In March 2001, Research and Development Project Committee for Medical Educational Programs proposed a model core curriculum for undergraduate medical education. In this curriculum, implementation of the clinical clerkship is strongly recommended. Two similar curriculum models were later presented by other organizations, and some differences were observed among them. We, Undergraduate Medical Education Committee, have evaluated and compared themodel core curriculum 2001 with the Japanese newer proposals as well as those of USA and UK. Here is reported our proposals for a better rewriting of the learning objectives in the model core curriculum 2001, with some emphasis on the nurture of the competence of the case presentation and decision making process.
In order to implement, or enhance the quality of clinical clerkship, it is necessary to develop good educational environment which will be appropriate to allow medical students participate in medical team services. Important things to be considered will be, (1) Systematic management of the individual department's program by the faculty of medicine, (2) Developing educational competency within the medical care team function, and (3) Nurturing students' awareness forself-diected learning and cooperative team work, and teaching- and medical staffs' awareness of their educational responsibilities. In this paper, to develop better educational environment for clinical clerkship, we propose a desirable situation of the educational organization, dividedly describing on the roles of dean, faculties, board of education, department of medical education, clerkship director, teaching physicians, residents and medical students.
“Cardiac Cycle: The First Step, ” which discretely, non-ambiguously, and accurately presents basic essential information on the cardiac cycle, was compared with conventional material in terms of educational efficiency. Twenty-six first-year medical students were randomly assigned to either material. The conventional group was presented with a standard textbook with a typical figure and text. The students were blinded as to the origin of the materials. After self-study, the same quiz (30 two-item choice questions asking basic essential information) was given to both groups and was scored by a blinded rater. The number of correct answers was 25.7±3.7 (mean±SD) in the conventional group and 29.4±1.1 in the ‘first-step group’(p<0.01).
To clarify the core competencies developed through postgraduate clinical training, we analyzed the conditions of our residency program with qualitative research methods. Seven residents (6 first-year residents and 1 second-year resident) answered a questionnaire and underwent semistructured interviews about postgraduate training. We also worked with the residents as “participant observers” of the treatment team. We found that residents often had trouble formulating diagnostic/treatment plans and tended to rely excessively on laboratory data to make decisions. We attribute these problems to a lack of practice in questioning expectations. We hypothesized that mitate-ryoku, the ability to describe the course of a patient's illness, is an extremely important clinical competency. According to the hypothesis, we tried to listen to the residents' description and to discuss it logically as colleagues. The residents described the patients expected condition over the next few days, considering both data and information they obtained from interviews and physical examinations. They adapted their ideas through logical discussion and were thus able to make acceptable decisions by themselves.
To assess the acceptance of peer physical examination training and the acquisition of professional attitudes as medical doctors, a questionnaire was given to 245 medical students (second, fourth, and sixth year) of Chiba University. All students recognized the value of peer physical examination training, and female students recognized the necessity of training with male examinees. Male students accepted roles of both examiner and examinee, but female students refused to be examined by male students or to be taught by male instructors. The genders of students and instructors must be considered when physical examination curricula are planned.
Although great changes have already been made to medical education in Japan, the public health system urgently requires a paradigm change in the educational model. Recently, changes in the concept of public health have been proposed as “New Public Health” based on the World Health Organization's Health Promotion Movement in developed countries. We defined the core concepts and basic theories of New Public Health and have evaluated the validity to New Public Health of the community-based public health education model used since 1978 at Shimane Medical University. We have also established an educational environment that supports the development and dissemination of the model.
The current conditions of the medical system and the health insurance system in Japan and situations in other countries indicate that pharmacoeconomics will become indispensable for pharmacists. In the model core curriculum issued by the Pharmaceutical Society of Japan in August 2002 pharmacoeconomics is a special field of pharmaceutical science to be taught at colleges. However, most instructors at colleges of pharmaceutical science are unfamiliar with pharmacoeconomics. I shall describe efforts to introduce pharmacoeconomics into the curriculum for pharmaceutical science. Because some instructors opposed a class devoted to pharmacoeconomics, I started to teach pharmacoeconomics as a part of an existing class. Considerable effort will be required to establish a required class devoted to pharmacoeconomics.
To increase the safety and effectiveness of clinical clerkships, we have developed a 4-week preclinical training program, “Problem-Based Clinical Training, ” based on the concept of problem-based learning with the aim of encouraging life-long self-directed learning. The first week is a preparation period for clinical practice in which students are trained in problem-solving skills, basic-practice skills, and clinical reasoning. The second and third weeks are a practical training period in which students learn how be in charge of a patient's care. The fourth week was a problem-solving period without practical training in which students learned to solve problems. The students were encouraged to record daily “problem notes” describing problems and “problem solving notes” summarizing problems solved. To emphasize lessons learned, the students also presented and discussed problems. Evidence-based medicine was used as a tool for problem solving. Furthermore, medical record training based on the problem-oriented system using evaluations by other students encouraged self-development to improve clinical practice and the medical record. This curriculum should be effective for mastering the skills of self-directed learning and for motivating for advancement due to consideration of contributable proposals for the patients.