生坂 政臣

OBJECTIVES: The "5-microskills" instructional method for clinical reasoning does not incorporate a step for learners' critical reflection on their predicted hypotheses. This study aimed to correct this shortcoming by inserting a third step in which learners conduct critical self-examinations and furnish evidence that contradicts their predicted hypotheses, resulting in the "6-microskills" method. METHODS: In this cross-sectional study, changes in learners' confidence in their predicted hypotheses were measured and examined to modify confirmation bias and diagnoses. A total of 108 medical students were presented with one randomly assigned clinical vignette from a set of eight, having to: (1) describe their first impression; (2) provide evidence for it; and (3) finally identify inconsistencies/state evidence against it. Participants rated their confidence in their diagnosis at each of the three steps on a 10 point scale, and results were analyzed using a two-way ANOVA with repeated measures for two between-participant levels (correct or incorrect diagnosis) and three within-participant factors (diagnostic steps). The Bonferroni method was used for multiple comparison tests. RESULTS: Mean confidence scores were 5.01 (Step 1), 5.20 (Step 2), and 4.98 (Step 3); multiple comparisons showed a significant difference between Steps 1-2 (P =.04) and 2-3 (P =.01). Verbalization of evidence in favor of the predicted hypothesis (Step 2) and against it (Step 3) prompted changes in diagnosis in four cases of misdiagnosis (three at Step 2, one at Step 3). CONCLUSIONS: The 6-microskills method, which added a part encouraging learners to verbalize why something "does not fit" with a predicted diagnosis, may effectively correct the confirmation bias associated with diagnostic predictions.

Background In the United States (US), most physicians who commit sexual misconduct are male, and such misconduct is associated with the absence of chaperones. Several organizations recommend a chaperone during all intimate examinations (breast, genital, and rectal exams). However, in Japan, guidelines are not clearly defined, and hospitals and medical societies have not established standardized protocols. At Chiba University Hospital's Department of General Medicine, female nurses are requested to act as chaperones during female patients' physical examinations. However, limited medical resources make this challenging. Thus, it is necessary to investigate the necessity of female chaperones for the examination area to prioritize their presence. This study surveyed physicians to determine which examination areas require the presence of female chaperones during the examination of female patients by male physicians. The necessity was stratified and compared by the physician's sex and age. Methods This pilot cross-sectional study surveyed physicians in the Department of General Medicine at Chiba University Hospital. The study content was explained via email, and only those who consented to participate were asked to complete the questionnaire. Only physicians who had passed the Japanese medical licensing examination and had completed two years of residency were included. The primary factors were the physician's sex and age. The necessity for female chaperones was measured using a five-point Likert scale for different examination areas and patient age groups. The Mann-Whitney U and Kruskal-Wallis tests were also employed. Results Responses were obtained from 17 of the 19 physicians (89%; 10 male and seven female). Regardless of sex, there was consensus on the necessity of female chaperones when examining intimate parts (chest, thighs (disrobed), breasts, inguinal region, perineum, and buttocks). Female physicians were more likely to consider chaperones necessary for additional areas, including the head/face (p=0.014), chest (clothed) (p=0.019), abdomen (clothed/disrobed) (p=0.003, 0.033), back (clothed) (p=0.001), buttocks (clothed) (p=0.023), shoulder-upper arm (clothed) (p=0.005), and thighs (clothed) (p=0.033). The necessity for chaperones decreased as the patient's age increased. Conclusion Female physicians presented more cautious opinions, considering chaperones necessary for a broader range of examination areas beyond the traditionally defined intimate parts.

BACKGROUND: Discrepancies existed between the medical knowledge sections of the Model Core Curriculum for Medical Education (MCC) and the Guidelines for the National Examination for Medical Practitioners (GNEMP) in Japan. These discrepancies have been one of the underlying factors hindering the development of learner-centered medical education in the country. The project team responsible for the 'Problem-Solving' section of the MCC aimed to address discrepancies between the disease lists in the MCC and the GNEMP. METHOD: We refined the disease list for the 2022 revision of the MCC using a three-phase process: (a) procedure development, (b) selection, and (c) adjudication. First, we developed a scoring system for sifting and prioritizing diseases in the GNEMP, selecting those that met our scoring criteria. An expert adjudication panel then finalized the list of diseases through discussion. RESULTS: Among the 1,456 diseases identified in the GNEMP, 781 met the selection criteria. The adjudication panel selected 56 of these diseases to be newly added to the 2022 MCC, resulting in a total of 691 diseases. CONCLUSIONS: The list of diseases defined as required medical knowledge in the MCC was finalized through dialogue among medical education stakeholders, effectively minimizing discrepancies between the MCC and GNEMP.