How can we design a curriculum for a resilient medical student? - A blueprint for resiliency programs for med students in Japan

Recent research around the world has consistently reported that medical students experience a high rate of psychological morbidity, depersonalization, and low personal accomplishment. Resilience-enhancing programs have been proposed and implemented even in Japan. However, most of them remain extracurricular programs that are not specifically tailored to medical students. Additionally, they mostly mimic resiliency programs in North America, although studies have indicated that cultural perspective to the self, others, and context contribute to the capacity to respond to a stressful situation.In this context, the presenters investigated what factors might affect the similarities or differences in the perceptions of resilience among experienced palliative care physicians in Canada and Japan in 2017-2018 in order to propose a theory for a resiliency curriculum from a different cultural perspective. This study showed that Japanese physicians are more likely to rely on “Relationships” with other persons such as mentors, family, friends, or colleagues; in contrast, Canadian physicians tended to be more focused on individual factors such as “Autonomy” and “Confidence”.As a result, Showa University School of Medicine in Japan has developed a progressively advancing resiliency program for first through fourth year medical students as part of a new curriculum, implementation of which will begin in the spring of 2020. This represents one of the largest revisions in the school’s history. In this presentation, a blueprint for resiliency programs in a new curriculum will be presented, including course description, course content, educational objectives, learning resources, timetables, and instructional strategies.

Dermoscopy of Rippled Pattern Sebaceoma

A 77-year-old Japanese woman presented a dome-shaped pinkish nodule on the scalp. Dermoscopy demonstrated yellowish homogeneous ovoid areas with translucent whitish veil and arborizing vessels. No association with Muir-Torre syndrome was found. Histopathology revealed a smooth-bordered neoplasm in the dermis with partial connection to the epidermis. The tumor was composed mainly of germinative cells. The tumor focally showed a typical “rippled pattern”. There were only a few vacuolated cells suggesting sebaceous differentiation. These cells were highlighted with adipophilin antibody. No nuclear atypia or mitotic figures were observed. We regarded the neoplasm as sebaceoma. Dermoscopy demonstrated clearly visualized yellowish homogeneous ovoid areas. This feature usually corresponds to dermal conglomerations of the cells with sebaceous differentiation. However, this case histopathologically showed only limited area with sebaceous differentiation. We presented a case of rippled-pattern sebaceoma and described its dermoscopic features. This was the first report referring to the dermoscopic features of sebaceoma

Zolpidem therapy in dystonia

Although there are some newly developed options to treat dystonia, its medical treatment is not always satisfactory. Zolpidem, an imidazopyridine agonist with a high affinity on benzodiazepine subtype receptor BZ1 (ω1), was found to improve clinical symptoms of dystonia in a limited number of case reports. To investigate what subtype of dystonia is responsive to the therapy, we conducted an open label study to assess the efficacy of zolpidem (5–20 mg) in 34 patients suffering from miscellaneous types of dystonia using the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS). Patients were entered into the study if they had been refractory to other medications as evaluated by BFMDRS (no change in the previous two successive visits). After zolpidem therapy, the scores in the patients as a whole were decreased from 7.2 ± 7.9 to 5.5 ± 5.0 (P = 0.042). Patients with generalized dystonia, Meige syndrome/blepharospasm, and hand dystonia improved in the scale by 27.8, 17.8, and 31.0%, respectively, whereas no improvement was found in cervical dystonia patients. Overall response rate among patients were comparable to that of trihexyphenidyl. Zolpidem may be a therapeutic option for generalized dystonia, Meige syndrome, and hand dystonia including musician’s. Drowsiness was the dose-limiting factor

Efficacy of Zolpidem for Dystonia: A Study Among Different Subtypes

Although there are some newly developed options to treat dystonia, its medical treatment is not always satisfactory. Zolpidem, an imidazopyridine agonist with a high affinity on benzodiazepine subtype receptor BZ1 (ω1), was found to improve clinical symptoms of dystonia in a limited number of case reports. To investigate what subtype of dystonia is responsive to the therapy, we conducted an open label study to assess the efficacy of zolpidem (5–20 mg) in 34 patients suffering from miscellaneous types of dystonia using the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS). Patients were entered into the study if they had been refractory to other medications as evaluated by BFMDRS (no change in the previous two successive visits). After zolpidem therapy, the scores in the patients as a whole were decreased from 7.2 ± 7.9 to 5.5 ± 5.0 (P = 0.042). Patients with generalized dystonia, Meige syndrome/blepharospasm, and hand dystonia improved in the scale by 27.8, 17.8, and 31.0%, respectively, whereas no improvement was found in cervical dystonia patients. Overall response rate among patients were comparable to that of trihexyphenidyl. Zolpidem may be a therapeutic option for generalized dystonia, Meige syndrome, and hand dystonia including musician’s. Drowsiness was the dose-limiting factor

Experimental demonstration of a quantum receiver beating the standard quantum limit at the telecom wavelength

Discrimination of coherent states beyond the standard quantum limit (SQL) is an important tasknot only for quantum information processing but also for optical coherent communication. In orderto optimize long distance optical fiber networks, it is of practical importance to develop a quantumreceiver beating the SQL and approaching the quantum bound at telecom wavelength. In this paper,we experimentally demonstrate a receiver beating the conventional SQL at telecom wavelength. Ourreceiver is composed of a displacement operation, a single photon counter and a real time adaptivefeedback operation. By using a high performance single photon detector operating at the telecomwavelength, we achieve a discrimination error beyond the SQL. The demonstration in the telecomband provides the first step important towards quantum and classical communication beyond theSQL using a coherent state alphabet, and we envision that the technology can be used for long-distance quantum key distribution, effective quantum state preparation and quantum estimation

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

A Case of Primary Cutaneous Basal Cell Carcinosarcoma

A 94-year-old man consulted our hospital due to a rapidly growing tumor on the left cheek. The histological diagnosis of the tumor was basal cell carcinosarcoma, which was composed of intermingled epithelial and mesenchymal components. The former was basal cell carcinoma, while the latter was spindle cell sarcoma. The tumor was completely resected with a 3-mm margin and the patient remained free of local recurrence or distinct metastasis for 2 years. We report here a case of cutaneous basal cell carcinosarcoma and a review of the literature