Aim and Method: We sent a questionnaire to clinical instructors of junior residents to examine the validity of the guidelines of the national board medical examination for physicians.

Results: They estimated that about 10% of the diseases listed in the guidelines were beyond the scope of the training for junior residents. In addition, the examination questions did not necessarily reflect the importance in the training.

Conclusion: These results suggest that there is a discrepancy between the national board medical examination and the content of postgraduate training.

1) We searched the Internet with Google and the key words "GIO," "SBO," "general objectives," and "behavioral objectives."2) Most of the top 100 Web sites found with searches using the key words "GIO" and "SBO" were related to Japanese medical education.3) Most of the top 100 sites found through searches using the Japanese key words "general objectives" and "behavioral objectives" were related to medical education.

Objective: Teachers of various departments are in charge of medical interview training classes with the participation of simulated patients. However, it is not clear whether there are differences in feedback (FB) among teachers. The objective was to examine differences in FB among teachers, investigate effective FB methods, and evaluate the effect of an FB manual.
Methods: We conducted a questionnaire survey of students to assess their evaluation of FB by teachers. In the meantime, we transcribed and analyzed teachers' FB on the basis of video recordings. We created a teacher's manual for FB on the basis of these results. We conducted a similar survey the following year.
Results: The evaluations from students included many positive opinions, such as "we heard from the teachers about their clinical experiences" . Analysis of the videos showed significant differences in the contents of FB among groups. The performance of the interview strongly influenced the content of the FB. Variations in each group tended to be reduced the following year.
Conclusions: 1) There were significant differences in FB among teachers. 2) FB that includes the clinical experiences of the teacher and discussion among students may enhance the learning effect. 3) Introduction of the manual increased the relevance of FB.

　It is necessary to perform out-patient training in order to acquire the basic medical skills of primary care. However, the actual situation of out-patient training has not been clarified in Japan. Therefore, we performed a survey of out-patient training by junior residents at university hospitals throughout Japan.

　A questionnaire survey was performed on out-patient training for junior residents at 80 university hospitals (main hospitals) nationwide. We received responses from 39 hospitals. The hospitals where out-patient training by junior residents was performed numbered 34, and there were 26 hospitals in which the training in out-patient reception hours is being performed. Hospitals which received training on related hospitals were also noted. There were many hospitals receiving a few patients with common symptoms. It is important to conduct training in university hospitals in cooperation with local hospitals.

1) Afghanistan is one of countries facing serious health situation in the world, and Japan starts support in various area after Tokyo international conference for Afghanistan reconstruction in January, 2002.
2) International Research Center for Medical Education (IRCME), the University of Tokyo, sent faculties as members of JICA expert team for Kabul in 2003 and 2004, and launched support reconstruction of medical education of Afghanistan.
3) IRCME formed consortium in cooperation with Japan Society for Medical Education, International Medical Center of Japan Bureau of International Cooperation and other institutions in order to carry out Medical Education Project to support medical education development of Kabul Medical University, Afghanistan.

This study explored the general public's perception of the clinical competence of residents. Methods: Individual interviews of laypersons, medical students, and residents and focus-group interviews of residents were conducted. Results: Individual interviews revealed the belief that residents acquired various clinical skills immediately after passing the national examination for medical practitioners. These skills included: assessment of the need for referrals, on-call jobs for after-hours and emergency services, interpreting X-ray films, performing cardiopulmonary resuscitation, performing surgery for appendicitis, and treating bone fractures and joint dislocations. Focus-group interviews revealed differences between residents and laypersons in the perception of residents' clinical skills. These skills included: general knowledge of diseases and medications, guidance about lifestyle after discharge, physical examinations, explanation of treatment, diagnostic imaging, and knowledge of or expertise in other medical professions. Conclusion: Laypersons and medical personnel have different perceptions about the clinical competence of residents.

Teaching ambulatory-care medicine is essential for primary-care education. However, few studies of ambulatory-care training have been done in the past decade. We performed a nationwide survey to examine whether and how ambulatory medicine is taught to medical students and residents. We sent questionnaires to all medical schools (n=80) and accredited teaching hospitals (n=389) in February 2001. The response rates were 83.3% and 79.2%, respectively. Fifty-one (78.5%) of the 65 medical schools provided ambulatory-care education, although the programs varied considerably from school to school. Only 104 teaching hospitals (26.7%) had an ambulatory-care training program.

Although postgraduate training in an ambulatory care setting is recognized as beneficial in Japan, such training has not been widely implemented. In April 2001 we surveyed all 389 accredited teaching hospitals in Japan about their ambulatory care training. We asked 1) whether they provide a postgraduate training program in ambulatory care, particularly for problems commonly encountered in primary care settings, 2) if such a program was provided, how it was organized, and 3) if such a program was not provided, what the reasons were. One hundred eighty physicians responsible for the residency programs of 120 hospitals replied (response rate, 87%). Most residents at these hospitals see patients in outpatient clinics regularly during their training. Many faculty members supervise their residents at the outpatient clinic and also see their own patients. Sixty-eight percent of the respondents did not set teaching objectives for ambulatory care training. Frequently mentioned barriers to providing ambulatory care training were limited space and tight outpatient schedules. To promote postgraduate ambulatory care training in accredited teaching hospitals, adequate resource allocation and a national policy are needed.