DREEM, PHEEM, ATEEM and STEEM in Japanese

Dear Sir

We would be very happy to announce to international readers that we created the Japanese version of DREEM (Dundee Ready Educational Environment Measure) (Roff 2005), PHEEM (Postgraduate Hospital Educational Environment Measure), ATEEM (Anaesthetic Theatre Education Environment Measure) and STEEM (Surgical Theatre Education Environment Measure). They were published in the Journal of Medical Education (Japan) (Nishigori & Yoshida 2006). We hope they will be of great help to measure education environment in Japanese medical education.

Hiroshi Nishigori

International Research Center for Medical Education

The University of Tokyo

7-3-1 Hongo Bunkyo-ku

Tokyo 113-0033

Japan

E-mail: [email protected]

Makiko Nishigori

Japanese Health Cooperatives Association

Tokyo

Japan

Hiroshi Yoshimura

South-Okinawa Medical Center

Okinawa

Japan

Dear Sir,

In the 2006–2007 academic year we arranged interpersonal skills teaching for 5-year-medical students (N = 126). The teaching sessions comprised three phases: firstly, the students attended a lecture on key concepts on interpersonal skills. Secondly, the students were divided into patient–doctor pairs. Each pair performed an imaginary surgery situation based on real patients. The videotaped performances were viewed together with a larger group and analysed during general discussion led by teachers. Thirdly, the students assessed the teaching and their own learning by answering open questions. This letter reports how the students responded to the question ‘If there was something you learned, what was it?’ The answers were analysed using the method of inductive content analysis (Elo & Kyngäs 2008).

The answers included references to internal matters, such as thoughts and feelings, and to external matters such as gestures, facial expressions and techniques. There was some overlapping between these categories, like the answer ‘Confrontation is not good while on call in a health care centre’ included both an external component (confrontation as a method) and an internal component (assessment of the method). Similar overlapping was seen in the answer ‘I realised that the weaknesses I had previously thought existed in my own interpersonal skills were relatively well under control’. A feature repeated in many answers was that students mentioned learning things by seeing, i.e. by seeing themselves, other students, as well as facial expressions, gestures and personal appearance at the time of videotaping. Verbal and non-verbal messages had also been observed by seeing and listening. The answers given by the students showed that the majority were able to reflect on their own actions and that it had an impact on their learning process.

In recent years, critical attention has been focused on the teaching and learning of interpersonal skills in basic medical education. Interpersonal skills are not taught sufficiently, the teaching is not systematically integrated into medical studies, the skills adopted by students or teaching methods used have been little studied, and there is still a lot of room for improvement in patients’ satisfaction with doctors’ communication skills (Cox & Irby 2007).

The results of our study made us concluded, firstly, that learning reflection does play a key role in learning communication skills, and secondly, that the use of videotaping in interpersonal course training provides an opportunity for self-evaluation and for getting feedback from others and thus increase sense of competence associated with interpersonal skills even in basic medical education.

Tuuli Kyrö¹, Riitta Läärä¹, Juhani Tiuraniemi² & Sari Lindeman^1,3*

¹Department of Psychiatry, University of Oulu P.O. Box 5000, 90014 Finland

²Department of Psychology, University of Turku FI-20014 Turku Finland

³Department of Psychiatry, Oulu University Hospital P.O. Box 26 90029 Finland

*Email: [email protected]

Dear Sir

Smoking and lack of exercise are among leading causes of poor health (Mokdad 2004). To assess preparedness of future physicians to cope with these topics, a questionnaire was administered to 83 final year medical students in a leading faculty of medicine, representing one third of the medical students concluding their studies in Israel in 2003.

Students lacked knowledge about hazards of smoking and benefits of exercise. Nearly half of the students denied or didn’t know the impact of smoking on morbidity and mortality, including that smoking causes abortions or that passive smoking causes pneumonia, otitis and meningitis. Many students denied or didn’t know that physical activity decreases the risk of breast or colon cancer (over 80% of students) and that physical activity decreases the risk of diabetes or stroke (over 15% of students). Many students had incorrect impressions on most prevalent causes of premature death: 75% believed that smoking is not a most frequent cause of mortality. They rated other options as most frequent cause of early death: car accidents (37%), cancer (34%), lack of physical activity (5%), medical errors (4%) and terrorists’ attacks (2%).

Over half of students reported having little or no exposure during medical school to physicians advising patients to quit smoking (52%) or to exercise (66%); only few rated such exposures as frequent. 68% believed that there is a need to intensify the teaching of these topics at medical school.

As to their future role-modeling as physicians, 30% of students felt that their own lifestyle has little or no importance for their future patients, while 70% rated it as important or very important. Students reporting exposure to physicians advising patients to exercise regularly claimed they would advise the same to their future patients more often than students not reporting such exposure (p = 0.05).

As to own health behavior, 27% of medical students reported current smoking, with an additional 18% reporting having stopped smoking in the past 5 years. Regular exercise was reported by 30% of the students.

In conclusion, future physicians lack knowledge on healthy lifestyle, often with own behavior not conducive to future role-modeling for patients. The faculty of medicine fails to educate students in major aspects of disease prevention. Since physicians have an important role in health promotion, medical schools should monitor and improve education on healthy lifestyle.

Tal Haimov MD

Robert Cohen PhD

Mayer Brezis MD, MPH

Oded Shamriz, MD

Center for Clinical Quality & Safety

Box 53, Ein Kerem Campus

Hadassah – Hebrew University Medical Center

P.O. Box 12000, Jerusalem 91120, Israel

[email protected]

Dear Sir

Increasing centralisation of surgical services, European working time directives and modernizing medical careers have forced a complete ‘re-think’ of the way in which surgical training is delivered. Traditional methods are no longer suitable and new, more efficient approaches to skill acquisition are needed as the amount of training received in the operating theatre is under constant threat.

Despite its central role in surgical training, the teaching and assessment of technical skills has been the least standardized component of surgical education. Recent high-profile cases of ‘surgical misadventure’ have acted as catalysts to focus the attention of the general public on methods of competency assessment prior to independent surgical practice. The Kennedy Report (2001) recommended, in the interest of patient safety and public concern, reliable and validated systems need to be in place for the acquisition and maintenance of essential competencies by surgical practitioners. These changes in public expectation, in combination with political pressure and an ever-changing training program, have necessitated a more formal measurement of an individual's fitness to practice independently.

The accreditation of surgeons for independent practice in the UK is currently the task of the The Joint Committee for Higher Surgical Training. Trainees undergo annual formative and summative assessments [Record of In Training Assessment (RITA)] designed to evaluate progress through the training program (5–6 years duration). In addition, trainees must pass a national examination [Fellowship of Royal College of Surgeons (FRCS)] in their penultimate year of training. This consists of two components; Multiple Choice Questions and a Viva Voce/clinical examination.

In recent years, an increasing number of surgeons have voiced their dissatisfaction at the current assessment process. In particular, they have questioned the ability of the process to accurately assess technical skills (Pollock 1996). Without doubt the qualities of a good surgeon extend beyond technical skills. Knowledge, clinical acumen, professionalism, communication, self-reflection and teaching skills are amongst the mandatory qualities of a competent surgeon. However, above all one could argue the distinguishing feature of a surgeon compared to other medical professionals is the mastery of technical skills and operative theory needed to safely and successfully perform complex operations.

We feel the continuing omission of an objective assessment of a surgeons’ technical skill invalidates the current assessment process and requires urgent attention so that the quality of future surgeons is to be assured within the UK.

RSM Davies, K Futaba, ML Wall, DJ Adam

University Department of Vascular Surgery Heart of England NHS Foundation Trust Birmingham, UK

Dear Sir,

Integration provides a holistic approach to medicine and its learning since patients present integrated and not in subjects. An electronic medium that captures skills to be acquired and makes them user friendly can go a long way in solving the problems of modern medical education, including the need for integration.

The Electronic School of Medicine, which took 7 years to build (2001–2008) provides a means of learning procedures and integrating medicine (www.oluwoleogunranti.com). In this model of electronic medicine for medical education, a student can examine a patient, order investigations and perform postmortems without any gadgetry except a virtual screen and manipulating mouse and keyboards with integration of subjects of medicine for learning. Other programs include dissections (eDissector), embryology with animations of all processes, histology with animations of histological functions and all other subjects in medicine. An Electronic Objective Structured Clinical Examination (eOSCE) includes long and short cases with multiple choice questions that provide objective scores.

Other programs which are more complex in nature are available at this school and they include eMidwife, eSurgeon, eDoctor, eSubjects, etc. But, just like all programs designed by humans it has its limitations. It may not be well amenable to all the fives senses. It uses mainly for vision and hearing. It also uses JAVA program for fine discrimination and encryption.

J. O. OGUNRANTI

Department of Anatomy

Faculty of Medical Sciences

University of Jos

Jos

Nigeria

E-mail: [email protected]