Introduction of GRACE program required for COVID-19 disaster - especially for exhausted healthcare workers

The global pandemic of COVID-19 has exhausted many citizens around the world, especially health care workers. In times like these, mindfulness and compassion are necessary to heal many people. GRACE is a program that healthcare professionals can easily use in clinical practice. This program was developed by Roshi Joan Halifax, Ph.D., a Buddhist teacher, Zen priest, anthropologist, Cynda Rushton, the Bunting Chair of Ethics at Johns Hopkins University, and Professor Tony Back, a palliative care physician and medical oncologist at the University of Washington to prevent burnout among medical professionals. G.R.A.C.E. was developed in response to the deficit of compassion in the world today. The G.R.A.C.E. process includes the following five steps. G: Gathering attention and Grounding, R: Recalling intention, A: Attuning to self and other, C: Considering what will serve, E: Engaging and ending. G.R.A.C.E. is a tool for anyone, especially those in leadership roles or helping professions, such as medical workers, teachers, human rights workers, and more. In Japan, we invited three of the developers to hold training sessions since 2015. We held an annual conference every year, and monthly study sessions, in Tokyo and Osaka. Currently, we are planning to translate the online course developed in the US into Japanese and use it for training. In this presentation, we will report on the spread of G.R.A.C.E. in Japan, along with an overview of G.R.A.C.E

Adaptive challenges of curriculum implementation for enhancing medical student resilience at Showa University in Japan

It has been consistently reported that medical students experience a high rate of psychological morbidity, depersonalization, and low personal accomplishment around the world. Under the circumstances, resilience-enhancing programs have been gathering attention and partially implemented even in Japan. However, most of the programs just imitate resiliency programs in North America even though studies have indicated that there are cultural differences between East Asia and North America in the capacity to cope with a stressful situation. The presenters investigated what factors might affect the similarities or differences in the perception of resilience among experienced palliative care physicians in Canada and Japan in 2017-2018. This study showed that Japanese physicians are more likely to rely on “Relationships” with other persons such as family members, friends, mentors or colleagues; in contrast, Canadian physicians tended to be more focused on individual factors such as “Autonomy” and “Confidence”. As a result, the presenters at Showa University School of Medicine in Japan have implemented a progressively advancing resiliency program in a passed manner for the 1st through 6th year medical students as part of a new curriculum. This represents one of the most drastic revisions of curriculum in the school’s history. This presentation will introduce a course for resiliency programs as part of a new curriculum, including course description, course content, educational objectives, instructional strategies and the tips for the classroom teaching and learning. &nbsp

Culturally-adapted resilience-building curriculum for medical students: a comprehensive approach at Showa University School of Medicine, Japan

The growing prevalence of psychological morbidity, depersonalization, and low personal accomplishment among medical students underscores the need for resilience-enhancing programs tailored to their specific needs. Incorporating cultural perspectives and societal context into these interventions is crucial to ensure their effectiveness and relevance. In response, Showa University School of Medicine in Japan has pioneered a culturally-adapted, resilience-based curriculum for medical students from their first through sixth years since 2020. This presentation will outline the comprehensive framework of the resilience-focused curriculum, including course objectives, content, learning resources, timetables, and pedagogical approaches. Key components of the curriculum encompass self-assessment and reflection, stress management strategies, effective communication and conflict resolution skills, and fostering a growth mindset. Additionally, interdisciplinary collaborations with psychology and social work departments provide individual supports and resources for students. Emphasizing the distinct challenges faced by medical students, such as academic stressors, relationships with senior clinical educators, patient and family interactions, and managing errors and burnout, the presentation will highlight the classes on the curriculum, support systems and mentorship programs in promoting mental well-being and resilience. The experiences and outcomes of the 2020-2022 cohorts will be shared, offering valuable insights into the effectiveness of the resilience-building curriculum in the Japanese context. Lessons learned from the implementation process, including challenges faced and strategies employed, will provide practical examples for other medical schools seeking to develop similar programs

Factors associated with the mental health status of medical students during the COVID-19 pandemic: a cross-sectional study in Japan

Objective The COVID-19 pandemic had a substantial impact on university students, including those in medical schools, with disruption in routine education causing significant psychological distress. The objective of this study was to evaluate the factors associated with psychological distress among medical students during the period of enforced home quarantine from March through May 2020.Design A cross-sectional study.Setting One Japanese medical school.Participants 571 medical students.Primary and secondary outcome measures Self-administered electronic questionnaires including the K-6 scale for psychological distress, the Rosenberg Self-Esteem Scale (RSES) for self-esteem and the General Self-Efficacy Scale (GSES) for self-efficacy were distributed. To assess the determinant factor for psychological distress, variables such as sex, grade in school, living conditions, and RSES and GSES scores were evaluated in regression analysis.Results 163 respondents (28.5%) scored ≥5 on the K-6 scale, indicating a significant degree of psychological distress. Logistic regression revealed that a higher score on RSES (p<0.001) and GSES (p<0.01) was an independent factor associated with lower levels of psychological distress. Multiple regression analysis focusing on students with a K-6 score ≥5 revealed that higher scores on RSES correlated with lower levels of psychological distress. By contrast, those with higher GSES scores also scored higher for indicators of psychological distress.Conclusions This study identified that self-efficacy and self-esteem were both influential factors for predicting psychological distress during the current COVID-19 pandemic. Medical schools should provide support for mental health and educational initiatives directed at enhancing self-esteem and self-efficacy, with a focus on improving personal resilience. In emergency situations, such as that faced in response to the COVID-19 pandemic, initial programmes might target students with higher levels of self-efficacy. By contrast, under routine situations, these efforts should be directed towards students with lower self-esteem as primary means to prevent depression

Four Different Tumors Arising in a Nevus Sebaceous

Nevus sebaceous is known by its association with one or more secondary tumors, but more than three multiple tumors arising from a nevus sebaceous is extremely rare. A 67-year-old female presented with a light brown plaque on the back of her head that contained a dome-shaped black node and an erosive lesion. Histopathological examination showed atypical basaloid cells in the black node. At the periphery of that node, structures resembling follicular germs extruded from interlacing cords in the upper portion and tumor nests with sebocytes were in the lower portion. In the erosive lesion, papillated structures with an apocrine epithelium were observed. In the light brown plaque, enlargement of sebaceous lobules was noted. From those histopathological features, a diagnosis of syringocystadenoma papilliferum, sebaceoma, trichoblastoma and basal cell carcinoma arising from a nevus sebaceous was made. We discuss the rarity of multiple tumors arising from a nevus sebaceous