The Keio Journal of Medicine
Online ISSN : 1880-1293
Print ISSN : 0022-9717
ISSN-L : 0022-9717
Volume 56, Issue 3
Displaying 1-4 of 4 articles from this issue
REVIEW
  • 5. Implementing a More Integrated, Interactive and Interesting Curriculum to Improve Japanese Medical Education
    Kanchan H. Rao, R Harsha Rao
    2007 Volume 56 Issue 3 Pages 75-84
    Published: 2007
    Released on J-STAGE: January 15, 2008
    JOURNAL FREE ACCESS
    Exact parallels can be drawn between the shortcomings in medical education in the US in the 80s and those prevalent in Japan today. Research and clinical practice had primacy over teaching, and primary care medicine, with its focus on humanistic principles, was subordinated to specialization and tertiary care. US medical schools undertook a wide-ranging reform of the traditional curriculum, recognizing its four major shortcomings. These were (i) an institutional failure to accord academic status to teaching, resulting in a disincentive to teach, (ii) a failure by faculty to perceive a shared interest in education, resulting in teaching that was fragmented and even contradictory, (iii) a failure to integrate preclinical and clinical material, resulting in fragmented learning, (iv) a failure to encourage the development of the most important attributes of a physician (independent thinking, problem solving, and self-directed learning). The reform of medical education in the US was achieved through a wholesale restructuring that (i) integrated basic science with clinical medicine across the curriculum; (ii) coordinated teaching across departments by organizing the curriculum into "blocks"; (iii) integrated problem based instruction into the curriculum to encourage active learning; and (iv) elevated the importance of both teaching and primary care. The successful effort to reform medical education in the US can serve as a source of encouragement and a road map for academic institutions in Japan, like Keio University, who recognize the same shortcomings in Japanese medical education and are attempting to develop and implement a curriculum that is more integrated and problem-oriented.
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ORIGINAL ARTICLE
  • Hideki Ishikawa, Shingo Hori, Naoki Aikawa
    2007 Volume 56 Issue 3 Pages 85-91
    Published: 2007
    Released on J-STAGE: January 15, 2008
    JOURNAL FREE ACCESS
    The Meiji Jingu Baseball Stadium attracts a large number of spectators in the Tokyo metropolitan area. To clarify the demand for medical care at a public ballpark, we analyzed following two types of medical records maintained at the stadium: (1) "Report of Aid": a record of patients visiting the first-aid station in 2003 season and (2) "Report of Accidents": a record of patients referred to clinics/hospitals between 1996 and 2003 season. (1) In 2003, approximately 1,582,000 spectators watched 67 professional baseball games (60 night games). Of the 247 spectators received medical care at the first-aid station (3.7 persons per game, 1/6,405 spectators), 128 (51.8%) had trauma and 109 (44.1%) had illness. The incidence of trauma was relatively higher before the start and near the end of the night games. The risk of becoming sick/wounded per spectator or the number of the sick/wounded per game differed depending on the participating sports teams. (2) Ninety-three spectators referred to clinics/hospitals during the 8-year period from 1996 to 2003, of which 57 were transferred by ambulance. Direct ball injury accounted for 65 (69.9%) cases of trauma, followed by stumbling/falls (18 cases, 19.4%). Twenty patients were diagnosed to have fractures at the clinics/hospitals. Intrinsic cardiopulmonary arrest occurred in one spectator. Trauma due to direct ball injury accounted for the largest number of wounded patients referred to clinics/hospitals. Treatment to patients at the first-aid station in the stadium may optimize the frequency of hospital visits. Records of medical care are effective to analyze the demand for medical preparedness.
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CASE REPORT
  • Jun Iwamoto, Tsuyoshi Takeda, Kiyohisa Ogawa, Hideo Matsumoto
    2007 Volume 56 Issue 3 Pages 92-95
    Published: 2007
    Released on J-STAGE: January 15, 2008
    JOURNAL FREE ACCESS
    We report on a case of muscle strain of the subscapularis muscle in a baseball player. An out-fielder (throws right-handed and bats left-handed) hurt his right shoulder while playing baseball. He complained of right-shoulder pain just after he forcefully hit his right hand against the fence in an attempt to jump and catch a flying ball with a glove on the left hand during a baseball game. Fat-suppressed T2-weighted magnetic resonance images (MRIs) of the right shoulder joint revealed muscle strain in the middle part of the subscapularis muscle, and the injury was surmised to have occurred on account of eccentric contraction of the subscapularis muscle. The case was considered to have moderate muscle strain, because he had modest muscle weakness with a negative lift-off test. Active stretching exercises were begun just after his first visit to our clinic, and throwing exercises were started 3 weeks later, by when the right-shoulder pain had completely disappeared. Repeat MRIs of the right shoulder joint obtained 4 weeks after his first visit to our clinic revealed a significant reduction of the high-intensity lesions in the subscapularis muscle. Conservative treatment was effective for managing moderate muscle strain of the subscapularis muscle. Muscle strain of the subscapularis muscle should be taken into consideration in the differential diagnosis of shoulder injuries in athletes.
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OPINION
  • Masami Kitano
    2007 Volume 56 Issue 3 Pages 96-101
    Published: 2007
    Released on J-STAGE: January 15, 2008
    JOURNAL FREE ACCESS
    Medical systems in the USA such as EBM., DRG., Informed Consent and Second Opinion have already been introduced into the Japanese medical system. However, some of these systems have met resistance from a part of the population due to the differences of social structures, morals and customs between the two countries. Briefly, I described the medical education and licensure, the private practice and "open hospital system" of the USA. The following 4 topics which drew great interest in Japan will be discussed.
    1) Cerebral death and Bioethics: Cerebral death has been restrictively accepted as human death since the 1980's only in terms of terminal cares in clinical medicine. The rather simplified current neurological criteria for death are approved in the USA. In order for an organ transplant to take place, a potential doner must be diagnosed as brain dead. However, Japanese society has not accepted the concept of cerebral death completely because of an accident in the 1960's where an organ was improperly removed when the donor who was not in the state of brain death. Recently, more people in Japan are showing interest in Dignity and Euthanasia from the point of view of "Right to die".
    2) Malpractice and Litigation: "To err is human" was introduced by the Institute of Medicine for Risk Management. Accidental deaths of patients under medical care ranks No.8 in total number of deaths in the USA. There are 100,000 malpractice cases in the "Lawsuit Society" of America, which is 100 times that of Japan. Furthermore, the legal fees and insurance premiums are extremely high in the US as opposed to very low in Japan.
    3) Health Care Insurance: To reduce medical costs, the insurance companies introduced "Competitive Managed Care" which resulted in the formation of "Health Maintenance Organizations" (HMO). Furthermore, when you compare the two countries in respect to those who have health insurance, 44 million in the USA carry no health insurance, whereas in Japan, the government cover for everybody's health insurance.
    4) Disclosures in the USA: Medical bills and statements are sent to all patients. Maintenance records belong to the patient. The Medical Board discloses those physicians who are facing disciplinary action.
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