Perspectives in Medical Education

Abstract

Reform of medical education at Keio University has been underway since 2003. We measure the progress made since then in five specific categories that span fifteen recommendations presented in our"Blueprint for Reform"at the outset of the effort. These are effectiveness of leadership, curriculum reform, recognition of teaching, clinical competence, and comprehensive training in general internal medicine (GIM). First, effective leadership is being sustained through a succession of Deans, although a potentially crippling loss of leadership in the Department of Medical Education must be offset through timely appointment. Second, curriculum reform is awaiting the implementation in 2012 of an integrated, organ system-based curriculum with an emphasis on ward clerkships, but the introduction of PBL has been delayed indefinitely. Third, teaching is being recognized through the use of student feedback to reward good teachers and through funds for six full-time equivalent salaries dedicated to medical education, but promotions still depend exclusively on research, without consideration of teaching ability. Fourth, clinical skills training is still lacking, although enthusiasm for it seems to be building, thanks to the presence on the wards of a (still miniscule) cadre of dedicated teachers. Finally, exposure to GIM remains non-existent; however, visionary leadership in a newly-independent Emergency Department and the wide variety of medical problems seen there provide a remarkable opportunity to craft a uniquely Japanese solution to the problem. The changes implemented to date are impressive, and we remain enthusiastic about the future, even as we recognize the magnitude of the task that lies ahead. (Keio J Med 59 (2) : 52 -63, June 2010)

Professionalism Mini-Evaluation Exercise for medical residents in Japan: a pilot study

“…At the same time, public attention to medical professionalism has recently increased in Japan 14 . However, little information on assessing the professionalism of Japanese doctors has been available 15 . Although medical professionalism is a difficult competency to assess, it is important to develop a useful and valid tool for assessing medical professionalism among Japanese doctors in order to investigate the current state of this critically important issue in the Japanese medical environment.…”

Prioritizing Clinical Teaching Excellence: A Hidden Curriculum Problem

“…The lack of recognition and rewards for teaching when compared with the patient care and research domains is a welldocumented and concrete inequity that clinical teachers often experience in AMCs. [32][33][34][35][36][37] This inequity exists despite proclamations of the merit and incentives for teaching excellence in AMC mission statements and reward policies and guidelines. 11,38 Institutional proclamations about the incentives for teaching excellence can be undermined by a HC that transmits contradictory messages to clinical teachers about the actual value of teaching.…”

Preliminary report of a Web-based instrument to assess and teach knowledge and clinical thinking to medical student

“… 2 However, the basic undergraduate medical university curriculum remains unchanged with fifth and sixth year medical students undertaking 15-17 two to three week clinical rotations with minimal practical clinical skills training. 3 , 4 Although improvements have been reported, a recent survey revealed 83% Japanese postgraduate first year residents felt incompetent in their clinical skills. 5 Moreover, errors in cognitive thinking, one of core clinical skills, among physicians were linked to the most important cause for medical litigation cases in Japan.…”

“… 5 Moreover, errors in cognitive thinking, one of core clinical skills, among physicians were linked to the most important cause for medical litigation cases in Japan. 6 Solutions to improve clinical skill training at Japanese medical universities have included 1) Ministry of Education mandated core curriculum implementation and testing, 2 2) US medical schools conducting skill training workshops at both Japanese and American medical universities, 7 3) American medical educators leading Problem Based Learning (PBL) workshops in Japan, 4 , 8 and 4) Japanese medical universities appointing Japanese physicians trained abroad in clinical skills to educational leadership positions. 9 , 10 Recently, we reported Japanese medical student-initiated attempts to improve clinical thinking via real time audio-video Internet based seminars via the Worldwide Web [Webinars].…”