Introduction: In Japanese emergency departments, many physicians have to decide immediately whether they should limit life-sustaining treatments for critically ill elderly patients who may be at their end-of-life (EOL) or in cardiopulmonary arrest. To propose effective medical training, we investigated the ability of junior residents to recognize this challenging problem.
Method: We conducted a semi-structured interview of 38 junior residents who had completed the junior residency program of University Hospital, Kyoto Prefectural University of Medicine. We then qualitatively analyzed the transcripts of the interviews.
Results: Through observation of the attending physician's interview, which is a discussion about decision-making with the patients and their families, junior residents recognized the problem of EOL and made their decision. Finally, they preferred "doctor-led discussion" or "neutral discussion."
Discussion: We recommend that attending physicians should give junior residents many opportunities to observe their interview about decision-making.
Introduction: Fundamental Simulation Instructional Methods (FunSim) is an international simulation faculty development course for Japanese healthcare educators, with English and Japanese language versions. The objectives of this study were to assess post-course outcomes of international "FunSim" , and identify barriers to the implementation of simulation-based education (SBE) for Japanese simulation educators.
Methods: Using a 73-item web-based questionnaire, FunSim course outcomes were assessed at Kirkpatrick model level one (Reaction) ; two (Learning) ; and three (Behavior) . A Likert-type rating scale (1-7) was used for course evaluation (level one) , and for confidence and competency (level two) ; four different types of Yes-No question were used for level three. A Likert-type rating scale (1-5) was used to rate twelve pre-defined potential barriers to the implementation of SBE methods.
Results: A total of 178 (63%) of 283 participants responded; FunSim language was 47.8% English (E) and 57.3% Japanese (J) , with no differences between (E) and (J) "language barrier" responses. Eighty-eight percent of ratings for the 7-course evaluation items were > 4. Confidence and competency scores decreased "at the time of the survey" compared to "at the end of the course" (P<0.05) . Pre/Post-course participants who were active simulation faculty members increased from 68 to 112 (P<0.001) . Human factors such as "Simulation specialist availability" , " Time for teaching and faculty development" , " Number of trained faculty" , "Faculty development availability" , and "Faculty skill" were predominant barriers compared to other issues.
Conclusion: FunSim participants reported positive course feedback and no critical language barriers. Barriers to the implementation of SBE are primarily human factors. Work release, hiring simulation specialists, and faculty development must be addressed to establish effective SBE systems.
Few studies have examined medical students' perceptions of community medicine and specialty choice through comparison between students of quotas related to community medicine and regular admission. We conducted a questionnaire survey on students' desire for future work places, types of health facility/hospital, medical specialization, and community medicine involving year 1 to year 5 students in Gifu University School of Medicine (n=335, selective admission: regular admission=81:254) . This study demonstrated that the selected students for community medicine (years 1 to 5) preferred to work at a core/small-sized hospital in a rural area and tended to choose the specialties that were characterized by primary care, such as pediatrics. Moreover, they had positive perceptions of community medicine. Further follow-up study needs to be undertaken in order to explore how students are actually engaging in community medicine after graduation.
It is necessary to perform out-patient training in order to acquire the basic medical skills of primary care. However, the actual situation of out-patient training has not been clarified in Japan. Therefore, we performed a survey of out-patient training by junior residents at university hospitals throughout Japan.
A questionnaire survey was performed on out-patient training for junior residents at 80 university hospitals (main hospitals) nationwide. We received responses from 39 hospitals. The hospitals where out-patient training by junior residents was performed numbered 34, and there were 26 hospitals in which the training in out-patient reception hours is being performed. Hospitals which received training on related hospitals were also noted. There were many hospitals receiving a few patients with common symptoms. It is important to conduct training in university hospitals in cooperation with local hospitals.
In this study, the impact of our training program on students' education was surveyed based on the 3 aspects of knowledge, skills, and attitudes. The data of 11 occupational therapy students were reviewed, who had received long-term clinical training in Fukuma Hospital.
From the aspect of knowledge, the past questions from national examination for medical practitioners were revised for use as criteria, since there were no other appropriate evaluation indicators. From the aspect of skills, "Interpersonal Relations" and "Work" , the subscales of Life Assessment Scale for the Mentally Ill (LASMI) were used. From the aspect of attitudes, the Attitudes Toward Disabled Persons (ATDP) scale was utilized.
As a result, from the aspect of knowledge, the performance deteriorated. From the aspect of skills, "Interpersonal Relations" with patients improved. From the aspect of attitudes, we compared the former to latter regarding the 3 factors, extracted by Yamamoto, et al., and they came to recognize the patients' ability negatively. From these results, the impact of our clinical training on students' education was discussed to formulate some proposals concerning future training.
The higher level postgraduate education hospitals are required to have a system with well-developed programs, instruction, and supervision of doctors in clinical training. The Social Medical Corporation Kojunkai Daido Hospital has been maintaining efforts to be a clinical training hospital of excellence.
In order to nurture supervisory doctors, the first workshop for supervisory doctors in clinical training was held at Daido Hospital on February 22nd and 23rd, 2014. With consciousness reform in mind, interprofessional relations between the many types of medical professional were established.
Daido Hospital was evaluated by the Japan Council for Evaluation of Postgraduate Clinical Training on December 12th, 2014. It was an opportunity to recognize the need for further improvement as a clinical training hospital.
On March 7th, 2015 the Objective Structured Clinical Examination for the second year of training doctors in Daido Hospital was held. Clinical training guidance doctors, Nurses, and paramedics learned the skills necessary for the methods and the evaluation in clinical teaching and evaluation.
Daido Hospital continues making efforts by conducting a review of the clinical training based on the evaluation of the clinical ability of residents, the ability for education and the clinical skill of teaching doctors, and the training environment.
Background: Electronic portfolios (ePFs) which can be accessed from personal computers and mobile devices are gaining in importance in medical education.
Methods: We sent out by post written invitations to participate in an online survey to the medical education units of all 80 medical schools in Japan.
Results: Of the 70 schools from which replies were received, 16 use paper-based portfolios, 14 use ePFs, 8 use both, and 32 do not use either. The most commonly used ePF systems are Mahara, manaba folio, and WebClass, and they are used in particular for clinical training. An increased burden on the faculty is considered a demerit of ePFs. Compared with paper-based portfolios, ePFs facilitate timely feedback and the better storage and sharing of data, but, on the other hand, they are demanding in terms of infrastructure and technical administration. Current ePF solutions are not considered optimized for medical education.
Discussion: There is a need for the development of a common ePF environment for use in medical education.