Education as a means of reducing medical expenses

Abstract

In treating patients with infectious diseases, key knowledge and experience are essential in making appropriate clinical decisions. Medical students in Japan receive limited tuition in clinical pharmacology and microbiology in their undergraduate curriculum. Education and guidance in these fields are not always provided, even during postgraduate training. To help overcome this problem, we have devised a quick medical reference system to support antimicrobial chemotherapy, and this has been operating in our hospital since May 1994. This system is integrated in order to convey the maximal significance of test results by providing detailed information on various kinds of pathogens and antibiotics immediately on every computer display. This is a unique system in Japan, and aims to help doctors provide effective therapy. Using this system, we have succeeded in reducing medical expenditure for antimicrobials by around 10%.

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

“…One doctor admitted to the author that a doctor may have, say, performed a year of research on otitis media and use that as justification to advertise an otolaryngology specialty. Designations of ‘specialist’ do occur via specialty academic societies, but it is a once‐in‐a‐lifetime process as re‐certification and continuing medical education are not required 4 …”

“…To understand postgraduate clinical education before the 2004 reforms, one must understand the structure of Japanese clinical−academic departments. If the format of medical school in Japan originally hailed from Germany 4 and the pedagogical principles utilised seem Chinese, 5 then the organisation and operation of these clinical departments derive from a traditional Japanese hierarchical model. Clinical departments, known as ikyoku , 6 are headed by a department chair who single‐handedly controls virtually every aspect of the department.…”

“…First, systematic, structured rotations through various departments in both inpatient and outpatient settings usually were not included 7 . Second, training was skewed by a narrow, longitudinal apprenticeship with a single mentor who was typically a research‐trained subspecialist 4,8 , 9…”

“…This linkage is evidence of a lack of delineation between clinical and research training; the ikyoku‐kōza is dominated by doctor‐scientists but a paucity of clinician‐educators 10,11 . Indeed, there is no clinical professorship system in Japan 4 . Given the ikyoku‐kōza 's emphasis on training doctor‐scientists, 1 medical graduates may stay in the ikyoku‐kōza for many years to pursue a PhD or research, spending only limited time on clinical duties.…”

The perception of the hidden curriculum on medical education: an exploratory study

“…However, no similar qualitative study concerning the perception of the hidden curriculum in Japanese medical schools has ever been conducted. Since many traditional Japanese medical schools adopted elements of the German style [12], which is quite distinct from the system in place in the UK, it is expected that many disparate themes may evolve from a similar survey in Japan.…”