The aim of this study was to investigate using questionnaire surveys the effects of two events-enactment of the Organ Transplant Law and the first organ transplantations from brain-dead donors-on the knowledge, attitudes, and hypothetical behavior of medical students. Knowledge, including the judgment process, significantly increased after the law was enacted. After the law was enacted senior students were more likely to accept brain death and transplantation but freshmen were less likely. After the firstransplantation, freshmen were less likely to accept brain death and transplantation, whereas seniors showed little change in attitude. After the law was enacted seniors were more willing to donate either their own or their family's organs, but freshmen showed no change in attitude. However, after the first transplantation, the seniors' willingness to donate either their own or their family's organs decreased markedly. In conclusion, the effects of the two events on the attitudes and behavior of medical students were not straightforward and differed between freshmen and senior students. An increase in knowledge and an affirmative change in attitudes did not always cause an affirmative change in behavior.
We analyzed the scores of objective structured clinical examinations (OSCEs) and written examinations administered to fourth-year medical students after practical training in clinical skills and to fifth-year medical students after clinical training and scores of graduation examinations taken by sixth-year medical students. Correlations were analyzed among the scores of 96 students who had taken all 3 examinations during a 3-year period. Mean scores on examinations in the fourth, fifth, and sixth years were compared between sixth-year students who did or did not graduate and between graduating students who did or did not pass the national examination for medical practitioners in Japan. Significant correlations in the scores were found between 1) OSCEs and written examinations for fourth-year students versus those for the fifth-year students; 2) OSCE and written examinations for fourth-year students versus graduation examination scores for the sixth-year students; and 3) OSCE and written examinations for fifth-year students versus graduation examination scores for sixth-year students. In addition, the mean scores in the fourth and fifth years were significantly higher for sixth-year students who graduated and passed the national examination than for students who did not graduate or who graduated but failed the national examination. These results suggest that the practical training in clinical skills given to fourth-year students and the clinical training given to fifth-year students strongly affect the overall evaluation of the ability of sixth-year students and success on the national examination.
A new method for quality control of multiple-choice tests was developed with the assumption that there are two classes of items-beneficial and nonbeneficial-to evaluate students' ability. The information function is applied to distinguish these two classes. Of 316 items on multiple-choice tests at Tokai Medical School in 1993, 224 (70.9%) were beneficial and 92 (19.1%) were nonbeneficial. Between these classes, the averages of passing percentage and the discrimination index were significantly different. The percentage of beneficial items varies with the form of items, whereas the average discrimination index does not.
In Japan problems of the pediatric emergency-care system have recently increased the needs of consultation to deal with the growing anxiety of parents about how to raise their children and have decreased the number of pediatricians. We believe that one solution is to make pediatric primary care a required part of postgraduate clinical training and thereby increase the ability of nonpediatricians to provide pediatric primary care and to support the care of children. We hope that postgraduate clinical training programs will be reformed so that physicians of all departments can contribute to improving pediatric primary care.
Primary care education is extremely important for undergraduate medical students. We evaluated a primary care program with fifth-or sixth-year medical students at the Hokkaido University School of Medicine from October 2002 through July 2003. The aim of this study was to examine differences in the medical situation between a university hospital and primary care clinics and to determine the importance of primary care. We assessed students' opinions about primary care on the basis of student reports. After completing this program, medical students (30.7%) believed primary care medicine was necessary, recognized the importance of the medical techniques, and were motivated to study primary care medicine (93.6%). The problems of this program were the short schedule and the cost of public transportation. We conclude that this primary care program is extremely effective for teaching undergraduate medical students about primary care medicine.
To demonstrate the quality assurance of comprehensive examinations for fourth-year students at Nippon Medical School, scores on comprehensive examinations were compared with those on a trial of computer-based testing (CBT) of a nationwide medical and dental student evaluation system in 2003. Pearson's correlation coefficients between scores of two comprehensive examinations and the CBT score were 0.45 and 0.67, and the correlation coefficient between the average score of the two comprehensive examinations and the CBT score was 0.55. Fourth-year comprehensive examinations are useful tools for summative evaluation and prediction of CBT performance.
A clinical clerkship in medical informatics was introduced in the 5th year of medical school. One goal is computer literacy, which means comprehension of the hospital information system including security policy and privacy preservation. The other is information literacy; The students make presentations concerning the medical information system and information technology within approximately ten minutes. All participants were enthusiastic about preparing the presentation. Seventy percent of them acknowledged the significance of explaining persuasively to others what they studied and the usefulness of these skills developed in this clerkship in their future. This result implies the importance of the shift to information literacy.
To evaluate the educational effects of a lung-sound auscultation simulator, “Mr. Lung”, we compared outcomes of fifth-year medical students in 2001 and 2002. From June 2001 through March 2002, we used “Mr. Lung” for small-group teaching for 100 fifth-year medical students. The following year, we opened our laboratory so that the fifth-year students could study with “Mr. Lung” by themselves for 1 month. “Mr. Lung” was then used for objective structured clinical examinations in May 2002. From June 2002 through April 2003, we used “Mr. Lung” again for small-group teaching for 91 fifth-year students. The class consisted of 90 minutes' training for the auscultation of lung sounds. At the beginning of class, auscultation tests were performed in which the students listened through their stethoscopes to 3 examples of abnormal lung sounds on “Mr. Lung” and answered questions about the location and quality of the sounds. The percentages of correct answers in 2001 and 2002, respectively, were 36.9% and 35.4% for differences between bilateral lung sounds, 52.5% and 55.8% for coarse crackles, 34.1% and 58.3%(p<0.05) for fine crackles, 69.2% and 70.8% for wheezes, 62.1% and 90.7%(p<0.01) for rhonchi, and 22.2% and 32.6% for stridor. In conclusion, 1 month's self-study with “Mr. Lung” to prepare for the objective structured clinical examinations improves auscultation skills.