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Komasawa N, Yokohira M. Survey on Medical Students' Attitudes Toward Medical Practice Just Before Clinical Clerkship in Japan. Cureus 2024; 16:e52899. [PMID: 38406098 PMCID: PMC10891475 DOI: 10.7759/cureus.52899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION The present study examined the confidence in essential medical practices during clinical clerkship (CC) and performance in preparing education for medical students who are just starting CC at our university. METHODS We conducted a survey using questionnaires with 105 fourth-year medical students just before starting CC. This questionnaire analysis consists of the confidence in objective structured clinical examination (OSCE) and computer-based testing (CBT) performance toward essential medical practice recommended in the "Report on Medical Practice during Clinical Clerkship" by the Japanese Ministry of Health, Labor, and Welfare and medical safety for CC. RESULTS The response rate was 67.6% (71/105). As for the performance in each OSCE theme, the confidence in basic clinical technique was significantly smaller compared to chest or abdominal examination, medical interview, and emergency response (p<0.05 each). Medical interviews showed stronger confidence compared to gynecological, breast, or rectal examinations and prostate palpitation among medical examinations (p<0.05 each). In the basic technique during CC, skin disinfection showed stronger confidence compared to other techniques (p<0.05 each). On surgical technique during CC, surgical hand washing and gown technique significantly showed stronger confidence compared to skin suture, suture removal, bleeding control, and surgical assistant (p<0.05 each). CONCLUSION Our results suggest that medical students just before CC have less confidence in invasive medical practice during CC. As medical practice by student doctors becomes public, further systematic basic skill training both before and during CC is warranted.
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Affiliation(s)
- Nobuyasu Komasawa
- Community Medicine Education Promotion Office, Faculty of Medicine, Kagawa University, Takamatsu, JPN
| | - Masanao Yokohira
- Department of Medical Education, Faculty of Medicine, Kagawa University, Takamatsu, JPN
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O'Doherty J, Hyde S, O'Connor R, Brown MEL, Hayes P, Niranjan V, Culhane A, O'Dwyer P, O'Donnell P, Glynn L, O'Regan A. Development and sustainment of professional relationships within longitudinal integrated clerkships in general practice (LICs): a narrative review. Ir J Med Sci 2021; 191:447-459. [PMID: 33641086 DOI: 10.1007/s11845-021-02525-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Longitudinal integrated clerkships (LICs) are a relatively new model of clinical medical education, whereby students participate in patient care over time and develop relationships with those patients', their clinicians, and other health care staff involved in the care of those patients. It has been called 'relationship-based education' but, to date, no review has investigated the development and impact of these central relationships within this curricula model. AIMS The aim of this study is to review the literature pertaining to relationships in LICs, specifically to understand how they come about and how they affect learning. METHODS The search strategy systematically explored PubMed, ERIC (EBSCO) and Academic Search Complete, using key words and MESH terms. Original research published in peer-reviewed journals between January 2007 and August 2020 that were written in the English language were included in the review. RESULTS After applying set inclusion and exclusion criteria, 43 studies were included in this review. A qualitative thematic analysis was undertaken, and results were synthesised narratively. Four distinct categories were identified: defining relationships in LICs, developing relationships in LICs, relationship maintenance and multi-stakeholder impact. CONCLUSIONS The longitudinal integrated clerkship model of clinical education facilitates the development of meaningful triangular relationships between student, clinical teacher and patient, which are the central drivers of successful learning within the context of an LIC. These relationships are nested in a set of important supporting relationships involving other supervisors, the medical school and university, the practice clinical and administrative team and peers.
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Affiliation(s)
- Jane O'Doherty
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland.
| | - Sarah Hyde
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
| | - Raymond O'Connor
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
- Mid-West Specialist Training Programme in General Practice, University of Limerick, Plassey, Limerick, Ireland
| | - Megan E L Brown
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Peter Hayes
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
| | - Vikram Niranjan
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
| | - Aidan Culhane
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
| | - Pat O'Dwyer
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
| | - Patrick O'Donnell
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
| | - Liam Glynn
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
| | - Andrew O'Regan
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
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Ohta R, Ryu Y, Sano C. The Contribution of Citizens to Community-Based Medical Education in Japan: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1575. [PMID: 33562329 PMCID: PMC7915629 DOI: 10.3390/ijerph18041575] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 02/07/2023]
Abstract
Community-based medical education (CBME) offers vital support to healthcare professionals in aging societies, which need medical trainees who understand comprehensive care. In teaching comprehensive care practices, CBME can involve citizens from the relevant community. This research synthesizes the impact of the involvement of communities on the learning of medical trainees in CBME. We conducted a systematic review, in which we searched ten databases from April 1990 to August 2020 for original articles in Japan regarding CBME involving citizens and descriptively analyzed them. The Kirkpatrick model was used to categorize the outcomes. Our search for studies following the protocol returned 1240 results; 21 articles were included in this systematic review. Medical trainees reported satisfaction with the content, teaching processes, and teachers' qualities. Medical trainees' attitudes toward community and rural medicine improved; they were motivated to become family physicians and work in communities and remote areas. This review clarified that citizen involvement in CBME had an effective impact on medical trainees, positively affecting perceptions of this type of education, as well as improving trainees' knowledge about and attitude toward community and rural medicine.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan 699-1221, Shimane, Japan;
| | - Yoshinori Ryu
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan 699-1221, Shimane, Japan;
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, Izumo 693-8501, Shimane, Japan;
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Tanaka K, Son D. Experiential learning for junior residents as a part of community-based medical education in Japan. EDUCATION FOR PRIMARY CARE 2019; 30:282-288. [DOI: 10.1080/14739879.2019.1625288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Daisuke Son
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Brown MEL, Anderson K, Finn GM. A Narrative Literature Review Considering the Development and Implementation of Longitudinal Integrated Clerkships, Including a Practical Guide for Application. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519849409. [PMID: 31206031 PMCID: PMC6537286 DOI: 10.1177/2382120519849409] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/15/2019] [Indexed: 05/31/2023]
Abstract
Hailed by supporters as the answer to many challenges facing medical schools and the wider health care system, longitudinal integrated clerkships (LICs) offer a practical and sustainable alternative to more traditional block rotational models. Given this, their popularity as a curricular measure is increasing, although such clerkships remain relatively novel within the United Kingdom. This narrative literature review of international work provides a comprehensive introduction to developing and implementing LICs within medical education. This review generates a practical guide for medical educators with a focus on the development and implementation of LICs within the United Kingdom, on which there is little work. Using illustrated examples and with reference to contemporary literature, it outlines the rationale for considering an LIC within a curriculum, the different types of LIC, barriers and enabling factors to LIC implementation and considers the contemporary application of LIC models within the United Kingdom. The practical guide details key questions educators must consider when developing and implementing an LIC, particularly within the landscape of UK medical education.
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Affiliation(s)
- Megan EL Brown
- Megan EL Brown, Health Professions Education
Unit, Hull York Medical School, University of York, York YO10 5DD, UK.
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Somporn P, Ash J, Walters L. Stakeholder views of rural community-based medical education: a narrative review of the international literature. MEDICAL EDUCATION 2018; 52:791-802. [PMID: 29603320 DOI: 10.1111/medu.13580] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 01/02/2018] [Accepted: 02/07/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT Rural community-based medical education (RCBME), in which medical student learning activities take place within a rural community, requires students, clinical teachers, patients, community members and representatives of health and government sectors to actively contribute to the educational process. Therefore, academics seeking to develop RCBME need to understand the rural context, and the views and needs of local stakeholders. OBJECTIVES The aim of this review is to examine stakeholder experiences of RCBME programmes internationally. METHODS This narrative literature review of original research articles published after 1970 utilises Worley's symbiosis model of medical education as an analysis framework. This model proposes that students experience RCBME through their intersection with multiple clinical, social and institutional relationships. This model seeks to provide a framework for considering the intersecting relationships in which RCBME programmes are situated. RESULTS Thirty RCBME programmes are described in 52 articles, representing a wide range of rural clinical placements. One-year longitudinal integrated clerkships for penultimate-year students in Anglosphere countries were most common. Such RCBME enables students to engage in work-integrated learning in a feasible manner that is acceptable to many rural clinicians and patients. Academic results are not compromised, and a few papers demonstrate quality improvement for rural health services engaged in RCBME. These programmes have delivered some rural medical workforce outcomes to communities and governments. Medical students also provide social capital to rural communities. However, these programmes have significant financial cost and risk student social and educational isolation. CONCLUSIONS Rural community-based medical education programmes are seen as academically acceptable and can facilitate symbiotic relationships among students, rural clinicians, patients and community stakeholders. These relationships can influence students' clinical competency and professional identity, increase graduates' interest in rural careers, and potentially improve rural health service stability. Formal prospective stakeholder consultations should be published in the literature.
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Affiliation(s)
- Praphun Somporn
- Hatyai Medical Education Centre, Hatyai Hospital, Hat Yai, Songkhla, Thailand
| | - Julie Ash
- Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, South Australia, Australia
| | - Lucie Walters
- Flinders Rural Health South Australia, Flinders University, Mount Gambier, South Australia, Australia
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Saiki T, Imafuku R, Suzuki Y, Ban N. The truth lies somewhere in the middle: Swinging between globalization and regionalization of medical education in Japan. MEDICAL TEACHER 2017; 39:1016-1022. [PMID: 28758830 DOI: 10.1080/0142159x.2017.1359407] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Japan is well known as a super-aging society, with a low birth rate, and has been ranked as one of the countries having the highest quality of healthcare system. Japan's society is currently approaching a major turning point with regard to societal and healthcare reforms, which are influenced by international trends and regional needs. Development of Japanese healthcare human resources, including medical students, is now expected to ride the wave of globalization, while resolving regional problems in the training and delivery of healthcare. Terms and global trends in medical education, such as outcome-based education, community-based education, reflective learning, international accreditation of medical education, and professionalization of educators are well translated into the Japanese language and embraced positively among the Japanese medical educators. However, these trends occasionally sit uncomfortably with cultural variations that are often a common approach in Japan; notably, "hansei" (introspection) and "kaizen" (change for the better). In the world facing a new era where people are unsettled between globalism and regionalism, Japan's future mission is to steer a balanced route that recognizes both global and regional influences and produce global health professionals educators.
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Affiliation(s)
- Takuya Saiki
- a Gifu University Medical Education Development Center , Gifu , Japan
| | - Rintaro Imafuku
- a Gifu University Medical Education Development Center , Gifu , Japan
| | - Yasuyuki Suzuki
- a Gifu University Medical Education Development Center , Gifu , Japan
| | - Nobutaro Ban
- b Aichi Medical School of Medicine , Medical Education Center , Aichi , Japan
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Takamura A. The new era of postgraduate certified general practice training in Japan. EDUCATION FOR PRIMARY CARE 2016; 27:409-412. [PMID: 27658321 DOI: 10.1080/14739879.2016.1220235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This paper describes the background to, and the recent evolution of general practice as a recognised medical specialism in Japan (2015), and the evolution of a system of training to support this development. We, the general practitioners (GPs) in Japan have not been recognised as one body of medical specialists and have been training in our own way. A new certified training system will commence in 2018, authorised by a new third organisation, the Japanese Medical Specialty Board. An effective educational system has been developed for medical graduates that have a career intention in general practice that is distinct from other basic medical fields, but collaborates with them. A challenge exists to provide clarity to the Japanese population about what the specialty of general practice is, and what professionals in general practice can do for them. Japan currently has approximately 500 certified GPs and it is unclear at present what numbers will eventually be required. This paper reviews some of the challenges facing the development of general practice from the perspective of the Japan Primary Care Association.
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Affiliation(s)
- Akiteru Takamura
- a Member of the Programme Certification Committee and the Specialist Certification Committee of the Japan Primary Care Association: Official Member Organization of WONCA in Asia-Pacific Region , Tokyo , Japan.,b Department of Medical Education , Kanazawa Medical University , Kanazawa , Japan.,c Department of Family Medicine , Mie University School of Medicine , Tsu , Japan
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