To establish a framework for clinical education as a continuum from undergraduate clinical clerkships to postgraduate residency programs is an enormous challenge for Japanese medical education. The purpose of this article is to compare learning objectives achieved by clinical clerkship students to those achieved by postgraduate residents.1) Eighty-seven clerkship students and 67 residents at our hospital were assessed with the Web-based Evaluation System of Postgraduate Clinical Training with 253 learning objectives established by the Ministry of Health, Labour and Welfare.2) Clerkship students achieved most attitudinal objectives and performed well on the medical interview, basic physical examinations, and physician's order sheet.3) Clerkship students could observe major symptoms and diseases.4) These findings indicate the need to establish a common template for learning objectives used in both clerkships and residency programs.

1)The purpose of this study was to evaluate a role–playing class for informed consent with fifth–year students playing the role of physicians and first–year students playing the role of patients.
2)The first–year students were competent as simulated patients for the informed consent role–playing and were a worthy educational human resource.
3)This role–playing was effective for helping both first–year and fifth–year students understand informed consent and the mentality of patients and to motivate students to study informed consent. This joint class also allowed fifth–year students to review their progress over time and gave first–year students a chance to meet role models.

Laryngeal granulomas which grow in the rear of the vocal cords can be a refractory and recurrent condition, because of various pathogeneses and a lack of established treatment guidelines. We experienced a laryngeal granuloma case which recurred repeatedly, and was resistant to modern medicinal treatment. The laryngeal granuloma recurred after microlaryngosurgery. And though a second microlaryngosurgery and laser cauterization was done, followed by prescription of lansoprazole, tranilast, chlarithromycin and inhalation of fluticasone propionate, the laryngeal granuloma recurred once more. Thus, we tried Kampo medicines at the this time. Hangekobokuto, saishakurikkunshito and keikyososooushimbuto were stopped due to lack of efficacy on the ganuloma, and the Kampo formulation was changed to kairosan. Three weeks after changing formulation, the granuloma was no longer seen with laryngeal fiberscopy. And to-date, recurrence of the granuloma has not been confirmed. This case suggests that fatigue, body weight loss, bilateral Kyokyo-kuman (discomfort of the hypochondrium), bilateral excessive strain of abdominal muscles, pulsation of both the upper and lower navel, and tympanitic sound in upper abdomen may be clinical indications for kairosan.
Granuloma ; recur ; Red color ; Granuloma, Laryngeal ; Medicine, Kampo

OBJECTIVES: As the population ages, the number of lumbar spinal surgeries performed on sarcopenic patients will increase. The purpose of this study was to investigate the prevalence of sarcopenia and evaluated its impact on the results of lumbar spinal surgery. METHODS: This study included 2 groups: One group consisted of patients who underwent whole-body dual-energy X-ray absorptiometry (DXA) scanning before the option of undergoing surgery for lumbar spinal disease (LSD group) and a second group consisted of patients underwent DXA scanning for osteoporosis screening under hospital watch at the geriatric medicine department (control group). In order to evaluate the impact of sarcopenia on the clinical outcome of lumbar spinal surgery, the Japanese Orthopedic Association (JOA) score, the recovery rate based on the JOA score, and visual analogue scale (VAS) scores for lower back pain, lower extremity pain, and lower extremity numbness were compared within the LSD group. RESULTS: The prevalence of sarcopenia showed no statistical difference between groups (control group, 50.7%; LSD group, 46.5%). In the LSD group, while the changes in VAS scores showed no statistical difference between the nonsarcopenia subgroup and sarcopenia subgroup, the sarcopenia subgroup demonstrated inferior JOA scores and recovery rates at the final follow-up when compared with the nonsarcopenia subgroup (P < 0.05). CONCLUSIONS: This study demonstrated a high prevalence of sarcopenia among the elderly populations in Japan and a negative impact of sarcopenia on clinical outcomes after lumbar spinal surgery.
Absorptiometry, Photon ; Aged ; Asian Continental Ancestry Group ; Follow-Up Studies ; Humans ; Hypesthesia ; Japan ; Low Back Pain ; Lower Extremity ; Lysergic Acid Diethylamide ; Mass Screening ; Orthopedics ; Osteoporosis ; Prevalence ; Sarcopenia ; Spinal Diseases