I briefly summarized major innovative movements and events in medical education in Japan during the last 25 years. We recognized that constant efforts have been exerted and resulted in changes in manyaspects of medical education in our country. Traditional medicine is rapidly changing, developing and expanding to more sophistication and integration. The world is changing, thus the needs for medicine and medical care are different from even those several years ago. To update medical education in order to meet social needs and demands, we have to install a device which constantly renews ourselves in each school and in the government. Both governmental and non-governmental approaches in cooperation seem to be necessary in our country. I have shown our non-governmental efforts from various sources. We recognize that our thinking and discussions in an environment of freedom have contributed a great deal to national decision making.
This report provides information on curriculum in the medical humanities in Japanese medical schools. We sent a questionnaire to the same eighty medical schools in 1988 for the first survey, and again in 1994 for the second survey. Seventy-eight medical schools (98%) responded in the first survey, and all eighty medical schools (100%) responded in the second survey. A curriculum in medical humanities was offered at 67 medical schools (86%) in the 1st survey, and at 71 medical schools (89%) in the 2nd survey. Courses in medical humanities were required subjects in 63 medical schools (91%) in the 1st survey, and in 62 medical schools (87%) in the 2nd survey. These courses were taught in the 1st grade at 47 % of schools in the 1st survey and at 60% of schools in the 2nd survey. Total teaching time was 30hours in 33% of schools in the 1st survey and in 36% of schools in the 2nd survey. Subjects included in the medical humanities course included death, communication between doctors and patients, the bioethics of birth, organ transplantation, the history of medicine, and early exposure in the hospital. According to our survey the teaching of medical humanities has become popular at the new national medical schools. At present, it is one of the most important courses in medical education.
The 2nd year student evaluation of didactic lectures by one instrustor was carried out anonymously in 1991 in order to establish the most appropriate set of questionnaire items (including 11 types of questions with 5 choices of responses each and space for a free answer). The study was repeated 11 times, with a total of 286 responses collected. There was a certain amount of variability in the means and standard deviations in the data. Mutivariate analysis, such as multiple regression, was appled and three principal components (students' concern and lecturer's attitude, utilization of visual aids, and preparation and clarity of lectures) were extracted out 11 items by means of principal component analysis. In concluding, the author stresses the necessity of the further studies.
We evaluated the interview skills of 46 sixth year medical students (32 men, 14 women) in our outpatient clinic. Six items were evaluated, including the manner in which students responded to patients, the number of times students interrupted patients' statements with closed-ended questions, and the extent to which students maintained eye contact with patients. We found that students interrupted patients every 46.2 seconds on average, and often did not make eye contact with tha patients. It became clear that, although we teach medical interview skills to students, students do not learn these skills very well. We suggest that in order to properly educate medical students, close cooperation between departments is needed.
Participation of students in the management of patients was evaluated by analyzing medical records written by the students. Sixty-four percent of the students wrote in the medical chart everyday, however the amount of data was on average only 5.6 lines per day. Descriptions of subjective data were scant. Physical complaints were described for 65% of patients, but were insufficient in detail. Psychic and social complaints were rarely described. Objective data on the physical examination comprised the main body of chart notes recorded by the students, although only 37% of these were judged to be sufficient. Laboratory and radiological data were described less thoroughly than data from the physical examination, and were completely absent from 64% of charts. Assessments were incomplete, and patient problems were not clearly elucidated for most patients. These undergraduate students failed in their assessment of patient problems during their one week of bedside learning.
With the development of sophisticated medical technologies, there has been a tendency to belittle the taking of the “history and physical, ” even in the field of cardiology. We have been holding cardiology case conferences for general medical residents, with the main focus on history taking and physical examination since 1992, so that all residents are able to provide a certain level of primary care for patients with cardiac diseases regardless of his or her future sub-speciality. We present our methods and the educational effect of these conferences.
Based on 20 years of experience with an unique postgraduate clinical training program, consisting of “g eneral wards ” and “inninr-residents in general medicine” at Tenri Hospital (Nara, Japan), we have identified the following points for the successful evaluation of residents: 1) unlike undergraduate teaching, item-based evaluations do not fit teaching in the clinical setting, 2) evaluation of residents' attitudes should be emphasized, 3) comprehensive evaluation in regular meetings by the teaching staff is practical and useful, 4) mechanisms to reflect patients' opinions should be included in the evaluation process.
Recently, course lectures have been divided up into many pieces given by different lecturers with narrower but deeper knowledge. This is in contrast to the older style of all lectures in a course being delivered by a single lecturer. The lectures today are thus overflowing with too much content for students to handle. As a result, oral lectures have lost popularity as educational tools, since their utility is diminished by information overload. The original function of the oral lecture as a method of transmitting knowledge should be reinstated, with the strong support of various educational materials and computers.