This is the report of the 1st Workshop on Basic Clinical Competence Education held on November 22-24, 1996, in Tokyo. Twenty eight medical teachers from 28 medical schools in Japan participated in the workshop. The many aspects of clinical skills education were discussed ; Goals, teaching strategy and evaluation of clinical skills, Teaching methods of medical interviewing and physical examination, Training methods of standardized patients, and Organizing OSCE. Post-workshop questionnaire revealed a great satisfaction among participants. Many participants expressed the need to have this kind of workshop on a regular basis.
Clinical Epidemiology has been increasingly recognized as a basic science of clinical medicine as well as a prerequisite discipline necessary in practicing evidence-based medicine. However, no formal curriculum has been formulated for teaching clinical epidemiology to undergraduate medical students in Japan. We, as the Education on Clinical Epidemiology Working Group of Japan Society for Medical Education, here propose a curriculum of clinical epidemiology consisting of 15 sessions of 90 minute lectures, small group discussions, and practice. Learning such basic concepts as study design, bias, chance, and confounding factors is to be followed by case-based discussions and practicing on-line reference retrieval using MEDLINE. Our proposal awaits further refinement after its implementation at ambitious medical schools.
We analyzed the student self-assessment on education in cardiology using a questionnaire. Subjects: Ninety-six 5th-year students at Saga Medical School who have completed the lectures and bedside teaching were evaluated. Methods: A questionnaire survey of 14 topics in cardiology was performed at the finish of 3 weeks of bedside teachings. Self-assessment was categorized into 4 grades; 1) completely understood (3 points), 2) almost completely understood (2 points), 3) could be understood (1 point), and 4) could not be understood (0 point). Self-assessment scores were calculated for each topic in cardiology. Results: Questionnaires were returned by 88 students (91.7%). Self-assessment scores were high for myocardial infarction, angina pectoris, and electrocardiogram reading. Scores were low for primary care, vascular diseases, and pericardial disease. Self-assessment scores did not significantly correlate with the length of lectures but did correlate with the number of admitted patients (r= 0.93) and scores on achievement tests (r= 0.43) in each topic. Conclusions: Because students observed many patients with myocardial infarction and angina pectoris during bedside teaching, the self-assessment scores were high. Bedside teaching is important for medical students to understand topics in cardiology.
To improve physical examination skills of medical students, our original system of specialty-based physical examination (SBPE) was introduced into the diagnostic medical practice for 4th-year students. SBPE consisted of clinical practice and tests of every part of the physical examination which were administered and judged by each specialist, thereby greatly reducing the doctors' burden compared with a nonspecialist system. Because of the difficulty of preparing enough simulated or standardized patients, the medical interview was omitted from the system. Instead, the medical interview was directed stepwise according to a separate curriculum. Thus, these characteristics made SBPE much more practical to introduce. Results with this SBPE and those with a previous non-SBPE system were compared; the SBPE succeeded in reducing the number of “poor” grades and increasing the number of “good” grades on the test. These results demonstrate that SBPE is clinically efficacious because specialists could make an accurate evaluation and because the introduction of SBPE strongly motivated students.
We have conducted weekly 40-minute training session of ECG diagnosis for lst-year postgraduate medical trainees for 6 months. Their abilities to read ECGs were tested before and after training sessions. Before training (just after graduation from medical school) they were able to diagnose typical ECGs if each tracing had only one abnormality and if enough time was given for interpretation. However, they frequently misdiagnosed even ECGs that they had correctly diagnosed on pre-tests if they were presented with many other ECGs and the time for interpretation was limited. Post-tests by students and teachers showed that our training of systematic and orderly reading of ECGs has enabled students to describe ECG findings fairly accurately but could not teach them to diagnose underlying cardiac disorders.
In 1996, our medical school introduced symposium-style learning that is focused on recent advances in medical science as a regular undergraduate program for 6th-year students. The goals of this program are as follows: 1) to teach that good scientific research is essential to support high-quality medical education and medical care, 2) to have students enjoy research in a way they cannot in the ordinary curriculum, and 3) to stimulate interest in research in medical students who may become researchers in the future. Although a long-term survey is needed to evaluate the effects of this kind of learning strategy, an analysis of questionnaires showed that it was effective for the intended purposes. Today, the content of medical education has become diversified, and the social demands on medicine have changed greatly. Thus, we believe it is necessary to develop an education program separately from traditional ones that are primarily oriented to transmission of knowledge.
Tutors must understand their role in advance so that tutorial education can be conducted smoothly and effectively. These abilities and attitudes require training. At our school, tutors serve as faculty for basic courses and clinical courses. We assessed their training conditions and future tasks. Of the 1, 077 faculty members who received tutor training between 1988 and 1997, 935 are current faculty members who have completed in-service training (basic course, 115; clinical course, 820). Before 1989, training was on campus, but since 1990 it has been conducted at Shirakawa Seminar House with a 2-day program. The number of working tutors per year is 192, with a basic course to clinical course ratio of 3: 7. About half of the faculty members in the basic course have had four or more experiences as tutors, whereas most clinical course faculty members have had only one experience. Thus, many tutors have had no experience. In a questionnaire survey after undergoing the training program, most participants felt that they were able to understand the theory of tutorial education and the actual role of the tutor and that they were able to concentrate on off-campus training that was removed from their everyday work. To provide added impetus to tutorial education, we suggest that in the future, in addition to the understanding and mutual cooperation of those involved, it will be necessary to provide an advanced program to train tutors who have appropriate abilities and attitudes.
I visited three hospice facilities in Japan. Learning about palliative medicine by myself and not as part of the medical school curriculum was beneficial. The three hospices differed in several respects, such as their philosophy, style of care, and religion affiliation. However, one common characteristic was the idea that the patient is the center of the hospice. I am very interested in the use of music and other methods for pain relief. I think that learning about terminal care is necessary for medical students and hope that we gain a deeper understanding of hospices.