INTRODUCTION

Kampo medicine has a method of diagnosis called Fukushin, or abdominal palpation, that has undergone independent development in Japan. In this method, the practitioner applies pressure with her fingers on the patient's abdomen, using the sensation and the patient's reaction to judge the patient's condition. The information obtained in this way is called an Abdominal diagnosis1-4). Training doctors to perform the palpa-tion correctly and obtain a correct abdominal diagnosis is challenging: it is a burden on human subjects, and in any case it is difficult to find sub-jects exhibiting the important main abdominal patterns in daily clinical activity.

Using simulators has been shown to be a viable way around this problem5-7). Yakubo et al. have developed the Fukushin simulator for pedagogical purposes, consisting of the major abdominal patterns con-

sidered of clinical significance in Kampo medicine (Figure 1)8-12). This makes it possible for students to gain practical experience in Fukushin across all the major abdominal patterns irrespective of the availability of human subjects.

One important clinical sign is abdominal strength. Yakubo et al. cre-ated models to manifest five gradations of abdominal strength: Marked excess, Slight excess, Intermediate, Slight deficiency, and Marked defi-ciency. 80.0% of practitioners given an opportunity to evaluate the mod-els found them acceptable10).

The Fukushin simulator has been used in university-level Kampo education. At Nihon University's School of Medicine, Fukushin work-shops using the simulator were conducted with approximately 30 stu-dents per group. Five Abdominal strength pattern models were prepared, as well as several Abdominal specific pattern models, with plates attached on which the abdominal diagnoses were written. The lecturer explained the techniques necessary for abdominal diagnosis using slides. Afterwards, students went around the room freely, performing

International Medical Journal Vol. 28, No. 5, pp. 539 - 541 , October 2021

KAMPO MEDICINE

A New Method for Training Medical Students in Abdominal Diagnosis in Kampo Style through Use of a Simulator

Masaki Baba1), Toshisuke Tanaka1), Shuji Yakubo1,2), Eriko Fukuda1), Koji Sakata1), Mita Tomohiro1), Shiho Kaibara1), Arisa Oka1), Mayu Watanabe

1), Tomohiro Hattori2,3),

Takao Namiki4), Daisuke Kon5), Richard S. Lavin6)

ABSTRACTPurpose: When conducting workshops on abdominal palpation, a kind of examination by touch favoured in Kampo medi-

cine, with medical students, we have observed students who, even when given an opportunity to practice the method for them-selves, are reluctant to do so. In this paper, we describe a teaching method that aims to encourage all students to take an active part.

Methods: We prepared Abdominal strength pattern models (5 gradations) and 8 Abdominal specific pattern models with the Fukushin simulator, labeled not with the name of the model but a number or letter and arranged at random around the room. Students are required to go around the room and perform abdominal diagnosis on the different models, attempting to write the correct diagnosis for each one.

Results: The inclusion of this type of activity appeared to make the training more enjoyable for students, with all of them carrying out diagnosis enthusiastically.

Conclusion: The results appear to show that it is desirable to incorporate this type of training (Abpalle KAMPO for stu-dents) as a standard part of Fukushin education for students.

KEY WORDSKampo Medicine, abdomimal palpation, abdominal diagnosis, simulator, medical students

Received on February 16, 2021 and accepted on April 22, 20211) Department of Clinical Kampo Medicine, Meiji Pharmaceutical University 2-522-1 Noshio, Kiyose-city, Tokyo 204-8588, Japan2) Division of General Medicine, Department of Internal Medicine, Nihon University, School of Medicine 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo 173-8610, Japan3) Deparment of Pulumonary Medicine, International University of Health and Welfare Ichikawa Hospital 6-1-14, Konodai, Ichikawa-city, Chiba 272-0827, Japan4) Department of Japanese-Oriental (Kampo) Medicine, Graduate School of Medicine, Chiba University 1-8-1 Inohana, Chuo-ku, Chiba-city, Chiba 260-8677, Japan5) Nomura Techno Co., Ltd. 2-2-1 Shinkiba, Koto-ku, Tokyo 136-0082, Japan6) Faculty of Letters, Prefectural University of Kumamoto 3-1-100 Tsukide, Higashi-ku, Kumamoto-city, Kumamoto 862-8502, JapanCorrespondence to: Shuji Yakubo(e-mail: yakubo@my-pharm.ac.jp)

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C 2021 Japan University of Health Sciences & Japan International Cultural Exchange Foundation

Baba M. et al.540

abdominal diagnosis on the models. Student impressions of this work-shop were favourable13). However, we observed some students who were not active in this workshop and tended to avoid performing abdominal diagnosis themselves using the simulator. Therefore, we resolved to develop an Abdominal palpation learning system in Kampo style for medical students that would encourage all students to participate active-ly. We dubbed this system Abpalle KAMPO for students.

MATERIALS AND METHODS

(i) In our established method for Fukushin simulator workshops, plates with the names of five Abdominal strength pattern models (Table 1) and eight Abdominal specific pattern models (Table 2) were set next to the corresponding models. In the new method, the models were not labeled in the same way; rather, the models were arranged in random order and plates were labeled from A to E for the strength pattern mod-els, and Ⅰ to Ⅷ for the specific pattern models (Figure 2).

(ii) As in our established method, the lecturer gave a lecture using prepared slides on Abdominal diagnosis, including technique.

(iii) The lecturer prepared a handout containing the names of the five Abdominal strength patterns and eight Abdominal specific patterns, with spaces for students to enter the corresponding models (Figure 3).

(iv) Students went around the room carrying out abdominal diagno-sis on all the models, using their best judgment to decide with which diagnosis on the handout each one corresponds and entering the appro-priate number or letter on the handout.

(v) Finally, the lecturer gave the correct answers, explaining each diagnosis again.

Figure 1: Current abdominal palpation examination simulator covered with polyvinylchloride resin

Table 1. Abdominal strength pattern modelsAbdominal diagnosis: Description

Marked excess pattern: Strongest resistance of abdominal wall and obvious abdominal distension

Slight excess pattern: Somewhat strong resistance of abdominal wallIntermediate pattern: Neither strong nor weak resistance of abdominal wallSlight deficiency pattern: Somewhat weak resistance of abdominal wallMarked deficiency pattern: Weakest resistance of abdominal wall and

retraction of abdomen

Table 2. Abdominal specific pattern modelsAbdominal specific pattern model: Description

Stuffiness and rigidity below the heart model: Increased resistance in the epigastric region

Fullness in the chest and hypochondrium model: Increased resistance on both sides of the hypochondriac region

Rectus muscle tension model: Increased resistance in the area correspond-ing to the abdominal rectus muscle

Lower rectus muscle tension model: Increased resistance in the area corre-sponding to the abdominal rectus muscle in the lower abdomen

Lower abdominal fullness model: A horseshoe-shaped area of markedly increased resistance in the lower abdomen

Lower abdominal numbness model: Diminished resistance in the center of the lower abdomen

Abdominal fluid congestion model: A splashing sound is heard on tapping the abdomen

Abdominal palpitation model: A pulsating sensation can be felt in the abdomen

Figure 2: Arrangement of Abdominal strength pattern models and Abdominal specific pattern models. Note that plates have numbers and letters rather than names of Abdominal patterns.

Figure 3: Students quiz paper, with spaces for students to write the appropriate letter or number

Figure 4: Learning pyramid. See14).

A New Training Method in Abdominal Diagnosis in Kampo Style 541

RESULTS

Using the new method, we observed that all students participated actively, carrying out abdominal palpation on the various models in the Fukushin simulator. The "quiz" element, whereby students were required to conduct diagnosis themselves and try to match each model with the correct pattern, appears to have contributed to student enthusi-asm.

DISCUSSION

The U.S.'s Educational Commission for Foreign Medical Graduates has determined that, starting in 2024, graduates of overseas medical schools will not be eligible for licensing under the provisions of the United States Medical Licensing Examination unless their medical school has been accredited by the commission. To become eligible, all of Japan's medical schools are introducing major changes to their curric-ula, reducing time spent in lectures and increasing time spent in practi-cal training in medical wards. In these circumstances, it has become more important to maximize the efficiency of our Kampo medical edu-cation programs.

As suggested by the learning pyramid (Figure 4), in order to learn the skills necessary for clinical practice lectures alone may not be very effective14). It is often pointed out that practical experience is an import-ant part of effective education, and that is the impetus behind many active learning initiatives15).

Yakubo et al. use a simulator in their Fukushin Training Sessions for Practitioners. Results of a questionnaire survey administered at these sessions indicate greater understanding of abdominal patterns as a result of the training sessions and favorable impressions of the participants regarding the usefulness of the sessions16). In addition, Yakubo et al.'s Abdominal palpation learning system in Kampo style (Abpalle KAMPO), also aimed at helping practitioners to learn abdominal diag-nosis, has been evaluated highly as a practical and efficient way of deepening understanding of abdominal diagnosis17). Arita et al. also report that, in a Fukushin practicum for students, the use of the Fukushin simulator was effective18). In short, it appears that it is possible to increase the efficiency of students' learning of abdominal diagnosis through active learning featuring the Fukushin simulator.

Unfortunately, though, even in active learning classes featuring the Fukushin simulator, there are some students who do not participate actively. It is necessary to devise a different approach in order to increase their motivation or enhance their awareness of the purpose of the classes.

Therefore, in the present study we added a quiz component to our active learning design featuring the Fukushin simulator, in an attempt to heighten students motivation. This resulted in increased participation.

Other innovations can be envisaged. Students could work collabora-tively in groups to answer the questions; alternatively, pairs of students could compete to get the highest number of correct answers. We believe that it may be necessary to incorporate a gaming element to maximally motivate all students.

CONCLUSION

It appears that, in Kampo training, featuring practical experience using the Fukushin simulator is insufficient, since there are some stu-dents who fail to engage actively. Therefore, we introduced a quiz com-ponent after letting students try out abdominal diagnosis for themselves using the simulator. This resulted in increased active participation in the training. Future work needs to focus on increasing motivation further through the incorporation of gaming elements.

CONFLICTS OF INTEREST

The authors declare that there are no conflicts of interest regarding

the publication of this paper.

ACKNOWLEDGEMENT

This work was supported by Japan Kampo Medicine Education Foundation.

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