Because Canada is an extremely large country, the main issue in medical education in Canada is fostering physicians who are highly competent in practical skills. For this reason, clinical clerkships and the national examination for evaluating clinical skills and attitudes in Canada are quite advanced. The Canadian medical education system can provide useful information for Japan.

 Accreditation for medical education has been introduced in several countries to ensure and improve the quality of education programs in medical schools. In the standards for accreditation, the assessment of faculty activity and development is described as important to improve medical education. The balance of teaching, research, and service functions is considered in the assessment. The results of the appraisal are reflected in the faculty's appointments, promotions, and compensation increases in many countries.

1)In the Netherlands, only high school graduates are accepted to medical schools.2) Several medical schools divide their courses into a bachelor's course and a master's course, according to the Bologna process.

1)In Spain, only high school graduates are accepted to medical schools.2) Although the reform of medical education is in progress, there are barriers to reform, especially at universities with a long history.

　Medical education in Germany has undergone significant reforms since the new law, “Regulation of the Licensing of Doctors,” was introduced in 2003. The major point of the reforms is the shift from theoretical education to practical clinical training. The national licensure examination consists of 2 parts: an examination for knowledge of basic medicine in the second year of medical school, and an examination for clinical knowledge and skills after clinical clerkships. These reforms should provide useful information for the reform of medical education in Japan.

　France’s sophisticated system of medical education achieves a seamless link between undergraduate education and postgraduate training and has eliminated the uneven distribution of physicians among disciplines and regions. The Épreuves Classantes Nationales （national ranking examination）, introduced in 2004, improved the uneven distribution of physicians among disciplines and regions. Although the medical board examination is not used in France, the unique medical education system, which develops both general practitioners and specialists, provides useful information for improving medical education in Japan.

・We visited the National Board of Medical Examiners and the Clinical Skills Evaluation Collaboration Center to discuss with the examiners the present state of the USMLE （United States Medical Licensing Examination）, to which clinical skills evaluation has been introduced.
・Evidence that the introduction of clinical skills evaluation to the USMLE has affected the reform of medical schools curricula in the United States supports the necessity of introducing clinical skills evaluation to the Medical Board Examination of Japan.

1) We report on medical education programs in Malaysia on the basis of investigations of 2 national universities and 1 private medical college.2) Although the history of medical education in Malaysia is short, the education programs are efficient and conform to global standards.

1) At Dundee University, which has an excellent history of medical education and where the objective structured clinical examination was developed, hematology and dermatology play integrated roles in the second semester of the first-year curriculum. 2) Integrated curriculums, exemplified by the study of hematology, are expected to be introduced to medical schools in Japan.

　Based on our experience of visiting the Medical Council of Canada and observing large-scale OSCE (objective structured clinical examination) in Canadian Qualifying Examination Part II , we report differences operation system, implementation status, and examination questions compared to Japan. This very important examination after the post-graduate residency program may provide several invaluable tips when we introduce nation-wide clinical performance examinations.