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.

Current States and Challenges of Clinical Training Systems from The Perspective of Trainers and Trainees / 医学教育

Introduction: We conducted a survey to examine the current state of objectives, evaluation, and issues related to the current clinical resident training system.Methods: We conducted focus group interviews using Skype software for qualitative analysis and classified the data using content analysis. The subjects were 20 experienced residents and/or attending physicians from the current and previous training systems.Results: The collective opinions were classified as positive, negative and neutral opinions with respect to ‘objectives', ‘evaluation' and ‘training program'.Discussion: The findings are expected to provide a basis for revising the current system.

A questionnaire survey regarding the guidelines of the national board medical examination from the perspective of postgraduate trainings / 医学教育

<p></p><p>Aim and Method: We sent a questionnaire to clinical instructors of junior residents to examine the validity of the guidelines of the national board medical examination for physicians.</p><p>Results: They estimated that about 10% of the diseases listed in the guidelines were beyond the scope of the training for junior residents. In addition, the examination questions did not necessarily reflect the importance in the training.</p><p>Conclusion: These results suggest that there is a discrepancy between the national board medical examination and the content of postgraduate training.</p>

Survey of out-patient training by junior residents at university hospitals in Japan / 医学教育

<p>　It is necessary to perform out-patient training in order to acquire the basic medical skills of primary care. However, the actual situation of out-patient training has not been clarified in Japan. Therefore, we performed a survey of out-patient training by junior residents at university hospitals throughout Japan.</p><p>　A questionnaire survey was performed on out-patient training for junior residents at 80 university hospitals (main hospitals) nationwide. We received responses from 39 hospitals. The hospitals where out-patient training by junior residents was performed numbered 34, and there were 26 hospitals in which the training in out-patient reception hours is being performed. Hospitals which received training on related hospitals were also noted. There were many hospitals receiving a few patients with common symptoms. It is important to conduct training in university hospitals in cooperation with local hospitals.</p>

Students in medical interview training classes prefer the teacher's feedback, including stories of their clinical experiences, and discussion among students / 医学教育

<p>Objective: Teachers of various departments are in charge of medical interview training classes with the participation of simulated patients. However, it is not clear whether there are differences in feedback (FB) among teachers. The objective was to examine differences in FB among teachers, investigate effective FB methods, and evaluate the effect of an FB manual.<br>Methods: We conducted a questionnaire survey of students to assess their evaluation of FB by teachers. In the meantime, we transcribed and analyzed teachers' FB on the basis of video recordings. We created a teacher's manual for FB on the basis of these results. We conducted a similar survey the following year.<br>Results: The evaluations from students included many positive opinions, such as "we heard from the teachers about their clinical experiences" . Analysis of the videos showed significant differences in the contents of FB among groups. The performance of the interview strongly influenced the content of the FB. Variations in each group tended to be reduced the following year.<br>Conclusions: 1) There were significant differences in FB among teachers. 2) FB that includes the clinical experiences of the teacher and discussion among students may enhance the learning effect. 3) Introduction of the manual increased the relevance of FB.</p>

The feelings of residents in the face of the large-scale rationalization of medical resources : A qualitative study on the way of streamlining community medicine, examining a local area in Hokkaido as an example / 日本プライマリ・ケア連合学会誌

<b>Object</b> : Through understanding feelings of residents in the face of the large-scale rationalization of medical resources and their views about the new system of community medicine, we clarify how we should streamline community medicine along the opinion of residents living in local areas.<br><b>Methods</b> : We interviewed some residents in the face of the economic collapse in X city. Through the interviews, we qualitatively analyzed their feelings that they had concerning the large-scale rationalization of medical resources and their views about community medicine in the future.<br><b>Results</b> : We found three common themes with regard to how to streamline community medicine along the residents' opinions : the way of the rationalization of medical resources, the state of community medicine, and the attitude of the municipal government and medical institutions.<br><b>Conclusion</b> : To carry out streamlining community medicine, it is important for the municipal government and medical institutions to take account of residents' opinions more seriously in the process and the content of the rationalization of medical resources, and to understand the social background of the community and residents' feelings more deeply.

Leaning Objectives of Medical Education in Japan / 医学教育

1) We searched the Internet with Google and the key words "GIO," "SBO," "general objectives," and "behavioral objectives."2) Most of the top 100 Web sites found with searches using the key words "GIO" and "SBO" were related to Japanese medical education.3) Most of the top 100 sites found through searches using the Japanese key words "general objectives" and "behavioral objectives" were related to medical education.

What does the General Public Think Residents can Do?: Exploratory Research on Layperson's Perceptions of Residents' Clinical Competence / 医学教育

This study explored the general public's perception of the clinical competence of residents. Methods: Individual interviews of laypersons, medical students, and residents and focus-group interviews of residents were conducted. Results: Individual interviews revealed the belief that residents acquired various clinical skills immediately after passing the national examination for medical practitioners. These skills included: assessment of the need for referrals, on-call jobs for after-hours and emergency services, interpreting X-ray films, performing cardiopulmonary resuscitation, performing surgery for appendicitis, and treating bone fractures and joint dislocations. Focus-group interviews revealed differences between residents and laypersons in the perception of residents' clinical skills. These skills included: general knowledge of diseases and medications, guidance about lifestyle after discharge, physical examinations, explanation of treatment, diagnostic imaging, and knowledge of or expertise in other medical professions. Conclusion: Laypersons and medical personnel have different perceptions about the clinical competence of residents.

Reconstruction of Medical Education in Afghanistan / 医学教育

1) Afghanistan is one of countries facing serious health situation in the world, and Japan starts support in various area after Tokyo international conference for Afghanistan reconstruction in January, 2002.<BR>2) International Research Center for Medical Education (IRCME), the University of Tokyo, sent faculties as members of JICA expert team for Kabul in 2003 and 2004, and launched support reconstruction of medical education of Afghanistan.<BR>3) IRCME formed consortium in cooperation with Japan Society for Medical Education, International Medical Center of Japan Bureau of International Cooperation and other institutions in order to carry out Medical Education Project to support medical education development of Kabul Medical University, Afghanistan.

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.

Evaluation of the Clinical Clerkship Program at the University of Tokyo (part 2): Course Evaluation and Faculty Evaluation by Students / 医学教育

The purpose of this study was to evaluate the clinical clerkship program at the University of Tokyo Hospital. We report results of course and faculty evaluations by students and of qualitative evaluations, such as students, free comments and group interviews. Methods: Each item of the course and faculty evaluations was related to the overall educational goals developed in advance. Students evaluated the course and faculty immediately after the course ended. Results: Students rated the clerkship program favorably overall, but the scores of thesecond month (3.38) were lower that those of the first month (3.63). Although learning basic clinical procedures is not the main educational goal of the clerkship, students varied widely in their opportunities to perform procedures. Scores of faculty evaluations ranged from 2.93 to 3.87 in the first month and were lower in the second month for all but two items. Interviews revealed that students had fewer learning experiences in the second month because new residents started their rotations at that time. Conclusion: The results suggest that the scheduling of clinical clerkships should be changed. The contents of clerkship need further consideration.

Evaluation of the Clinical Clerkship Program at the University of Tokyo (part 1): Student's Self-evaluation and Evaluation by Faculty / 医学教育

A clinical clerkship program was introduced at the University of Tokyo in 2002 to help students acquire clinical knowledge, skills, and attitudes by increasing their involvement in clinical activities. We assessed the learning effectiveness of clinical clerkships at the University of Tokyo Hospital by examining evaluations of student's clinical competence by themselves and by the faculty. Methods: We evaluated each clerkship with reference to overall educational goals developed in advance. We measured students' self-evaluations and evaluatio s by the faculty before and after the clerkship. Results: At the end of the 2-month clerkship, students' self-evaluation scores (3.18) were significantly higher than before the clerkship (2.71). In particular, scores for patient care were markedly higher. Evaluation scores by the faculty were also higher during (3.64) and after (3.57) clerkships than before (3.26) clerkships. Conclusion: We will use this data to make next year's clerkship programs more effective. We should also develop more-objective strategies for evaluation and establish relevant educational goals.

Postgraduate Ambulatory Care Training at Government-accredited Teaching Hospitals: Results of a Nationwide Survey in Japan / 医学教育

Although postgraduate training in an ambulatory care setting is recognized as beneficial in Japan, such training has not been widely implemented. In April 2001 we surveyed all 389 accredited teaching hospitals in Japan about their ambulatory care training. We asked 1) whether they provide a postgraduate training program in ambulatory care, particularly for problems commonly encountered in primary care settings, 2) if such a program was provided, how it was organized, and 3) if such a program was not provided, what the reasons were. One hundred eighty physicians responsible for the residency programs of 120 hospitals replied (response rate, 87%). Most residents at these hospitals see patients in outpatient clinics regularly during their training. Many faculty members supervise their residents at the outpatient clinic and also see their own patients. Sixty-eight percent of the respondents did not set teaching objectives for ambulatory care training. Frequently mentioned barriers to providing ambulatory care training were limited space and tight outpatient schedules. To promote postgraduate ambulatory care training in accredited teaching hospitals, adequate resource allocation and a national policy are needed.

Teaching Ambulatory Care Medicine in Japan: A Nationwide Survey / 医学教育

Teaching ambulatory-care medicine is essential for primary-care education. However, few studies of ambulatory-care training have been done in the past decade. We performed a nationwide survey to examine whether and how ambulatory medicine is taught to medical students and residents. We sent questionnaires to all medical schools (n=80) and accredited teaching hospitals (n=389) in February 2001. The response rates were 83.3% and 79.2%, respectively. Fifty-one (78.5%) of the 65 medical schools provided ambulatory-care education, although the programs varied considerably from school to school. Only 104 teaching hospitals (26.7%) had an ambulatory-care training program.