Sadayoshi Ohbu

Assessment of professionalism: Recommendations from the Ottawa 2010 Conference

Over the past 25 years, professionalism has emerged as a substantive and sustained theme, the operationalization and measurement of which has become a major concern for those involved in medical education. However, how to go about establishing the elements that constitute appropriate professionalism in order to assess them is difficult. Using a discourse analysis approach, the International Ottawa Conference Working Group on Professionalism studied some of the dominant notions of professionalism, and in particular the implications for its assessment. The results presented here reveal different ways of thinking about professionalism that can lead towards a multi-dimensional, multi-paradigmatic approach to assessing professionalism at different levels: individual, inter-personal, societal–institutional. Recommendations for research about professionalism assessment are also presented.

Psychological adjustment has a greater effect on health-related quality of life than on severity of disease in Parkinson's disease

The objective of this study was to investigate the effect of psychological adjustment to Parkinsons disease (PD) on the health‐related quality of life (HRQL) in patients with this condition. One hundred eighty‐three patients (77 male, 106 female; mean age, 65.8 years) were evaluated using the Parkinsons Disease Questionnaire (PDQ‐39) and the Japanese version of the Nottingham Adjustment Scale (NAS‐J). Multiple regression analysis was performed using age and sex as the explanatory variables. Comparisons were made of changes in R2 when severity and psychological adjustment subscales were added. In addition, comparisons were made of HRQL scores between groups with different levels of psychological adjustment. R2 was higher when psychological adjustment was included in comparison with severity in the some subscales (emotional well‐being, stigma, social support, cognition, communication, and bodily discomfort). HRQL was significantly lower in the low‐adjustment group compared with other groups. Psychological adjustment had a greater effect than severity of disease on several subscales in the HRQL of patients with PD. This finding suggests that, in addition to any suppression of the progression of symptoms, psychological intervention may also be effective in enhancing the HRQL of patients with PD.

Professionalism Mini-Evaluation Exercise for medical residents in Japan: a pilot study.

Context  Assessing medical professionalism among medical residents is of great importance. The Professionalism Mini‐Evaluation Exercise (P‐MEX) is a tool for assessing professionalism that was developed, tested for reliability and validated in Canada. Prior to the present study, no Japanese version of the P‐MEX had been tested.

Impact and characteristics of quality of life in Japanese patients with multiple sclerosis

PurposeTo evaluate health-related quality of life (HRQOL) in Japanese patients with multiple sclerosis (MS) and investigate associations between the results of these QOL assessments and disease severity.MethodsOne-hundred sixty-three Japanese MS patients completed a questionnaire battery comprising the Functional Assessment of MS (FAMS), the Nottingham Adjustment Scale-Japanese version (NAS-J), and the European QOL scale (EQ-5D). Additional five factors affecting QOL as identified by MS patients in a focus group interview were also investigated: employment status, change of income, availability of disease information, communication with medical staff, and care received. Disease severity was determined using the Expanded Disability Status Scale (EDSS).ResultsThere was a strong negative correlation of the subscale scores for mobility, symptoms, emotional well-being, thinking and fatigue, and additional concerns on the FAMS with EDSS score. For the NAS-J, only acceptance of the condition was correlated with disease severity. Among the five additional aspects of the condition identified by patients, employment status, income, and disease information were shown to be important for maintaining QOL in patients with MS.ConclusionsSupport for finding employment and having increased or maintained household income and readily available information about the disease contribute to improving QOL in Japanese MS patients.

Introducing the professionalism mini-evaluation exercise (p-MEX) in Japan: Results from a multicenter, cross-sectional study

Purpose Despite the growing importance of and interest in medical professionalism, there is no standardized tool for its measurement. The authors sought to verify the validity, reliability, and generalizability of the Professionalism Mini-Evaluation Exercise (P-MEX), a previously developed and tested tool, in the context of Japanese hospitals. Method A multicenter, cross-sectional evaluation study was performed to investigate the validity, reliability, and generalizability of the P-MEX in seven Japanese hospitals. In 2009–2010, 378 evaluators (attending physicians, nurses, peers, and junior residents) completed 360-degree assessments of 165 residents and fellows using the P-MEX. The content validity and criterion-related validity were examined, and the construct validity of the P-MEX was investigated by performing confirmatory factor analysis through a structural equation model. The reliability was tested using generalizability analysis. Results The contents of the P-MEX achieved good acceptance in a preliminary working group, and the poststudy survey revealed that 302 (79.9%) evaluators rated the P-MEX items as appropriate, indicating good content validity. The correlation coefficient between P-MEX scores and external criteria was 0.78 (P < .001), demonstrating good criterion-related validity. Confirmatory factor analysis verified high path coefficient (0.60–0.99) and adequate goodness of fit of the model. The generalizability analysis yielded a high dependability coefficient, suggesting good reliability, except when evaluators were peers or junior residents. Conclusions Findings show evidence of adequate validity, reliability, and generalizability of the P-MEX in Japanese hospital settings. The P-MEX is the only evaluation tool for medical professionalism verified in both a Western and East Asian cultural context.

Reanalysis of unruptured intracranial aneurysm management: effect of a new international study on the threshold probabilities.

Objective. This report updates previous clinical decision analysis for patients with unruptured intracranial aneurysm (UN-AN) based on newly published data and discusses the role of reanalysis in individual decision making. Methods. The authors employed probabilities for the natural history of UN-AN and results of preventive surgery based on the report by the International Study of Unruptured Intracranial Aneurysms. Probabilistic sensitivity analysis with Monte Carlo simulation and traditional n-way sensitivity analyses were used to assess the uncertainty of clinical decisions. Results. The baseline decision in favor of preventive surgery is reversed by new data from the international study. Probabilistic sensitivity analyses revealed several populations showing heterogeneity in terms of strategy selection. One- and two-way sensitivity analyses detected two important factors for decision making: annual rupture rate and utility for knowingly living with UN-AN. Conclusions. Annual UN-AN rupture rate and the utility for knowingly living with UN-AN are key factors when deciding on a therapeutic strategy. Also, updating published decision analyses can improve clinical decision making by integrating clinical judgment and newly available clinical data.

Infarction of the Conus medullaris

We encountered a patient with acute cauda equina syndrome. The clinical course, laboratory data and imaging study, including magnetic resonance imaging (MRI) strongly suggested that this episode was caused by a vascular disorder of the conus medullaris. We emphasized the diagnostic usefulness of MRI in the vascular disease of the conus medullaris as well as the clinical importance of this disease in the differential diagnosis of acute cauda equina syndrome.

Japanese physicians’ preferences for decision making in rheumatoid arthritis treatment

Background Rheumatoid arthritis (RA) is a complex chronic illness requiring continued medical care. During the past decade, the therapeutic options for RA have increased significantly; these often have a higher risk of adverse effects and are more expensive than traditional drugs. Rheumatologists may hence face difficulties when deciding on the optimal modality in initiating or changing treatment. The aim of this study was to explore the Japanese physicians’ usual style of and preferences for decision making regarding RA treatment. Methods This was a cross-sectional study conducted using an Internet survey. Respondents were asked about their usual style of making treatment decisions (perceived style), and their perception of the importance of physicians’ actions and patients’ attitudes. Results Of the 485 physicians who were sent the questionnaire, 157 responded completely (response rate: 32.3%). Ninety-two percent of the respondents were men, and 57% were clinicians with more than 20 years of experience. Their specialties were general medicine (29%), rheumatology (27%), orthopedics (31%), and rehabilitation (12%). Sixty-one (39%) stated that they usually presented multiple treatment options to their patients and selected a decision for them, 42 (27%) shared the decision making with their patients, 34 (22%) let their patients choose the treatment, and 20 (13%) made the treatment decision for the patients. Physicians using the shared decision making (SDM) style desired for their patients to have supportive family and friends, to discuss with nurses, and to follow the doctors’ directions more strongly compared with physicians using the other styles. There were no significant differences in sex, duration of clinical experience, major place of clinical work, and number of patients per month by the styles. More number of rheumatologists and physicians with specialist qualifications stated that they practiced SDM. Conclusion To enhance patient participation, physicians need to recognize the importance of discussing treatment options with patients in addition to giving them information.