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The cultural context of teaching and learning sexual health care examinations in Japan: a mixed methods case study assessing the use of standardized patient instructors among Japanese family physician trainees of the Shizuoka Family Medicine Program.

Shultz CG, Chu MS, Yajima A, Skye EP, Sano K, Inoue M, Tsuda T, Fetters MD - Asia Pac Fam Med (2015)

Bottom Line: Residents' and SPIs' perceptions of the training were universally positive, with SPIs observing a positive effect on residents' knowledge, confidence, and skill.SPIs found specific instruction-related approaches to be particularly helpful, such as the positioning of the interpreter and the timing of interpreter use.Deep-rooted taboos surrounding gender-specific health care appear to be a significant barrier preventing experimentation with SPI-based sexual health training in Japan.

View Article: PubMed Central - PubMed

Affiliation: Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI 48104-1213 USA.

ABSTRACT

Background: In contrast to many western nations where family medicine is a cornerstone of the primary care workforce, in Japan the specialty is still developing. A number of services within the bailiwick of family medicine have yet to be fully incorporated into Japanese family medicine training programs, especially those associated with sexual health. This gap constitutes a lost opportunity for addressing sexual health-related conditions, including cancer prevention, diagnosis, and treatment. In this mixed methods case study we investigated the perceived acceptability and impact of a standardized patient instructor (SPI) program that trained Japanese family medicine residents in female breast, pelvic, male genital, and prostate examinations.

Case description: Building on an existing partnership between the University of Michigan, USA, and the Shizuoka Family Medicine Program, Japan, Japanese family medicine residents received SPI-based training in female breast, pelvic, male genital, and prostate examinations at the University of Michigan. A mixed methods case study targeting residents, trainers, and staff was employed using post-training feedback, semi-structured interviews, and web-based questionnaire.

Discussion and evaluation: Residents' and SPIs' perceptions of the training were universally positive, with SPIs observing a positive effect on residents' knowledge, confidence, and skill. SPIs found specific instruction-related approaches to be particularly helpful, such as the positioning of the interpreter and the timing of interpreter use. SPIs provided an important opportunity for residents to learn about the patient's perspective and to practice newly learned skills. Respondents noted a general preference for gender concordance when providing gender-specific health care; also noted were too few opportunities to practice skills after returning to Japan. For cultural reasons, both residents and staff deemed it would be difficult to implement a similar SPI-based program within Japan.

Conclusions: While the SPI program was perceived favorably, without sufficient practice and supervision the skills acquired by residents during the training may not be fully retained. Deep-rooted taboos surrounding gender-specific health care appear to be a significant barrier preventing experimentation with SPI-based sexual health training in Japan. The feasibility of implementing a similar training program within Japan remains uncertain. More research is needed to understand challenges and how they can be overcome.

No MeSH data available.


Overview of the standardized patient instructor experience for Japanese family medicine residents and the mixed methods case study procedures
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Fig1: Overview of the standardized patient instructor experience for Japanese family medicine residents and the mixed methods case study procedures

Mentions: As part of the SMARTER-FM project, all Shizuoka Family Medicine residents had a 2-week rotation at the University of Michigan, usually in their first year (Fig. 1). In addition to other clinical teaching and experiences during this rotation, residents received SPI-based training in female breast, pelvic, male genital, and prostate examinations. The SPI-based training started with residents reviewing in advance textual materials and online videos, followed by didactic sessions—delivered by an attending family medicine physician from the University of Michigan (EPS)—focusing on anatomy and proper examination technique. Didactic sessions were augmented with hands-on practice using models simulating physical examination findings. On separate days, residents worked with a female SPI for female breast and pelvic exams, and a male SPI for male genital and prostate exams. An experienced Japanese-English interpreter was present for each resident throughout the training. Ample opportunity was provided for one-on-one practice and feedback. During the 2-week experience, residents worked closely with University of Michigan family medicine faculty at the Japanese Family Health Program in Ann Arbor, MI (USA), where the SPI-based training was reinforced through focused instruction with consenting patients.Fig. 1


The cultural context of teaching and learning sexual health care examinations in Japan: a mixed methods case study assessing the use of standardized patient instructors among Japanese family physician trainees of the Shizuoka Family Medicine Program.

Shultz CG, Chu MS, Yajima A, Skye EP, Sano K, Inoue M, Tsuda T, Fetters MD - Asia Pac Fam Med (2015)

Overview of the standardized patient instructor experience for Japanese family medicine residents and the mixed methods case study procedures
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4597438&req=5

Fig1: Overview of the standardized patient instructor experience for Japanese family medicine residents and the mixed methods case study procedures
Mentions: As part of the SMARTER-FM project, all Shizuoka Family Medicine residents had a 2-week rotation at the University of Michigan, usually in their first year (Fig. 1). In addition to other clinical teaching and experiences during this rotation, residents received SPI-based training in female breast, pelvic, male genital, and prostate examinations. The SPI-based training started with residents reviewing in advance textual materials and online videos, followed by didactic sessions—delivered by an attending family medicine physician from the University of Michigan (EPS)—focusing on anatomy and proper examination technique. Didactic sessions were augmented with hands-on practice using models simulating physical examination findings. On separate days, residents worked with a female SPI for female breast and pelvic exams, and a male SPI for male genital and prostate exams. An experienced Japanese-English interpreter was present for each resident throughout the training. Ample opportunity was provided for one-on-one practice and feedback. During the 2-week experience, residents worked closely with University of Michigan family medicine faculty at the Japanese Family Health Program in Ann Arbor, MI (USA), where the SPI-based training was reinforced through focused instruction with consenting patients.Fig. 1

Bottom Line: Residents' and SPIs' perceptions of the training were universally positive, with SPIs observing a positive effect on residents' knowledge, confidence, and skill.SPIs found specific instruction-related approaches to be particularly helpful, such as the positioning of the interpreter and the timing of interpreter use.Deep-rooted taboos surrounding gender-specific health care appear to be a significant barrier preventing experimentation with SPI-based sexual health training in Japan.

View Article: PubMed Central - PubMed

Affiliation: Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI 48104-1213 USA.

ABSTRACT

Background: In contrast to many western nations where family medicine is a cornerstone of the primary care workforce, in Japan the specialty is still developing. A number of services within the bailiwick of family medicine have yet to be fully incorporated into Japanese family medicine training programs, especially those associated with sexual health. This gap constitutes a lost opportunity for addressing sexual health-related conditions, including cancer prevention, diagnosis, and treatment. In this mixed methods case study we investigated the perceived acceptability and impact of a standardized patient instructor (SPI) program that trained Japanese family medicine residents in female breast, pelvic, male genital, and prostate examinations.

Case description: Building on an existing partnership between the University of Michigan, USA, and the Shizuoka Family Medicine Program, Japan, Japanese family medicine residents received SPI-based training in female breast, pelvic, male genital, and prostate examinations at the University of Michigan. A mixed methods case study targeting residents, trainers, and staff was employed using post-training feedback, semi-structured interviews, and web-based questionnaire.

Discussion and evaluation: Residents' and SPIs' perceptions of the training were universally positive, with SPIs observing a positive effect on residents' knowledge, confidence, and skill. SPIs found specific instruction-related approaches to be particularly helpful, such as the positioning of the interpreter and the timing of interpreter use. SPIs provided an important opportunity for residents to learn about the patient's perspective and to practice newly learned skills. Respondents noted a general preference for gender concordance when providing gender-specific health care; also noted were too few opportunities to practice skills after returning to Japan. For cultural reasons, both residents and staff deemed it would be difficult to implement a similar SPI-based program within Japan.

Conclusions: While the SPI program was perceived favorably, without sufficient practice and supervision the skills acquired by residents during the training may not be fully retained. Deep-rooted taboos surrounding gender-specific health care appear to be a significant barrier preventing experimentation with SPI-based sexual health training in Japan. The feasibility of implementing a similar training program within Japan remains uncertain. More research is needed to understand challenges and how they can be overcome.

No MeSH data available.