INTL-XXXX - Japan Global Health

INTL-XXXX - Japan Global Health

Elective Title: Japan Global Health
Course Number: INTL-XXXX
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 1
Prerequisites: Successful completion of Year 3
Additional Requirements: students interested in global health
Responsible Faculty Director: Sagar Kamprath, MD Periods Offered: 1-7, 9-13 excluding holiday period 8 
Coordinator: Bradley Brock Other Faculty:
Location to Report on First Day:
Teine Keijinkai Hospital, Sapporo Japan



Students will be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.


- To develop and improve the teaching skills of residents through the opportunity to serve in a resident as educator capacity and receive feedback from learners and program leadership

- To promote culture competence and understanding of patient perspectives from different cultures on health care in the future practice of medicine

- To expose residents to a unique and different approach to health care systems and the practice of medicine

You will also serve as an ambassador of our program and generally the US medical education system. You will have time to formally and informally through social activities share your experiences training in the US and more about the US health care system. In addition, you will be immersed in Japan's health care system, gaining insight into the similarities and differences relative to the practice of medicine and health care system between the two countries.

Specific aims:

o As part of your rotation, you will be expected to select a topic for study during your rotation that compares an element of the Japanese and US Health Care Systems. This can be a larger health policy or systems issue or an individual topic of interest. You will make a presentation on your selected topic to Japan and UTMB audiences. Topic examples (open to interest of resident):

- Comparison of BMI rates in the US vs Japan

- Suicide rates in the US vs Japan

- Colon Cancer Screening Approaches / Rates in the US vs Japan

- Health Insurance in Japan vs US

- Health care spending in Japan vs US

- Length of stay, Readmission in Japan vs US

- Dementia care in Japan vs US

- Care of the elderly population (institutions / structures / payment) in US vs Japan

Description of course activities
This rotation is designed to provide students an experience working within and interacting with a residency training program in Sapporo, Japan. You will primarily be working with Japanese student doctors in their PGY1 / 2 years in Japan, which is a similar level clinically to 3rd and 4th year medical students in the United States.

o See table below for an outline of the rotation schedule.

o The resident/student will have the primary responsibility of leading teaching sessions in English during their stay in Japan, this will include leading a morning report once a week, rounding with the Medicine team each morning and giving input and feedback on cases presented in English during rounds (typically will be table rounds).

Cultural immersion with weekly morning report in English as well rounds with the inpatient team, followed by teaching in the afternoon

Type of students who would benefit from the course
those interested in global health, ideally 4th year with interest in language and culture

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday 8:30- 12:00 morning conference and rounds 1-5 teaching/office hours and afternoon rounds
Tuesday 8:30- 12:00 morning conference and rounds 1-5 Karinpa outpatient clinic
Wednesday 8:30- 12:00 morning conference and rounds 1-5 teaching/office hours and afternoon rounds
Thursday 8:30- 12:00 morning conference and rounds 1-5 home visits/Karinpa Clinic
Friday 7:30- 8:30 report, 8:30-12:00 conf. & rounds 1-5 teaching/office hours and afternoon rounds

 Average number of patients seen per week: 20
 Call Schedule: no

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Inpatient team included medical students, residents, and doctors
  B. Frequency / Duration of Presentation(s)?
    1-2 per day
  C. Format - What guidelines are set for the student's presentation?
    SOAP format
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    end of rotation research paper or essay
  B. Format - What guidelines are set for the student's written work?
    TBD case reports vs narrative options
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    presentation at global health conferences, eg AAFP global health summit etc

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".
    Students will cover cost of airfare and travel

7.  Other Modes of Evaluation
  Please explain below.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.