluated by clinical teachers, the CC integrative test, and the graduation examination in 2018-2020 graduates from our medical school. Subgroup analyses excluding repeat-year students were also performed. From 2018 to 2020, 328 medical students graduated from our medical school. There were significantly fewer repeat-year female students compared to male students (P = .010), and the average number of years to graduate was significantly higher for male students than female students (P < .001). Female students showed higher scores and performance in all integrative tests and CC (P < .05, each). In analysis excluding repeat-year students, there were no significant gender difference in performance on the CBT, and CC integrative test, although female students significantly outperformed male students on the CC and graduation examination. Female medical students had a fewer number of repeat-years and performed better in the CC and graduation examination compared to their male counterparts.

Correlation of student performance on clerkship with quality of medical chart documentation in a simulation setting.

BACKGROUND: Medical chart documentation is an essential skill acquired in a clinical clerkship (CC). However, the utility of medical chart writing simulations as a component of the objective structured clinical examination (OSCE) has not been sufficiently evaluated. In this study, medical chart documentation in several clinical simulation settings was performed as part of the OSCE, and its correlation with CC performance was evaluated. METHODS: We created a clinical situation video and images involving the acquisition of informed consent, cardiopulmonary resuscitation, and diagnostic imaging in the emergency department, and assessed medical chart documentation performance by medical students as part of the OSCE. Evaluations were conducted utilizing original checklist (0-10 point). We also analyzed the correlation between medical chart documentation OSCE scores and CC performance of 120 medical students who performed their CC in 2019 as 5th year students and took the Post-CC OSCE in 2020 as 6th year students. RESULTS: Of the OSCE components, scores for the acquisition of informed consent and resuscitation showed significant correlations with CC performance (P<0.001 for each). In contrast, scores for diagnostic imaging showed a slightly positive, but non-significant, correlation with CC performance (P = 0.107). Overall scores for OSCE showed a significant correlation with CC performance (P<0.001). CONCLUSION: We conducted a correlation analysis of CC performance and the quality of medical chart documentation in a simulation setting. Our results suggest that medical chart documentation can be one possible alternative component in the OSCE.

A text mining analysis of perceptions of the COVID-19 pandemic among final-year medical students.

AIM: The coronavirus disease 2019 (COVID-19) pandemic has presented various challenges to medical schools. We performed a text mining analysis via essay task to clarify perceptions among final-year medical students toward the COVID-19 pandemic. METHODS: We posed the following essay question to 124 final-year medical students: "What should medical staff do during the COVID-19 pandemic; what should you do?" Responses were subjected to quantitative analysis using a text mining approach. Frequently occurring key words were extracted, followed by multidimensional scaling and co-occurrence network calculations. RESULTS: Of the 124 students, 123 (99.2%) responded to the essay question. The following seven key words were identified as high-frequency words: medical, infection, patient, human, myself, doctor, and information. Co-occurrence network calculations revealed that the word "medical" had a high degree of correlation with most key words, except for "doctor." The word "myself" was correlated with not only "medical" but also "infection," "human," and "doctor." CONCLUSION: Our analysis of perceptions among final-year medical students toward the COVID-19 pandemic revealed that most medical students are strongly affected by the COVID-19 pandemic and are motivated to work as physicians among health care professionals.

Relationships between objective structured clinical examination, computer-based testing, and clinical clerkship performance in Japanese medical students.

BACKGROUND: It is unclear how comprehensive evaluations conducted prior to clinical clerkships (CC), such as the objective structured clinical examination (OSCE) and computer-based testing (CBT), reflect the performance of medical students in CC. Here we retrospectively analyzed correlations between OSCE and CBT scores and CC performance. METHODS: Ethical approval was obtained from our institutional review board. We analyzed correlations between OSCE and CBT scores and CC performance in 94 medical students who took the OSCE and CBT in 2017 when they were 4th year students, and who participated in the basic CC in 2018 when they were 5th year students. RESULTS: Total scores for OSCE and CBT were significantly correlated with CC performance (P<0.001, each). More specifically, medical interview and chest examination components of the OSCE were significantly correlated with CC performance (P = 0.001, each), while the remaining five components of the OSCE were not. CONCLUSION: Our findings suggest that the OSCE and CBT play important roles in predicting CC performance in Japanese medical education context. Among OSCE components, medical interview and chest examination were suggested to be important for predicting CC performance.