Self-Introduction Note: 'Are you really a UTokyo graduate?' — The story of how I, who couldn't function in the field even as a UTokyo medical graduate, vowed to 'change medical education'

Introduction

This was a remark made by a senior doctor when I was completely stuck dealing with a patient during my first year of residency.

The day I passed the entrance exam for the University of Tokyo Faculty of Medicine, I vowed, 'In the future, I want to provide the best medical care to my patients.'
I had worked harder than anyone else on my exam studies. I believed I wouldn't lose to anyone when it came to knowledge.

I, who became a doctor believing that, 'could do nothing' in the clinical setting.

In this note, I will honestly write about the frustration and resolve that became the starting point for why I, who was a 'doctor with knowledge but unable to act in the field,'
have come to think that I 'want to change medical education' now.
I will write about the frustration and resolve that became the starting point.

1. Even as a UTokyo medical graduate, I was 'incompetent' as a resident

During my student days, I felt I had read more reference books, guidelines, and papers than anyone else.
But when I actually stood in the field, I couldn't do anything.

• What should I do about the IV drip?

• What about tests and monitoring?

• Is it really okay to let them go home like this?

The knowledge I thought I had memorized wouldn't come out in the field.
There was a deep and wide valley between 'knowing' and 'being able to use'.

And above all, what was painful was that 'even though I kept trying, I couldn't do it.'
Even after reading books and listening to senior doctors, there was a version of me that couldn't act in the field.
That was a far more painful experience than just a lack of effort.

2. Doctors become unable to act just because the 'order' of knowledge is different

For example, when you open a medical book dealing with hyperkalemia, many of them start like this, don't they?

...Do you think about that in front of a patient?

What is needed for a patient who has collapsed due to high potassium is:

1. Urgency assessment

2. Initial treatment (Calcium gluconate, etc.)

3. Differential diagnosis and follow-up

It is this order.

In the field, it is not 'what you think' but 'the order in which you think' that determines life or death.

That is what is overwhelmingly lacking in current medical education.

It is too biased toward 'teaching' knowledge,
and there is not enough education on 'how to use' that knowledge.

3. The ideal of education is a 'cram school,' the reality is a 'school'

Knowledge that can be used in the field should be taught like in a cram school,

• based on exam trends,

• emphasizing actual usage,

• and organizing priorities.

It should be taught this way.

But current medical education is closer to a 'school'.

Emphasis is placed on covering all items, while how to use them is neglected.

4. The spell of EBM and the pressure of a complaint-driven society

Recently, with the spread of Evidence-Based Medicine (EBM), the phrase 'Is there evidence for that?' has become a stronger weapon than anything else.

But hasn't that robbed us of our 'ability to think'?

One house-call doctor was achieving wonderful blood pressure control by finely adjusting the dosage and type of antihypertensive drugs according to the patient's blood pressure changes.

When written down, it looks like a normal thing. However, the precision was extraordinary.

'If blood pressure is 130 or higher, take 2.5mg of Amlodipine with your usual medicine; if 150 or higher, take 5mg as a PRN dose; if blood pressure is on the low side, do not take this oral medication'...

He was instructing patients to adjust their daily medication based on their daily blood pressure readings.

But a university professor said this in response to that.

...There is no way there is.
It is impossible to set up a prospective study for such personalized medicine.

I feel uncomfortable with the trend of dismissing 'field wisdom' as worthless because 'there is no evidence'.

5. Just because a professor wrote it doesn't mean it's correct

This is a story that actually happened when I was a resident.

Medical textbooks say to use 10% calcium chloride for hyperkalemia.
It was also written that way in famous journals and in articles by prominent university professors.

But in reality, 10% preparations are not distributed in Japan.
The only ones available are 2% or 6% preparations.

It was the moment I, who had swallowed it whole because 'a professor wrote it,'
began to doubt, 'Has this person ever actually used this in the field?'

6. 'Consistency with the field' is more important than the 'correctness' of knowledge

This is what I think.

Knowledge is, after all, just a tool.
What matters is 'how to apply it in the field' and 'how it is useful for the patient.'

Even if there is no evidence,
even if there are no papers,
if something seems 'useful' based on theory and clinical experience, you should use it with confidence as a doctor.

The criteria for that judgment are the pharmacology, pathology, and physiology learned at university.
In other words, it is **consistency with 'medical common sense'**.

7. That is why I want to share 'usable knowledge'

I am currently
'medicine that can be used in the field starting tomorrow'
sharing information on note and social media with this as my theme.

• 'In what order' to differentiate differential diagnoses

• How to act when you see shock

• Manual-like thinking patterns of 'just do this for now'

I want to make it so that these 'field-priority-based thinking methods'
can be learned from anywhere in Japan.

That is the goal I want to achieve throughout my career as a doctor.

Conclusion

If you just want to gain knowledge, you can learn as much as you want on the internet now.
But to learn 'how to use knowledge,' education on 'field sense' and 'prioritization' is essential.

I want to deliver that.

That is what I strongly believe.

Profile

• Graduated from the University of Tokyo Faculty of Medicine

• Currently working in Cardiology (approaching 10 years of medical practice)

• While involved in medical education, I am focusing on creating manuals for clinical practice and sharing information.

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