Effects of a 60-Minute Lecture About Diagnostic Errors for Medical Students: A Single-Center Interventional Study.

INTRODUCTION: The danger of diagnostic errors exists in daily medical practice, and doctors are required to avoid such errors as much as possible. Although various factors, including cognitive, system-related, and patient-related factors, are involved in the occurrence of diagnostic errors, the percentage of doctors with insufficient medical knowledge among those factors is extremely low. Therefore, lectures on diagnostic errors might also be useful for medical students without experience working as doctors. This study investigated whether a 60-minute lecture on diagnostic errors would enable Japanese medical students to consider the factors involved in diagnostic errors and how their perceptions of diagnostic errors change. METHODS AND MATERIALS: This single-center interventional study was conducted in October 2022 among fourth-year medical students at the Faculty of Medicine, Saga University. A questionnaire survey was conducted before and immediately after the lecture to investigate changes in the perceptions of medical students regarding diagnostic errors. One mock case question was given on an exam the day after the lecture, and the number of responses to cognitive biases and system-related and patient-related factors involved in diagnostic errors were calculated. RESULTS: A total of 83 students were analyzed. After the lecture, medical students were significantly more aware of the existence of the concept of diagnostic error, the importance of learning about it, their willingness to continue learning about it, and their perception that learning about diagnostic errors improves their clinical skills. They were also significantly less likely to feel blame or shame over diagnostic errors. The mean numbers of responses per student for cognitive bias, system-related factors, and patient-related factors were 1.9, 3.4, and 0.9, respectively. The mean number of responses per student for all factors was 5.6. CONCLUSION: A 60-minute lecture on diagnostic errors among medical students is beneficial because it significantly changes their perception of diagnostic errors. The results of the present study also suggest that lectures may enable Japanese medical students to consider the factors involved in diagnostic errors.

Digital Transformation Will Change Medical Education and Rehabilitation in Spine Surgery.

The concept of minimally invasive spine therapy (MIST) has been proposed as a treatment strategy to reduce the need for overall patient care, including not only minimally invasive spine surgery (MISS) but also conservative treatment and rehabilitation. To maximize the effectiveness of patient care in spine surgery, the educational needs of medical students, residents, and patient rehabilitation can be enhanced by digital transformation (DX), including virtual reality (VR), augmented reality (AR), mixed reality (MR), and extended reality (XR), three-dimensional (3D) medical images and holograms; wearable sensors, high-performance video cameras, fifth-generation wireless system (5G) and wireless fidelity (Wi-Fi), artificial intelligence, and head-mounted displays (HMDs). Furthermore, to comply with the guidelines for social distancing due to the unexpected COVID-19 pandemic, the use of DX to maintain healthcare and education is becoming more innovative than ever before. In medical education, with the evolution of science and technology, it has become mandatory to provide a highly interactive educational environment and experience using DX technology for residents and medical students, known as digital natives. This study describes an approach to pre- and intraoperative medical education and postoperative rehabilitation using DX in the field of spine surgery that was implemented during the COVID-19 pandemic and will be utilized thereafter.

Improvement in medical students' communication and interpersonal skills as evaluated by patient satisfaction questionnaire after curriculum reform.

Fifteen years of undergraduate medical education curriculum reform at Saga Medical School was evaluated by measuring medical students' communication and interpersonal skills with a patient satisfaction questionnaire developed by the American Board of Internal Medicine. A multiphase cross-sectional study was conducted at the General Medicine Clinic of Saga Medical School Hospital in phase I (1998-1999), phase II (2001-2002), and phase III (2009-2010). A total of 1,963 patient ratings for 437 medical students' performance was analyzed. The average scores of phases II and III were significantly higher than for phase I. The average score of female students showed a significant difference between phases I and II, but no difference between phases II and III. The average score of male students showed no difference between phases I and II, but significant difference between phases II and III. The phase II curriculum introduced basic clinical skills and examination and improved female students' performance. The phase III curriculum was effective for male students because it emphasized the clinical skill program more and introduced problem-based learning. Curriculum reform at Saga Medical School is considered to have made good progress in improving students' clinical competence and patient-centered attitudes.

Effectiveness of student tutors in problem-based learning of undergraduate medical education.

Problem-based learning (PBL) is a teaching and learning method designed to develop clinical reasoning skills. Tutor performance in PBL affects both the process and outcome of student learning. In this study, we investigated the factors that influence the evaluation by undergraduate students on the performance of tutors in medical education. From April 2009 to February 2010, 49 PBL sessions were conducted for 191 3rd- and 4th-year medical students at Saga Medical School in Japan. Twenty-nine 6th-year students and 205 faculty members tutored these sessions. After each session, students evaluated their tutor by a Likert scale. This evaluation score was dichotomized and used as the dependent variable. A multivariate logistic regression analysis was used to assess the contribution of student's gender and year level (3rd or 4th), the tutor's gender and background, and the quality of the case scenario to evaluation ratings. A total of 4,469 responses were analyzed. Male student and tutor background were associated with excellent tutor evaluation. Concerning the tutor background, compared with basic scientists, the 6th-year students and content-expert clinicians were positively associated with excellent tutor evaluations (ORs of 1.77 [95% CI: 1.15-2.72] and 1.47 [95% CI: 1.11-1.97]), while non-content-expert clinicians received negative evaluations (OR of 0.72 [95% CI: 0.55-0.95]). The quality of the case scenario was also associated with excellent tutor evaluation (odds ratio [OR] of 12.43 [95% CI: 10.28-15.03]). In conclusion, excellence of case scenarios, 6th-year student tutors, and content-expert clinicians show positive impact on tutor evaluation in a PBL curriculum.

Feeding with olive oil attenuates inflammation in dextran sulfate sodium-induced colitis in rat.

Chronic inflammation of long-term ulcerative colitis contributes to an increased risk of colon cancer. Few studies address whether extra-virgin olive oil (EVOO) intake suppresses inflammation, cell proliferation and signal transducers and activators of transcription (STAT) in the experimental colitis model. The aim of this study was to assess whether a 5% EVOO suppressed inflammation, increased cell proliferation and the expressions of STAT3 and STAT3 phosphorylation (pSTAT3) in dextran sulfate sodium (DSS)-induced colitis. Rats were administered DSS via drinking water (weight percentage: 4%) for 1 week with a 1-week recovery period for three cycles. Rats were divided into three groups: control group, standard diet without DSS; DSS group, standard diet+DSS; and DSS+EVOO group, EVOO diet (weight percentage: 5%)+DSS. Rats were sacrificed 5 weeks after DSS was first administered, and colonic damage was histologically and biochemically evaluated. As a result, chronic feeding of 5% EVOO attenuated inflammation. This was evaluated using a disease activity index, body weight loss and a histological score. Enhanced expressions of STAT3, pSTAT3, COX-2 and iNOS by DSS was attenuated by EVOO. In addition, EVOO attenuated increases in cell proliferation (PCNA) caused by DSS and recovered decreases in apoptosis (cleaved caspase-3). In conclusion, the study indicated that chronic feeding of 5% EVOO inhibited chronic inflammation in DSS-induced colitis in rats and also attenuated cell proliferation and recovered apoptosis in DSS colitis.

The characteristics of a good clinical teacher as perceived by resident physicians in Japan: a qualitative study.

BACKGROUND: It is not known whether the characteristics of a good clinical teacher as perceived by resident physicians are the same in Western countries as in non-Western countries including Japan. The objective of this study was to identify the characteristics of a good clinical teacher as perceived by resident physicians in Japan, a non-Western country, and to compare the results with those obtained in Western countries. METHODS: Data for this qualitative research were collected using semi-structured focus group interviews. Focus group transcripts were independently analyzed and coded by three authors. Residents were recruited by maximum variation sampling until thematic saturation was achieved. RESULTS: Twenty-three residents participated in five focus group interviews regarding the perceived characteristics of a good clinical teacher in Japan. The 197 descriptions of characteristics that were identified were grouped into 30 themes. The most commonly identified theme was "provided sufficient support", followed by "presented residents with chances to think", "provided feedback", and "provided specific indications of areas needing improvement". Using Sutkin's main categories (teacher, physician, and human characteristics), 24 of the 30 themes were categorized as teacher characteristics, 6 as physician characteristics, and none as human characteristics. CONCLUSIONS: "Medical knowledge" of teachers was not identified as a concern of residents, and "clinical competence of teachers" was not emphasized, whereas these were the two most commonly recorded themes in Sutkin's study. Our results suggest that Japanese and Western resident physicians place emphasis on different characteristics of their teachers. We speculate that such perceptions are influenced by educational systems, educational settings, and culture. Globalization of medical education is important, but it is also important to consider differences in educational systems, local settings, and culture when evaluating clinical teachers.

Risk factors for resistance to proton pump inhibitor maintenance therapy for reflux esophagitis in Japanese women over 60 years.

AIM: The aim of this study was to evaluate risk factors for proton pump inhibitor (PPI) resistance in older Japanese female patients with reflux esophagitis evaluated by physicians. METHODS: The study included 462 Japanese female patients aged over 60 years with reflux esophagitis who received PPI maintenance therapy for more than 6 months. RESULTS: The characteristics of all 462 patients were: age: 76.4 ± 7.6 years, height: 147.2 ± 6.1 cm, weight: 49.9 ± 8.4 kg and body mass index: 24.0 ± 3.5. The reflux esophagitis grades were A in 69.5%, B in 15.8%, C in 9.1% and D in 5.6%. Helicobacter pylori was positive in 60.6%. Regarding PPI maintenance therapy for clinical symptoms evaluated by the attending physicians, 66.7% were 'good control', 26.8% were 'reasonable control' and 6.5% were 'bad control: resistant'. PPI maintenance therapy was less effective in patients with more severe reflux esophagitis of grades C and D (OR: 0.027; 95% CI: 0.010-0.077) and negative H. pylori infection status (OR: 4.470; 95% CI: 1.631-12.247). Lumbar kyphosis and hiatus hernia were risk factors for severity grading of reflux esophagitis. CONCLUSIONS: PPI maintenance therapy evaluated by attending physicians indicated that reflux esophagitis severity and negative H. pylori status were risk factors for treatment resistance.

Endoscopic reflux esophagitis and Helicobacter pylori infection in young healthy Japanese volunteers.

BACKGROUND/AIMS: The prevalence of endoscopic esophagitis in young Japanese individuals is not fully apparent. The aim of this study was to determine the prevalence of reflux esophagitis (RE) and Helicobacter pylori infection and their relationship in young healthy Japanese volunteers. METHODS: Upper gastrointestinal endoscopy was performed in 242 young healthy Japanese medical students (age range 22-29 years, mean 23.2 years) at Saga Medical School between 2008 and 2010. H. pylori infection was determined by detecting urinary IgG antibodies to H. pylori. RESULTS: H. pylori antibodies were detected in 30 of the 242 subjects (12.4%). All 30 subjects had endoscopic chronic gastritis without peptic ulcers. Endoscopic RE was present in 27 of the 242 subjects (11.2%), corresponding to grade A in 19 subjects (7.9%), grade B in 7 (2.9%) and grade C in 1 (0.4%). Only 1 subject with RE was H. pylori-positive; the other 26 subjects with esophagitis were H. pylori-negative. We found no risk factors for H. pylori infection, but a risk factor for endoscopic esophagitis was alcohol consumption. CONCLUSION: The prevalence of H. pylori infection and endoscopic RE was 12.4 and 11.2%, respectively, in young healthy Japanese volunteers. Alcohol consumption was a risk factor for RE.

Patient satisfaction questionnaire for medical students' performance in a hospital outpatient clinic: a cross-sectional study.

Medical education in Japan has undergone significant reforms. Patient perspective and outcome have been highly valued in curricular reforms. Therefore, we evaluated an undergraduate curriculum particularly on communication skills by comparing outpatient satisfaction before and after the reforms implemented at Saga Medical School. Cross-sectional study was conducted at the General Medicine Clinic of Saga University Hospital in 1999 and 2009. A total of 729 newcomer patients evaluated 159 students; namely, 287 patients evaluated sixth-year medical students (n = 82) in 1999, and in 2009, 442 patients evaluated fifth-year medical students (n = 77). Students interviewed newcomer patients prior to a faculty's clinical examination. After a student-patient encounter, the patient was asked to fill in six-item Patient Satisfaction Questionnaire (PSQ) developed by the American Board of Internal Medicine. Mixed model two-way analysis of variance (ANOVA) with covariant of students' gender was conducted. Effect sizes were calculated to evaluate the amplitude of influence. The average score in 2009 was significantly higher than that in 1999 (3.63 ± 0.62 versus 3.36 ± 0.66; p < 0.001). Since the "encouraging and answering questions" and "clear explanations" were lower than those of the other items (3.24 ± 0.98 and 3.46 ± 0.85), these two items showed the most significant improvements (Phi coefficient = 0.31 and 0.24, p < 0.001). Thus, students' performance has improved since 1999, which may represent the success of curricular reforms at Saga Medical School. We propose that "encouraging and answering questions" and "clear explanations" should be emphasized in interview training.

The pathological role of visceral fat accumulation in steatosis, inflammation, and progression of nonalcoholic fatty liver disease.

BACKGROUND: Our previous studies have indicated a close association between visceral fat accumulation and hepatic steatosis in nonalcoholic fatty liver disease (NAFLD). This study investigated whether visceral fat accumulation was related to the pathogenesis and disease progression of nonalcoholic steatohepatitis (NASH)/NAFLD. METHODS: First, a total of 550 subjects who underwent a health checkup and measurement of visceral fat accumulation, done with a bioelectrical impedance analyzer (X-SCAN; Owa Medical, Fukuoka, Japan), were included. The relationship between visceral fat accumulation and biochemical parameters was examined. Second, a total of 74 patients with NASH/NAFLD who underwent liver biopsy were reviewed. Visceral fat accumulation was determined by abdominal computed tomography. The association between visceral fat accumulation and the histopathological grade/stage determined by the NAFLD activity score and Brunt's classification was evaluated. RESULTS: There was a significant relationship between visceral fat accumulation and glucose, triglyceride, and alanine aminotransferase (ALT; r = 0.423, P < 0.01). In stepwise regression analysis, visceral fat area (VFA), serum triglyceride level, and serum low-density lipoprotein (LDL)-cholesterol level were selected as predictor variables for serum ALT level, in a continuous manner (serum ALT level = -1.359 + 0.143 × VFA + 0.046 × triglyceride + 0.059 × LDL, R(2) = 0.217, P < 0.001). In patients with NASH, there was no correlation between histological grade and the visceral fat volume. Visceral fat accumulation in patients with stage 3/4 advanced NASH was greater than that in patients with stage 1/2 early NASH (P < 0.05). CONCLUSIONS: These results suggest that visceral fat accumulation plays a role in steatosis and fibrosis in the pathogenesis and prognosis of NAFLD.

A pilot trial of body weight reduction for nonalcoholic fatty liver disease with a home-based lifestyle modification intervention delivered in collaboration with interdisciplinary medical staff.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of the metabolic syndrome. The aim of this study was to evaluate a 6-month home-based lifestyle modification intervention delivered in collaboration with physicians, hygienists, registered dietitians, and nurses. METHODS: Outpatients with NAFLD diagnosed by abdominal ultrasonography were eligible for this study. Abdominal computed tomography (CT) scan evaluated liver fat deposition by the liver-spleen ratio (L/S ratio) and visceral fat accumulation as the visceral fat area (VFA; cm(2)). During the 6-month home-based lifestyle modification intervention, each patient was examined by physicians, nurses, hygienists, and registered dietitians, who provided individualized advice to the patients. Patients recorded their daily weight for self-control of weight with recommended diet and exercise regimens. RESULTS: Sixty-seven NAFLD patients were enrolled in this study and 22 patients (32.8%) completed the 6-month intervention. Nineteen of the 22 patients achieved significant improvements in body weight, body mass index (BMI), waist circumference, VFA, L/S ratio, and systolic blood pressure, with improved laboratory data. Overall, 39 patients withdrew from the intervention. The mean age of the patients who withdrew was 50.0 +/- 11.0 years, which was significantly younger than that of the patients who were followed up (60.1 +/- 10.1 years; P < 0.01). CONCLUSIONS: The reduction in body weight achieved by NAFLD patients during the 6-month intervention was associated with improved fat deposition and liver function. This intervention offers a practical approach for treating a large number of NAFLD patients with lifestyle modification therapy.

Status of medical education reform at Saga Medical School 5 years after introducing PBL.

In Japan, problem-based learning (PBL) is a relatively new method of educating medical students that is reforming the face of medical education throughout the world, including Asia. It shifts from teacher-centered learning strategies (for example, lectures in large auditoriums) to student-centered, self-directed learning methods (for example, active discussions and problem-solving by students in small groups under the guidance of faculty tutors). Upon a recommendation by the Japan Model Core Curriculum, Saga Medical School introduced a PBL curriculum 5 years ago. A full PBL curriculum was adopted from the McMaster model through Hawaii. A description of how PBL was implemented into the 3rd and 4th year (Phase III curriculum) is given. The overall result has been good. Students who experienced PBL had increased scores on the National Medical License Exam, and Saga increased its ranking from 56th to 19th of the 80 medical schools in Japan. A key step was introduction of the educational scaffolding in PBL Step 0. Students were allowed to see page one of the PBL case, containing the chief complaint, on the weekend before meeting in small groups. Despite a perceived overall benefit to student learning, symptoms of superficial discussions by students have been observed recently. How this may be caused by poor case design is discussed. Other problems, including "silent tutors" and increased faculty workload, are discussed. It is concluded that after 5 years, Saga's implementation of a PBL curriculum has been successful. However, many additional issues, including motivation of students and preparation for PBL in the first 2 years, must still be resolved in the future. This is the first description of the positive and negative outcomes associated with the reform of medical education and the introduction of PBL to a traditional medical school curriculum in Japan.