We conducted a nationwide survey to examine the primary care (PC) curricula for undergraduates at Japanese medical schools. The present status of PC curricula and the degree of recognition of the need for improvement were examined. Seventy (88%) of the medical schools in Japan responded. PC education programs have been organized and are carried out by various departments in each school. Of the 69 medical schools, 42% have a PC education program with lectures to teach the role of PC physicians, 65% have a program to provide experience in community medical care, and 80% have programs to provide experience in health care institutions and welfare facilities. Although the number of schools with lectures and experience programs for PC has increased at least three-fold in the past decade, many medical school presidents (more than 60%) recognize PC education should be improved. By comparing medical schools with and without experience programs in clinic more presidents of schools without such programs recognized the need to improve PC education.
With the increase in chronic diseases and the assertion of consumerism by patients, the “mutual participation model” has recently been advocated. This model has changed the traditional paternalistic doctor-patient relationship to a doctorpatient alliance in which doctors share information with patients to encourage their active participation in the treatment process. The gap between the doctor's and the patient's points of view could be bridged. Patient participation would be promoted by communication and information disclosure in the mutual participation model. We should clarify the effects of communication on both doctors and patients through empirical studies, which would also contribute to the improvement of medical education for communication skills.
There are few training programs in Japan for doctors who wish to practice in rural areas. We propose a postgraduate training program for doctors practicing in rural areas which would include the conditions of training hospitals and requirements for teaching staff. This program clarifies not only the content necessary for doctors practicing in rural areas but also the fundamental competence of all doctors. We sent questionnaires about this program to 24 physicians (20 working at university hospitals and 4 working at community hospitals). Physicians working at university hospitals replied that a program of 3 years is too short and contains too much material. Physicians working in a community hospital replied that this program would be extremely useful for medical students and residents who wish to practice in rural areas. Training programs for doctors who wish to practice in rural areas are needed to improve postgraduate training programs.
Systematic residency education curricula can provide students and residents opportunities to learn a broad range of clinical skills. One curricular model for Japanese general medicine departments (sogoshinryo-bu) is family-practice residencies in the United States. The values of family practice include first-contact care, continuity, comprehensiveness, coordination, community health, and care of the person. The precepting system is the pillar of resident education and provides the structure for physician-teachers to guide a medical school graduate to become a competent family physician by the end of 3 years of clinical training. Family-practice centers, community-based clinics where university faculty and residents provide care, have a proven record in the United States as clinical classrooms for teaching the values and skills needed for high-quality primary care and could greatly facilitate practice-focused training in Japan.
Teaching ambulatory-care medicine is essential for primary-care education. However, few studies of ambulatory-care training have been done in the past decade. We performed a nationwide survey to examine whether and how ambulatory medicine is taught to medical students and residents. We sent questionnaires to all medical schools (n=80) and accredited teaching hospitals (n=389) in February 2001. The response rates were 83.3% and 79.2%, respectively. Fifty-one (78.5%) of the 65 medical schools provided ambulatory-care education, although the programs varied considerably from school to school. Only 104 teaching hospitals (26.7%) had an ambulatory-care training program.
We organized a problem-oriented education program for fifth-year medical students to help them develop a patientoriented point of view. Each student was introduced to an outpatient who had never visited our hospital. Students escorted the patients through an entire day of care at the hospital but were not allowed to take part in clinical practice, even if tempted by a professor to perform a clinical examination. The students' duty was to record the time and nature of every event and to record every feeling they had while communicating with the patients. At the end of the day, a discussion was held with the students about the patients and problems in the clinics. The students pointed out the bitter attitudes of medical staff (64%), unbearably long waiting times (56%), inadequate signage (24%), some of which could be resolved with information systems. We conclude that the education program is effective for helping fifth-year medical students develop a patient-oriented viewpoint.
A medical-ethics course was anonymously evaluated by first-year students over 2 years. The course emphasizes problem-based learning through group discussion of clinical cases and lectures on ethical issues. A tutorial system was added to the course in the second year. Students' evaluations indicated that most students had positive attitudes about the course and that both group discussion and lectures were helpful for achieving the general instructional objectives and specific behavioral objectives of the course. A comparison of the 2 years showed that a majority of evaluated items received higher evaluations from second-year students than from first-year students. We attribute the difference to the livelier discussion with the introduction of the tutorial system and the smaller discussion groups. These results indicate that students consider medical-ethics education to be useful.
This is a report on a workshop entitled “Integration of Complementary and Alternative Medicine (CAM) into Medical Education Curriculum: Models In-Progress” held at the International Scientific Conference on Complementary, Alternative and Integrative Medicine Research. Four universities, supported by funds from the National Institutes of Health, described their curriculums for medical students, and we discussed how to integrate CAM into conventional medical education. They recommended that CAM curriculums should be interdisciplinary and be developed by specialists in various fields. They emphasized the need to train students to evaluate CAM by means of evidence-based medicine and to embrace CAM.
We are medical students (second-year students) who visited Thomas Jefferson University in Philadelphia for 2 weeks during summer vacation. We audited some psychiatry classes and visited several departments at the Thomas Jefferson. University Hospital. Through these experiences, we learned about differences in healthcare between Japan and the United States. Furthermore, we started to think about the future of medicine.