Recent changes in social needs and the health care system have prompted the development of new teaching strategies and methods in which active learning by students in small groups is emphasized. We created an “early exposure” training program to enable freshman medical students to obtain practical experience at medical and welfare institutions. This program was designed with the following features 1) student-centered and self-directed learning, 2) integrated education for knowledge, skills, attitude and ethics, 3) training in communication skills, and 4) tutor-assisted and small-group discussion. Tutors were recruited from basic medical science departments. In a self-evaluation survey, 92% of students found this early exposure training to be excellent or good. Most students achieved improvement in communication skills, attitude and ethics among the educational objectives. However, a few students did not fulfill any objectives, and thus we should consider further improvements in the tutorial system.
A new method of evaluating learning, combining the 2 categories of knowledge/skills and attitude, has been introduced into the course on preventive medicine and community health. The goal was to improve student attitudes towards learning. In this article, our five years' experience from 1989 to 1993 is reported and follows a previous similar study from 1986 to 1988. This time, the records of 3 of 490 students were judged to be inadequate for promotion to the next grade. Although one-half of the students agreed with this method of evaluation, 15 % disagreed. The usefulness ofthis new method is discussed, based on our results.
The learning of problem-solving skills at the bedside in our department was investigated by comparing the results of student self-evaluations with teacher evaluations before and after the bedside learning (BSL) course. Students evaluated their behavior highly in terms of 1) positiveness, 2) motivation, and 3) bedside manner. However, they evaluated their medical competence poorly in terms of the ability to 4) perform physical examinations, 5) analyze medical histories and clinical findings, 6) interpret ECG and X-ray films, and 7) gather data, and 8) recall medical knowledge. The results of the student self-evaluations on items 5) to 8) were compared to those of the teacher evaluations before the BSL course (term examination in the fourth year) and after the BSL course. The student self-evaluations were not correlated with the two teacher evaluations, but there was a very close correlation between the two teacher evaluations.
When serious emergency patients come to a 3rd-level emergency hospital, they are able to obtain optimal medical treatment for their condition. However, the emergency room of general hospitals are extremely crowded with many kinds of patients, ranging from 1st-to 3rd-level emergencies. Thus, a good training program in triage is necessary for emergency medicine doctors because of the risk of inappropriate management of patients. In this study, we examined the number of 2nd-and 3rd-level emergency patients who came to our emergency room initially as walk-in 1st-level emergency patients in 1991 and 1992. Our results indicate that the education for emergency medicine doctors needs to cover a wide range of medical fields dealing with 1st-to 3rd-level emergency patients, and that ideal training in emergency medicine must be organized in hospitals that accept 1st-to 3rd-level emergency patients.
The X2 type question consists of a multiple true-false method of testing, with 2 true and 3 false items. Its standard score rate is 56.6%, and its accidental score rate is 10%. Since the standard score rate of the present national board examination is almost 71%, the number of unsuccessful examinees will increase when the X2 type question is used while maintaining the same passing mark. Quantitative analysis shows that the score rate of X2 type questions is determined mostly by correct thinking on the most difficult true item and the most difficult false item. These results are important to the development of future examinations using X2 type questions.
The Jichi Medical School has trained doctors for work in community health care for over 20 years.Students learn medical communication skills by role-play. In this role-play, doctors and patients areplayed by students. Discussions are also held by students. The teaching staff give additional explanations, suggestions and demonstrations. By themselves, students learn about 1) general practice, 2) theprocess of consultation, 3) medical communication and 4) patients' emotions. We plan to develop othereducational resources such as trained simulated patients.
In March 1986, an academic program on family care medicine was started at Jikei University School of Medicine upon consultation with Prof. Masakazu Abe, then President of the Jikei University School of Medicine, and Dr. Tomojiro Nagai, founder of the Medical Practitioners' Association of Japan. The program offers two elective seminars on family care medicine in the spring and summer for 4th and 5th year medical students. The objective was to give students opportunities to visit and observe medical care provided by practitioners, to teach them the importance of the function of family physicians, and to offer them options in their future careers. The total number of participating students from the first through 20th seminars was 121, with a maximum number of participants per seminar of 11 and a minimum of 3 (average of 6). A total of 37 instructors took part in the program by giving from 1 to 18 seminars per instructor (average of 3.3). We found these seminars to be highly educational not only for the students but also for the instructing physicians.
In the 1970's, a sudden increase in the amount of medical information repressed the learning will of medical students in Western countries. In response to this, a few medical schools in Europe and the United States developed a “new medical curriculum.” Since learning will occurs in the limbic system, which is refractory to the neocortex, special measures are needed to heighten it. The “new medical curriculum” represents one such measure. Differences between medical schools in terms of efforts to stimulate learning will may make a significant difference in the quality of their graduates in the future.