I’m Tomatsu, a 6-year med student.
The latest Clinical Dojo Advanced took place in Zoom on September 17th!
Our team has 12 members, consisting of Chief Dr.Nogi, a student organizer, Fukuda, and
other 8 participants from any grade, any med school in Japan.
In the previous Dojo, we learned how to use semantic qualifiers. This time we acquired
problem representation skill. The case of the day was that a 70-year-old Filipino female
presented with chest pain and came into the ED.
After 30 minutes of history taking, and physical examination by group working…below is
the information gained. “Malia is a 70-year-old Filipino female active smoker with PMH of
uncontrolled DM, HT, who is present to the ED, complaining of subacute intermittent chest
pain with shortness of breath and diaphoresis. She states that the pain begins when she
exercises and lasts around 1 hour followed by a radiation pain around the shoulder. On
exam, she is tachycardic, hypertensive, with orthopnea. “To summarize in 1 sentence…”A
70-year-old coronary-risk woman presents with acute progressive chest pain with angina.
“We include critical features and exclude non-particular ones while answering 3 questions:
• Active smoker, DM, HT → Coronary risk factor

• Subacute, intermittent chest pain, exacerbated with exercise, relieved with rest → Angina
• The pain begins and lasts around 1 hour → acute
• Who is the patient? → A 70-year-old coronary-risk woman
• What is the time course? → acute
• What is the clinical syndrome? → progressive chest pain with angina
Overall, our discussion went on an interactive way and had loads of learning points.
When tackling this issue, pre-clinical year 1-4 students did a very good job at history taking
and physical examinations. Also, Clinical year 5-6 could summarize the patient’s
information and generate problem representation with semantic qualifiers.
If you’d like to join Clinical Dojo Advanced, don’t hesitate to contact us!