Joshua L. Jacobs

Assessing Items on the SF-8 Japanese Version for Health-Related Quality of Life: A Psychometric Analysis Based on the Nominal Categories Model of Item Response Theory

OBJECTIVES The Short Form-8 (SF-8) questionnaire is a commonly used 8-item instrument of health-related quality of life (QOL) and provides a health profile of eight subdimensions. Our aim was to examine the psychometric properties of the Japanese version of the SF-8 instrument using methodology based on nominal categories model. METHODS Using data from an adjusted random sample from a nationally representative panel, the nominal categories modeling was applied to SF-8 items to characterize coverage of the latent trait (theta). Probabilities for response choices were described as functions on the latent trait. Information functions were generated based on the estimated item parameters. RESULTS A total of 3344 participants (53%, women; median age, 35 years) provided responses. One factor was retained (eigenvalue, 4.65; variance proportion of 0.58) and used as theta. All item response category characteristic curves satisfied the monotonicity assumption in accurate order with corresponding ordinal responses. Four items (general health, bodily pain, vitality, and mental health) cover most of the spectrum of theta, while the other four items (physical function, role physical [role limitations because of physical health], social functioning, and role emotional [role limitations because of emotional problems] ) cover most of the negative range of theta. Information function for all items combined peaked at -0.7 of theta (information = 18.5) and decreased with increasing theta. CONCLUSION The SF-8 instrument performs well among those with poor QOL across the continuum of the latent trait and thus can recognize more effectively persons with relatively poorer QOL than those with relatively better QOL.

Residents’ Experience of Scholarly Activities is Associated with Higher Satisfaction with Residency Training

ABSTRACTBACKGROUNDThe Ministry of Health, Labour and Welfare of Japan has been promoting participation in scholarly activities for physicians during residency training. However, there is debate regarding whether this is worthwhile for residents.OBJECTIVETo evaluate residents’ opinions of engaging in scholarly activities and identify factors associated with overall satisfaction with their training program.DESIGNCross-sectional national survey.PARTICIPANTS1,124 second-year residents in teaching hospitals in Japan in 2007MEASUREMENTSCollected data included demographics, teaching hospital characteristics and resources, residents’ research experiences, including type of activities, barriers to performing scholarly activities, residents’ opinions of scholarly requirements, and resident satisfaction with their residency program.RESULTS1,124 residents/1,500 responded for a response rate of 74.9%. Our data showed that 60.2% of Japanese residents engaged in some type of scholarly activity. Barriers included: “No resident time”; “No mentor;” and “No resident interest.” Sixty-three percent of residents thought that research should be a residency requirement. In multivariate logistic analysis, residents’ overall satisfaction with their residency program was significantly associated with participation in research activity (odds ratio (OR), 1.5; 95% confidence interval (CI), 1.1–2.1); male gender (OR, 1.5; 95% CI: 1.1–2.2); satisfaction with residency compensation (OR, 3.8; 95% CI, 2.6–5.0), and satisfaction with the residency curriculum (OR, 19.5; 95% CI, 13.7–27.7).CONCLUSIONSThe majority of residents surveyed thought that research activity was worthwhile. Residents’ participation in research activity was associated with higher levels of satisfaction with residency training. Implementing measures to overcome existing barriers may have educational benefits for residents.

Undergraduate educational environment, perceived preparedness for postgraduate clinical training, and pass rate on the National Medical Licensure Examination in Japan

BackgroundWe investigated the views of newly graduating physicians on their preparedness for postgraduate clinical training, and evaluated the relationship of preparedness with the educational environment and the pass rate on the National Medical Licensure Examination (NMLE).MethodsData were obtained from 2429 PGY-1 physicians-in-training (response rate, 36%) using a mailed cross-sectional survey. The Dundee Ready Education Environment Measure (DREEM) inventory was used to assess the learning environment at 80 Japanese medical schools. Preparedness was assessed based on 6 clinical areas related to the Association of American Medical Colleges Graduation Questionnaire.ResultsOnly 17% of the physicians-in-training felt prepared in the area of general clinical skills, 29% in basic knowledge of diagnosis and management of common conditions, 48% in communication skills, 19% in skills associated with evidence-based medicine, 54% in professionalism, and 37% in basic skills required for a physical examination. There were substantial differences among the medical schools in the perceived preparedness of their graduates. Significant positive correlations were found between preparedness for all clinical areas and a better educational environment (all p < 0.01), but there were no significant associations between the pass rate on the NMLE and perceived preparedness for any clinical area, as well as pass rate and educational environment (all p > 0.05).ConclusionDifferent educational environments among universities may be partly responsible for the differences in perceived preparedness of medical students for postgraduate clinical training. This study also highlights the poor correlation between self-assessed preparedness for practice and the NMLE.

Use of surgical face masks to reduce the incidence of the common cold among health care workers in Japan: A randomized controlled trial

BACKGROUND Health care workers outside surgical suites in Asia use surgical-type face masks commonly. Prevention of upper respiratory infection is one reason given, although evidence of effectiveness is lacking. METHODS Health care workers in a tertiary care hospital in Japan were randomized into 2 groups: 1 that wore face masks and 1 that did not. They provided information about demographics, health habits, and quality of life. Participants recorded symptoms daily for 77 consecutive days, starting in January 2008. Presence of a cold was determined based on a previously validated measure of self-reported symptoms. The number of colds between groups was compared, as were risk factors for experiencing cold symptoms. RESULTS Thirty-two health care workers completed the study, resulting in 2464 subject days. There were 2 colds during this time period, 1 in each group. Of the 8 symptoms recorded daily, subjects in the mask group were significantly more likely to experience headache during the study period (P < .05). Subjects living with children were more likely to have high cold severity scores over the course of the study. CONCLUSION Face mask use in health care workers has not been demonstrated to provide benefit in terms of cold symptoms or getting colds. A larger study is needed to definitively establish noninferiority of no mask use.

Development of a simple model for predicting need for surgery in patients who initially undergo conservative management for adhesive small bowel obstruction

BACKGROUND Among patients with adhesive small bowel obstruction (ASBO) initially managed with a conservative strategy, predicting risk of operation is difficult. METHODS We investigated ASBO patients at 2 different periods to derive and validate a clinical prediction model for risk of operation. RESULTS One hundred fifty-four patients were enrolled into the derivation cohort and 96 into the validation cohort. Based on the derived scoring, including age > or =65 years, presence of ascites, and gastrointestinal drainage volume >500 mL on day 3, each patient was classified into 1 of 4 risk classes from low risk to high risk. When applied to the validation cohort, the positive predictive value (PPV) for operation in the high-risk class was 72%, while the negative predictive value (NPV) in the low-risk class was 100% with high sensitivity (100%) and specificity (96%). CONCLUSIONS The prediction model performs well for risk stratification of need for surgical intervention following conservative strategy among ASBO patients.

Building a successful platform for interprofessional education for health professions in an Asian university

Implementing Interprofessional Education (IPE) across health professions schools is challenging. Within an Asian context, academic staff at the National University of Singapore designed a platform to create a sustainable IPE effort. A two-pronged approach was developed to ensure adequate coverage of key concepts relating to IPE within each involved faculty. The Interprofessional Core Curricula (ICC) component ensures that each health profession student will be exposed to IPE concepts in their required curriculum. Interprofessional Enrichment Activities (IEA) incentivize further cross-faculty participation and progress within the IPE competency framework. Best practices and success factors were identified, while lessons learned led to further improvements. Adoption of this approach can help circumvent well-known barriers to implementation.

A global template for reforming residency without work-hours restrictions: Decrease caseloads, increase education. Findings of the Japan Resident Workload Study Group

Background: Japanese physician training programs are currently not subject to rigorous national standardization. Despite residency restructuring in 2004, little is known about the current work allocation of residents in Japan. Aims: We quantified the amount of time that Japanese junior residents spend in service versus education in the context of caseload, fatigue, and low-value administrative work. Methods: In this prospective, time-and-motion study, the activity of 1st- and 2nd-year residents at three Japanese community hospitals was observed at 5-min intervals over 1 week, and categorized as patient care, academic, non-patient care, and personal. Self-reported sleep data and caseload information were simultaneously collected. Data were subanalyzed by gender, training level, hospital, and shift. Results: A total of 64 participating residents spent substantially more time in patient care activities than education (59.5% vs. 6.8%), and little time on low-value, non-patient work (5.1%). Residents reported a median 5 h of sleep before shifts and excessive sleepiness (median Epworth score, 12). Large variations in caseload were reported (median 10 patients, range 0–60). Conclusions: New physicians in Japan deliver a large volume of high-value patient care, while receiving little structured education and enduring substantial sleep deprivation. In programs without work-hour restrictions, caseload limits may improve safety and quality.

Implementing an online curriculum management database in a problem-based learning curriculum.

Managing a medical school curriculum is a difficult challenge. The body of knowledge is large, diverse, and changing. Continuous oversight is required to ensure the proper balance of learning opportunities, to eliminate redundancies, and to fill in gaps. Within the context of the integrated problem-based learning curriculum at the University of Hawaii John A. Burns School of Medicine (JABSOM), the authors describe a 2003 transition from a paper-based method of curriculum tracking to an online international database. The tool chosen, the Curriculum Management and Information Tool (CurrMIT®), allows for myriad ways of entering data and structuring the curriculum, but presents unique challenges as well. The authors describe how this new tool was implemented at JABSOM, which included initial data entry by course directors, who provided close scrutiny of course content and took the opportunity to more closely align course objectives with course content. A keyword meta-data strategy was adopted to tag each curriculum element. Despite some difficulties, the resulting ease and accuracy of report generation has produced significant benefit to course directors and to the curriculum oversight committee, and has allowed even further improvement in the educational process. This strategy has been successfully adopted and adapted by other institutions.

Video‐enhanced problem‐based learning to teach clinical skills

Context and setting Uganda is one of the world’s least developed countries. Makerere Medical School has neither an equipped skills laboratory nor designated trained personnel for teaching clinical skills. Makerere lacks the funds to construct and equip a skills laboratory and train the trainers. Training of clinical skills to medical students has been implemented traditionally during the clinical clerkships in Uganda. In 2003–04 a problem-based learning (PBL), student-centred medical undergraduate curriculum was introduced with the stated goal of early clinical exposure and training of clinical skills. Why the idea was necessary Early introduction of clinical skills was viewed to be beneficial, as these skills may take a significant time to develop. Moreover, early introduction of these skills would probably facilitate the integration of clinical and basic science knowledge. The objectives of the training were to develop competency in communication and history taking, as well as procurement of vital signs. What was done? A clinical skills training curriculum was developed through a number of meetings, and consultation workshops with institutional leaders and faculty. At these forums, consensus was reached regarding the objectives, format and content of the curriculum in order to match and maintain relevance between PBL cases and the skills training curriculum. Initial implementation of the clinical skills training took place during the 2nd semester of 2004. Students in the 1st and 2nd years received 2 clinical skills training sessions of 2 hour each over a period of 15 weeks; 1st-year skills in interpersonal communication and vital signs were taught using mini-lectures, demonstrations and role play, and 2nd-year skills covered interpersonal communication and general history-taking procedures. Teachers demonstrated skills to students, who in turn performed the procedure on their peers. A ratio of 1 teacher to 15 students was maintained. In order to determine the students’ perceptions of the programme, a questionnaire using a 5-point Likert scale was administered to 32 randomly selected 1st-year students from a population of 100. The teachers’ opinion on how to improve the curriculum and their enjoyment of the training were also elicited. Student assessment was not performed in this pilot programme, which was used to obtain data for assessment criteria. Evaluation of the results and impact All students and teachers indicated that they had enjoyed the training sessions. All the students surveyed agreed that the clinical skills programme was tailored to their knowledge level, that session objectives were clear and that teachers demonstrated the skills adequately. Students indicated concern about timely feedback, lack of equipment for learning and time for supervised practice. Faculty recommended improvement of the facilities and recruitment of more faculty to teach the course. This project demonstrated that early training in clinical skills is feasible in resource-limited environments. Moreover, training space may be upgraded as a result of the pilot.

Teaching in the clinical environment: Guide Supplement 34.1–Viewpoint

Teaching in the clinical environment is a complex proposition. The AMEE guide of the same title authored by Ramani and Leinster (2008) sets as its ambitious goal, to provide background information on the theoretical underpinnings and practical advice to assist with this task. As with any guide, it is essential to keep in mind the assumptions that were used to establish a baseline from which to interpret the guidance described. In the present AMEE Guide, it appears the authors wrote assuming that the clinical teaching would be occurring within the context of an established course, in a medical training programme. While some of the guidance may be applied to other health professions, interdisciplinary team training is not directly addressed. Additionally, for clinical teaching that occurs in the absence of clearly defined roles, goals and objectives, these teachers are best advised to obtain training in establishing these basic parameters to maximize the benefits of the guide. In order to apply the advice presented, it is imperative to have a clear course infrastructure in place.