Cardiac patient simulators are commonly used in Japanese educational institutions; however, most institutions have not established concrete learning objectives or strategies for mastering physical examination of the circulatory system, including cardiac auscultation. In this study, we propose clear learning objectives and strategies for simulator practice for fifth-year medical students who have passed the objective structured clinical examination, and explored their educational effectiveness.
1)The subjects were fifth-year medical students (n=94) at the University of Miyazaki. Learning objectives were the mastery of the sequential physical examination and the ability to distinguish 6 cardiac findings, including normal status. The subjects were evaluated with a checklist before and after lectures and simulator practice.
2)The mean score (maximum score=14) significantly increased from before simulator practice (2.2±0.9) to after simulator practice (11.4±1.5; p<0.001). There was no difference in scores after practice among the cardiac diseases.
3)Before practice more than 50% of subjects could use a stethoscope on only right positions and could indicate only the maximum point of a cardiac murmur; in contrast, after practice more than 90% of the subjects could sequentially describe physical findings and accurately predict cardiac diseases.
4)In a questionnaire administered after practice, 83% of the subjects answered that all physicians should acquire proficiency in cardiac auscultation regardless of their specialty.
Simulator practice with clear learning objectives may help improve clinical examination skills when both time and human resources are limited. The reevaluation of the program's continuing educational effectiveness and the establishment of an iterative learning program will be needed.

Abstract
Objective : Laninamivir Octanoate (LO) is a novel anti-influenza drug administered by inhalation only once administration, and with a very simple dosage adjustment regimen. Conversely, inhalation might be expected to fail in some groups of patients, particularly the very young and very elderly because of poor inhalation technique. Therefore, we undertook a study to investigate the success and failure rates of the dry powder inhalation formulation of LO.
Methods : We observed 159 patients who were prescribed LO. Pharmacists observed the administration technique after explaining how to inhale the drug. Success was defined as patients who could inhale the drug without a problem. Failure was defined as those patients who were judged to have inhaled less than 75％ of the drug. We also examined the success rate between pharmacies and the success and failure rates according to age.
Results : A 4-years-old patient was the youngest to fail LO therapy whereas a 5-years-old patient was the youngest to succeeded with the therapy. The success rate did not differ significantly between pharmacies. The success rate was 88.9％ in patients under the age of 9 years, but which was significantly lower compared with 97.9％ in the group of patients over 10 years of age.
Conclusion : This survey revealed that many cases of inhalation failure of LO anti-influenza therapy occur below the age of 9 year.

The Professionalism subcommittee of Japan Society for Medical Education has been examining a diverse range of issues related to medical professionalism education for approximately the past 20 years. In July 2015, the committee formulated and presented a draft on “ The Attributes and Competencies of Physicians: An Exploration of Professionalism” Based on this, we have been conducting educational activities on professionalism education, but we had not documented this draft. We are now re-presenting the draft here with minor lexical corrections and additional notes. The professionalism of physicians is delineated in seven attributes and competencies :1. Sense of mission and responsibility towards society2. Practice of patient-centered health care3. Demonstration of integrity and justice4. Acceptance of diverse values and sharing of fundamental values5. Fulfilling roles as leaders/members in organizations and teams6. Pursuit of excellence and lifelong learning7. Self-management and career developmentThis document is presented with the expectation that it will contribute to future discussions on professionalism education.