The 5th RFC seminar – Deep Dive into Cardiology –

Tomohiro Hirai (Mie University)

Yoshito Nishimura M.D., Ph.D. (Department of General Medicine, Okayama University Hospital)

I believe every one of you might have felt cardiology is difficult to learn. In the 5th Resident-Fellow Committee (RFC) Seminar on November 10, is a solution for those people.

The RFC Seminar is held up to twice a year. In the seminars, we invite internal medicine subspecialists as well as doing a brief “Dr’s Dilemma” like session to disseminate the high-tiered, essential internal medicine skills to medical students and residents. Through the seminars, we aim to get them together to strengthen the community of ACP as well. The 5th RFC Seminar was held in Nihonbashi, Tokyo. The guest lecturers were Dr. Akio Kawamura, Professor and Director of Department of Cardiology, International University of Health and Welfare, and Dr. Atsushi Mizuno from Cardiovascular Center of St. Luke’s International Hospital. Approximately 30 participants gathered Tokyo for the seminar.

In the lecture of Dr. Kawamura, he showed us his career path as a cardiologist as well as his view on medical education and treatment of patent foramen ovale (PFO). He also briefly summarized the clinical implication and rationale to treat PFO, which was meaningful to generalists as well.

Dr. Mizuno organized a session in a group-work style to let participants learn “how to manage heart failure and its complications”. Through the session, participants acquired skills of initial managements, differential diagnosis and clinical management. All the participants apparently enjoyed his session.

Lastly in the afternoon, the RFC committee presented a small Dr’s Dilemma-like session. Not only the participants solved the quizzes, Dr. Mizuno also added clinical implications and reality in the frontline clinical field to every question and answer. We are sure that this was the way to get the most from clinical quizzes.

RFC plan to continue seminars like this. Through the seminars, annual meetings and so on, we hope to contribute to the further development of ACP Japan Chapter as well as the field of Internal Medicine in Japan.

Report my experience in the externship at the Department of Hospital Medicine in Shands Hospital, UF Health

Tokyo Bay Urayasu Ichikawa Medical Center General Internal Medicine Resident

Shuhei Uchiyama

I am honored to report my experience in the externship at the Department of Hospital Medicine in Shands Hospital, UF Health, a program by the International Exchange Program Committee of ACP Japan Chapter.

I applied to this program because I would like to be a resident in the U.S., and to become a specialist in hospital medicine in the future. Since the field is not yet common in Japan, I thought that I would be able to gain a lot of experience that could not be obtained in my country. Consequently, my guess was correct.

I observed two branches of the division; the floor team and the consultation team. The floor team basically takes care of inpatients who have multiple health problems not limited to one organ. In my hospital, I usually work as a general internal medicine doctor, and I noticed that there is not such a big difference in terms of work content and treatment strategy between U.S. and Japan. I was pleased to know that the clinical skills that I have gained in my workplace are as good as the ones residents of one of the best teaching hospitals in the U.S. can learn.

The consultation team consists of a resident and an attending doctor. They accept consultations from other departments and procedures including thoracentesis, paracentesis, lumbar puncture, and so on. The main cases of referrals are co-management of patients in surgery divisions. For example, we get many patients from orthopedics with comorbidities such as hypertension, diabetes, and heart failure. The cooperation between each department to treat patients was quite impressive.

Since this unique consultation system is the biggest reason for me to become a hospitalist in the U.S., I was happy to have the chance to observe their work. Though the system is not prevalent in my country, I am convinced that it is beneficial to both patients and doctors in other departments because surgeons do not have to take care of those problems and can concentrate on their specialties, and patients are treated by specialists of internal medicine. In the future, I would like to learn about this culture and bring it back to my country to make the Japanese healthcare system better.

Not only was it an excellent chance to learn about medicine in America, but it was also such a great opportunity for me in terms of my future carrier as a resident. Doctor Kattan, the attending doctor, was so generous that he allowed me to see patients and make presentations on each round. Although it was a short externship, I felt that I made a significant improvement in my clinical skills through this experience. I believe that it was achieved by reflecting on the attending doctor’s evaluation and advice about my assessments, plans, and presentations every day. He also asked me a lot of clinical questions related to patients during rounds, which revealed that I need to be more familiar with a wide variety of diseases, treatments, etc. I also realized that it was vital for me to acquire his ability to educate residents and medical students in the future.

Through this externship, my determination of becoming a hospitalist has only gotten deeper. I strongly recommend this program to those who wish to work in the United States.

Finally, I would like to express my heartfelt gratitude to the attending doctors who gave us the chance to join the externship, doctors in IECP of ACP Japan Chapter including Dr. Maliishi, and Dr. Stein who kindly and wholly helped me before and during my stay in Gainesville, Florida.

My externship experience at Division of Nephrology, University of Florida

Yoshitsugu Obi, MD, PhD, FJIM, FASN

Advisor, Obi Clinic

I am a PGY-16 board-certified nephrologist and have done my clinical and epidemiological research at University of California Irvine between 2014-2018. While studying there, I have become intrigued with the US clinical practice, which I was not able to get familiar with just reading articles or analyzing data. I do need to do clinical practice by myself for this purpose, and I started preparing to become a US-certified physician even though it may seem ridiculous to start over my career at the age of 40’s. Therefore, it was very fortunate for me to obtain an opportunity for the 3-week externship at Division of Nephrology, University of Florida (UF). I learned a lot there, but here I would like to briefly summarize some of the most impressive experience.

Figure 1. South tower view from North tower

UF Shands hospital is a huge hospital with more than 800 beds (Figure 1), and health care is provided across four buildings including its associated Veterans Affairs medical center. The nephrology team divides into several groups into those physicians who cover the general wards and ICU, those who cover ER and the chronic care hospital, and those who cover kidney transplantation. Nephrology fellows rotate these locations throughout their training period. At Shands hospital, the primary care providers for inpatients are hospitalists and/or surgeons, and the main role of the nephrology team is consultation where they suggest treatment advice and provide dialysis treatments. They take care mainly of dialysis patients admitted for complications and those inpatients suffering from acute kidney injury and/or electrolyte abnormalities. Fellows see patients early in the morning and then meet the attending physicians to discuss treatment options. They start ward round after electric medical record review, which is very similar to what I have done in Japan.

One of the biggest differences to Japan was the socioeconomic backgrounds of patients. There were quite a few young patients with alcoholic cirrhosis complicated by hepatorenal syndrome and those IV drug users with infectious endocarditis complicated by acute kidney injury. I often encountered hemodialysis patients coming into ER for fluid overload after skipping their last treatment session for a variety of reasons. Also, I recall meeting an undocumented and uninsured immigrant patient with ESRD who presented to the ER in the middle of the night after driving all the way from Orlando, where he had been receiving regular hemodialysis care for many years, in the hopes of receiving a kidney transplant. Shands hospital, like most hospitals in the US, face challenges of taking care of uninsured and undocumented patients with chronic comorbidities such as CKD and heart failure. Some states, such as California and Illinois, are able to offer kidney transplantation to select undocumented ESRD patients, mainly because it is less costly than continuing regular hemodialysis. Nevertheless, I was deeply impressed to see that the nephrology physicians always made every effort to listen to patients, feel for them, and respect their will regardless of their social backgrounds.

Dr. Tantravahi

Dr. Ali

Figure 2.  


I had been just certified by ECFMG when I started this externship, and now I am preparing to start my career as a physician in the US. Therefore, it was a highly valuable opportunity for me to observe real clinical practice at UF Shands hospital before I work as a nephrology fellow. I greatly thank the nephrology attendings Dr. Tantravahi and Dr. Ali (Figure 2) who gave me flexible learning opportunities and taught me US medicine through discussions during their busy working time. I also thank Dr. Mark Segal, the Chief of Nephrology, and all the staff including Kayla; they welcomed me with warm hospitality although I was a total stranger to them. My special thanks go to Dr. Gerald Stein and ACP Japan Chapter for providing such a unique program. My experience at UF Shands hospital will definitely help me pursue my ambition to become a physician-scientist in the US, and I will strive to make my best effort to achieve my goal.

Memories of ACP Japan Chapter Meeting June 8-9, 2019’ Kyoto Japan

Dr. Anuj Maheshwari, MD, FICP, FACE, FACP, FRCP (London, Edinburgh)
Professor & Head in General Medicine, BBD University, Lucknow, India
Organising Secretary, Annual Congress of ACP-India Chapter “Medicine 2018” at Lucknow

It has been my first visit to Japan. I had heard lot of good things about this country but found it much better than of my imagination. It has really been a wonderful experience for me and my family. It has been an excellent hospitality with flawless arrangements from beginning to the end. First of all, I shall like to pay my gratitude to our India Chapter Governor Dr Muruganathan who recommended and given me opportunity to represent India Chapter during annual conference of Japan Chapter. At the same time I can never forget to pay sincere thanks from core of my heart to Dr. Takahiko Tsutsumi and Dr. Tetsuya Makiishi who were our guest speakers in annual conference of ACP-India Chapter 2018 at Lucknow. Not only their deliberations were outstanding here in India but they must had praised us well there in Japan. After receiving a lovely invitation by Dr. Sugihiro Hamaguchi, chair Scientific program committee, ACP Japan Chapter, Dr. Yuka Kitano helped me in understanding the learning objectives of physicians in Japan regarding Diabetes. For me It was really seeming tough to keep audience attentive for one hour of my lecture. Yuka not only encouraged me but also helped me in deciding content to be included in my presentation which can create interest in Japanese audience. Evening before, I got an opportunity to see and pay my gratitude to Governor Japan chapter outgoing and incoming both together with Robert M. McLean, the President of the American College of Physicians (ACP) elected in 2019 with his wife.

As I have been given the topic to speak on treatment options, I tried to focus my talk on common factor between two populations, India & Japan. Although diabetes prevalence is increasing in both the countries, but faster is the progression in India for conspicuous reasons like carbohydrate rich diet, sudden affluence and luxury lifestyle with lack of physical activity. All this has happened in last 20-30 years which has changed typical Asian phenotype in India to overweight and obesity making Indians more prone to diabetes in lack of physical activity. In addition to these reasons our large population is also responsible for ten times more number of diabetic patients. In Japan 7.2 millions are suffering with diabetes while this number is 72 million in India second highest in the world next to China. Diabetes prevalence in Japan is 7.7 % while it is 8.8% in India.

If we really talk about common factors, typical Asian phenotype is actually a common characteristic between people of India and Japan. This typical Asian phenotype is characterised with accumulation of visceral fat with lean phenotype in extremities. Healthy Food habits and good amount of physical activities in Japan keeps away abdominal obesity and insulin resistance at large while in India same phenotype has progressed to abdominal obesity and Insulin resistance causing type 2 diabetes. What I noticed in ten days visit to Japan, plants & vegetables are used in good amount with food but with much less oil and fat contrary to India. Lot of lessons are there for Indians in Japanese life style.

Glucose control in diabetes deteriorates over time with the progressive nature of disease resulting in risk of developing various micro and macro vascular complications. Many classes of anti-diabetic drugs are available for treatment including metformin, sulfonylureas, glitazones, glinides, α glucosidase inhibitors and nearly a century old insulin. Newer drugs like gliptins (DPP-4 inhibitors), GLP1 agonist, flozins (SGLT-2 inhibitors) and insulin analogues have been added to the list during the last few years. These drugs effectively address various pathophysiological defects. However, given the need for multiple drug therapy, there is still a significant unmet need in the management of T2DM. Non-insulin antidiabetic agents have a potential to reduce HbA1c by an average of 1% and the simultaneous use of combination therapy can result in greater HbA1c reduction. Position statement on Standard of Care by ADA, recommends metformin as preferred initial pharmacological agent. Though we Asians do not match exactly with Americans, we need different recommendations to treat diabetes as we are not only different genetically but environmental factors, body habitus are also different.

A lot of questions had arisen out of these recommendations from audience citing Japanese are not usually obese or overweight then why is it necessary to begin treatment with metformin? It is true that Japanese may have many genes susceptible to diabetes including thrifty genes. Various environmental factors, added to these genetic factors, are considered responsible for the onset of disease, and the number of patients is increasing rapidly reflecting recent lifestyle changes. Impaired insulin secretion is characterized by lowered glucose responsiveness. In particular, the decrease in postprandial-phase secretion is an essential pathophysiological condition. Glucolipotoxicity, if left untreated, results in the decrease in the functional pancreatic cell mass. So it is not only an issue to improve insulin sensitivity. Metformin facilitates peripheral utilisation of glucose and equally beneficial in Insulin deficient type 2 diabetes mellitus. Although it may have some concerns for Indians as many of them are vegetarian having Vitamin B12 deficiency causing anaemia but not in Japanese. So it is appropriate selection of pharmaceutical agent which has immense importance. Now further recommendations should continue as follows:

  • If metformin monotherapy at highest tolerated dose does not achieve the optimum level, a second oral or injectable agent should be added.
  • Choice of the second pharmaceutical agent should be a based on environmental factors influencing therapeutic response.

Apart from this AACE suggests to start with dual drug therapy if HbA1c is 7.5 or more. If HbA1c is 9 or more at beginning, triple therapy is recommended to start with. If patient is symptomatic at 9 or more HbA1c, insulin should be a part of triple therapy.

Queries came from audiences regarding relevance of using pharmaceutical agents with weight loss potential in Japanese population like GLP1RA & SGLT-2 Inhibitors. A convincing explanation lies in visceral fat causing abdominal obesity giving rise a peculiar Asian phenotype. SGLT2 inhibitors act on the non-classical pathway and reduce hyperglycaemia by inhibiting renal reabsorption of glucose and thereby increasing urinary glucose excretion.  They also lead mild reduction in blood pressure due to chronic osmotic diuresis and associated with lower risk of hypoglycemia.

SGLT-2 Inhibitors can only be justified if a person is having significant amount of visceral fat reducing insulin sensitivity. It also promotes usage of alternative fuels like fat for production of energy. As far as GLP-1RA is concerned, they increase insulin secretion in response to oral glucose ingestion, induce satiety by slowing gastric emptying, suppresses appetite, inhibit glucagon secretion and also have been proposed to cause ß cell regeneration. Endogenous GLP1 released from intestinal L cells has a short half-life of 4 – 11 min. To overcome this, GLP1 analogues resistant to degradation by DPP4 have been devised. Low dose usage can be safely done for Japanese population with central adiposity.

Later I got an opportunity to judge selected research papers for oral presentations by students, residents, Fellows & early career physicians. One of the most stimulating session with high class research had made it more challenging to decide the best. All research papers and presentations were so good that it was difficult to select one for “Kurokawa Prize”.

Then I got a chance to attend few plenary sessions which were in Japanese language but I am thankful of my interpreter Mr. Hideta Teshirogi who is pursuing his medical studies there. He has been so wonderfully translated all sessions on the spot sitting aside me. I appreciate his knowledge and translation power so fast. My medico daughter Shivangi who is also pursuing medical studies in India enjoyed all English sessions and Kurokawa Prize session.

Overall it has been a wonderful academic feast for me and my family at one of the most beautiful city of world Kyoto. We attended welcome dinner in evening with all attendees and faculties. Next day enjoyed sightseeing at Arashiyama before leaving back home India. It has been an unforgettable experience while being at Japan. I wish to thanks all members of organizing team and Governor Japan Chapter Dr. Kenji Maeda for great conference with wonderful hospitality. We shall surely try our best to reciprocate when Dr. Kenji Maeda comes India for our annual conference at Kolkata. We can plan many joint ventures together including Asia specific guidelines in future.

ACP Japan Chapter Meeting June 8-9 2019’ Kyoto Japan

President of the American College of Physicians

Robert McLean, MD, FACP

I was honored to have the opportunity to participate in the ACP Japan chapter meeting in early June. Chapter governor Dr. Kenji Maeda and the rest of his chapter leaders were wonderful hosts. It was very interesting to hear firsthand from many chapter members about the Japan healthcare system and especially the medical education and training system. I enjoyed the opportunity to speak on the topic and discuss how the current changes in the Japanese training and board certification processes will be very helpful to ensure that internal medicine specialists who choose to enter general primary care practice will have adequate training to deliver high-quality care to patients.

I also had the opportunity to give a brief update on activities of the American College of Physicians and review how Global Engagement and the role of international chapters continues to grow. The Japan Chapter was ACP’s first international chapter and remains a role model for how to grow and develop. I also gave a talk on the ACP’s guideline development process, using the Gout Clinical Practice Guidelines as an example. I explained how different guideline processes between various organizations lead to slightly different conclusions and recommendations. Some in the media tends to report these as controversies, when in reality they merely reflect different processes and the lack of definitive evidence to answer many of the clinical questions we face on a daily basis.

I greatly enjoyed the opportunity to tour the beautiful historic city of Kyoto and learn much about Japanese history and culture there. Following several days in Kyoto, I had the opportunity to travel to Tokyo and similarly tour and learn a great deal while spending several days there before returning home to Connecticut. After such a wonderful experience, I clearly intend to return to Japan! I thank all the Chapter members with whom I had the chance to interact.



The road to an FACP – Why do we aim for it? –

The road to an FACP – Why do we aim for it? –

(Health and Public Policy Committee (HPPC) project)

Kichijoji Asahi Hospital, Internal Medicine

Yuhta Oyama, MD, FJSIM, FACP

On the second day of ACP Japan Branch Annual Meeting 2019, the afternoon of June 9, we held a session with the above title as a project of HPPC. There are 337 FACPs, 6 MACPs and 1 Honorary Fellow as of December 18, 2018 in the ACP Japan branch. By listening to the reason why they aimed at Fellow, how they changed their daily work by becoming Fellow, and how they would like to act as Fellow in the future, we hope more member aim to FACP.

We had conducted a similar session at the annual meeting last year, and in this project, we also conducted a preliminary questionnaire on acp-exchange etc. We ask FACP and MACP about the process of becoming FACP/MACP and the change after that, etc., we ask Members about the image of FACP and whether or not they are aiming, and how they think they would change by becoming a FACP.

In the session, after explaining the purpose first, we presented the results of the preliminary questionnaire. Based on the results, valuable comments were received from Dr. Kenji Maeda, the current Governor of the Japan Chapter, Dr. Fumiaki Ueno, the former Governor of the Japan Chapter, and Dr. Noriko Yamamoto, chair of the Women’s Committee. As a result, a more meaningful message was delivered to everyone who participated, as well as to HPPC members. We would like to deeply thanks to the three commentators for taking part in this session despite the busy period. There are various motives when becoming a Member or Fellow, but being a Fellow gives them a mental motivation such as pride, confidence, and a sense of responsibility that seems important to continue the profession of a doctor.

After that, participants, commentators, and HPPC members joined to form three small groups, and group discussion were conducted along the theme. Participants exchanged their opinions easily, and active conversations were held in all groups. Finally, we made a summary and ended this session.

Members who participated in the session could hear the story from Fellow in the group discussion, so they would have thought of becoming a Fellow. Thank you very much for all the participants who have been listening diligently. It is hoped that more people aim for Fellow with this project as opportunity, but eventually it is the hope of us that ACP Japan chapter members will be more by repeated such projects.

Contemplate the Healthcare Reform

Report from Women’s Committee 2019 June、2019

Chair; Noriko Yamamoto, MD FACP(President of Yamamoto Clinic)

Contemplate the Healthcare Reform.     9 June,2019 AM11:55-14:00

Women’s Committee;

Chair; Noriko Yamamoto, MD FACP

Co-Chair; Noriko Kawashima, MD FACP

Member; Keiko Arai, MD FACP, Yuko Morishima, MD FACP, Eri Matsumoto, MD Ayako Miki, MD


1, Become the best hospital many doctors would like to work at.

NPO Corporation Director Dr.Toshiko Takino, MD

2, How the maternity leave system works in the US and how to keep work-life Balance?

Sapporo Tokusyuukai Hospital Dr. Shadia Constantine, MD FACP

3, Diversity management of the Palliative care Division at Iizuka Hospital.

Iizuka Hospital Palliative care Division Director Dr. Hideyuki Kashiwagi MD

4, The approach at Tokyo Women’s Medical School, Now and then, in future. From medical education to re-training as physician after any leave.

Tokyo Women’s Medical School Center of the Adult Diseases. Professor Dr. Noako Iwasaki, MD

5, Career Support multiply Patients Safety equal Work style Reform to have approached For 12 years at Okayama University medical school.

Okayama University medical school Professor Dr. Hitomi Kataoka.MD


First speaker Dr. Takino has the corporation E-J net to measure the functions to work comfortably in the hospitals for female physicians. That is called HOPIRATE by Dr. Takino. She told why she has begun this program, she was a physician of gastroenterology and almost got burn-out when she was working the hospital by fulltime back in her days.  She said recently young doctors has been changing to make much of work-life balance and female doctors make things of their personal life , they don’t take care of the patients around time of their return. Other male doctors compensate the patients care after female doctors left and they must work till late hour. The male doctors feel nuisance for that and think female doctors make trouble but are not useful. So HOPIRATE has changed the marks for measurement about working with high motivation not only the conditions of work place with childcare facilities, short time working. The hospital where female doctors are working cheerfully will gather good nurses and office workers and they get more fixed at the hospital, increase the number of patients, they will get more incomes and be happy.

Next speaker is Dr. Shadia Constantine. She was graduated from medical school of Panama and got her residency at US. She has come to Japan as the teaching stuff of the medical education and has three young kids. She told about the maternity leave system in the US. Most of all female physicians can take the maternity leave for about 8weeks. She is working as a teaching physician in Japan and learning at Oxford University.

Third speaker Dr. Hideyuki Kashiwagi has a certified MBA and qualification of social welfare. He affirmed not to admit the stereotype for previous winner. He declare the vision and mission of their division and he and his subordinates pursue to achieve them. He always try to get his subordinates engagement, stimulate their mindsets, share their Why thing. He gave the example the Mikoshi model, Mikoshi is portable shrine. 5 people keep to shoulder the Mikoshi and 2 people come to join, 7 people carry the Mikoshi comfortably but then they feel heavy strangely, 2 person hang the Mikoshi and load them. He told to start conducting easy issues he could do although they have many tough issues.

Fourth speaker Dr. Naoko Iwasaki is Professor of the Tokyo women’s medical school. Tokyo women’s medical school is very unique because the only female students study to become doctors and they perform to educate to become good female doctors and live their lives as doctors. They continue to educate their students why they want to become doctors, they must keep working as physicians. They have had some surveys for alumni association what you are doing. They especially told young female students must have the motivations to become good doctors. Also they perform the work-style reform to go back home at 18 o’clock.

Last speaker is Professor Dr. Hitomi Kataoka. She has a 2 years old baby. She has been working the MUSCAT career center at Okayama University medical school for 12 years. In rural area in Japan the numbers of doctors is running short, in city area especially Tokyo area the numbers of doctors is too much.  She think the working doctors now in Okayama don’t quit and keep working with any personal conditions. Most of all doctors think they must work for their local patients because local medical care will collapse if they would quit to work. She told we have to balance between doctor’s well-being and local medical care continuity. They need the supports from their family, comprehension from co-workers. She told when female doctors is increasing in the hospital the female doctors got to have more motivation for upper titles of academic societies.

We held this long time symposium for about 130 minutes, but I didn’t feel too long. 5 doctors talked different issue from various viewpoints. I felt they all talked we need to change our perception for our well-being and social rules. Generation X and young generations have different wishes and lifestyles. But we will avoid to collapse the local medical care, Dr. Iwasaki and Dr. Kataoka have been working for medical education and making mediating center for re-job placement for long time. It would be most difficult and important that we must have been working for long time to change people’s mindset for equity in gender. But now we must take action for this issue with our colleagues and families.

I felt their each efforts are very venerable they have been working on their own identities. But I felt sorry the participants were very small this day. I think young doctors want to go to the educational sessions. They seem to think the work-life reform is not their issues, older peoples like directors and professors must think and perform that for young doctors. I don’t think young doctors don’t need to involve this issue I rather think they must involve this issue for themselves. And work-style reform is not only for female physicians. I think all the physicians must involve and think of this matter and take actions for it. The hospital that female physicians work comfortably and actively will gather good nurses and co-medical staffs and increase the numbers of patients and incomes. And I think the critical point about work-life reform is Patients First. I think we don’t forget we are working for the patients, not only to increase our medical knowledges and practices for ourselves. We must have the balance between personal life and work. But that will not always keep same balance. Sometimes doctors will make a thing of the work as physician but another time they will make a thing of the personal life. This seems long time challenges. But I think at this matter the important thing is physician’s Professionalism. I think we physicians must keep going upon the Professionalism. And we have to keep up with fast pace of daily life and receive the diversity, I think we have to change the mindset and stereotype about gender .That would be much more challenges.

Finally I would like to thank you for the 5 speakers. And I appreciate to Dr. Noriko Kawashima she designed this symposium and I admire her intelligence and networks. The members of our committee had meetings for respective charge and conducted their own ideas. I am very proud of them and appreciated.

A report of the seminar; “Is there a doctor on board?”

A report of the seminar; “Is there a doctor on board?” at the annual conference of American College of Physicians, Japan Chapter

GIM, Saitama Medical University Hospital

Yuji Yamada, M.D.

We held a seminar, the title of which was “Is there a doctor on board? -to be a physician who can confidently raise a hand to help in-flight medical emergencies” at the annual conference of American College of Physicians, Japan Chapter, Kyoto, Japan. Our initial plan was to create a seminar which can help participants improve their English communication skills. Through our discussion we found in-flight medical emergencies are not well recognized in Japan and decided to focus on this in our seminar.

The number of annual commercial airline passengers exceeded 4 billion for the first time in 2017 according to the report from International Air Transport Association (IATA) and it is expected to increase further. More than 5,000 aircrafts fly at an altitude of 30,000 feet at any given time and ten million people spend several hours daily on the plane. Here comes the problem: In-Flight Medical Emergencies (IMEs).

The estimated prevalence of IMEs is approximately 1 in 600 flights, meaning 1,000 IMEs occur somewhere in the sky every day. As a result, it is becoming inevitable to encounter some kind of IMEs when we take a flight. Therefore, learning and preparing for IMEs are essential for us physicians. The main purpose of this seminar was to provide basic knowledge and important skills to better cope with them.

On the day of this seminar more than 50 participants gathered early in the morning. After quick icebreaking activities, we started the session with a short play. Dr. Makiishi, who belonged to a drama club, played a role of a physician passenger. Dr. Tsutsumi became a passenger from Singapore, who developed syncope in the aircraft. Ms. Komazaki, who is a former cabin attendant, played a cabin attendant role very naturally. Their impressive performance instantly grabbed audience’s heart and greatly helped them understand the concept of IMEs. Lectures were also given in-between the performance, regarding 1) common presentations and proper management of IMEs based on up-to-date medical literatures, 2) tips of history taking in English, and 3) introduction of cabin attendants’ role in IMEs and emergency medical kits available on airplanes. I believe the lectures given not only by a physician but also by a cabin attendant made the understanding of audience even deeper.

It is essential to learn and prepare for IMEs in advance to care sick passengers efficiently since the condition in airplanes is quite unusual. However, in reality, there are not many workshops or seminars available in Japan. We hope this seminar was a great opportunity for audience to recognize the importance of preparation for IMEs and also a great start to expand this type of activities in the future.

Governor’s Message

Message from the new Governor

After appointed to the post of governor, I was taken by surprise to know that governors have wide range of missions and now I’m feeling heavy responsibilities. However, as the three great predecessors, Drs. Kiyoshi Kurokawa, Shotai Kobayashi and Fumiaki Ueno, had set the right track, I believe that all I have to do is to go forward on the same track.

It has been 23 years since I became a member of ACP. Time flies! In those days, I was a co-chair of a committee of the Association of FJSIM (Fellows of Japanese Society of Internal Medicine) to encourage FJSIMs to join ACP, so Japanese Society of Internal Medicine (JSIM) was a close society with us in the beginning. I think ACP Japan Chapter and JSIM should cooperate in the future again because the purpose of the two organizations is the same. The first cooperation of the two entities was realized this year as a joint session for students and residents in the annual meeting of JSIM. I hope we will have chances to cooperate again and I will make efforts to achieve that aim.    

Thank you for everything you do for our chapter and for our profession.

All the best,

Kenji Maeda, MD FACP

Governor, American College of Physicians, Japan Chapter

ACP internal medicine meeting 2019 の様子

2019年度のACP internal medicine meetingが4月11-13日の日程でPhiladelphiaで開催されました。




日本支部はまず最初に昨年に引き続きChapter Excellence Awardを受賞しました。これは本部の指定した一定の基準を満たす活動成果をあげた支部に贈られるもので,他の多くの支部とともに受賞に至りました。

さらにcompetitiveなAwardとして、John Tooker Evergreen Awardがあります。この賞は支部を活性化させるための革新的な活動を評価するもので、今年は25支部から28件の応募がありました。この賞にnominateするだけで高い評価をうけるのですが、大変ハードルが高く、今年応募したのは全支部の3分の1未満です。そうした各支部の自信作がひしめき合う中,日本支部は他の4支部と共にこのEvergreen Award Winnerに選ばれました。海外支部では唯一のものです。

その受賞理由を選考委員会ChairのDr. Michael Tanの文面を引用しお知らせします。
Your submission, “In the Clinic: Japanese Translation Project,”  captures the spirit of innovation that the John Tooker Evergreen Awards Program seeks to recognize.  The Chapter subcommittee felt this was an outstanding initiative that demonstrates a powerful way that ACP international chapters can be active at the local level.  Subcommittee members commended this program
for not only being innovative, but provides member
encouragement, engagement, and recruitment/retention all in one.
This program is a great model for other international chapters.

このプロジェクトを企画提案され、実務を率先して牽引されてきたPublic Relations Committeeの北野夕佳副委員長,グループを見事に統率された大島康雄委員長、原眞純副委員長、当初責任者となられていた安藤聡一郎前委員長(現理事)、そして実際の翻訳作業に携わった熱意溢れるプロジェクトメンバーの先生方に心より感謝いたします。また忘れてならないのは事務局の皆さまのサポートで、特に事務局の作成した応募文は選考委員の心を鷲掴みするような秀逸な内容でした。




ACP日本支部が、In the Clinic 翻訳プロジエクトが認められて、Evergreen Awards授賞しました!翌日のACP新聞に掲載されました。

In the Clinic 翻訳プロジェクト2ndシーズンも近く募集いたしますので是非ご応募ください。

And a happy reunion at Fellowship Convocation Ceremony with my residency classmate and attending from Virginia Mason Medical Center!! 


この”In the Clinic: Japanese Translation Project”は多くの先生方の協力によって成功しました。


In The Clinic翻訳プロジェクトメンバー


・In The Clinic翻訳プロジェクトリーダー、PRC副委員長

聖マリアンナ医科大学 横浜西武病院 救命救急センター          北野 夕佳


ノバルティスファーマ株式会社 安全性・再審査統括部            大島 康雄


帝京大学医学部附属溝口病院 第四内科学講座            原 眞純


・In The Clinic翻訳プロジェクト補佐

明石医療センター総合内科              官澤洋平



東京女子医科大学 総合診療科      川名正敏

力田病院 内科  小野広一

西伊豆健育会病院 内科  西村光滋

あらまき内科クリニック  荒牧昌信

川田内科医院      川田秀一

きたじま田岡病院/徳島大学          板東浩

筑波大学医学医療系 呼吸器内科    森島祐子

平野内科クリニック          平野昌也

産業医科大学病院 感染制御部        鈴木克典

国立国際医療研究センター国府台病院 呼吸器内科  大藤貴

なかたクリニック 院長    中田壮一

医療法人アリエス まみ内科クリニック 院長              宮地真由美

札幌東徳洲会病院 総合診療部        安尾和裕

相澤病院 総合内科            山本智清

東京医科歯科大学初期研修医          大竹眞央



大阪赤十字病院 第一消化器内科部長、消化器内科統括部長  大崎往夫

やまと在宅診療所大崎 院長          大蔵暢

東京ベイ浦安市川医療センター 総合内科    平岡栄治

東京女子医科大学総合診療科・循環器内科  川名正敏

帝京大学医学部附属溝口病院 神経内科        馬場泰尚

帝京大学医学部内科学講座 消化器内科      山本貴嗣





水戸協同病院     小林 裕幸、児玉 泰介、児玉 祐希子、内田 卓郎、伊藤 慶、橋本 恵太郎、片山 真穂

東京都立多摩総合医療センター       島田 薫



熊本大学             松井 邦彦、谷口 純一、田宮 貞宏、佐土原 道人、小山 耕太、前田 幸祐


神戸大学             森 寛行、乙井 一典、森 健太

加古川中央市民病院         金澤 健司



聖路加国際病院 感染症科             松尾 貴公

聖路加国際病院 内科      木下 雄仁、金 允泰、中村 友昭、西澤 俊紀

神戸赤十字病院 呼吸器内科           杉本 裕史

聖路加国際病院 外科             難波 俊文

千葉大学 心臓血管外科        西織 浩信



東海大学           柳 秀高、沖 将行、峠田 晶子、真鍋 早季、桑野 公輔



名古屋第二赤十字病院総合内科            横江 正道、吉見 祐輔、久田 敦史、末松 篤樹、宮川 慶、竹内 元規、礒田 翔

名古屋医療センター総合内科  安藤 諭



愛媛生協病院         原 穂高、尾﨑 達也、水本 潤希

慈恵大学病院  竹越 大輔



高槻病院 総合内科           筒泉 貴彦、平山 沙織、三木 綾子

明石医療センター 総合内科           官澤洋平、世戸博之、大西 潤、辻本 泰貴、水木真平


東京大学             江頭 正人、泉谷 昌志、林 幹雄、大沢 樹輝、大山 貴司、岡本 耕、後藤 隆之介、千葉 滋



横浜市立大学医学部         太田 光泰、稲森 正彦

神奈川県立足柄上病院     吉江 浩一郎、岩渕 敬介、倉上 優一、安田 優

横浜保土ケ谷中央病院      八百 壮大


・QC担当 慶応大学チーム

慶應義塾大学医学部漢方医学センター      吉野 鉄大

横浜市立大学医学部血液・免疫・感染症内科      加藤 英明

慶應義塾大学医学部血液内科        住谷 智恵子

慶應義塾大学医学部精神神経科、東京武蔵野病院     山本 玲美子

慶應義塾大学医学部血液内科・永寿総合病院        山口 健太郎

社会医療法人財団 董仙会 恵寿総合病院    二川真子

兵庫県立こども病院         広田幸穂

慶應義塾大学病院             丸山 篤志、栁下 陽香

長野医療生活協同組合 長野中央病院          平野 翔大



聖マリアンナ医科大学横浜市西部病院 薬剤部         中薗 健一、勝 綾香


次回のACP internal medicine meetingは4月23-25日でLos Angelesで行われるそうです。ぜひ、ご参加ください。

(PRC委員 宮内隆政)