2. ARN14 Feb. 2002 JSPS visit Showa University Petronas Twin Tower – K.L.C.C

3. ARN14 Feb. 2002 JSPS visit Showa University School of Medical Sciences - USM

4. ARN14 Feb. 2002 JSPS visit Showa University School of Medical Sciences - USM Established in 1979 The main activities are: Teaching Patient care Research

5. ARN14 Feb. 2002 JSPS visit Showa University Hospital USM The Medical School is serviced by a 716- bed teaching hospital functioning at tertiary care level with international standard facilities.

6. ARN14 Feb. 2002 JSPS visit Showa University School of Medical Sciences – USM Courses Offered; MD M.Med (16 specialities) M.Sc; Ph.D M.Sc (Sports Science),& (Sports Medicine) Postgraduate Diploma in Medical Therapeutics

7. ARN14 Feb. 2002 JSPS visit Showa University MD Program In general this program is taught with an integrated multidisciplinary approach, based on organ and system with emphasis on problem solving.

8. ARN14 Feb. 2002 JSPS visit Showa University Curriculum The program runs for 5 years and is divided into 3 phases; ( with professional examinations at the end of each phase ) Phase I-First year Phase II-Second year Third year Phase III-Fourth year Fifth year

9. ARN14 Feb. 2002 JSPS visit Showa University Phase I Bioethics and Nursing – 1 week General Block – 5 weeks Haemopoeitic and lymphoid system – 2 weeks Musculo-skeletal system – 4 weeks Nervous system – 4 weeks Reproductive system – 1 week Gastrointestinal and nutrition – 4 weeks Endocrine system and metabolism – 3 weeks Cardiovascular system – 3 weeks Respiratory system – 2 weeks Urinary system – 2 weeks Host and environment 4 weeks First aid – 1 week

10. ARN14 Feb. 2002 JSPS visit Showa University Phase II General Block Haemopoeitic and lymphoid system Reproductive system Musculo-skeletal system Psychological medicine Infectious disease Cardiovascular system Respiratory system Genito-urinary system Gastrointestinal system Endocrine system Nervous system In phase II students are introduced to clinical clerkship, community and family case studies and will undergo 6 weeks of elective posting.

11. ARN14 Feb. 2002 JSPS visit Showa University Phase III General block lectures and Interdisciplinary activities Clinical postings – Rotation through all clinical disciplines Community and family case studies Elective (year 4)

12. ARN14 Feb. 2002 JSPS visit Showa University Mode of teaching Formal lectures Small group discussions Problem-based learning Fixed learning module Self-study Seminars Interdisciplinary activities (symposium-like presentations presented by students) Therapeutic ward round (problem-based) Clinical ward rounds

13. ARN14 Feb. 2002 JSPS visit Showa University Co-curriculum Wednesday afternoons are reserved for co-curricular activities whereby students are required to participate in uniformed brigades like military cadets, sports or socio-cultural activities and self-defence art.

14. ARN14 Feb. 2002 JSPS visit Showa University Teaching of pharmacology and therapeutics  Phase I - Introduction - Autonomic pharmacology - Pharmacokinetics anf pharmacodynamics  Phase II - Pharmacology teaching follows the blocks according to system  Phase III - Pharmacology teaching is given in the general block lectures, interdisciplinary activities, seminars and therapeutic ward rounds.

15. ARN14 Feb. 2002 JSPS visit Showa University 2 nd P-Drug workshop 1999 - Hieizan

16. ARN14 Feb. 2002 JSPS visit Showa University Rational Use of Drugs - what are the Issues? Assoc. Professor Haji Abd Rahman Noor Departments of Pharmacology and Paediatrics School of Medical Sciences Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, MALAYSIA

17. ARN14 Feb. 2002 JSPS visit Showa University No. of physicians in the U.S. = 70,000 Accidental death caused by physicians per year = 120,000  accidental death per physicians = 0.171 (source: U.S. Dept. of Health and Human Services) cf. No. of gun owners in the U.S. = 80,000,000 No. of accidental gun death per year = 1500 No. of accidental gun death per gun owner = 0.0000188 Statistically doctors are approximately 9000 more dangerous than gun owners.

18. ARN14 Feb. 2002 JSPS visit Showa University Instrument left by a surgeon removed from patient’s abdomen

19. ARN14 Feb. 2002 JSPS visit Showa University Rational Use of Drugs: Are there any issues? Yes! Evidence – literature reference Activities by WHO Activities by individual countries

20. ARN14 Feb. 2002 JSPS visit Showa University In Australia National Medicines Policy is well established, which includes Quality Use of Medicines Quality Use of Medicines achieved by partnership approach with “medication team” concept involving doctors, pharmacists, nurses and consumers, based on the following principles;

21. ARN14 Feb. 2002 JSPS visit Showa University R. Kausal et al – JAMA 2001;285:16;2114-2120 Conducted a study in 2 teaching hospitals in Boston to assess the rates of medication errors, adverse drug events and potential ADE’s in paediatric patients;

22. ARN14 Feb. 2002 JSPS visit Showa University Kausal R. (cont). 10778 medication orders were reviewed:  616 (5.7%) showed medication errors  115 (1.1%) showed potential ADE’s  26 (0.24%) showed ADE’s ( 19% were preventable ). The preventable ADE’s were similar to a previous study in adults but the potential ADE’s rate was 3 times higher.

23. ARN14 Feb. 2002 JSPS visit Showa University Netherlands; Medications that are initiated by specialists are continued by G.Ps. G.Ps admit that their prescribing behaviour partly results from repeat prescriptions by specialists. Communications between specialists and G.Ps are crucial.