The innovation of the University Chartering Standards Law in 1991 triggered changes in general education in almost all medical schools in Japan. These changes include: 1) frequent abolition of the department of general education; 2) an expansion in the offerings of specialty subject; and 3) increase in early exposure programs. The Model of general education has, in general, changed from the liberal arts model to the one that emphasizes the development of physicians. One remaining problem is that, although the system of general education has changed, the traditional pedagogy has generally persisted. These are at least two possible forms that general education can take in the future. The first one comes from the U.S., in which students enter medical schools after finishing their general college education. The other one stems from an European model in which high school provide students with part of their general education, and medical schools provide them with intensive basic and humanity education that is necessary for physicians. Medical schools in Japan now face three major challenges for the future: 1) seeking how to teach ways of thinking other than medical one; 2) establishing an education system corresponding with recent changes in young people; 3) establishing divisions which comprehensively organize and supervise general education.

The activity of the Simulated patient/Standardized patient has been spreading rapidly in Japan since 1992. At the end of 1998, there are fifteen SP groups all over Japan. Total number of the SP are 108; 21 male and 87 female. We listed all the activity of these SP groups.

Background and Method: To identify the cause of conflicts between medical residents and nurses during daily care practices in a general medicine ward, we observed and conducted interviews with 12 residents in their second postgraduate year. Results: We found three typical situations that are likely to lead to conflicts. 1) Both residents and nurses, especially when they are less experienced, are too occupied with their daily tasks to understand their counterpart's difficulties. 2) Nurses push residents to make quicker decisions beyond their discretion and ability. 3) The medical priority of making a precise diagnosis conflicts with the nursing priority of keeping patients comfortable.

Occupational health was taught to 3rd-year medical students using simulated patients and role playing. Patient profiles were created to enable students to consider psychosocial aspects, such as work environment and lifestyles, involved in occupational health. Simulated patients were used, later, students acted as patients and each student played the role of an occupational health doctor. The aim of the exercise was for students, through their own actions and observations, to learn communication skills and approaches to occupational health, such as prevention, health promotion, and the importance of health education, which are based on a biopsychosocial model.
Students were extremely interested and found the course valuable. This result shows the effectiveness and current shortage of active learning methods as well as the need for acquiring communication skills.
Although learning communication skills is most relevant to clinical medicine, active learning and communication training is also important for occupational health education because the latter should be based not on the traditional doctor-patient relationship but on the biopsychosocial model.

Although the Ministery of Health and Welfare, Japan, has an intention to revamp the medical care delivery system, the majority of physicians are currently practicing in the context of some sort of public medical insurance system. Therefore, it is madatory that medical students and young physicians understand public medical insurance system and economical issues to practice medicine in a cost-effective way. We propose here neurosurgical cases used for that purpose employing problem-based learning method in tutorial system.

SPs have made a dramatic development in medical education over 10 years, due to the influence of medical education curriculum reform and the introduction of the Objective Structured Clinical Examination. However the quality of SPs' activities varies. In order to increase the quality it is necessary to analyze the psychological needs of SPs. The purpose of this survey is to explore SPs' personal characteristics and how they feel during their activities.
1) In a nationwide survey of Japanese SPs, 332 SPs (62%) out of 532 responded.
2) Sixty percent of SPs were between the ages of 50 and 69 years and the ratio of male to female SPs was 1: 4. The ratio of workers and non-workers was 1: 2.
3) A qualitative analysis found that SP motivations were derived mainly from making a contribution to society and self-improvement. Ninety six percent of SPs were satisfied with being an SP, especially when they saw improvements in the students.
4) However, 67% of SPs expressed difficulty with the three core skills of feedback, evaluation and performance.

1) We visited 5 Scottish universities (the Universities of Aberdeen, St Andrews, Dundee, Glasgow, and Edinburgh) to observe and learn about simulated-patient programs and communication-skills training.
2) Each medical school has developed its own approach for using simulated patients in training and for giving feedback to medical students.
3) In Scotland, where all medical schools adhere to“Tomorrow's Doctors”and“the Scottish Doctor Curriculum Outcomes, ”curriculum styles vary greatly, but the differences are celebrated.The simulated-patient programs are integrated into each program in a way unique to each school.

The role of standardized patients (SPs) has developed rapidly over the last10years because of medical education curriculum reform and the introduction of the objective structured clinical examination (OSCE). As the participation of SPs in medical education has increased, the anxieties and frustrations of SPs have also increased. We believe that an understanding of the attitudes of SPs would improve the quality of their activities. The purpose of this survey was to study the activities and psychological needs of Japanese SPs in the OSCE.
1) The response rate to the nationwide survey was62% (332of532SPs).
2) Role-playing and group discussion were the most common training methods, and the length of training varied from 0 to 40 hours.
3) The factors that SPs felt difficult were judging how much to respond in their performances (73%) and maintaining consistent standards in evaluating examinees (66%).
4) Our results suggest that SPs require more training and that the number of SP educators should be increased.

Objectives: To clarify differences in medical students’ emotional intelligence and empathy among 4 school years and sex.
Methods: A cross-sectional study of 370 medical students in years 1, 2, 4, and 6 was performed with Japanese versions of 2 self-reported questionnaires: the Trait Emotional Intelligence Questionnaire–Short Form （TEIQue-SF） and the Jefferson Scale of Physician Empathy–Student Version （JSPE-S）.
Results: Total scores of the TEIQue–SF tended to decrease in higher school years. However, the total score of the JSPE-S was significantly increased in year 6 but was decreased in year 4. Male students had higher TEIQue–SF scores, and female students had higher JSPE-S scores. Of the 4 factors of the TEIQue–SF compared （well-being, self-control, emotionality, and sociability）, only sociability was higher in males. No differences were found among school years. The scores of the TEIQue–SF and the JSPE-S showed a weak correlation. Of the factors of the TEIQue–SF, only self-control showed no correlation with the JSPE-S.
Discussion and Conclusion: These results suggest that the emotional intelligence of both male and female medical students tends to decline. The increase in JSPE-S scores in year 6 suggests that medical interview training is effective. Furthermore, training is important both to enhance emotional intelligence and to teach self-control skills.