The 2nd MKSAP study session

National Hospital Organization Tokyo Medical Center
PGY 2 Tomohiro Hirai

Center Hospital of the National Center for Global Health and Medicine
PGY 1 Rika Terashima

The Resident Fellow Committee (RFC) of the American College of Physicians (ACP) Japan Chapter held their second MKSAP study session on Sunday, April 18, 2021. This session, utilizing ACP’s famous online learning tool MKSAP, is approved by ACP Headquarters. Dr. Yuji Yamada (Department of Geriatrics and Palliative Medicine, The Mount Sinai Hospital) was invited for this session with the theme of “Hematology”, and he explained five pre-selected questions from MKSAP. We had a lively study session, with participants answering each question and many more questions flying in the chat box.

The 1st question was about the “treatment of iron deficiency anemia,” and Dr. Yamada gave an in-depth explanation of common problems we encounter in our daily clinical practice.

The 2nd question was about “how to deal with poor INR control associated with warfarin usage”. Recently, DOACs are being used more frequently, and the occasions for prescribing warfarin are decreasing, but this is still a problem we encounter often. The lecture was full of useful tips for tomorrow’s practice, such as the differentiation of various anticoagulants.

The 3rd question was about the “diagnosis of polycythemia vera.” Dr. Yamada provided a clear explanation utilizing a diagnosis flowchart style, and we were able to hear Dr. Yamada’s personal experience where changes in lab data led to the diagnosis of a new hidden disease.

The 4th and 5th questions were about “HIT (heparin-induced thrombocytopenia)” and “DIHA (drug-induced hemolytic anemia)”. We discussed their differences and what to look out for in these diseases. We may know these diseases as medical knowledge but feel uneasy about actually clinically managing them. We also studied a wide range of topics, including the introduction of VITT (Vaccine-induced Immune Thrombocytopenia), a new finding that has become a hot topic with the new coronavirus vaccine.

This MKSAP study session was also a time to increase motivation for daily study. Dr. Yamada carefully explained important points in actual clinical management, including common pitfalls. He taught us in a way that is easy for non-specialists to understand, while mixing in his expertise and advanced viewpoint.

RFC will continue to hold events, including this study session, to improve our daily practice. In addition, we will provide a platform for those who want to go abroad. The ACP Japan Chapter Annual Meeting is scheduled to be held, for the first time online, on June 26 and 27, 2021. The next MKSAP workshop is scheduled to be held in August or September after the Annual Meeting. We look forward to seeing you at our ACP Annual Meeting and at one of our many study sessions.

第2回MKSAP 厳選5題 -Training with Specialist-



国立病院機構 東京医療センター
初期研修医2年 平井智大

米国内科学会(ACP)日本支部の若手医師部会(Resident Fellow Committee:RFC)は、2021年4月18日(日)にACP本部公認のMKSAP勉強会を開催いたしました。

第2回となる今回は「血液内科」領域をテーマに山田 悠史先生(マウントサイナイ医科大学 老年医学・緩和医療科)をお招きし、MKSAPより厳選した5題を解説いただきました。当日は、1問ごとに参加者が回答、チャットボックスには質問が飛び交う、活発な勉強会となりました。

第1問は「鉄欠乏性貧血の治療」について、日常臨床でよく出会うプロブレムを病態から掘り下げて解説いただきました。Common diseaseということもあり、多くの時間を割いたこの問題では、鉄動態に重要なヘプシジンに関連した新薬が生まれつつあるという最新の知識に触れ、病態に立ち戻ることの大切さを考えさせられました。



第4、5問は「HIT(ヘパリン起因性血小板減少症)」「DIHA(薬剤性溶血性貧血)」に関する問題でした。知識としては知っていても、実際のマネジメントには不安を覚える疾患について、鑑別や考えるべきことをまとめて話していただきました。また、新型コロナウイルスワクチンで話題となった新しい知見「VITT(Vaccine-induced Immune Thrombotic Thrombocytopenia)」の紹介を含めて幅広く解説していただきました。



The 1st MKSAP study session

US Naval Hospital Okinawa, PGY4
Shota Obata

Gunma University
Rika Terashima


The Resident Fellow Committee (RFC) of the American College of Physicians (ACP) Japan Chapter held a MKSAP study session on February 17, 2021. This new project was made a regular series because of its high popularity, as seen in the results of last RFC seminar’s survey. An expert in the field of internal medicine was invited, and each of the five pre-selected problems were explained in detail by RFC members. The purpose of this series is to learn the latest clinical knowledge from frontline experts through MKSAP’s high quality problems and enhance our knowledge of each internal medicine field in a short amount of time. We plan on holding this seminar series every few months.

For this session, we invited Dr. Jun Kataoka (Department of General Emergency Medicine and Intensive Care Unit, Nerimahikarigaoka Hospital) to talk about “Respiratory and Intensive Care”.

For the first and second question, he explained in detail using slides: the indications for intubation in acute respiratory failure, and the treatment of ARDS. Personally, even if I could choose the best treatment option, I have always found it difficult to explain why that particular treatment is effective. Dr. Kataoka’s concise and clear explanations with regard to respiratory physiology and ground-breaking research, helped deepen my understanding.

The third question was about different types of pleural effusion. We tend to treat pleural effusion without much thought because it is a condition that we routinely encounter in the medical setting. However, by reviewing the condition’s definition and categorization, I managed to improve my understanding. I found the clinical experience-based explanation on indications and pitfalls of pleural effusion drainage to be especially memorable.

The fourth question was about treatment methods for severe acute exacerbations of asthma. I felt the differentiation of these drugs in clinical practice is directly relevant to how we treat these patients daily. As a related topic, he also touched on the latest treatment for chronic management of asthma, which further expanded my knowledge.

The last question was about the treatment of COPD with repeated acute exacerbations. What I found most interesting was the relationship between the patient’s eosinophil count and the efficacy of ICS for patients with COPD. We were able to see the thought process behind choosing which patients to put on ICS, as well as how to take into account eosinophil count and asthma comorbidity. It was a very meaningful and helpful topic to learn about.

RFC will continue to hold events, including this study session, to improve our daily medical practice. In addition, we will continue to provide a platform for those who want to practice abroad. As mentioned in the previous newsletter, the ACP Japan Chapter Annual Meeting will be held, for the first time online, in June 2021. If you are interested, please join us.

第1回MKSAP 厳選5題 -Training with Expert-



沖縄海軍病院 PGY4
尾畑 翔太


米国内科学会(ACP)日本支部の若手医師部会(Resident Fellow Committee: RFC)は、新企画として2021年2月17日(水)にMKSAP勉強会を開催いたしました。これは、前回のRFCセミナーのアンケートでMKSAPの勉強会が好評であったことから、定例化したものです。当日は、内科領域の専門家を招聘し、1つ1つの問題を丁寧に解説いただきました。取り上げたのはRFCメンバーがピックアップした5問で、1問ごとに、参加者各自が考え、回答を投票し、解説を受けるというサイクルを回すことで、理解を深めることができました。MKSAPの良質な問題と専門家の最新の知見に触れることで、短時間で各分野の知識を磨くことを目的としており、今後も数ヶ月に1回の頻度で開催していく予定です。







Resident-Fellow Committee

American College of Physician Japan Chapter: Interim Report 2020

Resident-Fellow Committee

Koma Hotta, MD
Department of General Internal Medicine
Aso Iizuka Hospital

Report (What we have done)

Our committee (Resident-Fellow Committee; RFC) held a seminar called “The 6th RFC Seminar featuring infectious disease in November 2020. Holding “RFC Seminars” is one of our main projects to broaden the community of RFC in Japan. In November, more than 100 Japanese medical students, junior residents and fellows gathered on web seminar to learn together to strive for excellence in internal medicine frontlines.

Also, we posted an article about RFC semiar on ACP Japan Chapter RFC Facebook page on purpose of increasing the number of ACP members.

Plan (What we are going to do)

We are planning to organize a new seminar, by which junior residents and fellows can enhance the quality of postgraduate internal medicine training. At the same time, it is intended to become a “communication and collaboration hub”. We will find the best way to enhance the quality of postgraduate internal medicine training with the COVID-19 outbreak.

The 6th RFC seminar – GIM x Infectious Diseases –




Toshiro Goto, MD
Nerima Hikarigaoka Hospital, Tokyo, Japan


The Resident Fellow Committee (RFC) of the American College of Physicians (ACP) Japan Chapter held the 6th RFC Seminar on Saturday, November 21, 2020. This seminar is held twice a year and aims to improve young physicians’ clinical skills through lectures by experts in various internal medicine fields, and the “Bullet Diagnosis Dojo” which uses ACP’s lifelong learning material, the MKSAP. The theme of this year’s workshop was “GIM x Infectious Diseases”. We invited Dr. Harumi Yano (Professor of Infectious Diseases, International University of Health and Welfare, School of Medicine) and Dr. Mikiro Kato (Department of Infectious Diseases, University of Tsukuba, School of Medicine) to join us for a very productive workshop. Although this was our first time to holding the seminar online due to COVID-19, we received over 100 participants across the country, including eager medical students, young doctors, and veteran doctors. The seminar was a great success, with many engaging questions and discussions taking place in the chat room.

The event began with a message-driven case review session featuring guest lecturer Dr. Kato, on a Nigerian patient presenting with diarrhea. The intriguing case reminded us the necessity of returning to the basic principle of infectious disease treatment whenever we encounter complex cases, which is to perform culture and determine drug susceptibility. In the second session by Dr. Yano on antimicrobial agents, Dr. Yano reiterated the importance of linking pathology, microorganisms, and antimicrobial agents to each other. We learned to take a thorough history, understand the entire clinical course, make a wide range of distinctions, and select the appropriate antimicrobial agents for a given microorganism. At the “Bullet Diagnosis Dojo,” we presented a series of four case questions based on the famous ACP’s official question book MKSAP. Participants received educational comments and tips on each question, which deepened their understanding on infectious disease medicine.

RFC will continue to organize events where young doctors and medical students can learn medical knowledge and techniques useful for tomorrow’s clinical practice that will help them achieve a higher level of excellence. We will also continue to strive to be a platform for those who wish to gain clinical experience abroad. If you are interested, please consider joining us.

ACP日本支部 Resident-Fellow Committee主催 「第6回RFCセミナー」




練馬光が丘病院 初期研修医1年目
後藤 寿郎


米国内科学会(ACP)日本支部の若手医師部会(Resident Fellow Committee:RFC)は、2020年11月21日(土)に第6回RFCセミナーを開催いたしました。本セミナーは、内科系各分野の専門家を講師としてお招きし、講演やACPの生涯学習教材MKSAP等を用いた「弾丸診断道場」を通じて、若手医師の臨床能力の向上を図ることを目的に、年2回程度開催しているものです。





RFCでは、今後も若手医師や医学生がワンランク上の診療を目指せるような、明日からの診療に役立つ知識やテクニックを学べるイベントを行っていきます。それと同時に、海外を目指す方々のプラットフォームであり続けられるよう努めます。2021年6月には、初めての試みとなるA C P日本支部年次総会のオンライン開催が予定されております。関心のある方はぜひご参加ください。

New Member of Resident/Fellow Committee

Committee: Resident/Fellow Committee

Job Title: Resident

Name: Sayaka Aoyama

Degree: –

Institution: Mitokyodo General hospital

Division/Department: –

Hobby: Music, Cooking

Message: I do my best. 🙂

My motto is ”Live as if you were to die tomorrow. Learn as if you were live forever” by Mahatma Gandhi.

New Member of Resident/Fellow Committee

Committee: Resident/Fellow Committee

Job Title: Japanese Fellow

Name: Shota Obata

Degree: MD

Institution: United States Navy Hospital in Okinawa

Division/Department: –

Hobby: Ice hockey

Message: あまり、委員会などに参加したことがないので、自分の殻を破って積極的に参加していきたいです。

New Member of Resident/Fellow Committee

Committee: Resident/Fellow Committee

Job Title: Medical student

Name: Rika Terashima

Degree: –

Institution: Gunma University

Division/Department: School of Medicine

Hobby: Traveling

Message: “Chance favors the prepared mind.”