Development of problemsolving skills in Japanese residency program FUKUOKA Toshio Chief Director of General Medicine Director of Medical Education Kurashiki Central Hospital
ContentsBackgroundJapanese reform of medical educationCore competency of residency program Japan vs USProblem solving skill development of theprogram guideline.
BackgroundNational examination at the graduation of medicalschools is no longer regarded as a guarantee oflifelong competency as a physician.Knowledge gained at a medical school becomeoutdated soon after graduation.The goal of continuing medical education is to achieveand keep clinical competency of physician in his or herchosen specialtiesDevelopment of Clinical problem solving skills is themost important competency for their professional life
Japanese reform of medical eduction Classroom to Bedside Knowledge to SkillContents & Structure to Competency & Outcome
Short 6 year in medical school BSL In 1980 Clinical General Basic Medical Medical Science Science Science Barrier testFrom 2005 Clinical Bedside General Basic Medical Learning Science Medical Science Science
Reform of Under- graduate EducationStudents spend more time at the bedside ofpatients than before. Less than 1 year -> Nearly 2 years.Clinical skill assessment of the students hasbecome a key part of medical education. Objective structured clinical examination (OSCE) and Computer based Test before bedside learningProblem-based learning was introduced.
National exam schoolIn 1980s Practice and Training as Physician Certiﬁcation National of ﬁnishing the exam program schoolFrom 2004 2 year Practice and Residency Training as Program Physician
Reform of Residency Training ProgramIn 2004, two-year residency program isobligated after passing of the nationallicense examination. Japanese Ministry of Health, Labor and Welfare (MHLW) set the guideline for the residency program. After 2006, a certiﬁcate of the residency program is required to become a Japanese health insurance manager.
Training and Continuing Education of Medical Specialty in Japan In Japan, the credible accreditation of medical specialty had been lacking. Most of the specialties were accredited by each Japanese society of medical specialties based on the length of training and membership. In Japan there was no independent accreditation organization with governmental support, such as JCAHO in US.
Accreditation of Residency ProgramQuite recently, Japan Council for Evaluation ofPostgraduate Clinical Training (JCEP) has beenestablished.JCEP is a non-proﬁt organization that evaluatesteaching hospitals and their residency programs inJapanThe evaluation is focused on the structure andcontents of the hospitals.Structure & Content to Competency & Outcome
Contents or CompetenciesDetermining the structure and contents oftraining duration is not enough for curriculardevelopment.Japanese health care consumers are highlydemanding physicians with high competency.
Contents or CompetenciesPersonal view of Developing the training program
Traditional concept of training.Traditional requirements of residency training were aﬁxed period of time of the training, structuraleducational contents and actual experience withpatients.The curricular development was focused ondetermining the length of the training period and thenumber of treated patients during the period.There was little attention to the actual needed timeand patient volumes for acquisition of the physiciancompetency as a specialist for each trainee. And theoutcome of the training assessed after the end oftraining as a qualifying examination
Competency based TrainingThe competences of the specialty should bedeﬁned clearly.The assessment of acquired competences oftrainees is available during the training. These trainees with prior learning can save the training time and the trainees without speciﬁc experience might become a competent specialist after adding the speciﬁc short training
Shifting Paradigms Structure-based Competency-based (time-based)Driving force for Content-knowledge Outcome-knowledge curriculum acquisition applicationDriving force for Teacher Learner process Hierarchical Non-hierarchicalPath of learning teacher -> student teacher <-> student Typical Single subjective Multiple objectiveassessment tool measure measures Program Fixed time Variable time completion Carraccio C et al: Acad Med 2002, 77: 361-367
Key component ofCompetency based trainingIdentiﬁcation of speciﬁc competencies. Pre-deﬁnedskills and knowledge as core competencies. Surveillance is necessary. Core-competencies (standard) should be set.Instruction and Training program aimed at alearner achieving competency. Efﬁcient local training program should be developed.Certiﬁcation based on the correct assessment ofcompetencies achieved off-the-job and on-the-job. Assessment tool should be provided.
Competency of the residencyprogram of Japan by MHLW Patient-physician relationship Team-based practice Problem solving skills Safety management Case presentation skills Medical practice in social context
Six Core-competency MHLW and ACGME Japan (MHLW) ACGME Patient-physician relationship Patient care Team-based practice Medical knowledge Practice-based learning and Problem solving skills improvement Interpersonal and communication Safety management skills Case presentation skills ProfessionalismMedical practice in social context Systems-based practice
Problem solving skills MHLW vs ACGMEIn Japan, problem solving skills is deﬁned as a corecompetency of residency programProblem solving skills Practice in “evidence-based” way. Perform practice based improvement of the skills. Have an interest in clinical studies with a knowledge of study designs.
Problem solving skills MHLW vs ACGMEIn US, problem solving skill is not deﬁned as a corecompetency but it is dispersed throughout thedeﬁned competency. Patient Care: “make informed decisions ... based on patient information and preferences, up-to- date scientiﬁc evidence, ...” Practice based learning: “locate, appraise, and assimilate evidence from scientiﬁc studies related to their patients health problems” 22
Setting the guidline ofdevelopment of the skillsIn 2005, draft of the guideline of develpment ofresidency program was set.In the guideline, EBM in the problem solving skills isdevided into 3 components Deﬁning a problem in clinical practice Gathering and appraising the information for solving the problem Making clinical decision and practice in safe and effective manner
Guideline of develpmentof problem solving skills Sorry, Japanese only.
Guideline of develpmentof problem solving skills Sorry, Japanese only.
Guideline of develpmentof problem solving skillsIn 2008, the guideline of develpment of residencyprogram will be set. The draft is available on the net. Some teaching materials and scinario are also available. Check on the net. We need your opinion and feedbackDeﬁning the clear competency is required foroutcome-based program evaluation.
ContentsBackgroundJapanese reform of medical education Skill based training. Intermediate assessmentTraining and Continuing Education of Medical Speciality of Japan Setting accreditation system.Develpment of guideline of residency program. Fundamental of outcome-based assessment of the program. Still underway. We need your opinion and support.