Departments of general medicine in medical schools have a mission to innovate in clinical education. However, the kind of work departments should do to promote a newly developed method of clinical education is unclear. In our medical school, the department of general medicine was organized in 1997. In that year, the first task of this department was to strengthen a program of physical-diagnosis skills. Since 1999, this program has developed further and been reorganized. The basic clinical skills course has been organized to include communication, physical diagnosis, basic laboratory examination, and basic surgical skills. In this course students do not rotate through clinics in groups but learn together via a systematic program with simulators. The department of general medicine played a central role in establishing this course. This course led to the introduction of clinical clerkships at our medical school.
Self-made electric circuits for low-energy cardiac defibrillators were used to interest students in electrical experiments in our clinical engineering course. We propose that this experimental approach, which includes training methods and teaching tools from advanced medical engineering education, be used for elementary medical engineering education.
To assess the effectiveness of a problem-based learning tutorial system introduced at Gifu University School of Medicine in 1995, we conducted a questionnaire survey of medical knowledge, attitudes about learning, communication ability, and social behavior in sixth-year medical students. The questionnaire was given to instructors and attending physicians at community hospitals who were involved in clinical education. Many of the evaluators felt that students who trained with the tutorial system showed improved understanding, a more active attitude toward learning, and a better attitude toward patients than did students who received traditional, lecture-based education.
Videotape feedback reportedly improves communication skills in students learning to conduct medical interviews. We carried out a study of videotape feedback in the undergraduate training program of the department of neuropsychiatry. To evaluate the interviews, we used objective structured clinical examinations and feedback from interviewed patients. The students showed several shortcomings, such as passive investigation into symptoms, past history, family history and explanatory models; poorly expressed empathy; unclear summation; poor explanation about what interviewees should do after the interview; and infrequent use of specific probes and silence skills. Feedback from patients was more favorable than that from instructors. Because our program asking psychiatric patients to participate as interviewees seems to have both advantages and disadvantages, using simulated patients would be helpful for examining the validity of our program.
Problem-based learning (PBL) has been recognized as an effective method of medical education in many countries. Because establishing comprehensive PBL is often difficult, we attempted to use clinical clerkship in home medical care as an opportunity for comprehensive PBL education. Both students and teachers benefitted by studying the backgrounds and needs of home medical care patients, discussing various topics, and recognizing and discussing multiple aspects of medicine. Our experiences suggest that this style of learning can be an effective method of PBL education in any medical school and that clinical clerkships in home medical care can easily be adapted for effective PBL with actual patients.
At the Niigata University School of Medicine, objective structured clinical examinations (OSCEs) were performed for the first time in 2001 for 92 fourth-year medical students. The average evaluation scores students received from instructors were summarized, and the differences between scores given by different instructors were examined. We found that practice methods for the medical interview and physical examination before OSCE and the question topics and evaluation methods of OSCE were appropriate, but scores on some items were extremely low. The standardization and objectivity of the evaluation were satisfactory, perhaps because one explanatory conference and two training conferences were held for instructors before OSCE. However, some questions tended to produce differences between instructors, as did some topics, especially in the medical interview. The scores with standardized patients and those by teachers were strongly correlated, but those with the former were lower than those by the latter.
We developed a problem-oriented simulation system for medical diagnosis which works on personal computers without special equipment. In this simulation system the history of illness can be presented by voice, and physical findings are presented audiovisually through the student's actions, in a manner that closely resembles an actual medical examination. The laboratory findings are also presented through the student's actions. Students compile a database with information that they collect, create a problem list, and devise an initial diagnostic plan for the patient's most important problem. This computer-assisted system will help medical students learn diagnostic strategies in a simulated clinical setting. We believe that this system is a promising method that will facilitate problem-oriented learning in the virtual multimedia environment with special convenience for medical students to share time and facilities and to lower costs.
Many medical students seem to be more interested in clinical medicine topics than in social medicine topics. Through a problem-based, small-group learning course, we examined whether students' degrees of interest differ between topics and change during learning. At the start of the course, students were more interested in clinical/practical medicine topics than in industrial/environmental health topics. However, after the course their degrees of interest in both types of topic had increased and showed no significant difference. In particular, the degree of interest in sociomedical topics increased. In problem-based learning, knowing students' interests in learning about topics helps improve teaching strategies.