Considering life through death - introduction to lessons of life

I am a palliative care physician for 30 years. And I have been teaching " Lessons of Life " to medical students and elementary, junior high, and high school students for 30 years. Based on the words left behind by the deceased patient, these are classes to think about life through death. I would like to introduce some of the lectures at this conference. When I took care of a 23-year-old female terminal cancer patient, her pain of bone metastasis, which could not be removed, was relieved by a wedding ceremony. I was taught that pain is relieved not by drugs but by supporting the hopes and dreams of patients. A 21-year-old woman with cancer of unknown primary cancer, who had not been told of her prognosis, realized that she was dying and left a letter for her mother. She wrote, "I am glad I was born as your daughter” with gratitude. A 17-year-old high school male student, who had a brain tumor, left a diary. In the diary, he wrote, "If I were to die tomorrow, what would I do today? All I can do now is to live my life to death as I am.”An 18-year-old woman, battling rhabdomyosarcoma,said,“Walking, talking, seeing, hearing, laughing, crying, and living. You may think it’s normal as someone who always takes it for granted, but that’s not the case.” Through the words and actions left behind by my patients, I learn that we are living a day that is irreplaceable. &nbsp

Survey on the current status of undergraduate education on self-care in university medical schools and medical colleges in Japan

A survey on the current status of undergraduate education on self-care was conducted in university medical schools and medical colleges in Japan. This survey was planned and conducted by the Professionalism Subcommittee of the Japan Society for Medical Education. Prior approval was given by the Ethics Committee of Showa University. Self-care education was defined as education to enhance the well-being (physical and mental health) of medical students. Of the 82 universities invited to participate, 65 universities responded to the survey, giving a response rate of 79.3%. Of these 65 universities, 32 universities (49.2%) indicated that they were implementing self-care education programs. Stress management, mindfulness, self-awareness, resilience, and improvement of self-affirmation were the most common topics, and many of the faculty in charge of the topics were psychiatrists, psychologists, and medical education faculty members. Although about half of the universities implemented self-care education programs, the educational content has not yet been standardized, suggesting the need for standardization of self-care education in the future. The survey was conducted in all medical year levels, and the results showed that self-care education is given to first- and second-year medical students. It was suggested that it is necessary to provide more education to upper-year medical students who undergo clinical practice and experience increased stress. The need for self-care education for medical students has become even more important since 2020 and onwards, partly because of the impact of the COVID-19 pandemic

Mindfulness-based self-care education for healthcare professional students in Japan

[Background] Recent studies have consistently shown that medical students experience a high rate of psychological symptoms. In this situation, teaching mindfulness in medical school has the potential to prevent student burnout. However, there are few consistent educational programs in medical schools throughout Japan.[Method] Since 2015, Showa University (Tokyo) has practiced an intensive self-care program based on mindfulness for 600 first-year healthcare professional students in the schools of medicine, dentistry, pharmacy, nursing, and rehabilitation. The target objectives of this program were as follows: understand the needs of self-care, enhance self-awareness, evaluate evidence of mindfulness for mental diseases, and practice formal/informal mindfulness-based activities. This program consisted of a 90-minute lecture, followed by consecutive reflective activities, including completing personal journals and portfolios. The students were required to plan how to make use of what they learned in this course. The students were asked to complete a questionnaire upon completion of the course.[Results] The questionnaire indicated that more than 90% of the students were satisfied with the program, and about 25% started regular mindfulness-based practices such as meditation and breathing methods aimed to reduce test anxiety. Descriptions from the e-portfolio showed that the participants understood evitable stressors and the importance of the body-mind relationship.[Conclusion] Mindfulness-based self-care education can encourage healthcare students to understand the necessity of self-care during the early stages of their professional training. This program for the first year students will be followed by a course on Professionalism for healthcare professional students during their subsequent years of university education. 

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

The self-care education for healthcare professional students using mindfulness

Background Recent studies has consistently shown medical students experience high rate psychological symptoms. Under this circumstance teaching mindfulness is a possible option. However, there are few consistent educational courses in medical schools in Japan.Method Showa University (Tokyo, Japan) launched an intensive self-care program based on mindfulness for 600 first-year healthcare professional students in 2015 (120 medicine, 110 dentistry, 210 pharmacist, 100 nursing, 60 PT and OT). The target achievements of this program were as follows:Understand the needs of self-care, Enhance self-awareness, Evaluate evidence of mindfulness for mental diseases, Practice formal/informal mindfulness-based activities. This program consisted of a 90-minutes lecture, and consecutive reflective activities completing personal journals and portfolio follow the lectures. The students are required to plan how to make use of what they learned in this course. The students were asked to complete a questionnaire after the course.Results The questionnaire indicated that 98% of the students were satisfied with the course materials. In particular, some participants stated that regular mindfulness-based practices such as meditation, breathing method, and even informal mindfulness activities in daily life reduced test anxiety, mood- dependent behavior, and absence of flexibility. Descriptions from the e-portfolio showed that the participants understood the importance of body-mind relationship and evitable stressors around them.ConclusionTeaching mindfulness could encourage healthcare students to understand the necessity of self-care at early stages of their professional training. The results would help to develop our next stage of this self-care program based on mindfulness, 12 weekly 1.5-hours session. 

A New Description of a Healthcare Professional’s Resilience, Incorporating an Eastern Philosophical Perspectives of Self-definition. How to Bridge the Gap between Independent and Interdependent Self-definition in Medical Education

Teaching about resilience is one of the biggest challenges in medical education. One of the problems is that medical educators might still ascribe to the individualistic self-definition mainly promoted in the North American society. This definition includes characteristics such as “enduring ongoing hardship,” “thriving on challenges,” “being healthy,” and “being stronger,” which may raise hidden expectations that a healthcare professional’s personality should be strong enough to bounce back to his or her original condition even in a psychologically demanding situation. Psychological theorists describe two broad modes of self-definition in two different cultures: independent self-definition in North American individualism and interdependent self-definition in East Asian collectivism. Despite this seemingly stereotypical discussion on the characteristics of self-definition, a discussion of the two types of self-definition can still encourage medical educators to propose a broader model of resilience in medical education. More specifically, a person using an independent self-definition may become be a complete, whole, autonomous entity, without others, and thus tends to achieve more and become more productive in a competitive society. In contrast, a person using an interdependent self-definition is more likely to be open to another aspect of the context and thus might be able to find and value the self in different ways even in the same context. However, these two self-definitions may not be dichotomous or mutually exclusive but occur in varying ratios in any one individual, particularly as trends of increased globalization, immigration, and technology call for changes in an individual’s value systems in countries. From this standpoint, this review proposes a new definition of resilience in medical education, which is ‘a person’s capacity to be aware of the aspects of the self differently identified in each context, and to consciously value oneself and others in the context’. This is the first article that incorporates the concept of the two self-definitions into resilience education in healthcare. The proposed definition may provide a broader model of resilience in a healthcare professional for educators as well as trainees in medical education

Do Canadian and Japanese palliative care physicians perceive the concept of resilience differently?

Teaching about resilience is one of the biggest challenges in medical education. One of the problems of currently accepted definitions is that they attribute individualistic notions mainly originating in North American society, such as “endure ongoing hardship,” “thrive on challenges,” “be healthy,” and “be stronger.” In response to this situation, Tsuchiya et al (2017) proposed a description of a broader model of a resilient physician in healthcare that incorporates concepts of self-definition as described in both North American and the East Asian societies; that is, “a person’s capacity to be aware of the aspects of the self differently identified in each context, and to consciously value oneself and others in the context”. However, the concept is still theoretical, and more empirical understanding is needed.This presentation will examine the findings from our exploratory study on physician resilience using semi-structured interviews with 20 palliative care physicians (10 each in Canada and Japan) to answer the following questions:(1) Are there any differences in the way Canadian and Japanese palliative care physician perceive resilience? (2) What factors might affect the similarities or differences of their perceptions of resilience? (3) Are these findings consistent with Tsuchiya’s description? Following qualitative analysis using a grounded theory approach, a schematic representation of resilience in physicians will be offered, to inform a coherent educational program for resilient healthcare professionals.

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.

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