We analyzed and evaluated problem lists compiled by students during bedside learning. Ninety percent of the items on problem lists were medical problems, 4% were psychological problems, and 6% were social problems. Among medical problems, items related to laboratory data were most prominent, followed by data from physical examination, symptoms, and complications. Highly evaluated problem lists contained items related to psychological problems and social problems, while poorly evaluated lists did not include such items. Students with good scores on problem lists also achieved good scores in problem-oriented system fields other than compiling problem lists. It was extremely useful for students to write problem lists on problem-oriented system bedside learning.

The learning of problem-solving skills at the bedside in our department was investigated by comparing the results of student self-evaluations with teacher evaluations before and after the bedside learning (BSL) course. Students evaluated their behavior highly in terms of 1) positiveness, 2) motivation, and 3) bedside manner. However, they evaluated their medical competence poorly in terms of the ability to 4) perform physical examinations, 5) analyze medical histories and clinical findings, 6) interpret ECG and X-ray films, and 7) gather data, and 8) recall medical knowledge.
The results of the student self-evaluations on items 5) to 8) were compared to those of the teacher evaluations before the BSL course (term examination in the fourth year) and after the BSL course. The student self-evaluations were not correlated with the two teacher evaluations, but there was a very close correlation between the two teacher evaluations.

Participation of students in the management of patients was evaluated by analyzing medical records written by the students. Sixty-four percent of the students wrote in the medical chart everyday, however the amount of data was on average only 5.6 lines per day. Descriptions of subjective data were scant. Physical complaints were described for 65% of patients, but were insufficient in detail. Psychic and social complaints were rarely described. Objective data on the physical examination comprised the main body of chart notes recorded by the students, although only 37% of these were judged to be sufficient. Laboratory and radiological data were described less thoroughly than data from the physical examination, and were completely absent from 64% of charts. Assessments were incomplete, and patient problems were not clearly elucidated for most patients. These undergraduate students failed in their assessment of patient problems during their one week of bedside learning.

Student self-evaluations in pediatric bedside learning based on a problem-oriented system (POS) were compared with teacher evaluations of the same items. Self-evaluations were also compared with two different methods: unsigned and signed submissions. Students evaluated themselves poorly in the ability to recall pediatric knowledge and highly in the ability to investigate and summarize suggested topics. They evaluated themselves more highly on signed submissions than on unsigned submissions left in a box. Evaluations by teachers were higher than or equal to student self-evaluations. There were few critical evaluations or complaints about POS-bedside learning, but the ratio of criticism was four-fold higher on unsigned submissions. Bedside learning based on POS was accepted willingly by students.

We investigated the effects on medical education of early exposure of undergraduate students to a summer camp for children with asthma. An objective evaluation by the editorial staff found final improvements in the following areas (in descending order of frequency): learning of basic medical behavior (91% of students); cooperative attitude of medical staff in general treatment with the patient and the patient's family (88%); understanding of childhood growth and development (80%); knowledge of childhood asthma (69%); and mastery of basic techniques for therapy and examination (41%). The differences in the ratio of improvement (%) before and after visiting the camp, were (in descending order of frequency): cooperative attitude of medical care staff in general medical treatment with the patient and the patient's family (47%); understanding of childhood growth and development (45%); knowledge of childhood asthma (38%); learning of basic medical manner (34%); and mastery of basic techniques for therapy and examination (25%). These findings suggest that a summer camp is useful for exposing undergraduate medical students to children with asthma and is effective for helping them understand patients and family-oriented pediatric medicine.

In March 2001, Research and Development Project Committee for Medical Educational Programs proposed a model core curriculum for undergraduate medical education. In this curriculum, implementation of the clinical clerkship is strongly recommended. Two similar curriculum models were later presented by other organizations, and some differences were observed among them. We, Undergraduate Medical Education Committee, have evaluated and compared themodel core curriculum 2001 with the Japanese newer proposals as well as those of USA and UK. Here is reported our proposals for a better rewriting of the learning objectives in the model core curriculum 2001, with some emphasis on the nurture of the competence of the case presentation and decision making process.

In order to implement, or enhance the quality of clinical clerkship, it is necessary to develop good educational environment which will be appropriate to allow medical students participate in medical team services. Important things to be considered will be, (1) Systematic management of the individual department's program by the faculty of medicine, (2) Developing educational competency within the medical care team function, and (3) Nurturing students' awareness forself-diected learning and cooperative team work, and teaching- and medical staffs' awareness of their educational responsibilities. In this paper, to develop better educational environment for clinical clerkship, we propose a desirable situation of the educational organization, dividedly describing on the roles of dean, faculties, board of education, department of medical education, clerkship director, teaching physicians, residents and medical students.