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

 

Chapter Business Report 2017-2018: IEPC

International Exchange Program Committee

Chair: Harumi Gomi MD, MPH, FACP

Report:

What We Accomplished

  • 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.

Seminar Notice

International Exchange Program Committee

ACP Japan Chapter Annual Meeting

Luncheon seminar

Time: 11:40-12:40, Saturday, June 2, 2018

“Why not pursue a global career path?”

Held by International Exchange Program Committee

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。

研究の経緯

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。

自分が眼底診察を教えてみると、なぜ観察が難しいのかに気付いた。それは、学習者と指導者が同じ画面を共有できないことにある。学習者からすれば、今確認しているものが、本当に正しいのかについてフィードバックを受けられず、確証が得られない。また指導医も、なぜ確認できていないのかを指摘するのは至極難しい。そんなジレンマを感じていた。

研究の転機

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。

千葉大学医学部クリニカル・クラークシップへの導入

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。

今後の期待

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:黒川賞演題候補としてのプレゼンテーション

写真:スクリーンに自分の名前が映し出された時には心が震えた瞬間であった

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: CMC

Credentials/Membership committee

Chair: Eiji SHINYA

Vice-chair: Koichiro YUJI

Members: Katsuhisa BANNO, Hitoshi SAWAOKA, Shunji YAZAKI, Hideto WATABE, Jotaro OHNO, Yusaku KAJIWARA, Satoshi, JOSHITA、Tsunenori SAITOand Minako YAMAOKA-TOJO

Report:

  • Reviewed 14 application forms and the applicants’ qualifications for the FACP advancement.
  • Nine new fellows, including Three invited fellows, were elected from June 2017 to May 2018.
  • Revised the descriptions of each membership category in the home page to augment the recruitment of new members
  • Co-hosted the FACP session in the annual meeting of ACP Japan Chapter, to promote the understanding of FACP as well as the application for it

Plan:

  • Review application forms for FACP advancement and judge the applicants’ qualifications by online as quickly as possible.
  • Respond to queries from members and board of ACP Japan Chapter regarding membership in collaboration with secretary.
  • Co-host the FACP session in the annual meeting to promote the understanding of FACP to promote the applications for it

Chapter Business Report 2017-2018: ECPC

Early Career Physicians Committee

Chair: Akihito Kawashima, MD

What We Accomplished

  • 2017年度ACP日本支部総会において、若手医師および医学生を対象に国際学会会場でも積極的に討論へ参加できるような『英語力の身につけ方』についてのセッションを開催しました。
  • 日常の臨床現場で研修医のために役立つワンポイントレクチャーとして、『5分間ティーチング』と題してグループワークを開催しました。

What We are Working On

  • 若手医師に対して研修医への教育方法や自身のキャリアデベロップメントについての提案を行っています。
  • 委員内のディスカッションをよりタイムリーに、より活発にできるようにSNSを積極的に取り入れています。

What We Plan To Initiate

  • 2018年度ACP日本支部総会において、若手医師および医学生を対象に国際学会会場でも積極的に討論へ参加できるような『英語力の身につけ方』についてのワークショップを開催する予定です。
  • 2018年秋に関東でのワークショップも検討しています。
  • テクノロジーの目覚ましい進歩に着目しディープラーニングやAIの医療への応用について、積極的に検討していこうと考えています。

Chapter Business Report 2017-2018: HPPC

Health and Public Policy Committee

Yuhta Oyama MD, FJSIM, FACP

Report:

Planned and going to have a workshop at the 2018 chapter meeting titled “The road to an FACP – Why and how do we aim for it? -“

Plan:

  1. Continue to develop a model to resolve common challenges on medical professionalism
  2. Preparation of criteria for COI disclosure of roles at ACP Japan Chapter (ACP-JC) and COI disclosure at annual meeting of ACP-JC
  3. Attempt to publish Choosing Wisely lists as the ACP-JC based on questionnaire of ACP-JC members
  4. Examine and discuss “End of life care” that would more suitable for Japanese medical circumstances
  5. Analyze the attitude of ACP headquarters towards COI and report it to the ACP-JC members

Chapter Business Report 2017-2018: LNC

Local Nominations Committee

Nobuhito HIRAWA MD FACP

REPORT:

We recruited the candidate of new governor of ACP Japan Chapter. And we selected Dr. Kenji Maeda MD, FACP as the candidate of the next governor and reported it to ACP headquarter.

The following ACP members were selected to receive each award.

–  Laureate Award

Yuko Takeda MD, FACP (ACP Number 1009004)

–  Sakura Award of Excellence

Haruko Miyamoto (The former clerk of ACP Japan Chapter)

–  Volunteerism Award

There is not an applicable person this year.

–  ACP Japan Chapter Contribution Award

Yugo Shibagaki MD, FACP (ACP Number 1245920)

Soichiro Ando MD, FACP  (ACP Number 1290215)

Harumi Gomi Yano MD, FACP (ACP Number 1098937)

Eiji Shinya MD, FACP (ACP Number 1064281)

Nobuhito Hirawa MD, FACP  (ACP Number 1271684)

The shield or the commendation with a pin badge is conferred on the prize winner.

 

PLAN:

–  Start to accept recommendations for 2019 Laureate Award, Volunteerism Award, Sakura Award of Excellence and ACP Japan Chapter Contribution Award.

–  Start to search candidates for Mastership next year

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

Members:

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 (http://www.acpjapan.org/acp2017/)

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 (http://www.acp2018.org/)

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.

Chapter Business Report 2017-2018: WC

Women’s Committee:

Chair; Noriko Yamamoto MD, FACP, Yamamoto Clinic

Co-Chair; Noriko Kawashima, MD, FACP, Kawashima Neurology Clinic

Members; Keiko Arai MD, FACP, Arai Clinic

Yuko Morishima MD, FACP, Division of Clinical Medicine Department of Pulmonary Medicine, University of Tsukuba

Eri Kimura,MD,Iizuka hospital

 

Report;

We has started the activity of Women’s committee on late July 2017.

We hold the panel Discussion at the annual session of ACP Japan Chapter (Today)

3 Women’s Leader talk and discuss important and tough subjects what young female doctors take great interest . They will give many tips to young doctors and medical students.

*We opened a page of Facebook as ACP Japan Women’s Committee(Closed Group)

 

Plan;

Next year we will hold a session to encourage young female doctors and students

In the annual session of ACP Japan chapter.

We will recruit some members this year.( es,young doctors and medical students)

We will have a plan to make a networking of female doctors and medical students in ACP Japan Chapter. We will be able to have mentorship among the chapter in the future. We also will utilize our facebook page.