Version 1
(2009-2011)
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Resident
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Emergency department in hospital
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1) Identifying critical
diseases
2) If necessary, start initial management (e.g. giving oxygen or providing intravenous access)
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Triage and management of patients with (2) fever, (3) febrile convulsion, (4) wheezing, (5) abdominal pain, and (6) nausea and vomiting, (7) rash
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Using mannequins
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Continuous formative assessment
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No instruction guide
Experience-based teaching
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Program held at the clinical training hospital
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“The main concept for residents in the early stages of their residency who do not examine children is making sure they do not overlook children.” (Jan. 2014, Kyoto)
“From a certain point, the focus was placed on family physicians involved in primary care and GPs, and subsequently on nurses….” (June 2014, Kyoto)
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“The motivation (for starting the program) was the fact that first-year residents in 2008 began examining children in the emergency outpatient ward at Iizuka Hospital.” (Jan. 2014, Kyoto)
“Primary care physicians began to participate in the programs we were running, and as a result we started hearing comments like ‘It’s impossible to insert an intravenous line” and “It is impossible to take a blood sample.” This was in 2011. So we made some refinements and switched to a setting that is closer to primary care.” (Jan. 2014, Kyoto)
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“The course is for the purpose of deciding whether a patient is in danger or whether or not the patient can wait until morning, without jumping right to a diagnosis.” (June 2014, Hokkaido)
“I have honestly heard that if you pass a patient on to a pediatrician, in many cases, the Department of Pediatrics finds that the patient had a disease that could wait until morning and sends the patient home. So, although it is important to know which diseases should not be overlooked, I have heard the opinion that people in the Department of Pediatrics would also appreciate it if there was some instruction on sending patients home when they have diseases that do not warrant a hospital stay.” (Jan. 2014, Kyoto)
“It is necessary to have the ability to make a presentation (when consulting with a pediatrician) when it is determined that the patient cannot be sent home.” (June 2014, Hokkaido)
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“From among the signs that are frequently seen during (pediatric) emergency outpatient visits, we try to make sure the most acute (diseases) are not overlooked….” (Jan. 2014, Kyoto)
“The symptom that has the highest needs is “Rash”. Next is “Not doing well”.” (Jan. 2014, Kyoto).
“But, if you think about the 6-hour framework, something has to be reduced.” (Jan. 2014, Kyoto)
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“I thought roleplay would be key because it is a simulation. Now, we are using dolls and laminated photos of children’s faces. If only there were a scenario with a child with asthma, and a scenario of a child with intussusception of intestine who said that he had abdominal pain – of course, roleplays have limitations too – but if we tried that now, we could improve on it in the future. This time, we tried using an iPad” (June 2014, Hokkaido)
“We used a very real simulator and did an extremely real simulation, so I had the feeling that I understood, but I do not think I’ll really understand unless I examine an actual patient myself. So, it isn’t really necessary to be overly focused.” (June 2014, Hokkaido)
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“I felt that perhaps one of the advantages was the fact that I could see how others behave and use that to correct my own behavior.” (Jan. 2014, Kyoto)
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“The facilitator was very skilled, I thought…the facilitator maintained overall control while still making sure that learning was taking place…it is extremely difficult to verbalize facilitation and so I think it is difficult to learn….” (Jan. 2014, Kyoto)
“The fact that you get to become one of the teachers very quickly was very good, and the fact that you learn as you teach … compared to other courses, you do more learning as you teach … on the other hand, that can be a disadvantage as well, but the quality of those who teach is quite different.” (June 2014, Hokkaido)
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Program held at the academic conference
Aug, 2010
Japan primary care association (JPCA) Jul, 2011
JPCA
Aug, 2011
The Society of Ambulatory and General Pediatrics of Japan
(SAGPJ)
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Version 2
(2011-2014)
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Resident
Primary care physician
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Emergency department in hospital
Urgent Care Center
Clinic
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1) Same
2) If necessary, start oxygen supplementation and intravenous access if possible;
early consultation
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Triage and management of patients with (2) fever, (3) febrile convulsion (FC), (4) wheezing, (5) abdominal pain, and (6) nausea and vomiting
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Mannequins
Photo of child's face (looking ill)
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Sharing schedule and content information before the program using communication methods such as Skype
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Clinical training hospital
Academic conference
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“I worked in an NICU, but I spent 8 years treating only neonates. Originally, I was in adult wards as well, but despite the fact that nurses are supposed to be generalists, I worked in many fields that I had never studied, so I was motivated to get at least a little exposure to other fields.” (July 2015, Tottori)
“I was a student when I attended the program. I did not take it because I wanted to be involved in pediatrics or anything like that. I had nothing like that on my mind when I attended. I still do not have much involvement with pediatrics, so what I learned was like a “model.” Maybe not exactly like a “manual,” but I thought of it as an example of how I should go about a medical examination.” (July 2015, Tottori)
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“Now I’m a Japanese Red Cross Society Infant Safety Advisor and so sometimes I teach in the local community. That is why I do not want to teach mothers to do the wrong thing, and as I get many questions, I want to be well informed. That’s why I participated.” (June 2015, Nagahama)
“For example, we have as many telephone consultations as we do examinations. However, I have a feeling that there are more areas in the gray zone, such as questions about certain symptoms related to what I learned.” (June 2015, Nagahama)
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“Regarding the use of drugs, nurses think that this does not fall under their area of responsibility. However, I thought that the workshop was very good by the end. If we are going to be required to do that sort of thing, however, I wonder if we really should be doing it.” (June 2015, Nagahama)
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“The triage scenario used anaphylaxis in triage 1, but as there is a lot of public concern about food allergies…after the simulation ended, I learnt about how to treat patients with the EpiPen, but it is better to use the EpiPen at exactly the right dosage and then evaluate…and I think it should be based on the correct process up until the device is introduced, so we switched from the original triage items to a detailed scenario.” (Feb. 2015, Tokyo)
“The groups always referred to the text but no reference was made to the text during the scenario, so I felt as though I didn’t really understand how to use drugs throughout the entire program.” (Feb. 2015, Kyoto)
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“T&A itself is both teaching pediatrics and providing a framework for multidisciplinary cooperation, right? In that sense, it is a mixture, and since it is something that you might be subjected to, it is better to be aware that people might find that you cannot do it, right?” (Feb. 2015, Tokyo)
“I’d be happy if we had a Help Card. If doctors do not understand or if they are unable to understand beyond a certain point, it is better for them to be able to express themselves, because it is difficult for nurses when they are unable to express what they mean. This not the TV show “Who Wants to Be a Millionaire?” so there is no option to “Ask the Audience” or “Phone-a-Friend” so the Help Card makes things easier.” (June 2015, Nagahama)
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“The participants probably ultimately felt that they confidently achieved the partial verbalization and noticed things during the pair feedback that was part of the process. However, I think it would be better to have some kind of system where you have points that you can check to see if you successfully completed the learning tasks either during the process or at the end.” (April 2016, Tochigi)
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“We discussed all this in the pre-meeting, but if there was a written version like a facilitator manual or an SP manual of some kind, then even people who are not able participate in the web conference might come, so it should be left in that form.” (Feb. 2015, Kyoto).
“The fact that there were some people who had done facilitating in the past and the fact that there were some nurses among a large number of doctors made it a bit difficult for the nurses.” (Feb. 2015, Fukuoka)
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Sep, 2012 JPCA
Jul, 2013 JPCA
Jun, 2014 JPCA
Aug, 2012-2014 SAGPJ
Jan, 2014 Japan Medical Association in Kyoto
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Version 3
(Now)
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Resident
Primary care physician
(Junior – senior)
Nurse
Junior pediatrician
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Emergency department in hospital
Urgent Care Center
Clinic
Nurse triage
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In addition to Version 2,
consider the timing of the consultation with the pediatrician.
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In addition to Version 2, strive to enhance the list of disease entities associated with rash
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iPad includes
*SimMon (iApp)
*Breath sounds
*Ultrasound videos
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In addition to Version 2,
*Facilitation guide
*Prepare the FAQs
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Clinical training hospital
Academic conference
Japan Medical Association
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