Community medicine clerkships are said to be an important element of current undergraduate medical education. However, little is known about what medical students actually learn from them.Therefore, we performed a study by means of significant event analysis to examine what medical students had learned from 2-week community medicine clerkships. 1) Students in 2006 took part in 2-week community medicine clerkships and then in sessions at the end of their clerkships to review their experiences. 2) The review sessions were recorded, and the students'impressions were extracted and categorized. 3) The depth of their impressions was categorized into 4 depth levels (describing, commenting, generalizing, and planning). 4) Students gave their impressions of the medical system, the role of physicians, patient-centered care, role models, and clinical ethics, and the impressions of most students were at the levels of commenting and generalizing. 5) Medical students learned system-based practice and medical professionalism during their community medicine clerkships, and significant event analysis was a valuable tool for understanding their experiences.
Recent changes in the relationship between physicians and society has affected the values and ethics of physicians, and a“Physician Charter”on medical professionalism has been drafted by the American Board of Internal Medicine Foundation, the American College of Physicians-American Society of Internal Medicine Foundation, and the European Federation of Internal Medicine.We conducted this survey to determine whether the“Physician Charter”can be used to examine the medical professionalism of Japanese physicians. 1) A questionnaire to examine the perceptions of physicians in Japan and the United States of the responsibilities of the “Physician Charter” was distributed. 2) In both countries 30% of physicians understood the contents of the “Physician Charter, ”and 60% believed the charter should be used in every country. 3) The physicians in the United States tended to consider most responsibilities more urgent than did Japanese physicians, and the perceptions of several responsibilities differed between physicians in the two countries.A generation gap among Japanese physicians was observed for some responsibilities.
In Europe and the United States, residents develop“burnout syndrome”or depression because of stress, and these conditions are associated with withdrawal from training programs and undesirable clinical outcomes, such as unethical practices.How stress affects Japanese medical residents and their practice is uncertain, as are factors that relieve stress.Furthermore, a theoretical model of stress in Japanese medical resident is uncertain. 1) Focus group interviews were performed for 25 junior residents at 10 institutions to explore their stress reactions and stress-relieving factors.A theoretical model of stress was then constructed. 2) Adverse effects in patient care and in training, in addition to events in daily life, were found to occur as stress reactions. 3) Improvements in the support system and positive feedback from patients were found to be stress-relieving factors. 4) A theoretical model of stress for trainee physicians was constructed and was similar to a general occupational stress model. 5) Stressors should be reduced and stress-relieving factors should be improved to improve the working conditions of residents and the quality of medical care.
Postgraduate residents face formidable stress. Unfortunately, many residents withdraw from training programs because of reactions to stress, such as depression. We performed a comprehensive study to examine the working conditions and stress of residents to improve the conditions of resident-training programs and reduce levels of stress. 1) The study examined 548 first-year residents starting postgraduate clinical training at 41 hospitals in Japan. A selfadministered questionnaire, which included questions about working conditions, job stressors, buffer factors, and stress reactions, was answered before and 2 months after the start of training. 2) A total of 318 subjects completed the survey.Of these subjects, 80 (25.2%) had depression after the start of training. 3) Job stress patterns of residents were characterized by high workload and extremely low “reward from work” and “Job control.” 4) Many residents had depression after the start of training.To improve residency programs, program directors should recognize the specific characteristics of residents' job stress and focus on buffer factors.
1) Although maternity leave can facilitate the professional success of female students.The extent to which maternity leave is implemented remains unknown.A cross-sectional questionnaire survey of all Japanese medical schools and postgraduate schools in medicine (N=81) was performed.Responses were received from 55 medical schools and postgraduate medical schools (response rate=67.9%).The results showed that no school had formally established a maternity leave policy for students. 2) We found that medical educators had reorganized clinical clerkship programs to accommodate the pregnancies of students but expressed confusion about how to manage such situations. 3) We also found that many female postgraduate students drop out because of pregnancy or child-care responsibilities. Medical schools and postgraduate schools should recognize the importance of maternity leave and should not close their doors to pregnant students who are contending with both motherhood and academic achievement.
1) Medical-interview behaviors that are effective in Western countries do not always work effectively in Japan. 2) Facilitation, the open-to-closed cone, and summarization effectively elicit physical information from patients. 3) Open-ended questions may effectively elicit emotional information from patients. 4) Reflection and legitimization increase patient satisfaction. 5) Patients' subjective assessment of the duration of a medical interview is based more on patient satisfaction than on the actual duration. 6) It is unclear whether nonverbal communication in Japan is more closely linked to patient satisfaction than it is in Western countries.
1) We visited 5 Scottish universities (the Universities of Aberdeen, St Andrews, Dundee, Glasgow, and Edinburgh) to observe and learn about simulated-patient programs and communication-skills training. 2) Each medical school has developed its own approach for using simulated patients in training and for giving feedback to medical students. 3) In Scotland, where all medical schools adhere to“Tomorrow's Doctors”and“the Scottish Doctor Curriculum Outcomes, ”curriculum styles vary greatly, but the differences are celebrated.The simulated-patient programs are integrated into each program in a way unique to each school.