Although postgraduate training in an ambulatory care setting is recognized as beneficial in Japan, such training has not been widely implemented. In April 2001 we surveyed all 389 accredited teaching hospitals in Japan about their ambulatory care training. We asked 1) whether they provide a postgraduate training program in ambulatory care, particularly for problems commonly encountered in primary care settings, 2) if such a program was provided, how it was organized, and 3) if such a program was not provided, what the reasons were. One hundred eighty physicians responsible for the residency programs of 120 hospitals replied (response rate, 87%). Most residents at these hospitals see patients in outpatient clinics regularly during their training. Many faculty members supervise their residents at the outpatient clinic and also see their own patients. Sixty-eight percent of the respondents did not set teaching objectives for ambulatory care training. Frequently mentioned barriers to providing ambulatory care training were limited space and tight outpatient schedules. To promote postgraduate ambulatory care training in accredited teaching hospitals, adequate resource allocation and a national policy are needed.
Since the model core curriculum was shown in public, the discussion about the medical education is getting hot in every medical school. In the model core curriculum, the integrated course is designed with the basic sciences and the clinical medicine via pathophysiology, which will be educated by the PBL tutorial. Thus, the model core curriculum is suitable for growing up better clinician. The problem involved in the context is the lower recognition to the basic sciences and also the missing of the next generation in the teaching staff of the basic sciences. The introduction of the information technology to the medical education should be much progressive. The new integrated course with the structure and function should be designed with the information technology, which will fit to the new medical education in the 21st century.
Remedial education in the basic sciences (biology, physics, and chemistry) for medical students was introduced at Kinki University in 1993. The effects and problems of premedical education were examined on the basis of a questionnaire to students and of scores on biology examinations at the time of university entrance and at the end of the first academic year. From 1999 through 2002, the average percentage of incoming freshmen who had not taken a biology course in senior high school ranged from 45.8% to 61.6%. The average score of these students on biology examinations was 23.2 to 29 points higher at the end of the first academic year than at university entrance. Thus, we found that remedial education helped improve these results. However, according to the questionnaire 26.4% of students who received remedial education felt that it had had no effect. Even at the end of the first academic year, the difference in the average score between students who had studied biology in high school and those who had not was 17 points.
The Ibaraki Prefectural University of Health Sciences has introduced an integrated education management system to improve the quality of education. The management system was implemented by the Academic Affairs Committee and is run by the newly-created Kyouiku Suishin Shitsu (Educational Development Services). The management system evaluated past curricula and coordinated the introduction of new courses and integrated curricula designed to stimulate selflearning by students. The management system also integrated the student evaluation system and simultaneously coordinated faculty development workshops for all university staff to improve teaching skills. Several questionnaires showed that the new curricula met students' learning needs and provided a more objective evaluation system. The integrated education management system functions as a positive component in the improvement of the education system for students of allied health professions.
To evaluate the training effect in cataract surgery, we studied four right-handed ophthalmologists who were learning temporal corneal incision. The surgical technique included phacoemulsification of cataractous lens nuclei with an ultrasonic handpiece and insertion of intraocular lenses with the right hand for the right eye and with the left hand for the left eye. We recorded the ultrasound time and energy to evaluate the training process quantitatively and compared 10 early cases with 10 cases treated after 6 to 15 months of training. We found that ultrasound time decreased after training and did not differ significantly between the right and left hands for three trainees. However, one trainee continued to require longer ultrasound time with the left hand even after training. The reduction in energy was greatest for the youngest trainee, indicating the training effect was also greatest. We could evaluate the training process quantitatively and could determine individual characteristics for a standardized technique, such as phacoemulsification in cataract surgery.
We have developed a training system for endophthalmic surgery at Osaka Medical College and reviewed its effects on residents. The training program consists of preoperative and postoperative examinations, lectures on techniques such as suturing through microscopes, and exercises with pig eyes. Residents can practice any time with microsurgery instruments in our department. Such practice enables residents to acquire skills more easily. Highly sensitive microphones are attached to operative microscopes so that residents can learn during surgery and watch videotapes with faculty members afterward. Exercises with pig eyes are especially useful for practicing microsurgery. After basic training, residents start performing actual surgeries step by step under the supervision of faculty members until they master the basic techniques. We think highly of our educational method. Teaching hospitals should establish efficient systems for training in cataract surgery without negatively affecting patients.
In 2002, Japanese medical students began computer-based testing (CBT) to assess their basic and clinical medical knowledge, based on the model core-curriculum, before starting clinical clerkships. Of 9, 919 multiple choice questions submitted by 80 medical schools, 2, 791 were used for CBT and 7, 128 were rejected. To improve the quality of future CBT, we analyzed why questions were rejected. The most commons reasons were difficulty, length, and inappropriate choice of answers. A training course may be needed to improve the ability of medical school staff to devise questions.
We examined issues in balancing professional obligations with family needs, especially parenting, in female physicians. Questionnaires were given to all female physicians who had graduated from Jichi Medical School. Of the 196 graduates, 155 responded (79.1%), and younger graduates accounted for a greater proportion of subjects. Although many female physicians did not live with their parents, female physicians or their parents were usually responsible for caring for children when they become ill. Many respondents demanded better access to day care and greater flexibility in accepting sick children. Female physicians should contribute to society using the knowledge and skills they acquired in medical school; to do so they need support systems in their workplace and child-care services.