Comunicación interpersonal de médicos-docentes en las prácticas formativas de un pregrado de medicina

Introducción: La comunicación es una competencia esencial en los currículos médicos, y es fundamental en modelos de atención centrados en el paciente. Las prácticas clínicas, eje en la formación médica, son escenarios de interacciones docente-estudiantes-pacientes; en ellas, los estudiantes aprenden a comunicarse con el paciente de la mano de sus profesores. El objetivo del estudio fue comprender la comunicación de médicos-docentes en prácticas clínicas de un pregrado de medicina. Metodología: Investigación cualitativa desde el marco interpretativo del interaccionismo simbólico y el análisis bajo los lineamientos de la teoría fundamentada. Se entrevistaron quince médicos docentes de cursos clínicos. Las entrevistas se grabaron, transcribieron y codificaron por unidades de sentido. Resultados: Del análisis emergen diferentes visiones del estudiante e interés por los elementos comunicativos con este y el paciente y la reflexión de la práctica docente. Los docentes son conscientes del rol de modelaje para el aprendizaje de los estudiantes; consideran a los pacientes como seres vulnerables, generosos, agradecidos, que representan el recurso más valioso para la enseñanza; con ellos desarrollan su doble misión de resolver problemas de salud y enseñar. Conclusiones: Los docentes, en la interacción con los estudiantes y pacientes, transforman una práctica más instruccional y disciplinar a una centrada en los sujetos y sus necesidades. La regulación del currículo y la normativa de las instituciones de salud genera tensiones a los docentes entre el quehacer médico y el deseo de enseñar.

Introduction: Communication is an essential skill in medical curricula and crucial in patient-centered care models. Resident experience is fundamental in medical training. These experiences offer teacher-student-patient interactions where students learn about doctor-patient communication directly from their preceptors. The objective of the study was to understand doctor-teacher communication during clinical practices in an undergraduate medical program. Methodology: Qualitative research undertaken from the interpretive framework of Symbolic Interactionism andanalysis under Grounded Theory guidelines. Fifteen (15) clinical-course medical doctors were interviewed. The interviews were recorded, transcribed, and coded by meaning units. Results: Different student views emerged, including student interest in student-patient communicative aspects as well as their own thoughts on teaching. Teachers are aware of their role as models in student learning; they see patients as vulnerable, generous, grateful people that represent the most valuable asset in their teaching endeavor; with them, teachers develop their dual mission, that is, solving health-related problems and teaching. Discussion and conclusions: During their interaction with students and patients, teachers transform an essentially instructional and disciplined practice into one centered on the patient and their needs. The stress doctors face when addressing the medical task itself versus their desire to teach is compounded by curriculum guidelines and health agency norms. This is, in fact, part of the hidden curriculum that influences student learning

Desempenho do julgamento clínico de enfermeiros na aplicação do processo de enfermagem / Desempeño del juicio clínico de enfermeros en la aplicación del proceso de enfermería / Clinical judgment performance of nurses in the application of the nursing process

Objective: To verify the applicability of the Lasater Clinical Judgment Rubric (LCJR) instrument to rate nursing professionals' performance regarding the development of clinical judgment in the application of the Nursing Process (NP). Materials and methods: Descriptive survey using the LCJR instrument ­consisting of four phases and eleven dimensions­ to classify clinical judgment. Results: Thirty-four nurses from a public hospital in western Santa Catarina, Brazil, distributed in six sectors, participated in the study. Nurses were classified by performance levels in relation to the ability of clinical judgment in the application of the steps of the NP. It was observed that at the "beginner" level there is a higher prevalence of professionals related to the dimensions Search for information, Recognizing deviations from expected standards, and Technical skills, linked to the intensive care unit clinic. As for the "exemplary" level, none of the sectors scored on the analyzed dimensions. Moreover, it was found that a longer time of clinical experience and of systematic application of the steps of the NP fosters a better classification in almost all dimensions. Conclusions: Through this research, we verified the assertiveness of the use of the instrument to evaluate the clinical judgment of nurses regarding the application of the steps of the NP. Thus, the use of the LCJR is encouraged as a tool to evaluate the effectiveness of educational interventions performed to nurses and, consequently, stimulate clinical judgment.

Objetivo: validar la aplicabilidad del instrumento Lasater Clinical Judgment Rubric (LCJR) para clasificar el desempeño de los profesionales en enfermería con relación al desarrollo del juicio clínico en la aplicación del proceso de enfermería (PE). Materiales y método: investigación descriptiva que adoptó el instrumento LCJR, compuesto de cuatro fases y once dimensiones, para clasificar el juicio clínico. Resultados: el estudio contó con la participación de 34 profesionales en enfermería de un hospital público del oeste del estado de Santa Catarina (Brasil), distribuidos en seis grupos. Los participantes fueron clasificados por niveles de desempeño en relación con la capacidad de juicio clínico en la aplicación de los pasos del PE. Se evidenció que en el nivel "principiante" existe una mayor prevalencia de profesionales relacionados con las dimensiones: Búsqueda de información, Reconocimiento de desviaciones de los estándares esperados y Habilidades técnicas, vinculadas principalmente a la práctica en unidad de cuidados intensivos. En cuanto al nivel "ejemplar", ninguno de los sectores obtuvo puntajes en las dimensiones analizadas. Además, se identificó que un tiempo mayor tanto de experiencia clínica como de aplicación sistemática de los pasos de la PE conducen a una mejor clasificación en casi todas las dimensiones. Conclusiones: a través de esta investigación fue posible validar la idoneidad del uso del LCJR para evaluar el juicio clínico de los profesionales en enfermería en cuanto a la aplicación de las etapas del PE. Por ende, se recomienda el uso de esta herramienta para evaluar la efectividad de las intervenciones educativas con estos profesionales, estimulando con ello el juicio clínico.

Objetivo: verificar a aplicabilidade do instrumento Lasater Clinical Judgment Rubric (LCJR) para classificar o desempenho dos profissionais de enfermagem quanto ao desenvolvimento do julgamento clínico na aplicação do processo de enfermagem (PE). Materiais e método: trata-se de uma pesquisa descritiva que adotou o instrumento LCJR que é fundamentado em quatro fases e onze dimensões, a fim de classificar o julgamento clínico. Resultados: participaram do estudo 34 profissionais de enfermagem de um hospital público do oeste de Santa Catarina, Brasil, distribuídos em seis setores, os quais foram classificados por níveis de desempenho com relação à habilidade de julgamento clínico na aplicação das etapas do PE. Foi evidenciado que no nível "iniciante" há uma maior prevalência de profissionais relacionados às dimensões Busca de informações, Reconhecimento de desvios dos padrões esperados e Habilidades técnicas, vinculadas principalmente à unidade de terapia intensiva clínica. Quanto ao nível "exemplar", nenhum dos setores obteve pontuação nas dimensões analisadas. Ademais, verificou-se que o maior tempo de experiência clínica e o maior tempo de aplicação sistemática das etapas do PE repercutem em uma melhor classificação nos níveis, em quase todas as dimensões. Conclusões: a partir da pesquisa, verificou-se a assertividade quanto à utilização do instrumento LCJR para avaliar o julgamento clínico de enfermeiros com relação à aplicação das etapas do PE . Dessa forma, incentiva-se o uso dessa ferramenta para avaliar a efetividade de intervenções educativas realizadas com profissionais de enfermagem e assim estimular o julgamento clínico.

O julgamento clínico e a tomada de decisão nos estudantes do Curso de Licenciatura em Enfermagem / Clinical judgment and decision-making of the Undergraduate Nursing students

Resumo O julgamento clínico e a tomada de decisão são competências fundamentais em enfermagem, cujas aprendizagens vêm emergindo como áreas crescentes da formação na profissão. Com o objetivo de caraterizar os tipos de julgamento clínico e de tomada de decisão dos estudantes de enfermagem em ensino clínico, optou-se por um estudo de natureza qualitativa, de carácter exploratório e descritivo, com recolha de dados efetuada por meio de análise documental dos jornais de aprendizagem elaborados pelos estudantes de enfermagem em ensino clínico. A análise dos dados foi realizada segundo Bardin, por intermédio do software webQDA. Participaram no estudo 34 estudantes a frequentarem a Unidade Curricular de Ensino Clínico Cuidar de Clientes com Vulnerabilidade Acrescida e Famílias em Transição, que elaboraram um total de 40 jornais de aprendizagem. Das 248 unidades de registo identificadas, destacam-se o julgamento avaliativo, com 45, e a decisão de intervenção, com 55 unidades de registo. Conclui-se que os estudantes, nas suas reflexões em contexto de ensino clínico, destacaram a avaliação da situação de cuidados e ainda a tomada de decisões relacionadas com o agir. Pretende-se que este estudo oriente a aprendizagem destas competências na formação em enfermagem.

Abstract Clinical judgment and decision-making are essential competencies in nursing, emerging as expanding learning areas of nursing education. Aiming to characterize the types of clinical judgment and decision-making adopted by nursing students in clinical education, we designed a qualitative, exploratory and descriptive study, with data collection obtained through documental analysis of nursing student's reflective journals, in clinical education settings. Data analysis was performed according to Bardin using the webQDA software. Thirty-four students participated in the study, while attending the Clinical Learning Curricular Unit: Caring for Clients with Increased Vulnerability and Families in Transition, producing a total of 40 reflective journals. Of the 248 identified registration units, we highlight the evaluation decision-making with 45 registration units and the intervention decision-making, with 55 registration units. It is concluded that student´s reflections in the context of clinical teaching, are mainly about the assessment of the care situation and the decision-making related to the action. This study is intended to guide the learning of these competencies in nursing education.

Reasons for medical students selecting a rural prefecture in Japan for initial clinical training: a single-center-based cross-sectional study / Journal of Rural Medicine

Objective: Securing a sufficient number of medical residents to work in rural areas is an urgent issue. This study sought to clarify the factors that cause medical students at a rural university in Japan to select a particular place for their initial clinical training.Materials and Methods: A questionnaire was administered to all medical students at Saga University between February and March 2021. Participants were divided into two groups based on their training location choice: those who chose Saga Prefecture (Saga group) and those who selected other prefectures (non-Saga group). Then, logistic regression analysis was performed.Results: The questionnaire was answered by 300 students (46.3% response rate), of whom 291 agreed to participate in the study; 122 (41.9%) and 169 (58.1%) students were allocated to the Saga and non-Saga groups. Within the Saga group, the following factors were statistically significant: being admitted to Saga University’s medical school through the system of special allotment of admission to applicants pledging to work in Saga Prefecture following graduation (or regional quota programs for admission) (odds ratio [OR], 19.18; 95% confidence interval [CI], 6.99–52.60); and being from Saga Prefecture (OR, 6.05; 95% CI, 2.24–16.35). With the non-Saga group, the desire to work in an urban area (OR, 0.03; 95% CI, 0.00–0.37) was statistically significant.Conclusion: To encourage medical residents to choose this prefecture for their initial clinical training, the focus should be on medical students who are from Saga Prefecture or admitted through the regional quota program.

Introduction of Insulin Experiential Learning for Medical Students during Clinical Clerkship / 医学教育

In the treatment of diabetes, insulin therapy is becoming increasingly important. However, it is reported that insulin initiation is often delayed due to psychological resistance in patients and physician’s concerns about patient education. One of the reasons for this problem is medical doctors’ inadequate understanding of insulin self-injection and patients’ perspectives. Therefore, we introduced a new strategy for learning this more effectively. We set student doctors as target learners. The learning strategy consists of experiential learning through the use of insulin injection model, in-patient interviews, and small group learning. Our new practice seems to be useful to understand the perception gap between medical professionals and patients.

Communication Difficulties International Students Feel in Practical Training / 医学教育

Background and purpose: With the increase in the number of international medical students, there is an urgent need to develop programs to foster communication skills in Japanese, but the communication problems of international medical students are not clear. Methods: Semi-structured interviews and questionnaires were conducted with 10 international students to identify communication difficulties during clinical practice. Results: Regarding communication with patients, the frequently reported difficulties were difficulty in hearing elderly voices, difficulty with dialects, and difficulty with onomatopoeia. As for communication with health care professionals, the top concerns were not being able to understand jargon and difficulty in speaking concisely using technical terms. Discussion: Language input is a major problem. In educational institutions, they need to listen to a variety of speakers, learn frequent onomatopoeia, and practice oral case reports.

A Review of Junior Residents Who Interrupted Postgraduate Clinical Training in Kurume University Hospital / 医学教育

Objective: To examine the course after junior residents interrupted their clinical training program in Kurume University Hospital and to examine the reasons for interruption. Method: 700 junior residents were recruited from 2004 to 2018. We investigated whether training was restarted and completed for those who had interrupted training. Results: There were 9 residents who interrupted their studies (1.3%). The interruption rate was high among female residents, 2.8% for female and 0.4% for male. The most common reason for interruption was 5 due to illness, of which 4 had mental health problems. All but one, who took a research position, had resumed and completed training at another facility. Summary: It was confirmed that most of the residents who interrupted their studies had completed their training. Our findings help to deepen our knowledge of the type of support residents need to restart their training.

Using a Variable Working Hour System in Compliance with Labor Standards Law in a Japanese Residency Program / 医学教育

Introduction: Work style reform of medical doctors is now an actively discussed matter in Japan. There is also the problem of how to balance the management of legal working hours and the value of medical education in junior residency programs. In particular night and holiday shifts in emergency departments are one of the most important causes of working hour elongation for junior residents. We tried to construct a legally appropriate management method to control their working hours including night and holiday shifts. Method: One-Month Variable Working Hours System and two-shift system were applied to labor management in the medical residency program. Night and holiday working hours were included in regular working hours. Day-time working hours were adjusted to the weekly schedule of each clinical department to cover most of its daily work. Result: Overtime working hours of all residents, including the night and holyday shifts, were managed within the legal limits of 45 hours a month, unless additional overtime work was required. Discussion: Managing worktime through the use of the One-Month Variable Working Hours System is thought to be feasible. In the junior residency program, night and holiday shifts in the emergency department could also be balanced.

Educational Problem-solving Conference as Work-based Faculty Development / 医学教育

We conducted a case conference to solve problems in teaching practices and for clinician teachers to discuss various issues occurring in the field. The conference was based on the presentation of individual educational practice cases from faculty development workshops approved by the Ministry of Health, Labor and Welfare. We prepared two months before the event and dealt with four cases on the day of the event. During the discussion, we tried to link educational problems with a theory or a conceptual framework in medical education so that participants, including case presenters, would have a better understanding of clinical training settings. In addition, communication across disciplines was facilitated through discussions. This attempt has the potential to contribute to the development of a community of practice related to cross-disciplinary education. The key to success for this case conference was the "interpreter" role. The person in that role considers the background and context of practice and links practice with theory appropriately. In addition, faculty development for educators who can play the role will also be an issue in the future.

The Psychosocial Process of Overcoming Difficulties in Dental Trainees / 医学教育

Introduction・Purpose: We conducted qualitative research to explore the psychosocial processes by which dental trainees overcome difficulties during clinical training. Our focus was on their resilience.　Methods: Semi-structured interviews with nine trainee dentists were conducted. For the data analysis, we used Modified Grounded Theory Approach.　Results: The three factors, namely, “relationships with others” , “inner strengths” , and “acting autonomously” , contributed to the processes by which negative effects of trainee dentists changed into positive ones.　Discussion: It was suggested that these factors could provide clues to understanding the psychological burden of dental trainees and how to support them in gaining self-confidence.

An introduction to the orthodontic resident training program at Osaka Dental University and its reference value to orthodontic resident training in China / 口腔疾病防治

@#Orthodontic resident training has a long history abroad. Its purpose is to teach general practitioners in dentistry about basic knowledge and operating standards and to lay a solid foundation for the normalization and standardization of techniques. Osaka Dental University, established in 1911, is one of the oldest dental higher education facilities in Japan and Asia. Its systematic orthodontic resident training program has specific characteristics, including a thorough foundation in basic training, sufficient practice time in clinical work, and an emphasis on both clinical thinking ability and technical detail mastery. Recently, orthodontic resident training programs in China have achieved significant progress in a short period. In this manuscript, we introduce the orthodontic training program of Osaka Dental University in terms of enrollment, training arrangements, orthodontic basic education and clinical training in order to offer a reference for the continuous improvement of the standardized training system for resident doctors of stomatology in China.

A supervisão na clínica-escola como báscula para a psicanálise na universidade / The supervision on clinical training school as a counterweight for psychoanalysis in the university / La supervisión en la clínica-escuela como báscula para el psicoanálisis en la universidad

O artigo parte da elaboração sobre a experiência de trabalho como supervisor em uma Clínica-Escola de Psicologia. Indaga-se sobre as formas através das quais a supervisão pode emergir como espaço privilegiado de transmissão da psicanálise. Procede-se a uma revisão bibliográfica sobre a supervisão na história da psicanálise e no contexto das Clínicas-escola em seu tensionamento com a universidade. A partir de vinhetas clínicas de supervisão, delineamos uma reflexão por duas vias: a respeito da formação dos praticantes e da sua função de suporte na condução dos tratamentos. Finalmente, argumenta-se que a supervisão pode emergir, a partir do discurso do analista, como báscula e que este pode encontrar ali terreno fértil para exercer sua função de operar giros nos discursos, os quais coexistem na Universidade. Conclui-se que a supervisão pode gerar efeitos de transmissão que presentifiquem a ética da psicanálise em extensão, ou seja, presente no mundo para além dos consultórios

The article emerges from the elaboration of an experience of some years working with supervision in a clinical training school. We investigate the ways in which supervision can emerge as a privileged space for psychoanalytical transmission. Thus, a bibliographic review is carried out looking forward to highlight the supervision's role in the history of psychoanalysis and in the context of the clinical training schools, questioning the relationship psychoanalysis-university. Starting from supervision's clinical vignettes, we delineate a reflection in two ways: concerning the training of practitioners and its function as support role in treatments' conduct. Finally, it is argued that supervision might emerge from the analyst's discourse as a counterweight in which he may find fertile ground for the exercise of his function of operating turns in discourses, which coexist, including in the University. It is concluded that the supervision can produce effects of transmission that presents the ethics of psychoanalysis in extension, that is, present in the world beyond the offices

El artículo parte de la elaboración sobre la experiencia de trabajo como supervisor en una Clínica-Escuela de Psicología. Se indaga sobre las formas a través de las cuales la supervisión puede emerger como espacio privilegiado de transmisión del psicoanálisis. Se procede a una revisión bibliográfica sobre la supervisión en la historia del psicoanálisis, y en el contexto de las Clínicas-escuela en su tensión con la universidad. A partir de viñetas clínicas de supervisión, delineamos una reflexión por dos vías: acerca de la formación de los practicantes y su función de soporte en la conducción de los tratamientos. Finalmente, se argumenta que la supervisión puede emerger, a partir del discurso del analista, como báscula y que éste puede encontrar allí terreno fértil para ejercer su función de operar giros en los discursos, los cuales coexisten en la Universidad. Se concluye que la supervisión puede generar efectos de transmisión que presentifiquen la ética del psicoanálisis en extensión, o sea, presente en el mundo más allá de los consultorios

Learning strategies for family medicine residents on clinical rotations / 中华全科医师杂志

Many clinical teachers who train general practice residents are specialists from other departments and are not fully familiar with the work of general practitioners.By socio-culturally adapting concepts from the Preceptor Education Project (PEP) developed over the past 25 years in the United States,this paper provides seven principles general practice residents can consider during rotations in other specialties.(1) Having clear learning objectives makes teaching and studying easier;(2) Teaching takes time,(3) Ask to be observed;(4) Teaching physicians should evaluate you;(5) Patients may resent meeting with a medical resident;(6) Make allies and treat them well;(7) Teach others.These principles can guide general practice residents to take responsibility for excellent training.

The Current Status and Issues of Clinical Training Workshops for Attending Physicians at Kyorin University Affiliated Hospital / 医学教育

Objective: To analyze participants’ opinions regarding the content of clinical training workshops for attending physicians.　Method: A total of 225 people participants in the workshops (approximately 17 hours in 2 days) that were held between 2013 and 2016. We provided the following training sessions: (1) Kawakita Jiro Method (KJ), (2) Process of clinical training, (3) Training program planning procedure, (4) Training objectives, (5) Classification of objectives, (6) Professionalism (PF), (7) 6 Microskills (6MS), (8) Significant event analysis (SEA), (9) Training strategies, (10) Coaching, (11) Educational evaluation, (12) Clinical training systems (CTS), and (13) Roles of attending physicians (RAP). We only used the results of questionnaires obtained from participants who consented to the investigation, and reviewed them for (1) training proficiency, (2) session interest, and (3) course evaluation.　Results: Training sessions showing high proficiency were KJ, RAP, and CTS, and those indicating low proficiency were educational objectives, SEA, and PF. Training sessions that were of great interest were 6MS, Coaching, and KJ.　Conclusion: In the evaluation of the entire course, overall value scored the highest, followed by significance of future participation and applicability of content. Overall, the participants felt that the time for the training course was a little long and that the difficulty level was somewhat high.

How Are Trainee Dentists Able to Autonomously Engage in Clinical Practice? / 医学教育

Introduction: This study aims to explore the processes by which trainee dentists are able to autonomously engage in clinical practice.Methods: Semi-structured interviews with 16 trainee dentists were conducted. For the data analysis, Modified Grounded Theory Approach was employed in this study.Results: At the early stage of clinical education, trainees tended to passively receive and follow the supervisor's instruction. However, through their reiterative reflection on clinical experience and feedback from their supervisor, they gradually established a proper way of treating and caring for patients. They also understood their own abilities. Furthermore, they could obtain a holistic viewpoint of dental treatment. Their experiences led to active engagement with dental practice.Discussion: In order for the learners to be autonomously involved in their practice, educators need to provide scaffolding and support that encourage them to solve individual problems in the given context.

How Are Trainee Dentists Able to Autonomously Engage in Clinical Practice? / 医学教育

Introduction: This study aims to explore the processes by which trainee dentists are able to autonomously engage in clinical practice.Methods: Semi-structured interviews with 16 trainee dentists were conducted. For the data analysis, Modified Grounded Theory Approach was employed in this study.Results: At the early stage of clinical education, trainees tended to passively receive and follow the supervisor's instruction. However, through their reiterative reflection on clinical experience and feedback from their supervisor, they gradually established a proper way of treating and caring for patients. They also understood their own abilities. Furthermore, they could obtain a holistic viewpoint of dental treatment. Their experiences led to active engagement with dental practice.Discussion: In order for the learners to be autonomously involved in their practice, educators need to provide scaffolding and support that encourage them to solve individual problems in the given context.

Medical Professionalism and Continuing Professional Development in the Next Amendment of the Postgraduate Clinical Training System / 医学教育

Under the current postgraduate clinical training system for physicians, three principles have been emphasized in its basic tenets; cultivation of character appropriate for physicians, generation of awareness to the societal role of medical science and healthcare, and mastery of basic clinical skills needed to respond appropriately to injuries and illnesses frequently encountered in general practice. In accordance with its quinquennial review rule, the Clinical Training Committee under the Medical Caucus of the Healthcare Professions Council released draft revisions of a notification published by the Director general of the Health Policy Bureau of the Ministry of Health, Labor and Welfare in March, 2018. The document is entitled "On the operation of the ordinance concerning the postgraduate clinical training prescribed in the paragraph (1) of Article 16-2, Medical Practitioners Act" .　A Key distinction of the revised draft is new learning outcomes featuring core values shared by physicians: commitment to physicians' societal mission of public health, altruistic behavior, respect for humanity, and maintaining one's own integrity. Another key distinction is securement of longitudinal consistency in the set of required faculties, from medical school curriculum to continuing professional development programs. Further improvements in systems and environments to enhance devotion to life-long learning are needed.

Survey on status and demands of advanced clinical training among community general practitioners in two districts of Shanghai / 中华全科医师杂志

Objective To survey the status and related demands of advanced clinical training among community general practitioners (GPs) in Shanghai.Methods A survey on the status and demands of advanced clinical training was conducted with a self-designed questionnaire among GPs in Minhang District and Jiading District of Shanghai from January to May 2016.The questionnaire included basic information , experience of advanced clinical training , satisfaction with training and training demands .Results Total 526 questionnaire were distributed and 478 valid questionnaires were returned with a response rate of 90.9%. Among the participants 202 (42.3%) had experience of advanced clinical study ; the training units were mainly secondary hospitals in Shanghai (69.3%, 140/202); 67.2%(131/195) participants considered that the previous training did not fully meet the needs of the community .There was significant difference in the training demands among participants with different ages , professional titles, and working years ( χ2＝12.754, 7.912, 4.501, all P＜0.01); those with younger age, higher education and shorter working years had higher training demands .Survey showed that 57.3%( 274/478 ) of participants demanded further studies in the future; 58.3%( 239/410) of them chose tertiary hospitals in Shanghai as training unit , 79.0%(321/406) chose internal medicine and geriatrics as training specialties , particularly in outpatient clinic (73.2%, 298/407); the length of study should be 3 months (32.8%, 132/402) or 6 months (27.6%, 111/402), and completed in segments (61.5%, 253/411).The purpose of training was mainly to upgrade clinical competence (94.2%, 258/272); busy working schedule (53.4%, 66/116) was the main reason for not intending the advanced clinical studies .Conclusions The community general practitioners in Shanghai have high demands for advanced clinical training .The training should meet the needs of clinical practice in community and the mode of study should be more flexible .

History of Medical education in Japan / 医学教育

At the time of 1945, the number of entrance to medical school in our country exceeded 10,000 people. After the end of the war, Colonel Sams reformed the doctor training course, consolidation of medical schools, national examination, internship system was introduced. After the internship system changed to postgraduate clinical training in 1968 and clinical training based on law in 2004. Before introducing the clinical training based on law, the doctor nurturing pathway was deeply involved by "Ikyoku-Kouza" system in faculty and attached hospital. Medical education standard was established at 1948 and became a nationwide unified curriculum, but the freedom of the curriculum has increased with the advent of Tsukuba University School of Medicine at 1973. Based on these histories, it is necessary to think about the ideal way of making a physician pathway and the future way of the medical education curriculum development.

Analysis of Japanese Postgraduate Clinical Training System from the Perspective of Quality of Education / 医学教育

"Quality of education" has various definitions, and the definitions are classified mainly into five categories. Introducing the definition categories of "quality of education" , we analyze what aspects of the postgraduate clinical training system for physicians as an educational program have been reconsidered and redesigned. According to the analysis, we propose to introduce a programmatic assessment, which compose of several assessment methods, for evaluation at each stage of medical education from undergraduate to continuous professional development. Realizing such evaluation, we also propose to introduce a student/trainee assessment from a patient's perspective.