To clarify the problems in the introduction of clinical clerkship in obstetrics and gynecology, inquiries were sent to medical schools in Japan. Most schools offer traditional types of clinical education, in which students participate little in clinical works, such as clerkships. Informed consent was usually not obtained when students worked with doctors doing vaginal examinations or vaginal deliveries. Even fewer schools thought that students need to perform vaginal examinations. At many schools are short of cases for students to experience deliveries. With traditional clinical education, students may have fewer and fewer chances to perform gynecologic examinations. We suggest that introduction of clinical clerkships should be considered in obstetrics and gynecology.

[Objective]This study was performed to clarify the benefits and challenges of the acupuncture clinic at the university hospital.
[Methodology]In May, 2012 information on acupuncture clinics from the websites of 80 university hospitals in Japan was analyzed. Information on the experience of the acupuncture clinic at Mie University Hospital was provided by the department of anesthesia at that hospital.
[Results]The number of university hospitals which operate acupuncture clinics was 16. Three types of acupuncture clinics were observed, first was an independent center separated from the university hospital, second was a department specific to oriental medicine within the hospital, and third was a certain medical department such as anesthesia or rehabilitation. In the case of Mie University Hospital, establishment of the acupuncture clinic was proposed in 2007 as a part of collaborative works under the partnership agreement between Mie University and Suzuka University of Medical Science. The acupuncture clinic was then established as the outpatient clinic of anesthesia from 2010. The staff of the acupuncture clinic consists of three acupuncturists belonging to Mie University Hospital, and three faculty members from Suzuka University of Medical Science. A total of 2,749 medical treatments were carried out in the past two years. Through case conferences between physicians and acupuncturists, the level of acupuncture care has improved. For example, electronic medical records were shared, and medical safety management was intensified. However, the number of referrals of hospitalized patients to the acupuncture clinic fell sharply in the second year of the establishment. The main reason was thought to be that the patients who required pain management were referred to the palliative care team which had started full-fledged operation during the second year. An effort to promote cooperation between acupuncturists and the palliative care team is now in progress.
[Discussion]Although there are some challenges to be overcome, establishment of the acupuncture clinic at the university hospital may help promote acupuncture based on scientific evidence, and improve the understanding of acupuncture in the entire medical community. Active proposals of treatments by acupuncturists and promotion of mutual understanding and cooperation between acupuncturists, physicians, and other health care professionals are essential for the successful establishment of acupuncture clinics.
[Conclusion]Although there are several challenges to be overcome, establishment of the acupuncture clinic at the university hospital has a great significance for the promotion and development of acupuncture in Japan.

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.