Interdisciplinary problem-based learning (PBL) aims to provide students with opportunities to develop the necessary skills to work with different health professionals in a collaborative manner. This discourse study examined the processes of collective knowledge construction in Japanese students in the tutorials. Analyses of video-recorded data elicited from three multidisciplinary cohorts and their learning portfolios provided insights into their participation and introspection during the discussions. The results indicate there were two patterns of knowledge construction: (a) co-constructions between students from different disciplines and (b) elaborations between students from the same discipline. Their learning processes were mediated by their cultural assumptions, professional identities, understanding of other professionals, and perceptions of collaborative learning. The finding suggests that interdisciplinary PBL has the potential to enhance students' collaborative learning skills, and students' participation is situated within a cultural context. Keywords:Interprofessional education, health professional education, social interaction in PBL, reflective learning, classroom discourse analysis IntroductionThe focus of this study is on examining undergraduate students' participation and reflection on learning experiences in an interdisciplinary problem-based learning (PBL) tutorial in the context of Japanese health professional education. PBL is a learner-centered approach "that empowers learners to conduct research, integrate theory and practice, and apply knowledge and skills to develop a viable solution to a defined problem" (Savery, 2006, 12). Interdisciplinary PBL is part of interprofessional learning to develop mutual professional respect and trust, which is essential in patient-centered practice. In this PBL, each student needs to take an interactive approach to learning in order to construct knowledge among the different professionals. In this sense, social interaction and collaborative learning play an important role in multidisciplinary group student-centered learning environment.Although the interdisciplinary PBL was designed to foster students' collaborative and active learning skills, we know little about the process of working together amongst students from different disciplines during the tutorial. In this regard, Leung (2002) emphasized the importance of obtaining a better understanding of the complex processes of students' participation in the context of student-centered learning. Hak and Maguire (2000) also pointed out that evidence from ethnographic and discourse research approaches are efficient and rational to exploring inside the PBL process.A small body of qualitative and discourse research on student learning in PBL identified the emergence of students' co-constructed knowledge and their highly interactive dynamics in tutorial groups (for example, Hmelo-Silver and Barrows, 2008;Koschmann et al., 1997;Visschers-Pleijers et al., 2006;Woodward-Kron and Remedios, 2007). For instance, Vissche...

Background: Clinical decision-making skills are essential for providing high-quality patient care. To enhance these skills, many institutions worldwide use case-based learning (CBL) as an educational strategy of pre-clinical training. However, to date, the influence of different learning modalities on students' clinical decision-making processes has not been fully explored. This study aims to explore the influence of video and paper case modalities on the clinical decision-making process of midwifery students during CBL. Methods: CBL involving a normal pregnant woman was provided for 45 midwifery students. They were divided into 12 groups; six groups received the video modality, and six groups received the paper modality. Group discussions were video-recorded, and focus groups were conducted after the CBL. Transcripts of the group discussions were analysed in terms of their interaction patterns, and focus groups were thematically analysed based on the three-stage model of clinical decision-making, which includes cue acquisition, interpretation, and evaluation/ decision-making. Results: The students in the video groups paid more attention to psychosocial than biomedical aspects and discussed tailored care for the woman and her family members. They refrained from vaginal examinations and electric fetal heart monitoring. Conversely, the students in the paper groups paid more attention to biomedical than psychosocial aspects and discussed when to perform vaginal examinations and electric fetal heart monitoring. Conclusion: This study clarified that video and paper case modalities have different influences on learners' clinical decision-making processes. Video case learning encourages midwifery students to have a woman-and familycentred holistic perspective of labour and birth care, which leads to careful consideration of the psychosocial aspects. Paper case learning encourages midwifery students to have a healthcare provider-centred biomedical perspective of labour and childbirth care, which leads to thorough biomedical assessment.

Interprofessional collaboration is an essential approach to comprehensive patient care. As previous studies have argued, interprofessional education (IPE) must be integrated in a stepwise, systematic manner in undergraduate health profession education programmes. Given this perspective, first-year IPE is a critical opportunity for building the foundation of interprofessional collaborative practice. This study aims to explore the first-year students' learning processes and the longitudinal changes in their perceptions of learning in a year-long IPE programme. Data were collected at a Japanese medical university, in which different pedagogical approaches are adopted in the IPE programme. Some of these approaches include interprofessional problem-based learning, early exposure, and interactive lecture-based teaching. The students are required to submit written reflections as a formative assessment. This study conducted an inductive thematic analysis of 104 written reflections from a series of e-portfolios of 26 first-year students. The themes related to learning outcomes from student perspectives included communication (e.g., active listening and intelligible explanation), teams and teamwork (e.g., mutual engagement and leadership), roles/responsibilities as a group member (e.g., self-directed learning and information literacy), and roles/responsibilities as a health professional (e.g., understanding of the student's own professional and mutual respect in an interprofessional team). The study also indicated three perspectives of students' learning process at different stages of the IPE, i.e., processes by which students became active and responsible learners, emphasised the enhancement of teamwork, and developed their own interprofessional identities. This study revealed the first-year students' learning processes in the year-long IPE programme and clarified the role of the first-year IPE programme within the overall curriculum. The findings suggest that the students' active participation in the IPE programme facilitated their fundamental understanding of communication/teamwork and identity formation as a health professional in interprofessional collaborative practice.

Japan is well known as a super-aging society, with a low birth rate, and has been ranked as one of the countries having the highest quality of healthcare system. Japan's society is currently approaching a major turning point with regard to societal and healthcare reforms, which are influenced by international trends and regional needs. Development of Japanese healthcare human resources, including medical students, is now expected to ride the wave of globalization, while resolving regional problems in the training and delivery of healthcare. Terms and global trends in medical education, such as outcome-based education, community-based education, reflective learning, international accreditation of medical education, and professionalization of educators are well translated into the Japanese language and embraced positively among the Japanese medical educators. However, these trends occasionally sit uncomfortably with cultural variations that are often a common approach in Japan; notably, "hansei" (introspection) and "kaizen" (change for the better). In the world facing a new era where people are unsettled between globalism and regionalism, Japan's future mission is to steer a balanced route that recognizes both global and regional influences and produce global health professionals educators.

BackgroundHow medical residents’ experiences with care for dying patients affect their emotional well-being, their learning outcomes, and the formation of their professional identities is not fully understood. We examine residents’ emotional states and learning occurring during the provision of care to dying patients and specifically discuss the impact of providing end-of-life (EOL) care on professional identity formation.MethodsSemi-structured interviews were conducted with 13 residents who had graduated in the last 3 to 5 years. Thematic theoretical analysis was applied, and key themes were developed based on Kolb’s experiential learning cycle.ResultsEight key themes emerged from the analysis. The residents experienced dilemmas in confronting the reality of medical uncertainty as well as a disruption of emotional state and self-efficacy. Although the residents felt a sense of helplessness and guilt, they were able to reflect on strategies for handling medical care that focused on patients and that required a truly sincere attitude. They also contemplated the importance of palliative care and communication with patients, patients’ family members and medical staff. Building on these experiences, the residents rebuilt a sense of awareness that allowed them to directly engage with the type of medical care that they are likely to be called upon to perform in the future as the population continues to age.ConclusionsThis study revealed Japanese residents’ perceptions, emotions and learning processes in caring for dying patients by applying Kolb’s experiential learning theory. The findings of this study may illuminate valuable pieces of knowledge for future education in EOL care.