To improve doctors' understanding of dietary and nutritional therapy, clinical nutrition must be taught during undergraduate medical education. Using questionnaires given to every medical university in Japan, we examined how clinical nutrition education has been adopted into their curricula. Only 9 (12.9%) of 70 universities have adopted this topic as a cultural or professional subject. Many other universities are performing nonintegrated nutrition education by teaching nutrition-related items in basic and clinical subjects. Although many nutrition-related topics are included in the Essentials for the National Medical Board Examination published by the Ministry of Health and Welfare, only 1% to 5% of the 320 to 330 questions appearing on the national medical board examination are nutritionrelated. The present report suggests that the nutritional knowledge of doctors and medical students is not sufficient. We believe that national guidelines for problem-based nutritional education as part of an integrated curriculum must be established. The present situation of nutrition education in the United States, the United Kingdom, and Europe are also discussed.

Medical interviewing skills were assessed with the objective structured clinical examination using simulated/standardized patients (SP) in 36 5th-year medical students. ultaneously, assessment of cognitive-behavioral characteristics was performed using 7 kinds of scales (locus of control, social skills, self-esteem, general self-efficacy, medical interviewing-specific self-efficacy, person perception of self, and person perception of the patient) on the same students to clarify correlations with medical interviewing skills. Students who had attended a small-group mini-workshop session for medical interviewing skills showed only a significantly better ability to summarize. Personal familiarity with the patient was the only factor among the cognitive-behavioral factors studied which was a significantly correlated with medical interviewing skills. Among the six medical interviewing skills, only summarization and confirmation skills were positively correlated with the students' self-efficacy and the objective assessment with the objective structured clinical examination. We conclude that 1) medical interviewing skills can be taught regardless of the cognitive-behavioral abilities of each student; 2) teaching summarization and confirmation skills are especially valuable and important in teaching medical interviewing to medical students.

A program for teaching basic clinical skills to fifth-year medical students was started at Toyama Medical and Pharmaceutical University in 1999. The five units of basic clinical skills included: 1) medical interviewing, 2) general physical examination, 3) chest examination, 4) abdominal examination, and 5) neurologic examination. The educational strategies and evaluations in each unit consisted of: 1) lectures, 2) videotape demonstrations, 3) role-playing in small groups, 4) practice on patients in small groups, 5) written examinations, and 6) objective structured clinical examinations. The students evaluated each session of the program with a five-grade rating scale and comments. Small-group sessions (role play and practice on patients) and objective structured clinical examinations received the highest scores, followed by videotape demonstrations. Lectures received significantly lower scores than did other parts of the program. In addition, most students recommended standardization of educational content, increased practice time, and fewer lectures. We conclude that evaluation by students is essential for improving programs for teaching basic clinical skills.

To clarify the core competencies developed through postgraduate clinical training, we analyzed the conditions of our residency program with qualitative research methods. Seven residents (6 first-year residents and 1 second-year resident) answered a questionnaire and underwent semistructured interviews about postgraduate training. We also worked with the residents as “participant observers” of the treatment team. We found that residents often had trouble formulating diagnostic/treatment plans and tended to rely excessively on laboratory data to make decisions. We attribute these problems to a lack of practice in questioning expectations. We hypothesized that mitate-ryoku, the ability to describe the course of a patient's illness, is an extremely important clinical competency. According to the hypothesis, we tried to listen to the residents' description and to discuss it logically as colleagues. The residents described the patients expected condition over the next few days, considering both data and information they obtained from interviews and physical examinations. They adapted their ideas through logical discussion and were thus able to make acceptable decisions by themselves.

The objective is to explore the effect and the mechanism of arsenic trioxide, As(2)O(3), on different cell lines of chronic myeloid leukemia (CML). Different concentrations of As(2)O(3) (0.2, 2 and 10 micro mol/L) were added to CML cell lines KU812 and MEG-01 and other leukemia cell lines U937 and PL21, the cell numbers were counted at different times, TUNEL and DNA ladder were assayed. Different antibodies, CD34, CD13, CD33, CD19, CD11b, CD14 and CD7, were added to detect the change of the molecules on cell surface, the change of bcr-abl by RT-PCR and the activity of caspase-3 were assayed. The results showed that different concentrations of As(2)O(3) had different effects on the survival of the 4 cell lines. After culture for 24 hours with As(2)O(3), there was no significant increase in CD11b in all the four cell lines. There were no changes of bcr-abl in the two CML cell lines treated and untreated with As(2)O(3) by RT-PCR. Activities of caspase-3 were all increased. It is concluded that As(2)O(3) can induce apoptosis in CML cell lines, the concentration to induce apoptosis is different, CML cell lines are more sensitive than the other 2 leukemia cell lines. As(2)O(3) induced apoptosis may have some relation with the activation of caspase-3.
Antineoplastic Agents ; pharmacology ; Apoptosis ; drug effects ; Arsenicals ; pharmacology ; Caspase 3 ; Caspases ; metabolism ; Cell Division ; drug effects ; Dose-Response Relationship, Drug ; Fusion Proteins, bcr-abl ; genetics ; Humans ; In Situ Nick-End Labeling ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; drug therapy ; genetics ; pathology ; Oxides ; pharmacology ; Tumor Cells, Cultured