Although the Ministery of Health and Welfare, Japan, has an intention to revamp the medical care delivery system, the majority of physicians are currently practicing in the context of some sort of public medical insurance system. Therefore, it is madatory that medical students and young physicians understand public medical insurance system and economical issues to practice medicine in a cost-effective way. We propose here neurosurgical cases used for that purpose employing problem-based learning method in tutorial system.
To clarify the problems in the introduction of clinical clerkship in obstetrics and gynecology, inquiries were sent to medical schools in Japan. Most schools offer traditional types of clinical education, in which students participate little in clinical works, such as clerkships. Informed consent was usually not obtained when students worked with doctors doing vaginal examinations or vaginal deliveries. Even fewer schools thought that students need to perform vaginal examinations. At many schools are short of cases for students to experience deliveries. With traditional clinical education, students may have fewer and fewer chances to perform gynecologic examinations. We suggest that introduction of clinical clerkships should be considered in obstetrics and gynecology.
To clarify the experience in clinical practice of students at Osaka University Medical School, a questionnaire survey was performed according to the International Classification of Primary Care. More than half of the students had observed only 6 of the 23 reasons for seeking primary care such as headache and hypertension but had not experienced 17 of the 23 reasons, such as cough and abdominal pain. Most students had observed malignancy and chronic diseases, but more than half had only knowledge of 54 of 105 diseases such as appendicitis. In conclusion, medical students' experiences in clinical practice are not well balanced.
Small groups of 5th-year medical students performed a survey of hospital patient services in hygiene and public health, with an emphasis on patient waiting time. The purpose of this course was to give medical students the opportunity to experience the waiting time endured by patients and to obtain some understanding of the quality of hospital services from the patient's point of view. The survey was performed as follows. Groups of five students accompanied new patients in the department of internal medicine from registration until payment. The students recorded waiting time and examination time. During the waiting time, the students asked the patient questions to evaluate service. Patients were cooperative in giving responses during the survey. After the survey, the students summary proposed how to improve services for patients. By accompanying and talking with patients, the medical students were able to understand hospital systems from the patient's point of view. This course should prove useful for these students future careers in medicine.
To introduce problem-based learning (PBL) in small groups to medical education in Japan, a questionnaire was sent to 10 foreign medical schools where PBL has been used. Five schools in the United States and one each in the United Kingdom, Canada, and Australia responded to all 15 questions concerning their educational system, faculty training, faculty evaluation, and student evaluation. The faculty is trained in 7 medical schools, retrained in 4, and self-trained in 5. The faculty is objectively evaluated by students and a faculty committee in seven schools and the results are returned to the faculty. The students are evaluated by self-evaluation, written tests, and oral examination in al schools, and also by peer-evaluation in one school. The evaluation of students directly affects their promotion in all schools but one. Such effective evaluation and feedback systems, including evaluations of the students' learning skills and their attitude toward learning, play important roles in effective PBL.
Tsukuba University Hospital introduced clinical clerkships for 5th-year medical students in 1995. The process of developing guidelines for medical students and their implementation on the pulmonary ward are described here. We have also developed forms for program evaluation and student self-evaluation and have welcomed feedback and constructive criticism to improve the educational program. Emphasis was placed on house officers on the ward because of their importance as teachers for medical students; specific written instruction were given to each house officer. Our program was rated as excellent by 5th-year medical students in clinical clerkships at our university.
Workshops for medical education have been held at Kurume University every 1 or 2 years since 1977. In these workshops, teachers and students passionately discuss methods and strategies for improving medical education. The purpose of medical education is to produce good physicians through free and comprehensive ways of thinking. The outcomes of the workshops have been introduced to the curriculum in approximately 65% of the areas discussed. To take part in workshops increases motivation for education in more than 80% of the participants.
As part of the safety control education for medical instruments, a student developed an instrument for measuring current leakage. Measurements made with this instrument were satisfactory. Moreover, the use of the self-made instrument was found to promote experimentation by students in medical engineering education.
Medical education in Japan has centered upon Western medicine since the Meiji Era. Nevertheless, because patients have a great interest in Oriental medicine, many physicians have treated patients with traditional Chinese medicine. The Oriental Medicine Research Institute of Tokyo Women's Medical University opened in 1992, when education in Oriental medicine became a part of the curriculum. To understand the status of education in Oriental medicine in Japan, we conducted a questionnaire survey of all medical schools in the nation. With a response rate of 97.5%, the survey found that one university in four teaches Oriental medicine. Since 1990, recognition of “alternative medicine, ” in contrast to “modern medicine, ” has gradually increased in both research and education around the world. In Germany, which was the model for the introduction of western medicine to Japan, the use of traditional herbs and spa treatment is already taught in medical school. In the United States, where the National Institutes of Health have established an alternative treatment clinic, research and education are already ongoing at many medical schools. In such a global situation, the need for education in traditional Oriental medicine will increase, and systematizing such education may become a great challenge. We expect that Oriental medicine will one day be taught at all medical schools in Japan and will become part of the state medical examination.
We have attempted to train 1st-year medical residents who have just received their medical licenses in palpation of the thyroid gland. The residents were instructed to palpate goiters by an otolaryngologist responsible for the ultrasonography laboratory for thyroid disease, and palpation findings were compared with ultrasonography findings. Each resident examined an average of 6.0 patients with diffuse goiter and 4.6 patients with nodular goiter. One year later, 75% of the residents had confidence in palpation of the thyroid gland, and every resident had palpated the thyroid gland as a part of the physical examination for all inpatients, but not for outpatients. This training was useful for familiarizing medical residents with palpation of the thyroid gland in routine physical examination.