A student's medical interview in an objective structured clinical examination (OSCE) may be assessed slightly differently by simulated patients and by the faculty. In this study, we compared three different scores given by the faculty or simulated patients in the assessment of OSCE medical interviews conducted at our department for 3 years. Scores compared were the total score and the behavior score given by the faculty and the score given by simulated patients. The total score and the behavior score given by the faculty correlated well with the score given by simulated patients. However, for students who received a poor assessment from simulated patients, the three scores were weakly correlated; in particular, the behavior score given by the faculty differed markedly from the score given by simulated patients. These results suggest that simulated patients have a different and important viewpoint on assessment of the medical interview in an OSCE.

1) A possible reason that medical students do not complete problem-oriented medical records is a problem in putting information received from patient into a problem list.
2) We invented a clinical case and asked students to list problems from the case and to establish an initial plan for admission. The exercise was effective for teaching students to complete medical records.

The purpose of this study was to investigate the accuracy of estimating human body composition changes using bioelectrical impedance (BI) methods during a weight-loss intervention. Subjects were forty-three obese men (age : 49.2±10.5 yr, BMI : 27.8±1.7 kg/m²) who completed a 14-week weight-loss intervention. In all subjects, fat mass (FM) and fat-free mass (FFM) were assessed by dual energy x-ray absorptiometry (DXA) as well as single- and multi-frequency BI methods (SBIM, MBIM) before and after the intervention. Resistance parameters were measured by SBIM and MBIM (SBIM : R₅₀ ; MBIM : R∞, R0, and Rfc). In nine subjects these variables were also measured at weeks 1 and 4. Weight decreased (P<0.05) by -8.0±3.2 kg during the intervention while FFM changes averaged -0.4±1.6 kg (DXA), -2.0±1.5 kg (SBIM), and -1.6±1.7 kg (MBIM). BI methods overestimated FFM before the intervention (before ; DXA : 54.4±4.8 kg, SBIM : 56.5±4.3 kg, MBIM : 55.9±4.5 kg). In nine subjects, FFM measured by SBIM (FFM_SBIM) and MBIM (FFM_MBIM) was similar to FFM measured by DXA(FFM_DXA)(after ; DXA : 54.6±5.4 kg, SBIM : 54.6±3.8 kg, MBIM : 54.6±4.1 kg), although BI methods overestimated the FFM before the intervention (before ; DXA : 54.9±5.1 kg, SBIM : 56.9±3.8 kg, MBIM : 56.3±4.4 kg). The ΔFM_SBIM and ΔFM_MBIM were highly correlated with the ΔFM_DXA(SBIM : r=0.87, MBIM : r=0.88). The ΔFFM_SBIM andΔFFM_MBIM were significantly correlated with the ΔFFM_DXA(SBIM : r=0.54, MBIM : r=0.49). The ΔR₅₀ and ΔRfc were also significantly correlated with the ΔFFM_DXA(R₅₀ : r=-0.63, Rfc : r=-0.48). These results suggest that during a weight-loss intervention, 1) BI methods and DXA provide similar estimates of human body composition change, although they overestimate FFM in obese men, and 2) changes of resistance parameters observed with BI methods may estimate human body composition change more accurately.

Fifth-year medical students at the Yamaguchi University School of Medicine must pass an objective structured clinical examination (OSCE) before beginning bedside learning. Because the OSCE is performed over 3 days, examinees on later days are suspected of having an advantage over those tested on early days. In this study, mean values for each day's scores by one examiner were statistically compared in stations of the medical interview to investigate the difference in scores obtained on each of the OSCE days. In addition, for stations at which one student was evaluated by two examiners, their scores for each student were compared statistically in the same manner. We found no significant day-todaydifferences in mean values of the scores over the 3 examination days. However, significant differences were found between the two examiners' scores in 2 of 3 stations for the medical interview. Although there were no differences in scores among participants during the 3-day communication OSCE, examiner's evaluations and formats should be standardized for OSCE stations.

BACKGROUND: Medical students need interviewing skills to be effective in dealing with patients. However, it is presumed that there are some problems in evaluating the competencies medical students are required to have for practicing medicine.
OBJECTIVE: During Objective Structured Clinical Examinations (OSCE) in Japan, instructors usually evaluate examinee's behavior and attitude toward doing medical interviews. To improve the objectivity of these examinations we examined the assessment of our OSCE medical interview.
METHODS: Medical interviews are usually evaluated using a rating list. The standardized list used in most medical schools is composed of two parts: one scores the student's behavior while conducting the interview and the other evaluates the student's ability to gather information from patients. For 5^thyear student OSCE medical interviews are performed twice, before and after ward rotation. The results of two OSCEs were analyzed in terms of scores on conducting an interview, collecting patient information, and SP, or simulated patient. Data analysis of the students' behavior and attitude were taken over 3 years, from 2000 to 2002.
RESULTS: Total scores and scores on conducting interviews, collecting information, and SP's evaluation all increased when comparisons were made between before and after ward rotation. However, only the differences in the total score and SPs score in 2000 were statistically significant. Moreover, clinical skills for collecting patients' information were found to be unsatisfactory.
CONCLUSIONS: As the standardized OSCE medical interviews are performed at all medical schools in Japan today, further improvements in education and in the evaluation system will be required in the future to ensure students obtain the skills expected of them for practicing medicine.

Endoscopic submucosal dissection (ESD) is the standard treatment method for esophageal, gastric, and colorectal cancers. However, it has not been standardized for duodenal lesions because of its high complication rates. Recently, minimally invasive and simple methods such as cold snare polypectomy and underwater endoscopic mucosal resection have been utilized more for superficial nonampullary duodenal epithelial tumors (SNADETs). Although the rate of complications associated with duodenal ESD has been gradually decreasing because of technical advancements, performing ESD for all SNADETs is unnecessary. As such, the appropriate treatment plan for SNADETs should be chosen according to the lesion type, patient condition, and endoscopist’s skill.

Prediction of histology by endoscopic examination is important in the clinical management of non-ampullary duodenal epithelial tumors (NADETs), including adenoma and adenocarcinoma. The use of a simple scoring system based on the findings of white-light endoscopy or magnified endoscopy with narrow-band imaging is useful to differentiate between Vienna category 3 (C3) and C4/5 lesions. Less invasive endoscopic resection procedures, such as cold snare polypectomy, are quick to perform and convenient for small (<10 mm) C3 lesions. Neoplasms with higher grade histology, such as C4/5 lesions, should be treated by endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or surgery. Although EMR often requires piecemeal resection, the complication rate is acceptable. Excellent complete resection rates could be achieved by ESD; however, it remains a challenging method considering the high risk of complications. Shielding or closure of the ulcer after ESD is effective at decreasing the risk of delayed bleeding and perforation. Laparoscopic endoscopic cooperative surgery is an ideal treatment with a high rate of en bloc resection and a low rate of complications, although it is limited to high-volume centers. Patients with NADETs could benefit from a multidisciplinary approach to stratify the optimal treatment based on endoscopic diagnoses.

Background/Aims: 5-Aminosalicylic acid (ASA) causes intolerance reactions in some patients. This study was performed to examine the prognosis of patients with ulcerative colitis (UC) and 5-ASA intolerance, and to evaluate the potential interaction between 5-ASA intolerance and the intestinal microbiota. Methods: We performed a retrospective cohort study of patients with UC who visited participating hospitals. The primary endpoint was to compare the incidence of hospitalization within 12 months between the 5-ASA intolerance group and the 5-ASA tolerance group. The secondary endpoint was to compare the risk of adverse clinical outcomes after the start of biologics between the 2 groups. We also assessed the correlation between 5-ASA intolerance and microbial change in an independently recruited cohort of patients with UC. Results: Of 793 patients, 59 (7.4%) were assigned to the 5-ASA intolerance group and 734 (92.5%) were assigned to the 5-ASA tolerance group. The admission rate and incidence of corticosteroid use were significantly higher in the intolerance than tolerance group (P< 0.001). In 108 patients undergoing treatment with anti-tumor necrosis factor biologics, 5-ASA intolerance increased the incidence of additional induction therapy after starting biologics (P< 0.001). The 5-ASA intolerance group had a greater abundance of bacteria in the genera Faecalibacterium, Streptococcus, and Clostridium than the 5-ASA tolerance group (P< 0.05). Conclusions In patients with UC, 5-ASA intolerance is associated with a risk of adverse clinical outcomes and dysbiosis. Bacterial therapeutic optimization of 5-ASA administration may be important for improving the prognosis of patients with UC.