To the Editor
The novel coronavirus disease 2019 (COVID-19) has profoundly impacted the learning
environment of universities, especially medical schools, leading to a significant
loss of educational opportunities. This situation has sparked a global controversy,
with over 30% of medical students worldwide reporting anxiety, emphasizing the need
for transformation in medical education.
1
Indeed, reports indicate that approximately 5% of Japanese students who suspended
their studies in the 2021 academic year did so due to the COVID-19 pandemic, emphasizing
the need for a transformation in medical education that aligns with environmental
changes and evolving student needs.
2
In response to similar challenges, a medical school in Hungary, for example, provided
study guidelines and COVID-19 stress management materials on demand, aiming to alleviate
students' potential psychological anxiety about self-study during the pandemic.
3
However, multiple reported instances in Japan suggest that the prioritization of learning
opportunities for medical students was seemingly overlooked.
Illustrating the above challenges, a pre-medical student at the University of Tokyo
(UT) was compelled to repeat a year due to absences resulting from a COVID-19 infection.
4
The student contracted COVID-19 in May 2022 and could not attend classes or submit
assignments, and although he had submitted a medical certificate, the assigned professor
graded his assignment with zero points and did not allow him to undergo a make-up
course because he missed the prescribed deadline. Although the student completed credits
for other courses using alternative procedures, he was forced to repeat a year due
to failing this one course that was not approved for such procedures. The student
filed an appeal, but the response from the faculty was that the credit would not be
granted even with a make-up course, and the course grade was inexplicably reduced
by 17 points. Subsequently, the student held a press conference, demanding a justifiable
explanation for the grade reduction and the absence of make-up courses. However, the
UT faculty argued that since the student accessed their website on the evening of
his absence, it was challenging to believe his COVID-19 symptoms were severe enough
to prevent course participation. Additionally, they later revealed to the media that
the point reduction was the faculty member's mistake in entering grades. As a result,
the student deemed this response to be unfair and filed a lawsuit against the university
requesting the implementation of make-up courses, which is still undergoing litigation
without any resolution in sight.
Another case highlighting the disruptions in medical education can be seen at Gunma
University, where an extraordinary circumstance arose. While approximately 90% of
students in Japanese medical schools graduate within six years, 24 out of about 120
students at this university failed compulsory courses 'Medical Ethics' and 'Humanities
in Medicine', taught by a specific professor.
5
Moreover, this decision, where students were assessed based on impromptu performances
simulating medical scenarios instead of test results aligned with the syllabus, sparked
allegations of academic harassment from students and drew substantial media attention
in October 2022. Indeed, this professor had a known history of academic harassment.
Consequently, one of his students, who had taken a leave of absence after developing
severe post-traumatic stress disorder as a result of such harassment, filed a lawsuit
seeking damages from the university, yet the university continued to allow this professor
to take classes despite the fact that this issue was unresolved. The response from
the university to this issue was also inadequate, only involving the removal of the
professor from teaching duties and offering make-up courses only to eight of the students
who were in their third year. Consequently, such a series of insincere responses resulted
in a decline in trust towards the university among the medical students, exacerbating
their dissatisfaction and inciting controversy.
These cases highlight the potential neglect of students' needs by universities and
faculties in Japan, drawing attention to the issue at a time when the global discourse
centers on the loss of learning opportunities due to COVID-19. Amid the pandemic's
chaos, faculty members, traditionally upholding the principle of infallibility common
in Japanese organizations,
6
may have been overwhelmed by the transition to new educational methods like online
systems,
7
which could have complicated their ability to prioritize and heed student voices.
Nevertheless, failing to progress to the next academic year imposes a significant
financial and mental burden on students in terms of tuition, living costs, and potential
disadvantages to them regarding career progression, necessitating a swift and flexible
response in both cases. Therefore, the bureaucratic approach of the faculties underscores
the need for improved communication and a collective understanding in addressing such
unprecedented situations.
Furthermore, a common problem highlighted by both cases was the need for more transparency
in the processes of grade evaluation and implementation of make-up courses, indicating
a wider systemic issue. Specifically, although the Japanese Ministry of Education,
Culture, Sports, Science, and Technology instructed all universities to flexibly establish
systems such as the provision of alternative learning if infected with COVID-19,
8
it was suggested that merely issuing such directives by the government is insufficient
in the actual context of medical education. To ensure objectivity and fairness in
grade evaluations, universities must disclose the evaluation criteria to students
in advance and assess them according to these criteria, promoting the achievement
of educational objectives.
9
Ambiguous grade evaluation criteria are contrary to these principles, and the failure
to provide opportunities for re-examinations or make-up courses could be seen as an
abuse of discretion, highlighting the need for a tra parent grade evaluation system.
In medical education, building adequate trust between faculty and students proves
challenging when students' needs are overlooked, and the transparency of grade evaluations,
along with the criteria for providing make-up courses, remains unclear. Therefore,
involving students in the decision-making process is believed to be paramount to realizing
a student-centric education. In fact, there is a growing global trend, prevalent in
countries like the United States, to involve students directly in curriculum design,
with several medical institutions empowering students to spearhead curriculum changes.
10
In addition, by leveraging the shift towards online medical education due to COVID-19,
7
mutual sharing and feedback on the realities of medical education with other universities
through online platforms could effectively prevent similar incidents at specific institutions.
Expanding such initiatives, continually incorporating student feedback into medical
education, and constantly adapting the curriculum to meet the demands of the times
could be potential solutions.
In conclusion, the COVID-19 pandemic has exposed significant deficiencies within the
Japanese medical education framework. These shortcomings, particularly concerning
the provision of make-up courses, transparency in grade evaluations, and faculty-student
relationships, point to a need for systemic reforms and international cooperation.
The visibility of such cases is typically low, and it remains unclear to what extent
medical students worldwide are confronted with such circumstances. Consequently, these
cases should not be trivialized as a problem in specific medical schools in Japan.
These issues warrant a more comprehensive discussion and concerted efforts to establish
an international consensus, aiming to foster a more flexible and adaptable environment
for medical education, during both pandemics and normal circumstances.
Conflicts of Interest
The authors declare that they have no conflict of interest.