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.
The report of the Canadian Medical Association (CMA) Committee on health care of the elderly was translated, in reference to the teaching of geriatric medicine. The present state of geriatric medicine teaching, the characteristics of health care for the elderly, the integration of geriatric medicine education, the curriculum of geriatrics, and the particular problems of postgraduate education in Canada were analysed. Some recommendations for improvement were proposed.
We evaluated our undergraduate clinical clerkship system in 1992, using the multiplication method advocated by the Working Group on “Evaluation of clinical skills of medical students ” of the Japan Society for Medical Education. We divided the clinical training period into three terms: the first term was held from May through June, the second from September through October, and the third from December through January. We determined scores using checklists and rating scales in ten categories, totalled the scores for each period, and compared them between periods. The total scores for the third period were the highest, followed by those for the second period. Scores for basic knowledge, data gathering, and basic technical procedures increased with increase in the number of training hours. However, scores for manner, attitude, and interviewing skills were already high in the first period. We conclude that the multiplication method is useful for objectively evaluating students' clinical skills.
We conducted an opinion survey of on-site collaborators after three field work sessions during the period from 1990 to 1992. As part of our public health course, these field work sessions were implemented on a small-group basis in various settings, such as schools and local public health centers. Selfadministered questionnaires on student behavior and performance were distributed to the collaborators on the days of the student visits. Completed questionnaires were then collected by mail within a couple of weeks. The total number of respondents for the three years surveyed was 205, reflecting a response rate of 100 percent. The following results were obtained; 1. Many collaborators admired the good behavior of the students, 2. Several respondents considered student knowledge of public health issues less adequate than they had expected, and 3. Some respondents commented on the passiveness of student involvement in their work. These survey results provided the faculty with valuable insights on the implementation of the field work sessions.
A self-reporting questionnaire was designed and sent to our Jichi Medical School graduates each year since 1980, in order to investigate clinical competence. The format was designed based on several major reports concerning postgraduate clinical training in primary medical care. We found that more than 70% of Jichi Medical School graduates trained in the multi-specialty rotation style in general hospitals that were certified by the Ministry of Health and Welfare. Our results also suggested that these graduates obtained a relatively high level of clinical competence in performing physical examinations, basic laboratory testing, clinical procedures, and various treatments.
The process of doctors formulating their attitudes toward truth-telling in the care of dying patients was examined, and factors influencing the process were analyzed based on an interview survey of 38 doctors. Learning of conventional ways of handling information in medicine, clinical experience, and personal beliefs were the major factors found to determine doctors' attitudes toward truth-telling. Doctors conform to the current practice of not telling the truth to patients because of instructions by superiors, the need for team care, dominant social norms, and the fear of responsibility in initiating new methods. In terms of clinical experience, both interaction with specific patients and the necessity of an efficient routine in case management affect doctor behavior. Since each doctor's personal philosophy is considered to be the basis of his or her attitude toward truth-telling, most doctors avoid interfering with the decisions of other doctors, and view teaching ethics in medicine rather skeptically.
We report on the state of postgraduate anesthesiology training (3 months) at Fukui Medical School. This report was based on a questionnaire sent to 144 doctors who had undergone this training. The response rate was 68%. Participants entered anesthesiology training at a mean of 1.9 ± 1.2 years after graduation. Seventyone trainees (91%) were actively involved in clinical anesthesiology, among which 48 trainees (63%) had experienced between 31 to 60 cases over a 3 month period. Twenty-four trainees (31%) indicated that the training period (3 months) was too short. After such training, 50 doctors (66%) practiced anesthesia, among which 29 encountered difficulties with endotracheal intubation. Sixty-nine trainees (93%) thought the training would be useful for resuscitation. We conclude that anesthesia training is effective at the end of a 2-year postgraduate training course, and recognize the need for improvement in the teaching of anesthesiology.
Some comments of the author are presented on his experience concerning the use of computer quizes in teaching fundamental microbiology to medical students. The simple true-false type question was one of the best suited forms for computer display because of its simplicity. Multiple choice questions consisting of pleural (usually five) simple true-false sentences were too cumbersome. Repeatability is one of the advantages of computer quizes. Furthermore the shuffling of questions is simple to perform on the computer. The computer quiz is one form of preparation and review, and differs from examinations in that students have mutiple chances and time to take the quiz. With the computer-quiz teachers also have the chance to make better contact with students, and through their care of students, teachers remember more faces and names of students.