There are some issues concerning the domains of “attitude” and “habit” which are indispensable for medical students, such as motivation for problem-based learning and acquiring skills for smooth communication with medical staff and patients. In addition, some well-known limitations exist in medical education in these domains. Kochi Medical School has introduced an admissions-office (attitude-evaluation) system for enrollment selection to assess the abilities that applicants have acquired through experiences since birth. Although this system has a very short history, a follow-up survey 1 year after admission strongly suggests that this type of entrance examination system based on attitude evaluation is effective.
This paper discusses medical records, which are often disputed during lawsuits and play an important role in the factfinding process. There have been no published reports of problems related to medical records or concrete measures to deal with these problems on the basis of a review of judicial precedents. To avoid lawsuits, medical records should be considered in the context of judicial precedents (previous court rulings). The present paper therefore analyzes basic matters related to medical records that were disputed during lawsuits, in relation to judgments obtained in previous court rulings, to determine the judicial role of medical records and their ownership. Although the ownership of medical records is unclear, we believe that patients have some ownership rights over their medical records, that hospitals are responsible for the control of the records, and that physicians have the obligation to use and prepare them. Therefore, medical records can be seen as being jointly owned by the medical care provider and the patient. Analysis of relevant judicial precedents has also allowed us to clarify essential points related to avoiding lawsuits.
The quality of medical education should be improved so that a physician's entire personality is nurtured. To this end, applying teaching methods from overseas educational institutions at Japanese medical schools would be beneficial. A discussion class taught at the University of Iowa is designed to increase the efficiency and consistency of interactive education. Numerous techniques for teaching discussion introduced at the University of Iowa might help improve the problembased learning methods now commonly used at Japanese medical schools. Moreover, the University of Iowa's method for teaching communication skills, which emphasizes interaction between instructors and students, can provide a model for medical students to acquire essential skills. Therefore, examining the comprehensive teaching system at the University of Iowa will help medical schools fulfill their expected social mission.
Every year since 2001 each series of lectures at the Sapporo Medical University School of Medicine has been evaluated using 10 questions with classification into five grades. In this study, the evaluation scores for 2001 and 2002 were compared and analyzed statistically. The average score for all subjects increased by 0.15 point in 2002. The average scores for liberal arts and clinical medicine increased 0.18 and 0.27 point, respectively, whereas the score for basic medicine increased 0.03 point, suggesting improvements with the efforts of each lecturer. The standard deviations of the scores for 8 questions (2 questions on examinations were omitted) were smaller for clinical medicine than for liberal arts and basic medicine. Continuous formative evaluation of each series of lectures and analysis of the results are needed to improve teaching skills.
Opinions of young physicians about a course on end-of-life care which they took at the Kyushu University Medical School 10 years earlier were analyzed. Fifty-seven (23%) of 247 graduates responded to a questionnaire. All clinicians had been involved in end-of-life care to some extent. All respondents agreed that a course about end-of-life care should be included in the medical school curriculum. In general, they thought highly of the course on end-of-life care that they took in medical school. They thought that such a course should last 10 to 20 hours and should be given after the end of clinical lectures and before the start of clinical training. The respondents suggested a good basic policy would be to attach importance to contemplating the end of life rather than to simply memorizing information about end-of-life care.
Video recordings of two styles of consultation were created to assess how a physician's nonverbal communication behavior affects patients. A physician spoke the same lines for both recordings but demonstrated different nonverbal behavior: “immediacy” in one recording and “psychological distance” in the other. The frequency and length of the physician's nonverbal communication behavior were measured. Then two groups of subjects were asked to watch one of the recordings ( “immediacy” recording, n=32, and “psychological distance” recording, n=34) and rate the nonverbal behavior on a scale of 1 to 5. Subjects recognized that the physician was warmer, smiled and nodded more often, and made more eye contact with the patient in the “immediacy” recording than in the “psychological distance” recording. These video recordings could be used in patient-satisfaction surveys and medical education.
We conducted a questionnaire survey of attitudes about cancer disclosure, brain death, and organ transplantation among fifth-year medical students at Nagoya University from 2001 through 2003. Their attitudes about these topics did not change markedly during the period. Most students favored receiving information about their own diagnosis of cancer, but significantly fewer students favored informing their parents about their diagnosis. Students did not have a strong interest in brain death or organ transplantation. Less than 30% of students possessed donor cards. This survey indicates that attitudes about cancer disclosure, brain death, and organ transplantation among Japanese medical students remain different from those among Western medical students. Instruction designed to address these differences may be beneficial.
To evaluate training methods for basic clinical skills before bedside learning, we used questionnaires to ask students and instructors their opinions about the fixed-instructor system, in which one instructor teaches the entire course, and the rotation system, in which instructors share responsibilities for teaching according to their specialty. Students had positive impressions of training with both systems. Many students felt that communication with in structors was good inthe fixed-instructor system and that the specialized education provided by multiple instructors was good in the rotation system. However, students expressed dissatisfaction about differences in educational content between the systems. Instructors believed an advantage of the fixed-instructor system was that skills learned could be applied to all medical fields, whereas the rotation system made teaching easier because it was specialized. On the basis of this investigation, we conclude that training should establish good communication between instructors and students and should include the required educational contents. We also found that unifying educational contents is difficult, regardless of the training system. Few reports about educational methods used to teach basic clinical skills have been published in Japan, but studies focusing on this issue are becoming increasingly necessary.
Medical students are considered to have performed favorably if they graduate without repeating a year and pass the National Examination for Medical Practitioners on the first attempt. The 715 students who entered Osaka Medical College from 1991 through 1997 were divided into groups on the basis of sex and the interval between high school graduation and medical college entrance. The percentages of students having performed favorably were compared between the groups. The rate of favorable performance in medical courses (and of passing the National Examination on the first attempt) was higher for students who entered college immediately after high school graduation than for students who entered college more than 1 year after graduating from high school. However, when students were divided by sex, male students showed this difference, but not female students did not. Next, we divided the 715 students into two groups on the basis of whether they chose biology as a subject for the college entrance examination. We found no difference in the rate of favorable performance between students who chose and did not choose biology. Therefore, we conclude that students can perform well in medical college, even if they do not choose biology as an entrance examination subject. However, among female students who entered college directly after high school graduation, the rate of favorable performance was higher for those who chose biology than for those who did not choose biology.