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Development of the Japanese version of the Jefferson Scale of Attitudes toward Physician–Nurse Collaboration and measuring physicians'and nurses'attitudes toward collaboration in Japan

Keiko Komi ; Mami Onishi ; Katsuya Kanda

Medical Education.2011;42(1):9-17. doi:10.11307/mededjapan.42.9

　Physician–nurse collaboration is essential for realizing the team approach to health care. The current status of this collaboration must be examined from the viewpoints of both physicians and nurses. The present study, part of a larger study, aimed to translate the Jefferson Scale of Attitudes toward Physician–Nurse Collaboration （JSAPNC）, developed by Hojat et al. （1999）, into Japanese and to assess the attitudes of physicians and nurses toward collaboration in Japanese hospitals.
1）A self–administered questionnaire survey was distributed to 520 physicians and 2139 nurses at 4 hospitals in 4 prefectures, and valid responses were received from 51.0％ of physicians and 76.2％ of nurses.
2）Factor analysis revealed that the factorial structure of the Japanese version of the JSAPNC was different from that of the original version. The Cronbach’s alphas of the scale were 0.79 for total scores and 0.5 to 0.7 for subscales.
3）The total score on the JSAPNC was higher for nurses than for physicians. No demographic characteristics of physicians were correlated with their total scores on the JSAPNC. In contrast, nurses’ age, length of clinical experience, qualifications, position, and affiliation were correlated with their total scores on the JSAPNC.
4）The total score on the JSAPNC could be used to compare the attitudes towards collaboration of physicians and nurses between Japan and other countries. The results show that the total score on the JSAPNC of our subjects in Japan was lower than those in previous studies in other countries. Education for facilitating and evaluating collaboration is needed.
5）Further investigation of factors related to physicians’ attitude toward collaboration is required. For nurses, it is necessary to investigate factors related to their attitude in combination with organizational factors.

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Trial of a joint class for role–playing of informed consent with first–year students as patients and fifth–year students as physicians

Makoto Takahashi ; Atsushi Okawa ; Masanaga Yamawaki ; Yoshihito Momohara ; Shinya Ohoka ; Yujiro Tanaka

Medical Education.2011;42(1):19-23. doi:10.11307/mededjapan.42.19

1)The purpose of this study was to evaluate a role–playing class for informed consent with fifth–year students playing the role of physicians and first–year students playing the role of patients.
2)The first–year students were competent as simulated patients for the informed consent role–playing and were a worthy educational human resource.
3)This role–playing was effective for helping both first–year and fifth–year students understand informed consent and the mentality of patients and to motivate students to study informed consent. This joint class also allowed fifth–year students to review their progress over time and gave first–year students a chance to meet role models.

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Learning from Rural Physician Associate Program at the University of Minnesota

Kosuke Yasukawa ; Kathleen Brooks

Medical Education.2011;42(1):25-28. doi:10.11307/mededjapan.42.25

1)Rural Physician Associate Program (RPAP) at the University of Minnesota is a 9–month rural medicine program whose primary goal is to increase the supply of rural primary care physicians.
2)Over 40% of RPAP graduates practice in non–metropolitan areas and contribute significantly to the supply of physicians in rural areas.
3)In recent years, Japanese medical schools are admitting more students with a rural background. It is important to develop systematic and comprehensive rural medicine programs for students interested in rural medicine in order to increase the supply of rural physicians.

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A Survey on Training of Simulated and Standardized Patients(SP)and SP Program in Undergraduate Medical Education in Japan

Toshiro Shimura ; Fumihito Yoshii ; Akinobu Yoshimura ; Keiko Abe ; Yuzo Takahashi ; Haruko Saeki ; Kazuhiko Fujisaki ; Ryoko Aso ; Chikako Inoue

Medical Education.2011;42(1):29-35. doi:10.11307/mededjapan.42.29

A survey was conducted to better understand the current status of training of simulated and standardized patients (SP) in medical education and training protocol of SP training at each site, and to determine the future planning of the committee
1) Methods: A series of questions regarding the SP and SP training was sent to all 80 medical schools in Japan.
2) Results: Responses were received from 68 medical school (85%). According to the survey result, 43 medical schools (63%) trained their own SP. The total numbers of SP reported in this survey were 1,036 with ratio of male to female 1:3. The average numbers of SP at each medical school were 24 (range 5 to 87). SP training protocols were included basic training (88%) and to prepare common achievement test OSCE (84%), classes (74%) and advanced OSCE(60%). Only 6 medical school (14%) had the systematic curriculum for SP training.
3) Conclusion: To produce standardized, accurate SP training for medical education, the committee recommends to establish the standard curriculum and portrayal requirements for SP training.

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A Comparative Analysis of Educational Effectiveness and Student Satisfaction in Early Exposure Training Programs

Yoshimi Otsubo ; Takanobu Sakemi

Medical Education.2011;42(1):1-7. doi:10.11307/mededjapan.42.1

1) We performed a questionnaire survey of educational effectiveness and student satisfaction in regards to early exposure training programs.
2) The most effective educational training programs were, in descending order, "outpatient escort practice," "nursery practice," and "ward nursing practice." The programs with the highest levels of student satisfaction were, in descending order, "nursery practice," "severely mentally disabled patients' care practice," and "experimental learning practice of wheelchair activity." Because we found a large discrepancy between educational effectiveness and student satisfaction, we searched for factors influencing student satisfaction by analyzing the comments students made about each training program.
3) Factors that significantly affected both student satisfaction and educational effectiveness were "useful experience for future medical practice," "feeling of being able to help others," and "a sense of achievement."

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Training in physical examination using a cardiac patient simulator for medical students during bedside learning

Hiroyuki Komatsu ; Yasuji Arimura ; Takuroh Imamura ; Kazuo Kitamura ; Akihiko Okayama ; Katsuhiro Hayashi

Medical Education.2011;42(2):55-63. doi:10.11307/mededjapan.42.55

Cardiac patient simulators are commonly used in Japanese educational institutions; however, most institutions have not established concrete learning objectives or strategies for mastering physical examination of the circulatory system, including cardiac auscultation. In this study, we propose clear learning objectives and strategies for simulator practice for fifth-year medical students who have passed the objective structured clinical examination, and explored their educational effectiveness.
1)The subjects were fifth-year medical students (n=94) at the University of Miyazaki. Learning objectives were the mastery of the sequential physical examination and the ability to distinguish 6 cardiac findings, including normal status. The subjects were evaluated with a checklist before and after lectures and simulator practice.
2)The mean score (maximum score=14) significantly increased from before simulator practice (2.2±0.9) to after simulator practice (11.4±1.5; p<0.001). There was no difference in scores after practice among the cardiac diseases.
3)Before practice more than 50% of subjects could use a stethoscope on only right positions and could indicate only the maximum point of a cardiac murmur; in contrast, after practice more than 90% of the subjects could sequentially describe physical findings and accurately predict cardiac diseases.
4)In a questionnaire administered after practice, 83% of the subjects answered that all physicians should acquire proficiency in cardiac auscultation regardless of their specialty.
Simulator practice with clear learning objectives may help improve clinical examination skills when both time and human resources are limited. The reevaluation of the program's continuing educational effectiveness and the establishment of an iterative learning program will be needed.

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Qualitative research for investigating the factors that facilitate or interfere

Hiroki Mishina ; Yoko Yokoyama ; Mitchell D Feldman ; Naoki Kakudate ; Shunichi Fukuhara

Medical Education.2011;42(2):75-80. doi:10.11307/mededjapan.42.75

Mentorship in academic medicine in the United States and Europe has been recognized as an effective system for increasing a mentee's research productivity, career success, and ability to obtain research grants. Therefore, to promote mentoring programs in Japanese academic medicine, it is important to investigate factors that facilitate or interfere with mentoring.
1)We interviewed 12 physicians who have performed clinical research under existing mentoring programs in Japan and asked them about factors that, in their experience, had facilitated or interfered with mentoring.
2)We qualitatively analyzed transcripts of interviews to identify these factors.
3)Factors identified as facilitating mentoring were: appropriate evaluation of a mentee's research skill, knowledge of a mentee's career goals, mutual communication between mentor and mentee, and the presence of senior researchers close to a mentee.
4)Factors identified as interfering with mentoring were: the busyness of a mentor, a mentee's concerns about giving offense by consulting the mentor about trivial matters, and the hierarchically organized social relationship in which the mentor is superior and the mentee is inferior.
5)Assessment of the mentoring process and education programs for mentors were expected to be necessary measures to promote mentoring programs.

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The changes in students' consciousness about community medicine during our program

Takuya Iwasaki ; Yoshifumi Takeyama ; Masayuki Iki ; Hiroyuki Itoh ; Harumasa Ohyanagi ; Hitoshi Shiozaki ; Osamu Matsuo

Medical Education.2011;42(2):101-112. doi:10.11307/mededjapan.42.101

The collapse of community medicine has becomes a serious social problem in Japan, and a variety of measures have been implemented to counter it. In medical education, the model core curriculum has been revised, and many universities have started programs for community medical. We have had a community-based medical course at the Kinki University School of Medicine since 2005. This study examined the changes in students' consciousness about and affinity for community medicine during our program.
1)Questionnaires were completed by 494 students taking part in community-based medical training from April 2006 through July 2010. Results from before and after training were compared.
2)The questionnaire had 3 parts. The first part concerned medical activities with community residents. The second part concerned medical activities with housebound elderly persons. The third part concerned the students' future plans.
3)Many students gave themselves high scores for activities with community residents and housebound elderly persons. More students preferred hospitals in regional towns. A few students chose rural areas.
4)In an introduction to community medicine, it is important to first foster cordial relations with community residents. Cultivating problem-solving skills is the next challenge.
5)Community-based medical programs enhance medical students' understanding of and affinity for community medicine. Furthermore, some students will choose community-based medicine as a specialty.

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Examination of reliability in assessing medical interviews in acupuncture and moxibustion training institutes

Daigo Kaneda ; Satoru Kitada

Medical Education.2011;42(2):113-117. doi:10.11307/mededjapan.42.113

Our institution has introduced the objective structured clinical examination as a means of objectively assessing the learning status of students. An annual task is to increase the reliability of assessment tables at medical interview stations. To increase the reliability of assessment tables, it might be necessary to increase the concordance among assessors. Thus, we examined the reproducibility of the assessment items.
1)With the cooperation of 4 training institutes for acupuncture and moxa cautery, medical interview examinations by 89 students were videotaped after they had heard a lecture on medical interviews, had been provided with information about the examination, and had given consent.
2)We asked 6 institute members with experience in assessing medical interview examinations to assess the same recorded videotaped interviews individually and in pairs. We asked them to assess the same video again after a certain period of time.
3)High concordance was observed for every item by single assessors but not for many items among assessors.
4)Single–assessor concordance was not necessarily correlated with that among assessors.
5)When agreement was not expected in advance, the assessors performed assessments on the basis of their own educational criteria, which may result in decreased concordance among assessors.

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A Report about Training in Clinical Research Program(TICR)at the University of California, San Francisco(UCSF)

Nobuaki Michihata ; Hiroki Mishina ; Hirokazu Sakai ; John Ichiro Takayama

Medical Education.2011;42(2):119-122. doi:10.11307/mededjapan.42.119

1)The primary author completed a one–year program for clinicians, Training in Clinical Research(TICR), at the University of California San Francisco(UCSF).
2)In TICR, several educational systems including mentoring and feedback were used.
3)The clinicians at UCSF were provided protected time for clinical research and research education.

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