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Background The coronavirus disease 2019 (COVID-19) pandemic has led to considerable advances in medical education through technological integration. The crisis generated by the pandemic in medical practice, education, and evolving technology has led to changes in the skills of medical professionals. This study aimed to examine the competencies required of medical students in the post-pandemic era. Methods We conducted 2 mixed-methods studies. Study 1 explored medical students’ necessary competencies after the COVID-19 pandemic. We conducted group work with faculty members and students from the Chiba University School of Medicine, captured proposed competencies, discussed them, and qualitatively analyzed the group work data using content analysis to extract the competencies. Study 2 was a secondary data analysis that compared the categories identified in Study 1 with the competencies required prior to the COVID-19 pandemic, which were extracted from the websites of all 82 medical schools and colleges in Japan, to identify the differences in competencies before and after the pandemic. Results Study 1 resulted in the identification of 12 categories and 62 subcategories. The results of Study 2 showed that the increased occurrence of competencies was related to the utilization of information and communication technology (ICT) and artificial intelligence (AI), self-management, information gathering and explanation, liberal arts and generic skills, and exploring medicine and medical care/research presentations. The prevalence rates of these factors prior to the COVID-19 outbreak were 17.1%, 28.0%, 39.0%, 41.5%, and 48.8%, respectively. Conclusions Competency-based medical education in ICT, self-management, and medical exploration has become increasingly important after the pandemic. Therefore, it is necessary to develop an educational curriculum to enable medical students to acquire these competencies. The study findings contribute to the literature on medical education and offer valuable insight into setting effective academic goals and designing suitable curricula for undergraduate medical students in the post-pandemic era.

Generative artificial intelligence (GAI), represented by large language models, have the potential to transform health care and medical education. In particular, GAI's impact on higher education has the potential to change students' learning experience as well as faculty's teaching. However, concerns have been raised about ethical consideration and decreased reliability of the existing examinations. Furthermore, in medical education, curriculum reform is required to adapt to the revolutionary changes brought about by the integration of GAI into medical practice and research. This study analyzes the impact of GAI on medical education curricula and explores strategies for adaptation. The study was conducted in the context of faculty development at a medical school in Japan. A workshop involving faculty and students was organized, and participants were divided into groups to address two research questions: (1) How does GAI affect undergraduate medical education curricula? and (2) How should medical school curricula be reformed to address the impact of GAI? The strength, weakness, opportunity, and threat (SWOT) framework was used, and cross-SWOT matrix analysis was used to devise strategies. Further, 4 researchers conducted content analysis on the data generated during the workshop discussions. The data were collected from 8 groups comprising 55 participants. Further, 5 themes about the impact of GAI on medical education curricula emerged: improvement of teaching and learning, improved access to information, inhibition of existing learning processes, problems in GAI, and changes in physicians' professionality. Positive impacts included enhanced teaching and learning efficiency and improved access to information, whereas negative impacts included concerns about reduced independent thinking and the adaptability of existing assessment methods. Further, GAI was perceived to change the nature of physicians' expertise. Three themes emerged from the cross-SWOT analysis for curriculum reform: (1) learning about GAI, (2) learning with GAI, and (3) learning aside from GAI. Participants recommended incorporating GAI literacy, ethical considerations, and compliance into the curriculum. Learning with GAI involved improving learning efficiency, supporting information gathering and dissemination, and facilitating patient involvement. Learning aside from GAI emphasized maintaining GAI-free learning processes, fostering higher cognitive domains of learning, and introducing more communication exercises. This study highlights the profound impact of GAI on medical education curricula and provides insights into curriculum reform strategies. Participants recognized the need for GAI literacy, ethical education, and adaptive learning. Further, GAI was recognized as a tool that can enhance efficiency and involve patients in education. The study also suggests that medical education should focus on competencies that GAI hardly replaces, such as clinical experience and communication. Notably, involving both faculty and students in curriculum reform discussions fosters a sense of ownership and ensures broader perspectives are encompassed.

At the beginning of their clinical clerkships (CCs), medical students face multiple challenges related to acquiring clinical and communication skills, building professional relationships, and managing psychological stress. While mentoring and structured feedback are known to provide critical support, existing systems may not offer sufficient and timely guidance owing to the faculty's limited availability. Generative artificial intelligence, particularly large language models, offers new opportunities to support medical education by providing context-sensitive responses. This study aimed to develop a generative artificial intelligence CC mentor (AI-CCM) based on ChatGPT and evaluate its effectiveness in supporting medical students' clinical learning, addressing their concerns, and supplementing human mentoring. The secondary objective was to compare AI-CCM's educational value with responses from senior student mentors. We conducted 2 studies. In study 1, we created 5 scenarios based on challenges that students commonly encountered during CCs. For each scenario, 5 senior student mentors and AI-CCM generated written advice. Five medical education experts evaluated these responses using a rubric to assess accuracy, practical utility, educational appropriateness (5-point Likert scale), and safety (binary scale). In study 2, a total of 17 fourth-year medical students used AI-CCM for 1 week during their CCs and completed a questionnaire evaluating its usefulness, clarity, emotional support, and impact on communication and learning (5-point Likert scale) informed by the technology acceptance model. All results indicated that AI-CCM achieved higher mean scores than senior student mentors. AI-CCM responses were rated higher in educational appropriateness (4.2, SD 0.7 vs 3.8, SD 1.0; P=.001). No significant differences with senior student mentors were observed in accuracy (4.4, SD 0.7 vs 4.2, SD 0.9; P=.11) or practical utility (4.1, SD 0.7 vs 4.0, SD 0.9; P=.35). No safety concerns were identified in AI-CCM responses, whereas 2 concerns were noted in student mentors' responses. Scenario-specific analysis revealed that AI-CCM performed substantially better in emotional and psychological stress scenarios. In the student trial, AI-CCM was rated as moderately useful (mean usefulness score 3.9, SD 1.1), with positive evaluations for clarity (4.0, SD 0.9) and emotional support (3.8, SD 1.1). However, aspects related to feedback guidance (2.9, SD 0.9) and anxiety reduction (3.2, SD 1.0) received more neutral ratings. Students primarily consulted AI-CCM regarding learning workload and communication difficulties; few students used it to address emotional stress-related issues. AI-CCM has the potential to serve as a supplementary educational partner during CCs, offering comparable support to that of senior student mentors in structured scenarios. Despite challenges of response latency and limited depth in clinical content, AI-CCM was received well by and accessible to students who used ChatGPT's free version. With further refinements, including specialty-specific content and improved responsiveness, AI-CCM may serve as a scalable, context-sensitive support system in clinical medical education.

Background Hidden curriculum (HC) can limit the effects of professionalism education. However, the research on how HC triggers unprofessional behavior among medical students is scant. Furthermore, there is no established approach for how faculty members may create a context, such as an educational environment and education system, that prevents students’ unprofessional behavior. This study aimed to develop an educational approach to prevent unprofessional behavior and clarify how faculty members consider HC that triggers students’ unprofessional behavior. Methods The study sample comprised 44 faculty members and eight medical students from the Chiba University School of Medicine. The participants were divided into groups and asked the following question: “What attitudes, statements, and behaviors of senior students, physicians, and faculty members trigger medical students’ unprofessional behavior?” The responses were collected using the affinity diagram method. The group members discussed the causes and countermeasures for the selected attitudes, statements, and behaviors of senior students, physicians, and faculty members based on the affinity diagram. The impact of the group work on the faculty members was surveyed using questionnaires immediately after its completion and six months later. Furthermore, the cards in the group work were analyzed using content analysis. Results The responses to the questionnaire on group work indicated that some faculty members (43.8%) improved HC, while others suggested conducting group work with more participants. The content analysis revealed six categories – inappropriate attitude/behavior, behavior encouraging unprofessional behavior, lack of compliance with regulations, harassment of other medical staff, inappropriate educational environment/supervisor, and inappropriate self-control – and 46 subcategories. Conclusions The HC that triggers students’ unprofessional behavior includes the words and actions of the educator, organizational culture, and educational environment. Group work makes faculty members aware of the HC that triggers unprofessional behavior, and induces behavioral change for HC improvement in the educational activities. Educators should refrain from using words and actions that encourage unprofessional behavior, such as personal anecdotes, as they reduce students’ learning motivation.

Background Report writing in class provides basic training for academic writing. However, report writing education in medical schools in Japan has rarely been reported and no teaching strategy has been established for it. Methods This study developed a report writing program using peer review for first-year medical students consisting of two 120-minute classes. The goal of being able to write reports appropriately was established and presented to students at the beginning of the program. In session 1, students decided on a topic, gathered information, and structured their report. In session 2, students’ written reports were peer reviewed. The reports were improved based on the peer reviews. The responses of the pre- and post-program questionnaires were evaluated to determine the program’s effectiveness. The other reports that were assigned one month after the program were used as comparison with the reports of students who did not participate. Furthermore, the long-term effects of the program were also evaluated by comparing the results of students from the previous year who did not participate in the program with those of program participants six months after the program. Results A total of 106 students completed the questionnaire evaluation. The program was rated as being acceptable for the students. Self-assessment of report writing significantly improved after the program. The report scores of program participants ( n  = 99) were significantly higher overall and in all domains than were those of non-participants ( n  = 99). The self-assessment of students who participated ( n  = 96) was significantly higher than that of non-participants ( n  = 109). No difference was observed for students’ sense of burden in report writing. Conclusions The report writing skills of medical students can be improved by clearly establishing the goals of report writing and practicing the basic skills of report writing step-by-step. Moreover, the use of peer review may enhance the effectiveness of learning opportunities for report writing.

In undergraduate medical education, clinical clerkships (CC) serve as a platform for acquiring the integrated competencies essential to physicians. Simultaneously, CC plays a crucial role in facilitating a smooth transition to postgraduate training and preventing burnout. This study aims to elucidate the effects of coaching on medical students during CC, with particular focus on self-efficacy and resilience. This was a mixed-methods study based on an explanatory sequential design. The participants were fifth-year medical students who underwent CC at Chiba University Hospital in Japan between June and October 2021. They received four weeks of one-on-one coaching during one department's CC by other attending physicians trained as coaches. The participants answered self-assessment web questionnaires using the Japanese version of the Generalised Self-Efficacy Scale (GSE-J) and the Brief Resilience Scale Japanese version (BRS-J) before and after coaching. In addition, they participated in semi-structured focus group interviews related to the effects of coaching. Narrative data were analysed using qualitative content analysis. Fifteen medical students participated in the study. The mean GSE-J and BRS-J scores (n = 13) significantly increased after coaching (from 71.0 (11.7) to 77.5 (16.2), = 0.018, = 0.76, = 0.71 and from 18.5 (4.7) to 21.4 (4.1), = 0.019, = 0.75, = 0.70, respectively). Four focus group interviews were conducted. The effects of coaching were classified into eight categories (goal setting and milestones, positiveness, verbalisation, self-confidence, proactivity, good communication, dealing with difficulties, and reflection and metacognition) related to self-efficacy and resilience. Medical students who receive coaching during CC improved their self-efficacy and resilience. Combining coaching with regular training in CC might serve as a useful educational strategy in terms of a smooth transition to postgraduate training and preventing burnout.

Biotin-rich intranuclear inclusions, also called \"optically clear nuclei,\" are observed in various neoplastic and non-neoplastic lesions, including pregnancy-related endometrium and benign and malignant neoplasms with morular structures. A recent study reported that lesions with biotin-rich intranuclear inclusions can be classified as \"(non-neoplastic) pregnancy-related endometrial\" and as \"(neoplastic) morular\" category. In the present report, we describe two cases of well-differentiated adenocarcinoma of the gallbladder in which biotin-rich intranuclear inclusions were found without morular structures. Immunohistochemically, as reported previously, the intranuclear inclusions were positive for biotin and two biotin-binding enzymes (pyruvic acid carboxylase and propionyl CoA carboxylase). Intranuclear expression of beta-catenin was also observed in neoplastic cells with and without intranuclear inclusion. We also detected a frame shift mutation of APC gene in one case but no mutation of beta-catenin gene in both cases. Although intranuclear expression of beta-catenin by mutation of APC gene might contribute to carcinogenesis in our cases, the relationships among intranuclear expressions of beta-catenin, biotin, biotin-binding enzymes and intranuclear inclusions remain unclear. Our cases are the first neoplastic lesions with biotin-rich intranuclear inclusions that lacked morular structures. We propose a new \"neoplastic/non-morular\" category for lesions with biotin-rich intranuclear inclusions.

Gastric cancer is one of the most common cancers. Molecular events in the carcinogenesis of gastric cancer remain, however, largely undefined. We investigated changes in DNA copy number in 102 gastric cancers by CGH. We found changes in DNA copy number in all cases, with frequent (≧30% of patients) gains at 20q, 8q, 20p, 7q, 17q, 5p, and 13q. Frequent (≧20%) losses were found at 19p, 18q, 5q, 21q, 4p, 4q, 15q, and 17p. The mean number of total alterations was significantly lower in grade 3 and scirrhous-type carcinomas (10.81 in grade 3 vs 13.98 in grade 1 and grade 2, 9.31 in scirrhous-type vs 13.18 in medullary- and intermediate-type). The mean number of losses and total alterations were higher in tumors at pT2, pT3 and pT4 (4.68 and 12.77 in pT2, pT3, and pT4 vs 2.55 and 9.22 in pT1). The mean number of losses was higher in carcinomas with lymph node metastasis (4.83). The mean number of gains and total alterations were higher in carcinomas with venous invasion (8.44 and 13.28). Several chromosomal alterations were linked in a statistically significant manner to specific clinicopathological parameters. Gain of 17q, 20p, and 20q and loss of 4p were associated with the pattern of the cancer–stroma relationship; loss of 18q was associated with pT category; gain of 5p was associated with pN category; loss of 4q and loss of 21q were associated with lymphatic invasion; gain of 7p and loss of 4q and 18q were associated with venous invasion; and loss of 18q was associated with pathological stage. These data suggest that gain of 20q and loss of 18q might play an important role in the development and progression of gastric cancer. Moreover, some genes on 20q and 18q might be target genes of gastric cancer.

In order to investigate whether the size of the caudate lobe of the cirrhotic liver is related to the hepatic functional reserve, the morphometric analysis of the caudate lobe was preformed retrospectively using computed tomography in 106 consecutive patients of whom 67 had compensated (group 1), and 39 uncompensated (group 2) liver cirrhosis. In 51 patients, hepatic measurements were repeated in follow-up. Age- and gender-matched controls were studied. The size of the caudate lobe and the ratio of the caudate to right lobe were correlated with liver function. The caudate lobe was larger in the study patients than in the controls, and larger in group 1 than in group 2 (P<0.01). The caudate to right lobe ratios were also greater in the study patients especially in group 1 (P<0.01). In follow-up, the regression coefficient for the caudate to right lobe ratio was positive in group 1 and negative in group 2 (P<0.05). Even though the caudate lobe of patients with uncompensated liver cirrhosis was larger than that of the controls, patients with compensated liver cirrhosis had a larger caudate lobe and higher caudate to right lobe ratio compared to the patients with uncompensated liver cirrhosis. The caudate lobe may have played an important role in maintaining proper liver function in these patients.