The purpose of this study is to investigate the outcome of patients with tracheostomy in a convalescence rehabilitation ward. Of 3,179patients who were discharged from our hospital in 4 years, 78subjects who had tracheostomy tubes at admission were included in the study. Forty-six of those patients (59%) were decannulated during hospitalization. The number of days required for decannulation was 35days on average. While all of the 78subjects had no oral intake at admission, upon discharge, 51subjects (65%) were able to take some kind of oral intake, and 38 of those were able to take oral nutrition fully. Additionally, those patients with consciousness disorders or severe physical impairments often had difficulty with decannulation. However, some cases with severe consciousness disorders or patients who were totally dependent for their physical care were successfully decannulated. Patients who require tracheostomy at the acute stage should be further evaluated for its necessity during the recovery phase. Some of the important aspects to consider in convalescence rehabilitation include evaluating the possibility of changing the type of tracheostomy tubes, examining the possibility of removing the tracheostomy tubes altogether, and performing dysphagia rehabilitation.

　For female physicians, it is important to nurture an environment that enables them to take advantages of support for child rearing as well as for their return to their original jobs. It is also critical for physicians, whether female or male, to receive education to recognize the professional/occupational missions of being a physician. Once they have received environmental support and mission clarification, they will be able to realize an uninterrupted career in order to attain their social contributions.

　The Committee on Studies of Career Education for Female Physicians has set five learning objectives by examining the required abilities and capabilities of a physician.

The proposed five learning objectives are to acquire:

(1) Professional awareness of the missions of being a physician,

(2) Ability to make career plans,

(3) Flexibility to embrace diverse values of the profession,

(4) Appropriate attitudes for both those receiving and those offering the support, because it should be the responsibility of the medical community,

(5) Recognition of social gender differences and acquires the capability to deal with such differences.

All organizations related to medical education should promote these five learning objectives.

　The Committee on Studies of Career Education for Female Physicians set five learning objectives for all physicians to nurture abilities for continuous public participation by women physicians. Next, we discussed the learning objectives corresponding to the learning period and made a road map. Further more, we proposed our new target-based education program and methods for its assessment.

1)Continuing medical education (CME) systems were researched in 10 countries. In all countries but one CME is mandatory. Only Spain has voluntary CME, as does Japan.
2)The traditional CME systems in many countries were changed after 2000. We believe this change reflects a global revolution associated with a new wave of medical risk management.
3)To provide better medical services, we must keep improving Japan's CME system. Such improvement is an important responsibility to society.

We collected and analyzed large-scale data concerning the fall of stroke inpatients in convalescent rehabilitation wards. Three hundred seventy-four of 1,107 inpatients experienced one fall or more, and 16 factors associated with falls were clarified by the chi-square test. To extract the significant item from a multifactor, the logistic regression analysis of 16 factors was carried out, and we developed an assessment sheet for the risk degree of first fall prediction in stroke inpatients. We selected eight variables as the items on the assessment sheet : history of previous falls, central paralysis, visual impairment, sensory disturbance, urinary incontinence, use of psychotropic medicines, mode of locomotion, and cognitive impairment. The total score of the assessment sheet was ranged from 0 to 10 and the mean score of fallers (6.4±1.5) among subjects was significantly higher than that of non-fallers (5.1±1.9) (p <0.001). When the subjects were classified into three groups, a significant difference (p<0.001) in the tendency of fall incidence in term of days after admission was found among the three groups on the basis of the Kaplan-Meier survival curve.

Objective: To investigate the current state of awareness and practice among hospital staff in advance care planning (ACP). Methods: A total of 782 hospital staff workers were administered an anonymous questionnaire. Results: Among the participants, 27.7% answered “I have discussed the will of end-of-life care in family.” and 11.0% answered “I have discussed the surrogate decision maker.” Moreover, only 1.1% of the respondents answered “I have made document of end-of-life care in family.” Conclusion: The awareness and practice among hospital staff in ACP is still developing, suggesting the need for more knowledge and experience.

OBJECTIVEWe conducted a study to develop an assessment sheet for fall prediction in stroke inpatients that is handy and reliable to help ward staff to devise a fall prevention strategy for each inpatient immediately upon admission.

METHODSThe study consisted of three steps: (1) developing a data sampling form to record variables related to risk of falls in stroke inpatients and conducting a follow-up survey for stroke inpatients from their admission to discharge by using the form; (2) carrying out analyses of characteristics of the present subjects and selecting variables showing a high hazard ratio (HR) for falls using the Cox regression analysis; (3) developing an assessment sheet for fall prediction involving variables giving the integral coefficient for each variable in accordance with the HR determined in the second step.

RESULTS AND DISCUSSION(1) Subjects of the present survey were 704 inpatients from 17 hospitals including 270 fallers. (2) We selected seven variables as predictors of the first fall: central paralysis, history of previous falls, use of psychotropic medicines, visual impairment, urinary incontinence, mode of locomotion and cognitive impairment. (3) We made 960 trial models in combination with possible coefficients for each variable, and among them we finally selected the most suitable model giving coefficient number 1 to each variable except mode of locomotion, which was given 1 or 2. The area under the ROC curve of the selected model was 0.73, and sensitivity and specificity were 0.70 and 0.69, respectively (4/5 at the cut-off point). Scores calculated from the assessment sheets of the present subjects by adding coefficients of each variable showed normal distribution and a significantly higher mean score in fallers (4.94 +/- 1.29) than in non-fallers (3.65 +/- 1.58) (P = 0.001). The value of the Barthel Index as the index of ADL of each subject was indicated to be in proportion to the assessment score of each subject.

CONCLUSIONWe developed an assessment sheet for fall prediction in stroke inpatients that was shown to be available and valid to screen inpatients with risk of falls immediately upon admission.

Objective: To analyze participants’ opinions regarding the content of clinical training workshops for attending physicians.　Method: A total of 225 people participants in the workshops (approximately 17 hours in 2 days) that were held between 2013 and 2016. We provided the following training sessions: (1) Kawakita Jiro Method (KJ), (2) Process of clinical training, (3) Training program planning procedure, (4) Training objectives, (5) Classification of objectives, (6) Professionalism (PF), (7) 6 Microskills (6MS), (8) Significant event analysis (SEA), (9) Training strategies, (10) Coaching, (11) Educational evaluation, (12) Clinical training systems (CTS), and (13) Roles of attending physicians (RAP). We only used the results of questionnaires obtained from participants who consented to the investigation, and reviewed them for (1) training proficiency, (2) session interest, and (3) course evaluation.　Results: Training sessions showing high proficiency were KJ, RAP, and CTS, and those indicating low proficiency were educational objectives, SEA, and PF. Training sessions that were of great interest were 6MS, Coaching, and KJ.　Conclusion: In the evaluation of the entire course, overall value scored the highest, followed by significance of future participation and applicability of content. Overall, the participants felt that the time for the training course was a little long and that the difficulty level was somewhat high.

At Saitama Medical University, experience training for first-year medical students was conducted for the purpose of communicating with people who live in an institution and have severe motor and intellectual disabilities. However, due to the spread of COVID-19, training at this institution has been suspended completely, which has led us to conduct the training remotely. In the remote training sessions, people with disabilities who only had nonverbal communication tools joined a Zoom meeting where they were able to communicate with students from inside the institution. In the past, there have been other times when training was suspended due to infectious disease outbreaks. Despite this, remote training has made it possible to carry out training without being affected by the environment. Compared to conventional training, remote training did not allow students to experience the atmosphere of the institution or interaction with the people on-site. However, it did have other advantages in that it enabled students to understand the disabilities at a deep level, making them realize the importance of nonverbal communication, and increasing their motivation to learn.