Clinical Reasoning Webinar Project 2010-2015

I invite you to access seven publications of our recently completed Monkosho-funded medical education demonstration project, "
臨床推論能力の評価と能力向上トレーニングの開 発研究 "[研究課題番号:23590870],

freely translated 'Development and evaluation of a prototypical clinical reasoning module.'


1. Gerald H. Stein, MD, Ayako Shibata, BS, Miho Bautista, MD, MS.

Webinar: Free international distant real time interactive tutoring.
Medical Teacher. 2010; 32: 619-620.

[Reprint available on request]

2. Gerald H. Stein, MD, Ayako Shibata, BS, Miho Bautista, MD, MS Yasuharu Tokuda, MD, MPH.

Webinar: An Initial Experience with Web-based Real Time Interactive Clinical Seminars for Japanese Medical Students.
General Medicine. 2010; 11: 87-90.

3. Gerald H. Stein, MD, Hironobu Tokunaga, MD, Hirotaka Ando, MD, Mikako Obika, MD, PhD, Tomoko Miyoshi, MD, Yasuharu Tokuda, MD, MPH, Miho Bautista, MD, MS, Hitomi Kataoka, MD, PhD,
and Hidekazu Terasawa, MD.

Preliminary report of a Web-based instrument to assess and teach knowledge and clinical thinking to medical student.
International Journal of Medical Education. 2014:5:1-6.

4. Gerald H. Stein, MD, Hironobu Tokunaga, MD, Hirotaka Ando, MD, Mikako Obika, MD, PhD, Tomoko Miyoshi, MD, Yasuharu Tokuda, MD, MPH, Yoshinori Noguchi, MD, MPH, Mitsuyo Kinjo, MD, MPH, Shun Kohsaka, MD, Hitoshi Honda, MD, Yuka Kitano, MD, Hidetaka Kitazono, MD, Hitomi Kataoka, MD, PhD, Hidekazu Terasawa, MD.

Clinical Reasoning Web-based Prototypic Module for Tutors Teaching 5
th Grade Medical Students : A Pilot Randomized Study. General Medicine. 2015: 16(1): 13-25.

5. Gerald H. Stein, Hironobu Tokunaga, Hirotaka Ando, Mikako Obika, Tomoko Miyoshi, Yasuharu Tokuda, Yoshinori Noguchi, Hitomi Kataoka and Hidekazu Terasawa.

Medical students’ opinion of a Web-based module to teach clinical thinking and knowledge.

General Medicine. 2015;16(2): 76-83.
[Pre-print available on request]

6. Takata  Yukari, Stein H Gerald, Endo  Kuniyuki, Arai  Akiko, Kohsaka  Shun, Kitano  Yuka, Honda  Hitoshi, Kitazono  Hidetaka, Tokunaga  Hironobu, Tokuda  Yasuharu, Obika  Mikako, Miyoshi  Tomoko, Kataoka  Hitomi, Terasawa  Hidekazu.

Content analysis of medical students’ seminars: a unique method of analyzing clinical thinking.
BMC Medical Education. 2013. 13:156.

7. Gerald H. Stein, MD.

Clinical reasoning: An unfinished journey. General Medicine. 2015; 16(1): 5-7;

I hope many readers and their colleagues will consider ways to build on our documented clinical reasoning base to improve, expand, and apply our reform-minded prototypical clinical reasoning module to undergraduate medical educational curriculum in Japan.

I offer my deepest appreciation and thanks to the many contributors that permitted the successful completion of the clinical reasoning WP.

Invited Lectures:
“Clinical thinking Web-based prototypic module for Japanese medical students.”

1. Division of General Internal Medicine, Department of Medicine, University of Florida, Gainesville Florida, USA; April 24, 2014.
2. Nagoya 2nd Red Cross Hospital, Nagoya, Japan; June 9. 2014.
3. Department of Emergency Medicine, General Internal Medicine and Community Medicine, Fukui Faculty of Medicine, Fukui, Japan; June 20, 2014.

Preliminary Announcement


The Webinar Project team at FukuiDai( Professor Terasawa Hidekazu), OkayamaDai(Professor Kataoka Hitomi) and TsukubaDai(Professor Tokuda Yasuharu) is please to release preliminary information about the demonstration project

1. Tutor Japanese 5th grade medical students in clinical thinking skills.
2. Assess the effectiveness of this tutoring
3. Develop and implement a test to measure basic clinical thinking
4. Perform "Content Analysis" of students and tutors speaking.

1. Randomly selected 24 5th grade Japanese medical students, 12 tutored, 12 self-studied
2. Two volunteer tutors who completed Japanese and North American general medicine residencies
3. Tutoring conducted on the Internet, in real time interactive audio and video communication. Each of 2 'classrooms' has 6 students with one tutor.
4. Tutors taught from a uniform interactive syllabus
5. Assessment was by answering questions of a clinical case in which narrative data was presented, a question ask, students wrote answers in text, correct answers appeared, more clinical data presented leading to differential diagnosis. This test is called Sequential Question Answer(SQA). The test was accessed by any standard Internet browser.

1. All 12 tutored students attended the 4 tutored sessions
2. Each class met weekly 4 times, each session lasted 1.5 hours
3. All 24 students completed the pre and post tutoring SQA assessment
4. SQA results pending
5. "Content Analysis" of medical students' and tutors' speaking pending

Funding in part from Monkasho:

臨床推論能力の評価と能力向上トレーニン グの開発研究

[ Developmental research project for medical student clinical thinking training and evaluation]

Selected comments from tutored students' questionnaire

I think that increased knowledge was worth enough. But the actual idea further, and learned the process of thinking that has been used in clinical teacher, very helpful I think.
・知識が増えたという意味だけでも十分勉 強になりました。でもそれ以上に、「臨床医の先生が実際に現場で使っている思考の過程を学ぶことが出来た」ということが、大変意 味がありました。

I think a very good system. Lectures in small groups is also easy to go to my head. Also be done in conjunction with the other students are better able to compare their knowledge, etc.. Including teachers, can be met off-campus, I could help in the future.
・(Webinarという遠隔授業は)とても良いシステムだと思います。少人数での 講義というのも頭に入りやすかったです。また、他大学の学生と同じクラスで受講できたために、自分の知識等を比較したりすること も出来ました。講師の先生を含めて学外に知り合いができることも、今後役立つかもしれないと感じました。

Selected comments from tutors' questionnaire[English only]:

It was a great experience for me to have 4 sessions of Webinar to teach clinical thinking process. I myself am doing that clinical reasoning on daily work my hospital, but it takes longer and more energy to let students/residents fully understand and acquire that thinking process. This Webinar project helped me to know how to do it.

For information please contact FukuiDai’s Dr. Hironobu Tokunaga ( Chief Coordinator):


University of Florida’s Dr. Gerald Stein (Project Director)