A questionnaire survey of newly enrolled medical students on the sensitivity to human death and dying was conducted at Yamaguchi University in June 1997 and June 1998. The survey was performed during lectures of an elective liberal arts course in medical ethics for first-year students. Responses were received from 415 students, including 63 medical students. Answers from new medical students were compared with those from new students of other faculties. Our results show that our medical school entrance examination does not generally select students with a high motivation for bioethics. We should consider further improvement in the curriculum of the introduction to medicine (igakugairon in Japanese).

We introduced active educational methods in medical ethics education and evaluated their effect on medical students. Three methods were used: 1) small-group discussion to clarify the clinical ethical issues, 2) self-study to analyze examples of doctors' explanations to patients, and 3) self-study with videotapes to recognize informed consent. We asked students to write a report on each subject of the three studies. Before grading their reports, we determined a standard answer for each subject and marked their reports according to an absolute standard. We found the mean value and standard error of the students' scores in study 1 were significantly higher than those in study 2 or 3. These results suggest that small-group discussion is an effective educational method and useful in the analysis of clinical ethical issues.

A student's medical interview in an objective structured clinical examination (OSCE) may be assessed slightly differently by simulated patients and by the faculty. In this study, we compared three different scores given by the faculty or simulated patients in the assessment of OSCE medical interviews conducted at our department for 3 years. Scores compared were the total score and the behavior score given by the faculty and the score given by simulated patients. The total score and the behavior score given by the faculty correlated well with the score given by simulated patients. However, for students who received a poor assessment from simulated patients, the three scores were weakly correlated; in particular, the behavior score given by the faculty differed markedly from the score given by simulated patients. These results suggest that simulated patients have a different and important viewpoint on assessment of the medical interview in an OSCE.

Fifth-year medical students at the Yamaguchi University School of Medicine must pass an objective structured clinical examination (OSCE) before beginning bedside learning. Because the OSCE is performed over 3 days, examinees on later days are suspected of having an advantage over those tested on early days. In this study, mean values for each day's scores by one examiner were statistically compared in stations of the medical interview to investigate the difference in scores obtained on each of the OSCE days. In addition, for stations at which one student was evaluated by two examiners, their scores for each student were compared statistically in the same manner. We found no significant day-todaydifferences in mean values of the scores over the 3 examination days. However, significant differences were found between the two examiners' scores in 2 of 3 stations for the medical interview. Although there were no differences in scores among participants during the 3-day communication OSCE, examiner's evaluations and formats should be standardized for OSCE stations.

BACKGROUND: Medical students need interviewing skills to be effective in dealing with patients. However, it is presumed that there are some problems in evaluating the competencies medical students are required to have for practicing medicine.
OBJECTIVE: During Objective Structured Clinical Examinations (OSCE) in Japan, instructors usually evaluate examinee's behavior and attitude toward doing medical interviews. To improve the objectivity of these examinations we examined the assessment of our OSCE medical interview.
METHODS: Medical interviews are usually evaluated using a rating list. The standardized list used in most medical schools is composed of two parts: one scores the student's behavior while conducting the interview and the other evaluates the student's ability to gather information from patients. For 5^thyear student OSCE medical interviews are performed twice, before and after ward rotation. The results of two OSCEs were analyzed in terms of scores on conducting an interview, collecting patient information, and SP, or simulated patient. Data analysis of the students' behavior and attitude were taken over 3 years, from 2000 to 2002.
RESULTS: Total scores and scores on conducting interviews, collecting information, and SP's evaluation all increased when comparisons were made between before and after ward rotation. However, only the differences in the total score and SPs score in 2000 were statistically significant. Moreover, clinical skills for collecting patients' information were found to be unsatisfactory.
CONCLUSIONS: As the standardized OSCE medical interviews are performed at all medical schools in Japan today, further improvements in education and in the evaluation system will be required in the future to ensure students obtain the skills expected of them for practicing medicine.

The ratio of men to women was studied in 331 patients hospitalized into our department for the past three years for various liver diseases. Two factors seemed to affect the sex difference in the morbidity of liver disease. One was a history of drinking, the other a positive ratio of HBs antigen. So, heavy drinkers and HBs antigen positive cases were excluded from the patients with chronic hepatitis, liver cirrhosis and hepatocellular carcinoma, and the male/female ratio was studied again. The ratio of men to women in the patients with liver cirrhosis was 1.3: 1, 4. 1: 1 in the patients with hepatocellular carcinoma and 2.0: 1 in the patients with chronic hepatitis. The male ratio was strikingly high in the case of hepatocellular carcinoma. It is thought that liver cirrhosis is a cause of hepatocellular carcinoma. And then differences in the results of liver function tests between men and women were studied in the patients with liver cirrhosis. However, no remarkable difference was found between men and women.

We gathered information of both drinking and smoking habits by questionnairing. The subjects of our study were 116 men around Yanai City. They were divided into five groups. 1st: neither drinking nor smoking habits (23 cases). 2nd: 20 or 40 grams of ethyl alcohol daily and no smoking habit (31 cases). 3rd: more than 40 grams daily and more than 10 cigarettes (32 cases). 4th: 20 grams daily and more than 10 cigarettes (16 cases). 5th: no drinking habit and more than 10 cigarettes daily (14 cases).
The 1st group was a control group, and was compared with the 2nd, 3rd 4th and 5th groups. Consequently both systolic and diastolic blood pressure levels rose significantly only in the 3rd group. Only systolic blood pressure level rose significantly in the 4th group. And so it was suggested that both drinking and smoking habits raised both systolic and diastolic blood pressure levels.

The subjects are 223 women who participated in a mass medical examination. Their ages are between 40 and 79 years. We divided them into four age groups, and studied how aging and obesity influenced their physical health. The results showed the obesity index and serum total protein level were significantly low in the 70-to-79 age group. The serum total cholesterol level was significantly high in the age group between 40 and 50, and it was thought that the elevated cholesterol levels were due to menopause. Thus in females this suggests that a great physical change occurs first in the age group between 40 and 50, and second in the age group between 60 and 70.
Using 165 female cases whose ages were between 40 and 69 years were subdivided into four obesity index groups, we studied how the obesity influenced their physical health. The results showed that the problems include the elevation of diastolic blood pressure levels and serum uric acid levels.

To find a link between lifestyle and arteriosclerosis, the serum lipid values were studied in those who had entered our hospital for a thorough physical examination. The subjects were 136 men and 31 women. They were divided into six groups. 1st: neither drinking nor smoking habits (24 cases). 2nd: 20 or 40 grams of ethyl alcohol daily and no smoking habit (45 cases). 3rd: more than 40 grams daily and more than 10 cigarettes (21 cases). 4th: 20 grams daily and more than 10 cigarettes (25 cases). 5th: no drinking habit and more than 10 cigarettes daily (21 cases). 6th: women who had neither drinking nor smoking habits (31 cases).
The 2nd group was a control group, and was compared with each group. It was found that only TG values were significantly high in the 3rd group. HDL-C values were significantly low in the 5th group. There were no significant differences in the 1st and 4th groups. T-CHO and LDL-C values were significantly high in the 6th group. These facts suggest that it is difficult to correlate both drinking and smoking habits with the incidence of arteriosclerosis. And perhaps it is the same in women, because LDL-C values were high in women, but at the same time HDL-C values were high.

Recently, as the practical training for clinical skills are extensively introduced in the curriculum of medical schools, the objective structured clinical examinations (OSCEs) is taken to assess the clinical skills of trainees. However, there have been very few papers mentioned about correlation between scores on a written examination of the clinical sciences and those on OSCE in Japan. In this study, to compare these of two kinds of examinations in year five medical students of Yamaguchi University, their scores of the stations of OSCE and those of the written examinations of clinical sciences which seemed to correlate stations of skill's examinations were studied statistically. As a result, there were no statistical significances in each scores between skill's evaluations and written tests. This results that these two examinations estimated the different abilities of students on the taxonomy of medical education. Moreover, OSCE is reconfirmed to be identical as an evaluative method of clinical skills. Now, new medical educational systems should be introducted for the training of skills and attitude for students.