Learning auscultation with a cardiac sound simulator is extremely beneficial for medical students. However, the students should first choose a good stethoscope and learn how to use it well. Common problems that students have are: 1) failure to press the bell of the stethoscope firmly against the skin, 2) lack of audibility due to low-intensity sounds and inability to recognize the timing of sounds, and 3) difficulty in discriminating the systolic and diastolic phases. The cardiac sound simulator improves the accuracy of cardiac examination because it allows the precise timing of cardiac auscultatory events. Onomatopoesis, in which students mimic the sounds they hear, is also useful for learning auscultation with a simulator. However, the simulator is not well utilized, if students just listen to the sounds as they are produced by the simulator. We should assess the usefulness and limitations of the cardiac sound simulator and understand the likely pitfalls of auscultation.
To examine the present state of postgraduate ethics education for residents in Japan, we sent an anonymous self-administered questionnaire to the directors of all 640 hospitals in Japan with a registered postgraduate clinical residency program. A total of 258 hospitals returned the questionnaire (response rate: 40.3%). Of these hospitals, 69 (26.7%) had a program for ethics education and 189 (73.3%) did not. The presence of a program was strongly correlated with the number of hospital beds and a history of problems with ethics education. Respondents showed a high degree of awareness about such significant topics in ethics education as “informed consent, ” “patient privacy, ” “patient rights, ” and “physician duties.”
In the United States, the Family Case Study is a tool used in family medicine to teach students about clinical problems and the effects of illness on the patient and the family. Because the Family Case Study is not well known in Japan, the purpose of this paper was to introduce the Family Case Study on the basis of our experiences and to describe its implementation in the Department of Family Medicine of the University of Michigan Medical School. Although the Family Case Study must be adapted for Japan, we urge its use as a practical means of learning about family medicine and the concept of the biopsychosocial approach through practical learning experiences.
A survey was performed to examine residents' awareness of patient safety. Sixty-two residents who had just finished their first year of residency participated in the study. Of the 62 residents, 30 were training at Yokohama City University Hospital and 32 were training at other hospitals. Although all residents knew about the serious medical mishap ( “surgical mix-up” ) that had occurred at Yokohama City University Hospital in 1999, only 53% knew about the judicial verdict in this case. The residents most often believed that the mishap was the fault of the hospital and its system (82%), followed by nurses (73%), supervising doctors (62%), and residents (45%). Seventy percent of the residents knew about the “Incident Reporting System, ” but only 20% had written an incident report. Incidents experienced or observed by residents were most often medication-related. No significant differences in the results of the survey were found between residents of Yokohama City University Hospital and those of other hospitals. In conclusion, although residents recognize the importance of patient safety at the end of the first year of their residency program, they still cannot deal properly with incidents.
Conjoint analysis was used to assess resident preference for teaching hospitals that offer postgraduate clinical training programs. Data for the analysis were collected from 46 clinical residents who participated in an emergency room seminar held in July 2005. Categories that received high utility scores in the attributes of teaching hospitals were “hospital has a renowned teaching doctor”, “hospital is partnered with overseas institutions”, “conferences/study sessions are held more than 8 times per month”, “bedside teaching takes place daily”, “a monthly salary of 500, 000 yen”, “80 working hours per week”, “the hospital is located in a nearby city”, and “the hospital is not affiliated with a university” . Conjoint analysis is a useful analytical method for developing education systems and programs, as it can predict the degree of change in resident preference made by improving these categories.