Doctor’s Dilemma in ACP Japan Chapter Annual Meeting 2018 (2)


Dr. Uchiyama and I joined Doctor’s dilemma on behalf of our hospital. Doctor’s dilemma is one of the most popular part of Japan chapter, which is held every year in Kyoto. Luckily, We could win the championship. This article will be a simple report of my experience. It would be my pleasure if you get a rough image of what ACP Dr’s dilemma is and get interested in it.
Doctor’s dilemma is so called medical knowledge competition. Residents from many hospitals join it in pairs. More and more teams are taking part in it every year. The winner will be given the chance to participate in Doctor’s dilemma held in USA.
Doctor’s dilemma is divided into two parts, Preliminary and Final. In the Preliminary, we used smartphones to answer the questions. The questions were not so difficult, which made us a little bit nervous as losing even one question would be deadly. Ten team passed the Preliminary, which included us.
The Final started after short break. We answered 25 question from 5 areas, GIM, ID, Collagen, Nephro and Hemo. The questions were very practical and connected directly to what we do every day. We finished 25 questions at the second place.
The final question was to diagnose the case. I felt a little bit awkward because I have never seen the disease. However, the case was so typical that we were able to give the right answer. The final question was special because we could bet points as we wanted. We bet all the points and got our score double. We succeeded in making comeback to win.
It was a good match. Many factors contributed to our win. One of the reasons I would like to emphasize is that we belong to Tokyo bay medical center. We bought MKSAP with help and we use it as a self assessment literally. Attending stuffs are also very educative and nice. They Kindly cheered for us on the day. I strongly recommend you come to our hospital.
Finally, I would like to thank everyone who helped holding the ACP Japan chapter. I expect Dr’s dilemma to be even more competitive next year.
Keisuke Takano
Tokyo Bay Urayasu Ichikawa Medical Center

Drʼs Dilemma に参加して(2)

先のACP日本支部総会におけるDoctor’s Dilemmaで見事優勝した東京ベイ・浦安市川医療センターチームの高野敬佑先生からの寄稿(日本語ver)です。是非、ご覧ください。(PRC 小尾佳嗣)

 この度、京都大学で開催されたACP日本支部のDr’ Dilemmaに参加させて頂きました。パ-トナーにも恵まれ優勝する事ができ、2019年にフィラデルフィアで開催される本選に日本支部代表として参加することになりました。簡単ではありますが、当日の報告をさせて頂きたく思います。
 私はACPの会員ではありましたが毎年京都で行われている日本支部には参加したことはなく、もちろんDr’ Dilemmaという企画の存在も知りませんでした。しかし今回参加してみて、非常に教育的なセッションが多く、充実した2日間を過ごす事ができたと感じています。京都へのアクセスが大変という方もいるとは思いますが、その労力をはるかに上回るものを得られるので、ぜひ1度は参加してみることをお勧めします。
 Dr’ Dilemmaは2日目に行われました。合計20チーム以上が参加していました。予選と決勝の2部構成で、予選ではスマートフォンを使って回答する方式でした。問題の内容はCBT~国家試験レベルで一見簡単ですが、その分1問のミスも許されないレベルの高い争いとなることが予想されたためかえって緊張しました。結果は4問間違いの4位で通過することができました。
高野 敬佑

Doctor’s Dilemma in ACP Japan Chapter Annual Meeting 2018


I am honored to report that Dr. Takano and I won first prize in the American College of Physicians (ACP) Doctor’s Dilemma competition in Japan.

At first, my goal in joining the competition was simply to assess my skills as an internist. Since distinguished young doctors from all over Japan would be in the contest, I wanted to compare my abilities to theirs. However, with the support of my partner, Dr. Takano, I ended up winning the championship.

Several factors contributed to our victory. First, we prepared for the competition by working up many MKSAP questions to enhance our medical knowledge. Second, our teamwork might have been superior to that of other teams because Dr. Takano and I have been colleagues since we were junior residents. Above all, I believe that our success resulted from our day-to-day sincere attitude and strong passion for helping every patient we see in our hospital. Our success was cultivated in the excellent environment that the attending doctors in our hospital promote. The victory led me to conclude that our hospital is the ideal place to practice medicine and improve my skills as a physician.

I am quite excited about the chance to participate in the ACP Doctor’s Dilemma Final that will be held in Philadelphia in 2019. Since Japanese teams typically struggle in the tournament, our biggest goal is to win the first game. I have no doubt that we can do it. I look forward to it and will continue to brush up on my medical knowledge until then.

Finally, I would like to express my heartfelt gratitude to the attending doctors who gave us the chance to join the competition, the friends who congratulated us, and my family who support me unconditionally.


Shuhei Uchiyama

Tokyo Bay Urayasu Ichikawa Medical Center

Drʼs Dilemma に参加して

先のACP日本支部総会におけるDoctor’s Dilemmaで見事優勝した東京ベイ・浦安市川医療センターチームの内山秀平先生からの寄稿(日本語ver)です。是非、ご一読ください。(PRC 小尾佳嗣)

この度、京都にて開催されました米国内科学会(ACP)日本支部総会におきまして、Dr.’s dilemmaで優勝をおさめ、2019年に行われるPhiladelphiaでの本選に出場する機会を頂くことができました。日本全国の名だたる病院の若手医師が集まる中、優勝という最高の形で終えられたことは私にとって大きな驚きであり、また同時に喜びになりました。これからPhiladelphiaにおける本選に向けてさらに知識を高め、本番ではできる限りの力を尽くし、悔いのないように取り組みたいと考えております。

出場者にとってのこのイベントの最大の魅力は、日常のトレーニングの成果を試す機会が得られることであると感じています。日々の診療は一つの施設内で行われるため、自身の医療知識やスキルを相対的に評価する場面はなかなかありません。今回のDr.’s dilemmaは、非常に限られた領域ではありますが内科医師としての力を他施設の若手医師の皆様と比較する非常に良いチャンスとなりました。この文を読んでいる初期研修医・後期専修医の皆様、自身の力試しと考えて、ぜひ奮って来年以降の本イベントへの参加をご検討ください。



そして、このような貴重な機会をいただくことができましたACP 日本支部の諸先生方に感謝を申し上げ、優勝報告といたします。




Greetings from Dr. Ende (Immediate Past-President of ACP)

Impressions of Japan ACP Chapter Meeting 2018

Jack Ende, MD, MACP, Immediate Past-President, ACP


I was honored early in June to present a plenary talk on Professionalism and the College Update for the ACP Japan Chapter Annual Meeting 2018.  The meeting was a great success.  The topics presented ranged broadly across the practice of internal medicine, medical education, professional development, and, even, physical diagnosis.  What left the greatest impression on me, however, was the theme of the meeting:  “Mind and Arts as Essentials for Internists:  Beyond Evidence and Technology.”

As Meeting Chair, Yugo Shibagaki, MD, FACP, so eloquently wrote in the program guide, “Patients’ needs are not only for medical treatment or cure, they’re also for relief and comfort, sincere attitude and sympathy, and for compassion of doctors and medical staff to listen to their mental as well as physical suffering.”  Dr. Shibagaki continued, “Medical schools tend to teach only skills and knowledge, but not professional or affective attitude or mindfulness.”

What is mindfulness and how does mindfulness relate to practicing internal medicine?

Mindfulness can be defined as the psychological process of bringing one’s attention to experiences occurring in the present moment.  It is a heightened sense of awareness of what is really happening.  In our field, internal medicine, mindfulness is appreciating that a patient is sad or angry or confused – and doing something about these emotions, even if it is merely providing an empathetic comment.  It is appreciating that a patient’s clinical situation is determined by their environment, their relationships, and their lived experiences – and then factoring those social determinants into the treatment plan.  It is also the doctor recognizing within him or herself that, at least at that moment, the stress may be too intense, or the workload too great – and then taking steps to improve those unfavorable conditions.

I also appreciated the message of the program was intended to move us forward, not backward.  This was clear from the subtitle:  “Beyond Evidence and Technology,” calling attention to the word “beyond.”  Mindfulness does not take us back, it moves us forward to a different level – I would say a higher level – of clinical expertise as internists.

The 2018 ACP Japan Chapter meeting was enormously successful, which is not at all surprising given the outstanding commitment and energy of the Chapter’s leadership, members and staff.  The program demonstrated just how enriching medical practice can be, particularly when that practice goes beyond evidence and technology.  I am grateful to have been part of the meeting.

Greetings from Dr. Muruganathan (Governor of ACP India Chapter)


Date: June 9th, 2018

Dear Brothers and Sisters, Greetings!

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

Kurokawa Prize in Student

Toshiro Goto, senior medical student

Tokai University

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.

Kurokawa Prize in Early Career Physician

Section: Recipient’s Remarks

Kiyoshi Shikino, MD

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.

Poster_ACP Japan 2018_Shikino


ACP日本支部2018年次総会 黒川賞(若手医師部門)を受賞して

千葉大学医学部附属病院 総合診療科の鋪野 紀好先生から、ACP日本支部2018年次総会 黒川賞(若手医師部門)受賞の報告を頂きましたので、PRC委員会から広報いたします。(PRC 宮内隆政)


ACP日本支部2018年次総会 黒川賞(若手医師部門)を受賞して

千葉大学医学部附属病院 総合診療科

鋪野 紀好

この度は、ACP日本支部2018年次総会で黒川賞を頂き、大変光栄です。2018年度から”Best Abstract”は「黒川賞」に変更となり、最初に黒川賞を受賞できたことを大変名誉に思います。


今回研究を行うきっかけとなったのは、眼底鏡診察を、自信を持って実施できる内科医は少ないと感じたことである。自分の周りも見回しても、我が師匠である生坂先生を除いて、眼底鏡を実際の診療で積極的に活用している医師はほとんどいなかった。共同研究者である菊川誠先生(九州大学大学院医学研究院 医学教育学講座)が発表されているが、初期研修医、内科専攻医、内科指導医のいずれも、約90%は眼底鏡を利用していないまたは2、3ヵ月に1回の使用頻度とされる。その理由としては、眼底鏡診察が苦手というのがほとんどの理由であった。



研究の転機となったのは2017年3月のスタンフォード大学医学部内科への視察であった。そこで、エロル・オズダルガ医師と出会い、眼底鏡の教育にiExaminer systemを用いた教育手法について学んだ。彼とは、この教育手法を日本に持ち帰り実践したいこと、また教育効果についてリサーチしたいことを語りあい、快く承認してくれた。


まず、このiExaminer systemを用いて実際の教育を行ったところ、学生からの満足度は高く、今後の臨床実習でも積極的に使っていきたいという声が相次いだ。次に、本当にスキルが向上するかを確認するために、本学のシミュレーションセンターである、クリニカル・スキルズ・センターへ眼底鏡シミュレータの協力を仰いだ。教育の前後で評価することで、教育効果を明確にするためだ。題材は何にするか、問題数はいくつにするかなど、共同研究者とのやり取りは白熱した。特に今回の研究は「観察力」の評価だったので、そこに「解釈力」の評価が混入しないように腐心した。また、教員による教育効果は二重盲検化がデザイン的に困難であったため、最小限にするための工夫を行った。


今回の研究では、iExaminer systemを用いることで、眼底鏡診察の診断精度が向上し、かつ観察時間が短縮されることが示された。iExaminer systemは約8000円のアダプターと、今日だれもが携帯しているiPhoneさえあれば、フリーで利用できるため明日からでも実施可能である。この教育手法が広まることで、自信を持って眼底を診察できる医師が1人でも増えることを祈ってやまない。

Poster_ACP Japan 2018_Shikino



写真:右からBA Muruganathan先生、Jack Ende先生、筆者、黒川 清先生

写真:応援に駆けつけてくださった千葉大学医学部附属病院 総合診療科 メンバーと

Chapter Business Report 2017-2018: SPC

Scientific Program Committee

Chair; Yugo Shibagaki,  MD, FACP


Agenda 1  Organization 2017-18


Chair:  Yugo Shibagaki

Vice-chair:  Teruhisa Azuma, Sugihiro Hamaguchi


Masako Utsunomiya, Shungo Yamamoto, Yasuhiro Akai, Tsuguru Hatta

Hideaki Shimizu, Mikio Hayashi, Shunpei Yoshino, Sho Fukuoka, Atsuko Uehara

and Noriaki Kurita


Agenda 2   Chapter Business Report: June 2017 – Present (June 2018)

– ACP Japan Chapter Annual Meeting 2017 (

Last year, we held the ACP Japan Chapter Annual Meeting 2017 at the Kyoto University Clock Tower Centennial Hall and the Kyoto University International Innovation Center on June 10th and 11th, 2017. Since we expanded the venues (rooms) for the session, we could accommodate as many as 32 sessions (didactic sessions, workshops), 8 luncheon seminars, special sessions (Plenary session, Governor’s address, Dr’s Dilemma and ACP update), a poster session with almost 100 abstracts with best poster presentation on the following day, so we kept the number of the sessions which increased significantly every year since 2013. The Doctor’s Dilemma (Medical quiz session) attracted many contestants from hospitals all over Japan which ended with a much success and the some of the winners were selected as the members representing ACP Japan Chapter and just participated and did their best in the Doctor’s Dilemma held in Internal Medicine 2018 held in May, 2018 in New Orleans. The poster discussion was a very lively session with many participants with full of discussions. Three presenters with each representative of students, residents and young physicians were awarded and had a chance to give a presentation in the main hall the next day, applied to the Internal Medicine Meeting 2018 and seemed to get motivated by this wonderful experience. We had the immediate past president, Dr. Nitin Damle, who provided the educational talk at the plenary session and ACP update.

Agenda 3     Chapter Business Plan:

– Organizing the Annual Meeting 2018 of the ACP Japan Chapter (

On June 2nd and 3rd, 2018, we will organize the Annual Meeting 2018 of the ACP JC in Kyoto. Beginning last year, Kyoto University International Innovation Center was added to the venue of the Meeting as well as Kyoto University Clock Tower Centennial Hall to accommodate more attractive sessions and lectures. In fact, this year we accommodate 45 sessions with special sessions

The theme of the Meeting this year is “Mind & Arts as Essentials for Internists: Beyond Evidence and Technology”. We will address this very important issue in the plenary session, following the keynote lecture from the immediate past president of ACP, Dr. Jack Ende, with experienced physicians who practice medicine with mindfulness as guest speakers, discussing how we can raise the mindful care as well as technical part of medicine in the era of super-aging society with the frail elderly. In addition, we will offer sessions like Dr’s Dilemma (an inter-institutional Quiz tournament by teams of residents), the poster-discussion session, as well as the special talk by Dr. Jack Ende. This time, we also invite Dr. Muruganathan from India chapter of ACP to enhance the partnership with Asian chapters.


– Organizing the Annual Meeting 2019 of the ACP Japan Chapter

We are planning to hold ACP JC 2019 on June 1st and 2nd in Kyoto with the same venue as this year.