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.

Recent Trends of Medical Education Reforms in United Kingdom: / 医学教育

Background: Globalization urges us to discuss rationale and policy towards establishing a medical education accrediting body in Japan. Experience of General Medical Council （GMC） suggests us some useful lessons.<br>Method: Based on our visits and investigation into in GMC, we inquire how Quality Assurance （QA） was introduced in UK with what incentives and how QA has brought reforms in the medical schools in UK.<br>Result: Since 2003, GMC has changed its policy for QA from ‘inspection’ to ‘dialogue’. Dialogical QA asks a medical school to think critically of their education and consider vigorous actions for further improvements.<br>Discussion: Implications from the experience of GMC are: 1.QA process in GMC makes medical schools take robust steps towards changes, 2. Sharing the rational and policy for QA created the solid base for its effective implementation, 3. There are possible difficulties in establishing structure to do an enormous amount of coordinating work, which is necessary for constructing ‘dialogue with medical schools’.

Feedback for inappropriate behavior of medical students in early clinical exposure / 医学教育

<br>Background: Some early clinical exposure programs in the community have been implemented in our medical school from years 1 to 3: community service for the handicapped in year 1, care for severely handicapped children in year 2, and health care at home with district nurses in year 3. The directors of these programs informed us, in feedback reports, of the inappropriate behavior of medical students. We then provided feedback directly to the students. We investigated the changes in student behavior after feedback during the 3 years they participated in these programs.<br>Methods: We analyzed the feedback reports from these 3 early clinical exposure programs from 2009 to 2011. Inappropriate behavior of medical students and changes in behavior were recorded.<br>Results: Inappropriate behaviors reported were: 1） lack of essential learning behavior, 2） lack of positive attitude and acceptance of learning in the programs, and 3） lack of communication skills. The numbers of students who received feedback about inappropriate behaviors were 26 in year 1, 11 in year 2, and 2 in year 3. Feedback to students from early clinical exposure programs may lead to changes in their behavior.

What do medical students learn from home care practice? / 医学教育

Objectives: This study aimed to investigate what third–year students of the J University School of Medicine had learned in home care practice.<br>Methods: We analyzed the students’ reports and focused on the description of the learning for the practice. We extracted the category of learning using qualitative content analysis.<br>Results and Conclusion: The core categories we extracted from the analyses were: 1） characteristics of home healthcare, 2） patients, 3） families, 4） home–visiting nurses, 5） medical treatment teams, 6） frank remarks of medical students and physicians, and 7） necessities as a physician. The frank remarks of medical students and physicians included the distrust of physicians and the hopes of medical students. The students gained valuable experience from this practice. In particular, learning about the distrust of physicians and the hopes of medical students may be difficult without such practice.

Historical development of the systems of medical education and medical licensure and its effect on the evolution of medical schools in Japan / 医学教育

1) The historical development to date of the systems of medical education and medical licensure were reviewed, and the quantitative and qualitative evolution of medical schools was divided into 7 stages.2) In the early Meiji era, persons who had already practiced medicine could apply to receive a medical license. Until the Taisho era, medical licenses were granted either to graduates of medical universities and relevant special schools or to those who passed the national examination. Thus, the criteria for medical license were not uniform during this period.3) Before the end of World War II, medical schools aimed to improve the quality of medical education so that their graduates could receive medical licenses without taking the national examination and to raise their status to the level of universities. However, because the types of medical schools during this period varied and included imperial universities, colleges, and specialty schools, the quality of medical education also varied.4) After World War II, the introduction of the state examination for the license to practice medicine and a new university system standardized medical education to guarantee its quality.5) The quantitative expansion of the medical education occurred mainly in the 12 years after 1919, in the 7 years after 1939 and during the war, and in the 10 years after 1970, and, except for the years of violent change before 1887, the number of medical schools has otherwise remained stable.

Trends of graduate-entry programmes in the United Kingdom / 医学教育

1) We reported recent movement to graduate entry program (GEP) of medical education curriculum in the UK by both interviewing faculty members who are in charge of GEP and doing literature review.<BR>2) In GEP, we may be able to make better doctors in short term.However, as long term outcome is not known so far, further discussion is necessary.<BR>3) Many contents can be improved by just curriculum change, not by introducing GEP.Besides it can be said that GEP can make diverse doctors.

Medical education and graduate-entry program in Australia / 医学教育

1) We visited four universities in Australia where both graduate-entry and undergraduate-entry programs are adopted.<BR>2) Although there is not clear difference in the outcome between the two programs, preference for graduate-entry program was recognized.

Comparative Analysis of Faculty Development in Japanese Medical Schools from 2003 through 2005 / 医学教育

1) The faculty development at each medical school from 2003 through 2005 was analysed.<BR>2) The major themes in faculty development were problem based learning, tutorial, computer based testing, and clinical training.<BR>3) Faculty development is considered an effective way to enhance the contributions of faculty members to medical education.

Current Situation of Medical Student Abuse / 医学教育

1) To our knowledge, medical student abuse has not previously been studied in Japan.<BR>2) In our survey, 68.5% of respondents experienced medical student abuse.<BR>3) Several students reported that they had been frequently neglected or ignored by teaching physicians during clinical clerkships and that such attitudes discouraged them and decreased their motivation.<BR>4) To improve the learning environment, medical educators must take action to resolve this serious issue.

Analysis of the Questionarre for Nationwide Common Achievement Test System for Entering Clinical Clerkship in Japan / 医学教育

Nationwide common achievement test system for entering clinical clerkship will formally start from December 2005. Before the start, four times trial examination were carried out. Based on these trials, some problems for the test sytem were pointed out. We have analysed the problems proposed to induce more suitable examination system.

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.

Evaluation of Surgical Clerkships by Graduates / 医学教育

We performed a questionnaire survey of 199 graduates regarding surgical clerkships to help select future clinical trainingmethods for fifth-year medical students. Many of the graduates understood the significance of clerkships, and 70%were able to benefit from their participation in clinical training. They approved of clerkships, but 22% had critical opinions.Clinical instructors were asked to teach with greater enthusiasm, to be easier to talk with, and to have a deeperknowledge of diseases. Graduates who attended very few lectures in the fourth year were less likely to expect clinical instructorsto teach well. Most graduates believed that clinical instructors should have at least 5 years' clinical experience.These results suggest that all faculties should continue to place a greater emphasis on education and that faculty developmentshould be expanded.

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.

Elective Overseas Clinical Clerkships and Related Problems / 医学教育

At this university, an overseas component has been included in the elective clinical clerkship program for sixth-year students since 1998. Since that time, 28 students have done short-term clinical clerkships in various foreign countries. This report presents results of a questionnaire survey of students who have done overseas clerkships. The questionnaire comprised 8 items, including the reason for selecting the clerkship location and the contents of the training program. Questionnaires were returned by 68% of students. Most of the 28 students did clerkships in English-speaking countries. The average duration of study was 2.3 months (range, 1 to 3 months). All students were satisfied with their training experience; however, many felt their language skills were insufficient for participating in overseas training programs. In addition, more comprehensive arrangements, including establishing close contact with the receiving institutions and insurance provisions, are needed to maintain and further develop overseas clinical clerkships.

Desirable Educational Environment for the Better Clinical Clerkship / 医学教育

In order to implement, or enhance the quality of clinical clerkship, it is necessary to develop good educational environment which will be appropriate to allow medical students participate in medical team services. Important things to be considered will be, (1) Systematic management of the individual department's program by the faculty of medicine, (2) Developing educational competency within the medical care team function, and (3) Nurturing students' awareness forself-diected learning and cooperative team work, and teaching- and medical staffs' awareness of their educational responsibilities. In this paper, to develop better educational environment for clinical clerkship, we propose a desirable situation of the educational organization, dividedly describing on the roles of dean, faculties, board of education, department of medical education, clerkship director, teaching physicians, residents and medical students.

Evaluation of the Model Core Curriculum for Clinical Clerkship / 医学教育

In March 2001, Research and Development Project Committee for Medical Educational Programs proposed a model core curriculum for undergraduate medical education. In this curriculum, implementation of the clinical clerkship is strongly recommended. Two similar curriculum models were later presented by other organizations, and some differences were observed among them. We, Undergraduate Medical Education Committee, have evaluated and compared themodel core curriculum 2001 with the Japanese newer proposals as well as those of USA and UK. Here is reported our proposals for a better rewriting of the learning objectives in the model core curriculum 2001, with some emphasis on the nurture of the competence of the case presentation and decision making process.

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.

Assessment of a System for Evaluating Pulse and Blood Pressure Measurement Skills in the Objective Structured Clinical Examination / 医学教育

Purpose: To assess problems of a system for evaluating educational methods which cause interevaluator variability at the pulse and blood pressure measurement station of the objective structured clinical examination. Subjects: 186 evaluations for 93 fourth-year medical students. Method: The vital-sign station consists of pulse examination, blood pressure measurement, and a 1-minute oral examination. To assess interevaluator reliability, the differences between two evaluations of each of 15 evaluation steps were calculated and divided into three categories: “greater than 95% agreement, ” “unidirectional disagreement, ” and “bidirectional disagreement.” Results: The steps of “consent to examination, ” “proper verbal instructions, ” “valve release, ” “estimation by palpation”, a question about “normal systolic blood pressure, ” and a question about “the interval and the number of repetitions” showed greater than 95% agreement. The steps of “manner of speaking, ” “palpation of peripheral pulse, ” “stethoscope placement, ” “cuff deflation, ” “presentation of blood pressure, ” and a question about “absolute arrhythmia” showed unidirectional disagreement. The steps of “presentation of pulse measurement, ” “cuff wrapping, ” and “cuff inflation” showed bidirectional disagreement. Discussion: Suggestions to improve intervaluator reliability include:(1) decreasing the evaluation steps to two with a single checkpoint, (2) presenting blood pressure with the palpation method, (3) deleting the oral examination, (4) providing adequate instruction about the differences in the types of cuffs and bladders, and (5) clarifying evaluation criteria and the training of evaluators.

Model Core Curriculum and Student Evaluation System for Entering to a Clinical Clerkship. A Nation-wide Medical and Dental Student Evaluation System for Entering to a Clinical Clerkship: Computer Based Testing and Objective Structured Clinical Examination / 医学教育

The first trial of nation-wide medical and dental student evaluation system has begun from this January. This system is consisted of computer-based testing (CBT) using multiple choice questions, and objective structured clinical examination (OSCE). The purpose is to measure a student's competence to learn at clinical settings. This paper mentioned about an outline of CBT and OSCE in this system, and issues to be solved in future.

A Tutorial Education System Using Patient-Care Models to Develop Problem-Solving Skills through Discovery Learning / 医学教育

To develop problem-solving skills and to motivate learning, The Jikei University School of Medicine started a tutorial educational program for fourth-year preclinical students in April 1999. Student doctors' patient-care models focused on discovery learning and acquiring strategies for general medicine through problem-solving skills. After information was first provided by prepractice handouts, one or two tutorial sessions were performed each week. Minimum requirements for each step were established, and instructors provided printed materials, display materials, and detailed oral information to facilitate discovery learning. This program is based on problem-finding and problem-solving through selfdirected learning and feedback systems for tutorial sessions. Examinations used multiple stations to reconfirm program aims and to reinforce problem-solving skills. On a questionnaire survey, 85% of fifth-year students taking part in practical clinical education thought that the tutorial education was needed to acquire problem-solving skills necessary for fifth-year clinical training.