Japanese Medical Schools Research Articles

Mixed-methods study of medical students’ attitudes toward peer physical examinations in Japan

BackgroundMost Japanese medical schools likely continue to rely on peer physical examination (PPE) as a tool to for teaching physical examination skills to students. However, the attitudes of medical students in Japan toward PPEs have not be identified. Therefore, we evaluated students’ attitudes toward PPE in a Japanese medical school as a preparation for developing a PPE policy tailored to the context of Japanese culture.MethodsWe conducted a mixed-methods study with an explanatory sequential approach, in which qualitative data were used to interpret the quantitative findings. Surveys and interviews were conducted with medical students and junior residents at a Japanese university. A total of 63 medical students and 50 junior residents responded to the questionnaire. We interviewed 16 participants to reach theoretical saturation and investigated the attitudes of medical students toward PPE and the themes emerging from the interview data, providing detailed descriptions of the quantitative findings.ResultsFemale participants were significantly more likely than male participants to report varying degrees of resistance to being a model patient during PPE (male: 59.7%, female: 87%, p < 0.001). Most of the participants who took on the role of patients that involved undressing were males. The participants expected improvements in issues related to the guarantee of freedom to refuse to be a model patient and measures to protect confidentiality. Approximately 22% of the participants reported that they witnessed incidental findings (including variations within the normal range) in front of other students during PPE.ConclusionsThe findings imply that medical students expect high levels of autonomy and confidentiality when volunteering as model patients during PPE. Thus, developing a PPE policy suitable for Japanese culture may be effective in establishing a student-centered PPE environment.

A Trial to Convert Graduation Competency Question-naire Data into Key Performance Indicators in Japanese Medical Schools

A Trial to Convert Graduation Competency Question-naire Data into Key Performance Indicators in Japanese Medical Schools

Factors associated with regional retention of physicians: a cross-sectional online survey of medical students and graduates in Japan

BackgroundPhysician shortage and maldistribution is an urgent health policy issue requiring resolution. Determination of factors associated with regional retention and development of effective policy interventions will help to solve this issue. The purpose of the present study was to identify factors associated with regional retention and discuss their policy implications.MethodsWe conducted a cross-sectional online survey from February to March of 2022 for graduates from regional quotas (special quotas for medical schools to select students engaged in community medicine) and Jichi Medical University (JMU) and students at 10 medical schools including JMU. Completed surveys were obtained from 375 graduates and 1153 students. Questions included intention to continue to work in their home prefecture in the future, as well as background information and potential factors associated with regional retention. In the analyses, regional quotas and JMU were referred to as community medicine-oriented programs and schools (CMPS). We performed logistic regression analyses to identify factors associated with regional retention.ResultsAmong the students, scholarship-bonded obligatory service, satisfaction with current life, intention to belong to ikyoku (a traditional physician allocation/training system in Japanese medical schools), and interest in general practice/family medicine were significantly positively associated with regional retention. Among the graduates, satisfaction with training environment, intention to belong to ikyoku, and recommending their program to high school students were significantly positively associated with regional retention. For students of CMPS, satisfaction with the career development program was positively associated with future regional retention. For graduates, this association was observed only in the crude analysis.ConclusionsIn addition to known factors such as interest in general practice/family medicine, intention to belong to ikyoku had a substantial impact on regional retention. The present results suggest that the career support system represented by ikyoku as well as a career development program are of potential importance for increasing regional retention through the mechanisms of a sense of belonging and a life-long education system. These findings provide useful information for the development of further policy interventions that interweave traditional and new systems to maximize their effectiveness.

Proposing a Questionnaire for Assessing English Proficiency Among Japanese Medical Students: Current Perspectives and a Pilot Survey.

Background Japanese medical schools have made advances in terms of English and Medical English teaching in the past decade, in keeping with their importance in medical communication and research. English skills and proficiency levels differ across different institutions due to the variable adoption of general teaching requirements. A limitation in assessing English proficiency among Japanese medical students continues to exist due to the lack of standardized testing requirements. Methods A new questionnaire was developed by faculty members and medical students. Areas of importance were: demographics, proficiency and confidence ratings, history of learning and usage, duration of usage, perceived importance, and improvement goals. The final draft of the constructed questionnaire contained 21 questions in total. The questionnaire was administered over a three-month period in incremental order of enrollment through a digital online platform. Results A total of 133 students, 64 (48.1%) males and 69 (51.9%) females, participated. The average age was 23.7 ± 4.8 years. Based on an incremental Likert scale, respondents rated themselves as 1.0 ± 0.8 for English proficiency and 0.5 ± 0.7 for Medical English proficiency. The confidence level for English medical discussions was 0.2 ± 0.6 on a similar scale. Students on average attended 18.0 ± 30.0 classes per year and presented medical materials in English around 1.7 ± 1.7 times in total. The English language was used for 2.1 ± 6.3 hours per week in personal settings and 0.5 ± 1.7 hours per week in professional settings. Conclusions The proposed questionnaire was able to give valuable information about language skills and proficiency levels, but would require an incentive for improved participation. The pilot analysis showed that English and Medical English proficiency levels remain low with limited opportunities for using English in some areas within Japan. It may be beneficial to provide Japanese medical students with more occasions where they can use or practice their English skills.

Effect of problem-based learning tutor seniority on medical students’ emotions: an equivalence study

BackgroundThe effectiveness of peer learning has been recognized and discussed by many scholars, and implemented in the formal curriculums of medical schools internationally. However, there is a general dearth of studies in measuring the objective outcomes in learning.MethodsWe investigated the objective effect of near-peer learning on tutee’s emotions and its equivalence within the formal curriculum of a clinical reasoning Problem Based Learning session in a Japanese medical school. Fourth-year medical students were assigned to the group tutored by 6th-year students or by faculties. The positive activating emotion, positive deactivating emotion, negative activating emotion, negative deactivating emotion, Neutral emotion were measured using the Japanese version of the Medical Emotion Scale (J-MES), and self-efficacy scores were also assessed. We calculated the mean differences of these variables between the faculty and the peer tutor groups and were statistically analyzed the equivalence of these scores. The equivalence margin was defined as a score of 0.4 for J-MES and 10.0 for the self-efficacy score, respectively.ResultsOf the 143 eligible participant students, 90 were allocated to the peer tutor group and 53 were allocated to the faculty group. There was no significant difference between the groups. The 95% confidence interval of the mean score difference for positive activating emotions (–0.22 to 0.15), positive deactivating emotions (–0.35 to 0.18), negative activating emotions (–0.20 to 0.22), negative deactivating emotions (–0.20 to 0.23), and self-efficacy (–6.83 to 5.04) were withing the predetermined equivalence margins for emotion scores, meaning that equivalence was confirmed for these variables.ConclusionsEmotional outcomes were equivalent between near-peer PBL sessions and faculty-led sessions. This comparative measurement of the emotional outcomes in near-peer learning contributes to understanding PBL in the field of medical education.

Regional quota replaced by COVID-19 quota?: the dilemma of Japanese medical school admissions.

Regional quota replaced by COVID-19 quota?: the dilemma of Japanese medical school admissions.

Complex motivations of Japanese medical students to an online medical English course during the COVID-19 pandemic

Background: In response to globalism, many East-Asian countries now include a Medical English course in their undergraduate medical education syllabus. Traditional didactic educational culture is a potential barrier for teaching and learning medical English in East-Asian countries. Online technology-based learning has been recognized as an effective instructional strategy for teaching medical English in the East. The purpose of this study was to explore the relationship between the related attribute factors of students' motivation to learn medical English through an online modality. Methods: Of 134 eligible fourth-year medical students who participated in an online medical English course at a Japanese medical school, 105 were enrolled in this single cohort study. The participants completed pre- and post-course surveys regarding their motivation during the course, including perceived academic control and task value, and their assignment scores. A structural equation model was used to examine the hypothesized relationship of constructs, based on control-value theory. Results: The model showed a good fit for the data (χ 2[df=7] = 1.821, p=0.969, CFI = 1.000, RMSEA &lt; 0.001, SRMR &lt; 0.05, GFI = 0.993, AGFI = 0.980). The latent variables of the perceived course achievement related to the observed variables of academic control and task value scale scores, and negatively predicted willingness for self-study after course completion. In addition, the preference of English as the course language negatively predicted willingness for self-study of medical English. Conclusion: Choice of English as the language of instruction and perceived high course achievement negatively predicted students’ motivation for further English self-study after the class. The importance of incorporating the perspective of lifelong learning into the teaching of medical English was recognized.

Eleven years of data on the Jefferson Scale of Empathy – medical student version: Japanese norm data and tentative cutoff scores

BackgroundMore and more studies investigate medical students’ empathy using the Jefferson Scale of Empathy (JSE). However, no norm data or cutoff scores of the JSE for Japanese medical students are available. This study therefore explored Japanese norm data and tentative cutoff scores for the Japanese translation of the JSE-medical student version (JSE-S) using 11 years of data obtained from matriculants from a medical school in Japan.MethodsParticipants were 1,216 students (836 men and 380 women) who matriculated at a medical school in Japan from 2011 to 2021. The JSE-S questionnaire was administered to participants prior to the start of the program. Data were summarized using descriptive statistics and statistical tests were performed to show the norm data and tentative cutoff scores for male and female students separately.ResultsThe score distributions of the JSE-S were moderately skewed and leptokurtic for the entire sample, with indices -0.75 and 4.78, respectively. The mean score (standard deviation) for all participants was 110.8 (11.8). Women had a significantly higher mean score (112.6) than men (110.0; p < 0.01). The effect size estimate of gender difference was 0.22, indicating a small effect size. The low and high cutoff scores for men were ≤ 91 and ≥ 126, respectively, and the corresponding scores for women were ≤ 97 and ≥ 128, respectively.ConclusionsThis study provides JSE-S norm data and tentative cutoff scores for Japanese medical school matriculants, which would be helpful in identifying those who may need further training to enhance their empathy.

Students’ perception of problem-based learning at a Japanese medical school: an exploratory sequential mixed method

This study aimed to assess the perception of PBL among Japanese medical students. Learning effects and challenges of PBL from the students' viewpoint were assessed with an exploratory sequential mixed method. Focus group discussions followed by thematic analysis were conducted with 27 students and residents. Then a questionnaire survey was carried out. A total of 119 out of 258 students (46.1%) responded. The results from 24 questions were analyzed with a residual analysis. Thematic analysis extracted 14 themes from four discussion topics. The participants in focus group discussion regarded the PBL program as a better learning method than lectures. But some key phrases on the challenge of social interaction, including reluctance to actively discuss and collaborate with unfamiliar peers, were found. The questionnaire survey revealed a significantly lower adjusted standardized residual (ASR) for the positive response in five of six questions in the category of social interaction; improvement of communication skills (ASR = -3.303, n = 118, p < .001), enhancement of responsibility at group discussions (ASR = -2.078, n = 119, p = .038), building social networking (ASR = -3.006, n = 119, p = .003), becoming to sympathize with patients (ASR = -2.449, n = 119, p = .014) and understanding social aspects of clinical practice (ASR = -5.790, n = 119, p < .001). Conclusion: The Japanese medical students perceived PBL as an effective learning strategy. However, they had a problem with social interactions.

Comparison of Younger and Older medical student performance outcomes: A retrospective analysis in Japan.

The present study examined the impact of age on medical student repeat-year experience and performance outcomes on the objective structured clinical examination (OSCE), Clinical Clerkship (CC), and other relevant examinations in the Japanese medical school system. This retrospective analysis examined the number of students with repeat-years and the years required to graduate, stratifying students by the age they entered medical school (Younger: within 4 years of high school graduation; Older: 5 or more years after high school graduation). Scores of the Pre-CC OSCE, Computer-based testing (CBT), CC performance, CC integrative test, and graduation exams were compared among those graduating from our medical school between 2018 and 2020, and examined correlations between student age and performance outcomes. From 2018 to 2020, 328 medical students graduated. Of these, 283 had entered within 4 years of high school graduation (Younger), while 45 did so 5 or more years after high school graduation (Older). The number of repeat-years did not differ significantly between groups. The average number of years required to graduate was slightly higher for the Older group and the Younger group scored significantly higher on the CC integrative test. No significant differences were found for the remaining tests. These results suggest that older medical students in general show no significant inferiority in their performance of most clinical skills and competencies relative to younger students in Japan.

Current perception of social accountability of medical schools in Japan: A qualitative content analysis

Introduction The concept of social accountability in medical schools is globally accepted, but data regarding Japanese medical schools are lacking and unclear. This study aimed to elucidate the perception of social accountability of medical schools in Japan and compare this to global frameworks. Methods A document on Japanese medical accreditation standards (Basic Medical Education: Japanese Specifications WFME Global Standards for Quality Improvement) was used for this study. We included 45 medical schools in a qualitative content analysis done via inductive category formation. The documents were also assessed using the social obligation scale. Results Three main categories and 15 categories were identified. The three main categories were as follows: Issues in society, Quality assurance of medical school, and Improvement of individual quality. Most categories were common to those in global frameworks, but some were characteristic of the Japanese context. The distribution of schools on the social obligation scale in six elements varied mainly ‘from responsibility to responsiveness’ or equal unless the elements were promoted by national policy. Conclusions The social accountability of Japanese medical schools is mostly common with the global frameworks. Our findings will help the social accountability of medical schools to become better understood and developed beyond contextual borders.

Cross-sectional survey of education on LGBT content in medical schools in Japan

ObjectivesWe aimed to clarify current teaching on lesbian, gay, bisexual, transgender (LGBT) content in Japanese medical schools and compare it with data from the USA and Canada reported in 2011...

Gender bias in the medical school admission system in Japan

The 2018 Japanese Ministry of Education, Culture, Sports, Science, and Technology (MEXT) survey revealed discrimination against women in the admissions process of four Japanese medical schools, although it is not known how unusual the trend is for entire medical schools to enroll men and women. Therefore, this paper aims to examine how women are disadvantaged when they take entrance examinations for medical schools in Japan, compared to other academic disciplines. A null hypothesis that the average enrollment rates by gender in each academic discipline from 2015 to 2020 are the same was used to test the population ratio, and p-values were calculated. The results showed that no significant gender differences were found in the other disciplines, but the male enrollment rate was significantly higher only in medical schools (p < 0.01). This could be because the academic performance of men exceeds that of women in admissions. However, the percentage of women who passed the national examination for medical practitioners has been consistently high since 1997, suggesting that women were subjected to more difficult admission standards than their male counterparts or may have performed better during their years at medical school. As university entrance examinations in Japan are conducted in a closed environment, further information is expected to be disclosed as the matter continues to attract social attention for a better admission system.

Complex motivations of Japanese medical students to an online medical English course during the COVID-19 pandemic.

Background: In response to globalism, many East-Asian countries now include a Medical English course in their undergraduate medical education syllabus. The purpose of this study was to explore the relationship between the related attribute factors of students' motivation to learn medical English through an online modality. Methods: Of 134 eligible fourth-year medical students who participated in an Online Medical English course at a Japanese medical school, 105 were enrolled in this single cohort study. The participants completed pre- and post-course surveys regarding their motivation during the course, including perceived academic control and task value, and their assignment scores. A structural equation model was used to examine the hypothesized relationship of constructs, based on control-value theory. Results: The model showed a good fit for the data (χ 2[df=7] = 1.821, p=0.969, CFI = 1.000, RMSEA < 0.001, SRMR < 0.05, GFI = 0.993, AGFI = 0.980). The latent variables of the perceived course achievement related to the observed variables of academic control and task value scale scores, and negatively predicted willingness for self-study after course completion. In addition, the preference of English as the course language negatively predicted willingness for self-study of medical English. Conclusion: Choice of English as the language of instruction and perceived high course achievement negatively predicted students' motivation for further English self-study after the class. The importance of incorporating the perspective of lifelong learning into the teaching of medical English was recognized.

Attitudes and Motivation Toward Community-based Medical Education Among Students Enrolled in a Regional Quota Program at a Japanese Medical School

Attitudes and Motivation Toward Community-based Medical Education Among Students Enrolled in a Regional Quota Program at a Japanese Medical School

Association of Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder Traits with Depression and Empathy Among Medical Students.

PurposeThis study aimed to investigate the associations of the traits of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) with depression and empathy among medical students.Patients and MethodsA cross-sectional survey was conducted with 202 fifth-year students at a Japanese medical school for 10 months during their clinical clerkship. The survey included sociodemographic questions and validated tools to measure depressive symptoms (Hospital Anxiety and Depression Scale [HADS]), medical students’ empathy for patients (Jefferson Scale of Empathy-Student version [JSE]), ADHD traits (ADHD Self-Report Scale Screener [ASRS Screener]), and ASD traits (Autism-Spectrum Quotient Japanese version-21 [AQ-J-21]).ResultsA total of 151 students (response rate: 74.7%) participated in the survey. Of these, 41 (27.2%) reported a total score of ≥ 20 on the HADS and were categorized as depressed. Depressed students reported significantly lower and higher rates of having a part-time job and a history of enrolment in other faculties, respectively, than non-depressed students. According to the cutoff criteria of the ASRS Screener and AQ-J-21, 31 (20.5%) and 42 (27.8%) students reported ADHD and ASD traits, respectively. Multivariate regression analysis, controlling for age and sex, reported that higher age, ASRS Screener scores, and AQ-J-21 scores were significant predictors of higher HADS total scores. Additionally, higher AQ-J-21 scores significantly predicted lower JSE scores.ConclusionThe degree of ADHD and ASD traits was significantly associated with depression. Moreover, the degree of ASD traits was significantly associated with lower empathy for their patients. It is important to consider that about 20–30% of medical students have these neurodevelopmental traits and to develop intervention strategies for improving depression and empathy.

Survey of Japanese Medical Schools on Involvement of English-speaking Simulated Patients to Improve Students’ Patient Communication Skills

Phenomenon With increasing mobility of people across borders and medical tourism, more countries are called to make their healthcare environment ready to accept foreign patients. Patient communication skills in English are indispensable for healthcare professionals in non-English-speaking countries. This is not only in caring for foreign patients within the country but also contributing to the global health by practicing outside of the country. Although Japanese-speaking simulated patients have been involved in medical education in Japan since the 1970s and with Objective Structured Clinical Examinations formally implemented in 2005, very few medical schools have been working with English-speaking simulated patients (ESSPs). Approach A nationwide survey was conducted to investigate the involvement of ESSPs at medical schools in Japan. A questionnaire with closed and open-ended questions was mailed to the deans of 80 medical schools to determine the current ESSP involvement and the problems educators were facing in regard to working with or not working with ESSPs. The survey was conducted from November 2015 through March 2016. Data were analyzed to find problems regarding ESSPs so that their involvement could be enhanced toward developing medical students’ patient communication skills. Findings Responses from 60 medical schools (75% response rate) were received and analyzed. Among them, 22 schools were working with ESSPs, and 23 schools were willing to introduce them into their programs. The background of ESSPs varied with international students or faculty often filling the role. Many ESSPs received less than two hours of training. ESSP programs were required in the preclinical years, and more often elective in the clinical years. Medical schools mentioned the difficulty of recruiting and training ESSPs and finding the funding to pay for their remuneration and travel expenses. Insights ESSPs were increasingly used in Japanese medical schools but they were haphazardly recruited from within the school or from the local community, not trained fully, and inconsistent performers. Nevertheless, an encounter with a non-Japanese English-speaking simulated patient was regarded effective in developing medical students’ patient communication skills in English (language skills and cultural sensitivity). Ways must be found to assure the availability, quality, and sustainability of trained ESSPs so that more authentic practices and high-stakes skills exams can be introduced to ensure patient safety in the globalized world. As countries become more multicultural and international migration of healthcare professionals expands, ESSPs can be a valuable source for training and assessing international medical students and trainees’ English-language patient interviewing skills. Regional hubs of ESSPs and the use of telehealth in collaboration with educators around the world could enhance the use of ESSPs worldwide.

Impact of general medicine rotation training on the in-training examination scores of 11, 244 Japanese resident physicians: a Nationwide multi-center cross-sectional study

BackgroundAlthough general medicine (GM) faculty in Japanese medical schools have an important role in educating medical students, the importance of residents’ rotation training in GM in postgraduate education has not been sufficiently recognized in Japan. To evaluate the relationship between the rotation of resident physicians in the GM department and their In-Training Examination score.MethodsThis study is a nationwide multi-center cross-sectional study in Japan. Participants of this study are Japanese junior resident physicians [postgraduate year (PGY)-1 and PGY-2] who took the General Medicine In-Training Examination (GM-ITE) in fiscal years 2016 to 2018 at least once (n = 11,244). The numbers of participating hospitals in the GM-ITE were 381, 459, and 503 in 2016, 2017, and 2018.The GM-ITE score consisted of four categories (medical interview/professionalism, symptomatology/clinical reasoning, physical examination/procedure, and disease knowledge). We evaluated relationship between educational environment (including hospital information) and the GM-ITE score.ResultsA total of 4464 (39.7%) residents experienced GM department rotation training. Residents who rotated had higher total scores than residents who did not rotate (38.1 ± 12.1, 36.8 ± 11.7, and 36.5 ± 11.5 for residents who experienced GM rotation training, those who did not experience this training in hospitals with a GM department, and those who did not experience GM rotation training in hospitals without a GM department, p = 0.0038). The association between GM rotation and competency remained after multivariable adjustment in the multilevel model: the score difference between GM rotation training residents and non-GM rotation residents in hospitals without a GM department was estimated as 1.18 (standard error, 0.30, p = 0.0001), which was approximately half of the standard deviation of random effects due to hospital variation (estimated as 2.00).ConclusionsGM rotation training improved the GM-ITE score of residents and should be considered mandatory for junior residents in Japan.

Differences in the perceived importance of professional behaviors in academic and clinical settings from an alumni survey of a Japanese medical school

Differences in the perceived importance of professional behaviors in academic and clinical settings from an alumni survey of a Japanese medical school

Prevalence and curriculum of sexual and gender minority education in Japanese medical school and future direction

ABSTRACT Background: In Japan, sexual and gender minorities (SGM) remain stigmatized, provoking hospital access barriers and health disparities from judgmental care. Japan’s Western-influenced introduction of SGM course content into medical education for future physicians addresses these disparities, although often perfunctorily and inconsistently. Objective: To examine the prevalence and characteristics of medical education curriculum with respect to SGM patients, we surveyed medical schools. Methods: A medical education faculty member from each of 80 Japanese medical schools received double postcards to identify relevant SGM coursework. Upon acknowledgement, 43 schools received seven-item anonymous questionnaires in March 2018. Survey results were analyzed from the perspective of three of the qualities and abilities required of a physician – Patient Care, Knowledge for Practice, and Professionalism from Japan’s Medical Core Curriculum – to develop recommendations for outcomes-based SGM curriculum through the lens of Van Melle’s medical education framework. Results: The response rate was 46%, with 22 schools providing SGM lectures mostly to first- and third-year students. Obstetrics and Gynecology, Neuropsychiatry, and Introduction to Medicine lectures were the top three subjects offering SGM lectures, primarily consisting of basic knowledge of SGM and Differences in Sex Development. Several lectures addressed the health challenges of SGM. Primary reasons for not offering SGM lectures were lack of suitable instructors or no school policies. Conclusions: Students can best experience the humanity of SGM patients and employ more appropriate diagnostic practices and modes of treatment with targeted curriculum to address SGM health disparities and inclusion of SGM patients in clinical practice training. To disseminate SGM education in Japanese medical schools, development of qualified instructors and policies is essential, employing currently active experts. The Van Melle reforms framework can guide in the development of recommended tailored learning experiences and lectures for improved and expanded SGM education, integrating appropriate coursework within current medical core curriculum structure.