Because first-yearresi dents don't have adequate skills to handle the minor surgical problems that they will immediately begin to surface in the emergency room or other place, we advocate that teaching surgical techniques of office minor surgery to medical students should be encouraged. We designed a practical exercise session as one of the bed side teaching program at Kawasaki Medical School to help medical students learn some basic surgical techniques of office minor surgery. Fresh frozen pig's feet were used following the examples of medical training in America. Eighty percent of all students acknowledged in the questionnaire that this exercise seems to be very useful for their medical training.
A comparison of simple true-false questions (STFQ) and multiple choice questions (MCQ) plus multiple true-false questions (MTFQ), in the same contents was done at the graduation examination of our department (on 1987. 12. 7.). The mean score of STFQ was 83.7 mark and its standerd deviation was 4.6 mark, and in MCQ plus MTFQ the value was 77.1, 9.0, respectively. At the same student, the mark of STFQ and MCQ plus MTFQ was correlated. We concluded that the handling of the question with high percent of correct answer was induction of the individual total item check method. Then, evaluation got more validity.
The new community-based curriculum in Shimane Medical University, Japan, which are mainly based on family health practice and community health approach, is useful for students to understand the comprehensive medicine and holistic approach to community-based primary health care. It is important to introduce district health workers in the preventive education for medical students to obtain to humanistic attitude and to change their value and behavior. The importance of the exposure to the community health activities organized with man power and social resources should be more stressed in the improvement of the medical education curriculum and also of educational methodology to learn the essential physicians' nature such as humanity, responsibility, cooperation, positive attitude, and ability of problem solving.
To evaluate the achievement of medical or dental education the criterion-referenced tests must be used. In this paper we proposed a new setting method of the difficulty level of the multiple-choice questions (MCQs) used in the National Board Examinations for Medical or Dental Practice. The difficulty levels should be determined by using the idea of the “Correct Terminal” which is consisting of the minimal sets of items to answer correctly. The difficulty level, the percentage of correct answer and the phi-coefficient of a question vary depending on the arrangement of the items in the question. Therefore, it is very difficult to get the real evaluation by the criterion-referenced measurement as far as we use MCQs. We should deepen our understanding of the limit of MCQ tests rather than we might expect the limitless possibility.
The curriculum evaluation by students was introduced into the two-weeks clinical curriculum of fifth years students at Saga Medical School, Department of Anesthesiology. The evaluation form is consisted of forty questions with the eleven figures from -5 to +5. These questionaries were divided into seven parts and covered instructors' evaluation and the minute course evaluation. This evaluation was done anonymously at the end of the two-weeks clinical course in Anesthesiology. The analysis was done as follows: 1) divided up into the positive group, the neutral group and the negative group; 2) difined the positive rate, the negative rate and the effective rate; 3) presented these rates visually. The result runs as follows: 1) the effective rate is proportional to the interaction between instructors and students; 2) a quick feedback can be done on instructors. Finally, the important thing for medical education is not only curriculum but the interaction between instructors and students. In this sense, this trial in Saga Medical School is significant for medical education.
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. 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.
A series of basic questions on medical bacteriology for the 1st grade of medical students was prepared on computer display (computer quiz). This computer quiz consists of 163 short sentences with either right or wrong content. Students can challenge the computer quiz as many times as they wish whenever students are free from their formal curriculum. A printed list of questions and their answers was handed to students in advance because the computer quiz was opened to students in advance of concomitant lectures and students had no previous knowledge on which they might relied. This computer quiz might serve not only as an alternative of conventional methods for evaluation of progress in students' studies but also as a convenient tool to let medical students efficiently memorize the outlined index for basic bacteriology.
Undergraduate medical students in their 5th year were given integrated lectures on two topics, “ The cerebellum ” and “Patient -centered medical care”. The results of a questionaire survey indicated that students had hoped for continuation and expansion of the lectures to include many other topics. A series of discussions among faculty however, disclosed two problems with regard to continuation and expansion, i. e., a lack of experts for integration and lack of adequate means to assess educational impact. Teaching personnel in integrated lectures need not necessarily be experts or professors, but persons who can be in close contact with one another for the purpose of integration. Setting aside rigid discussions on validity, small achievement tests may be useful in assessing the degree of student comprehension.
Reviewing the present status of medical education in Japan, the author emphasized that the promotion of scientific research in medical education is most urgent in order to implement various proposals for the improvement of medical education which were made public in the past. In comparison of situations between the United States and Japan, a plan of establishing a national center for medical education research which has been recently proposed in the United States seems to be premature in Japan where interest in education research is not yet much heightened among medical educators. Instead, the establishment of an organizational unit specialized in medical education at individual institutions is more realistic and should be promoted nation-widely in Japan. In this unit, medical education research in each institution should be properly evaluated as an important factor to influence the personnel affairs including selection and promotion. A case of “Center for Research in Medical Education and Health Care” in Thomas Jefferson University (Director: Prof. J. S. Gonnella) was introduced as a typical example of the individual unit.
I reported a personal impression on my own experience of undergraduate clinical education undergoing at Harvard Medical School during the exchange clerkship program in 1989 spring at MGH, New England Deaconess Hospital Childrens Hospital Medical Center, and Brigham and Women's Hospital, all which are the teaching hospitals of Harvard Medical School.
The personal experiences as a student of the “New Pathway Program” at Harvard Medical School and one of its 17 affiliated institutions, New England Deaconess Hospital (March, 1988 and March and April, 1989), are reported. In a problem-based curriculum, students' learning occurs mainly around investigative and clinical problems. In the Department of Cardiology, the consultation service, intern conference, medical grand round, CCU, noon talk and cardiology conference are described. In the Department of General Surgery, under the “Blue Team”, team round, tumor conference, surgical grand rounds, surgical operation, morbidity mortality conference, chief conference, night duty and chief resident conference are described. In summary, the clinical clerkship of the students and teaching by the residents are much more intensive than those in Japanese medical schools.
The “New Pathway Program” for clinicians and “Harvard-MIT program” for medical researchers are described under the guidance of Prof. A. Leaf, who reformed the medical education earlier. The core of this educational methodology is the use of problem-based discussions and independent study. In this approach, small groups of students analyze a problem with a faculty leader and then identify a learning agenda for selfstudy. In follow-up tutorial sessions, students use what they have learned to reexamine the problem and refine their knowledge. This approach is based on adult learning theory, which casts the student in the role of active, responsible participant in the educational processes. In order to implement this New Pathway, both abundant learning resources (faculty, facility etc.) and excellent admission procedures for students (interviews etc.) are also described.
Balint Method is developed by Balint, M. born in Hungary and opened his clinic in London as a gneral practitioner. He developed his way of medical interview by “listening” to the patient. He tried to understand a patient bio-psychosocially. He began his group-work (so called Balint group) in order to educate general practitioners so that they could understand their patients as whole persons. Further more, his group work makes it possible to understand doctor-patient relationship, and doctor's attitude objectively. Now, this group work is performed all around the world to educate docter's attitude before and after the graduation of medical schools.