At the ACP Japan Chapter Annual Meeting 2018, we held a lecture session on “how to train speaking skills in English” for young doctors and medical students who have difficulty speaking out at international conferences because of language barriers.
To facilitate active discussions inside our committee, we made a SNS group account for the members.
Plan:
This fall we’re planning to hold a spin-off workshop of the lecture session in the Annual Meetig 2018 in the Kanto area. This time, the focus will be on “how to read medical English efficiently”.
We’re also interested in advancement of technology in medicine. We’re now discussing ideas about holding an event featuring deep learning and application of AIs to medicine.
Overcoming the Challenge to the World !
Dr’s Dilemma, ACP Internal Medicine 2018
Department of General Medicine, Okayama University Hospital
Chair, Resident-Fellow Committee, American College of Physician Japan Chapter
Yoshito Nishimura M.D.
I departed from Japan to New Orleans with determination to fight against the United States teams in the Dr’s Dilemma National Competition in ACP Internal Medicine Meeting 2018. Dr’s Dilemma is a competition to test the medical knowledge of around 50 teams, each representing each ACP chapters around the World. I participated in the competition with doctors from Nerima Hikarigaoka Hospital, the champion team in the 2017 ACP Japan Chapter Dr’s Dilemma Competition. In the elimination round, we fought against 4 teams including the state of Washington and Massachusetts. Quizzes were first read loud by the speaker, and the scripts were shown up on the screen afterward. Although we could reach the final question, we could not go through to the semi-final round. We ended up being the 4th, taking out the Massachusetts team. Not only I could compete in the great competition, the conference itself also gave me opportunities to expand the wave of exchange with physicians around the world, making the experience was an one chance in a million, I deeply appreciate everyone in the ACP Japan Chapter and Okayama University Hospital, Department of General Medicine, for substantial support. Finally, I would like to thank ACP Japan Chapter for supporting us with travel grants.
Dr’s Dilemma Japan Chapter Members
Nerima Hikarigaoka Hospital, Department of Medicine
Hayato Mitaka M.D.
Nerima Hikarigaoka Hospital, Department of Medicine
Tomohiro Matsumoto M.D.
Okayama University Hospital, Department of General Medicine
The 3rd Resident-Fellow Committee Seminar “Setting Out for the World Ahead!”
Department of General Medicine, Okayama University Hospital
Chair, Resident-Fellow Committee, American College of Physician Japan Chapter
Yoshito Nishimura M.D.
We are glad to report that we have successfully finished the 3rd RFC seminar with a slogan “Setting Out for the World Ahead!” on April 15, 2018. In the seminar, we set up 2 venues: Room A for ones who want to acquire the most important skills related to internal medicine in daily clinical encounters, and Room B to for young doctors interested in the evidence-based medical educational skills. Despite April, the busy first month of the fiscal year, there were 62 participants total. In the room A, we have invited 2 significant guest speakers; Dr. Yuka Kitano from the St. Marianna University School of Medicine, Yokohama City Seibu Hospital, and Dr. Sou Sakamoto from the Juntendo University, Nerima Hospital. In a 90-minute session each, Dr. Kitano held the session “Practical 5-min Teaching Skills for Clinicians”, for which she even has a blog. Dr. Sakamoto gave an interactive lecture “Approach for Patients with Altered Mental Status”. All the 43 participants in the Room A seemed to be immersed in the world of those leaders, with serious yet amused looks on their faces. Dr. Tadayuki Hashimoto from Hashimoto City Hospital gave us a workshop with a motto “Residents as Teachers”. It was done in a completely bidirectional style with a lot of group works. Almost all the participants gave back us good feedbacks after all. In the 63 participants, 40 of them were ACP non-members, and 7 of whom enrolled onsite! We are looking forward to continuing the seminar, anticipating broader yet more solid committee management.
My pride as a doctor was born from my experience in Hawaii
Tokyo Women’s Medical University, Department of Nephrology
Yusuke Ushio, MD
In February 2018, I was trained at the Kuakini Medical Center and Queen’s Medical Center (QMC) in the state of Hawaii, U.S., through the ACP Japan International Exchange Program.
The main reason I applied to this program was that I wanted to learn more about medicine overseas and gain an objective view of medical practice in Japan. I had an opportunity to work with a physician who was trained in the U.S. during my residency and many colleagues were hoping to work abroad in the future. As a doctor, I wondered why they wanted to work abroad. At the time, my teacher said to me, “Not everything is always clear, at first,” and I decided to apply.
The first half of the training was held at Kuakini Medical Center. The institution was founded as Japan Charity Hospital for Japanese Immigrants. Following WWII, the name was changed to Kuakini Hospital and then its current name, Kuakini Medical Center.
I was trained in Family Medicine at Kuakini Medical Center. I shadowed the clinical professor of Family Medicine, Dr. Tokeshi, who was a student of the first graduating class of the John A. Burns School of Medicine at the University of Hawaii, established in 1973.
He said, “I like not only physiology but also surgery and all of the others, and I couldn’t decide on a department.”
In recent years, the concept of Family Medicine has been more acknowledged in Japan. The family physician is a doctor who provides wide-ranging, comprehensive medical care for the young and old, regardless of the affected organ. In U.K., there is a phrase “from the cradle to the grave.” The family physician is called a GP (General Practitioner) and provides primary care before patients see an organ specialist. Dr. Tokeshi has been providing this model of care for 40 years.
A wide range of medical students, residents, fellows, and even attending physicians from all over the world come to study under Dr. Tokeshi. The training provided by Dr. Tokeshi is called Tokeshi Dojo, and the doctors who study in Tokeshi Dojo are called Monkasei. A Monkasei’s day begins early in the morning; we attend a morning lecture at 6:30 and start working at 8:30. The most impressive aspect was the fact that Dr. Tokeshi asks us to take the details of patients’ social history. Questions include: “Where were you born? How did you grow up? How have you lived your life?” It is also important to remember his words, “It is not enough to only treat illnesses—doctors must be able to recognize all aspects of patients.” I took a look back on my own medical practice and reflected in my heart. “To always treat patients with respect is the most important thing of all” is a phrase I constantly repeated to myself. I learned from Tokeshi Dojo how to behave and live as a physician.
The second half of the training was held at QMC. At QMC, I shadowed Dr. Nogi, a hospitalist who is responsible for inpatient service at QMC. In recent years, the number of hospitalists has increased in the U.S. because of advantages such as a reduction in days of hospitalization. Because there is no outpatient duty, hospitalists can concentrate on inpatient care throughout the day. A shift system of seven days on duty and seven days off is common. Even in Japan, where voices calling for a revolution of work-life balance have become louder, there is a possibility that the number of hospitalists will increase if there is a major reform in the future and the need for hospitalists increases.
There are several small islands around Oahu Island where QMC is located, such as Hawaii Island and Maui Island. There was a case of consultation from a hospital in a small island via a video phone. Hospitalists at QMC provided appropriate instructions to the doctors at a hospital in Hawaii island, and the patient was taken to QMC by a medical helicopter on the next day. I think that such medical care can be applied to Japan, especially underpopulated areas, as a doctor on an isolated island can consult specialists in an urban area, using a video phone and can provide the best medical care.
I was also impressed by the medical education. I appreciated the idea of actively participating in a lecture rather than just listening to it. In resident conferences held twice a week, there was always an active discussion. In addition, I thought that this was a great opportunity to improve presentation skills. History and physical findings were considered more important to narrow down differential diagnoses than test results. I want to cultivate more this way of thinking.
Finally, since the time I studied in Hawaii until now, I have been reflecting on the days I spent there, wondering, “” When I look objectively at myself now, I think the days I spent were marvelous. I appreciate this wonderful experience and the support from all the committee members in ACP Japan, Dr. Tokeshi, and Dr. Nogi.
Thank you for inviting me to attend the ACP Japan Chapter Annual Meeting 2018. I thank Governor ACP Japan Chapter Dr. Fumiaki Ueno and family for the nice welcome and hospitality. You have chosen the right theme “Mind & Arts as Essentials for Internists: Beyond Evidence & Technology”. The practicing medicine is both science and art. Science of uncertainty and art of probability.
The arrangements, the venue, the registration procedures were really good. The workshop on Statin was very innovative and involved everyone. The participants in the workshop were made to ask clinical questions and also were made to use the internet to search the latest guidelines and articles relevant to the topic. There were debates whether they can trust the answer
they found.
The participant clearly understood the 5 steps of evidence based medicine. With the above background applying and sharing the decisions with the patient was also highlighted. I understood in Japan they use only small dose of Statin to reduce cholesterol. On the whole the workshop was simple and
complete to cover all the points regarding Statin usage.
I could attend only one workshop. There were other useful interesting topics in other halls like How to evaluate jugular venous pulse at bedside – you can do it, from now on, Minds and arts for end of life discussions through case discussions of cancer patients at terminal stage, A workshop to write “letter to the editor” and etc.
We had a good lunch with the dignitaries who include Dr. Jack Ende Past President ACP, Governor Dr. Fumiaki Ueno, Dr. Kenji Maeda Governor Elect and others. Regarding the session on hypertension there was an initial discussion about how to develop guidelines. During my talk on “Recommended Treatment Protocol for Improving Management of Hypertension Globally” I recommended the following 2 protocols.
There were lot of questions on hypertension regarding the definition, the target especially for elderly population etc. I always used to promote home blood pressure monitoring in my country. I am very happy to know most of the patients in Japan are using the home blood pressure monitoring. Ambulatory Blood Pressure Monitoring (ABPM) is ideal but it is not practical. Sooner there may be some devices like wrist watch which can record ABPM very easily. There were lot of discussion about automated office BP monitors. There were lot of lively questions on various aspects of treatment from the audience and
the hall was full.
I was fortunate to be a referee for the “Kurokawa Prize” for poster presentation. Lot of innovative original research papers were presented by the junior doctors. The talk given by ACP past President Dr. Jack Ende on Professionalism was mind boggling. Overall I learnt lot of new points both in academics and organizing. The award function and reception were well organized. I could meet lot of new fellows during the reception and made friendship with them. This also helped me to initiate exchange programme and other joint activities between Japan and India ACP chapter.
The people in Japan are very nice, cordial, honest and helpful. The transport like bullet train, subway train and busses were amazing. I and my family thoroughly enjoyed every movement of our stay in Japan both at Tokyo and Kyoto. We are looking forward to the next best opportunity to visit Japan again. Congratulations to Dr. Fumiaki Ueno, Dr. Yugo Shibagaki, MD, FACP Chair, ACP Japan Chapter Annual Meeting 2018, Governor Elect Dr. Kenji Maeda and members of the organising committee for the wonderful conference.
Thank you once again.
A. Muruganathan, MD, FACP
Governor, ACP India Chapter
I performed my presentation titled“Cavitary Lung Lesions in a Patient with Positive IGRA and PR3-ANCA are not Always due to TB or GPA: a Case Report of Right-Sided Infective Endocarditis”. It was an honor to receive first place in theKurokawa prize competition, the best abstract award (medical student section) at the annual conference of the ACP Japan Chapter 2018.
I am interested in clinical reasoning, so I often attend case conferences and journal club sat the General Internal Medicine department to read and discuss cases from theNew England Journal of Medicine. A doctor suggested that I write an abstract. However, I was a fourth-year student at that time and had not started my clinical clerkship yet, so I started asking about cases for the abstract. Since I have a passion for studying infectious diseases and rheumatology diseases, I still remember how excited I was when I took this case.
In this case, it was saddening to learn that is under standing of laboratory data led to them is diagnosis of the patient which resulted in anatrogenic exacerbation of the patient’s condition. We must consider bacteremia and infective endocarditis from the history and vital signs, and send a blood culture for examination. If the culture is positive, then we need to perform an echocardiogram. There is no doubt that his quality of life would have been improved with those few non-invasive procedures. A famous Japanese doctor who I respect says that the essence of the physician is the differential diagnosis. You can’t take note of the patient’s history, conduct a physical examination, perform a laboratory examination, and conduct the treatment without a differential diagnosis. So in this case, if infective endocarditis was included in the differential diagnosis in the early stages, we could have avoided such a situation by conducting a blood culture and an ultrasonography. It is said that a lot of unneeded laboratory examinations are performed in Japan. Some people even say “clicking the order button is not the prescription for a doctor’s anxiety to misdiagnosis”, but the lesson I learned from this case is that laboratory examinations sometimes startle us, not knowing the character of the laboratory examination.
In closing, I would like to take this opportunity to express my appreciation to you all. It would be impossible to have this award without your help. I will go forward on my newly set goal, which is to do a presentation at theACP Internal Medicine Meeting 2019 in Philadelphia, PA, USA. Thank you for your time.
Department of General Medicine, Chiba University Hospital
I am honored to have received the Kurokawa Prize at the ACP Chapter Annual Meeting, 2018. The “Best Abstract Award” was named as the “Kurokawa Prize” beginning in 2018, I am especially honored to be the first person to be awarded this prize.
Research particulars
What triggered this research was that I felt that there were few physicians who could perform the fundus examination confidently. Even when I observed others, few doctors were using the ophthalmoscope with confidence in actual medical practice, except for my mentor, Professor Masatomi Ikusaka. Makoto Kikugawa (Department of Medical Education, Kyushu University), one of the co-researchers, reported that approximately 90% of junior residents, senior residents, and fellows in internal medicine performed the fundus examination less than once in a few months. He also reported that the reason for the problem was mostly that they were not proficient at the fundus examination.
When I taught residents the fundus examination, I discovered why observing the fundus was difficult for them. Funduscopy is inherently difficult to teach because there is no way to verify that the learners have obtained a proper view of the fundus. The teacher cannot give students feedback on whether what they are seeing or the teacher is seeing.Furthermore, it is extremely difficult for the teachers to point out why learners cannot observe the fundus. It was such a dilemma.
Turning point
The turning point of our research was a visit to the Department of Internal Medicine, Stanford University Medical School in March 2017 where I met Dr. Errol Ozdalga and learned the educational method using the iExaminer system for fundus examination. I talked with him about implementing this educational method in Japan as well as to conduct research on its educational effect. He approved of it pleasantly.
Introduction to Clinical Clerkship at Chiba University School of Medicine
First, because of actual instruction in using this iExaminer system, student satisfaction was high, and I heard students saying that they wanted to use it actively even in future clinical training. Next, in order to confirm whether the skill really improved, I asked for the cooperation of the fundus examination simulator at the Chiba Clinical Skills Center. To evaluate the educational effects, we assessed fundus examination skills in a pre-test and a post-test. Discussions between co-researcherswere intense, raising questions such as what to make the subject matter, how many cases we must prepare, and so on. Since we were particularly interested in evaluating skills in “observing fundus,” I was keen to prevent the evaluation of skills in “interpreting fundus.” In addition,to minimize the influence of teachers’ educational skills, we developed an instructional design, led the faculty development, and randomly assigned the teachers.
Future expectations
In this study, the diagnostic accuracy of a fundus examination improved by using the iExaminer system and the time taken to identify funduscopic findingswas shortened. The iExaminer system can be implemented immediately because it can be used for free if you have the adapter and an iPhone. By spreading this teaching method, I hope that more internists can examine the fund us with confidence.
Clinical observership at Olive View Medical Center, University of California, Los Angeles (UCLA) was initiated in 2012, and ended as of August 2017. Since 2012 until the end of the program, there had been a total of sixteen observers through this program.
Masayuki Nogi and Jinichi Tokeshi, and other supportive local physicians at Department of Medicine, University of Hawaii kindly offered clinical observership for our two members in November 2017 and February 2018, respectively.
The committee has created evaluation criteria (evaluation sheet) for the candidates’ CVs and personal statement.
Mentorship has been introduced for each observer before, during, and after the observership.
An Email list serve for the alumni members of this program, committee members, and the ACP council members has been launched for a weekly report from the Olive View Medical Center by observers.
What We Were Already Working On
Revision of credential evaluation/support for the candidates
What We Initiated
More strategic recruitment for the candidates of the observership.
New members who are still early in their career (such as Drs. Yuji Yamada, Emily Muranaka) joined this committee to support the members to obtain international medical experiences.
After the obsevership at Olive View Medical Center, University of California, Los Angeles ended, our committee tried to find any new programs for clinical observership and Dr. Takahiko Tsutsumi has significantly contributed to explore and support the clinical observership program at University of Hawaii.
The committee will organize a seminar to help early career physicians understand clinical and research experiences they could have in international settings for physicians in early career at the annual meeting of ACP Japan Chapter in June 2018.
Plan:
What We Plan To Work On
discussion on how this committee could explore or continue any exchange programs or international exchange activities after the UCLA program ended. This includes accepting students/residents/fellows from other countries.
How to disseminate the experience report to the younger ACP members and non-members, and those who are interested in the clinical observership in the United States.
More comprehensive recruitment and support systems for the program applicants.
Creating alumni members activities and leadership to share and sustain learning experiences after the observership.
