The first trial of nation-wide medical and dental student evaluation system has begun from this January. This system is consisted of computer-based testing (CBT) using multiple choice questions, and objective structured clinical examination (OSCE). The purpose is to measure a student's competence to learn at clinical settings. This paper mentioned about an outline of CBT and OSCE in this system, and issues to be solved in future.

The pattern of variability in the pass rate of the national examination for physicians' license of Japan was analyzed. The variation in the pass rate of a medical school in a given year was moderately dependent on the variation in the pass rate in the previous year. There was a moderate negative correlation (r =-0.454, n=1262) between the variations in the pass rates in consecutive years. We termed this phenomenon “the previous-year effect.” The previous-year effect was greatest (r =-0.494, n=475) when the average pass rate of all medical schools changed from decrease to increase, but was smaller (r =-0.393, n=551) when the average pass rate changed from increase to decrease. These phenomena can be explained by interactions between the factors of examinees and examiners.

Objectives: This study aimed to investigate what third–year students of the J University School of Medicine had learned in home care practice.
Methods: We analyzed the students’ reports and focused on the description of the learning for the practice. We extracted the category of learning using qualitative content analysis.
Results and Conclusion: The core categories we extracted from the analyses were: 1） characteristics of home healthcare, 2） patients, 3） families, 4） home–visiting nurses, 5） medical treatment teams, 6） frank remarks of medical students and physicians, and 7） necessities as a physician. The frank remarks of medical students and physicians included the distrust of physicians and the hopes of medical students. The students gained valuable experience from this practice. In particular, learning about the distrust of physicians and the hopes of medical students may be difficult without such practice.

Background: Some early clinical exposure programs in the community have been implemented in our medical school from years 1 to 3: community service for the handicapped in year 1, care for severely handicapped children in year 2, and health care at home with district nurses in year 3. The directors of these programs informed us, in feedback reports, of the inappropriate behavior of medical students. We then provided feedback directly to the students. We investigated the changes in student behavior after feedback during the 3 years they participated in these programs.
Methods: We analyzed the feedback reports from these 3 early clinical exposure programs from 2009 to 2011. Inappropriate behavior of medical students and changes in behavior were recorded.
Results: Inappropriate behaviors reported were: 1） lack of essential learning behavior, 2） lack of positive attitude and acceptance of learning in the programs, and 3） lack of communication skills. The numbers of students who received feedback about inappropriate behaviors were 26 in year 1, 11 in year 2, and 2 in year 3. Feedback to students from early clinical exposure programs may lead to changes in their behavior.

To develop problem-solving skills and to motivate learning, The Jikei University School of Medicine started a tutorial educational program for fourth-year preclinical students in April 1999. Student doctors' patient-care models focused on discovery learning and acquiring strategies for general medicine through problem-solving skills. After information was first provided by prepractice handouts, one or two tutorial sessions were performed each week. Minimum requirements for each step were established, and instructors provided printed materials, display materials, and detailed oral information to facilitate discovery learning. This program is based on problem-finding and problem-solving through selfdirected learning and feedback systems for tutorial sessions. Examinations used multiple stations to reconfirm program aims and to reinforce problem-solving skills. On a questionnaire survey, 85% of fifth-year students taking part in practical clinical education thought that the tutorial education was needed to acquire problem-solving skills necessary for fifth-year clinical training.

Purpose: To assess problems of a system for evaluating educational methods which cause interevaluator variability at the pulse and blood pressure measurement station of the objective structured clinical examination. Subjects: 186 evaluations for 93 fourth-year medical students. Method: The vital-sign station consists of pulse examination, blood pressure measurement, and a 1-minute oral examination. To assess interevaluator reliability, the differences between two evaluations of each of 15 evaluation steps were calculated and divided into three categories: “greater than 95% agreement, ” “unidirectional disagreement, ” and “bidirectional disagreement.” Results: The steps of “consent to examination, ” “proper verbal instructions, ” “valve release, ” “estimation by palpation”, a question about “normal systolic blood pressure, ” and a question about “the interval and the number of repetitions” showed greater than 95% agreement. The steps of “manner of speaking, ” “palpation of peripheral pulse, ” “stethoscope placement, ” “cuff deflation, ” “presentation of blood pressure, ” and a question about “absolute arrhythmia” showed unidirectional disagreement. The steps of “presentation of pulse measurement, ” “cuff wrapping, ” and “cuff inflation” showed bidirectional disagreement. Discussion: Suggestions to improve intervaluator reliability include:(1) decreasing the evaluation steps to two with a single checkpoint, (2) presenting blood pressure with the palpation method, (3) deleting the oral examination, (4) providing adequate instruction about the differences in the types of cuffs and bladders, and (5) clarifying evaluation criteria and the training of evaluators.