Recently, performance appraisal became necessary for faculty members. According to the questionnaire survey by the Ministry of Education, Culture, Sports, Science and Technology, the number of questionnaire items on education is on the increase, and performance appraisal is widely used for decisions on allowance and employment. In our college, performance appraisal on education, research, and medical care is used to decide on the size of bonuses. Performance appraisal for faculty members has already come into force in many universities. However, services in medical schools include many different aspects, and precise quantification of performance appraisal is very difficult. Now, exact evaluation methods and appropriate utilization are necessary for performance appraisal for faculty members.

The objective structured clinical examination (OSCE) is expected to be used for the Japanese medical license exami-nation (Advanced OSCE). An Advanced OSCE trial was conducted at Hyogo College of Medicine. We examined 96 stu-dents in 11 areas in 1 day with 58 examiners, 5 simulated patients, 70 student volunteers, and 34 clerks. According to thequestionnaire filled out by the students and examiners, this trial was moderately or rather difficult. This trial suggeststhat the Advanced OSCE can be used for the license examination, although some aspects should be improved.

Effects of environmental (cold) stress and aging on cells in monocyte/macrophage lineage were investigated. We demonstrated that immune suppressive states seen in acute cold-stressed mice (8-10 weeks of age) is attributable to FcγRIIbright suppressor macrophages. Serum corticosterone levels were markedly increased in acute cold-stressed mice. In addition, expression of glucocorticoids (GC) receptor mRNA was observed in FcγRIIbright cells from these mice. The increase of FcγRIIbright cells in peritoneal exudate cells caused by acute cold stress was inhibited by adrenalectomy or administration of a saturating amount of the GC antagonist RU 38486 (mifepristone). On the contrary, administration of the GC agonist, dexamethasone, markedly increased the proportion of FcγRIIbright cells in peritoneal exudate cells of control mice. These results suggest that the generation of FcγRIIbright suppressor cells of monocyte/macrophage lineage by acute cold stress was mediated by action of GC through the GC receptor. We likewise found that the proportion of FcγRIIbright suppressor macrophages is increased in aged mice (22-24 months of age). Meanwhile, activated macrophages which function as antigen presenting cells were decreased in aged rats. Both the basal corticosterone concentrations in serum and the expression of mRNA for GC receptor in peritoneal macrophages increased significantly in aged animals, suggesting that these populational and functional changes of macrophages in aged animals were mediated, in part, by the increased basal levels of GC. This is probably being responsible for immunosenescence.
Neisseria gonorrhoeae ; Laboratory mice ; Acute ; Macrophages ; receptor

Introduction: Compared with faculties in clinical and medical research departments, those in medical departments are not appropriately evaluated in terms of their contributions to or achievements in medical education. Therefore, the aims of this study were to investigate the contributions of medical department faculties to medical education, and to examine differences in contributions according to duty positions and specialties.

Methods: Five-grade self-assessments in relation to 20 items on a rating form for performance in medical education, which was developed by the Japan Society for Medical Education's Committee for Performance Evaluation, were carried out by medical department faculties in Japanese universities. The data were then totalized and analyzed.

Results and Discussion: Although faculties belonging to departments other than medical education units did not actively participate in examinations or the education system, they still made contributions to lectures and practice. In addition, faculties with positions with more duties tended to show greater participation in the education system.

Conclusion: Based on these findings, we recommend the use of a rating form as a standard scale to evaluate performance in medical education.

Intracardiac repair for cardiac anomalies associated with a transposed aorta from the right ventricle is a technically demanding operation. We present two cases of left ventricular outflow tract (LVOT) obstruction after the use of an ePTFE flat patch to reconstruct the LVOT. Case 1 : A 10-year-old boy had undergone the Rastelli operation, VSD enlargement, and intraventricular re-routing using an ePTFE flat patch for repair of the DORV with noncommitted VSD and pulmonary stenosis at the age of 5. Five years later, catheter examination revealed severe LVOT obstruction. Intraventricular re-routing using a part of the ePTFE graft concomitant with re-replacement of an extracardiac conduit was successfully performed. Case 2 : A 13-year-old girl had undergone a double-switch operation (Senning operation, the Rastelli operation, and intraventricular re-routing by the use of an ePTFE flat patch) for the repair of corrected TGA, PA and VSD at the age of 7. Six years later, catheter examination revealed severe LVOT obstruction. Intraventricular re-routing using part of the ePTFE graft concomitant with re-replacement of an extracardiac conduit was successfully performed. We consider that the use of a flat patch for reconstruction of a left ventricular out flow tract in cases with transposition of the aorta from the right ventricle involves a risk of future development of LVOT obstruction.

A certain period of time has passed since the transition to the General Medicine residency system under the Japanese Medical Specialty Board and Family Medicine specialist training system by the Japan Primary Care Association. We have summarized the needs of residents identified in the survey, and detailed the activities to date and prospects of the Japanese Association of Family Physician Trainees, a self-help support organization, which is an official subcommittee of the Japan Primary Care Association, from the viewpoint of the residents. We believe that this paper will serve as a resource for the training of residents, help guide them under the new system, and help to improve the training system, considering evidence suggesting that information may not be reaching residents who need support.

A medical-ethics course was anonymously evaluated by first-year students over 2 years. The course emphasizes problem-based learning through group discussion of clinical cases and lectures on ethical issues. A tutorial system was added to the course in the second year. Students' evaluations indicated that most students had positive attitudes about the course and that both group discussion and lectures were helpful for achieving the general instructional objectives and specific behavioral objectives of the course. A comparison of the 2 years showed that a majority of evaluated items received higher evaluations from second-year students than from first-year students. We attribute the difference to the livelier discussion with the introduction of the tutorial system and the smaller discussion groups. These results indicate that students consider medical-ethics education to be useful.

Our medical ethics course emphasizes problem-based-learning (PBL) via group discussion of clinical cases. The significanceof instructors' assessments of PBL in ethics education was studied with different assessment tools during thelast 2 years. In the first year, students' behavior and level of functioning in group discussion were assessed on a group basiswith an 8-item instrument. In the second year, students' level of functioning and flexibility in response to differentopinions in group discussion were assessed on an individual basis with a 2-item instrument. Instsments ofstudent's performance in group discussion were positively but weakly correlated with scores of their reports derivedfrom group discussions. Instructors could consistently assess student performance in PBL in terms of behavior and levelof functioning in group discussions. Furthermore, instructors rated flexibility in response to other opinions as an importantfactor in group dynamics, including interaction between students and instructors. These results suggest that instructors'assessments can be used to help evaluate students in a medical ethics course. Instructors' assessments of studentflexibility during PBL can be particularly useful in this regard.

Abstract:

 This study examined the ability of medical students to self-assess basic clinical competence and learning strategies including simulation-based medical education for sixth-year medical students (n=903) at nine universities in Japan. About 40% of 27 procedures to achieve clinical skills in a model curriculum were taught using simulators with or without clinical training in hospitals. We noted that significant numbers of procedures were not practiced through any learning strategies. Higher self-assessment scores were observed among students in 4 schools who had more frequent learning opportunities through simulation-based education than among those with less frequent opportunities in 5 schools.

The combination of disease-specific human induced pluripotent stem cells (iPSC) and directed cell differentiation offers an ideal platform for modeling and studying many inherited human diseases. Wilson's disease (WD) is a monogenic disorder of toxic copper accumulation caused by pathologic mutations of the ATP7B gene. WD affects multiple organs with primary manifestations in the liver and central nervous system (CNS). In order to better investigate the cellular pathogenesis of WD and to develop novel therapies against various WD syndromes, we sought to establish a comprehensive platform to differentiate WD patient iPSC into both hepatic and neural lineages. Here we report the generation of patient iPSC bearing a Caucasian population hotspot mutation of ATP7B. Combining with directed cell differentiation strategies, we successfully differentiated WD iPSC into hepatocyte-like cells, neural stem cells and neurons. Gene expression analysis and cDNA sequencing confirmed the expression of the mutant ATP7B gene in all differentiated cells. Hence we established a platform for studying both hepatic and neural abnormalities of WD, which may provide a new tool for tissue-specific disease modeling and drug screening in the future.
Adenosine Triphosphatases ; genetics ; metabolism ; Cation Transport Proteins ; genetics ; metabolism ; Cell Differentiation ; Copper-transporting ATPases ; Hep G2 Cells ; Hepatocytes ; cytology ; metabolism ; Hepatolenticular Degeneration ; metabolism ; pathology ; Humans ; Induced Pluripotent Stem Cells ; cytology ; Mutation ; Neural Stem Cells ; cytology ; metabolism ; Neurons ; cytology ; metabolism ; Sequence Analysis, DNA