General Internal Medicine, as well as Family Medicine, plays an important role in the primary care of North America. General internists in Canada are virtually hospital-based physicians. However, most general internists in the United States are community-based primary care physicians. Although the system in both countries are different, the training of General Internal Medicine is very similar. General internists comprehensively manage patients with complex illnesses such as one with difficult diagnoses, multiproblem or chronic illness. In addition to basic clinical knowledge and skills, they teach students and residents clinical epidemiology, evidence based medicine and clinical decision making.

Influenced by a favorable environment, volunteer activities are integrated into medical education in the United States. Volunteer activities by medical students in hospitals are also becoming more common in Japan. With this background in mind, we performed a survey examining the nature of medical students' volunteer activities at the University of Hawaii in the United States and Saga University in Japan. By analyzing the percentages of students participating in volunteer activities and the location and content of the activities, we found that volunteer activities of medical students in Japan and the United States are strongly influenced by differences in the respective premedical education systems. We found that a premedical education that includes volunteer activities plays an important role in the United States. We suggest that further debate on premedical education that includes volunteer work is necessary for Japan to develop its own methods of medical education.

Background: Few studies have focused on the current state of referral and consultation practice between generalists and specialists at Japanese university hospitals.Methods: We retrospectively analyzed the electronic medical records of 513 outpatients (a cumulative total of 608 patients) who visited the Department of General Medicine of Toyama University Hospital between January and December 2016. All patients used our in-hospital consultation and referral service.Results: We referred 492 new patients to different specialists, with 40% referred to psychiatry, orthopedics, otolaryngology, and dermatology specialists. Our suspected diagnoses were correct for 285 of 395 patients (72%) who were referred to specialists to confirm the diagnosis. No abnormalities were observed in 86 patients (21%), and inappropriate referrals were made for 5 patients (1.2%). We also received 116 consultations from specialists, 66% of which were from orthopedics, psychiatry, gynecology, oral dental surgery, and neurosurgery specialists. Many of the referred patients had vague symptoms such as fever and general fatigue.Conclusion: Improving the practical skills of generalists regarding orthopedic and otolaryngologic problems may result in more appropriate referrals. Our department also served as a consultant for medical problems for specialists, especially orthopedic surgeons and psychiatrists.

Objective: To investigate the role and validity of the objective structured clinical examination (OSCE) for neurological screening (Neuro-OSCE) performed by medical students and to analyze the association between Neuro-OSCE score and student behavior for acquiring skills. Method: A 31-item Neuro-OSCE was created for systematic and time-saving screening of neurological findings. At Saga Medical School, 44 final-year students took a screening neurological examination course and performed Neuro-OSCE from August through October 1998. A questionnaire asked about self-educational behaviors, such as self-evaluation, mental concentration, and self-learning (knowlege-based), and self-practicing time. The relationship between Neuro-OSCE score and self-educational behaviors were analyzed. statistically. Results: Cronbach's coefficient alpha was 0.731, which indicated fair internal validity. The mean Neuro-OSCE score was 51.2± 6.6 (SD). Neuro-OSCE score was correlated with self-practicing time and mental concentration but not with self-learning time or self-evaluation. Conclusion: Our Neuro-OSCE has construct validity in the psychomotor domain from a taxonomic viewpoint because the Neuro-OSCE score was correlated with self-practicing time rather than self-learning time. Mental concentration was better a self-assessment method than was self-evaluation. However, setting self-educational goals for neurological examination is probably too difficult at the undergraduate level. Objective assessment by Neuro-OSCE is expected to foster relevant learning behavior.

Objective: To identify factors, such as embarrassment, contributing to the psychological resistance of female patients to physical examination.Methods: Female outpatients were given questionnaires asking about their degree of embarrassment in four areas of physical examination, their tolerance for disrobing during chest examination, and examples of actual episodes of embarrassment experienced during Physical examination. Answers were analyzed statistically. Results: Patients were more embarrassed when examiners were men or were students. When a male student examiner examined the chest and abdomen, the younger the female patients were, the greater their embarrassment was. Conclusions: Male student examiners should be most careful during Physical examination not to embarrass female patients. Gowning may reduce their embarrassment.

OBJECTIVE: To evaluate an undergraduate curriculum of communication skills by measuring satisfaction of outpatients whom final year students had examined.
METHODS: Cross-sectional surveys were conducted in General Medicine Clinic (GMC) of Saga Medical School (SMS) Hospital in 1999 and 2001. After the clinical clerkship in wards in fifth year, final year students experienced the two-week GMC clerkship, including seven hours of small group lecture in 1999, but partly converted into eight hours of small group discussion with a tutor in 2001. Six items in American Board of Internal Medicine Patient Satisfaction Questionnaire were selected as a validated instrument and incorporated into repeated measures ANOVA.
RESULTS: A total of 177 students were evaluated by 688 outpatients. Overall average score was 3.49+/-0.82. Average score in 2001 was significantly higher than that in 1999 (p<0.001; 3.58+ /-0.76vs 3.36+/-0.87) . The scores of“encouraging and answering questions”and“clear explanations”items were significantly lower than those of other items (3.21+/-0.98 and 3.37+/-0.92; Least Significant Difference) . The interaction between gender and years of curricula (1999 and 2001) was significant (p<0.001) ; female students showed remarkable improvement from 1999 to 2001 (Cohen's delta=0.67) .
CONCLUSIONS: Patient satisfaction scores indicated that undergraduate curriculum for communication skills in SMS improved from 1999 to 2001. Newly implemented small group discussion was a possible reason for the improvement, especially in female students. Further training for the skills of encouraging and answering questions and clear explanations will be the next step.

We participated in TIPS-FM (Toronto International Program to Strengthen Family Medicine and Primary Care) for two weeks in Toronto in June 2019. This program enabled us to learn many important factors for developing family medicine. Based on Canadian family medicine, which has a long history, we were able to review the missions of family medicine in Japan, and gained further insight into multilayered essentials on the patient-, community-, and global-levels.

Introduction: Primary care (PC) physicians often struggle with the local dialects of patients, especially when they work away from their hometowns.Method: We conducted a questionnaire survey of PC physicians in the Hokushinetsu region, the northcentral part of Honshu island of Japan, to understand how doctors recognize and deal with local dialects in their daily clinical practice.We also analyzed their comments qualitatively using the Steps for Coding and Theorization (SCAT) method.Results: Thirty-one physicians (21 men and 10 women) completed the questionnaire. Of the total, 71% of respondents worked away from their hometowns.Moreover, 81.8% of these respondents stated they had difficulties understanding the dialect spoken in the region of their workplaces and 36.3% misunderstood the meanings of the dialect spoken by their local patients as a result. Respondents often heard "ui" or "tekinai" as the chief complaints of local patients, and interpreted these words as physical symptoms such as fatigue, dyspnea, and abdominal distension. SCAT analysis suggested that these words can have different meanings depending on the context. PC physicians translate them into medical terms using paraphrasing techniques based on each patient's medical history. Furthermore, PC physicians use dialects according to their relationship with the patient.Conclusion: Understanding the characteristics of these dialects and using them appropriately may improve the doctor-patient relationship.

A cross-sectional study was performed in the general medicine clinic of Saga Medical School Hospital to evaluate the humanistic quality of the clinical curriculum by assessing Patient satisfaction. The Patient Satisfaction Questionnaire (PSQ) developed by the American Board of Internal Medicine, was translated into Japanese, and 6 of 10 items were selected to evaluate the humanistic qualities of 123 fourth-year medical students who performed medical interviews of 442 patients. The patients rated each PSQ item with a 5-point scale from poor to excellent. The mean PSQ score was 3.38±0.66 (good to very good). The scores for “answering questions” and “giving clear explanations” were significantly lower than were scores for attitudinal aspects. The results suggest that the undergraduate curriculum at Saga Medical School for patient education skills requires further improvement.