The innovation of the University Chartering Standards Law in 1991 triggered changes in general education in almost all medical schools in Japan. These changes include: 1) frequent abolition of the department of general education; 2) an expansion in the offerings of specialty subject; and 3) increase in early exposure programs. The Model of general education has, in general, changed from the liberal arts model to the one that emphasizes the development of physicians. One remaining problem is that, although the system of general education has changed, the traditional pedagogy has generally persisted. These are at least two possible forms that general education can take in the future. The first one comes from the U.S., in which students enter medical schools after finishing their general college education. The other one stems from an European model in which high school provide students with part of their general education, and medical schools provide them with intensive basic and humanity education that is necessary for physicians. Medical schools in Japan now face three major challenges for the future: 1) seeking how to teach ways of thinking other than medical one; 2) establishing an education system corresponding with recent changes in young people; 3) establishing divisions which comprehensively organize and supervise general education.

The Consensus of this Committee is:

1) To change the name of the present committee from "Premedical Education Committee" to "Committee on Behavioral and Social Science" ; accordingly to discuss theoretical foundations, clinical application, learning objectives and outcomes of behavioral and social science in Japanese medical schools.

2) To collect actual case studies of teaching behavioral and social sciences in Japanese medical schools and create a database for such practices.

3) To develop behavioral and social science curriculum content in Japanese medical schools.

4) To organize training courses for teaching methods for behavioral and social science curricula and develop standardized teaching methods and materials.

This is the report of the 1st Workshop on Basic Clinical Competence Education held on November 22-24, 1996, in Tokyo. Twenty eight medical teachers from 28 medical schools in Japan participated in the workshop. The many aspects of clinical skills education were discussed ; Goals, teaching strategy and evaluation of clinical skills, Teaching methods of medical interviewing and physical examination, Training methods of standardized patients, and Organizing OSCE. Post-workshop questionnaire revealed a great satisfaction among participants. Many participants expressed the need to have this kind of workshop on a regular basis.

We propose a new video system with four cameras aimed in different directions for use in objective structured clinical examinations (OSCEs) to 1) minimize the examiner's burden and 2) standardize the examiner's evaluation. The system consists of four charge-coupled device video cameras, several microphones, and a video tape recorder. The OSCE of each student was recorded with four cameras simultaneously aimed in different directions so that the student's performance could be viewed and evaluated at the examiner's convenience. Two trials for this system were undertaken at different times. More than 80% of those participating in the trials thought that this system was useful for examining the basic skills of medical students as part of the OSCE, and more than 70% thought that the system would increase educational efficacy. This system may improve the reliability and efficiency of OSCE.

To assess the effectiveness of a problem-based learning tutorial system introduced at Gifu University School of Medicine in 1995, we conducted a questionnaire survey of medical knowledge, attitudes about learning, communication ability, and social behavior in sixth-year medical students. The questionnaire was given to instructors and attending physicians at community hospitals who were involved in clinical education. Many of the evaluators felt that students who trained with the tutorial system showed improved understanding, a more active attitude toward learning, and a better attitude toward patients than did students who received traditional, lecture-based education.

The Common Achievement Tests Organization performed the first nationwide trial of computer-based testing (CBT) used to assess students entering the clinical phase of medical education. Seventy-seven medical schools participated in the trial. We compared performance on the national CBT with performance on preclinical tests administered at Gifu University School of Medicine. Despite some methodologic differences between the national CBT and our system, the overall results correlated well. Students who did poorly on the national CBT also did poorly on Gifu University's preclinical test. Correlation of these two performance scales suggests that nationwide CBT could be used to accurately assess preclinical skills.

Fructooligosaccharide (FOS) is a typical prebiotic agent. A randomized, double-masked, placebo-controlled study was performed to evaluate the prebiotic effect of daily intake of an isotonic solution containing FOS on body weight gain and the reduction of diarrhea in children in an urban slum in Bangladesh over six consecutive months. We enrolled a total of 150 children, aged 25-59 months. Sixty-four children in the FOS group received 50 mL of isotonic solution with 2 g of FOS added, and 69 children in the placebo group were given an identical solution with 1 g of glucose added, once a day. The measurement of body weight was carried out every other day; height and arm circumference were measured once a month; and the children‘s mothers were interviewed to obtain data about diarrhea, the consistency and constitution of stool, other symptoms, and antibiotic treatment. As a result, the body weight gain during the six-month period was 0.86±0.55 kg in the FOS group and 0.89±0.48 kg in the placebo group, while the increase in height and arm circumference were not significantly different between the two groups. The number of diarrhea episodes during the six-month period was not significantly different. A significant reduction in the duration of diarrhea days and of duration per episode was observed in the FOS group (p=0.039 and p=0.008, respectively). In conclusion, daily intake of FOS was associated neither with the children‘s growth nor with the number of diarrhea episodes, but a significant reduction in the duration of diarrhea days was observed. Further studies are needed to confirm the effects of FOS by changing the doses and eliminating the influence of antibiotics.

To evaluate the extension of the indications for operation and up-to-date problems in the surgical therapy of the acquired valvular disease, 581 consecutive patients of prosthetic valve replacement from January 1974 through December 1987 were analysed. The age at operation was 39.1 years (range 22 to 68) at 1974, but increased to 51.9 years (range 9 to 75) at 1987 (p<0.05). Early mortality was 3 deaths in 9 patients (33.3%) who were older than 70 years old, but its range was 0% through 7.7% in the younger patient group (p<0.05). Hospital mortality of the combined valve procedure for aortic, miral and tricuspid valvular disease was analysed. It was higher in the group of tricuspid valve replacement (30.0%) than the group of tricuspid annuloplasty (8.3%) (p<0.01). The former group was in poor preoperative state (cachexia, total bilirubin>2mg/dl, mean right atrial pressure>10mmHg and systolic pulmonary artery pressure >75mmHg), compared to the latter group. The cases of re-replacement of the prosthetic valve increased since 1985. The incidence of poor prognosis after operation, that included early death, late death and retire from society, was 47.1% in NYHA Class TV, and from 0 to 15.8% in NYHA Class I to Class III (p<0.01). 60 cases underwent valve replacement for infective endo-carditis, and 16 urgent operations were required in 23 active stage operations. Total early and late mortality was higher in active stage operation (30.0%) than in healed stage operation (2.7%) (p<0.01). In these way, the extension of the indications for operation was carried on the patients of advanced age, combined valve procedure for multiple valve disease, valve re-replacement and infective endocarditis. The operative risk was high in the patients older than 70 years old, the patients who had the risk factors of multiple organ failure after operation, valve re-replacement in NYHA Class IV, and the urgent operation at active stage of infective endocarditis.

Multiple endocrine neoplasia type 1 (MEN1) is an inherited autosomal dominant disease presenting with pancreatic neuroendocrine tumors (pNETs), parathyroid tumors, or pituitary tumors. Using the PubMed database, we reviewed the literature on information regarding the proper diagnosis and treatment of MEN1-associated pNET. Many cases of MEN1-associated pNET are functioning pNETs. Gastrinomas and insulinomas tend to occur frequently in the duodenum and pancreas, respectively. In addition to diagnostic imaging, the selective arterial secretagogue injection test (SASI test) is useful for localizing functioning pNET. The standard treatment is surgical resection. However, in the case of a functioning pNET, the tumor should first be accurately located using the SASI test before an appropriate surgical method is selected. In cases of a MEN1-associated non-functioning pNET that exceeds 2 cm in diameter, the incidence of distant metastasis is significantly increased, and surgery is recommended. In cases of unresectable pNET, a somatostatin analog has been shown to demonstrate antitumor effects and is considered to be a promising treatment. In addition, molecular-targeted drugs have recently been found to be effective in phase III clinical trials.
Diagnostic Imaging ; Duodenum ; Gastrinoma ; Incidence ; Insulinoma ; Multiple Endocrine Neoplasia ; Multiple Endocrine Neoplasia Type 1 ; Neoplasm Metastasis ; Neuroectodermal Tumors, Primitive ; Neuroendocrine Tumors ; Pancreas ; Pituitary Neoplasms ; Somatostatin

BACKGROUND/AIMS: The ability of endoscopic submucosal dissection (ESD) to resect large early gastric cancers (EGCs) results in the need to treat large artificial gastric ulcers. This study assessed whether the combination therapy of rebamipide plus a proton pump inhibitor (PPI) offered benefits over PPI monotherapy. METHODS: In this prospective, randomized, multicenter, open-label, and comparative study, patients who had undergone ESD for EGC or gastric adenoma were randomized into groups receiving either rabeprazole monotherapy (10 mg/day, n=64) or a combination of rabeprazole plus rebamipide (300 mg/day, n=66). The Scar stage (S stage) ratio after treatment was compared, and factors independently associated with ulcer healing were identified by using multivariate analyses. RESULTS: The S stage rates at 4 and 8 weeks were similar in the two groups, even in the subgroups of patients with large amounts of tissue resected and regardless of CYP2C19 genotype. Independent factors for ulcer healing were circumferential location of the tumor and resected tissue size; the type of treatment did not affect ulcer healing. CONCLUSIONS: Combination therapy with rebamipide and PPI had limited benefits compared with PPI monotherapy in the treatment of post-ESD gastric ulcer (UMIN Clinical Trials Registry, UMIN000007435).
Adenoma ; Cicatrix ; Cytochrome P-450 CYP2C19 ; Endoscopy ; Genotype ; Humans ; Multivariate Analysis ; Prospective Studies ; Proton Pump Inhibitors ; Proton Pumps* ; Protons* ; Rabeprazole ; Stomach Neoplasms ; Stomach Ulcer* ; Ulcer