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ObjectivesTraining strategies regarding entrustable professional activities (EPAs) vary from country to country; one such strategy is for residents. However, there are no reports of EPAs developed for residents who rotate to the nephrology departments. We aimed to construct such EPAs, which could be generalised to other institutions.DesignPurposive design and a modified Delphi method to build consensus.SettingThe department of nephrology in a university hospital in Aichi Prefecture, Japan.ParticipantsBased on the attainment goals used in our department, an initial list was developed within the research group. The expert panel included 25 nephrologists from our affiliate hospital. Responses were based on a 5-point method and agreement was reached if both (A) and (B) were met: (A) mean≥4 with a SD ResultsAn initial list of 11 items was developed; after three Delphi rounds and revisions, eight items remained that were then established as the final EPAs. These items can serve as a list of goals to be reached by residents who rotate to the department of nephrology. The results indicated that most of the experts believed residents should be able to perform tasks deemed necessary or urgent for all physicians, such as those that deal with hyperkalaemia and heart failure.ConclusionsThe concept of EPAs enabled us to develop goals and evaluation criteria for residents’ training in nephrology. This study can serve as a springboard for future discussions and contribute to the development of resident education in nephrology.

Background Contrastive learning is known to be effective in teaching medical students how to generate diagnostic hypotheses in clinical reasoning. However, there is no international consensus on lists of diagnostic considerations across different medical disciplines regarding the common signs and symptoms that should be learned as part of the undergraduate medical curriculum. In Japan, the national model core curriculum for undergraduate medical education was revised in 2016, and lists of potential diagnoses for 37 common signs, symptoms, and pathophysiology were introduced into the curriculum. This study aimed to validate the list of items based on expert consensus. Methods The authors used a modified Delphi method to develop consensus among a panel of 23 expert physician-teachers in clinical reasoning from across Japan. The panel evaluated the items on a 5-point Likert scale, based on whether a disease should be hypothesized by final-year medical students considering given signs, symptoms, or pathophysiology. They also added other diseases that should be hypothesized. A positive consensus was defined as both a 75% rate of panel agreement and a mean of 4 or higher with a standard deviation of less than 1 on the 5-point scale. The study was conducted between September 2017 and March 2018. Results This modified Delphi study identified 275 basic and 67 essential other than basic items corresponding to the potential diagnoses for 37 common signs, symptoms, and pathophysiology that Japanese medical students should master before graduation. Conclusions The lists developed in the study can be useful for teaching and learning how to generate initial hypotheses by encouraging students’ contrastive learning. Although they were focused on the Japanese educational context, the lists and process of validation are generalizable to other countries for building national consensus on the content of medical education curricula.

PURPOSE Social isolation has been identified as a major health problem, particularly in the elderly. In the present study, we examine the association between social isolation and patient experience in elderly primary care patients. METHODS This cross-sectional study was conducted in a primary care practice–based research network (28 clinics) in Japan. We assessed social isolation using an abbreviated Lubben Social Network Scale and patient experience of primary care using a Japanese version of the Primary Care Assessment Tool (JPCAT), which comprises 6 domains: first contact, longitudinality, coordination, comprehensiveness (services available), comprehensiveness (services provided), and community orientation. We used a linear mixed effects model to adjust clustering within clinics and individual covariates. RESULTS Data were analyzed for 465 elderly primary care patients aged ≥65 years. After adjustment for possible confounders and clustering within clinics, social isolation was negatively associated with the JPCAT total score, (mean difference = −3.67; 95% CI, −7.00 to −0.38). Among the JPCAT domain scores, social isolation was significantly associated with longitudinality, comprehensiveness (service provided), and community orientation scores. CONCLUSIONS Social isolation was associated with negative patient experience in elderly primary care patients. Raising awareness regarding patient social networks among primary care providers and targeted interventions for socially isolated elderly patients aimed at improving the experience of primary care, especially regarding longitudinality, comprehensiveness, and community orientation, may be warranted.

On March 11, 2013, the Great East Japan Earthquake (magnitude 9) hit the northern part of Japan (Tohoku), killing more than 15 000 people and leaving long-lasting scars, including psychological damage among evacuees, some of whom were health professionals. Little is known about meditation efficacy on disaster-affected health professionals. The present study investigated the effects of breathing-based meditation on seminar participants who were health professionals who had survived the earthquake. This study employed a mixed methods approach, using both survey data and handwritten qualitative data. Quantitative results of pre- and postmeditation practice indicated that all mood scales (anger, confusion, depression, fatigue, strain, and vigor) were significantly improved (N = 17). Qualitative results revealed several common themes (emancipation from chronic and bodily senses; holistic sense: transcending mind-body; re-turning an axis in life through reflection, self-control, and/or gratitude; meditation into mundane, everyday life; and coming out of pain in the aftermath of the earthquake) that had emerged as expressions of participant meditation experiences. Following the 45-minute meditation session, the present study participants reported improvements in all psychological states (anger, confusion, depression, fatigue, strain, and vigor) in the quantitative portion, which indicated efficacy of the meditation. Our analysis of the qualitative portion revealed what and how participants felt during meditating.