The aim of this research was to explore the educational effects of home-care training on resident trainees which have not previously been deliberately examined. We performed a qualitative study. Focus-group interviews were conducted to explore the views of residents who underwent medical training in 3 different settings: inpatient, outpatient, and home-care. Analysis of the interview data revealed 8 categories of resident experiences and their views on the effects of home-care training: 1)recognition of the importance of the concerns of the patient and the family in medical communication; 2)development of patient-centered and family-centered attitudes; 3)acquisition of the knowledge and skills of management, other than medical management, in home-care; 4)appropriate cooperation with other health professionals; 5)recognition of options for care settings; 6)knowledge of the community; 7)recognition of healthcare resources in the community; and 8)acquision of effective use of medical knowledge and skills. The findings of this study suggest that home-care training is effective for helping residents to develop patient-centered communication skills and attitudes and to develop management skills for a multidisciplinary team in the community to complement medical training in inpatient and outpatient settings.
1)With the implementation of mandatory clinical residency in Japan, resident evaluations have become an important part of clinical education. Recently, however, a greater emphasis has been placed on the evaluation of physician instructors. In the West, research examining the teaching skills of clinical physicians has been ongoing since the 1970s and is reviewed in this paper. 2)The Objective Structured Teaching Evaluation (OSTE), which uses standardized students, multiple stations, video recordings, and scoring by observers, was developed in the 1990s. 3)Unlike the Objective Structured Clinical Examination, which is an evaluation tool for medical students and residents, the OSTE is rarely used to evaluate individual performances or used as a part of certification exams. Instead, the OSTE serves as a tool for faculty development or as an outcome measure for the effectiveness of faculty development education initiatives. 4)If available in Japan, the OSTE would be an excellent resource for improving the teaching skills of physicians and would be a useful tool for training sessions for physician instructors. More research is needed to facilitate the introduction of the OSTE to Japan in the future.
1) Empathy is a psychological phenomenon that cannot be observed from the outside. The Japanese word kyokan is used to mean both "empathy" and "sympathy" in English. Therefore, instruction in and assessment of empathy are difficult and involve confusion. 2) In the "dialogue method" proposed in this paper, the responses of the medical care staff are divided into "confirmative responses" and "reactive responses." Instruction with this method contributes to the improvement of medical communication skills. 3) The effect of a "confirmative response" is similar to that of empathy. If attention is paid to these verbal communication skills, empathy can be assessed as an observable skill.
Many medical universities have developed community-medicine clerkships. However, few studies have examined what medical students have actually learned from these clerkships. 1) In 2006 students participated in a 2-week community-medicine clerkship, during which they were required to write about their experiences on a daily reflection sheet. 2) All reflection sheets were collected and analyzed. What students had learned from their clerkships was abstracted from the descriptions on their sheets, and the contents of students' learning were categorized. 3) The total number of abstracted learned items was 2243. The numbers of learned items for the areas of medical knowledge, communication, medical skills, clinical reasoning, clinical management, and patient management were 334, 232, 214, 111, 106, and 102, respectively. Learned items in these areas accounted for 49.0% of the total. 4) The numbers of learned items concerning the community and families were 84 (3.7%) and 117(5.2%), respectively, and were lower than the numbers for other categories. 5) A new strategy must be developed to enhance students' learning about the community and families.
1) Since the 2006 academic year, we have developed a 13-hour course in professionalism for fifth-year medical students at Sapporo Medical University. 2) The course included lectures and small-group discussions on the concept of medical professionalism, the definition of medical professionalism, clinical ethics, legal understanding, and the crisis of community medicine. At the end of the course, the students created their own student physician charter and recited it at the student physician charter ceremony. 3) Seventy-four percent of students evaluated the course positively, 18% pointed out positive and negative aspects of the course, and 8% evaluated the course negatively.
1) To become physicians who care for patients as human beings, medical students must know about child welfare. A serious problem in the fields of medicine and welfare is child abuse. Collaboration is needed to support children and families, but many challenges exist. 2) The goal of our Multidisciplinary Team Workshop, which started in 2006 and targets students in a wide range of fields, is to educate future practitioners about the necessity of multidisciplinary collaboration. 3) More than 80% of the participating students felt the workshop was useful, and the participation of medical students increased the significance of the workshop for students from other disciplines.