Evaluation of the outpatient clinic education of our department by the patient / 医学教育

1) We investigated the patients'evaluations of the students, our management of the medical training, and the patients' recognition of our outpatient clinic education. We then requested the patients to give their opinions regarding such interviews.<BR>2) The patients'evaluations of the outpatient clinic and the patients'recognition of our outpatient clinic education were relatively good, but some patients complained about the short duration of medical care and also expressed anxiety over the students'medical interview.<BR>3) Many patients expressed the desire to positively participate in medical education because the patients had high expectations of the medical students.In addition, this interview training fulfilled the patients'desire to be listened to and have their concerns acknowledged.

Influence of the Patient/Doctor Relationship on the Non-attendance Rate of General Practice, and Investigation of Reasons for Hospital Non-attendance / General Medicine

BACKGROUND: In general practice, though patients often stop visiting ambulatory clinics of their own vo-lition despite the need for ongoing medical treatment, there is little reported research on the reasons for nonattendance in Japan. In this study, we investigated whether the patient/doctor relationship influences nonattendance rates in general practice. In addition, we investigated the reasons why patients stopped visiting the hospital.<BR>METHODS: We collected data from 115 patients (58 males, 57 females; age range: 16 to 94 years old, median age: 52 years old) whose initial diagnoses were made in our department from June to July 2000. We classified the patients into five groups based on the level of their complaints concerning the initial consultation (‘A’ representing the highest degree of complaint, ‘E’ representing the lowest) and determined the relationship between the strength of complaints and the non-attendance rate. Furthermore, we investigated the reasons for non-attendance concerning 28 patients who stopped visiting the hospital from April 2000 to November 2001.<BR>RESULTS: The non-attendance rates were 0% (014) for group A, 14.3% (2114) for group B, 5.6% (5189) for group C, 33.3% (216) for group D, and 50% (1/2) for group E. The rate tended to be higher in groups with fewer complaints. The reasons for non-attendance were the following: remission of symptoms (9 patients), request for another hospital or department (6 patients), relief due to consultation at the university hospital (6 patients), and lack of time to come to the particular hospital (5 patients) . In contrast, the most common reason for satisfaction at the time of consultation was ‘enough explanation and listening to complaints well’ in 7 of 11 patients who were satisfied with the consultation.<BR>CONCLUSIONS: The level of patient's complaints at the time of consultation is related to the non-attendance rate. However, sufficient explanation about symptoms and careful listening to complaints are important for establishing a good patient/doctor relationship.

Examination of Training Methods for Basic Clinical Skills Before Bedside Learning: Comparison Between Fixed-Instructor and Rotation Systems / 医学教育

To evaluate training methods for basic clinical skills before bedside learning, we used questionnaires to ask students and instructors their opinions about the fixed-instructor system, in which one instructor teaches the entire course, and the rotation system, in which instructors share responsibilities for teaching according to their specialty. Students had positive impressions of training with both systems. Many students felt that communication with in structors was good inthe fixed-instructor system and that the specialized education provided by multiple instructors was good in the rotation system. However, students expressed dissatisfaction about differences in educational content between the systems. Instructors believed an advantage of the fixed-instructor system was that skills learned could be applied to all medical fields, whereas the rotation system made teaching easier because it was specialized. On the basis of this investigation, we conclude that training should establish good communication between instructors and students and should include the required educational contents. We also found that unifying educational contents is difficult, regardless of the training system. Few reports about educational methods used to teach basic clinical skills have been published in Japan, but studies focusing on this issue are becoming increasingly necessary.

A Role of University Hospital for Undergraduate Medical Education / 医学教育

As undergraduate medical education in Japan has been changing, the role of university hospitals is reassessed in this paper. It is essential for medical students to acquire basic knowledge and skills before clinical training. During this term it is necessary for them to learn in university hospitals. However following clinical trainings, especially primary care, lifestyle-related diseases, and clinical clerkship in home medical care, are not performed sufficiently under the present condition in university hospitals. In this training term, we have to introduce community-based medical education under closer cooperation with medical facilities.

Effect of Warm Bathing with Artificially produced CO2Bubble on Cerebral Blood Flow in the Early Stage of the Patient Cerebrovascular Disease / 日本温泉気候物理医学会雑誌

It has often been pointed out that introduction of early rehabilitation programs may convey a considerable risk of cerebral hypoperfusion, presumably due to dysautoregulation. Cerebral blood flow (CBF) was measured in six patients with cerebrovascular disease using ^99mTc-hexamethyl propyleneamine oxime single photon emission computed tomography (99^mTc-HM-PAO-SPECT) to investigate whether warm bathing with CO₂ bubble stimulation (CO₂ bathing) can be applied to early rehabilitation programs. The subjects comprised two patients with hypertensive cerebral hemorrhage, two with aneurysmal subarachnoid hemorrhage, and two with cerebral infarction. CO₂ bubble stimulation was produced by dissolving 100g of commercially available CO₂ bubble forming tablets in 300L of warm water (41°C) and a course consisting of 10 minutes of CO₂ bathing was applied for seven days. Vital signs such as blood pressure, pulse rate, and body temperatures at the axilla and the external auditory canal adjacent to the ear drum were checked during each bathing. CBF measurements and routine laboratory examinations were made before and after the seven-day course of CO₂ bathing. Student-t test was used for statistical analysis.<br>No definite changes were shown in vital signs before and after CO₂ bathing. A significant decrease in WBC counts was observed after CO₂ bathing, but there were no changes in values of C-reactive protein. Although no significant changes in hemisphere CBF were identified, actual values of regional CBF in the unaffected hemisphere tended to increase in two patients.<br>These results suggest that CO₂ bathing produces no adverse effects on cerebral perfusion and can be applied safely to early rehabilitation programs.