Winner of Dr’s Dilemma

Shogo Shirota

Tochigi Medical Center

I am honored to report that Dr. Kawaguchi and I won the first prize in the American College of Physicians (ACP) Doctor’s Dilemma competition 2019.

I have participated in ACP Japan Chapter(JC) since I was a medical student. Each year, I took a lot of interesting and interactive workshops, and got to know many outstanding medical students and doctors. Doctor’s Dilemma is one of the most interesting program, but I could not take part in it, because I was not able to get a partner.

There were the largest number, 35, of participating teams from various hospitals this year. In the Preliminary, we used smartphones to answer multiple choice questions. The questions are not so difficult, which made us nervous because losing even one question would be critical. We got 6th place and cleared the Preliminary.

The Final started after two-hour break. There were buzzer quiz at first, then more difficult, multiple choice questions from every areas of internal medicine. It was difficult to get point at first, because other team pressed the buzzer while we are discussing whether our answer was absolutely correct. Once we were able to select the multiple choice questions that every team had the right to answer but lost points with each incorrect answer, we could get almost all of the answers right. They were questions that were directly connected to what we do every day, and some of them we knew from MKSAP. That’s how we won the championship.

There are several reasons why we won this year. In addition to working up many MKSAP questions by ourselves, we see a variety of patients every day as a GIM physician. Moreover, we have various kinds of study sessions in our hospital which vary from day to day. These include clinical reasoning conference, learning how to make clinical question and search for it, introducing several papers in a short time, and so on. They made us deepen our medical knowledge very efficiently.

Finally, I would like to express my heartfelt gratitude to the attending doctors who mentored us, the colleagues and friends who congratulated us, and every staff who helped holding the ACP Japan chapter.

ACP日本支部総会2019 Dr’s Dilemma優勝者のことば

この度、京都大学で開催されたACP JC年次総会2019のDr’s Dilemmaにおいて、優勝させていただきましたのでご報告致します。

私は学生の頃からACP JCに参加しており、毎年様々なレクチャーやワークショップに参加して新しいことを学んだり、同じように頑張っている仲間に出会い刺激を受けていました。Dr’s Dilemmaはいつも楽しみにしていた企画ではありましたが、なかなか相方がいなかったので、今回が初参加でした。




日々我々を教育してくださった指導医の方々に改めて感謝申し上げます。また、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。



Winner of Kurokawa Prize in Students section

Comments on receiving the Kurokawa Prize (Medical Student branch) at the ACP Japan Chapter Annual Meeting 2019


Medical Student, Juntendo University School of Medicine

Saki Fukumoto

I am very honored to be awarded the Kurokawa Prize at the American College of Physicians (ACP) Japan Chapter Annual Meeting 2019 in Kyoto.


At the meeting, I made a presentation entitled “Unaware of glaucoma and traffic accidents: a proposal to detect visual field defects by CLOCK CHART”. I presented this issue, because I believe that it is clinically and socially significant for us to screen for glaucoma using CLOCK CHART, considering that this pathological condition is related to traffic accidents.


One of main research themes at the Department of Public Health, Juntendo University, is “health-related traffic accidents”, which include the effects of obstructive sleep apnea, hay fever and glaucoma. Among these, the prevalence of glaucoma is around 5% for those aged 40 years and over in Japan, whereas 90 percent of those affected are not aware of their disorder and remain untreated. Numerous previous studies reported the association between glaucoma and traffic accidents. Thus, there will be many latent patients with glaucoma who need appropriate diagnosis and treatment.


To address this, I collected 5 cases with glaucoma and examined their visual fields using both a Humphrey Field Analyzer and CLOCK CHART, the latter of which is a handy visual field screening tool. I found that the agreement rate between the Humphrey Field Analyzer and CLOCK CHART was substantially high. Therefore, it is concluded that screening visual fields using CLOCK CHART by general physicians would enhance the detection of glaucoma, leading to its early diagnosis and treatment, and reducing “health-related traffic accidents”.


I am also on a team investigating over 2000 commercial drivers. While still in progress, we are now analyzing the inter-relationships between traffic accidents and visual field defects detected by CLOCK CHART.

Finally, I would like to express my gratitude to Professor Tanigawa, Dr. Wada and all other teachers for their kind advice.

ACP日本支部総会2019 黒川賞(学生部門) 受賞者のことば

ACP日本支部年次総会・講演会2019 黒川賞(医学生部門)受賞のご報告






この度、私は交通事故の一因である緑内障に対するクロックチャートを用いたスクリーニングの有用性について、「Unaware of glaucoma and traffic accidents: a proposal to detect visual field defects by CLOCK CHART」という演題名で発表を行いました。





Dr. Yuichiro Matsuo, Winner of Kurokawa Prize in Early Career Physicians section

Yuichiro Matsuo

Tokyo Bay Urayasu Ichikawa Medical Center, Department of Internal Medicine


I am grateful that I could receive the Kurokawa Prize in the Annual Meeting of ACP Japan 2019. The basic idea of our study “Japanese people tend to overestimate their future cardiovascular risk” originated from the question, “aren’t people unnecessary worried about developing cardiovascular disease (CVD)?” In Japan, the risk of developing CVD in a patient with a slightly elevated LDL cholesterol is relatively low, in most cases, only a few percent in 10 years. Our impression was that people seem to be much more worried about developing CVD.


In our study, we could show that patients undergoing routine health check-up in our center significantly overestimated their risk of developing cardiovascular disease. Patients estimated their 10-year CVD risk as around 30%, compared with the calculated risk of 3%. From this result, we can make a hypothesis that CVD risk management in Japan may be conducted based on this misunderstanding.


We are planning for further research on this field. Will this misunderstanding affect the patient’s health seeking behavior, satisfaction, outcome, and will there be a positive effect of correcting this misunderstanding?


I would like to thank my boss, Dr. Eiji Hiraoka for supporting the whole work, and I would also like to thank all the people who were responsible for preparing this meeting.

ACP日本支部総会2019 黒川賞(若手医師部門)受賞者のことば 松尾裕一郎

ACP日本支部 2019年次総会 黒川賞(若手医師部門)受賞によせて


東京ベイ・浦安市川医療センター 総合内科 松尾裕一郎



この度は、栄誉ある黒川賞をいただき、大変光栄に思います。今回の私達の研究「健康診断を受診する患者は、自身の心血管病リスクを過大評価する」は、私達が普段の外来診療で感じていた疑問、違和感を検証したものです。健康診断では、一般にLDLコレステロールが120mg/dLを超えると「軽度の異常」という判定になります。では実際に、それらの患者がその後10年でどのくらいの確率で心血管病を発症するかというと、問題が軽度の高LDL血症だけであれば数%以下程度です。しかしながら、患者自身はリスクがもっと高いと考えており、心血管病発症を必要以上に心配しているのではないか?というのが私達の疑問です。結果は私達の予想通り、Suita Scoreにより計算される患者の心血管病リスクは3%程度であるのに対し、患者自身が予測するリスクは30%程度である、というものでした。このことから、日本における脂質異常症などの生活習慣病診療が、患者の誤解のもとに行われている可能性、自身のリスクについて医療者と話をする機会の無い患者が、不必要な不安を抱えている可能性などを、間接的に示すことができたと考えています。





Dr. Mai Okamoto, Winner of Kurokawa Prize in Resident/Fellow section

I am very honored to receive the Kurokawa Prize at the ACP Japan 2019. I greatly appreciate the support of attending doctors.


History of research

I have been interested in the appropriate antibiotics in my medical student days, but It was different from what I imagine in clinical settings. One of the reasons was that it needs several days to identify bacteria from specimens. Although the antimicrobial agent is determined on the assumption of the microbes, it does not always proceed as expected. In some cases, empirical treatment has failed to cover, on the other hand, I tended to use inappropriate broad-spectrum antibiotics.


The turning point of research

In July 2018, when I was the second year of residency, “FilmArray multiplex PCR” was introduced in our hospital. This machine can identify bacteria in the blood more rapidly than the conventional method. When the blood culture becomes positive, the FilmArray can detect in about one hour. This system has already been introduced abroad, and some studies have shown efficacy for antimicrobial stewardship. There are few experiences in our country and the microbiology laboratory setting is different from that high volume centers in prior reports. So, I decided to examine the change in the usage of antimicrobial agents before and after introducing FilmArray system.


Future expectations

This study showed that the time to start anti-MRSA drug for MRSA was shortened, and furthermore, 28-days overall survival was improved in the Gram-positive cocci baceteremia group by using FilmArray. The improvement of the survival rate is different from the prior studies, and it is considered that further study is necessary. However, our study suggested that the use of FilmArray may help the appropriate use of antibacterial agents. We hope further research will progress and would like to contribute to ASPs.


2019年ACP日本支部総会 黒川賞(研修医部門) 受賞者のことば

ACP日本支部2019年次総会 黒川賞(研修医部門)を受賞して

岩国市立美和病院 内科 岡本麻衣











2019年 ACP日本支部年次総会・講演会のご案内

Scientific Program Committee委員長の濱口杉大先生より、今週末に京都で開催されるACP日本支部年次総会・講演会のご案内です。ふるってご参加ください。
(PRC委員 小尾佳嗣)
濱口 杉大


Scientific Program Committee委員長の濱口杉大先生よりいただいた、第116回日本内科学会総会・講演会の「医学生・研修医の日本内科学会ことはじめ2019 名古屋」にて行われた日本内科学会とACP日本支部とのジョントセッションの活動報告を紹介いたします。

(PRC委員 小尾佳嗣)













日時:2019年4月27日 12時45分~14時15分(90分間)

場所:ポートメッセなごや イベント館2階



米国臨床研修経験者8名を講師として招聘し、1ブースに1名の講師がいる計8つのブースを、海外研修に興味をもちあらかじめ募集をした医学生・研修医グループ(1グループ7名で計 8グループ)がローテーションします。







北野夕佳 先生

現所属:聖マリアンナ医科大学 横浜西部病院 救命救急センター



Let’s Learn GENERAL RULES from everyday cases. 5-minute bedside teaching

We’ll do a brief case discussion of a bread and butter case on hospitalist service or general internal medicine clinic.

The goal of my session is for the participants to achieve a sense of learning concise general rules (”5-minute bedside teaching”) from a simple case.


田川美穂 先生

現所属:奈良県立医科大学 腎臓内科



Bed side teachingのすすめ

アメリカの初期研修では、指導医と研修医が患者を一緒に回診します。研修医が患者についてプレゼンテーションを行い、指導医が症例について、teaching pointをその場でdiscussion形式で教えてくれます。実臨床に即した考え方の道筋を学ぶことができ、非常に有用でした。今回のセッションでは、このbed side teachingの雰囲気を味わっていただければと思っています。皆さんとのdiscussionを楽しみにしています。


関口健二 先生

現所属:信州大学医学部附属病院 総合診療科




  1. やるべきかやらざるべきか それが問題だ
  2. どうして米国臨床研修を実際に経験した人はみんな留学を強く勧めるのに、やってない人はそうでもないのか?
  3. 米国臨床研修じゃなきゃ得られなかったものと米国でなくても得られたであろうもの
  4. 米国臨床研修で失ったもの
  5. 「肚を決める」


八重樫牧人 先生

現所属:亀田総合病院 総合内科






Dr. Shadia Constantine



Are you interested in medical training in the US? Let’s contrast your questions with my experience as an International Medical Graduate (IMG) in the US. We will talk about the following topics:

  1. Why? Could you believe that the US was NEVER in my dreams?
  2. Traditional path: studying and taking the tests, ERAS application, matching. Share some of your plans and I will share what I did.
  3. Challenges? Share your fears and I will share the main obstacles I had to jump
  4. Is the US the only way to have an international medical career?


Dr. Gautam Deshpande



During this activity, interested students and residents will be taken through a typical `day in the life` of a first-year intern in an Internal Medicine training program in a US hospital. Topics included will include pre-rounding, structure of supervision, daily presentations to attending physicians, balance of hospital vs outpatient clinic work, and expectations for education. Topics will also touch on chief resident opportunities and preparing for fellowships in the US. The format will be primary lecture-based, with ample time for question-and-answer. Time permitting, we will also discuss some fundamental strategies to prepare for a successful US residency.


鈴木孝幸 先生

現所属:University of Utah Health Care, Division of Gastroenterology




Dr. Robert Dobbin Chow

現所属:University of Maryland School of Medicine


Residency Training in the United States:  Why, What, and How

  1. Why choose to train in the United States?
  2. What is the difference between Internal Medicine training in Japan and training in United States?
  3. Emphasis on evidence based medicine
  4. Exposure to alternative teaching styles: emphasis on bedside rounding and physical examination skills
  5. Multi-disciplinary approach to patient care
  6. Research opportunities for residents; opportunities to present at national professional meetings
  7. Structured feedback and evaluation system based on milestones
  8. Duty hours and restricted service size for residents – attention to resident wellness
  • What are the challenging aspects of training in the United States?
  1. English can be a limiting factor
  2. American culture and values do not promote humility, respect, politeness
  3. Lack of a personal support system
  4. Cost of application and travel for rotations, CS, interviews
  5. How to apply
  6. USMLE Step I, Step 2 CK, Step 2 CS => ECFMG certification
  7. 3-4 letters of recommendation
  8. Clinical experience in the U.S.
  9. ERAS application, including personal statement




上野文昭 前支部長