Faculty Profiles - NISHIGORI Hiroshi

Association between daily breakfast habit during pregnancy and neurodevelopment in 3-year-old offspring: The Japan Environment and Children’s Study Open Access

Imaizumi K., Murata T., Isogami H., Fukuda T., Kyozuka H., Yasuda S., Yamaguchi A., Sato A., Ogata Y., Shinoki K., Hosoya M., Yasumura S., Hashimoto K., Fujimori K., Nishigori H., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Sobue T., Shima M., Nakamura H., Suganuma N., Kusuhara K., Katoh T.

Scientific Reports Vol. 14 ( 1 ) 2024.12

Publisher：Scientific Reports

The association between daily breakfast habits during pregnancy and offspring neurodevelopment remains unknown. We evaluated the association between breakfast habits during pregnancy and offspring neurodevelopment. Data of 72,260 women with singleton deliveries at and after 37 weeks of gestation enrolled during 2011–2014 in the Japan Environment and Children’s Study were analysed. Offspring neurodevelopmental delays at 3 years of age were evaluated using the Ages and Stages Questionnaire, Third Edition (ASQ-3). Participants were stratified by tertiles of maternal daily energy intake (DEI) (Groups 1, 2, and 3:< 1400, 1400–1799, and ≥ 1800 kcal, respectively) during pregnancy and by offspring sex. The adjusted odds ratio (aOR) for abnormality in communication among participants with daily breakfast consumption habit was 0.87 (95% confidence interval, 0.80–0.96). A stratified analysis based on total DEI showed no significant differences in the neurodevelopment of Group 1 offspring. The aOR for abnormality in communication was 0.80 (95% confidence interval, 0.68–0.94) in Group 2. The aOR for abnormality in personal–social characteristics was 0.84 (95% confidence interval, 0.71–0.99) in Group 3. Maternal daily breakfast habits are associated with offspring neurodevelopment at 3 years of age, with the association influenced by maternal DEI and offspring sex.

DOI： 10.1038/s41598-024-55912-x

What can Japanese medical education contribute to the world?

Exploring yarigai: The meaning of working as a physician in teaching medical professionalism Reviewed Open Access

Nishigori, H; Shimazono, Y; Busari, J; Dornan, T

MEDICAL TEACHER Vol. 46 ( 11 ) page： 1486 - 1493 2024.11

Language：English Publisher：Medical Teacher

Introduction: The shift in medical professionalism now considers the well-being of physicians, given the prevalence of burnout and the importance of work-life balance. To reconsider the question ‘Why do doctors work for the patient?’ and explore the meaning of working as a physician, this study adopts the concept of ‘yarigai,’ which represents fulfillment and motivation in meaningful work. The authors’ research questions are: How do doctors recount experiences of yarigai in caring for patients? What kind of values are embodied in their stories about yarigai? Method: They adopted narrative inquiry as the methodology for this study. They interviewed 15 doctors who were recognized by their colleagues for their commitment to patient-centered care or had demonstrated yarigai in caring for patients. The semi-structured interviews were conducted face-to-face with each participant by the Japanese researchers, yielding 51 cases of patient-doctor interactions. After grouping the interview data, they translated the cases into English and identified four representative cases to present based on the set criteria. Results: From the 51 case studies, they constructed four representative narratives about the yarigai as a physician. Each of them spoke of (1) finding positive meaning in difficult situations, (2) receiving gifts embodying ikigai, (3) witnessing strength in a seemingly powerless human being, and (4) cultivating relationships that transcend temporal boundaries, as being rewarding in working as a physician. The main results of the study, which are the narratives, are described in the main body of the paper. Conclusion: The stories on yarigai gave intrinsic meanings to their occupational lives, which can be informative for students, residents, and young physicians when contemplating the meaning of their work as doctors. Rather than demanding selfless dedication from physicians towards patients, they believe it more important to foster yarigai, derived from the contribution to the well-being of others through patient care.

DOI： 10.1080/0142159X.2024.2316227

錦織　宏　名古屋大学総合医学教育センター長・教授

錦織宏

医学教育 Vol. 55 ( 5 ) page： 374 - 376 2024.10

Nishigori, H; Haruta, J; Urushibara-Miyachi, Y

MEDICAL TEACHER Vol. 46 ( sup1 ) page： S1 - S3 2024.6

Medical education in Japan

Nishigori, H

MEDICAL TEACHER Vol. 46 ( sup1 ) page： S4 - S10 2024.6

Language：English Publisher：Medical Teacher

The Model Core Curriculum for Medical Education (MCC) currently, there are 82 medical schools in Japan. The combined enrollment capacity of medical schools nationwide stands at 9,217. Students are eligible to enter medical school upon graduation from senior high school. The standard undergraduate medical education curriculum in Japan spans six years. The Model Core Curriculum for Medical Education (MCC), developed by the Ministry of Education, Culture, Sports, Science and Technology (MEXT), serves as the guideline for all medical school curricula. The Common Achievement Tests Organization (CATO) conducts the Computer-Based Testing (CBT) and the Objective Structured Clinical Examination (OSCE) in all medical schools. The Japan Accreditation Council for Medical Education (JACME), formally recognized by the World Federation of Medical Education (WFME), is responsible for the accreditation of undergraduate medical education in Japan. The National Examination for Medical Practitioners, administered by the Ministry of Health, Labour and Welfare (MHLW) and held annually, is a paper-based examination in which examinees answer multiple-choice questions. After graduating from medical school and obtaining a medical license, individuals progress to a two-year basic postgraduate clinical training program. Upon completion, they advance to a three-to-five-year specialty training phase. The lifelong learning of physicians is overseen by the respective medical societies and the Japan Medical Association. Current issues facing medical education in Japan include bloated curricula, faculty members’ busy schedules and burdens, educational disparities and admission selection, and uneven distribution of specialties. The author believes that medical education should continue to evolve to reflect future changes in society.

DOI： 10.1080/0142159X.2024.2372108

Association of cesarean section and infectious outcomes among infants at 1 year of age: Logistic regression analysis using data of 104,065 records from the Japan Environment and Children's Study Open Access

Maeda H., Hashimoto K., Iwasa H., Kyozuka H., Kume Y., Go H., Sato A., Ogata Y., Murata T., Fujimori K., Shinoki K., Nishigori H., Yasumura S., Hosoya M., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Iso H., Shima M., Kurozawa Y., Suganuma N., Kusuhara K., Katoh T.

PLoS ONE Vol. 19 ( 2 February ) 2024.2

Publisher：PLoS ONE

Background There has been a recent decrease in the prevalence of infectious diseases in children worldwide due to the usage of vaccines. However, the association between cesarean delivery and infectious diseases remains unclear. Here, we aimed to clarify the association between cesarean delivery and the development of infectious diseases. Methods This study is a cross-sectional study. We used data from the Japan Environment and Children's Study, which is a prospective, nationwide, government-funded birth cohort study. The data of 104,065 records were included. Information about the mode of delivery, central nervous system infection (CNSI), otitis media (OM), upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), gastrointestinal infection (GI), and urinary tract infection (UTI) was obtained from questionnaires and medical records transcripts. Multiple logistic regression analysis was used to assess the association between cesarean delivery and CNSI, OM, URTI, LRTI, GI, and UTI risk. Results We included a total of 74,477 subjects in this study, of which 18.4% underwent cesarean deliveries. After adjusting for the perinatal, socioeconomic, and postnatal confounding factors, children born by cesarean delivery did not have an increased risk of developing CNSI (95% confidence interval [CI] 0.46-1.35), OM (95% CI 0.99-1.12), URTI (95% CI 0.97-1.06), LRTI (95% CI 0.98-1.15), GI (95% CI 0.98-1.11), or UTI (95% CI 0.95-1.45). Conclusions This nationwide cohort study did not find an association between cesarean delivery and CNSI, OM, URTI, LRTI, GI, and UTI. However, further studies are needed to evaluate the role of cesarean delivery in the development of infectious diseases. Copyright:

DOI： 10.1371/journal.pone.0298950

Prenatal folic acid supplement/dietary folate and cognitive development in 4-year-old offspring from the Japan Environment and Children’s Study Open Access

Nishigori H., Nishigori T., Obara T., Suzuki T., Mori M., Imaizumi K., Murata T., Kyozuka H., Ogata Y., Sato A., Shinoki K., Yasumura S., Hosoya M., Hashimoto K., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Sofue T., Shima M., Nakamura H., Suganuma N., Kusuhara K., Katoh T.

Scientific Reports Vol. 13 ( 1 ) 2023.12

Publisher：Scientific Reports

We evaluated the association between maternal prenatal folic acid supplement use/dietary folate intake and cognitive development in 4-year-old offspring (N = 3445) using data from the Japan Environment and Children’s Study. Cognitive development was evaluated using the Kyoto Scale of Psychological Development 2001. Multiple regression analysis revealed that offspring of mothers who started using folic acid supplements pre-conception had a significantly higher language-social developmental quotient (DQ) (partial regression coefficient 1.981, 95% confidence interval 0.091 to 3.872) than offspring of mothers who did not use such supplements at any time throughout their pregnancy (non-users). Offspring of mothers who started using folic acid supplements within 12 weeks of gestation had a significantly higher cognitive-adaptive (1.489, 0.312 to 2.667) and language-social (1.873, 0.586 to 3.159) DQ than offspring of non-users. Regarding daily dietary folate intake from preconception to early pregnancy, multiple regression analysis revealed that there was no significant association with any DQ area in the 200 to < 400 µg and the ≥ 400 µg groups compared with the < 200 µg group. Maternal prenatal folic acid supplementation starting within 12 weeks of gestation (but not adequate dietary folate intake from preconception to early pregnancy) is positively associated with cognitive development in 4-year-old offspring.

DOI： 10.1038/s41598-023-36484-8

Association between gestational age at threatened preterm birth diagnosis and incidence of preterm birth: the Japan Environment and Children’s Study Open Access

Murata T., Isogami H., Imaizumi K., Fukuda T., Kyozuka H., Yasuda S., Yamaguchi A., Sato A., Ogata Y., Shinoki K., Hosoya M., Yasumura S., Hashimoto K., Nishigori H., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Sobue T., Shima M., Nakamura H., Suganuma N., Kusuhara K., Katoh T.

Scientific Reports Vol. 13 ( 1 ) 2023.12

Publisher：Scientific Reports

We evaluated the association between gestational age at threatened preterm birth (TPTB) diagnosis and preterm birth (PTB) incidence using a nationwide birth cohort. Data of 94,236 women with singleton deliveries from the Japan Environment and Children’s Study (enrolled between 2011 and 2014) were analysed. Participants were divided based on parity and gestational age at TPTB diagnosis (22–24, 25–27, 28–30, 31–33, and 34–36 weeks). Multivariable logistic regression models were used to calculate the odds ratios (ORs) for PTB before 37 and 34 weeks in women from all groups, using participants without TPTB as the reference. The adjusted ORs for PTB before 37 weeks were the highest in the latest gestational age group in nulliparous and multiparous women without previous PTB, while those before 34 weeks were the highest in the earliest and latest gestational age group in multiparous women without previous PTB and in the earliest gestational age group in multiparous women with previous PTB. The association between gestational age at TPTB diagnosis and PTB incidence varies based on maternal parity and PTB before 37 or 34 weeks. Further studies with detailed clinical data and a unified TPTB diagnosis protocol are necessary to clarify this association.

DOI： 10.1038/s41598-023-38524-9

Deconstructing the masculinized assumption of the medical profession: narratives of Japanese physician fathers Reviewed Open Access

Kamihiro, N; Taga, F; Miyachi, J; Matsui, T; Nishigori, H

BMC MEDICAL EDUCATION Vol. 23 ( 1 ) page： 857 2023.11

Language：English Publisher：BMC Medical Education

Background: Gender studies in the medical profession have revealed gender biases associated with being a doctor, a profession often regarded as more suitable for men. The path to gender equality inevitably involves deconstructing this masculinized assumption. Despite the decades-long expectation that ikumen–men who actively participate in childcare in Japan–would contribute to a change toward gender equality, Japanese society is still male dominated, and women suffer from a large gender gap. With the aim of exploring implicit gendered assumptions concerning being a caregiver and a doctor, the authors focused on the experience of individuals juggling the binary roles of a professional and a caregiver. Methods: The authors conducted subjectivist inductive research, recruited ten Japanese physician fathers through purposive sampling, and collected data through one-to-one semi-structured interviews between October 2017 and December 2018. The authors recorded and transcribed the narrative data, and extracted themes and representative narratives. Results: The study identified three themes about the reproduction and potential change of the gender gap: maintaining gendered assumptions of the medical profession without experiencing conflict, maintaining gendered assumptions of the medical profession while experiencing conflict, and deconstructing gendered assumptions of the medical profession through conflict. The authors found that these negotiations interplayed with the gendered division of labor between male doctors and their wives as well as the patriarchal family structure. Conclusions: The study revealed how gendered assumptions of the medical profession, as well as gender stereotypes and gendered division of household labor, were reproduced in the course of male doctors’ negotiations when they became fathers. For male doctors to question their unconscious gender bias, the authors emphasize the importance of men gaining knowledge about gender stereotypes, and propose that educators create such opportunities. Moreover, the authors assert that increasing doctors’ awareness of how masculinized assumptions implicitly interact with ideas of being a doctor—an aspect rarely discussed among medical professionals—is crucial for deconstructing the gendered normativity in the medical field.

DOI： 10.1186/s12909-023-04855-4

宮地純一郎, 錦織宏

月刊地域医学 Vol. 37 ( 9 ) page： 65 2023.9

Report on Workshops at the 55th Annual Conference Reviewed

Takeda Yuko, Tsuchiya Shizuma, Saiki Takuya, Maeno Takami, Imafuku Rintaro, Matsuyama Yasushi, Yagi Machiko, Kikukawa Makoto, Obara Haruo, Shiibashi Michio, Nakamura Mariko, Takamura Akiteru, Nagasaki Kazuya, Kobayashi Shizuko, Tsuruta Jun, Miyachi Yuka, Nishigori Hiroshi

Igaku Kyoiku / Medical Education (Japan) Vol. 54 ( 4 ) page： 406 - 409 2023.8

Narrative Review of Feedback -From Definition to Recent Discussion- Reviewed

Kimura Takeshi, Nishigori Hiroshi

Igaku Kyoiku / Medical Education (Japan) Vol. 54 ( 3 ) page： 255 - 265 2023.6

Language：Japanese Publisher：Japan Society for Medical Education

Feedback is an educational activity that occurs in a variety of settings in medical education and has been widely discussed since 2008, when Ridder et al. defined it as "Specific information about the comparison between a trainee's observed performance and a standard, given with the intent to improve the trainee's performance." (Ridder et al., 2008, p.3). Since then, discussions on effective feedback have shifted from a behaviorist, instructor-centered approach to a more multifaceted approach that focuses on relationship and the learner as recipient of feedback, or the learner's potential ability to make use of feedback (self-regulated learning, feedback literacy).

DOI： 10.11307/mededjapan.54.3_255

Reflection on Interprofessional Collaboration Based on Uncomfortable Experiences Reviewed

Sano Itsuki, Morishita Mariko, Nishigori Hiroshi

Igaku Kyoiku / Medical Education (Japan) Vol. 54 ( 3 ) page： 281 - 287 2023.6

Language：Japanese Publisher：Japan Society for Medical Education

The first author set up a study group with other members in 2014, aiming to improve multidisciplinary collaboration through reflection and discussions on discomfort ( “Moyatto” in Japanese) while focusing on group members’ experiences at work. One-hour online sessions were conducted monthly with multidisciplinary professionals from several institutions. We reflected on interprofessional collaboration based on Moyatto. This paper describes the history of the study group’s inception and development, the learning process of each session, and the theory as a framework. It also reports on the practice and changes in our study group, concluding that interprofessional collaboration requires first-order reflection within a same-profession group and second-order reflection among diverse professionals.

DOI： 10.11307/mededjapan.54.3_281

2. A Newly Established Quality/Competency "Taking a Multi-Systemic View towards a Patient as a Living Person" Reviewed

Haruta Junji, Ando Takayuki, Endo Amane, Kaneko Makoto, Shikino Kiyoshi, Nagamine Yuiko, Nishigori Hiroshi, Fujikawa Hirohisa, Yamanashi Hirotomo

Igaku Kyoiku / Medical Education (Japan) Vol. 54 ( 2 ) page： 142 - 148 2023.4

Language：Japanese Publisher：Japan Society for Medical Education

Based on the social context of an aging society and surveys conducted since 2020, the need for comprehensive perspectives and approaches that consider patients'psychosocial background and a cross-organ perspective has been identified. As a result, a new quality and ability, namely comprehensive attitudes toward patients, has been established as part of the core curriculum for medical education in FY2022. Specific learning objectives include "holistic perspectives and approaches," "community perspectives and approaches," "life perspectives and approaches," and "social perspectives and approaches". An educational design that draws on multiple learning theories to enable reflection on one's own way of being has been proposed to integrate abstract and concrete, conceptual and experiential, and self and others perspectives. It is expected that this medical education will lead to improvement in the well-being of individuals, families, and communities.

DOI： 10.11307/mededjapan.54.2_142

Forword　In Featuring the Special Topics Reviewed

Nishigori Hiroshi, Konishi Yasuhiko

Igaku Kyoiku / Medical Education (Japan) Vol. 54 ( 2 ) page： 133 - 133 2023.4

7. Educational Strategies and Good Practice (1) Reviewed

Matsushima Kayoko, Asada Yoshikazu, Nomura Osamu, Haruta Junji, Yamaguchi Kumiko, Kondo Takeshi, Nishigori Hiroshi, Konishi Yasuhiko

Igaku Kyoiku / Medical Education (Japan) Vol. 54 ( 2 ) page： 177 - 181 2023.4

Language：Japanese Publisher：Japan Society for Medical Education

In the 2022 revision of the Model Core Curriculum, a new "Educational Strategies and Assessment" section was added as a further development in outcome-based education. By adding a chapter on strategies and evaluation, which is an important element of the curriculum, and linking it to qualities and abilities, we have devised a way for learners and instructors to make use of the Core Curriculum more easily. In addition, 11 example of strategy and assessment cases are included as Good Practice to encourage practical application. However, since these are only examples, we hope this chapter will be further developed as universities create strategies and evaluations that make the most of their unique characteristics.

DOI： 10.11307/mededjapan.54.2_177

Summary　Outline of the 2022 Revision of the Model Core Curriculum for Medical Education in Japan Oversight of the Revision : Evidence-Based Medical Education Reviewed

Nishigori Hiroshi

Igaku Kyoiku / Medical Education (Japan) Vol. 54 ( 2 ) page： 199 - 202 2023.4

Language：Japanese Publisher：Japan Society for Medical Education

The 2022 revision of the Model Core Curriculum for Medical Education by the Japan Society for Medical Education was based on several data sets including academic papers and survey results. It is recommended that the formation of a team consisting of diverse attributes, sufficient discussion using a web conference system, smooth communication between the government and academic societies, and dialogue with organizations related to medical education be continued in the next revision. On the other hand, collaboration and communication with academic societies in specialized fields is an issue for the future.　Although the revised Model Core Curriculum for Medical Education is the product of the collective wisdom of experts in medical education in Japan in the early 2020s, it is by no means a legal mandate imposed by the state, nor does it force faculty members of each university to follow it blindly. We hope that those involved in medical education will use this Model Core Curriculum, which was prepared with an eye to society 20 years from now, as a reference guide, and at the same time, we hope that those involved in education in the field will implement the updated guidelines while sometimes questioning them.

DOI： 10.11307/mededjapan.54.2_199

Association of labour duration in spontaneous deliveries with low neonatal Apgar scores and foetal acidosis: the Japan Environment and Children’s Study Open Access

Murata T., Yasuda S., Imaizumi K., Isogami H., Fukuda T., Kyozuka H., Yamaguchi A., Sato A., Ogata Y., Shinoki K., Hosoya M., Yasumura S., Hashimoto K., Nishigori H., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Iso H., Shima M., Nakamura H., Suganuma N., Kusuhara K., Katoh T.

Scientific Reports Vol. 12 ( 1 ) 2022.12

Publisher：Scientific Reports

This study evaluated the association between labour duration (LD) and incidence of low neonatal Apgar scores and foetal acidosis. Data of 37,682 women with full-term singleton spontaneous vaginal deliveries from the Japan Environment and Children’s Study were analysed. Women were classified according to the median LD as nulliparous (< 10 or ≥ 10 h) or multiparous (< 5 or ≥ 5 h) and further into five subcategories: nulliparous (< 10.0, 10.0–12.9, 13.0–15.9, 16.0–18.9, and ≥ 19 h) and multiparous (< 5.0, 5.0–7.9, 8.0–10.9, 11.0–13.9, and ≥ 14.0 h). Multiple logistic regression models were used to determine odds ratios (ORs) for outcomes in women with over-median LD. Over-median LD exhibited no statistically significant association with low neonatal Apgar scores. The adjusted ORs for both umbilical artery (UmA-pH) < 7.2 and < 7.1 were increased in nulliparous women with over-median LD, whereas only the adjusted OR for UmA-pH < 7.2 was increased in multiparous women with over-median LD. Moreover, this association manifested as a plateau in nulliparous women with LD ≥ 13 h and without dose-dependent association in multiparous women.

DOI： 10.1038/s41598-022-24359-3

Association of Chlamydia trachomatis infection with pregnancy outcomes among Japanese pregnant women: The Japan environment and children’s study Open Access

Yasuda S., Kyozuka H., Endo Y., Kanno A., Murata T., Fukusda T., Yamaguchi A., Sato A., Ogata Y., Kuse M., Hosoya M., Yasumura S., Hashimoto K., Nishigori H., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Iso H., Shima M., Kurozawa Y., Suganuma N., Kusuhara K., Katoh T.

PLoS ONE Vol. 17 ( 11 November ) 2022.11

Publisher：PLoS ONE

This study aimed to investigate the impact of Chlamydia trachomatis (CT) infection on pregnancy outcome in pregnant Japanese women. We utilized the data from a nationwide birth cohort study, the Japan Environment and Children’s Study (JECS), for this study. We enrolled 26,385 individuals who could refer to data on pregnancy outcomes and confounding factors, with data on CT. Binominal logistic regression models were used to determine whether pregnant women with CT positivity were at more risk of experiencing adverse pregnancy outcomes, preterm birth (PTB), preterm prelabor rupture of membrane (pPROM), low birth weight (LBW) infants, small for gestational age (SGA) births, or hypertensive disorders of pregnancy (HDP). After adjusting for maternal age, parity, marital status, smoking status, and education status, there were no significantly increased risks of PTB, pPROM, LBW infants, SGA, and HDP in the odds ratios. No significant increase in the risk of adverse pregnancy outcomes was observed in any of the subgroup analyses, which were limited to the pregnancy women in Fukushima prefecture, where CT screening could be confirmed at 28-30 weeks of gestation. We believe that the results of this study will make a significant contribution to the future of medical care for pregnant women in Japan. Our findings are important for medical practitioners to contribute to the future medical treatment of Japanese pregnant women, and also to contribute to pre-conception care for Japanese society as a whole, including pregnant women.

DOI： 10.1371/journal.pone.0275573

Development of an Educational Program on Cultural Competence for Psychiatric Professionals Reviewed

Sano Itsuki, Morishita Mariko, Nishigori Hiroshi

Igaku Kyoiku / Medical Education (Japan) Vol. 53 ( 5 ) page： 447 - 452 2022.10

Language：Japanese Publisher：Japan Society for Medical Education

We developed an educational program on cultural competence for psychiatric professionals. Regarding social justice education that critically questions dominant ideologies, we held weekly 30-minute discussion groups with multidisciplinary professionals. Rather than focusing on a particular culture group, we aimed to realize through critical self-reflection, as advocated by Kumagai and Lypson, that “there is a part of the other that I cannot know,” and named this group the “Discussion Group on Otherness.” Using essays on medical culture written by researchers in the medical humanities as our main teaching material, we discussed what is (or should be) the relevant problem. This article discusses the issues that have emerged so far, the responses to these issues, and future developments.

DOI： 10.11307/mededjapan.53.5_447

「医学教育研究室の抄読会から」 (連載第14回) Reviewed

木村武司, 錦織宏

医学教育 Vol. 53 ( 4 ) page： 393 - 394 2022.8

「医学教育研究室の抄読会から」 (連載第13回) Reviewed

及川沙耶佳, 木村武司, 錦織宏

医学教育 Vol. 53 ( 3 ) page： 270 - 273 2022.6

高久史麿先生を偲ぶ Reviewed

岩崎榮, 錦織宏

医学教育 Vol. 53 ( 3 ) page： 268 - 269 2022.6

「医学教育研究室の抄読会から」 (連載第12回) Reviewed

木村武司, 種村文孝, 錦織宏

医学教育 Vol. 53 ( 2 ) page： 184 - 186 2022.4

Unprofessional Behavior Reviewed

Kimura Takeshi, Nishigori Hiroshi

Igaku Kyoiku / Medical Education (Japan) Vol. 53 ( 2 ) page： 163 - 169 2022.4

Language：Japanese Publisher：Japan Society for Medical Education

Teaching professionalism is one of the most important themes in medical education, but difficulties remain regarding teaching and assessment. From the perspective of professionalism assessment discussions have focused on observable “behaviors” and redefining them as unprofessional behaviors has been growing since around 2000, especially in North America. This paper summarizes the concepts related to classification, assessment, and remediation of unprofessional behavior, including Japanese trends. It also aims to enlighten the public on concepts related to unprofessional behavior and to promote research that is relevant to the Japanese context. Through appropriate management of unprofessional behavior, we hope to foster medical students and doctors who can better withstand the demands of society.

DOI： 10.11307/mededjapan.53.2_163

文化人類学にとっての医学教育モデル·コア·カリキュラム改訂の意義 Reviewed

「医学教育研究室の抄読会から」 (第11回) Reviewed

木村武司, 錦織宏

医学教育 Vol. 53 ( 1 ) page： 104 - 108 2022.2

小児集中治療に携わる医師に求められる能力とその評価 Reviewed

染谷真紀, 松井智子, 錦織宏, 及川沙耶佳

医学教育 Vol. 53 ( 1 ) page： 110 - 111 2022.2

Preface Reviewed

Claramita M., Findyartini A., Samarasekera D.D., Nishigori H.

Challenges and Opportunities in Health Professions Education: Perspectives in the Context of Cultural Diversity page： v - vii 2022.1

医療者向け人類学教育連携委員会, 木村周平, 飯田淳子, 伊藤泰信, 倉田誠, 錦織宏, 浜田明範, 春田淳志, 星野晋

文化人類学 Vol. 86 ( 3 ) page： 511 - 514 2021.12

Foundation Program in Medical Education Organized by Kyoto University Reviewed

Nishigori Hiroshi, Oikawa Sayaka, Tani Shoko, Kimura Takeshi, Tanemura Fumitaka

Igaku Kyoiku / Medical Education (Japan) Vol. 52 ( 6 ) page： 515 - 523 2021.12

Language：Japanese Publisher：Japan Society for Medical Education

Foundation Program in Medical Education organized by Kyoto University since 2015, previously funded by the Ministry of Education, Culture, Sports, Science and Technology (MEXT), is a program that combines face-to-face and distance learning to develop medical education training systematically. The students (or clinical teachers), who study about 120 hours a year, form a strong learning community, which is the envy of the supervisors, with their 12 peers. In addition, the program is characterized by its emphasis on educational philosophy and cultural anthropology.

DOI： 10.11307/mededjapan.52.6_515

「医学教育研究室の抄読会から」 (第10回) Reviewed

木村武司, 錦織宏

医学教育 Vol. 52 ( 6 ) page： 574 - 577 2021.12

Maternal sleep duration and neonatal birth weight: the Japan Environment and Children’s Study Open Access

Murata T., Kyozuka H., Fukuda T., Yasuda S., Yamaguchi A., Morokuma S., Sato A., Ogata Y., Shinoki K., Hosoya M., Yasumura S., Hashimoto K., Nishigori H., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Iso H., Shima M., Kurozawa Y., Suganuma N., Kusuhara K., Katoh T.

BMC Pregnancy and Childbirth Vol. 21 ( 1 ) 2021.12

Publisher：BMC Pregnancy and Childbirth

Background: The adequate maternal sleep duration required for favorable obstetric outcomes is unknown. We evaluated the association between maternal sleep duration and low birth weight infants, small for gestational age infants, and macrosomia. Methods: Participants enrolled in the Japan Environment and Children’s Study, a nationwide birth cohort study, with singleton pregnancies after 22 weeks, who gave birth between 2011 and 2014 were enrolled and categorized into five groups according to maternal sleep duration during pregnancy: < 6.0 h, 6.0–7.9 h, 8.0–8.9 h, 9.0–9.9 h, and 10.0–12.0 h. We evaluated the association between maternal sleep duration and the incidence of low birth weight infants (< 2500 g), very low birth weight infants (< 1500 g), small for gestational age infants, and macrosomia (> 4000 g), with women with maternal sleep duration of 6.0–7.9 h as the reference, using a multiple logistic regression model. Results: In total, 82,171 participants were analyzed. The adjusted odds ratios (95% confidence intervals) for low birth weight infants in women with maternal sleep duration of 9.0–9.9 h and 10.0–12.0 h and for small for gestational age infants in women with maternal sleep duration of 9.0–9.9 h were 0.90 (0.83–0.99), 0.86 (0.76–0.99), and 0.91 (0.82–0.99), respectively, before adjusting for excessive gestational weight gain. No significant association was observed between maternal sleep duration and these outcomes after adjusting for excessive gestational weight gain. Among women with appropriate gestational weight gain, the adjusted odds ratios (95% confidence intervals) for low birth weight infants and for small for gestational age infants with sleep duration of 9.0–9.9 h were 0.88 (0.80–0.97) and 0.87 (0.78–0.97), respectively. Conclusions: Maternal sleep duration of 9.0–9.9 h was significantly associated with the decreased incidence of low birth weight infants and small for gestational age infants in pregnant women with appropriate gestational weight gain, compared with that of 6.0–7.9 h. Care providers should provide proper counseling regarding the association between maternal sleep duration and neonatal birth weight and suggest comprehensive maternal lifestyle modifications to prevent low birth weight and small for gestational age infants.

DOI： 10.1186/s12884-021-03670-3

Immunoglobulin E levels and pregnancy-induced hypertension: Japan Environment and Children’s Study Open Access

Kyozuka H., Murata T., Fukuda T., Endo Y., Yamaguchi A., Yasuda S., Kanno A., Sato A., Ogata Y., Hosoya M., Yasumura S., Hashimoto K., Nishigori H., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Iso H., Shima M., Kurozawa Y., Suganuma N., Kusuhara K., Katoh T.

Scientific Reports Vol. 11 ( 1 ) 2021.12

Publisher：Scientific Reports

High serum immunoglobulin E (IgE) levels are associated with cardiovascular events. We aimed to evaluate the association between total IgE levels during the first trimester of pregnancy and pregnancy-induced hypertension (PIH) development in a large Japanese cohort. We analysed data pertaining to singleton primipara pregnancies recorded in the Japan Environment and Children’s Study involving births from 2011 to 2014. Serum IgE levels were determined using the immunonephelometric technique. High serum IgE was defined as level ≥ 170 IU/ml. Hypertensive disorders in pregnancy (HDP) were categorized into early onset (Eo) PIH (developed < 34 weeks) or late onset (Lo) PIH (developed ≧ 34 weeks). A multiple logistic regression model was used to estimate the risk of high serum IgE levels on PIH, Eo-PIH, and Lo-PIH. Overall, 32,518 participants were enrolled. The prevalence of total, Eo-, and Lo-PIH was 3.2%, 0.6%, and 2.3%, respectively. Patients with high serum IgE levels had an increased risk of Lo-HDP (adjusted odds ratio [aOR]:1.19, 95% confidence interval 1.01–1.40). No correlation was found with either PIH (total) or Eo-PIH. High serum IgE levels during the first trimester were associated with the risk of Lo-PIH. Our results could influence and shape further research regarding the pathogenesis of Lo hypertension.

DOI： 10.1038/s41598-021-88227-2

Maternal pre-pregnancy body mass index and foetal acidosis in vaginal and caesarean deliveries: The Japan Environment and Children’s Study Open Access

Murata T., Kyozuka H., Yamaguchi A., Fukuda T., Yasuda S., Sato A., Ogata Y., Shinoki K., Hosoya M., Yasumura S., Hashimoto K., Nishigori H., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Inadera H., Nakayama T., Iso H., Shima M., Kurozawa Y., Suganuma N., Kusuhara K., Katoh T.

Scientific Reports Vol. 11 ( 1 ) 2021.12

Publisher：Scientific Reports

A high maternal body mass index (BMI) is associated with increased risks of asphyxia-related neonatal morbidity. We evaluated the association between maternal pre-pregnancy BMI and foetal acidosis while accounting for the mode of delivery. Participants from the Japan Environment and Children’s Study with singleton pregnancies after 22 weeks of gestation who gave birth during 2011–2014 were included. The participants (n = 71,799) were categorised into five groups according to the pre-pregnancy BMI: G1 (BMI < 18.5 kg/m2), G2 (18.5 to < 20.0 kg/m2), G3 (20.0 to < 23.0 kg/m2), G4 (23.0 to < 25.0 kg/m2), and G5 (≥ 25.0 kg/m2). Foetal acidosis was defined as umbilical artery pH (UmA-pH) < 7.20 or < 7.10. Multiple logistic regression analyses were used to evaluate the effect of pre-pregnancy BMI on foetal acidosis risk, accounting for the mode of delivery. In Japanese women, pre-pregnancy BMI ≥ 25.0 kg/m2 significantly increased the likelihood of foetal acidosis in newborns delivered vaginally. We found no association between pre-pregnancy BMI and foetal acidosis in newborns delivered via caesarean section. Counselling for body weight control before pregnancy and adequate management and selection of the mode of delivery in pregnant women with a high BMI who are in labour may be essential to avoid foetal acidosis.

DOI： 10.1038/s41598-020-79178-1

Author Correction: Gestational weight gain and foetal acidosis in vaginal and caesarean deliveries: The Japan Environment and Children’s Study (Scientific Reports, (2020), 10, 1, (20389), 10.1038/s41598-020-77429-9) Open Access

Scientific Reports Vol. 11 ( 1 ) 2021.12

A collaborative clinical case conference model for teaching social and behavioral science in medicine: an action research study Reviewed Open Access

Miyachi, J; Iida, J; Shimazono, Y; Nishigori, H

BMC MEDICAL EDUCATION Vol. 21 ( 1 ) page： 574 2021.11

Language：English Publisher：BMC Medical Education

Background: Effective social and behavioral sciences teaching in medical education requires integration with clinical experience, as well as collaboration between social and behavioral sciences experts and clinical faculty. However, teaching models for achieving this integration have not been adequately established, nor has the collaboration process been described. This study aims to propose a collaborative clinical case conference model to integrate social and behavioral sciences and clinical experience. Additionally, we describe how social and behavioral science experts and clinical faculty collaborate during the development of the teaching method. Methods: A team of medical teachers and medical anthropologists planned for the development of a case conference based on action research methodology. The initial model was planned for a 3-h session, similar to a Clinicopathological Conference (CPC) structure. We evaluated each session based on field notes taken by medical anthropologists and post-session questionnaires that surveyed participants’ reactions and points of improvement. Based on the evaluation, a reflective meeting was held to discuss revisions for the next trial. We incorporated the development process into undergraduate medical curricula in clinical years and in a postgraduate and continuous professional development session for residents and certified family physicians in Japan. We repeated the plan-act-observe-reflection process more than 15 times between 2015 and 2018. Results: The development of the collaborative clinical case conference model is summarized in three phases: Quasi-CPC, Interactive, and Co-constructive with unique structures and underlying paradigms. The model successfully contributed to promoting the participants’ recognition of the clinical significance of social and behavioral sciences. The case preparation entailed unique and significant learning of how social and behavioral sciences inform clinical practice. The model development process promoted the mutual understanding between clinical faculty and anthropologists, which might function as faculty development for teachers involved in social and behavioral sciences teaching in medical education. Conclusions: The application of appropriate conference models and awareness of their underlying paradigms according to educational situations promotes the integration of social and behavioral sciences with clinical medicine education. Faculty development regarding social and behavioral sciences in medical education should focus on collaboration with scholars with different paradigmatic orientations.

DOI： 10.1186/s12909-021-03009-8

「医学教育研究室の抄読会から」 (第9回) Reviewed

及川沙耶佳, 木村武司, 錦織宏

医学教育 Vol. 52 ( 5 ) page： 443 - 445 2021.10

「医学教育研究室の抄読会から」 (第8回) Reviewed

森下真理子, 木村武司, 錦織宏

医学教育 Vol. 52 ( 4 ) page： 337 - 341 2021.8

医学教育に社会科学を活かすために Reviewed

飯田淳子, 木村周平, 伊藤泰信, 倉田誠, 浜田明範, 星野晋, 春田淳志, 錦織宏

医学教育 Vol. 52 ( 4 ) page： 342 - 344 2021.8

連載オンラインによる医療者教育はじめに Reviewed

錦織宏

医学のあゆみ Vol. 278 ( 7 ) page： 734 - 734 2021.8

Release from Restraint Reviewed

Kondo Takeshi, Nishigori Hiroshi

Igaku Kyoiku / Medical Education (Japan) Vol. 52 ( 3 ) page： 263 - 269 2021.6

Language：Japanese Publisher：Japan Society for Medical Education

The faculty development for clinical supervisor teaching residents (FD) was held for two nights on site in Japan. However, corona pandemic made it difficult to conduct the FD on site, thus we conducted it completely online. To avoid participants’ burden of long hours of synchronous online learning, we adopted a flipped classroom in which assignments in asynchronous online learning was used in discussion in synchronous learning. Assignments were issued sequentially five weeks prior to the synchronous session, and the synchronous session was held from 5:00 p.m. on Friday, November 13, 2020 to Saturday, November 14, 2020 for 45 participants. All participants completed the course by submitting all the assignments. The online flipped classroom utilizing assignments has a potential to significantly reduce the time constraints on busy clinicians.

DOI： 10.11307/mededjapan.52.3_263

5. Future of Behavioral and Social Sciences in Medical Education Reviewed

Nishigori Hiroshi

Igaku Kyoiku / Medical Education (Japan) Vol. 52 ( 2 ) page： 145 - 149 2021.4

Language：Japanese Publisher：Japan Society for Medical Education

With the accreditation of medical education by JACME, the discussion on behavioral and social sciences in medical education has become more active. In addition to the conceptualization of behavioral science, social science, medical jurisprudence, and medical ethics in this special issue, this article describes the status of behavioral and social sciences in medical education in the U.S. and the U.K., as well as the relationship between social medicine and social science. In addition, I will explain why behavioral and social sciences are based on disciplines such as psychology, anthropology, and sociology, and ask for opinions, objections, and counterarguments.

DOI： 10.11307/mededjapan.52.2_145

「医学教育研究室の抄読会から」第7回 Reviewed

木村峻輔, 木村武司, 錦織宏

医学教育 Vol. 52 ( 2 ) page： 161 - 163 2021.4

「医学教育研究室の抄読会から」 (第6回) Reviewed

木村武司, 錦織宏

医学教育 Vol. 52 ( 1 ) page： 58 - 60 2021.2

Report: Medical Education Cyber Symposium Reviewed

Medical Education Cyber Symposium Committee, Tanaka Junichi, Monkawa Toshiaki, Muraoka Chikusa, Asada Yoshikazu, Kimura Takeshi, Shimizu Ikuo, Nishigori Hiroshi

Igaku Kyoiku / Medical Education (Japan) Vol. 52 ( 1 ) page： 47 - 51 2021.2

Language：Japanese Publisher：Japan Society for Medical Education

The novel coronavirus infection (COVID-19) has significantly impacted medical education and the need to respond to rapidly changing and uncertain situation. In addition, with the decision to hold this year’s annual meeting, it was deemed necessary to have a forum for information sharing and discussion. Therefore, a special committee was formed to organize a cyber-symposium on medical education, and four symposia were held every two weeks, starting May 2020, under the themes of ‘Future Clinical Clerkship’, ‘Examinations’, ‘Post-graduate Education’ and ‘Medical Education with Corona’. This paper reports these symposia and provides an overview and future considerations.

DOI： 10.11307/mededjapan.52.1_47

Gestational weight gain and foetal acidosis in vaginal and caesarean deliveries: The Japan Environment and Children’s Study Open Access

「医学教育研究室の抄読会から」 (第5回)

種村文孝, 木村武司, 錦織宏

医学教育 Vol. 51 ( 6 ) page： 700 - 701 2020.12

Murata T., Kyozuka H., Yamaguchi A., Fukuda T., Yasuda S., Sato A., Ogata Y., Shinoki K., Hosoya M., Yasumura S., Hashimoto K., Nishigori H., Fujimori K., Kamijima M., Yamazaki S., Ohya Y., Kishi R., Yaegashi N., Mori C., Ito S., Yamagata Z., Nakayama T., Iso H., Shima M., Kurozawa Y., Suganuma N., Kusuhara K., Katoh T.

Scientific Reports Vol. 10 ( 1 ) 2020.12

Publisher：Scientific Reports

Inappropriate gestational weight gain (GWG), either above or below the recommended values, has been associated with an increased risk of adverse obstetric outcomes. To evaluate the risks of GWG for foetal acidosis according to pre-pregnancy body mass index (BMI) and mode of delivery, we analysed women with singleton pregnancies between 2011 and 2014 in the Japan Environment and Children’s Study. Participants (n = 71,799) were categorised according to pre-pregnancy BMI. GWG was categorised into insufficient, appropriate, or excessive. Foetal acidosis was defined as umbilical artery pH (UmA-pH) < 7.20 or < 7.10. Multiple logistic regressions were performed for each BMI category to identify the risks of GWG for foetal acidosis, accounting for the mode of delivery. Excessive GWG was significantly associated with increased foetal acidosis in overweight women and in women whose pre-pregnancy BMI was 23.0–25.0 kg/m2 especially in those with vaginal deliveries. Conversely, excessive GWG was not significantly associated with increased foetal acidosis in obese women and in women whose pre-pregnancy BMI was ≥ 25.0 kg/m2.

DOI： 10.1038/s41598-020-77429-9

Educational Problem-solving Conference as Work-based Faculty Development Reviewed

Kimura Takeshi, Tanemura Fumitaka, Kondo Takeshi, Nishigori Hiroshi

Igaku Kyoiku / Medical Education (Japan) Vol. 51 ( 5 ) page： 591 - 595 2020.10

Language：Japanese Publisher：Japan Society for Medical Education

We conducted a case conference to solve problems in teaching practices and for clinician teachers to discuss various issues occurring in the field. The conference was based on the presentation of individual educational practice cases from faculty development workshops approved by the Ministry of Health, Labor and Welfare. We prepared two months before the event and dealt with four cases on the day of the event. During the discussion, we tried to link educational problems with a theory or a conceptual framework in medical education so that participants, including case presenters, would have a better understanding of clinical training settings. In addition, communication across disciplines was facilitated through discussions. This attempt has the potential to contribute to the development of a community of practice related to cross-disciplinary education. The key to success for this case conference was the "interpreter" role. The person in that role considers the background and context of practice and links practice with theory appropriately. In addition, faculty development for educators who can play the role will also be an issue in the future.

DOI： 10.11307/mededjapan.51.5_591

letter to the editor (Book Review) : From the Book Club of the Center for Medical Education(No. 4)Writing Qualitative Research for the First Time Reviewed

Igaku Kyoiku / Medical Education (Japan) Vol. 51 ( 5 ) page： 615 - 617 2020.10

医学教育研究室の抄読会から　第3回 Reviewed

佐野樹, 木村武司, 錦織宏

医学教育 Vol. 51 ( 4 ) page： 466 - 467 2020.8

An Education Survey on "What is Medicine" -through the Perspective of Yonezo Nakagawa Reviewed

Toyama Shogo, Aoki Anna, Fujisaki Kazuhiko, Nishigori Hiroshi

Igaku Kyoiku / Medical Education (Japan) Vol. 51 ( 4 ) page： 379 - 388 2020.8

Language：Japanese Publisher：Japan Society for Medical Education

Background: We investigated how undergraduate medical curriculum handles the question “what is medicine” , which Yonezo Nakagawa raised in a field of study called “Igaku-gairon” .　Method: We analyzed the content, the amount, the methods, the assessment, and the teachers using syllabi that are accessible on the Internet as resources.　Results: In 69 schools, the total number of hours of instruction in “philosophy of medicine and medical ethics” , “sociology of medicine and medical anthropology” and “history of medicine” was 1066 h 20min, 213 h 5min, and 192 h 5min, respectively, representing 72%, 14%, and 13% of the total instruction.　Analysis: We found that their were classes which address the question “what is medicine” without using the word “Igaku-gairon” can be sporadically found in medical curriculum.

DOI： 10.11307/mededjapan.51.4_379

letter to the editor : Faculty Development for Clinician Educators Using Flipped Learning Reviewed

Igaku Kyoiku / Medical Education (Japan) Vol. 51 ( 2 ) page： 168 - 170 2020.4

「医学教育研究室の抄読会から」　第2回

木村武司, 種村文孝, 錦織宏

医学教育 Vol. 51 ( 2 ) page： 166 - 167 2020.4

Why Do We Write Medical Education Research Papers? A Narrative of a Retired Doctor Reviewed

Nishigori Hiroshi

Igaku Kyoiku / Medical Education (Japan) Vol. 50 ( 6 ) page： 559 - 562 2019.12

Language：Japanese Publisher：Japan Society for Medical Education

Why do we write medical education research papers and present them at academic conferences? Why do you read medical education research papers and listen to presentations at academic conferences? Medical education is often practiced in a closed space such as a lecture room, where there is a clear power dynamic such as <teacher / supervisor> and <medical student / resident>. In this paper, we will focus on power structure and develop an argument about the significance of educational case reports in medical education research from the epistemological standpoint of critical theory structure.

DOI： 10.11307/mededjapan.50.6_559

Incidence of Domestic Violence Against Pregnant Females after the Great East Japan Earthquake in Miyagi Prefecture: The Japan Environment and Children's Study

The Implications of Culture in the Education and Practice of Healthcare Professionals Reviewed Open Access

McKimm J., Nishigori H.

Asia Pacific Scholar Vol. 4 ( 3 ) page： 1 - 2 2019.9

Professional identity formation of female doctors in Japan - gap between the married and unmarried Reviewed Open Access

Matsui Tomoko, Sato Motoki, Kato Yoko, Nishigori Hiroshi

BMC MEDICAL EDUCATION Vol. 19 ( 1 ) page： 55 2019.2

Sakurai K., Nishigori H., Nishigori T., Mizuno S., Obara T., Iwama N., Watanabe Z., Ishikuro M., Tatsuta N., Nishijima I., Sugawara J., Fujiwara I., Arima T., Kuriyama S., Metoki H., Takahashi F., Nakai K., Yaegashi N., Saito H., Kishi R., Hashimoto K., Mori C., Hirahara F., Yamagata Z., Inadera H., Kamijima M., Konishi I., Iso H., Shima M., Ogawa T., Suganuma N., Kusuhara K., Katoh T.

Disaster Medicine and Public Health Preparedness Vol. 11 ( 2 ) page： 216 - 226 2017.4

Publisher：Disaster Medicine and Public Health Preparedness

Objective: This study aimed to clarify the correlation between the 2011 Great East Japan Earthquake and domestic violence (DV) against pregnant females after the disaster in Miyagi Prefecture, an area damaged by the earthquake and tsunami. Methods: We analyzed 7600 pregnant females from June to December 2011. The incidence of physical and mental DV and the proportions in the inland, north coastal, and south coastal areas of Miyagi Prefecture and nationwide were calculated, and a chi-square test was conducted for comparison. The risk factors for DV were estimated with multivariate logistic regression analyses on a prefecture-wide basis. Results: The incidence levels for physical DV were found to be 5.9% in the north coastal area, which was significantly higher than in the inland area (1.3%, P=0.0007) and nationwide (1.5%, P<0.0001). There were no significant differences in the incidence of mental DV between the 3 areas in Miyagi Prefecture (inland 15.2%, north coast 15.7%, and south coast 18.8%) or nationwide (13.8%). Experiencing disease or injury in someone close and changes in the family structure were significantly associated with mental DV in Miyagi Prefecture. Conclusion Continuous monitoring and support for pregnant females may be necessary to address this issue in disaster-affected areas.

DOI： 10.1017/dmp.2016.109

Determinants of polyunsaturated fatty acid concentrations in erythrocytes of pregnant Japanese women from a birth cohort study: Study protocol and baseline findings of an adjunct study of the Japan environment & Children's study Open Access

Saito S., Kawabata T., Tatsuta N., Kimura F., Miyazawa T., Mizuno S., Nishigori H., Arima T., Kagawa Y., Yoshimasu K., Tsuno K., Ito Y., Kamijima M., Nakai K., Yaegashi N.

Environmental Health and Preventive Medicine Vol. 22 ( 1 ) 2017

Publisher：Environmental Health and Preventive Medicine

Background: N-3 polyunsaturated fatty acids (n-3 PUFA) may have multiple beneficial effects on the outcome of pregnancy, maternal health and child development. The present study introduced the protocol of a birth cohort study to examine the beneficial effects of n-3 PUFA status in pregnant Japanese women as an adjunct study of the Japan Environment and Children's Study (JECS). Methods: The JECS participants in the coastal areas of Miyagi Prefecture were further invited to participate in this adjunct study, and 1,878 pregnant women were enrolled prior to delivery. Their n-3 PUFA status was evaluated with fatty acid profiles in erythrocytes of maternal blood collected from 1,623 mothers at 24-30 weeks of gestation and cord blood from 1,505 deliveries. Results: The baseline results, including comprehensive data on the fatty acid status and determinants affecting the PUFA status, were analyzed. In stepwise multivariate analyses, the cord blood docosahexaenoic acid (DHA) level was found to be significantly influenced by the DHA level in maternal blood, the child's sex, and the gestational period. The maternal DHA level was influenced by fish intake, maternal age, and the prepregnancy body mass index. While cord blood eicosapentaenoic acid (EPA) was influenced by maternal EPA, fish intake, and season at birth, additional factors such as maternal education, household income, and smoking habits affected the maternal EPA content. Conclusion: Further studies are warranted to clarify the nutritional impacts of n-3 PUFA in pregnant Japanese women of the cohort study.

DOI： 10.1186/s12199-017-0636-5

Fermented food consumption and psychological distress in pregnant women: A nationwide birth cohort study of the Japan environment and children’s study Open Access

Takahashi F., Nishigori H., Nishigori T., Mizuno S., Obara T., Metoki H., Sakurai K., Ishikuro M., Iwama N., Tatsuta N., Nishijima I., Fujiwara I., Arima T., Nakai K., Sugiyama T., Kuriyama S., Yaegashi N., Saito H., Kishi R., Hashimoto K., Mori C., Hirahara F., Yamagata Z., Inadera H., Kamijima M., Konishi I., Iso H., Shima M., Ogawa T., Suganuma N., Kusuhara K., Katoh T.

Tohoku Journal of Experimental Medicine Vol. 240 ( 4 ) page： 309 - 321 2016.12

Publisher：Tohoku Journal of Experimental Medicine

Health benefits of fermented foods are attracting attention worldwide, and they have been traditionally eaten in Japan. Moreover, a recent study showed the association between the higher intake of yogurt and lower prevalence of depressive symptoms during pregnancy. Psychological problems, such as anxiety and depression, during pregnancy are serious health concerns and may increase the risk of adverse outcomes in children. In this study, we explored the association between fermented food consumption and psychological distress in 10,129 pregnant Japanese women, using the fixed data of the Japan Environment and Children’s Study (JECS), an ongoing nation-wide birth cohort study. Food consumption was assessed with a semi-quantitative food frequency questionnaire (FFQ), and the Kessler 6-item psychological distress scale (K6) was administered to eligible women during their second or third trimester to eliminate overlap with the period of hyperemesis gravidarum. The mean median gestation in the subjects was 24.8 weeks. In total, 9,030 subjects completed the K6 questionnaire and FFQ. Importantly, the prevalence of the K6 score of ≥ 13 was 3.1% (280 subjects). This value was lower compared to precedent studies, which may reflect that cooperative and health conscious subject participated in the survey. The multivariate logistic regression analysis indicates that the intake of yogurt, lactic acid beverages, cheese, Japanese pickles, miso soup, or fermented soybeans was not significantly associated with a K6 score of ≥ 13. In conclusion, the present cohort study shows no association between fermented food consumption and psychological distress symptoms during the second or third trimester of pregnancy.

DOI： 10.1620/tjem.240.309

Proposals on the development of the JSME accreditation system for medical education expertise Reviewed

委員会報告日本医学教育学会認定医学教育専門家資格制度創設への提言 Reviewed

藤崎和彦, 田川まさみ, 西城拓也, 井内康輝, 錦織宏, 渡邊洋子, 大谷尚, 守屋利佳, 吉岡俊正, 吉田素文, 鈴木康之

医学教育 Vol. 43 page： 221 - 231 2012

Fujisaki Kazuhiko, Tagawa Masami, Saiki Takuya, Inai Kouki, Nishigori Hiroshi, Watanabe Yoko, Otani Takashi, Moriya Rika, Yoshioka Toshimasa, Yoshida Motofumi, Suzuki Yasuyuki

Igaku Kyoiku / Medical Education (Japan) Vol. 43 ( 3 ) page： 221 - 231 2012

Development of education system for medical educationist in Japan : an introduction

SUZUKI Yasuyuki, YOSHIOKA Toshimasa, YOSHIDA Motofumi, TAGAWA Masami, NISHIGORI Hiroshi, SAIKI Takuya, MORIYA Rika, OTANI Hisashi, WATANABE Yoko

Vol. 40 ( 4 ) page： 235 - 236 2009.8

Questionnaire survey on the development of education system for medical educationist in Japan Reviewed

SUZUKI Yasuyuki, YOSHIOKA Toshimasa, YOSHIDA Motofumi, TAGAWA Masami, NISHIGORI Hiroshi, SAIKI Takuya, MORIYA Rika, OTANI Hisashi, WATANABE Yoko

Igaku Kyoiku / Medical Education (Japan) Vol. 40 ( 4 ) page： 237 - 241 2009

Language：Japanese Publisher：Japan Society for Medical Education

1) The committee for the graduate education of medical educationists, Japan Society for Medical Education, investigated needs for the education system of medical educationists. 2) A questionnaire was sent to 1831 leaders in healthcare education and the society members, and 644 replied (recovery rate 35.2%). Fifty % of the respondents agreed the necessity of medical educationists. Certificate level was most popular, however, master and PhD degrees were also considered to be necessary. 3) These results support the establishment of educational system for medical educationists in Japan.

DOI： 10.11307/mededjapan.40.237

A model for attracting physicians to rural areas by improving residency training program, part 2

NISHIGORI Hiroshi, SUZUKI Tomio

Igaku Kyoiku / Medical Education (Japan) Vol. 40 ( 1 ) page： 27 - 33 2009

Language：Japanese Publisher：Japan Society for Medical Education

A shortage of physicians in rural areas has become a serious problem of the new residency training program in Japan. To address this problem, we propose a model for attracting physicians to rural areas by improving residency training programs and by evaluating a curriculum introduced to Kainan Hospital, a community hospital. In this second paper, we describe the middle-term curriculum evaluation and present our model. 1) Interviews of program directors revealed 8 items necessary to improve residency training programs. 2) After the residents finish their training, they remain at the same hospital, and the number of the number of physicians at the hospital increases, if the fellowship programs are well-organized. 3) Because universities are interested in hospitals at which many residents and fellows work, attracting attending physicians to these hospitals is easier. 4) Although attracting enough physicians by improving residency training programs requires 3 to 5 years, achieving this goal by increasing the larger number of medical students would take even longer.

DOI： 10.11307/mededjapan.40.27

A model for attracting physicians to rural areas by improving residency training programs, part 1

NISHIGORI Hiroshi, SUZUKI Tomio, MISHIMA Nobuhiko, YAMAMOTO Naohito

Igaku Kyoiku / Medical Education (Japan) Vol. 40 ( 1 ) page： 19 - 25 2009

Language：Japanese Publisher：Japan Society for Medical Education

A shortage of physicians in rural areas has become a serious problem of the new residency training program in Japan. To address this problem, we propose a model for attracting physicians to rural areas by improving residency training programs and by evaluating a curriculum introduced at Kainan Hospital, a community hospital. In this first paper, we describe the short-term evaluation of the curriculum. 1) We introduced clinical teams in which residents were able to actively participate in clinical practice as team members by being supervised by senior physicians. We also introduced teaching rounds and case conferences for residents. 2) Focus-group interviews of residents showed that "giving educational opportunities to residents" and "an explicit policy of the hospital to improve the residency training program" are examples of ways to improve residency programs. 3) The number of residents working at Kainan Hospital increased. The residency training program was somewhat improved. 4) An effective and easily generalized way to provide residents with more learning opportunities is to involve clinicians in teaching residents in hospitals.

DOI： 10.11307/mededjapan.40.19

Development of education system for medical educationist in Japan: an introduction

SUZUKI Yasuyuki, YOSHIOKA Toshimasa, YOSHIDA Motofumi, TAGAWA Masami, NISHIGORI Hiroshi, SAIKI Takuya, MORIYA Rika, OTANI Hisashi, WATANABE Yoko

Igaku Kyoiku / Medical Education (Japan) Vol. 40 ( 4 ) page： 235 - 236 2009

Language：Japanese Publisher：Japan Society for Medical Education

1) Japan Society for Medical Education launched a committee for the graduate education of medical educationists in Japan. The committee proposed a direction toward establishing the system, by way of discussion among the members, needs assessment, information gathering of overseas master courses, and discussion at the open meeting. 2) To promote medical education in Japan, we should establish 2 systems concurrently: (1) a graduate education for medical educationists who have a broad base of theories and can lead future medical education, and (2) a broader certificate system for medical teachers who have good practical teaching skills.

DOI： 10.11307/mededjapan.40.235

A mixed-methods study comparing human-led and ChatGPT-driven qualitative analysis in medical education research.

AAMC in Seattle, USA

AOMATSU Muneyoshi, NISHIGORI Hiroshi, OTAKI Junji, BAN Nobutaro

Vol. 38 ( 2 ) page： 119 2007.4

What's your diagnosis? [33] こんな結果でええんか?

菊川誠, 小島啓尚, 傍島由香, 飯島亜由子, 錦織宏, 鈴木富雄, 伴信太郎

JIM Vol. 15 ( 9 ) page： 715 - 718 2005.9

What's your diagnosis? [28] はれのちはれ

錦織宏, 小島啓尚, 鈴木富雄, 伴信太郎

JIM Vol. 15 ( 4 ) page： 275 - 277 2005.4

Report on 2nd Asia Pacific Medical Education Conference

NISHIGORI Hiroshi, YOSHIDA Ichiro

Vol. 36 ( 1 ) page： 44 2005.2

Takeshi Kondo, Junichiro Miyachi, Anders Jönsson, Hiroshi Nishigori

Nagoya journal of medical science Vol. 86 ( 4 ) page： 620 - 644 2024.11

Language：English Publishing type：Research paper (scientific journal)

Qualitative research, used to analyse non-numerical data including interview texts, is crucial in understanding medical education processes. However, it is often complex and time-consuming, leading to an interest in technology for streamlining the analysis. This study investigated the applicability of ChatGPT, a large language model, in thematic analysis for medical qualitative research. Previous research has used ChatGPT to explore the deductive process as a qualitative study. This study evaluated thematic analysis including the inductive process by ChatGPT with reference to human qualitative analysis. A convergent design mixed-methods study was used. Using a thematic analysis approach, ChatGPT (model: GPT-4) analysed some interview data from a previously published medical research article. The assessors evaluated the qualitative analysis of ChatGPT using human qualitative analysis as a benchmark. Three assessors compared the human-conducted and ChatGPT-driven qualitative analyses. ChatGPT scored higher in most aspects but showed variable transferability and mixed depth scores. In the integrated analysis including qualitative data, six themes were identified: superficial similarity of results with human analysis, good first impression, explicit association with data and process, contamination by directions in prompts, deficiency of thick descriptions based on context and research questions, and lack of theoretical derivation. ChatGPT excels at extracting key data points and summarising information; however, it is prone to prompt contamination, which necessitates careful scrutiny. To achieve deeper analysis, it is essential to supplement the research context with human input and explore the theoretical framework.

DOI： 10.18999/nagjms.86.4.620

Implementing digital transformation in the revision process for Japan’s Model Core Curriculum: A qualitative document analysis

To teach is to learn twice, revisited: a qualitative study of how residents learn through teaching in clinical environments Reviewed Open Access

Takeshi Kondo, Noriyuki Takahashi, Muneyoshi Aomatsu, Hiroshi Nishigori

BMC Medical Education Vol. 24 ( 1 ) page： 829 2024.8

Language：English Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

Abstract

Background

Teaching helps the teacher’s own learning as a professional—as the saying goes, ‘to teach is to learn twice’. Near-peer teaching in clinical practice has been shown to contribute to the development of both teaching skills and necessary competencies for doctors. Research on how near-peer teachers learn through their teaching roles has mainly focused on classroom learning. However, understanding how the phenomenon of ‘teaching is learning twice’ occurs in clinical settings and its influencing factors is important for the development of a quality workplace learning environment. Therefore, this study investigated how residents learn through teaching in clinical practice and the factors influencing this process.

Methods

This study’s methodology is based on the constructivist grounded theory from a social constructivist perspective. Several teaching hospitals in Japan were included, and the study participants were post-graduate year 2 residents (PGY2s) from these hospitals. The interviews were recorded, transcribed into text, and analysed by the first author.

Results

From January 2016 to July 2022, 13 interviews were conducted with 11 PGY2s from nine educational hospitals. The PGY2s played diverse educational roles in clinical settings and learned competencies as physicians in almost all areas through such roles. We found that knowledge transfer and serving as role models stimulated PGY2s’ intrinsic motivation, encouraged reflection on their own experiences, and promoted self-regulated learning. Further, educating about procedural skills and clinical reasoning prompted reflection on their own procedural skills and thought processes. Supporting post-graduate year 1 residents’ reflections led to the refinement of PGY2s’ knowledge and thought processes through the verbal expression of their learning experiences. Such processes required the formation of a community of practice. Thus, education promoted learning through reflection and clarified the expert images of themselves that PGY2s envisaged.

Conclusions

The study found that residents acquire various physician competencies through multiple processes by teaching as near-peer teachers in clinical settings, that a community of practice must be formed for near-peer teaching to occur in a clinical setting, and that teaching brings learning to those who teach by promoting reflection and helping them envision the professionals they aim to be.

DOI： 10.1186/s12909-024-05814-3

Other Link： https://link.springer.com/article/10.1186/s12909-024-05814-3/fulltext.html

教育実践報告フィードバックリテラシー涵養を目指した医学生授業の試み

木村武司, 錦織宏

医学教育 Vol. 55 ( Suppl. ) page： 311 - 311 2024.7

令和4年度改訂コアカリ導入に向けたニーズ調査結果とそれに応える資材の紹介令和4年度改訂版医学教育モデル・コア・カリキュラムの普及事業を通じて見えてきた今後の課題

松島加代子, 淺田義和, 高桑修, 長谷川仁志, 松山泰, 三浦聖子, 高橋誠, 錦織宏

医学教育 Vol. 55 ( Suppl. ) page： 139 - 139 2024.7

Takeshi Kondo, Takeshi Onoue, Seisyou Kou, Yoshikazu Asada, Masanori Isobe, Hiroshi Nishigori

Medical Teacher Vol. 46 ( sup1 ) page： S53 - S60 2024.6

Development of a competency-based national model core curriculum in Japan: A case study

Yuka Urushibara-Miyachi, Kayo Matsushita, Hiroshi Nishigori

Medical Teacher Vol. 46 ( sup1 ) page： S11 - S20 2024.6

Hirohisa Fujikawa, Takayuki Ando, Amane Endo, Makoto Kaneko, Kiyoshi Shikino, Yuiko Nagamine, Takeo Nakayama, Hiroshi Nishigori, Hirotomo Yamanashi, Junji Haruta

Medical Teacher Vol. 46 ( sup1 ) page： S21 - S30 2024.6

総合的に患者・生活者をみるために必要なコンピテンシーとは医学教育モデル・コア・カリキュラムへの新設

藤川裕恭, 安藤崇之, 遠藤周, 金子惇, 鋪野紀好, 長嶺由衣子, 中山健夫, 錦織宏, 山梨啓友, 春田淳志

日本プライマリ・ケア連合学会学術大会 Vol. 15回 page： 333 - 333 2024.6

An “integration” of professional identity formation among rural physicians experiencing an interplay between their professional and personal identities Reviewed Open Access

Junichiro Miyachi, Miho Iwakuma, Hiroshi Nishigori

Advances in Health Sciences Education 2024.5

Language：English Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

Abstract

The present understanding of professional identity formation is problematic since it underrepresents minority physicians and potentially excludes their professional identity formation experiences. Rural physicians are expected to have similar underrepresented aspects as minority physicians because of their specific sociocultural contexts and consequent private–professional intersection, which lead to ethical complexities. Therefore, to bridge this research gap, we interviewed 12 early- to mid-career Japanese physicians working in rural areas and explored their experiences. Through a narrative analysis guided by Figured Worlds theory, we analysed the data by focusing on the vocabulary, expressions, and metaphors participants used to describe their experiences. A central theme emerged concerning how the rural physicians configurated their personal versus professional participation in their local communities. Further, their identity narratives varied regarding how they constructed their identities, rural communities, and relationships as well as their identity formation ideals and strategies to achieve them. Informed by ‘Big Questions’ concerning worldview framework, we delineated four identity narratives as prototypes to describe how they participated in their communities. These identity narratives provide a preliminary understanding of how diverse identity formation is for rural physicians. In addition, our findings exposed the current professional identity formation framework as potentially biased towards single forms of participation in monolithic communities, overlooking complicated forms of participation in multiple communities. We argue that applying frameworks and concepts to capture these multiple forms of participation as well as revisiting the ‘discourse of integration’ are necessary steps to overcome the limitation of the current understanding of professional identity formation.

DOI： 10.1007/s10459-024-10337-z

Other Link： https://link.springer.com/article/10.1007/s10459-024-10337-z/fulltext.html

【地域医療実習・研修でなにを学ぶのか】実際に学ぶこと文化人類学的医療を学ぶ Reviewed

宮地純一郎, 錦織宏

地域医学 Vol. 37 ( 9 ) page： 879 - 884 2023.9

Language：Japanese Publisher：(公社)地域医療振興協会

＜POINT＞(1)文化人類学は現場に自分の生身の体を置くフィールドワーク,参与観察,文脈を踏まえた視点,自己相対化と自己変容を特徴とした学問である(2)文化人類学は,文脈にまつわる探究および医療者集団の価値体系と習慣に対する感受性と言語化を通じて臨床実践を変えうる(3)文化人類学の特徴を地域医療教育に加味することで,ただ現場に行くだけでは届かない深み・厚みが生まれうる(著者抄録)

教育実践報告航空業界の安全から医療安全を相対化するFaculty development

木村武司, 種村文孝, 清水郁夫, 錦織宏

医学教育 Vol. 54 ( Suppl. ) page： 199 - 199 2023.7

職種横断的な内省を通して思いのすれ違いを連携に活かす "多職種連携モヤっと研究会"の取り組み Reviewed

佐野樹, 森下真理子, 錦織宏

医学教育 Vol. 54 ( 3 ) page： 281 - 287 2023.6

Language：Japanese Publisher：(一社)日本医学教育学会

専門職間で起こる思いのすれ違いを「モヤっと」と名づけ,それを医療/教育現場での連携に活かすため,2014年から研究会を立ち上げた.多施設の多職種で月1回1時間のオンライン研究会を行い,モヤっとした経験について内省を行った.本稿では研究会について振り返る中で,会の発足と歩み,会の中で起きている学習プロセスや根拠となっている理論について述べる.さらに研究会での実践とその変化について共有しつつ,多職種連携(教育)での内省には,専門領域内でする一次内省と,領域の外から自らの専門を見つめる二次内省の両輪が必要であることを示す.(著者抄録)

10. The 2022 Revision of the Model Core Curriculum for Medical Education in Japan for Healthcare Professionals and Global Trends in Health Professions Education. Reviewed

Gomi Harumi, Matsuyama Yasushi, Oikawa Sayaka, Kikukawa Makoto, Shimizu Ikuo, Nomura Osamu, Nishigori Hiroshi

Igaku Kyoiku / Medical Education (Japan) Vol. 54 ( 2 ) page： 194 - 198 2023.4

Language：Japanese Publisher：Japan Society for Medical Education

Globally, there are currently three major competency models for healthcare professions education: CanMEDS 2015 in Canada, Accreditation Council for Graduate Medical Education Six-Competency model in the United States, and Tomorrow's Doctors in the United Kingdom. An investigation by the Revision Committee for the Japanese National Model Core Curriculum revealed that these competency models had been utilized in seven countries. In each country investigated for revision, medical schools were allowed to implement these major competency models flexibly. Although each university has a high degree of freedom in curriculum design and educational delivery, each country is regulated by a quality assurance system that requires accreditation by the World Federation for Medical Education (WFME) and other organizations. The 2022 Revision of the Japanese National Model Core Curriculum has also been translated into English and released to the global audience in the field.

DOI： 10.11307/mededjapan.54.2_194

8. Learning Assessment and Good Practice (2) Reviewed

Ito Shoichi, Okazaki Hitoaki, Komatsu Hiroyuki, Nishigori Hiroshi, Matsuyama Yasushi, Yamawaki Masanaga, Kikukawa Makoto, Shimizu Ikuo, Nakamura Mariko, Mitani Shohei

Igaku Kyoiku / Medical Education (Japan) Vol. 54 ( 2 ) page： 182 - 186 2023.4

Language：Japanese Publisher：Japan Society for Medical Education

In the 2022 Model Core Curriculum for Medical Education in Japan, "Chapter 3, Educational strategies and assessment" section II. "Learner Assessment," consists of three parts : II-1. Approaches to learner assessment, II-2. Assessment methods, and II-3. Questions about learner assessment. Based on the idea that "the way assessment is done varies from institution to institution," the answer to the "Question" is deliberately not included. We hope that readers will refer to this chapter when planning learning assessments in curriculum development while considering the curriculum's background and context.

DOI： 10.11307/mededjapan.54.2_182

【Making of医学教育モデル・コア・カリキュラム】資質・能力に新設された総合的に患者・生活者をみる姿勢について Reviewed

【Making of医学教育モデル・コア・カリキュラム】資質・能力に新設された総合的に患者・生活者をみる姿勢について Reviewed

春田淳志, 安藤崇之, 遠藤周, 金子惇, 鋪野紀好, 長嶺由衣子, 錦織宏, 藤川裕恭, 山梨啓友

医学教育 Vol. 54 ( 2 ) page： 142 - 148 2023.4

Language：Japanese Publisher：(一社)日本医学教育学会

少子高齢化社会の背景と令和2年度からの調査を踏まえ,患者の抱える問題を臓器横断的に捉えた上で,心理社会的背景も踏まえた総合的な視点とアプローチの必要性が示され,医学教育モデル・コア・カリキュラム(令和4年改訂版)に総合的に患者・生活者をみる姿勢が資質・能力に新設された.下位目標として「全人的な視点とアプローチ」「地域の視点とアプローチ」「人生の視点とアプローチ」「社会の視点とアプローチ」が位置づけられた.抽象と具体,概念と経験,自己と他者等の視点を統合し,自己の在り方を省察できるような複数の学習理論を踏まえた教育方法が提案された.このような医学教育を通じて,患者・生活者のウェルビーイングが向上することを期待する.(著者抄録)

春田淳志, 安藤崇之, 遠藤周, 金子惇, 鋪野紀好, 長嶺由衣子, 錦織宏, 藤川裕恭, 山梨啓友

医学教育 Vol. 54 ( 2 ) page： 142 - 148 2023.4

Language：Japanese Publisher：(一社)日本医学教育学会

Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00050&link_issn=&doc_id=20230516210002&doc_link_id=10.11307%2Fmededjapan.54.2_142&url=https%3A%2F%2Fdoi.org%2F10.11307%2Fmededjapan.54.2_142&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Reconstructing the concept of empathy: an analysis of Japanese doctors' narratives of their experiences with illness. Reviewed International journal Open Access

Mariko Morishita, Junko Iida, Hiroshi Nishigori

Advances in health sciences education : theory and practice Vol. 28 ( 1 ) page： 87 - 106 2023.3

Language：English Publishing type：Research paper (scientific journal)

The ability of doctors to empathise with patients is a crucial concern in establishing humanistic medicine. Therefore, the cultivation of this ability has been discussed extensively in medical education. One theory suggests that the experience of patienthood can increase empathy among doctors. This theory is supported by previous research that published doctors' illness narratives. However, the concept of empathy has been ambiguously defined in academic fields, including medicine; therefore, analysing how doctors experience 'empathy' in their interactions with patients is difficult. Our research question is how doctors who became patients describe the relationship between their illness experiences and the interactions with patients after their illness. To this end, this paper initially tracks the debates on 'empathy' in medicine and other disciplines, to develop a lens for analysing doctors' illness narratives. Next, we conduct a narrative analysis of illness stories from 18 Japanese medical doctors who became patients. Our analysis supports the traditional idea that an illness can enable a doctor to become more empathetic. However, this is overly simplistic; how doctors experience and subsequently process their illness is more complex. Moreover, this notion can disregard doctors' suffering in these circumstances, and fail to represent the often-lengthy process of mastering 'empathy' based on their experiences. Therefore, our analysis deconstructed the concept of 'empathy', showing that it can appear in various ways. Further research is required to elucidate how empathy is cultivated during the process of transformation of doctors' illnesses, focusing on their communities and practices.

DOI： 10.1007/s10459-022-10143-5

Psychological safety and Safety-II paradigm for faculty development Reviewed Open Access

Ikuo Shimizu, Shuh Shing Lee, Ardi Findyartini, Kiyoshi Shikino, Yoshikazu Asada, Hiroshi Nishigori

The Asia Pacific Scholar Vol. 7 ( 3 ) page： 60 - 62 2022.7

Locally adapting generic rubrics for the implementation of outcome-based medical education: a mixed-methods approach Reviewed Open Access

Takeshi Kondo, Hiroshi Nishigori, Cees van der Vleuten

BMC Medical Education Vol. 22 ( 1 ) page： 262 2022.4

Cultivating cultural awareness among medical educators by integrating cultural anthropology in faculty development: an action research study Reviewed Open Access

Sayaka Oikawa, Junko Iida, Yasunobu Ito, Hiroshi Nishigori

BMC Medical Education Vol. 22 ( 1 ) page： 196 2022.3

Language：English Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

Abstract

Background

In faculty development, understanding each participant’s cultural context is important. However, there is scarce evidence on how to improve cultural understanding in faculty development. Cultural anthropology is a discipline that focuses on developing cultural self-awareness by understanding different cultures. Professionals from this field can be crucial to the goal of cultivating cultural awareness among medical educators. The aims of this study are to 1) develop and modify cultural anthropology sessions in faculty development and 2) evaluate the effectiveness of these sessions, including their long-term impacts.

Methods

The cultural anthropology sessions were organized as part of a longitudinal faculty development program—Foundation Course for Medical Education—at Kyoto University in Japan. The study included 47 medical educators participating in faculty development and three lecturers: two cultural anthropologists and a medical educator. We developed the cultural anthropology sessions and implemented them in the longitudinal faculty development program. In these sessions, cultural anthropologists used inquiry-guided reflection. An action research methodology was employed and repeated in four cycles from 2015 to 2018. Qualitative and quantitative data were collected during the action research cycles. The qualitative data were thematically analyzed.

Results

The cultural anthropologists’ inquiries fostered learning during the sessions, and three themes—cultural relativism, attention to context, and reframing—were synthesized. As a long-term impact of the sessions, the learners reported becoming more aware of the cultural contexts in their daily educational and clinical activities.

Conclusions

The cultural anthropology sessions in the faculty development program were shown to have enhanced the participants’ awareness of cultural contexts. The concept and format of these sessions may be used more widely in faculty development programs.

DOI： 10.1186/s12909-022-03260-7

Other Link： https://link.springer.com/article/10.1186/s12909-022-03260-7/fulltext.html

Medical Students' and Trainees' Country-By-Gender Profiles: Hofstede's Cultural Dimensions Across Sixteen Diverse Countries Reviewed Open Access

Lynn V. Monrouxe, Madawa Chandratilake, Julie Chen, Shakuntala Chhabra, Lingbing Zheng, Patrício S. Costa, Young-Mee Lee, Orit Karnieli-Miller, Hiroshi Nishigori, Kathryn Ogden, Teresa Pawlikowska, Arnoldo Riquelme, Ahsan Sethi, Diantha Soemantri, Andy Wearn, Liz Wolvaardt, Muhamad Saiful Bahri Yusoff, Sze-Yuen Yau

Frontiers in Medicine Vol. 8 page： 746288 2022.2

Language：English Publishing type：Research paper (scientific journal) Publisher：Frontiers Media SA

<sec><title>Purpose</title>The global mobility of medical student and trainee populations has drawn researchers' attention to consider internationalization in medical education. Recently, researchers have focused on cultural diversity, predominately drawing on Hofstede's cross-cultural analysis of cultural dimensions from general population data to explain their findings. However, to date no research has been specifically undertaken to examine cultural dimensions within a medical student or trainee population. This is problematic as within-country differences between gender and professional groups have been identified within these dimensions. We address this gap by drawing on the theoretical concept of national context effects: specifically Hofstede's six-dimensional perspective. In doing so we examine medical students' and trainees' country profiles across dimensions, country-by-gender clustering, and differences between our data and Hofstede's general population data.

</sec><sec><title>Methods</title>We undertook a cross-cultural online questionnaire study (eight languages) containing Hofstede's 2013 Values Survey. Our questionnaire was live between 1st March to 19th Aug 2018, and December 2018 to mitigate country holiday periods. We recruited undergraduate medical students and trainees with at least 6-months' clinical training using school-specific methods including emails, announcements, and snowballing.

</sec><sec><title>Results</title>We received 2,529 responses. Sixteen countries were retained for analyses (<italic>n</italic> = 2,307, 91%): Australia, Chile, China, Hong Kong, India, Indonesia, Ireland, Israel, Japan, Malaysia, New Zealand, Pakistan, South Africa, South Korea, Sri-Lanka, Taiwan. Power distance and masculinity are homogenous across countries. Uncertainty avoidance shows the greatest diversity. We identified four country clusters. Masculinity and uncertainty are uncorrelated with Hofstede's general population data.

</sec><sec><title>Conclusions</title>Our medical student and trainee data provides medical education researchers with more appropriate cultural dimension profiles than those from general population data. Country cluster profiles stimulate useful hypotheses for further research, especially as patterning between clusters cuts across traditional Eastern-Western divides with national culture being stronger than gendered influences. The Uncertainty dimension with its complex pattern across clusters is a particularly fruitful avenue for further investigation.

</sec>

DOI： 10.3389/fmed.2021.746288

Advancing the science of health professions education through a shared understanding of terminology: a content analysis of terms for “faculty” Reviewed Open Access

Pim W. Teunissen, Anique Atherley, Jennifer J. Cleland, Eric Holmboe, Wendy C. Y. Hu, Steven J. Durning, Hiroshi Nishigori, Dujeepa D. Samarasekera, Lambert Schuwirth, Susan van Schalkwyk, Lauren A. Maggio

Perspectives on Medical Education Vol. 11 ( 1 ) page： 22 - 27 2022.1

Language：English Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

<title>Abstract</title><sec>
<title>Introduction</title>
Health professions educators risk misunderstandings where terms and concepts are not clearly defined, hampering the field’s progress. This risk is especially pronounced with ambiguity in describing roles. This study explores the variety of terms used by researchers and educators to describe “faculty”, with the aim to facilitate definitional clarity, and create a shared terminology and approach to describing this term.

</sec><sec>
<title>Methods</title>
The authors analyzed journal article abstracts to identify the specific words and phrases used to describe individuals or groups of people referred to as faculty. To identify abstracts, PubMed articles indexed with the Medical Subject Heading “faculty” published between 2007 and 2017 were retrieved. Authors iteratively extracted data and used content analysis to identify patterns and themes.

</sec><sec>
<title>Results</title>
A total of 5,436 citations were retrieved, of which 3,354 were deemed eligible. Based on a sample of 594 abstracts (17.7%), we found 279 unique terms. The most commonly used terms accounted for approximately one-third of the sample and included faculty or faculty member/s (<italic>n</italic> = 252; 26.4%); teacher/s (<italic>n</italic> = 59; 6.2%) and medical educator/s (<italic>n</italic> = 26; 2.7%) were also well represented. Content analysis highlighted that the different descriptors authors used referred to four role types: healthcare (e.g., doctor, physician), education (e.g., educator, teacher), academia (e.g., professor), and/or relationship to the learner (e.g., mentor).

</sec><sec>
<title>Discussion</title>
Faculty are described using a wide variety of terms, which can be linked to four role descriptions. The authors propose a template for researchers and educators who want to refer to faculty in their papers. This is important to advance the field and increase readers’ assessment of transferability.

</sec>

DOI： 10.1007/s40037-021-00683-8

Other Link： https://link.springer.com/article/10.1007/s40037-021-00683-8/fulltext.html

A scoping review of clinical reasoning research with Asian healthcare professionals Reviewed Open Access

Ching-Yi Lee, Chang-Chyi Jenq, Madawa Chandratilake, Julie Chen, Mi-Mi Chen, Hiroshi Nishigori, Gohar Wajid, Pai-Hsuang Yang, Muhamad Saiful Bahri Yusoff, Lynn Monrouxe

Advances in Health Sciences Education Vol. 26 ( 5 ) page： 1555 - 1579 2021.12

Language：English Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

<title>Abstract</title>Clinical reasoning is the thought process that guides practice. Although a plethora of clinical reasoning studies in healthcare professionals exists, the majority appear to originate from Western cultures. A scoping review was undertaken to examine clinical reasoning related research across Asian cultures. PubMed, SciVerse Scopus, Web of Science and Airiti Library databases were searched. Inclusion criteria included full-text articles published in Asian countries (2007 to 2019). Search terms included clinical reasoning, thinking process, differential diagnosis, decision making, problem-based learning, critical thinking, healthcare profession, institution, medical students and nursing students. After applying exclusion criteria, n = 240 were included in the review. The number of publications increased in 2012 (from 5%, n = 13 in 2011 to 9%, n = 22) with a steady increase onwards to 12% (n = 29) in 2016. South Korea published the most articles (19%, n = 46) followed by Iran (17%, n = 41). Nurse Education Today published 11% of the articles (n = 26), followed by BMC Medical Education (5%, n = 13). Nursing and Medical students account for the largest population groups studied. Analysis of the articles resulted in seven themes: Evaluation of existing courses (30%, n = 73) being the most frequently identified theme. Only seven comparative articles showed cultural implications, but none provided direct evidence of the impact of culture on clinical reasoning. We illuminate the potential necessity of further research in clinical reasoning, specifically with a focus on how clinical reasoning is affected by national culture. A better understanding of current clinical reasoning research in Asian cultures may assist curricula developers in establishing a culturally appropriate learning environment.

DOI： 10.1007/s10459-021-10060-z

【医学・医療者教育学を学ぶ我が国のプログラム】京大FCME(ふくみん) 現場で働く指導医のための医学教育学プログラム基礎編

Other Link： https://link.springer.com/article/10.1007/s10459-021-10060-z/fulltext.html

錦織宏, 及川沙耶佳, 谷昇子, 木村武司, 種村文孝

医学教育 Vol. 52 ( 6 ) page： 515 - 523 2021.12

Language：Japanese Publisher：(一社)日本医学教育学会

2015年に文部科学省の助成を受けて開講した京都大学の「現場で働く指導医のための医学教育学プログラム-基礎編」は対面型と遠隔型を組み合わせた形で医学教育学を体系的に学ぶプログラムである。1年間で約120時間学修することになる受講生は、課題に追われながらも12名の仲間と強固な学修コミュニティを形成していき、その様は講師が羨むほどである。また、プログラムに思想・哲学を掲げていること、そして文化人類学を重視したプログラムであることが特徴である。(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00050&link_issn=&doc_id=20220112190004&doc_link_id=10.11307%2Fmededjapan.52.6_515&url=https%3A%2F%2Fdoi.org%2F10.11307%2Fmededjapan.52.6_515&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

52巻3号掲載「拘束からの解放―反転授業を活用した完全オンライン型臨床研修指導医講習会―」を読んで, への応答 Reviewed

近藤猛, 錦織宏

医学教育 Vol. 52 ( 5 ) page： 450 - 451 2021.10

外科系医師はどのようにして医学教育のキャリアを形成していくのか? 臨床医から、臨床医の教育、そして医学教育学へ医学教育学を学ぶ産婦人科医として Reviewed

磯部真倫, 榎本隆之, 錦織宏

医学教育 Vol. 52 ( Suppl. ) page： 37 - 37 2021.7

Lists of potential diagnoses that final-year medical students need to consider: a modified Delphi study Reviewed Open Access

Yuka Urushibara-Miyachi, Makoto Kikukawa, Masatomi Ikusaka, Junji Otaki, Hiroshi Nishigori

BMC Medical Education Vol. 21 ( 1 ) page： 234 2021.4

Language：English Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

<title>Abstract</title><sec>
<title>Background</title>
Contrastive learning is known to be effective in teaching medical students how to generate diagnostic hypotheses in clinical reasoning. However, there is no international consensus on lists of diagnostic considerations across different medical disciplines regarding the common signs and symptoms that should be learned as part of the undergraduate medical curriculum. In Japan, the national model core curriculum for undergraduate medical education was revised in 2016, and lists of potential diagnoses for 37 common signs, symptoms, and pathophysiology were introduced into the curriculum. This study aimed to validate the list of items based on expert consensus.

</sec><sec>
<title>Methods</title>
The authors used a modified Delphi method to develop consensus among a panel of 23 expert physician-teachers in clinical reasoning from across Japan. The panel evaluated the items on a 5-point Likert scale, based on whether a disease should be hypothesized by final-year medical students considering given signs, symptoms, or pathophysiology. They also added other diseases that should be hypothesized. A positive consensus was defined as both a 75% rate of panel agreement and a mean of 4 or higher with a standard deviation of less than 1 on the 5-point scale. The study was conducted between September 2017 and March 2018.

</sec><sec>
<title>Results</title>
This modified Delphi study identified 275 basic and 67 essential other than basic items corresponding to the potential diagnoses for 37 common signs, symptoms, and pathophysiology that Japanese medical students should master before graduation.

</sec><sec>
<title>Conclusions</title>
The lists developed in the study can be useful for teaching and learning how to generate initial hypotheses by encouraging students’ contrastive learning. Although they were focused on the Japanese educational context, the lists and process of validation are generalizable to other countries for building national consensus on the content of medical education curricula.

</sec>

DOI： 10.1186/s12909-021-02652-5

Other Link： https://link.springer.com/article/10.1186/s12909-021-02652-5/fulltext.html

A Collaborative Clinical Case Conference Model for Teaching Social and Behavioral Science in Medicine: An Action Research Study Reviewed

Junichiro Miyachi, Junko Iida, Yosuke Shimazono, Hiroshi Nishigori

2021.2

Publisher：Research Square Platform LLC

<title>Abstract</title>
<bold>Background: </bold>Effective social and behavioral sciences teaching in medical education requires integration with clinical experience, as well as collaboration with social and behavioral sciences experts and clinical faculties. However, teaching models for achieving this integration have not been adequately established, nor has the collaboration process been described. This study aims to propose a collaborative clinical case conference model to integrate social and behavioral sciences and clinical experience. Additionally, we describe how social and behavioral science experts and clinical faculties collaborate during the development of the teaching method.<bold>Methods:</bold> A team of clinical teachers and medical anthropologists planned for the development of a case conference based on action research methodology. The initial model planned for a 3-hour session, similar to the Clinicopathological Conference structure. We evaluated each session based on fieldnotes taken by medical anthropologists, and post-session questionnaires that surveyed participants’ reactions and points of improvements. Based on the evaluation, a reflective meeting was held to discuss revisions for the next trial. We incorporated the development process into undergraduate medical curricula in clinical years and in a postgraduate and continuous professional development session for residents and certified family physicians in Japan. We repeated the plan-act-observe-reflection process more than 15 times between 2015 and 2018.<bold>Results:</bold> The development of the collaborative clinical case conference model is summarized in three phases: Quasi-CPC, Interactive, and Co-constructive with unique structures and underlying paradigms. The model successfully contributed to promoting the participants’ recognition of the clinical significance of social and behavioral sciences. The case preparation entailed a unique, significant learning of how social and behavioral sciences inform clinical practice. The model development process promoted the mutual understanding between clinical faculties and anthropologists, which might function as faculty development for teachers involved in social and behavioral sciences teaching in medical education. <bold>Conclusions:</bold> The application of fitting conference models and awareness of their underlying paradigm according to educational situations could promote the integration of social and behavioral sciences with clinical medicine education. Faculty development in social and behavioral sciences in medical education should focus on collaboration with scholars with different paradigmatic orientations.

DOI： 10.21203/rs.3.rs-138564/v1

Other Link： https://www.researchsquare.com/article/rs-138564/v1.html

Correlation between the number of laparoscopy-qualified gynecologists and the proportion of laparoscopic surgeries for benign gynecological diseases in Japan: An ecological study. Reviewed International journal

Masanori Isobe, Yuki Kataoka, Kenro Chikazawa, Tomonori Hada, Hiroshi Nishigori, Toshifumi Takahashi, Takayuki Enomoto

The journal of obstetrics and gynaecology research Vol. 47 ( 1 ) page： 329 - 336 2021.1

Language：English Publishing type：Research paper (scientific journal)

AIM: We aimed to evaluate regional disparities in the proportion of the three main laparoscopic surgeries for benign gynecological diseases among 47 prefectures in Japan and their correlation with the number of laparoscopy-qualified gynecologists per population. METHODS: In this retrospective ecological study, we collected the data of patients from 47 prefectures in 2017 using "The National Database of Health Insurance Claims and Specific Health Checkups of Japan" Open Data from the Ministry of Health, Labor and Welfare in Japan. The primary outcome of the study was the proportion of laparoscopic surgeries conducted for benign gynecologic diseases (hysterectomy, myomectomy and surgery for the benign ovarian diseases). The main exposure was the number of laparoscopy-qualified gynecologists per 100 000 females. RESULTS: The average proportion of laparoscopic hysterectomies, myomectomies and surgeries for the benign ovarian disease were 38% (standard deviation (SD) 16, range 12-74), 48% (SD 18, range 9-81) and 60% (SD 11, range 36-79), respectively. Multiple regression analysis showed a significant correlation between the number of laparoscopy-qualified gynecologists per 100 000 females and the proportion of the three main laparoscopic surgeries. CONCLUSION: There are obvious regional disparities in the proportion of the three main laparoscopic procedures for benign gynecological diseases among 47 prefectures. The number of laparoscopy-qualified gynecologists correlated significantly with these regional disparities. The academic society should monitor these regional disparities and make an effort to reduce these regional disparities by increasing laparoscopy-qualified gynecologists in areas where the widespread use of laparoscopic techniques is lagging.

DOI： 10.1111/jog.14528

Continuing medical education during pandemic waves of COVID-19: Consensus from medical faculties in Asia, Australia and Europe Reviewed

Carmen Wong, Walter van den Broek, Gillian Doody, Martin Fischer, Michelle Leech, Fabrizio De Ponti, Alexander Gerbes, Hiroshi Nishigori, Young Mee Lee, Maarten Frens, Hideki Kasuya, Franco Bazzoli, Reinhard Hickel, Hong Sik Lee, J.P.T.M van Leeuwen, Christina Mitchell, Kenji Kadomatsu, John Atherton, Francis Chan

MedEdPublish Vol. 10 ( 1 ) page： 64 2021

Development of entrustable professional activities for residents rotating nephrology department in a Japanese university hospital: a Delphi study Reviewed Open Access

Akihito Tanaka, Takeshi Kondo, Yuka Urushibara-Miyachi, Shoichi Maruyama, Hiroshi Nishigori

BMJ Open Vol. 11 ( 8 ) page： e047923 - e047923 2021

Language：English Publishing type：Research paper (scientific journal) Publisher：BMJ

<sec><title>Objectives</title>Training strategies regarding entrustable professional activities (EPAs) vary from country to country; one such strategy is for residents. However, there are no reports of EPAs developed for residents who rotate to the nephrology departments. We aimed to construct such EPAs, which could be generalised to other institutions.

</sec><sec><title>Design</title>Purposive design and a modified Delphi method to build consensus.

</sec><sec><title>Setting</title>The department of nephrology in a university hospital in Aichi Prefecture, Japan.

</sec><sec><title>Participants</title>Based on the attainment goals used in our department, an initial list was developed within the research group. The expert panel included 25 nephrologists from our affiliate hospital. Responses were based on a 5-point method and agreement was reached if both (A) and (B) were met: (A) mean≥4 with a SD <1; (B) more than 75% of respondents rated the item 4 or more. With agreement, the item was left for the next round. This round was repeated.

</sec><sec><title>Results</title>An initial list of 11 items was developed; after three Delphi rounds and revisions, eight items remained that were then established as the final EPAs. These items can serve as a list of goals to be reached by residents who rotate to the department of nephrology. The results indicated that most of the experts believed residents should be able to perform tasks deemed necessary or urgent for all physicians, such as those that deal with hyperkalaemia and heart failure.

</sec><sec><title>Conclusions</title>The concept of EPAs enabled us to develop goals and evaluation criteria for residents’ training in nephrology. This study can serve as a springboard for future discussions and contribute to the development of resident education in nephrology.

</sec>

DOI： 10.1136/bmjopen-2020-047923

Problem-Based Learning in Child and Adolescent Psychiatry: A Perspective from Japan Reviewed Open Access

Junko Iwatsuki, Takeshi Kondo, Noriyuki Takahashi, Hideki Takami, Hiroshi Nishigori, Itzel Bustos-Villalobos, Branko Aleksic, Hideki Kasuya, Nobutaro Ban, Tetsuya Yagi, Norbert Skokauskas

Advances in Medical Education and Practice Vol. 12 page： 1329 - 1335 2021

Differential Diagnoses That Final-Year Medical Students Need to Consider: A Modified Delphi Study Reviewed

Yuka Urushibara-Miyachi, Makoto Kikukawa, Masatomi Ikusaka, Junji Otaki, Hiroshi Nishigori

BMC Medical Education 2020.12

Authorship：Last author Language：English Publishing type：Research paper (scientific journal) Publisher：Research Square

<title>Abstract</title>
<bold>Background</bold>: Contrastive learning is known to be effective in teaching medical students how to generate diagnostic hypotheses in clinical reasoning. However, there is no consensus on comprehensive lists of differential diagnoses across different medical disciplines regarding the common symptoms that should be learned as part of the undergraduate medical curriculum. In Japan, the national model core curriculum for undergraduate medical education was revised in 2016, and lists of differential diagnoses for 37 common symptoms were introduced into the curriculum. This study aimed to validate the list of items based on expert consensus for use as a reference worldwide.<bold>Methods</bold>: The authors used a modified Delphi method to develop consensus among a panel of 23 expert physician-teachers in clinical reasoning from across Japan. The panel evaluated the items on a 5-point Likert scale, based on whether a disease should be hypothesized by final-year medical students considering a given symptom. They also added other diseases that should be hypothesized. A positive consensus was defined as both a 75% rate of panel agreement and a mean of 4 or higher with a standard deviation of less than 1 on the 5-point scale. The study was conducted between September 2017 and March 2018. <bold>Results</bold>: This modified Delphi study identified 275 essential and 67 supplemental items corresponding to the differential diagnoses for 37 common symptoms that Japanese medical students should master before graduation. <bold>Conclusions</bold>: The lists developed in the study can be useful for teaching and learning how to generate initial hypotheses by encouraging students’ contrastive learning. Although the lists may be specific to the Japanese context, the lists and process of validation are generalizable to other countries for building national consensus on the content of medical education curricula.

DOI： 10.21203/rs.3.rs-127514/v1

Other Link： https://www.researchsquare.com/article/rs-127514/v1.html

The number of overall hysterectomies per population with the perimenopausal status is increasing in Japan: A national representative cohort study Reviewed

Masanori Isobe, Yuki Kataoka, Kenro Chikazawa, Hiroshi Nishigori, Toshifumi Takahashi, Takayuki Enomoto

Journal of Obstetrics and Gynaecology Research Vol. 46 ( 12 ) page： 2651 - 2661 2020.12

Language：English Publishing type：Research paper (scientific journal) Publisher：Blackwell Publishing

Aim: This study aimed to investigate the trends in overall hysterectomy and other alternative therapies for benign uterine diseases per population aged 40–54 years in Japan. Methods: We conducted a national representative cohort study in Japan. We obtained data from ‘The National Database of Health Insurance Claims and Specific Health Checkups of Japan’ Open Data. The primary outcome was the number of overall hysterectomies for benign gynecologic diseases per population aged 40–54 years, from 2014 to 2017 in Japan. The secondary outcome was the number of alternative surgical and drug therapies to hysterectomy per population. We also analyzed the correlation between the number of laparoscopy-qualified gynecologists and the number of overall hysterectomies per population among 47 prefectures in 2017. Results: The number of overall hysterectomies for benign gynecological diseases per 100 000 females aged 40–54 years gradually increased from 320 in 2014 to 344 in 2017 (7.5% increase overall). Moreover, there was a significant increase in the use of levonorgestrel intrauterine systems. We could not explain the reason for this increase in the rate of overall hysterectomies by summarizing the increase or decrease of alternative therapies to hysterectomy. Multiple regression analysis showed a significant correlation between the number of laparoscopy-qualified gynecologists and the number of overall hysterectomies among 47 prefectures. Conclusion: Despite the spread of alternative therapies to hysterectomy, there was an increasing trend for overall hysterectomies in Japan. The reason was not clear but may be related to the spread of laparoscopic hysterectomy.

DOI： 10.1111/jog.14517

Failure or adaptation? - Redefining PBL from the perspective of the Safety II paradigm. Reviewed International journal

Ikuo Shimizu, Hiroshi Nishigori

Medical teacher Vol. 42 ( 9 ) page： 1076 - 1077 2020.9

Admission policies and methods at crossroads: a review of medical school admission policies and methods in seven Asian countries. Reviewed International journal Open Access

Diantha Soemantri, Indika Karunathilake, Jen-Hung Yang, Shan-Chwen Chang, Chyi-Her Lin, Vishna D Nadarajah, Hiroshi Nishigori, Dujeepa D Samarasekera, Shuh Shing Lee, Lilybeth R Tanchoco, Gominda Ponnamperuma

Korean journal of medical education Vol. 32 ( 3 ) page： 243 - 256 2020.9

Language：English Publishing type：Research paper (scientific journal)

Selecting the right applicants is an important part of medical student admission. While one universally accepted selection criterion is academic capacity, there are other criteria such as communication skills and local criteria (e.g., socio-cultural values) that are no less important. This article reviews the policies and methods of selection to medical schools in seven countries with varying socio-economic conditions and healthcare systems. Senior academics involved in medical education in Indonesia, Japan, Malaysia, the Philippines, Singapore, Sri Lanka, and Taiwan completed a pre-agreed pro-forma per each country to describe the country's admission policies and methods. The details were then compared and contrasted. This review identifies tension between many of the policies and methods used in medical school admissions, such as between the need to assess non-cognitive abilities and widen access, and between the need for more medical professionals and the requirement to set high entry standards. Finding the right balance requires careful consideration of all variables, including the country's human resource needs; socio-economic status; graduates' expected competencies; and the school's vision, mission, and availability of resources.

DOI： 10.3946/kjme.2020.169

目標・方略・評価を基盤とした卒後・専門教育のあり方〜現状とあるべき姿〜産婦人科領域における臨床研修医教育、専攻医教育、サブスペシャリティ教育における現状と問題点 Reviewed

Entrustable professional activity(EPA)を用いた、腎臓内科を研修する初期臨床研修医の到達目標と評価基準の作成 Reviewed

田中章仁, 近藤猛, 宮地由佳, 丸山彰一, 錦織宏

日本腎臓学会誌 Vol. 62 ( 4 ) page： 375 - 375 2020.7

磯部真倫, 錦織宏, 榎本隆之

医学教育 Vol. 51 ( Suppl. ) page： 42 - 42 2020.7

EPAを用いた老年医学分野における初期臨床研修到達目標の開発 Reviewed

渡邊一久, 近藤猛, 葛谷雅文, 錦織宏

医学教育 Vol. 51 ( Suppl. ) page： 207 - 207 2020.7

Faculty development in medical education: an environmental scan in countries within the Asia pacific region. Reviewed International journal Open Access

Dujeepa D Samarasekera, Shuh Shing Lee, Ardi Findyartini, Rita Mustika, Hiroshi Nishigori, Shunsuke Kimura, Young-Mee Lee

Korean journal of medical education Vol. 32 ( 2 ) page： 119 - 130 2020.6

Language：English Publishing type：Research paper (scientific journal)

PURPOSE: In recent years, faculty development (FD) research is more noticeable within an inter-professional context and in allied health education. However, there is a paucity of published literature on FD medical education programs in Asia. With the formation of the Asia Pacific Medical Education Network (APME-Net) in 2015, a scoping review of an environmental scan of FD medical education programs in main institutions in South East Asia and Australia in 2018 was conducted. METHODS: A survey was developed to collect data on FD in medical education after several rounds of discussion with APME-Net members. The representatives from nine countries in Asia and Australia were invited to partner in this research project. They sent the questionnaire to the Dean of all different medical schools after ethical clearance. The data collected was analyzed using descriptive statistics. RESULTS: Only institutions in four countries responded to the questionnaire. The medical/health professions education center/department/unit has been established in most educational institutions in these countries. These centers/departments/units mostly carry out FD programs to improve the teaching and learning skills of trained participants, particularly clinical teachers via workshops and seminars. Staffing issues and participant buy-in are the current key priorities of the center/department/unit in terms of FD. Lastly, research related FD program has not been well-supported in these countries, hence, the lack of publication in this area. CONCLUSION: Collaboration between countries to address key areas of interest and develop more standardized and productive FD medical education is required especially in research.

DOI： 10.3946/kjme.2020.160

Doctors' experience of becoming patients and its influence on their medical practice: A literature review.

Morishita M, Iida J, Nishigori H

Explore (New York, N.Y.) Vol. 16 ( 3 ) page： 145 - 151 2020.5

Doctors' experience of becoming patients and its influence on their medical practice: A literature review

Morishita Mariko, Iida Junko, Nishigori Hiroshi

EXPLORE-THE JOURNAL OF SCIENCE AND HEALING Vol. 16 ( 3 ) page： 145-151 2020

Current State and Future Opportunities for Continuing Medical Education in Japan. Reviewed International journal

Lawrence Sherman, Hiroshi Nishigori

Journal of European CME Vol. 9 ( 1 ) page： 1729304 - 1729304 2020

Language：English Publishing type：Research paper (scientific journal)

Globally, CPD systems vary widely. In Japan, the Japanese Medical Association (JMA) is responsible for identifying content and developing education for its speciality practice physicians. The JMA was concerned about persistent low levels of participation in its CME activities and wanted to better understand the root causes. The analysis would provide an opportunity to restructure its programme informed by the needs of its practising clinicians. The JMA engaged a global education provider to conduct an independent analysis of its CME programme. Using a mixed-methods approach, the education provider conducted an on-line survey (N = 338) and held two in-person focus groups (N = 24) to better understand the perspectives of physicians in speciality practice. The on-line survey was sent to over 7,000 practising physicians throughout Japan. Respondents reflected a variety of medical and surgical specialities and length in clinical practice. They described factors that influenced or were barriers to participation in JMA-sponsored education. Respondents also suggested changes to the current model of CME in Japan and expressed an ongoing commitment to life-long learning and achieving the goals set forth in Japan's vision for health care in 2035: Leading the World Through Health. Globally, medical associations are challenged with developing education that meets the needs of a diverse physician workforce. Improved understanding of the perspectives of its physician members and implementation of collaborations with speciality societies may be one strategy to improve quality and address healthcare population needs. Lessons learned from this analysis may help other medical associations with similar challenges.

DOI： 10.1080/21614083.2020.1729304

【医学教育における国際協力】タイ王国CPIRDのECMEにおける国際協働 Reviewed

Doctors as objects of worship: Reconsidering doctors’ competency based on cultural context Reviewed Open Access

Mariko Morishita, Hiroshi Nishigori

The Asia Pacific Scholar Vol. 4 ( 3 ) page： 99 - 101 2019.9

A two-edged sword: Narrative inquiry into Japanese doctors’ intrinsic motivation Reviewed Open Access

H Nishigori, T Suzuki, T Matsui, J Busari, T Dornan

TAPS Vol. 4 ( 3 ) page： 24 - 32 2019.9

Current status of medical education research in Japan: A meta-epidemiological investigation Reviewed

Yuki Kataoka, Hiraku Tsujimoto, Yasushi Tsujimoto, Yuka Urushibara-Miyachi, Yuda Miyamoto, Hideto Yasuda, Hiromitsu Yamashita, Ryohei Yamamoto, Hiroshi Nishigori

The Asia Pacific Scholar Vol. 4 ( 2 ) page： 7 - 13 2019.5

「将来構想に関する若手ワーキンググループ」の委員会報告について序文 Reviewed

鈴木康之, 錦織宏, 片岡裕貴, 宮地由佳, 蓮沼直子, 大槻眞嗣, 飯田淳子, 淺田義和

医学教育 Vol. 50 ( 1 ) page： 1 - 1 2019

【医学教育における国際協力】タイ王国CPIRDのECMEにおける国際協働

錦織宏, 及川沙耶佳, 松山泰, 藤原広臨, 宮地由佳, 柴原真知子, 春田淳志, 宮地純一郎, 茂木恒俊, 加藤浩晃, 谷昇子, 伊藤和史, 西城卓也, 飯田淳子, 大谷尚, 小西靖彦, Arora Rajin, Sriruksa Kanokwan

医学教育 Vol. 49 ( 4 ) page： 283 - 287 2018.8

医学教育 Vol. 49 ( 4 ) page： 283 - 287 2018.8

Translation and cultural adaptation of the Japanese version of the interprofessional facilitation scale. Reviewed International journal

Junji Haruta, Raoul Breugelmans, Hiroshi Nishigori

Journal of interprofessional care Vol. 32 ( 3 ) page： 321 - 328 2018.5

Language：English Publishing type：Research paper (scientific journal)

Effective interaction in interprofessional collaboration requires skills in interprofessional facilitation. The need for interprofessional learning and practice in Japan is highlighted by Japan's status as one of the most rapidly aging societies because good care for elderly people with complex needs requires effective collaboration between different professional groups. The development of interprofessional facilitation skills (including management of the additional complexities) among learners or professionals enhances interprofessional learning and consensus building and empowers them to make appropriate commitments when faced with difficult challenges. The 18-item interprofessional facilitation scale (IPFS) can be used to enhance interprofessional facilitation skills. Here, we aimed to develop a Japanese adapted version of the IPFS and to validate it for use with Japanese healthcare professionals. Consistent with guidelines for cross-cultural adaptation, three translators translated the original IPFS from English into Japanese, and an expert and all authors confirmed its face and content validity. The translated items were amended during backtranslation and expert reviews. Exploratory factor analysis was performed with 167 healthcare professionals to explore the underlying structure of the items. This analysis revealed two factors with good internal consistency (Cronbach's alpha > 0.8), which were labelled as: (1) encouraging interprofessional interaction and (2) respect for each professional. The original factor 'Encouraging interprofessional interaction' was divided into two factors in the study. One reason for this division might be related to the behaviour of Japanese health professionals, that is, most Japanese might understand that 'facilitation' encourages relationships as contextual belonging that are distinct from relationships based on respect for others. This mindset is likely based on the notion of 'relationalism', which is fundamental in Japanese culture. Further investigation of this Japanese version of the IPFS will strengthen factor construction and improve scrutiny of the relationships between factors.

DOI： 10.1080/13561820.2017.1398720

National survey of international electives for global health in undergraduate medical education in Japan, 2011-2014. Reviewed

Tomio Suzuki, Hiroshi Nishigori

Nagoya journal of medical science Vol. 80 ( 1 ) page： 79 - 90 2018.2

Language：English Publishing type：Research paper (scientific journal)

Interest in global health in medical education is increasing in Western countries, whereas data from non-Western countries is scarce. Here, we conducted a nationwide study of international clinical electives at Japanese medical schools from 2011 to 2013. We constructed a 28-item cross-sectional survey in Japanese to investigate the rate and characteristics of both Japanese students going abroad and international students coming on exchange to Japan. The surveys were sent to the administrative offices of all 80 Japanese medical schools in each of the three years, through the Japan Medical Education Foundation. All 80 medical schools responded to the questionnaire (response rate, 100%). An average of 70 of the 80 medical universities provided exchange programs across the three years to allow students to travel abroad as part of the school curriculum and obtain academic credit. The schools provided support in the form of in- and outside-class preparatory programs, tuition fee exemptions and housing. The most popular destinations for Japanese students going abroad were Europe and North America, which may reflect the desire of Japanese students to acquire medical knowledge or experience through exposure to the English language. In contrast, the most common countries of origin of international exchange students coming to Japan were Asian countries such as South Korea, Thailand and Taiwan, with pediatrics being the most popular elective. Foreign exchange programs are becoming increasingly incorporated into the Japanese medical education curriculum and can help to strengthen international partnerships and collaborations.

DOI： 10.18999/nagjms.80.1.79

臨床症例検討会を通じた文化人類学教育行動科学・社会科学教育の新しい形(その3) Reviewed

飯田淳子, 宮地純一郎, 島薗洋介, 錦織宏

医学教育 Vol. 48 ( Suppl. ) page： 156 - 156 2017.8

How do healthcare professionals and lay people learn interactively? A case of transprofessional education. Reviewed

Haruta J, Kitamura K, Nishigori H

The Asia Pacific Scholar Vol. 2 ( 3 ) 2017

医学教育分野の学術的国際交流に関する省察的記述文化進化主義から文化相対主義への変遷

宮地純一郎, 錦織宏

医学教育 Vol. 47 ( Suppl. ) page： 192 - 192 2016.7

A Potential Use for Manga in Medical Education. Reviewed International journal

Hiroaki Kato, Hiroshi Nishigori

Academic medicine : journal of the Association of American Medical Colleges Vol. 91 ( 3 ) page： 290 - 290 2016.3

Physical Examination and the Physician-patient Relationship: A Literature Review. Reviewed

Iida J, Nishigori H

MedEdPublish Vol. 5 ( 3 ) page： 14 2016

Beyond work-hour restrictions: a qualitative study of residents' subjective workload. Reviewed International journal

Hiroshi Nishigori, Gautam A Deshpande, Haruo Obara, Osamu Takahashi, Jamiu Busari, Tim Dornan

Perspectives on medical education Vol. 4 ( 4 ) page： 176 - 80 2015.8

Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Following the introduction of work-hour restrictions, residents' workload has become an important theme in postgraduate training. The efficacy of restrictions on workload, however, remains controversial, as most research has only examined objective workload. The purpose of this study was to explore the less clearly understood component of subjective workload and, in particular, the factors that influenced residents' subjective workload. METHOD: This study was conducted in Japan at three community teaching hospitals. We recruited a convenience sample of 31 junior residents in seven focus groups at the three sites. Audio-recorded and transcribed data were read iteratively and analyzed thematically, identifying, analyzing and reporting themes within the data and developing an interpretive synthesis of the topic. RESULTS: Seven factors influenced residents' subjective workload: (1) interaction within the professional community, (2) feedback from patients, (3) being in control, (4) professional development, (5) private life, (6) interest and (7) protected free time. DISCUSSION AND CONCLUSION: Our findings indicate that residents who have good interaction with colleagues and patients, are competent enough to control their work, experience personal development through working, have greater interest in their work, and have fulfilling private lives will have the least subjective workload.

DOI： 10.1007/s40037-015-0198-4

Why do students participate in medical education? Reviewed International journal

Hirohisa Fujikawa, Jeffery Wong, Hiroki Kurihara, Kiyoshi Kitamura, Hiroshi Nishigori

The clinical teacher Vol. 12 ( 1 ) page： 46 - 9 2015.2

Language：English Publishing type：Research paper (scientific journal) Publisher：Blackwell Publishing Ltd

BACKGROUND: Medical student involvement in curriculum development is important; however, little is known about why medical students become engaged in this activity. The aim of this study was to understand what motivates medical students at one university to participate in the process of curriculum development and gain a wider perspective on student engagement in medical education. METHODS: Grounded theory methodology was the foundation of this study. We conducted semi-structured interviews with seven medical students from the University of Tokyo who developed and participated in a group whose aim was to actively contribute towards improving their medical education. The data from the interviews were analysed by thematic synthesis, with triangulation. RESULTS: Three themes emerged as potential explanations for motivating student behaviour: (1) extracurricular interaction with faculty members; (2) engaging with highly motivated peers; and (3) student values for serving the public. CONCLUSIONS: Students working to improve educational processes at their medical schools had the opportunity to communicate more with faculty members, enjoyed opportunities for networking with other highly motivated peers and enhanced aspects of their developing professionalism.

DOI： 10.1111/tct.12240

鑑別診断を考えながら行う身体診察(HDPE)の教材作成用オンラインシステムの開発

Opinion: The learning objetive of ophthalmic examination for non-ophthalmologists

Kato Hiroaki, Nishigori Hiroshi

Igaku Kyoiku / Medical Education (Japan) Vol. 46 ( 5 ) page： 436 - 437 2015

アウトカム不在の学士入学制度におけるProfessional Identityの確立東京大学のケース Reviewed

佐々木那津, 錦織宏

医学教育 Vol. 45 ( Suppl. ) page： 121 - 121 2014.7

大滝純司, 錦織宏, 増田浩三, 菊川誠, 川島篤志

日本シミュレーション医療教育学会雑誌 Vol. 2 page： 81 - 81 2014.6

Bushido and medical professionalism in Japan. Reviewed International journal

Hiroshi Nishigori, Rebecca Harrison, Jamiu Busari, Tim Dornan

Academic medicine : journal of the Association of American Medical Colleges Vol. 89 ( 4 ) page： 560 - 3 2014.4

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

Medical professionalism has become a core topic in medical education. As it has been considered mostly from a Western perspective, there is a need to examine how the same or similar concepts are reflected in a wider range of cultural contexts. To gain insights into medical professionalism concepts in Japanese culture, the authors compare the tenets of a frequently referenced Western guide to professionalism (the physician charter proposed by the American Board of Internal Medicine Foundation, American College of Physicians Foundation, and the European Federation of Internal Medicine) with the concepts of Bushido, a Japanese code of personal conduct originating from the ancient samurai warriors. The authors also present survey evidence about how a group of present-day Japanese doctors view the values of Bushido.Cultural scholars have demonstrated Bushido's continuing influence on Japanese people today. The authors explain the seven main virtues of Bushido (e.g., rectitude), describe the similarities and differences between Bushido and the physician charter, and speculate on factors that may account for the differences, including the influence of religion, how much the group versus the individual is emphasized in a culture, and what emphasis is given to virtue-based versus duty-based ethics.The authors suggest that for those who are teaching and practicing in Japan today, Bushido's virtues are applicable when considering medical professionalism and merit further study. They urge that there be a richer discussion, from the viewpoints of different cultures, on the meaning of professionalism in today's health care practice.

DOI： 10.1097/ACM.0000000000000176

Recent Trends of Medical Education Reforms in United Kingdom : Quality Assurance in General Medical Council

The 6th Jakarta Meeting on Medical Education

Miyachi Yuka, Nishigori Hiroshi

Igaku Kyoiku / Medical Education (Japan) Vol. 45 ( 1 ) page： 43 - 44 2014

文化人類学と医学／医療者教育 Invited Reviewed

錦織宏, 道信良子

医学教育 Vol. 44 ( 5 ) page： 273 - 273 2013.10

共用試験OSCEの学習評価項目に対応したHDPE実技試験評価の試み

松井智子, 錦織宏, 菊川誠, 大滝純司

医学教育 Vol. 44 ( Suppl. ) page： 83 - 83 2013.7

鑑別診断を考えながら行う身体診察(HDPE)の教材作成用オンラインシステムの開発

大滝純司, 錦織宏, 増田浩三, 菊川誠, 川島篤志, 松井智子, 川畑秀伸

医学教育 Vol. 44 ( Suppl. ) page： 160 - 160 2013.7

学士入学経験が男性医師のキャリア形成に与える影響東大医学部のケーススタディ Reviewed

佐々木那津, 錦織宏, 大西弘高, 北村聖

医学教育 Vol. 44 ( Suppl. ) page： 101 - 101 2013.7

SHIBAHARA Machiko, NISHIGORI Hiroshi, NAKAMURA Mariko, SUZUKI Toshiya, TAKEDA Yuko, KONISHI Yasuhiko, FUKUSHIMA Osamu, NARA Nobuo

Igaku Kyoiku / Medical Education (Japan) Vol. 44 ( 2 ) page： 63 - 70 2013.4

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japan Society for Medical Education

Background: Globalization urges us to discuss rationale and policy towards establishing a medical education accrediting body in Japan. Experience of General Medical Council （GMC） suggests us some useful lessons. Method: Based on our visits and investigation into in GMC, we inquire how Quality Assurance （QA） was introduced in UK with what incentives and how QA has brought reforms in the medical schools in UK. Result: Since 2003, GMC has changed its policy for QA from 'inspection' to 'dialogue'. Dialogical QA asks a medical school to think critically of their education and consider vigorous actions for further improvements. Discussion: Implications from the experience of GMC are: 1.QA process in GMC makes medical schools take robust steps towards changes, 2. Sharing the rational and policy for QA created the solid base for its effective implementation, 3. There are possible difficulties in establishing structure to do an enormous amount of coordinating work, which is necessary for constructing 'dialogue with medical schools'.

DOI： 10.11307/mededjapan.44.63

CiNii Books

第48回医学教育セミナーとワークショップ in 京都大学

Other Link： http://search.jamas.or.jp/link/ui/2013256048

鑑別診断を考えながら行う身体診察(HDPE)の教材作成用オンラインシステムの開発

大滝純司, 錦織宏, 増田浩三, 菊川誠, 川島篤志, 小林智子, Yudkowsky R., Bordage G.

日本内科学会雑誌 Vol. 102 ( Suppl. ) page： 245 - 245 2013.2

鈴木康之, 錦織宏

医学教育 Vol. 44 ( 5 ) page： 368 - 369 2013

Reformation of Medical Education for an Aging Society in Japan. Invited Reviewed

Hiroshi Nishigori

Journal of Medical Research and Education. Vol. 1 ( 2 ) page： 8 - 9 2012.12

Minimum Requirementの身体診察法を網羅したHDPEモデル授業用シナリオの開発

小林智子, 錦織宏, 菊川誠, 大滝純司

医学教育 Vol. 43 ( Suppl. ) page： 184 - 184 2012.7

東京大学医学部医学科における女性学士入学者のアイデンティティの変遷 Reviewed

佐々木那津, 錦織宏, 大西弘高, 北村聖

医学教育 Vol. 43 ( Suppl. ) page： 56 - 56 2012.7

A global template for reforming residency without work-hours restrictions: decrease caseloads, increase education. Findings of the Japan Resident Workload Study Group. Reviewed International journal

Gautam A Deshpande, Kumiko Soejima, Yasushi Ishida, Osamu Takahashi, Joshua L Jacobs, Brian S Heist, Haruo Obara, Hiroshi Nishigori, Tsuguya Fukui

Medical teacher Vol. 34 ( 3 ) page： 232 - 9 2012

Language：English Publishing type：Research paper (scientific journal) Publisher：INFORMA HEALTHCARE

BACKGROUND: Japanese physician training programs are currently not subject to rigorous national standardization. Despite residency restructuring in 2004, little is known about the current work allocation of residents in Japan. AIMS: We quantified the amount of time that Japanese junior residents spend in service versus education in the context of caseload, fatigue, and low-value administrative work. METHODS: In this prospective, time-and-motion study, the activity of 1st- and 2nd-year residents at three Japanese community hospitals was observed at 5-min intervals over 1 week, and categorized as patient care, academic, non-patient care, and personal. Self-reported sleep data and caseload information were simultaneously collected. Data were subanalyzed by gender, training level, hospital, and shift. RESULTS: A total of 64 participating residents spent substantially more time in patient care activities than education (59.5% vs. 6.8%), and little time on low-value, non-patient work (5.1%). Residents reported a median 5 h of sleep before shifts and excessive sleepiness (median Epworth score, 12). Large variations in caseload were reported (median 10 patients, range 0-60). CONCLUSIONS: New physicians in Japan deliver a large volume of high-value patient care, while receiving little structured education and enduring substantial sleep deprivation. In programs without work-hour restrictions, caseload limits may improve safety and quality.

DOI： 10.3109/0142159X.2012.652489

A national survey of international electives for medical students in Japan: 2009-2010. Reviewed International journal

Hiroshi Nishigori, Osamu Takahashi, Naomi Sugimoto, Kiyoshi Kitamura, Graham T McMahon

Medical teacher Vol. 34 ( 1 ) page： 71 - 3 2012

Language：English Publishing type：Research paper (scientific journal) Publisher：INFORMA HEALTHCARE

BACKGROUND AND OBJECTIVES: International electives can provide experiences for medical students to learn about health systems and foster critical self-reflection. So far, little is known about the status of Japanese students' engagement in international electives. We sought to provide information about the internationalization of Japanese medical education by clarifying the current situations of international electives. METHOD: We undertook a cross-sectional national 17-item questionnaire survey of program officers in all medical schools in Japan in February 2010. RESULTS: Sixty-five (81.3%) of 80 Japanese medical schools responded to the questionnaire. 462 Japanese medical students (3% of all students in their clinical years) travelled to North America (45.5%), Asia (25.0%), or Western Europe (24.4%) to study abroad. The number of students who participated in international electives was significantly increased when academic credit was available (median 6 vs. 1, p < 0.001) and institutional affiliations were present (median 7 vs. 2 students, p < 0.001). Most students were evaluated by means of written assignment on return. DISCUSSION AND CONCLUSION: About 3% of Japanese medical students participate in international clinical exchanges. Academic credit and institutional affiliations appear to promote greater utilization of international exchange opportunities.

DOI： 10.3109/0142159X.2012.638014

東京大学医学部医学科学士入学制度の実態 Reviewed

佐々木那津, 錦織宏, 大西弘高, 北村聖

医学教育 Vol. 42 ( Suppl. ) page： 74 - 74 2011.7

A model teaching session for the hypothesis-driven physical examination. Reviewed International journal

Hiroshi Nishigori, Kozo Masuda, Makoto Kikukawa, Atsushi Kawashima, Rachel Yudkowsky, Georges Bordage, Junji Otaki

Medical teacher Vol. 33 ( 5 ) page： 410 - 7 2011

Language：English Publishing type：Research paper (scientific journal) Publisher：INFORMA HEALTHCARE

INTRODUCTION: The physical examination is an essential clinical competence for all physicians. Most medical schools have students who learn the physical examination maneuvers using a head-to-toe approach. However, this promotes a rote approach to the physical exam, and it is not uncommon for students later on to fail to appreciate the meaning of abnormal findings and their contribution to the diagnostic reasoning process. The purpose of the project was to develop a model teaching session for the hypothesis-driven physical examination (HDPE) approach in which students could practice the physical examination in the context of diagnostic reasoning. METHODS: We used an action research methodology to create this HDPE model by developing a teaching session, implementing it over 100 times with approximately 700 students, conducting internal reflection and external evaluations, and making adjustments as needed. RESULTS: A model nine-step HDPE teaching session was developed, including: (1) orientation, (2) anticipation, (3) preparation, (4) role play, (5) discussion-1, (6) answers, (7) discussion-2, (8) demonstration and (9) reflection. DISCUSSIONS AND CONCLUSIONS: A structured model HDPE teaching session and tutor guide were developed into a workable instructional intervention. Faculty members are invited to teach the physical examination using this model.

DOI： 10.3109/0142159X.2010.540269

Asian perspectives for reflection. Reviewed International journal

Hiroshi Nishigori, Kanokwan Sriruksa

Medical teacher Vol. 33 ( 7 ) page： 580 - 1 2011

医学部学士編入学試験受験者の受験準備の現状 Reviewed

佐々木那津, 錦織宏, 大西弘高, 北村聖

医学教育 Vol. 41 ( Suppl. ) page： 97 - 97 2010.7

What are portfolios and showcase portfolios? Reviewed

The Japanese journal of family practice Vol. 15 ( 2 ) page： 32 - 44 2010

A hypothesis-driven physical examination learning and assessment procedure for medical students: initial validity evidence. Reviewed International journal

Rachel Yudkowsky, Junji Otaki, Tali Lowenstein, Janet Riddle, Hiroshi Nishigori, Georges Bordage

Medical education Vol. 43 ( 8 ) page： 729 - 40 2009.8

Language：English Publishing type：Research paper (scientific journal) Publisher：WILEY-BLACKWELL PUBLISHING, INC

CONTEXT: Diagnostic accuracy is maximised by having clinical signs and diagnostic hypotheses in mind during the physical examination (PE). This diagnostic reasoning approach contrasts with the rote, hypothesis-free screening PE learned by many medical students. A hypothesis-driven PE (HDPE) learning and assessment procedure was developed to provide targeted practice and assessment in anticipating, eliciting and interpreting critical aspects of the PE in the context of diagnostic challenges. OBJECTIVES: This study was designed to obtain initial content validity evidence, performance and reliability estimates, and impact data for the HDPE procedure. METHODS: Nineteen clinical scenarios were developed, covering 160 PE manoeuvres. A total of 66 Year 3 medical students prepared for and encountered three clinical scenarios during required formative assessments. For each case, students listed anticipated positive PE findings for two plausible diagnoses before examining the patient; examined a standardised patient (SP) simulating one of the diagnoses; received immediate feedback from the SP, and documented their findings and working diagnosis. The same students later encountered some of the scenarios during their Year 4 clinical skills examination. RESULTS: On average, Year 3 students anticipated 65% of the positive findings, correctly performed 88% of the PE manoeuvres and documented 61% of the findings. Year 4 students anticipated and elicited fewer findings overall, but achieved proportionally more discriminating findings, thereby more efficiently achieving a diagnostic accuracy equivalent to that of students in Year 3. Year 4 students performed better on cases on which they had received feedback as Year 3 students. Twelve cases would provide a reliability of 0.80, based on discriminating checklist items only. CONCLUSIONS: The HDPE provided medical students with a thoughtful, deliberate approach to learning and assessing PE skills in a valid and reliable manner.

DOI： 10.1111/j.1365-2923.2009.03379.x

鑑別診断を考えながら行う身体診察(HDPE)の指導方法に関する教材開発の試み

大滝純司, 錦織宏, 増田浩三, 菊川誠, 川島篤志

医学教育 Vol. 40 ( Suppl. ) page： 145 - 145 2009.7

DREEM, PHEEM, ATEEM and STEEM in Japanese. Reviewed International journal

Hiroshi Nishigori, Makiko Nishigori, Hiroshi Yoshimura

Medical teacher Vol. 31 ( 6 ) page： 560 - 560 2009.6

I came, I saw, I reflected: a qualitative study into learning outcomes of international electives for Japanese and British medical students. Reviewed International journal Open Access

Hiroshi Nishigori, Takashi Otani, Simon Plint, Minako Uchino, Nobutaro Ban

Medical teacher Vol. 31 ( 5 ) page： e196-201 - e201 2009.5

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND AND AIM: Although medical students have increasingly more opportunities to participate in international electives, their experiences are usually unstructured and the literature referring to their learning outcomes, educational environment, and assessment is scanty. This study was undertaken to clarify qualitatively what students learn from their international electives. METHODS: We carried out semi-structured individual interviews with 15 Japanese students studying clinical medicine in British medical schools and six British students studying in Japanese medical schools. The thematic synthesis method was used in analysing the transcribed data and triangulation by multiple researchers was used to achieve higher reliability. RESULTS: The main learning outcomes identified were skills in history taking and physical examination with clinical reasoning and in management of diseases rarely seen in the students' own countries; awareness of clinical ethics and merits and demerits of different systems of healthcare and medical education; sensitivity to issues in doctor-patient relationships and work ethics; enhancement of cultural competence; and personal development. CONCLUSIONS: Most learning outcomes of international electives are culture- or system-dependent. Students achieved outcomes related closely to medical professionalism, mainly through reflection. International electives may give students opportunities to learn both professionalism and cultural competence.

DOI： 10.1080/01421590802516764