Robert Kamei - Academia.edu (original) (raw)

Papers by Robert Kamei

Medical Education Online, 2012

Context: Although longitudinal community-based care of patients provides opportunities for teachi... more Context: Although longitudinal community-based care of patients provides opportunities for teaching patient centredness and chronic disease management, there is a paucity of literature assessing learning outcomes of these clerkships. This study examines learning outcomes among students participating in longitudinal community based follow-up of patients discharged from the hospital. Methods: The authors conducted a thematic analysis of 253 student narratives written by 44 third-year medical students reflecting on their longitudinal interactions with patients with chronic medical illnesses. The narratives were written over three periods: after acute hospital encounter, after a home visit and at the end of the 10-month follow-up. Analysis involved coding of theme content and counting of aggregate themes. Results: The most frequent theme was 'chronic disease management' (25%) followed by 'patient-centred care' (22%), 'health care systems' (20.9%), 'biomedical issues' (19.7%), 'community services' (9.5%) and 'student's role conflict' (2.3%). There was a shift in the relative frequency of the different themes, as students moved from hospital to community with their patients. Biomedical (44.3%) and health systems (18.2%) were the dominant themes following the acute hospitalization encounter. Chronic disease management (35.1%) and patient centredness (31.8%) were the dominant themes after the 10-month longitudinal follow-up. Conclusion: Longitudinal community-based interaction with patients resulted in learning about chronic disease management, patient centredness and health care systems over time. Students shifted from learning biomedical knowledge during the acute hospitalization, to focus on better understanding of long-term care and patient centredness, at the end of the module.

American Journal of Health-system Pharmacy, Aug 1, 2000

Pediatric Dermatology, May 1, 1988

A newborn infant who developed a vesicular eruption, clinically indistinguishable from herpetic l... more A newborn infant who developed a vesicular eruption, clinically indistinguishable from herpetic lesions, eventually developed the classic features of Job's syndrome. The initial ares of involvement included the hands and feet, then the scalp, face, and suprapubic skin. The clear, tense vesicles varied only slightly in size and appeared as isolated, grouped, or confluent lesions on inflamed skin. Many eventually became umbilicated. The more typical eczematous component appeared over the course of the next several months. Although the child initially had an elevated white blood cell count and eosinophilia, his IgE level did not become dramatically elevated until after 1 year of age. Job's syndrome should be considered as part of the differential diagnosis of a vesicular eruption in the newborn.

AMA journal of ethics, Aug 1, 2003

Physicians have an obligation to report parents to the local Child Protective Services if they su... more Physicians have an obligation to report parents to the local Child Protective Services if they suspect that the parents are using corporal punishment as a form of discipline.

Medical Education Online, Dec 1, 2003

View related articles Citing articles: 1 View citing articles Kamei RK, Sectish TC. Evaluating a ... more View related articles Citing articles: 1 View citing articles Kamei RK, Sectish TC. Evaluating a residency program using reflections Med Educ Online

Radiology over the past several years has become an increasingly integral component of patient ma... more Radiology over the past several years has become an increasingly integral component of patient management, not only in helping clinicians coming to a diagnosis through a wide range of imaging modalities, but also in treatment of diseases. Interventional radiology has, in many instances, replaced conventional medical or even surgical therapy as the new standard of care. Despite this increasingly critical role in clinical medicine, there continues to be relatively little emphasis on radiology education in the curriculum of most medical schools. As a result, many interns and residents are not well trained in interpreting simple radiographs and scans or even in requesting the appropriate imaging modality to resolve a particular clinical problem. Despite imaging being such a critical component of day-today clinical practice, the lack of clinical radiology training is clearly undesirable and should therefore play a bigger role in medical student education. In 2005, a unique opportunity to develop an innovative teaching program integrating radiology training with core medical education arose when the Singapore Government announced the setting up of a second medical school in Singapore.

Pediatric Dermatology, Nov 1, 1985

Histiocytosis X is a disorder of histiocytes of the Langerhans' cell lineage. As the init... more Histiocytosis X is a disorder of histiocytes of the Langerhans' cell lineage. As the initial feature is often cutaneous, recognition of these skin changes is important. Several cutaneous manifestations have been described, most commonly, seborrheic dermatitis with a hemorrhagic component. We saw two patients with histiocytosis X with cutaneous manifestations resembling cherry angiomas.

Annals Academy of Medicine Singapore, Dec 15, 2006

Academic Medicine, Feb 1, 2008

Duke University and the National University of Singapore (NUS) have partnered to launch a new med... more Duke University and the National University of Singapore (NUS) have partnered to launch a new medical school that brings the American style of postbaccalaureate medical education to Asia. The new institution, called the Duke-NUS Graduate Medical School (GMS) and located in Singapore adjacent to the Singapore General Hospital, admitted its inaugural class of students representing citizens of seven nations in August 2007. The project represents an investment of more than $350 million Please see the end of this article for information about the authors.

International Journal of Medical Education, Nov 8, 2015

Objectives: To identify the factors associated with medical students' clinical reasoning (CR) use... more Objectives: To identify the factors associated with medical students' clinical reasoning (CR) use and evidence-based medicine (EBM) use in the clinical setting. Methods: Our cross-sectional study surveyed 44 final-year medical students at an emerging academic medical center in Singapore. We queried the students' EBM and CR value and experiences in the classroom and clinical settings. We compared this to their perceptions of supervisors' value and experiences using t-tests. We developed measures of teaching culture and practice culture by combining relevant questions into summary scores. Multivariate linear regression models were applied to identify factors associated with the students' CR and EBM clinical use. Results: Eighty-nine percent of students responded (n=39). Students reported valuing CR (p=0.03) and EBM (p=0.001) more than their supervisors, but practiced these skills similarly (p=0.83; p=0.82). Clinical practice culture and classroom CR experience were independently associated with students' CR clinical use (p=0.05; p=0.04), and classroom EBM experience was independently associated with students' EBM clinical use (p=0.03). Clinical teaching culture was not associated with students' CR and EBM clinical use. Conclusions: Our study found that medical students' classroom experience and the clinical practice culture influenced their CR and EBM use. The clinical teaching culture did not. These findings suggest that in order to increase student CR and EBM use, in addition to providing classroom experience, medical educators may need to change the hospital culture by encouraging supervisors to use these skills in their clinical practice.

Pediatric Clinics of North America, Jun 1, 1991

Chronic cough in children is a frequent complaint seen by the primary health care provider. Altho... more Chronic cough in children is a frequent complaint seen by the primary health care provider. Although many of these coughs spontaneously resolve, some are caused by a more serious process and require further attention. Selecting those patients who will benefit from a more extensive evaluation can be a difficult challenge. An overview is provided that emphasizes a systematic approach to the diagnosis and management of chronic cough.

Applied clinical research, clinical trials and regulatory affairs, Oct 1, 2015

The Clinical Teacher, May 27, 2015

Background : Although clinical reasoning (CR) and evidencebased medicine (EBM) are taught in some... more Background : Although clinical reasoning (CR) and evidencebased medicine (EBM) are taught in some medical schools, the curricular details and students' clinical use of these skills are unknown. A detailed description of, and student experiences with, a practical CR and EBM curriculum delivering recommended content and pedagogy in an emerging academic environment may be broadly informative. Purpose : To describe and characterise student experiences with a CR and EBM curriculum at a newly formed Academic Medical Centre (AMC). Methods : Applying expert recommended content and

Archives of pediatrics & adolescent medicine, May 1, 1991

Books for the general physician who encounters children with difficult diagnoses and management p... more Books for the general physician who encounters children with difficult diagnoses and management problems are few, but in great demand. The major pediatric textbooks emphasize individual diseases rather than problems of diagnosis and management. This book attempts to fill that void. The book is divided into two sections. We are told that the first section deals with approaches to evaluations of common problems and that the second section deals with specific disease entities that are difficult to diagnose or to distinguish from similar disorders. I was confused by exactly how each chapter was chosen for one section vs the other, and, therefore, this division into two sections did not help organize the book for me. Nevertheless, each chapter easily stands by itself. The book discusses a broad spectrum of disease categories, but as Stockman warns in his introduction, the list can hardly be comprehensive. While reading each chapter, it seemed

Ambulatory Pediatrics, 2004

Objective.-Residency programs with postcall afternoon continuity clinics violate the new Accredit... more Objective.-Residency programs with postcall afternoon continuity clinics violate the new Accreditation Council for Graduate Medical Education (ACGME) limitations on resident duty hours. We evaluated housestaff experience with a pilot intervention that replaced postcall continuity clinics with evening continuity clinics. Methods.-We began this pilot program at one continuity clinic site for pediatric residents. Instead of postcall clinics, residents had evening continuity clinic added to a regular clinic day when they were neither postcall nor on call. At 5 and 11 months, we surveyed housestaff satisfaction and experience with the evening clinics, particularly in comparison to postcall clinics. Results.-Nineteen of 23 pediatric residents participated in the pilot program. Twenty-two and 17 residents completed the 5-and 11-month follow-up surveys, respectively. A significantly greater proportion of residents rated their overall satisfaction with evening clinic as good/outstanding (16 ⁄ 18 , 89%) compared with postcall clinic (2 ⁄ 19 , 11%) at the 5-month survey (P Ͻ .01). Resident preference for evening clinic over postcall clinic persisted but was not statistically significant at 11 months (P ϭ .05), and overall satisfaction with evening clinic was unchanged from the 5-and 11-month surveys (P ϭ .64). All areas of patient care, medical education, and clinic infrastructure were better or equal in evening clinic in comparison to postcall clinic except for continuity of preceptors and access to medical services. Conclusion.-Housestaff had greater satisfaction and a better clinic experience with evening clinic versus postcall clinic. Evening continuity clinic is a viable solution to meeting the ACGME work hour limitations while preserving housestaff primary care education.

Annals of the Academy of Medicine, Singapore

Annals of the Academy of Medicine, Singapore

Introduction: The Academic Medicine Education Institute (AM∙EI), jointly established by Duke-NUS ... more Introduction: The Academic Medicine Education Institute (AM∙EI), jointly established by Duke-NUS Graduate Medical School (Duke-NUS) and Singapore Healthcare Services (SingHealth), is a newly formed health professions education academy designed to cultivate best education practices and create a community of health professions educators. To achieve the aims of AM∙EI, the needs of SingHealth educators have to be understood. Therefore, this study was carried out to assess educators’ perceptions towards the current education climate and their academic needs. Materials and Methods: A 28-item questionnaire consisting of free-response, Likert-type and ranking questions was developed. The questionnaire was electronically distributed to 200 medical and nursing educators, and made available to attendees of the 2012 Singhealth Duke-NUS Scientific Congress through hardcopies. Results: A total of 150 completed questionnaires were received (94 from electronic survey and 56 from Congress). Five the...

Annals of the Academy of Medicine, Singapore

EDULEARN proceedings, 2016

Medical Education Online, 2012

Context: Although longitudinal community-based care of patients provides opportunities for teachi... more Context: Although longitudinal community-based care of patients provides opportunities for teaching patient centredness and chronic disease management, there is a paucity of literature assessing learning outcomes of these clerkships. This study examines learning outcomes among students participating in longitudinal community based follow-up of patients discharged from the hospital. Methods: The authors conducted a thematic analysis of 253 student narratives written by 44 third-year medical students reflecting on their longitudinal interactions with patients with chronic medical illnesses. The narratives were written over three periods: after acute hospital encounter, after a home visit and at the end of the 10-month follow-up. Analysis involved coding of theme content and counting of aggregate themes. Results: The most frequent theme was 'chronic disease management' (25%) followed by 'patient-centred care' (22%), 'health care systems' (20.9%), 'biomedical issues' (19.7%), 'community services' (9.5%) and 'student's role conflict' (2.3%). There was a shift in the relative frequency of the different themes, as students moved from hospital to community with their patients. Biomedical (44.3%) and health systems (18.2%) were the dominant themes following the acute hospitalization encounter. Chronic disease management (35.1%) and patient centredness (31.8%) were the dominant themes after the 10-month longitudinal follow-up. Conclusion: Longitudinal community-based interaction with patients resulted in learning about chronic disease management, patient centredness and health care systems over time. Students shifted from learning biomedical knowledge during the acute hospitalization, to focus on better understanding of long-term care and patient centredness, at the end of the module.

American Journal of Health-system Pharmacy, Aug 1, 2000

Pediatric Dermatology, May 1, 1988

A newborn infant who developed a vesicular eruption, clinically indistinguishable from herpetic l... more A newborn infant who developed a vesicular eruption, clinically indistinguishable from herpetic lesions, eventually developed the classic features of Job's syndrome. The initial ares of involvement included the hands and feet, then the scalp, face, and suprapubic skin. The clear, tense vesicles varied only slightly in size and appeared as isolated, grouped, or confluent lesions on inflamed skin. Many eventually became umbilicated. The more typical eczematous component appeared over the course of the next several months. Although the child initially had an elevated white blood cell count and eosinophilia, his IgE level did not become dramatically elevated until after 1 year of age. Job's syndrome should be considered as part of the differential diagnosis of a vesicular eruption in the newborn.

AMA journal of ethics, Aug 1, 2003

Physicians have an obligation to report parents to the local Child Protective Services if they su... more Physicians have an obligation to report parents to the local Child Protective Services if they suspect that the parents are using corporal punishment as a form of discipline.

Medical Education Online, Dec 1, 2003

View related articles Citing articles: 1 View citing articles Kamei RK, Sectish TC. Evaluating a ... more View related articles Citing articles: 1 View citing articles Kamei RK, Sectish TC. Evaluating a residency program using reflections Med Educ Online

Radiology over the past several years has become an increasingly integral component of patient ma... more Radiology over the past several years has become an increasingly integral component of patient management, not only in helping clinicians coming to a diagnosis through a wide range of imaging modalities, but also in treatment of diseases. Interventional radiology has, in many instances, replaced conventional medical or even surgical therapy as the new standard of care. Despite this increasingly critical role in clinical medicine, there continues to be relatively little emphasis on radiology education in the curriculum of most medical schools. As a result, many interns and residents are not well trained in interpreting simple radiographs and scans or even in requesting the appropriate imaging modality to resolve a particular clinical problem. Despite imaging being such a critical component of day-today clinical practice, the lack of clinical radiology training is clearly undesirable and should therefore play a bigger role in medical student education. In 2005, a unique opportunity to develop an innovative teaching program integrating radiology training with core medical education arose when the Singapore Government announced the setting up of a second medical school in Singapore.

Pediatric Dermatology, Nov 1, 1985

Histiocytosis X is a disorder of histiocytes of the Langerhans' cell lineage. As the init... more Histiocytosis X is a disorder of histiocytes of the Langerhans' cell lineage. As the initial feature is often cutaneous, recognition of these skin changes is important. Several cutaneous manifestations have been described, most commonly, seborrheic dermatitis with a hemorrhagic component. We saw two patients with histiocytosis X with cutaneous manifestations resembling cherry angiomas.

Annals Academy of Medicine Singapore, Dec 15, 2006

Academic Medicine, Feb 1, 2008

Duke University and the National University of Singapore (NUS) have partnered to launch a new med... more Duke University and the National University of Singapore (NUS) have partnered to launch a new medical school that brings the American style of postbaccalaureate medical education to Asia. The new institution, called the Duke-NUS Graduate Medical School (GMS) and located in Singapore adjacent to the Singapore General Hospital, admitted its inaugural class of students representing citizens of seven nations in August 2007. The project represents an investment of more than $350 million Please see the end of this article for information about the authors.

International Journal of Medical Education, Nov 8, 2015

Objectives: To identify the factors associated with medical students' clinical reasoning (CR) use... more Objectives: To identify the factors associated with medical students' clinical reasoning (CR) use and evidence-based medicine (EBM) use in the clinical setting. Methods: Our cross-sectional study surveyed 44 final-year medical students at an emerging academic medical center in Singapore. We queried the students' EBM and CR value and experiences in the classroom and clinical settings. We compared this to their perceptions of supervisors' value and experiences using t-tests. We developed measures of teaching culture and practice culture by combining relevant questions into summary scores. Multivariate linear regression models were applied to identify factors associated with the students' CR and EBM clinical use. Results: Eighty-nine percent of students responded (n=39). Students reported valuing CR (p=0.03) and EBM (p=0.001) more than their supervisors, but practiced these skills similarly (p=0.83; p=0.82). Clinical practice culture and classroom CR experience were independently associated with students' CR clinical use (p=0.05; p=0.04), and classroom EBM experience was independently associated with students' EBM clinical use (p=0.03). Clinical teaching culture was not associated with students' CR and EBM clinical use. Conclusions: Our study found that medical students' classroom experience and the clinical practice culture influenced their CR and EBM use. The clinical teaching culture did not. These findings suggest that in order to increase student CR and EBM use, in addition to providing classroom experience, medical educators may need to change the hospital culture by encouraging supervisors to use these skills in their clinical practice.

Pediatric Clinics of North America, Jun 1, 1991

Chronic cough in children is a frequent complaint seen by the primary health care provider. Altho... more Chronic cough in children is a frequent complaint seen by the primary health care provider. Although many of these coughs spontaneously resolve, some are caused by a more serious process and require further attention. Selecting those patients who will benefit from a more extensive evaluation can be a difficult challenge. An overview is provided that emphasizes a systematic approach to the diagnosis and management of chronic cough.

Applied clinical research, clinical trials and regulatory affairs, Oct 1, 2015

The Clinical Teacher, May 27, 2015

Background : Although clinical reasoning (CR) and evidencebased medicine (EBM) are taught in some... more Background : Although clinical reasoning (CR) and evidencebased medicine (EBM) are taught in some medical schools, the curricular details and students' clinical use of these skills are unknown. A detailed description of, and student experiences with, a practical CR and EBM curriculum delivering recommended content and pedagogy in an emerging academic environment may be broadly informative. Purpose : To describe and characterise student experiences with a CR and EBM curriculum at a newly formed Academic Medical Centre (AMC). Methods : Applying expert recommended content and

Archives of pediatrics & adolescent medicine, May 1, 1991

Books for the general physician who encounters children with difficult diagnoses and management p... more Books for the general physician who encounters children with difficult diagnoses and management problems are few, but in great demand. The major pediatric textbooks emphasize individual diseases rather than problems of diagnosis and management. This book attempts to fill that void. The book is divided into two sections. We are told that the first section deals with approaches to evaluations of common problems and that the second section deals with specific disease entities that are difficult to diagnose or to distinguish from similar disorders. I was confused by exactly how each chapter was chosen for one section vs the other, and, therefore, this division into two sections did not help organize the book for me. Nevertheless, each chapter easily stands by itself. The book discusses a broad spectrum of disease categories, but as Stockman warns in his introduction, the list can hardly be comprehensive. While reading each chapter, it seemed

Ambulatory Pediatrics, 2004

Objective.-Residency programs with postcall afternoon continuity clinics violate the new Accredit... more Objective.-Residency programs with postcall afternoon continuity clinics violate the new Accreditation Council for Graduate Medical Education (ACGME) limitations on resident duty hours. We evaluated housestaff experience with a pilot intervention that replaced postcall continuity clinics with evening continuity clinics. Methods.-We began this pilot program at one continuity clinic site for pediatric residents. Instead of postcall clinics, residents had evening continuity clinic added to a regular clinic day when they were neither postcall nor on call. At 5 and 11 months, we surveyed housestaff satisfaction and experience with the evening clinics, particularly in comparison to postcall clinics. Results.-Nineteen of 23 pediatric residents participated in the pilot program. Twenty-two and 17 residents completed the 5-and 11-month follow-up surveys, respectively. A significantly greater proportion of residents rated their overall satisfaction with evening clinic as good/outstanding (16 ⁄ 18 , 89%) compared with postcall clinic (2 ⁄ 19 , 11%) at the 5-month survey (P Ͻ .01). Resident preference for evening clinic over postcall clinic persisted but was not statistically significant at 11 months (P ϭ .05), and overall satisfaction with evening clinic was unchanged from the 5-and 11-month surveys (P ϭ .64). All areas of patient care, medical education, and clinic infrastructure were better or equal in evening clinic in comparison to postcall clinic except for continuity of preceptors and access to medical services. Conclusion.-Housestaff had greater satisfaction and a better clinic experience with evening clinic versus postcall clinic. Evening continuity clinic is a viable solution to meeting the ACGME work hour limitations while preserving housestaff primary care education.

Annals of the Academy of Medicine, Singapore

Annals of the Academy of Medicine, Singapore

Introduction: The Academic Medicine Education Institute (AM∙EI), jointly established by Duke-NUS ... more Introduction: The Academic Medicine Education Institute (AM∙EI), jointly established by Duke-NUS Graduate Medical School (Duke-NUS) and Singapore Healthcare Services (SingHealth), is a newly formed health professions education academy designed to cultivate best education practices and create a community of health professions educators. To achieve the aims of AM∙EI, the needs of SingHealth educators have to be understood. Therefore, this study was carried out to assess educators’ perceptions towards the current education climate and their academic needs. Materials and Methods: A 28-item questionnaire consisting of free-response, Likert-type and ranking questions was developed. The questionnaire was electronically distributed to 200 medical and nursing educators, and made available to attendees of the 2012 Singhealth Duke-NUS Scientific Congress through hardcopies. Results: A total of 150 completed questionnaires were received (94 from electronic survey and 56 from Congress). Five the...

Annals of the Academy of Medicine, Singapore

EDULEARN proceedings, 2016