Papers by Hirotaka Onishi
Journal of General and Family Medicine, Jun 19, 2023
BackgroundPrimary care physicians (PCPs) play a critical role in disaster medicine. However, it i... more BackgroundPrimary care physicians (PCPs) play a critical role in disaster medicine. However, it is unclear how PCPs who provide chronic support to disaster‐affected areas learn from their experiences.MethodsThis qualitative study investigates the learnings of young PCPs who provided medical care during the chronic phase of the Great East Japan Earthquake disaster.ResultsThematic analysis of interviews with five physicians revealed the challenges faced by them and their learnings in providing medical support to disaster‐affected areas.ConclusionsThey not only learned medical skills but also humanistic aspects such as empathizing with the survivors' loss.
Nihon Naika Gakkai zasshi, 2012
BMC Medical Education, Oct 20, 2017
Following publication of the original article [1], the authors reported that the word "Tutee" on ... more Following publication of the original article [1], the authors reported that the word "Tutee" on the righthand side of Fig. 3 should read "Tutor".
Journal of medical education and curricular development, 2016
Case presentation is used as a teaching and learning tool in almost all clinical education, and i... more Case presentation is used as a teaching and learning tool in almost all clinical education, and it is also associated with clinical reasoning ability. Despite this, no specific assessment tool utilizing case presentations has yet been established. SNAPPS (summarize, narrow, analyze, probe, plan, and select) and the One-minute Preceptor are well-known educational tools for teaching how to improve consultations. However, these tools do not include a specific rating scale to determine the diagnostic reasoning level. Mini clinical evaluation exercise (Mini-CEX) and RIME (reporter, interpreter, manager, and educator) are comprehensive assessment tools with appropriate reliability and validity. The vague, structured, organized and pertinent (VSOP) model, previously proposed in Japan and derived from RIME model, is a tool for formative assessment and teaching of trainees through case presentations. Uses of the VSOP model in real settings are also discussed.
Journal of General and Family Medicine, Jun 11, 2020
BackgroundThe shortage of physicians in several specialties has been brought to public attention ... more BackgroundThe shortage of physicians in several specialties has been brought to public attention in several countries. However, little is known about factors affecting medical students’ specialty choice. The objectives of our study were to illustrate medical students’ career priority clusters and to assess their association with specialty preference.MethodsWe conducted a nationwide multicenter survey in 2015 at 17 medical schools. The study participants were asked their top three specialty preferences, demographic characteristics, and 14 career priority questions. Multilevel logistic regression models were used to determine the effect of each variable on student career choice.ResultsA total of 1264 responses were included in the analyses. The top five specialty choices were internal medicine: 833, general practice: 408, pediatrics: 372, surgery: 344, and emergency medicine: 244. An exploratory factor analysis mapped the 14 career priorities into 3‐factor solution: “primary care orientation,” “advanced and specific care,” and “personal life orientation.” Multilevel logistic regression models yielded satisfactory accuracy with the highest ROC curve (AUROC) noted in surgery (0.818), general practice (0.769), and emergency medicine (0.744). The career priorities under “primary care orientation” had positive association with choosing general practice, emergency medicine, internal medicine, and pediatrics. The “advanced and specific care” career priorities facilitated surgery and emergency medicine choice, while reducing the likelihood of choosing less procedure‐oriented specialties, such as internal medicine, general practice, and pediatrics.ConclusionsOur results demonstrated medical students’ career priorities and their association with specialty preference. Individualized career support may be beneficial for both medical students and each specialty fields.
Journal of Interprofessional Education and Practice, Dec 1, 2022
PubMed, 2017
Objective To examine the short-term effects of an inter-professional educational program develope... more Objective To examine the short-term effects of an inter-professional educational program developed for physicians and other home care specialists to promote home care in the community.Methods From March 2012 to January 2013, an inter-professional educational program (IEP) was held four times in three suburban areas (Kashiwa city and Matsudo city in the Chiba prefecture, and Omori district in the Ota ward). This program aimed to motivate physicians to increase the number of home visits and to encourage home care professionals to work together in the same community areas by promoting inter-professional work (IPW). The participants were physicians, home-visit nurses, and other home care professionals recommended by community-level professional associations. The participants attended a 1.5-day multi-professional IEP. Pre- and post-program questionnaires were used to collect information on home care knowledge and practical skills (26 indexes, 1-4 scale), attitudes toward home care practice (4 indexes, 1-6 scale), and IPW (13 indexes, 1-4 scale). Data from all of the participants without labels about the type of professionals were excluded, and both pre-test and post-test responses were used in the analysis. A Wilcoxon signed-rank test and a paired t-test were conducted to compare pre- and post-program questionnaire responses stratified for physicians and other professionals, and the effect size was calculated.Results The total number of participants for the four programs was 256, and data from 162 (63.3%) were analyzed. The physicians numbered 19 (11.7%), while other professionals numbered 143 (88.3%). Attending this program helped participants obtain home care knowledge of IPW and a practical view of home care. Furthermore, indexes about IPW consisted of two factors: cooperation and interaction; non-physician home care professionals increased their interactions with physicians, other professionals increased their cooperation with other professionals, and physicians increased their cooperation with other physicians.Conclusion Short-term effects to motivate physicians to increase home visits were limited. However, physicians obtained a practical view of home care by attending the IEP. Also, the participation of physicians and other home care professionals in this program triggered the beginning of IPW in suburban areas. This program is feasible when adapted for regional differences.
Nihon puraimari kea rengo gakkaishi, 2015
Nihon puraimari kea rengo gakkaishi, 2014
BMC Medical Education, Feb 22, 2021
Background: Examining the predictors of summative assessment performance is important for improvi... more Background: Examining the predictors of summative assessment performance is important for improving educational programs and structuring appropriate learning environments for trainees. However, predictors of certification examination performance in pediatric postgraduate education have not been comprehensively investigated in Japan. Methods: The Pediatric Board Examination database in Japan, which includes 1578 postgraduate trainees from 2015 to 2016, was analyzed. The examinations included multiple-choice questions (MCQs), case summary reports, and an interview, and the predictors for each of these components were investigated by multiple regression analysis. Results: The number of examination attempts and the training duration were significant negative predictors of the scores for the MCQ, case summary, and interview. Employment at a community hospital or private university hospital were negative predictors of the MCQ and case summary score, respectively. Female sex and the number of academic presentations positively predicted the case summary and interview scores. The number of research publications was a positive predictor of the MCQ score, and employment at a community hospital was a positive predictor of the case summary score. Conclusion: This study found that delayed and repeated examination taking were negative predictors, while the scholarly activity of trainees was a positive predictor, of pediatric board certification examination performance.
Asia Pacific Family Medicine, Jul 11, 2018
Background: In 2015 in Japan 12.7% of people die at home. Since the government has no policy to i... more Background: In 2015 in Japan 12.7% of people die at home. Since the government has no policy to increase the number of hospital beds, at-home deaths should inevitably increase in the near future. Previous researches regarding expected place of death have focused on end-of-life patients. The aim of this study is to clarify the percentage and factors of senior people who expect at-home deaths whether they are end-of-life or not. Methods: Using cross-sectional questionnaire survey data which had been taken by a research group with the support from Tama City Medical Association (Tokyo) in 2014, univariable and multivariable logistic regression analyses were conducted to identify associations among factors. The dependent variable was the expected site of death and other factors were set as independent variables. Results: Of 1781 respondents, 46.5% expected at-home deaths. Data from 1133 people were analyzed and 46.5% of those wanted at-home deaths. Factors significantly associated with expectation of at-home death were men, standalone houses for dwelling, expectation to continue life in Tama city, twosome life with the spouse, healthiness, and economic challenge. Conclusion: Percentage of those who expected at-home deaths was much higher than the latest percentage of athome deaths. Some factors associated with expectation of at-home deaths in this study have never been discussed.
BMJ Open, Jul 1, 2019
Objectives: Globalization has increased the opportunities for healthcare professionals working in... more Objectives: Globalization has increased the opportunities for healthcare professionals working in developed countries to provide clinical and educational support in developing countries. However, how these experiences contribute to the leadership competency of health care professionals is unclear; therefore, this study explored this with the objective of analyzing the process of developing individual leadership competency. Design: Qualitative descriptive study. Qualitative descriptive data were collected in face-toface, semi-structured interviews. Setting: The authors interviewed Japanese health professionals who participated in an international medical cooperation project as part of a multinational medical team between July 2017 and March 2018 and analyzed and interpreted the data using a social constructivism paradigm. Participants: The authors' interviews of 20 research participants, including five nurses, five dentists, and ten doctors with an average of 15.3 years of clinical experience. Results: The interviews identified 58 constituent elements related to their leadership competency, 23 of which affected the actual medical care in their own institution. The theoretical framework comprised seven primary factors: leadership concepts, teambuilding, direction-setting, communication, business skills, working with others, and self-development. The authors identified the relationships among each competency and identified differences between professions: nurses particularly reflected their empathic attitudes toward patient after global health experience; dentists tended to reflect their business skills; physicians tended to reflect their leadership concepts and teambuilding. Conclusions: This study clarified the leadership competency gained through short-term global health clinical experience and the process of individual leadership competency development.
Tohoku Journal of Experimental Medicine, 2014
Problem-based learning (PBL) is a teaching and learning method designed to develop clinical reaso... more Problem-based learning (PBL) is a teaching and learning method designed to develop clinical reasoning skills. Tutor performance in PBL affects both the process and outcome of student learning. In this study, we investigated the factors that influence the evaluation by undergraduate students on the performance of tutors in medical education. From April 2009 to February 2010, 49 PBL sessions were conducted for 191 3rd-and 4th-year medical students at Saga Medical School in Japan. Twenty-nine 6th-year students and 205 faculty members tutored these sessions. After each session, students evaluated their tutor by a Likert scale. This evaluation score was dichotomized and used as the dependent variable. A multivariate logistic regression analysis was used to assess the contribution of student's gender and year level (3rd or 4th), the tutor's gender and background, and the quality of the case scenario to evaluation ratings. A total of 4,469 responses were analyzed. Male student and tutor background were associated with excellent tutor evaluation. Concerning the tutor background, compared with basic scientists, the 6th-year students and content-expert clinicians were positively associated with excellent tutor evaluations (ORs of 1.77 [95% CI: 1.15-2.72] and 1.47 [95% CI: 1.11-1.97]), while non-content-expert clinicians received negative evaluations (OR of 0.72 [95% CI: 0.55-0.95]). The quality of the case scenario was also associated with excellent tutor evaluation (odds ratio [OR] of 12.43 [95%
Medical Teacher, Feb 23, 2011
Medical education research in general is a young scientific discipline which is still finding its... more Medical education research in general is a young scientific discipline which is still finding its own position in the scientific range. It is rooted in both the biomedical sciences and the social sciences, each with their own scientific language. A more unique feature of medical education (and assessment) research is that it has to be both locally and internationally relevant. This is not always easy and sometimes leads to purely ideographic descriptions of an assessment procedure with insufficient general lessons or generalised scientific knowledge being generated or vice versa. For medical educational research, a plethora of methodologies is available to cater to many different research questions. This article contains consensus positions and suggestions on various elements of medical education (assessment) research. Overarching is the position that without a good theoretical underpinning and good knowledge of the existing literature, good research and sound conclusions are impossible to produce, and that there is no inherently superior methodology, but that the best methodology is the one most suited to answer the research question unambiguously. Although the positions should not be perceived as dogmas, they should be taken as very serious recommendations. Topics covered are: types of research, theoretical frameworks, designs and methodologies, instrument properties or psychometrics, costs/acceptability, ethics, infrastructure and support. Preliminary statements Not so long ago, the main focus of assessment was on measuring the outcomes of the learning process, i.e. to determine whether the students had acquired sufficient knowledge, skills, competencies, etc. This approach is often referred to as assessment of learning. Currently, a second notion has gained ground, namely assessment for learning (Shepard 2009). In this view, assessment is seen as an essential and integral part of the learning process. The purpose of this article is not to elaborate further on these developments, nor to take a stance on it. The sole reason for highlighting it is that it makes the distinction between educational research and assessment research less clear. Therefore, it is inevitable that this article contains descriptions, positions and consensus that do not pertain exclusively to assessment research but may have bearing on more general educational research as well. So, although the remit for the theme group has been to focus on assessment, it cannot be avoided that some of its content is of more general pertinence. The terms assessment and evaluation are used interchangeably in the literature, yet can refer to different inquiries. Some languages have one word for both terms making translation difficult. The theme group on Research in Assessment has agreed that for purposes of clarification and consistency, the term assessment will be used to refer to the systematic determination of student/learner achievement and performance. The term evaluation will be used with reference to issues and questions related to programmes, projects and curriculum within which questions and issues of assessment of learners are nested and co-embedded with educational issues and questions related to resources, faculty, general institutional and programmatic outcomes as well as explanations of educational intervention.
Igaku Kyoiku / Medical Education (Japan), 1999
Nihon Naika Gakkai zasshi, 2008
General medicine, 2003
OBJECTIVE : To evaluate an undergraduate curriculum of communication skills by measuring satisfac... more OBJECTIVE : To evaluate an undergraduate curriculum of communication skills by measuring satisfaction of outpatients whom final year students had examined. METHODS: Cross-sectional surveys were conducted in General Medicine Clinic (GMC) of Saga Medical School (SMS) Hospital in 1999 and 2001. After the clinical clerkship in wards in fifth year, final year students experienced the two-week GMC clerkship, including seven hours of small group lecture in 1999, but partly converted into eight hours of small group discussion with a tutor in 2001. Six items in American Board of Internal Medicine Patient Satisfaction Questionnaire were selected as a validated instrument and incorporated into repeated measures ANOVA. RESULTS: A total of 177 students were evaluated by 688 outpatients. Overall average score was 3.49+/-0.82. Average score in 2001 was significantly higher than that in 1999 (p<0.001; 3.58+ /-0.76vs 3.36+/-0.87). The scores of•gencouraging and answering questions•hand•gclear explanations•hitems were significantly lower than those of other items (3.21+/-0.98 and 3.37+/-0.92; Least Significant Difference). The interaction between gender and years of curricula (1999 and 2001) was significant (p<0.001); female students showed remarkable improvement from 1999 to 2001 (Cohen's delta=0.67). CONCLUSIONS: Patient satisfaction scores indicated that undergraduate curriculum for communication skills in SMS improved from 1999 to 2001. Newly implemented small group discussion was a possible reason for the improvement, especially in female students. Further training for the skills of encouraging and answering questions and clear explanations will be the next step.
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Papers by Hirotaka Onishi