Oriental Medicine in 21 / 日本東洋医学雑誌

Advantage of oriental medicine of Japan has been stressed in this paper. This advantage should be utilized for globalization of the oriental medicine of Japan.

Statistical Analysis with the Item-Response Theory of the First Trial of the Computer-Based Nationwide Common Achievement Test in Medicine / 医学教育

Data from the first trial of the computer-based nationwide common achievement test in medicine, carried out from February through July in 2002, were analyzed to evaluate the applicability of the item-response theory. The trial test was designed to cover 6 areas of the core curriculum and included a total of 2791 items. For each area, 3 to 40 items were chosen randomly and administered to 5693 students in the fourth to sixth years; the responses of 5676 of these students were analyzed with specifically designed computer systems. Each student was presented with 100 items. The itemresponse patterns were analyzed with a 3-parameter logistic model (item discrimination, item difficulty, and guessing parameter). The main findings were: 1) Item difficulty and the percentage of correct answers were strongly correlated (r=-0.969to-0.982). 2) Item discrimination and the point-biserial correlation were moderately strongly correlated (r=0.304 to 0.511). 3) The estimated abilities and the percentage of correct answers were strongly correlated (r=0.810 to 0.945). 4) The mean ability increased with school year. 5) The correlation coefficients among the 6 curriculum area ability scores were less than 0.6. Because the nationwide common achievement test was designed to randomly present items to each student, the item-response theory can be used to adjust the differences among test sets. The first trial test was designed without considering the item-response theory, but the second trial test was administered with a design better suited for comparison. Results of an analysis of the second trial will be reported soon.

Effect of Workshops for Preparing Multiple-Choice Questions for Computer-Based Testing Used in the Nationwide Common Examination Before Clinical Clerkships / 医学教育

Computer-based testing (CBT) has been used in Japan since 2002 to assess medical students' basic and clinical medical knowledge, based on the model core-curriculum, before they start clinical clerkships. For effective CBT, multiplechoice questions must accurately assess the knowledge of students. Questions for CBT are submitted by all medical schools in Japan. However, only 40% of questions are chosen for CBT and used at random; the other 60% of questions are rejected because of poor quality. Toimprove the ability of medical staff to devise questions, workshops were held at 30 medical schools. The acceptance rate of questions from schools where workshops were held was significantly increased. The workshops were extremely effbctive for improving the quality of questions.

Report of the First Trial of Nationwide Common Achievement Test-Computer-Based Testing in Medicine / 医学教育

The first trial of common achievement test-computer-based testing was held from January through August 2002. The number of examinees was 5, 693, of whom 5, 676 were analyzed. Single-best-answer, five-choice questions were used. The highest score was 92 points, the lowest score was 19 points, and the average score was 55.9±10.2 points (standard deviation). Scores were distributed normally. The test sets did not differ significantly in difficulty, although test-set items differed for each student. The percentage of correct answers, the ∅-coefficient, and the point-biserial correlation coefficient were calculated for each category of the model core curriculum. The percentage of correct answers was highest in category A of the model core curriculum, and percentages of correct answers were similar in categories B, C, D, E, and F. The ∅-coefficient and the correlation coefficient were low in categories A and F and were highest in category C. Although the percentage of correct answers in this trial was lower than expected, many test items had discriminatory power. The Test Items Evaluation Subcommittee is now evaluating test items, determining pool items, and revising new test items for the second trial and expect to compile a useful item bank.

Problems in Preparing Multiple Choice Questions for Computer-based Testing Used in the Nationwide Common Examination before Clinical Clerkships / 医学教育

In 2002, Japanese medical students began computer-based testing (CBT) to assess their basic and clinical medical knowledge, based on the model core-curriculum, before starting clinical clerkships. Of 9, 919 multiple choice questions submitted by 80 medical schools, 2, 791 were used for CBT and 7, 128 were rejected. To improve the quality of future CBT, we analyzed why questions were rejected. The most commons reasons were difficulty, length, and inappropriate choice of answers. A training course may be needed to improve the ability of medical school staff to devise questions.

Medical education system. Report of the Working Group on the Medical Education System / 医学教育

The working group on the medical education system in the Japan Society for Medical Education had 2 meetings in 1997. In those meetings, members of the working group discussed on the following 4 problems related to the medical education;<BR>1) System to accept the graduates of other departments (Gakushi) into medical school<BR>2) Clinical professorship<BR>3) Post-graduate universities<BR>4) Education in the department of general medicine (Sogo-shinryo-bu)<BR>The results of the discussions are reported.

A Report of a Questionnaire Concerning the Present Programs of the Postgraduate Clinical Course in Japan / 医学教育

The aim of this study is to report and analyze the results of a questionnaire concerning the present programs for the junior residents in the postgraduate clinical course in Japan.<BR>A questionnaire was sent to the administrators or the persons in charge of the programs of 347 institutions including 80 university hospitals and 267 clinical training hospitalsas designated by the Ministry of Health and Welfare.<BR>Answers to a questionnaire were returned by 271 institutions (78.1%). The results were analyzed and summarized as follows.<BR>(1) About 95% of both university and clinical training hospitals have their own programs at present.<BR>(2) In the substantial formula of programs, university hospitals have had straight or rotation form while the clinical hospitals have selected rotation or super rotate (comprehensive) form.<BR>(3) The programs of university hospitals have started in majority before 1992 while those of clinical hospitals have began after 1993.<BR>(4) The programs of university hospitals have contained the clinical training at the other departments or institutions in a significantly higher ratio compared to those of clinical hospitals.<BR>(5) The check system for the evaluation of the programs has well functioned in half of both hospitals.<BR>(6) For the assessment of the programs used, about half of the staffs of both university and clinical hospitals feel unsatisfactorily in their active programs.<BR>(7) Concerning the intention to renewal or modification of their programs used, there were rather passive agreements in both university and clinical hospitals.

Report from Working Group on Postgraduate Medical School and Speciality Training. With a Special Emphasis on Clinical Course in Postgraduate Medical School / 医学教育

Discussions on the postgraduate medical school and the speciality training course after graduation had been conducted 2 times in 1994 among the members of the working group on postgraduate medical school and speciality training in Japanese Society for Medical Education. Results of the discussion are reported in this paper as a proposal for the improvement of the present state of education and training in the postgraduate medical schools in our country. In this report, several important proposals which need further discussions such as the shortening the clinical course in postgraduate medical school to 3 years from present 4 years and necessity of establishing the obligatory course for training the basic technology for life science research are presented. It is mandatory to have full time teaching staff as well as exclusive space for postgraduate course in each school to improve the of education of postgraduate medical schools.

A Committee Report on Compulsory Postgraduate Clinical Training / 医学教育

The aim of this study is to report the results of the workshop which was designed to define several indispensable conditions for the implementation of the compulsory clinical training. These conditions discussed include the guarantee of position and improvement of labor conditions for trainees, standard for the authorization of institutions receiving trainees, training curricula and teaching staff of institutions, and the certificate of qualification for the trainees after the compulsory training. The products of the workshop showed plans and guidelines to these conditions as seen in this paper.

Initial Two-Year Clinical Training Program in Postgraduate Medical Education / 医学教育

In 1991, the committee on postgraduate clinical training proposed revised behavioral objectives for basic clinical training in the initial two years. We present here a model for a clinical training program that should enable most residents to attain these objectives within two years.<BR>The program begins with orientation for 1-2 weeks, including a workshop on team care, and nursing practice.<BR>Basic clinical skills for primary care and emergency managements should be learned by experience during rotations through various clinical specialities. All staff members, even senior residents, should participate in teaching beginning residents in hospitals.

A Multicenter Study on the Effects of Subcutaneous Recombinant Human Erythropoietin to Improve Anemia after Autologous Blood Donation in Cardiac Surgery / 日本心臓血管外科学会雑誌

This multicenter study was designed to clarify the positive effects of recombinant human erythropoietin (EPO; epoetin alfa) by subcutaneous administration on anemia after autologous blood donation in cardiac surgery. A total of 55 patients undergoing elective heart surgery were enrolled in this study and subcutaneously given EPO at a dose of 200IU/kg (200IU group, <i>n</i>=23), 400IU/kg (400IU group, <i>n</i>=16) or 600IU/kg (600IU group, <i>n</i>=16) once a week for 3 weeks prior to surgery. Autologous blood (400g) was drawn twice from each patient, at 14 days and 7 days before surgery. Oral iron was given daily throughout this study. The mean reticulocyte counts increased significantly 2 weeks after the first administration of EPO in the 200IU group or 1 week after the first administration in the 400IU and 600IU groups. There was an increase in mean hemoglobin (Hb) levels 1 week after the initiation of EPO by 1.7, 2.8 and 2.1% in the 200IU, 400IU and 600IU groups, respectively. After the first drawing of autologous blood, the Hb levels decreased gradually in all groups despite the second administration of EPO. The change in Hb level immediately before surgery however, was a 4.2% decrease (<i>p</i><0.05) in the 200IU group and 0.8% decrease (N. S.) in the 400IU group and 0.7% increase (N. S.) in the 600IU group in comparison with the initial Hb level. In conclusion, subcutaneous administration of EPO was effective in improving anemia after autologous blood donation in cardiac surgery.

An ex post facto evaluation of the 82nd and 83rd national examination for Physicians' license / 医学教育

The 82 nd and 83 rd National Examination for Physicians' License, which were held in 1988 and 1989 respectively, were evaluated from question to question as well as in all the questions as a whole to set minimum pass scores and analysis “relevance” and “difficulty” in a matrix utilizing a modified Ebel's method.<BR>The evaluators were teachers in different disciplines in nationwide medical schools and teaching hospitals and clinical trainees who had taken and passed the immediate past examinations.<BR>Following data processing, the questionable and difficult questions were on the decrease compared with the preceding year, and it was tentatively concluded that the National Examinations have gradually improved year by year.

A plan of the curriculum of chemistry for medical students / 医学教育

Based on two years working of “the enlarged working group for the curriculum of chemistry for medical education”, a provisional plan of the curriculum of chemistry for medical students is proposed. The article is consist of four sections; namely A: general problems, B: “chemistry” as a general education, C: purpose and specific problems of the general education for medical students, D: a provisional plan of the curriculum of chemistry for medical students.<BR>The main part D is consist of three subsections: namely (1) a plan of the curriculum of physical and inorganic chemistry, (2) a plan of the curriculum of organic chemistry, (3) a plan of the curriculum of experiments.

Objectives of post-graduate clinical training / 医学教育

Japanese medical graduates are recommended to receive clinical training for more than two years after graduation, because undergraduate clinical training is insuffiicient.<BR>In 1976 the committee of postgraduate clinical training proposed the objectives of basic clinical training after graduation of medical schoool and in 1981 the committee proposed the objectives for the first postgraduate year of training and the methods of clinical skill assessment.<BR>We here present the revised objectives of basic clinical training after graduation of medical school.<BR>It is emphasized that clinical trainees should have basic clinical skills of primary and emergency care during the two year training.<BR>These clinical skills include interviewing techniques, skills in physical examination and interpretation of physical findings, laboratory skills, skills relating to diagnosis and managements, communication skills to other doctors and to other medical co-workers and terminal care.