Medical ethics is taught as a principle of medicine at medical schools in Japan. However, the best way to teach medical students about decision-making in ethical dilemmas in unclear. Therefore, we conducted a survey of 80 medical schools in Japan to identify the current issues in the teaching of medical ethics. We asked how and when students learned about medical ethics at medical school and asked about the objectives, achievement goals, contents, and curricula for the first to sixth years and postgraduate studies.1) A preliminary study of educational affairs at faculties of medicine (response rate, 99%) showed that medical ethics is most likely to be taught in the earliest year (first year, 61%) and is less likely to be taught in later years (fifth or sixth year, 11%). 2) Only 28% of lecturers who teach medical ethics are familiar with the whole curriculum of medical ethics, and only 15 medical schools had cross-faculty teaching.3) Lecturers' satisfaction with the system of teaching medical ethics at medical schools was related with the introduction of the elements of medical ethics at bedside teaching (odds ratio=7.4, p<0.01).4) A logistic regression model adjusted for lecturers' specialties indicated that sufficient content for teaching medical ethics was associated with classroom discussions with clinicians (odds ratio=9.3, p<0.05).5) Despite the recently increased recognition of the importance of teaching medical ethics, the human resources for teaching medical ethics at medical schools are scarce and insufficient. Urgent responses are needed to address current shortcomings in the teaching system and the advanced training of teachers.

BACKGROUND : In Japan, clinical ethics support services are only available at certain institutions. The actual conditions surrounding ethics consultation are unclear with few resources available for determining its efficacy. The object of this study is to clarify the expected outcome of ethics consultation and identify the appropriate mode. We also aim to elucidate the ideal consultant and the obstacles to achieving full utilization of ethics consultation.
METHODS : Eighteen medical practitioners participated in the study. We held semi-structured interviews and analyzed these interviews by qualitative content-analysis technique.
RESULTS : This study suggests that specific advice, new insights from outside parties, emotional support, and an appropriate process based on a division of labor between medicine and ethics all contribute to a team-based practice of medicine that avoids the arbitrariness and dogmatism of single practitioners. It is also indicated that timeliness and swift answers are required. Knowledge of medicine and ethics, communication skills, a close familiarity with actual conditions in medical practice, and empathy toward the medical staff were found to be as important as the qualifications of consultants. Contrarily, the participants suggested that the busy pace, lack of psychological breathing room, medical practitioners' pride, lack of awareness of ethical issues, and the negative image of the word “ethics” were significant impediments to achieving full utilization of ethics consultation.
CONCLUSIONS : The present study is the first of its kind to reveal the views of medical professionals regarding clinical ethics consultation in Japan. Further research is required to identify the features of a consultation system that can be easily accessed and effectively utilized in Japan.

1)Professionalism should be explicitly introduced as a fundamental content into curricula/programs of undergraduate medical education, postgraduate clinical training, and of continuing medical education provided by professional societies and the Japan Medical Association.
2)We need to enhance our research activities on goals and objectives which should be accomplished through professionalism education, effective learning strategies, appropriate assessment methods, as well as the impact of informal and hidden curricula.
3)We propose that the medical profession should collaboratively develop various activities to win the trust of the general society in tandem with the introduction of professionalism education.