In clinic-based training, medical students take part in various activities, including watching or assisting in clinical procedures and participating in home visits, vaccinations, industrial inspections, health education, and elderly service adjustment meetings. Through these experiences students gain a practical understanding of the importance to primary care of a close patient-physician relationship; consideration of the life and background of patients and families; continuity of care; a suitable relationship between a primary-care clinic and a hospital or specialist; a team approach with other medical staff, such as nurses, community health nurses, helpers, and social workers; and medical and welfare resources of the community. These concepts are difficult to teach effectively in a large university or private hospital. On the basis of my experiences, I would like to comment on the policy of clinic-based training and problems in expanding such training.

To examine ethical problems students may face during clinical clerkships and to help them to learn how to solve these ethical problems practically, we started a compulsory ethical case conference for medical students rotating through the department of general medicine. Actual cases were selected from among those students had encountered during their clinical clerkship. Groups of students were to analyze these cases and to discuss how to solve ethical problems. In this study, we evaluated this course on the basis of student's questionnaires and case sheets they submitted. Eighty students (92%) answered that they had encountered ethical problems. Each student encountered an average of 3.95±1.53 cases with ethical problems. Students noted 130 ethical issues (an average of 1.63±0.51 issues per case). Ethical issues included informed consent, treatment selection, refusal of treatment, medical distrust, and the doctor-patient relationship. In addition, such important subjects as economic burden, ability for self-determination, social rehabilitation, and patient-family relationships were mentioned, but only rarely. Eighty-five percent of students thought the conferences were valuable. Moreover, 87% of students thought such conferences would motivate them to think about ethical issues in the future. All students thought these compulsory ethical conferences should be continued. However, both the students' degree of participation and comprehensiveness of the conference contents could be improved.

There is no objection that the medical ethics enters basic matters of the undergraduate medical education. The curriculum plan of medical ethics in the medical school in our country is proposed. This curriculum aims at the participating education that the student personally chooses and discovers the result to be studied instead of the passive lecture like the boring preaching from the platform. This is the curriculum throughout a few years, because it is necessary to repeatedly study adjusting to the learning achievement.

We proposed the curriculum plan of medical ethics in the medical school in our country. That was the curriculum throughout a few years and the participating education. Now we present the manual for one case of the each six strategies. When the teacher holds classes according to this manual or with some modifications, the medical students will probably participate the education with high motivation to learn.

The first workshop on medical ethics education was held for 28 members including mainly university tutors and hospital tutors in November 2002 at Gifu. Trail for training of several kinds of medical ethics education technique was evaluated to a certain extent. We submit report of the practice and participants' evaluation of the workshop.

Increased emphasis on community-based education in medicine requires close collaboration with and cooperation from general practitioners. This study examined what motivates community physicians to participate in office-based education, to explore the most appropriate method for recognizing physicians' efforts and keeping them motivated with their precepting role. A large majority of respondents to a questionnaire survey thought that the opportunity to learn from their own teaching was an important reward. When the preceptors were asked what support would be most appropriate, a teaching certification plaque, continuing medical education courses, and a title were ranked highest, while financial reward was listed as the least important. Considered most essential by community preceptors were constructive feedback from students, medical-school instructors' understanding of the importance of community-based medicine, and the instructors' enthusiastic promotion of primary-care education.

To examine the present state of postgraduate ethics education for residents in Japan, we sent an anonymous self-administered questionnaire to the directors of all 640 hospitals in Japan with a registered postgraduate clinical residency program. A total of 258 hospitals returned the questionnaire (response rate: 40.3%). Of these hospitals, 69 (26.7%) had a program for ethics education and 189 (73.3%) did not. The presence of a program was strongly correlated with the number of hospital beds and a history of problems with ethics education. Respondents showed a high degree of awareness about such significant topics in ethics education as “informed consent, ” “patient privacy, ” “patient rights, ” and “physician duties.”