We compared the effects on clinical clerkships of an electronic medical record (EMR) system and a standard medical record system. Using an EMR system, students described medical records with a problem-oriented medical record system/subject objective assessment, and plan that was much better than the standard medical record system. In the EMR system, students cannot see physicians' medical records, including laboratory data and X-ray films. Instead, students themselves must obtain the patient history and request examinations as physicians do. This system helps supervisors give suitable comments and provide data that students have requested. Directors can also evaluate supervisors by reviewing their comments. Therefore, an EMR system has the advantage of problem-oriented medical record system-based learning for students and is also useful for clinical clerkships.

Problem-based learning (PBL) tutorials were introduced at our university in April 2001. Because a complete PBLbased curriculum could not be adopted, a transitional curriculum incorporating 3-hour PBL tutorial sessions into the traditional curriculum was introduced. More than 80% of students agreed that PBL is an effective way of learning problem solving at the bedside. Twenty percent to 40% of teachers felt that students who took PBL were more motivated for bedside learning and self-directed learning and had better at presentation than were students who did not take PBL. Because of 80% of the curriculum comprised didactic lectures, most students considered PBL tutorials a type of lecture. For this reason, motivating students to learn additional material originating from PBL tutorials was difficult. Although the combination of a traditional curriculum and PBL tutorials may appear to be a new curriculum, this type of PBL has limited value as a method for studying problem solving.