Osaka City University Medical School is now radically reforming its undergraduate curriculum for clinical medical education. Over the next 2 years, lecture will gradually be decreased from 773 to 433 sessions (each session lasting 105 minutes) by introducing organ-based integrated lectures, while practical clinical training will be increased to 15 months and classical bedside teaching will be replaced by clinical clerkships. A new teaching building to be completed by April 1998 will contain many rooms and facilities for students to study alone or in groups. Such innovations became possible only after continuous cooperation and planning by the newly organized curriculum committee and its subcommittees.

To evaluate clinical courses at teaching hospitals outside of Osaka City University Hospital, we used a questionnaire to ask instructors and sixth-year students about practical problems immediately after the end of the semester. This course was conducted for 7 weeks during the first semester at 24 hospitals and for 5 weeks during the second semester at 23 hospitals. In each semester about 40% of clinical practice at teaching hospitals was done in the style of clinical clerkships. About 90% of students were mostly or completely satisfied with their instructors and hospitals. Furthermore, about 70% of instructors felt more or less fulfilled by working with students and about 60% of them felt working with students was rewarding. More than 95% of instructors would be willing to teach medical students again. In conclusion, most instructors and students felt that clinical courses at teaching hospitals outside of Osaka City University Hospital were conducted without problems.

A program for early-exposure of first-year medical students to nursing and patient care was started at Osaka City University in 1994. Eighty students completed the program in the 2002 academic year. To improve methods of teaching and evaluation, we analyzed the responses of students and nursing instructors to questionnaires about satisfaction with the program after each practice session. Students were randomized to four settings (university hospital, general hospital, general emergency hospital, and general geriatric hospital). Responses of students and instructors did not differ between settings suggest that early exposure was uniform. Medical students gave higher scores for interest in and significance of early exposure, although nursing instructors did not. The success of the program of early exposure of medical students to nursing care will be used to further improve the curriculum.

Since 1999 all sixth-year students at Osaka City University Medical School have done clinical clerkships at teaching hospitals outside the university. Students can choose overseas or domestic hospitals. By the end of the 2002 academic year 32 students had done clerkships in 7 foreign countries. Arrangements for participating in overseas clerkships differ in many ways from those for domestic clerkships, as students must get information about hospitals and complete application forms in English. Because most medical students feel that making such arrangements is difficult and complex, in 2000 students established a volunteer organization that helps students to study abroad. To make the best use of this organization, Osaka City University Medical School has established several guidelines, including setting standards for students and criteria for choosing overseas hospitals. We report on some problems encountered by our school and on measures for dealing with them and report on the student-managed support organization for overseas clinical clerkships.

1) The central venous catheterization (CVC) training program for 2 trainees involves an instructor, a CVC insertion simulator (Kyoto Kagaku Co., Ltd), and a simulated patient.
2) The questionnaire filled out by trainees after the program showed favorable opinions, particularly the method of learning after the practice.
3) It is important that effective simulation programs for trainees are designed to develop practical procedures and professional attitudes as a physician using both a simulator and a simulated patient.

1) Osaka City University Medical School provides basic life support courses in the Skills Simulation Center. Most instructors are members of the Life Support Club, a medical students' extracurricular activity.2) We investigated the numbers and opinions of participants(December 2006 through July 2008). The numbers of trainee and instructors were 1071 and 1223, respectively. The student instructors considered their activities worthwhile.3) The trainees highly appreciated the student instructors and showed that the effectiveness of training was excellent. Our results show that basic life support courses taught by medical students are beneficial for both trainees and student instructors.