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2問は「ワーファリンでINRコントロール不良時の対応」についてでした。最近はDOACが頻用されてきており、ワーファリンの処方機会は減少しつつありますが、まだまだ出会うプロブレムです。抗凝固薬の使い分けなど、明日からの診療に役立つTipsが盛りだくさんでした。

第3問は「多血症の診断」でした。診断のフローチャートを見るような見事な解説と、検査の変化の裏に隠れている新たな疾患に気づかれた経験を伺うことができたのは、Liveの勉強会ならではであったと思います。

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。

今回のMKSAP勉強会も、専門家の視点を交えながらも、非専門家にもわかりやすく、よくある落とし穴を含めた実際のマネジメントで重要になる点を丁寧に解説していただき、日頃の学習へのモチベーションがアップする時間となりました。

RFCでは、今回の勉強会も含め日常の診療をステップアップさせるイベントを開催していきます。加えて海外を目指す方々のプラットフォームを提供していきます。2021年6月26、27日には初めての試みとなるACP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。次回のMKSAP勉強会は、総会終了後8、9月の開催を予定しております。関心のある方は総会企画とあわせて、ぜひご参加ください。

April 25, 2021

ACP日本支部　公式Twitter開始

このたびPRC委員の皆様のお陰で日本支部の公式ツイッターを立ち上げることが出来ました。ご活用いただき、皆様のお役に立てれば幸いです。

－ACP日本支部長　前田賢司

March 23, 2021

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。

今回は「呼吸器・集中治療」領域を題材として、片岡惇先生(練馬光が丘病院・総合救急診療科・集中治療部門)をお招きしました。

1問目・2問目は急性呼吸不全における挿管の適応やARDSの治療方法についてスライドを使用しながら詳しく解説をいただきました。個人的には、これまで治療法の選択肢を選ぶことができてもなぜその治療法が有効なのかは説明できず、難しいと感じておりました。しかし、呼吸生理学や画期的な研究の紹介を交えた簡潔かつ明瞭な解説で、一歩さらに深く理解できました。

3問目は胸水の性状に関する問題でした。日常でよく出会う疾患であるがゆえに普段何気なく診療しがちな領域ですが、一度振り返って定義を見直すとさらに見識を深めることができると実感しました。また、ドレナージの適応および落とし穴についての、実臨床に基づいた解説が印象的でした。

4問目は喘息の重症急性増悪に対する治療法について解説をいただきました。臨床現場での薬剤の使い分けは明日の診療に直結すると感じました。また、関連する話題として喘息の慢性期管理に関する最新の治療にも触れていただき、さらに知識を広げることにつながりました。

最後の問題は急性増悪を繰り返すCOPDの治療についての問題で、一番興味深く感じた点はCOPDに対するICSの有効性と注意点および好酸球数の関連性でした。ICSをどの患者に導入するか、好酸球数や喘息の合併などを考慮しながら決めていく実際の診療過程を垣間見ることができ、非常に有意義でした。

RFCでは、今回の勉強会も含め日常の診療をステップアップさせるイベントを開催していきます。加えて海外を目指す方々のプラットフォームを提供していきます。前回のLetterでもご紹介いたしましたが、2021年6月には初めての試みとなるACP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。

March 7, 2021March 7, 2021

Women’s Committee

American College of Physicians Japan Chapter Interim Report 2020

Women’s Committee

Chair: Noriko Yamamoto MD, FACP

Report: What we have done:

The Women’s Committee has 10 members including 4 male members. We started out with 6 female members from 2017 July. I am pleased to increase the male members. That’s because the female members don’t know how the male physicians feel about something female physicians work and struggle. And when the male members talk about their confusion to attend some problem with female physicians on our mailing list, female members notice their confusion and find their own problems and other obstacles .I think it’s important that such a mutual understanding keep going for long time, moreover the male and female physicians will get to sympathize each other.

Session Plan:

This June we couldn’t hold the annual session of Japan Chapter, we have a plan to hold the session at next annual meeting. We collaborate with the Physician’s Well-Being Team and have a plan to hold the work shop about physician ‘s Burn-out.

Facebook Page

We have the Facebook page. We post the news and articles of ACP and other information, news about gender inequity.

Woman in Medicine Month (September)

We recommended a FACP from women’s members on September, Dr. Naoko Iwasaki MD.

Plan: What we are going to:

We will hold the session about communications at the workplace next meeting. We are making the details of this session concretely. We collaborate with the Physicians Well-Being Team; we might have the workshop about physician’s Burn-out and coaching next year except annual meeting. I want to increase more female FACPs in Japan Chapter. I wish many female physicians will have activities in ACP Japan Chapter vividly, I will recruit some members for Women’s Committee next term.

March 7, 2021

Scientific Program Committee

American College of Physicians Japan Chapter Interim Report 2020

Scientific Program Committee

SPC Chair Sugihiro Hamaguchi

１．Report: What we have done

It is terribly regrettable to report that two major annual events, The ACP Japan Chapter Annual Meeting 2020 and The Joint session with Japanese society of Internal Medicine, were cancelled because of the enormous impact of corona virus disease 2019 pandemic not merely on our preparation procedures for the events but also all participants’ health and lifestyles changes.

The annual meeting 2020 was planned to be held on June 6 and 7, 2020 at Kyoto university and The Joint session with Japanese society of Internal Medicine was on April 11, 2020.

２．Plan: What we are going to do

We are now planning the ACP Japan Chapter Annual Meeting 2021. This will be a complete online meeting and is planned to be held on June 26th and 27th 2021.

There will be one website with several channels (rooms) for participants to enter and each channel has its own characteristics. Using some interesting and useful software, a feasible and enjoyable meeting is being planned.

The annual meeting of Primary Care Research connect (PCR connect) is going to be held on December 19th and 20th, 2020. (https://pcrconnect.org/) PCR connect is an integrated research network among ACP Japan Chapter, Japan Primary Care Association, and Society for Clinical Epidemiology for the enforcement of primary care related research outputs from Japan. It is planned to be held on December 12 and 13, 2020.

March 7, 2021

Student Committee

American College of Physicians Japan Chapter: Interim Report 2020

Student Committee

Chair: Hideta Teshirogi
Vice-Chair: Takeshi Matsushita

Our mission is to facilitate interest and interaction amongst ACP student members, provide an educational experience, and contribute to the further success of ACP Japan Chapter (ACPJC) and its international collaborations.

1.REPORT: What we have done

Recruited 11 new student committee members

We recruited 11 new committee members from 9 medical schools

including a medical school in China. Our new diverse and international members have widened our horizons and brought unique perspectives to our projects.

Survey: Japanese medical students’ view on their future international career

We conducted an online survey to bring to light Japanese medical students’ current thoughts on pursuing an international career in the future. The aim of our survey was to use the results to provide better educational opportunities and much-needed information to medical students. We had 549 participants from 58 universities, covering 70% of Japanese medical schools.

Public relations (Facebook page / Twitter Account)

In an effort to present our work to the public, we have created an ACPJC student committee Twitter account in addition to the Facebook page we already have. We have posted self-introductions of each committee member and meeting reports so that viewers feel closer to our organization. Our Facebook page has reached over 148 follows and 9639 views.

・ACPJC Student Committee Facebook
page: https://www.facebook.com/ACPSCJapan
・ACPJC Student Committee Twitter: https://twitter.com/acpsc_japan

2. PLAN: What we are going to do

Using the data we collected from the survey, we plan to hold seminars that respond to the participants’ needs and wishes. The topics include practicing international standardized medical history taking and learning how to pursue an international career as a Japanese physician. Simultaneously, we will prepare for the ACPJC Annual Meeting’s student session for next year and continue our SNS activities on Facebook and Twitter.

March 7, 2021

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 6^th 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.

March 7, 2021

Local Nominations Committee

American College of Physicians Japan Chapter Interim Report 2020

Local Nominations Committee

Chair: Masao Nagayama
Vice-Chairs: Toshihiko Hata and Takeshi Yanagawa
Members: Mio Ebato, Mikio Hayashi, Yohei Goto, and Yoshihisa Matsumura

Report: What we have done

We nominated Dr. Keijiro Saku, MD, FACP (ACP# 01075550), President of the Fukuoka University, for the mastership, and he was successfully attested by the ACP Awards Committee to be the Master of the ACP (MACP) at the initial application just like Dr. Katsuhiko Takabayashi last year. He is the eighth MACP from Japan following Shunichi Fukuhara, Hiromi Ishibashi, Shotai Kobayashi, Kiyoshi Kurokawa, Katsuhiko Takabayashi, Fumiaki Ueno, and Tsuyoshi Watanabe in alphabetical order.

PLAN: Where we are going to go

– Started preparation of the nominating for the Sakura Award、the Volunteerism Award、the ACP Japan Chapter Contribution Award (ACPJCCA), the ACP Japan Chapter Academic Award (ACPJCAA), and the Mastership nominee.
– Started preparation to launch the new Awards by the ACP Japan Chapter based on the encouragement by the ACP which may include the following awards;
- ACP Japan Chapter Young Leadership Award (ACPJCYLA)
- ACP Japan Chapter Women Leadership Award (ACPJCWLA)
- ACP Japan Chapter Senior Contribution Award (ACPJCSCA)

March 7, 2021

International Exchange Program Committee

American College of Physicians Japan Chapter: Interim Report 2020

International Exchange Program Committee

Chair： Takahiko Tsutsumi
Vice-Chair Yuji Yamada, Mitsuya Katayama

Our mission is to facilitate and promote international exchange opportunities in medical education for members of the ACP Japan Chapter.

Report: What We have done

Online workshop

Because of the worldwide COVID-19 infection, most activities which have been

promoted by IEPC have been limited or postponed indefinitely. To overcome this situation, we have focused on online workshop which cannot be affected by this devastating infection. On October 25th, 2020, IEPC held the online workshop “The first step for U.S. residency/fellowship^ using ZOOM. Total of 78 participants applied to our workshop.

The workshop was consisted of two parts. The first part was lectures performed by 4 physicians, Dr. Jindai, Dr. Nogi, Dr. Yamada, three of whom are IEPC members, and one guest speaker, Dr. Natsumi Tanabe, the current chief resident of University of Hawaii Internal Medicine Residency Program (UHIMRP). Their lectures were focused on the basic information, tips, and updates of residency/fellowship program.

The second part was Question/Answer session. All the questions which were collected from the participants beforehand were answered by the four physicians mentioned above and me, Dr. Tsutsumi. During this session, the function “chat system” were also used simultaneously. Participants can ask questions or comment anything using this chat system which was helpful to make this session interactive. Post-

workshop questionnaire from the participants showed a very positive response.

Plan: Where we are going to

We plan to hold subsequent online seminar which I believe will fit well in the current situation. We are also under negotiation with Dr. Jerald Stein, whose contribution to ACP Japan is well known. We are planning to perform online English oral presentation seminar which will be a great education for young physicians.

March 7, 2021

Health and Public Policy Committee

American College of Physicians Japan Chapter Interim Report 2020

Health and Public Policy Committee

Chair: Hiroshi Ono
Vice-chair: Masato Ito

REPORT: What we have done

Even now, it is still in the corona-era, and face-to-face meetings have not been held since last December. Furthermore, there is a history that ACPJC 2020 was not held this year　unfortunately, and no project has been completed since the committee was reorganized last July. We are currently continuing discussions on the mailing list for the topic mentioned in the PLAN below.

PLAN: What we are going to do

Evaluation and consideration of the integrity of online medical care/telemedicine

In Japan, which has a super-aging society, online medical care/telemedicine has been in the limelight since 1997 in order to solve the uneven distribution of doctors in metropolitan areas and the impaired accessibility to HCFs in rural areas. Since then, in 2018, concerning social issues such as rapidly expanding aging society across Japan, IT progression in this field was accelerated aiming to reduce outpatient visits as a patient factor, and to popularize telemedicine as part of reforming the working style of doctors (unfortunately, which was not noticeably spread at that time).

As the new coronavirus infection (COVID-19), which began in the winter of 2019, is spreading again, the government has been taking the initiative in accelerating to spread of telemedicine using phones and/or computer networks as solution tools for the concerning situation (e.g. getting become difficult for patients to consult doctors directly). Then, this type of medical care is once again in the limelight, and a scheme for its proper operation having been formed now. In response to these global and social movements, we all HPPC members are continuing discussions on the mailing list focusing on this topic.

Generally, telemedicine is conducted between doctors and patients, and it is possible to examine, monitor using some extra-equipment, and explain the diagnostic results of patients not in urgency, but in principle, the first examination must be face-to-face, and prescription can be made after the examination. However, the technology in this field is progressed largely from the IT professional’s view, not from the clinician’s view. Therefore, from the clinician’s standpoint, we are currently discussing the limitation of telemedicine, the practice of EBM, CW/HVC, and the method of establishing professionalism within “Human to Human (H2H)” communications, and we would like to make recommendations from this committee in the future.

American College of Physicians Japan Chapter Interim Report 2020

Women’s Committee

Chair: Noriko Yamamoto MD, FACP

Report: What we have done:

Session Plan:

Facebook Page

Plan: What we are going to:

American College of Physicians Japan Chapter Interim Report 2020

Scientific Program Committee

SPC Chair Sugihiro Hamaguchi

American College of Physicians Japan Chapter: Interim Report 2020

Student Committee

Chair: Hideta Teshirogi Vice-Chair: Takeshi Matsushita

1.REPORT: What we have done

Recruited 11 new student committee members

Survey: Japanese medical students’ view on their future international career

Public relations (Facebook page / Twitter Account)

2. PLAN: What we are going to do

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)】

【Plan (What we are going to do)】

American College of Physicians Japan Chapter Interim Report 2020

Local Nominations Committee

Chair: Masao Nagayama Vice-Chairs: Toshihiko Hata and Takeshi Yanagawa Members: Mio Ebato, Mikio Hayashi, Yohei Goto, and Yoshihisa Matsumura

Report: What we have done

American College of Physicians Japan Chapter: Interim Report 2020

International Exchange Program Committee

Chair： Takahiko Tsutsumi Vice-Chair Yuji Yamada, Mitsuya Katayama

Report: What We have done

Online workshop

Plan: Where we are going to

American College of Physicians Japan Chapter Interim Report 2020

Health and Public Policy Committee

Chair: Hiroshi Ono Vice-chair: Masato Ito

REPORT: What we have done

PLAN: What we are going to do

Evaluation and consideration of the integrity of online medical care/telemedicine

Chair: Hideta Teshirogi
Vice-Chair: Takeshi Matsushita

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

Chair: Masao Nagayama
Vice-Chairs: Toshihiko Hata and Takeshi Yanagawa
Members: Mio Ebato, Mikio Hayashi, Yohei Goto, and Yoshihisa Matsumura

Chair： Takahiko Tsutsumi
Vice-Chair Yuji Yamada, Mitsuya Katayama

Chair: Hiroshi Ono
Vice-chair: Masato Ito