A National Survey of Community-Based Medical Education in Japanese Medical Schools (second report) / 医学教育

Introduction: Recently, community-based medical education has become widespread in Japanese medical schools, but the current status is not clear on a national level. A second survey of community-based medical education at all Japanese medical schools was conducted. The first survey was done in 2011. Methods: Members of the Council made and distributed a questionnaire to medical schools in order to assess the situation of community-based medical education as of April 2014. Results: A total of eighty schools responded. The number of schools which had community medicine programs was seventy-eight. In the first survey, the number was seventy-three. Seventy-seven schools gave community-based clinical clerkships. Discussion: The number of medical schools that had curriculum about community medicine was more than indicated in the first survey. Further research about the contents or implementation system of community-based clerkships is needed.

A study of the triage function of referrals in an urban clinic / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : To promote disease management in the community, general physicians should refer their patients to specialists in a timely and appropriate manner. In this study, we propose an indicator for evaluation of such referrals.<br><b>Methods</b> : We analyzed all referrals in an urban clinic from September 1, 2011 to August 31, 2012. Symptoms and diagnoses documented by general physicians were collected from medical records, and the final diagnoses by specialists were collected from their reports. The symptoms and diagnoses were classified using the International Classification of Primary Care second edition (ICPC-2). Referral rates, hospitalization rates, and place of referral were analyzed.<br><b>Results</b> : The average number of encounters in the candidate clinic was 1402 per month, and the mean number of referrals was 23 (1.6% of encounters). Of patients who received a referral, 6.75 (29.1%) were admitted to hospitals. The symptoms and diagnoses of the referred patients were distributed across all chapters (A to Z) of ICPC-2. Diagnoses of admitted patients included pneumonia (R81) (24%), urinary tract infection (U70 and U71) (9%), and acute gastroenteritis with dehydration (D73 with T11) (9%).<br><b>Conclusion</b> : We identified the referral rates, hospitalization rates, and distribution of referral patients as indicators of the triage function of primary care physicians. These should be evaluated further as potential indicators of “the quality of medical care.”

The Analysis of questionares used in outpatient general practice clinics in Japan / 日本プライマリ・ケア連合学会誌

<b>Objective</b> : To analyze and reveal the contents of medical questionnaires distributed to nationwide general practice outpatients prior to their initial medical consultations.<br><b>Method</b> : An observational study was conducted, based on questionnaire format. Sample questionnaires were collected from 85 hospitals registered with the Japan Primary Care Association.<br><b>Results</b> : No standard format was found among the samples. A4 size forms (210 mm×297 mm) averaging 19.7 questions were in the majority, accounting for 68%. The distribution frequency of questionnaires reported by research cooperation centers listed 28 items (31.8%) concerning medical history, 19 items (21.6%) related to lifestyle, and 7 items (8.0%) referring to social and reproductive status.<br><b>Conclusion</b> : This research assessed the qualitative value of medical questionnaires used in General Practice Clinics in Japan. The results indicate the nature of the medical information required by physicians prior to medical consultation.

Opinions of Japanese Medical Students on the Necessity of Experience in Community-based Learning Programs / 医学教育

We conducted a questionnaire survey of all sixth-year students at 10 Japanese medical schools asking their opinions on the necessity of experience in community-based learning (CBL) programs. We developed a detailed questionnaire to examine students' experiences in CBL and their opinions of its necessity using the students' reports from CBL by Delphi process. After excluding data from 1 medical school because of a low response rate, we analyzed data from 659 students (response rate, 75%). The necessity of each item in the required programs, except “seeing labor in medical facilities, ” was more likely to be recognized by students who had experienced the item than by students who had not experienced it. The differences between experiencing and nonexperiencing students in recognizing necessity were greatest for “conversation with patients in their homes, ” “seeing physicians' consultation or referral to other medical institutions, ” “observing nurses work in the outpatient clinic, ” and “participation in conferences with various professional staff.” These results suggest that medical students can recognize the significance and meaning of CBL through experience.

Nationwide Survey of Primary Care Curricula for Undergraduate Medical Students in Japan / 医学教育

We conducted a nationwide survey to examine the primary care (PC) curricula for undergraduates at Japanese medical schools. The present status of PC curricula and the degree of recognition of the need for improvement were examined. Seventy (88%) of the medical schools in Japan responded. PC education programs have been organized and are carried out by various departments in each school. Of the 69 medical schools, 42% have a PC education program with lectures to teach the role of PC physicians, 65% have a program to provide experience in community medical care, and 80% have programs to provide experience in health care institutions and welfare facilities. Although the number of schools with lectures and experience programs for PC has increased at least three-fold in the past decade, many medical school presidents (more than 60%) recognize PC education should be improved. By comparing medical schools with and without experience programs in clinic more presidents of schools without such programs recognized the need to improve PC education.

Japanese and United States Family Medicine Resident Physicians' Attitudes about Training / General Medicine

OBJECTIVE: This is the first research known to compare residents' attitudes about training in two countries. The objective was to examine and compare Japanese and US family medicine residents' attitudes about their residency training.<BR>METHODS: A cross-sectional survey was conducted at two Japanese sites and one US site in 1991, and repeated in 1995 at these sites, as well as two additional US sites. Family practice residents completed a self administered, Likert scale format questionnaire containing items on demographics, identity as a family physician, resident education, the doctor-patient relationship, personal life, economic and women's issues.<BR>RESULTS: The response rates were Japan, 1991: 92% (12/13) ; US, 1991: 76% (13/17) ; Japan, 1995: 89% (34/38) ; and US, 1995: 91% (60/66) . Fewer Japanese residents reported feeling like an outsider, or discriminated against while on outside rotations. More US residents reported expectations for training were being met, and being satisfied with their education. More Japanese residents reported that outpatient training was inadequate. US residents responded more positively about the rewards of clinical decision making, patient management and the doctor-patient relationship. Japanese residents were less likely to report training as compromising their physical or mental health, or feeling overworked. Financial concerns were similar for both groups. Most female residents reported feeling that being a woman provider was an advantage.<BR>CONCLUSIONS: Some aspects of family medicine training are transculturally similar, while others are influenced by the medical culture of the respective countries. Family medicine residents' perspectives on training may be valuable to educators planning curriculum development.

Postgraduate Education Through Evidence-Based Medicine: Short-Term Effects on Knowledge and Behavior / 医学教育

Objective: To investigate whether postgraduate education through evidence-based medicine can affect the knowledge and behavior of residents.<BR>Design: Self-controlled and externally controlled trial.<BR>Setting: University hospital.<BR>Participants: Fifteen residents specializing in family medicine.<BR>Intervention: Four 2-hour seminars and weekly evidence-based medicine-style journal club meetings.<BR>Main outcome measures: Scores from a test of knowledge of evidence-based medicine and the number of MEDLINE searches conducted each month.<BR>Results: All residents improved their knowledge of evidence-based medicine and conducted more MEDLINE searches each month than did other medical residents or residents of our department last year.<BR>Conclusion: Postgraduate education through evidence-based medicine is effective in improving residents' knowledge and behavior.