Since 1993, we have used a clinical clerkship method in an attempt to improve the undergraduate clinical training in our department. At first, the students were given the opportunity to learn adequate basic clinical procedures (levels 1 to 3), but data on the effect of their training were lacking. Therefore, we conducted a survey to obtain the necessary information. Twenty-nine students (29 % of students in the sixth academic year) participated and wrote their survey reports at the end of the course. The reports were designed to evaluate their problem-solving skills and the effects of self-directed learning in clinical anesthesia and to obtain an overall impression of the training. The results revealed that the educational effect was insufficient for almost all students who participated because they were unable to fully solve the problems of anesthetic management from either a pathophysiologic or pathobiochemical standpoint. From these results and our further experiences from 1994 through 1996, we decided to reform our educational procedures. The important improvements are as follows. 1) Trainees must record the anesthesia course during the assigned anesthetic case and participate in the postoperative ward discussion. 2) A member of the teaching staff must discuss ways to manage and solve problems with trainees at the end of each case. 3) After the discussion, trainees must write a report about how and what they have learned.