Kyushu University Academic Staff Educational and Research Activities Database
List of Presentations
Kikukawa Makoto Last modified date:2021.07.02

Associate Professor / Department of Medical Education / Department of Medical Education / Faculty of Medical Sciences

2. Tadayuki Hashimoto, Makoto Kikukawa, Junji Otaki, Junichi Taniguchi, Syunsuke Kosugi, Takashi Kanazawa, Entrustable Professional Activities of resident-as-teacher ,Short communication
, AMEE2018, 2018.08.
3. Kiyoshi Shikino, Shingo Suzuki, Yusuke Hirota, Salcedo Daniel,Makoto Kikukawa, Masatomi Ikusaka, iExaminer system: An effective teaching method to improve fundus examination skills, 第50回日本医学教育学会大会, 2018.08, Introduction
Studies have shown that mastery of fundus examination skills is not as high as desired among general practitioners, which implies that innovative teaching methods are needed1,2 because there is no way for a teacher to verify if learners have obtained a proper view of the fundus.3,4 Sharing a visual field between learners and their teacher would facilitate the acquisition of those skills.
The iExaminer system consists of a PanOptic ophthalmoscope, an iPhone (Apple Inc), an adapter, and an application.5 This system allows learners and their teacher to share the same visual perspective. Our objective was to compare the effect of the iExaminer teaching method on fundus examination skills compared with the traditional teaching method.


A randomized clinical trial was designed to compare the effect of the iExaminer teaching method on fundus examination skills with the traditional teaching method. The trial protocol is available in Supplement 1. Participants consisted of medical students in a general medicine clinical clerkship rotation from September 2017 to July 2018. They were randomly assigned through simple randomization using Excel 2010 (Microsoft Corp) to the iExaminer method group (intervention group) or the traditional method group (control group). All instruction time was standardized to 30 minutes. Specially developed, identical training on the iExaminer method was provided to 3 instructors, who taught students using the iExaminer teaching method or the traditional teaching method. They were randomly assigned to the teaching method for each session.

The participants examined EYE Examination Simulator (Kyoto Kagaku Co) using a PanOptic ophthalmoscope before and soon after an educational session. In tests before and after training, participants were assigned 3 cases and observed 1 eye for 90 seconds. The diagnostic accuracy of ophthalmoscopic findings (ie, normal fundus, optic disc edema, pathological optic disc cupping, or not observed) and time taken to identify ophthalmoscopic findings were assessed in both tests.

Statistical analyses were performed using SPSS Statistics for Windows version 22.0 (IBM), with the level of significance set at P < .05. All tests were 2-tailed. Diagnostic accuracy and time were compared between the groups using a 2-way analysis of variance. Assuming an α error of .05, β error of 0.2, power of detection of 0.8, and effect size F of 0.25, a sample size of 128 tests was required for each group to allow for the comparison. This study was approved by the Ethics Committee of Chiba University School of Medicine. Written informed consent was obtained from all participants. This study followed the Consolidated Standards of Reporting Trials (CONSORT) reporting guideline, and the flow diagram is available in the eMethods in Supplement 2.
The total number of participants was 115. They had a median (interquartile range) age of 23 (21-31) years, and 81 (73.9%) were men. We found no statistically significant differences in demographic characteristics between the intervention and control groups. No participants had a prior clinical clerkship rotation in ophthalmology.
A 2-way analysis of variance revealed a significant effect of this intervention on diagnostic accuracy and time (Table). In the intervention group, compared with the control group, diagnostic accuracy was significantly higher (47.0% vs 30.0%; P = .002) and time was significantly shorter (mean [SD], 70.1 [21.9] seconds vs 76.2 [20.2] seconds; P = .006).
This study suggests that the iExaminer teaching method could be superior to the traditional teaching method for fundus examination training among medical students. The challenge for teaching the fundus examination is that teachers cannot easily determine how well the student sees the fundus.3,4 Students may not perform with confidence, potentially leading to the examination’s underuse.6 Shared visualization may explain the improved accuracy among the intervention group, but it could also be that better visualization by the student, independent of the presence of the teacher, led to this result. Other studies have successfully used covisualization techniques between learners and teachers in assessments of skill acquisition.4 The iExaminer teaching method may offer advantages, as demonstrated by the objective assessments in this study.
There are some potential limitations. First, this research was assessed in the simulator, not with real patients. Second, there is a possibility that the educational effect may depend on the teaching skill of faculty.
In this randomized clinical trial, the iExaminer teaching method led to improved diagnostic accuracy and reduced examination time for the fundus examination. The results suggest that the iExaminer teaching method may be superior to the traditional teaching method..
4. Ikuo Shimizu, Makoto Kikukawa, Teiji Kimura, Tsuyoshi Tada, Robbert Duvivier, Cees van der Vleuten, Measuring social interdependence in collaborative learning: Instrument development and validation, 第50回日本医学教育学会大会, 2018.08.
5. New attempt of medical education for High school students by medical students.
6. Makoto Kikukawa, Renee E. Stalmeijer, Takahiro Matsuguchi, Miyako Oike, Lambert Schuwirth, Albert J.J.A. Scherpbier., Understanding the Response Process of Residents Evaluating Clinical Teachers -influences of instrument and national culture-, 15th APMEC, 2018.01, 初期研修医が指導医評価表を記入する際にどのような思考プロセスをたどるかを質的に調査した。.
7. Makoto Kikukawa, Renee E. Stalmeijer, Tomoya Okubo, Kikuko Taketomi, Sei Emura, Yasushi Miyata, Motofumi Yoshida, Lambert Schuwirth, Albert J.J.A. Scherpbier., DEVELOPMENT OF CULTURAL SENSITIVE CLINICAL TEACHER EVALUATION SHEET IN JAPAN, AN EAST ASIAN SETTING., 14th APMEC, 2017.01, Title: Development of culture-sensitive clinical teacher evaluation sheet in the Japanese context Aim: Many instruments for evaluating clinical teaching have been developed, albeit most in Western countries. This study aims to develop a validated cultural and local context sensitive instrument for clinical teachers in an East Asian setting (Japan), Japanese Clinical Teacher Evaluation Sheet (JaCTES). Methods: A multicenter, cross-sectional evaluation study was conducted. We collected a total of 1368 questionnaires on 304 clinical teachers, completed by residents in 16 teaching hospitals. The construct validity was examined by conducting a factor analysis and using structural equation modeling (SEM). We also assessed the reliability using generalizability analysis and decision study. Results: Exploratory factor analysis resulted in three-factor (role model, teaching activities, and accessibility) model including 18 items. Confirmatory factor analysis was performed, using SEM. The comparative fit index was 0.931 and the root mean square error of approximation was 0.087, meaning an acceptable goodness of fit for this model. To obtain a reliable dependability-coefficient of at least 0.70 or higher, 5–8 resident responses are necessary. Discussion and conclusion: JaCTES is the first reported instrument with validity evidence of content and internal structure and high feasibility in Japan, an East Asian setting. Medical educators should be aware of the local context and cultural aspects in evaluating clinical teachers..
9. Tadayuki Hashimoto, Makoto Kikukawa, What should residents learn to teach? A modified Delphi survey to define competencies of resident-as-teacher., AMEE, 2016.08.
10. Mosaburo Kainuma, Makoto Kikukawa, Masaharu Nagata, Motofumi Yoshida., Exploring competencies needed for leaders of community-based medicine in Japan: a qualitative study., AMEE, 2016.08, Objectives To clarify competencies for inclusion in our curriculum that focuses on developing leaders in community medicine.

Design Qualitative interview study.

Setting All six regions of Japan, including urban and rural areas.

Participants Nineteen doctors (male: 18, female: 1) who play an important leadership role in their communities participated in semistructured interviews (mean age 48.3 years, range 34–59; mean years of clinical experience 23.1 years, range 9–31).

Method Semistructured interviews were held and transcripts were independently analysed and coded by the first two authors. The third and fourth authors discussed and agreed or disagreed with the results to give a consensus agreement. Doctors were recruited by maximum variation sampling until thematic saturation was achieved.

Results Six themes emerged: (1)‘Medical ability’: includes psychological issues and difficult cases in addition to basic medical problems. High medical ability gives confidence to other medical professionals. (2)‘Long term perspective’: the ability to develop a long-term, comprehensive vision and to continuously work to achieve the vision. Cultivation of future generations of doctors is included. (3) ‘Team building’:the ability to drive forward programmes that include residents and local government workers, to elucidate a vision, to communicate and to accept other medical professionals. (4)‘Ability to negotiate’: the ability to negotiate with others to ensure that programmes and visions progress smoothly (5) ‘Management ability’: the ability to run a clinic, medical unit or medical association. (6) ‘Enjoying oneself’: doctors need to feel an attraction to community medicine, that it be fun and challenging for them.

Conclusions We found six competencies that are needed by leaders in the field of community medicine. The results of this study will contribute to designing a curriculum that develops such leaders..
11. Kazuki Tokumasu, Haruo Obara, Makoto Kikukawa, How clinical experience influences residents' personal growth? A qualitative study., AMEE, 2016.08.
12. Makoto Kikukawa, Ikuo Shimizu, Harumi Gomi, Hiroshi Nishigori, Yasushi Matsuyama, Lessons from Japan, SHEILA Workshop in Milano, Italy , 2014.08.
13. Makoto Kikukawa, Ito Kozue, Kikuko Taketomi, Akihiro Yakaoka, Motofumi Yoshida, Medical Students’ Perceptions of the Purposes of Medical Interviews,, 11th Asia Pacific Medical Education conference (APMEC), 2014.01.
14. Hiroshi Nishigori, Yuka Miyachi, Makoto Kikukawa, Junji Otaki, FACILITATING A TEACHING SESSION FOR THE HYPOTHESIS-DRIVEN PHYSICAL EXAMINATION (HDPE), 11th Asia Pacific Medical Education conference (APMEC), 2014.01.
15. Makoto Kikukawa, Renee Stalmeijer, Sei Emura, Sue Roff, Albert Scherpbier, Development of an instrument for evaluating clinical teachers sensitive to the Japanese culture, Association for Medical Education in Europe (AMEE) , 2013.08.
16. Medical Students' Perceptions of Purposes of Medical Interviews.
17. Makoto Kikukawa, Kozue Ito, Kikuko Taketomi, Akihiro Yamaoka, Motofumi Yoshida, Medical Students’ Perceptions of the Purposes of Medical Interviews, 11th Asia Pacific Medical Education conference (APMEC), 2013.01.
18. The characteristics of a good clinical teacher as perceived by resident physicians in Japan.
19. Teaching physical examination with clinical reasoning: a trial hypothesis driven approach .
20. The characteristics of a good clinical teacher as perceived by resident physicians in Japan.
21. How to Develop Educational Abilities.