Medical Education In Japan Research Articles

Medical Education in Japan: Transforming to Transprofessional Education

Medical Education in Japan: Transforming to Transprofessional Education

日本・タイ・シンガポールの医学教育に関する研修報告

日本・タイ・シンガポールの医学教育に関する研修報告

医学部・医科大学における模擬患者・標準模擬患者養成および参加型教育に関する実態調査 第 16 期日本医学教育学会教材開発・SP 委員会

医学部・医科大学における模擬患者・標準模擬患者養成および参加型教育に関する実態調査 第 16 期日本医学教育学会教材開発・SP 委員会

Current Situation and Issues of Medical Education in Japan －from the Viewpoint of Communication－

In this article, I examine the current situation and issues of medical education in Japan. Expressly from the viewpoint of communication, I deal with three concerns: clinical clerkship, medical interview training using simulated patients, and the integration of the narrative approach within medical education. In conclusion, I maintain that narrative training can compensate for several shortcomings of medical interview training with simulated patients. Moreover, the narrative approach can promote better communication with local patients and residents, thereby fulfilling the basic requisite of any clinical clerkship. Towards these ends, an effective curriculum that integrates communicative training shall be vitally essential for Japanese undergraduate medical education.

Development of a nationwide consensus syllabus of palliative medicine for undergraduate medical education in Japan: A modified Delphi method

Background: There is currently no consensus syllabus of palliative medicine for undergraduate medical education in Japan, although the Cancer Control Act proposed in 2007 covers the dissemination of palliative care. Aim: To develop a nationwide consensus syllabus of palliative medicine for undergraduate medical education in Japan using a modified Delphi method. Design: We adopted the following three-step method: (1) a workshop to produce the draft syllabus; (2) a survey-based provisional syllabus; (3) Delphi rounds and a panel meeting (modified Delphi method) to produce the working syllabus. Educators in charge of palliative medicine from 63% of the medical schools in Japan collaborated to develop a survey-based provisional syllabus before the Delphi rounds. A panel of 32 people was then formed for the modified Delphi rounds comprising 28 educators and experts in palliative medicine, one cancer survivor, one bereaved family member, and two medical students. Results: The final consensus syllabus consists of 115 learning objectives across seven sections as follows: basic principles; disease process and comprehensive assessment; symptom management; psychosocial care; cultural, religious, and spiritual issues; ethical issues; and legal frameworks. Learning objectives were categorized as essential or desirable (essential: 66; desirable: 49). Conclusions: A consensus syllabus of palliative medicine for undergraduate medical education was developed using a clear and innovative methodology. The final consensus syllabus will be made available for further dissemination of palliative care education throughout the country.

「医学教育の改善に関する調査研究協力者会議-中間まとめ (昭和61年7月21日)」についての意見

「医学教育の改善に関する調査研究協力者会議-中間まとめ (昭和61年7月21日)」についての意見

Patient Satisfaction Questionnaire for Medical Students' Performance in a Hospital Outpatient Clinic: A Cross-Sectional Study

Medical education in Japan has undergone significant reforms. Patient perspective and outcome have been highly valued in curricular reforms. Therefore, we evaluated an undergraduate curriculum particularly on communication skills by comparing outpatient satisfaction before and after the reforms implemented at Saga Medical School. Cross-sectional study was conducted at the General Medicine Clinic of Saga University Hospital in 1999 and 2009. A total of 729 newcomer patients evaluated 159 students; namely, 287 patients evaluated sixth-year medical students (n = 82) in 1999, and in 2009, 442 patients evaluated fifth-year medical students (n = 77). Students interviewed newcomer patients prior to a faculty's clinical examination. After a student-patient encounter, the patient was asked to fill in six-item Patient Satisfaction Questionnaire (PSQ) developed by the American Board of Internal Medicine. Mixed model two-way analysis of variance (ANOVA) with covariant of students' gender was conducted. Effect sizes were calculated to evaluate the amplitude of influence. The average score in 2009 was significantly higher than that in 1999 (3.63 ± 0.62 versus 3.36 ± 0.66; p < 0.001). Since the "encouraging and answering questions" and "clear explanations" were lower than those of the other items (3.24 ± 0.98 and 3.46 ± 0.85), these two items showed the most significant improvements (Phi coefficient = 0.31 and 0.24, p < 0.001). Thus, students' performance has improved since 1999, which may represent the success of curricular reforms at Saga Medical School. We propose that "encouraging and answering questions" and "clear explanations" should be emphasized in interview training.

Medical Ethics in the Medical Education in Japan

Medical Ethics in the Medical Education in Japan

Leaning Objectives of Medical Education in Japan

Leaning Objectives of Medical Education in Japan

Questionnaire survey for challenging cases of medical professionalism in Japan

Background: Little information is available on evaluation of medical professionalism among Japanese physicians and on its education in Japanese medical schools.Aims: To assess professionalism and its education in Japan.Method: We analysed the responses to challenges to professionalism for Japanese residents and physicians, using the Barry Questionnaire, and to survey the extent of education related to professionalism during medical school curricula. The survey was conducted at 14 teaching hospitals in Kyushu and Okinawa, using existing hospital conferences.Results: We collected data from 175 participants (60 residents and 115 faculty physicians). The most challenging was the sexual harassment scenario, in which 51.4% provided the best or 2nd best answers, followed by the honesty scenario with 69.7% and the confidentiality scenario with 76.0%. Participants were more likely to provide the best or 2nd best responses to the scenarios involving physician impairment (87.4%), conflict of interest (81.1%), and acceptance of gifts (78.3%). Five (3%) participants reported learning experiences about professionalism during the curricula and the median hours for its course work were two hours. Only one resident reported that she was satisfied with these educational sessions.Conclusions: Many Japanese physicians were unable to provide an acceptable response to challenges to professionalism in several issues and few had received education in professionalism during school curricula. Greater teaching of professionalism is needed in medical education in Japan.

Perspectives in Medical Education

Reform of preclinical medical education in Japan requires changes in the curriculum to make it more clinically focused and interactive. At present, course content in Anatomy is usually designed and taught with little or no clinical direction and involves a heavy emphasis on by-rote learning to memorize often minor facts that have little importance in clinical medicine. As a result, the content is boring, it is learned solely for the purpose of passing exams and it is promptly forgotten, with little sense of its need in clinical practice. Successful reform of the curriculum in Anatomy requires two critical changes. The first is that content must be made interesting to students by emphasizing its clinical importance, through a close collaboration between preclinical and clinical departments, Thus, the Surgical Faculty must be incorporated in the organization and teaching of the Anatomy curriculum. Core content can thereby be pared down to only what is considered essential to provide a foundation for the later clinical years, and the clinical importance of that content will, in turn, be self-evident to students. The second change that must be implemented is to make the learning process more appealing to the students. This can be facilitated by the use of any of several commercial IT programs that make learning in Anatomy both dynamic and engaging. These dual strategies will considerably enhance the learning of one of the most basic subjects in the medical school and ensure that the review and retention of the material are enhanced.

Medical education in Japan: A challenge to the healthcare system

In response to a change in health and societal need, the system of medical education in Japan has undergone major reform within the last two decades. Although the general health status of Japanese citizens ranks amongst the highest in the world, a rapidly increasingly elderly population, a social insurance system in crisis and a decrease in the number of practicing physicians is severely affecting this enviable position. To compensate, the Government has reversed its previous decision to reduce the number of doctors. Concomitantly, public opinion is changing to that of support and sympathy for the practicing physician.In order to produce a new breed of future doctors, Japanese medical education has undergone major reform: problem-based learning and clinical skills development has been instituted in most medical schools, more rigid assessment methods, ensuring competency and fitness to practice have been introduced, and there has been an increase in purposeful clinical attachments with a hands-on approach rather than a traditional observation model. A new postgraduate residency programme, introduced in 2004, hopes to improve general competency levels, while medical schools throughout the country are paying attention to modern medical education and faculty development.

The current state of medical education in Japan: a system under reform

Not since just after World War II has there been as dramatic a change in the system of medical education in Japan as in the last several years. Medical school curricula are including more education that mimics clinical practice through problem-based learning, organ-based curricula and implementation of the objective structured clinical examination (OSCE). In response to criticism and concerns, the Japanese government has also implemented 2 major changes in the system of postgraduate medical education. First, a 2-year structured internship has been required of all medical school graduates; the first cohort to undertake this completed it in April 2006. Second, an internship matching system was adopted and first implemented in 2003. These reforms are leading to significant shifts in clinical education in Japan. Increasing numbers of medical graduates are entering residency programmes outside specialised university hospitals and core rotations place an increased emphasis on primary care. These changes in the training of young doctors suggest that the general clinical competency of doctors in Japan will improve in the coming years.

Misperceptions of medical education in Japan

A number of Western physicians have highlighted shortcomings in Japanese medical education over the years. In recent years, however, there has been dramatic change in the system of medical education in Japan that renders some of these observations inaccurate and others worthy of several caveats. Using a recent review article in the Keio Journal of Medicine as a starting point for discussion, the author responds to a number of historical concerns about medical education in Japan and includes updated information on recent reforms.

薬学教育へのＰＢＬ（Ｐｒｏｂｌｅｍ‐ｂａｓｅｄ Ｌｅａｒｎｉｎｇ）の普及・導入状況に関するアンケート調査

Pharmacy education in Japan has been reorganized into a six-year curriculum to provide the clinical education required by pharmacists to actively participate in patient care as drug therapy specialists. Problem-based learning (PBL) is a highly suitable method to educate students regarding diverse clinical issues and in Japan, it has already been recognized as a universal education method in the fields of medicine and nursing. However, the extent to which PBL had been adopted in pharmacy education had not been clear. In order to clarify the present situation and gain information on how to achieve the optimal use of PBL in pharmacy education in the future, we conducted a questionnaire survey.The questionnaire was sent to deans of pharmacy faculties or presidents of universities of pharmacy (62 institutions) in June 2005 and the recovery rate was 72.6% (45 institutions). It was found that 34% (15 institutions) of them had already adopted PBL in their education programs. It was being used for a wide range of students and encompassed case histories and various other themes and subjects ranging from basic subjects to social medicine, and various tutors and facilitators were involved. As for institutions that had not adopted PBL, 28% (7 institutions) intended to do so soon. Further, 66% (29institutions) of all institutions indicated a desire to adopt PBL in the six-year education curriculum. This tendency was especially remarkable for private institutions.The results of our survey suggested that PBL is likely to become increasingly widespread in healthcare-oriented pharmacy education as well as in medical education in Japan.

The Unitarian Service Committee Medical Mission

The Unitarian Service Committee Medical Mission

Medical Education in Japan

There are 79 medical schools in Japan--42 national, 8 prefectural (i.e., founded by a local government), and 29 private--representing approximately one school for every 1.6 million people. Undergraduate medical education is six years long, typically consisting of four years of preclinical education and then two years of clinical education. High school graduates are eligible to enter medical school. In 36 schools, college graduates are offered admission, but they account for fewer than 10% of the available positions. There were 46,800 medical students in 2006; 32.8% were women. Since 1990, Japanese medical education has undergone significant changes, with some medical schools implementing integrated curricula, problem-based learning tutorials, and clinical clerkships. A model core curriculum was proposed by the government in 2001 that outlined a core structure for undergraduate medical education, with 1,218 specific behavioral objectives. A nationwide common achievement test was instituted in 2005; students must pass this test to qualify for preclinical medical education. It is similar to the United States Medical Licensing Examination step 1, although the Japanese test is not a licensing examination. The National Examination for Physicians is a 500-item examination that is administered once a year. In 2006, 8,602 applicants took the examination, and 7,742 of them (90.0%) passed. A new law requires postgraduate training for two years after graduation. Residents are paid reasonably, and the work hours are limited to 40 hours a week. In 2004, a matching system was started; the match rate was 95.6% (46.2% for the university hospitals and 49.4% for other teaching hospitals). Sustained and meaningful change in Japanese medical education is continuing.

Perspectives in Medical Education

A blueprint for reform of medical education in Japan is presented, with the goal of training well rounded physicians who possess the ability to think critically and the clinical skill to function as generalists before they enter specialty training. Practical solutions are offered in three problem areas that lie at the heart of the shortcomings in Japanese medical education. They have to do with (i) the way Japanese students learn, (ii) the way Japanese teachers teach, and (iii) the material that students are taught. The inherently passive nature of Japanese students can be changed by emphasizing "active learning" and "critical thinking at the bedside" through a problem-oriented approach, both in the classroom and in the wards. Changing student learning, however, requires a commitment to teaching. At the present time, there is no incentive to teach at all, let alone teach in a constructive or interactive way. Teaching is widely perceived as a burden that takes time away from research, rather than as a credible and rewarding academic pursuit. Thus, promotion policies must be altered to reward teachers and accord teaching its rightful place as a primary function of the faculty. Finally, the introduction of active learning and interactive teaching depends on reducing the current emphasis on didactic instruction, which is passive and unidirectional. Thus, medical school curricula must be restructured to emphasize a problem-oriented, organ system-based approach throughout medical school, starting from the preclinical years. Reforms in all three areas must be implemented in concert for them to succeed.

Perspectives in Medical Education 1. Reflections on the state of medical education in Japan

The current shortcomings in Japanese medical education are highlighted by identifying four major areas of concern, based on the author's personal observations at Keio University Hospital. The first of these is a woeful lack of clinical skills among Japanese medical students and residents. This lack springs directly from the complete absence of any bedside clinical instruction, which constitutes the second area of concern. The third is the attitude of faculty towards teaching as a burden that detracts and diverts them from their primary goal of academic advancement through research. Finally, there is no recognition of the value of a problem-based approach to teaching clinical medicine, so that clinical problem-solving skills have atrophied to the point of near-extinction in the current generation of Japanese physicians. The promise of problem-based learning (PBL) provides a crucial starting point for efforts to change the system. PBL emphasizes the importance of an integrated approach to clinical problems, and a reliance on critical thinking--the basis of primary care. This contrasts with the selective and highly specialized approach to disease, and reliance on sophisticated technology, which are hallmarks of specialty care. The effort to reform medical education will fail without visionary leadership and without the willingness to confront the truth, as unpleasant as it may seem to be. Both these crucial elements exist at Keio University at this critical juncture. It is this happy confluence that emboldens the author to hope that the future of reform is in good hands at this august institution.

Perspectives in Medical Education 3. Reforming medical education to change healthcare practice in Japan

The enviable health status of Japanese citizens is one of the reasons for obdurate opposition to reform of Japanese healthcare practice. Change is widely believed to be unnecessary for a system that is both successful and profitably exploited to universal benefit. However, societal trends are conspiring to make current healthcare practice patterns and expenditures unsustainable in the future. In particular, Japan has undergone an unprecedented demographic shift from a society of young (and healthy) workers to one of older retirees with a higher prevalence of obesity. As a result, an equally dramatic future increase can be anticipated in the prevalence of age- and obesity-related disorders. The traditional paradigm of Japanese healthcare is not conducive to the restraint necessary for preserving its future viability, given these trends. Japanese healthcare does not reward clinical problem-solving skills, values specialists over generalists, places a heavy reliance on expensive technology, does not require interventions to be evidence-based, and provides no incentives to improve quality or efficiency. If this paradigm endures, Japanese healthcare faces the real prospect of bankruptcy. The failure of Japanese medical education to inculcate clinical skills and stress evidence-based medical practice lies at the heart of the impending crisis in healthcare. To solve the crisis, medical education in Japan must change its focus to training and developing a cadre of physicians with the broad-based expertise and clinical skills to make evidence-based decisions in a medically and fiscally responsible manner. The future health of the system and of the Japanese people depends on it.