The importance of psychosomatic medicine is clear to readers of this journal. However, their prevalence in other fields is limited. In the past, the existence of psychosomatic disorders was questioned. During my graduate school years, I researched the influence of stress on the onset and course of Graves’ disease, which was later included in the guidelines. I would like to encourage young doctors to build evidence themselves. Our society is also constructing systems to support young doctors, such as working groups. Collaboration with other departments is crucial for the spread of psychosomatic medicine to other fields. For instance, we demonstrated the usefulness of psychosomatic medicine through liaison activities with other departments and presented research results. To achieve further development, interdisciplinary research with experts outside of medicine is also considered important. In this regard, psychosomatic medicine is thought to have an affinity. For young doctors who lack the opportunity to conduct research or receive guidance, I recommend consulting seniors at conferences or social gatherings. The future of medicine rests on the shoulders of young doctors and I wish to support them actively. Please let me know if you require further assistance or adjustments.

Psychosomatic medicine represents an original discipline within medical science. Nevertheless, it encounters diverse challenges, including issues within the healthcare system, social biases, and insufficient evidence. In light of these challenges, what strategies should physicians in psychosomatic medicine employ to enhance its significance and enlighten individuals and society across various levels?

If we deviate from our originality, we no longer retain it. However, we should also acknowledge and appreciate the diversity that has stemmed from our originality, making it appealing to the medical community, both now and in the future. Incorporating the psychosomatic insights of psychosomatic medicine into areas where this originality has flourished, such as palliative and general medicine, appears to be feasible. We introduce proposals aimed at enhancing the management of organic diseases with psychosomatic tendencies, prioritizing primary psychotherapeutic interventions, and the integrating psychosomatic insights from disciplines associated with psychosomatic medicine. We hope that each individual reaffirms their irreplaceable originality and considers incorporating the diversity that has emerged from it into the field of psychosomatic medicine.

The present study aimed to explore the concept of psychosomatic disease and future directions for psychosomatic medicine-related research by comparing the training regimens of therapists and their responses to stress-related psychosomatic conditions in Germany and the United States with those in Japan. In Germany, courses in psychosomatic medicine are established at each university and doctors who do not belong to a psychosomatic medical department have access to a psychosomatic physician training program provided by the medical association; the specialists in Germany earn up to seven-fold higher medical reimbursements than those in Japan. In the United States, mental health issues are addressed at the national level, with an emphasis on the need for social, environmental, and political solutions. A distinctive feature of Japan is that various medical departments are affiliated with psychosomatic medicine associations. Going forward, the challenge will be to strengthen the biopsychosocial diagnosis and treatment methods utilized by all specialized departments. Based on these considerations, it is crucial to clarify the definition of psychosomatic diseases and obtain a deeper understanding of these conditions.

In recent years, the standardization of medical education has progressed and medical education reforms have been promoted at various universities. Therefore, the Model Core Curriculum for Medical Education was revised in 2022. These revisions emphasize the need for future physicians to acquire skills to understand and manage the psychological and social aspects of patient care. This shift reflects a broader understanding that medical care is not only limited to physical treatment but must also address the psychosocial aspects of health, which are important for effective disease management and patient satisfaction.

The problem at each university is “who” and “how” to teach these contents, and the current shortage of instructors is a major challenge. The role of psychosomatic medicine is significant for establishing future teaching systems and curricula.

It is important to construct a curriculum that serves as a model for psychosomatic medicine in medical education and to establish its position as a leader in holistic medicine.

Behavioral science is closely related to psychosomatic medicine in terms of its application for medical education and clinical practice. The 2022 Revision of the Model Core Curriculum for Medical Education in Japan posits behavioral science as a basic competency for healthcare professionals (with regard to holistic perspectives and approaches), with comprehensive perspectives on biopsychosocial issues among patients and individuals. The Japanese Society of Behavioral Medicine has proposed a Behavioral Science curriculum for undergraduate medical students in Japan ; this curriculum is outcome-oriented and covers several psychosomatic medicine-related aspects. Education aims to facilitate the creation of healthcare professionals who can implement holistic healthcare into practice. Currently, systematic education, from the lower grades to bedside learning, has not yet been implemented in many medical schools. Formative assessments should be introduced to foster attitudes and mindsets that support holistic perspectives and approaches. Psychosomatic medicine is believed to greatly aid and promote behavioral science education.

While there has not been any medical university with a department of Psychosomatic Medicine in the Chubu district, efforts have been made to incorporate this field into medical education and clinical practice. This article presents two trials conducted at the Aichi Medical University School of Medicine.

In 2018, optional classes were established in accordance with the medical educational content guidelines of the university. Since 2019, we have given lectures which covered topics as “What is Psychosomatic disease as a stress-related disease?”

Moreover, in 2020, a study group was established in which medical doctors and psychologists convened monthly to discuss patient care. This interdisciplinary collaboration was strengthened in 2021 as meetings were expanded to include other medical staff and researchers in the field through web conferences.

These endeavors represent significant strides in the integration of Psychosomatic Medicine into medical education and clinical practice at the Aichi Medical University of Medicine.

Medical education is undergoing annual reforms, and medical schools are being asked to adapt to these changes. As behavioral science is considered as educational content all medical schools must implement, it has become an important part of the educational curriculum.

The definition, position, and significance of behavioral science in medical education vary depending on the position and perspective of the faculty members involved in medical education, and the debate continues to this day. This part of the debate is similar to the divergence in opinions on the nature of psychosomatic medicine. On the other hand, comprehensive medicine, also a key concept in many medical schools, it is similar to the concept of psychosomatic medicine. When considering ways to develop psychosomatic medicine in medical education, it is necessary to consider the distinction between behavioral science and comprehensive medicine.

Background : In recent years, the importance of community medical training during postgraduate training has been recognized and is often included in the education of medical students. In addition, support for psychosocial aspects is indispensable in the field of regional medical care for organs and illnesses as well as for the holistic medical care of “caring for people.” Given this background, medical students should be able to understand holistic medical care in the practical medical field. We analyzed student reports and considered how they gained awareness.

Method : The contents were analyzed using the Modified Grounded Theory (M-GTA) from the reports of medical students who participated in regional medical training in the free-choice training of the 6th year at Nihon University School of Medicine.

Result : Seventeen student reports were analyzed. Primarily, it was classified into three categories : “noticing patients,” “noticed about practical medical care,” and “noticed about community medicine.” In addition, as subcategories, “how to deal with patients,” “the actual medical treatment,” “cooperation with patient families,” “the importance of communication,” “the importance of problems,” and “the reality of regional medicine” were analyzed. One student perceived the importance of medical care rooted in the area by observing the view of life and death transmitted to the area where the training was conducted and the response of the clinic doctors against that background. Another student imagined work and daily life and perceived the importance of paying attention to the psychosocial background of patients, such as psychological worries, relationships of acceleration, and the work environment when communicating with the five senses in mind.

Conclusion : Medical education is primarily conducted at medical schools, and the staff of each specialized department provide guidance. Individuals tend to focus on specialized medical care, but various notices, including psychosomatic backgrounds, were observed among students who participated in community medicine training. As such, students who participated in the training perceived the importance of treating patients as individuals. Each local inhabitant has various backgrounds depending on the area, and it is difficult to systematically incorporate them into medical education. However, some will be considered by the students themselves through the participation in community medical training.

Background : Somatic Symptoms and Related Disorders (SSRDs) are characterized by a wide variety of physical symptoms ; however, treatment is not well established and clinical outcomes are difficult to predict. In this study, we longitudinally followed patients with clinical symptoms of SSRDs and investigated factors that predicted improvement in disease status.

Methods : Patients with SSRDs who visited our department between February and March 2021 and continued treatment until the same period one year later were included. Age, gender, duration of treatment, alcohol consumption history, smoking history, comorbidities, and medications were included as background factors. The subjects were assessed using the Somatic Symptom Scale-8 (SSS-8) for physical symptoms, Hospital Anxiety and Depression Scale (HADS) for anxiety and depressive symptoms, and Pain Catastrophizing Scale (PCS) for catastrophic thoughts. The subjects were divided into symptom improvement and non-improvement groups based on improvement in their SSS-8 scores after one year. The groups were compared with each other for each endpoint and background factors. Next, logistic regression analysis was performed using presence or absence of improvement in the SSS-8 scores as the objective variable and factors that differed significantly (p＜0.05) or tended to differ significantly (p＜0.10) between the two groups as independent variables. Similar analysis was performed for the presence or absence of improvement in severity of SSS-8 scores.

Results : Valid responses were obtained from 50 subjects. Twenty-one subjects were assigned to the symptom improvement group and 29 to non-improvement group. Comparisons between these groups indicated that the symptom improvement group tended less likely to consume alcohol and significantly less likely to use anxiolytic medications. Logistic regression revealed that the use of anxiolytics such as benzodiazepines was a negative predictor of symptom improvement. Next, 14 subjects were assigned to severity improvement group and 36 to non-improvement group. The use of benzodiazepines was significantly less frequent in the severity-improved group and was also a significant negative predictor of symptom improvement as reported using the logistic regression analysis.

Conclusions : Patients with SSRDs who use benzodiazepines as anxiolytics are less likely to show improvement in their condition after 1 year of treatment.