The Second International Physician Seminar 講義内容
Joel Branch, BSc, MB BS, MRCP (UK).
Director of Internal Medicine Education & Simulation Skills Training, Shonan Kamakura General Hospital.
1993-1999 – University College London School of Medicine;
1999-2006 – Residency and specialization in Diabetes and Endocrinology with General Medicine, UK;
2006-2016 - Shonan Kamakura General Hospital: permanent teaching staff (see above).
Sandra Moody, M.D., B.S.N.
Professor-in-Residence at the Kameda Medical Center in the Department of Medicine/Graduate Medical Education, Visiting professor at Tsukuba University, Associate Professor of Clinical Medicine in the Department of Medicine/Division of Geriatrics at the University of California, San Francisco (UCSF) and the San Francisco Veteran Affairs Medical Center (SFVAMC)
【Profile】Dr. Moody received her MD from The Ohio State University College of Medicine in 1991. She completed a residency in Internal Medicine, a research fellowship in the Robert Wood Johnson Clinical Scholars Program, and a clinical and research fellowship in Geriatrics Medicine at the Yale University School of Medicine (1991-1998). Her first faculty position was at the University of North Carolina, Chapel Hill (1998-2001), and subsequently at the UCSF faculty (2001-present). She has maintained affiliation with UCSF as voluntary faculty since becoming the professor-in-residence at Kameda Medical Center in 2011. Dr. Moody has collaborated on and published research work related to the care of older adults. Her clinical work has been in the area of geriatrics, including nursing home and home care, and hospice and palliative care at UCSF; she now has clinical privileges at the U.S. Naval Hospital Yokosuka in the Internal Medicine Clinic. Dr. Moody has mentored numerous individuals in medicine at all levels. She has won honors and teaching awards for her contributions in geriatrics, palliative care, and medical education.
1) The Importance of How to Take a Patient History
2) Mock Interviews for International Residency Programs
3) The Do’s and Don’ts of the physical examination – the importance of bedside etiquette.
【SESSION CONTENT】Dr. Moody and Dr. Branch will be working together throughout the seminar in three different sessions.
In the first session, Dr. Branch will be a patient and Dr. Moody will demonstrate her skills of history taking to show how a thorough history can lead to a focused differential diagnosis even before a physical examination.
In the second session, Dr. Moody and Dr. Branch will both be interviewers! If you are interested in being interviewed in a way that would be common in Western countries, then please prepare yourself!! We would like at least two attendees to volunteer as mock interviewees and to undergo the interview process. In so doing, it will provide experience of what to expect during an interview, and with other attendees as onlookers. We want open discussion about the purpose of the interviewers’ questioning so that all attendees can understand what interviewers really think!
In the third and final session, Dr. Branch will demonstrate the ‘standard’ examination that would be expected level of a first year postgraduate doctor in a Western setting. Not only that, Dr. Branch will focus on correct bedside etiquette that is not taught routinely in Japan, but which is especially important for Japanese physicians to know if they wish to practice successfully abroad.
• “Being adept at acquiring a thorough history is the foundation of how to diagnose and treat your patient accurately and efficiently.”
• “Preparation for an interview is everything. Knowing what kinds of question you will expect to receive and knowing how to answer them in a truthful and confident manner will help you on your way to passing the interview process”
• “Knowing how to be considerate, gentle, and caring to the patients you are examining is extremely important. As physicians, we are in a position of power. Therefore, we must be mindful of our actions and how they affect our patients. We should never think that we are above our patients in any way. Being in a position of power does not give us the right to treat patients disrespectfully whatsoever. Practice of the physical examination in the correct way both in terms of technique, but also with etiquette, will make you better doctors and will help to create a much better relationship with you and your patients.”
details, you need to learn the art of looking and actively seeking pertinent details.”
• “To learn effective history taking and physical examination techniques, you need to have good textbooks on the subjects (and hopefully a good teacher!). You need to read them, practice the techniques on your colleagues and on real patients, and then you need to read the books again!”
• “Being able to pass an interview is not easy. Western interviewers want to see confident, vocal, knowledgeable, but also safe doctors. You will need to change your mindset to a Western perspective to truly compete against other international postgraduate physicians. Preparation for the interview is everything!”
• “Always be respectful to patients. Always consider their discomfort and distress. Remember to drape them, respect their privacy and maintain their dignity. They are gems that you should utmost cherish.”
Kris Siriratsivawong, M.D., F.A.C.S.
Department of Medical Education
1998-2002 Yale Univesity (Bachelors of Science in Molecular Biophysics and Biochemistry)
2002-2006 University of Pittsburgh School of Medicine (Doctor of Medicine)
2006-2007 Naval Medical Center San Diego (Basic Surgery Intern)
2007-2009 General Medical Officer (1st Marine Division)
2009-2013 Naval Medical Center San Diego (General Surgery Residency)
2013-2015 General Surgeon, Fleet Surgical Team, Amphibious Ready Group
2015-2017 General Surgeon and Department Head, U.S. Naval Hospital Yokosuka
2017-present Lecturer, Department of Medical Education, Showa University
【SESSION THEME】 The One-year Fellowship Program for Japanese physicians:
Clinical experience in Western-style Medicine in Japan
【SESSION CONTENT】 As former lead surgical educator for the Japanese Fellowship program, I had worked closely with Japanese physicians who have an interest in pursuing medical training in North America. There are multiple options for Japanese physicians to obtain clinical experience in U.S. style of medical practice. One of those options is to obtain the experience right here in Japan, by working at one of the U.S. military hospitals. I will discuss the options for those who wish to explore this valuable experience.
Furthermore, during this session, I will go over the keys to successfully obtaining a residency position in the United States. I will touch on the challenges and pitfalls that you might encounter along the way. We will discuss the learning points from Japanese physicians that spent time in the U.S. for medical training. For those who have successfully navigated this process, I also welcome your input.
・ A one-year fellowship experience at one of the U.S. Navy hospitals in Japan could be a potential stepping stone for further training in the United States and overseas.
・ Obtaining formal medical training in the United States is a challenging endeavor, which includes learning a different set of medical terminology and changing the cultural mindset of medical education, but can open doors of opportunities.
【FINAL WORDS】“If you can’t fly, run; if you can’t run, walk; if you can’t walk, crawl; but by all means keep moving.” - Martin Luther King Jr.
Andrew Ten Have MA, M.D., MPH
Board-certified Family Medicine Physician, CompHealth, Salt Lake City Utah
【Profile】 1990 - 1994 University of California School of Medicine, San Francisco (UCSF, Doctor of Medicine)
1995 - 1996 Kaiser Foundation Hospital, San Francisco (Internal Medicine PGY-1)
1996 - 1997 Harvard School of Public Health (Master of Public Health, Program in Clinical Effectiveness)
1997 - 1998 Eisai Pharmaceutical Co., Tokyo Japan (Pharmacovigilance physician)
1998 - 2000 University of Hawaii JABSOM Family Medicine Program (Residency)
2000 - 2013 Private Practice, Kamuela, Hawaii
2015 - 2017 Kawasaki Saiwai Hospital, Japan (Director of English-based 研修医 Training Program)
2014 - Present CompHealth, Salt Lake City, UT (Board-certified Family Medicine Physician)
2013 - Present HHR Health Research (consultancy), Tokyo, Japan (Medical Director)
【SESSION THEME】The structure, elements and style of the focused case presentation
【SESSION CONTENT】The purpose of the focused case presentation is to quickly share information and to debate and discuss diagnostic and treatment options. This is what your English-speaking medical colleagues want to hear and understand, whenever you speak to them about your patient. It is used in final-year clinical rotation (sub-internship), residency, fellowship and experienced clinical practice. Making a focused presentation also helps you to organize your thoughts, form your differential diagnosis, and manage your future patients more effectively.
・The focused case presentation focuses on the chief complaint, and it is brief, less than 10 minutes long.
・The HPI (history of present illness) is the core (or centerpiece) of the oral presentation! 90% of correct diagnoses are made from the HPI alone. It is the “story” that supports your idea of the diagnosis (your differential diagnosis).
・Present only facts. Save your comments and opinions for the “Assessment”.
・You will practice examples of the above points in small groups, and receive a hand-out sheet in English and Japanese, for your future review of the material learned in this session.
【FINAL WORDS】Both medical education and patient’s health hinge (depends strongly) on what physicians hear. Let us help them (other physicians and students) in the difficult task of listening. -- from Kurt Kroenke MD in “The Case Presentation: Stumbling Blocks and Stepping Stones” (1985).
Takayuki Oshimi M.D.
Associate Professor, International University of Health and Welfare School of Medicine
Executive Board member of the Japan Society for Medical English Education
【Profile】Dr. Takayuki Oshimi, Associate Professor of International University of Health and Welfare (IUHW) School of Medicine in Narita, is a program director of its very unique medical English curriculum. His clinical training was in gastroenterology at Asahikawa Medical University, and he received training as a medical interpreter and as a trainer of medical interpreting in the United States. Dr. Oshimi also obtained his post-graduate diploma in community interpreting and translation from Macquarie University in Sydney, Australia. He currently devotes the majority of his time to medical education, specialized in clinical communication skills as well as training health care interpreters at the IUHW’s graduate school.
【SESSION THEME】5 Steps for Answering to Challenging Questions at USMLE Step 2 Clinical Skills
【SESSION CONTENT】During your patient encounter at USMLE Step 2 Clinical Skills, every simulated patient will ask you one or more challenging questions, such as "Why have you kept me waiting so long?" and/or "Am I going to die?" In this 50-minute interactive session, we will have discussions and role plays to learn how to answer those challenging questions as well as how to counsel your patients to modify their unhealthy habits.
5-step strategy for challenging questions
Step 1: Express your interest in your patient’s concern
Step 2: Restate your patient’s concern to express your understanding
Step 3: Reassure your patient using the PEARLS technique
Step 4: Give your honest but diplomatic answer to the question
Step 5: Ask if your patient has more questions
【FINAL WORDS】"Fake it till you make it!"
Tamerlan Babayev MBBS BSc
Research Assistant, International University of Health and Welfare School of Medicine
【Profile】Dr. Tamerlan Babayev is a research assistant of the International University of Health and Welfare (IUHW) School of Medicine in Narita. He graduated from Imperial College London and undertook clinical training in general surgery in the United Kingdom. He moved to Japan in April 2017 to contribute to the forward-thinking medical English education program at IUHW where he focuses on teaching medical English, clinical history taking and examination skills.
【SESSION THEME】A framework for breaking bad news to patients
【SESSION CONTENT】In the past many physicians thought it inhumane to share bad news with their patients, and thus often kept negative clinical details to themselves. It has since been recognised that the overwhelming majority of patients want to know the truth about their diagnoses and thankfully medical practice has changed to follow suit.
How you share bad news may affect your patient’s understanding, satisfaction with their care and psychological wellbeing; but knowing this is the case does not in itself help you to do so.
In this session you will be introduced to a framework to help you develop the very challening skill of sharing bad news with a patient. By having a systematic, step-wise approach to these situations, you start to develop confidence and skill in this otherwise daunting task.
・ Sharing bad news is a complex skill that is more than just saying the right words
・ The SPIKES protocol is a practical guide to approaching these types of clinical encounter that can increase your confidence
・ Learn to do this right, and your patients will feel respected, cared for and supported.
【FINAL WORDS】"The physician should not treat the disease but the patient who is suffering from it.” - Maimonides
Junji Machi, M.D., Ph.D., F.A.C.S.
Professor of Surgery; Assistant Director of Office of Global Health/Medicine, JABSOM, University of Hawaii; Founder, JrSr Corporation
1970-1977 Juntendo University
1977-1981 Okinawa Chubu (resident)
1981-1984 University of Illinois (Research Fellow)(M.S. 1982, Ph.D. 1984)
1984-1987 Kurume University
1987-1993 Medical College of Pennsylvania (Research and Resident)
1993-1995 Mercy Hospital of Pittsburgh (Resident)
1995- present University of Hawaii . Abdominal ultrasound module director, American College of Surgeons
2014 Founder, Junior Senior (JrSr Corporation); 2017- University of Hawaii Japanese liaison representative, Okinawa Chubu Hospital Residency program.
【SESSION COORDINATION】As a coordinator of the second “JrSr International seminar for students and residents”, I welcome you all. The unique strengths of this seminar include 1) international passionate clinician-educators living in Japan, 2) small group interactive sessions, including USMLE mock oral interview, 3) emphasizing basic clinical skills (history and physical) and communication skills, and 4) potentially an excellent step to the US training. The key for success of this seminar is not JrSr, not teachers but it is you. You should and can enjoy the seminar by discussion, communication and participation in the seminar, by teaching and learning each other, and by making many friends. It is your seminar for improvement, globalization, prosperity and dream for your future career and your life.
・ Understanding global medical education, particularly the value of acquiring bedside clinical skills
・ Motivation to be an active learner and future passionate teacher
・ Recognition of your goals as a physician and your dreams in your life
【TODAY'S WORDS TO TOU】
“Every patient is your best teacher: every clinical opportunity is a teachable and learning moment.”
“Don’t worry about mistake or failure. Worry about the chances you miss when you don’t even try.”
“Learn from yesterday, live for today, hope for tomorrow. The important thing is to keep moving forward.”
“Don't quit, because you are not a failure until you quit or fail to try.”
“The future belongs to those who believe in the beauty of their dreams.”