This article summarizes the history of the modern Japanese healthcare system from the viewpoint of medical education, with emphasis on the role of general medicine and its core values as embraced by the members of the Japanese Society of General Medicine. The introduction of a German-based system, the role of universal national health care resulting in accessible healthcare, and the abolishment of American-type internships during Japan's period of student activism are among the topics covered. General medicine in Japan has been built upon the foundation of the Japan Society for Medical Education and the Japanese Society of General Medicine. The recent introduction of mandatory postgraduate clinical training for all medical graduates has alerted clinician-educators to the importance of competency-based approaches in medical professional education, especially in the areas of patient-centered care, team approaches, evidence-based medicine (EBM), and quality and safety. Generalist physicians should assume an active role as frontrunners in the current global trend toward healthcare reform, which requires healthcare providers be accountable and transparent in their professional activities.

General Internal Medicine, as well as Family Medicine, plays an important role in the primary care of North America. General internists in Canada are virtually hospital-based physicians. However, most general internists in the United States are community-based primary care physicians. Although the system in both countries are different, the training of General Internal Medicine is very similar. General internists comprehensively manage patients with complex illnesses such as one with difficult diagnoses, multiproblem or chronic illness. In addition to basic clinical knowledge and skills, they teach students and residents clinical epidemiology, evidence based medicine and clinical decision making.

To examine ethical problems students may face during clinical clerkships and to help them to learn how to solve these ethical problems practically, we started a compulsory ethical case conference for medical students rotating through the department of general medicine. Actual cases were selected from among those students had encountered during their clinical clerkship. Groups of students were to analyze these cases and to discuss how to solve ethical problems. In this study, we evaluated this course on the basis of student's questionnaires and case sheets they submitted. Eighty students (92%) answered that they had encountered ethical problems. Each student encountered an average of 3.95±1.53 cases with ethical problems. Students noted 130 ethical issues (an average of 1.63±0.51 issues per case). Ethical issues included informed consent, treatment selection, refusal of treatment, medical distrust, and the doctor-patient relationship. In addition, such important subjects as economic burden, ability for self-determination, social rehabilitation, and patient-family relationships were mentioned, but only rarely. Eighty-five percent of students thought the conferences were valuable. Moreover, 87% of students thought such conferences would motivate them to think about ethical issues in the future. All students thought these compulsory ethical conferences should be continued. However, both the students' degree of participation and comprehensiveness of the conference contents could be improved.

Influenced by a favorable environment, volunteer activities are integrated into medical education in the United States. Volunteer activities by medical students in hospitals are also becoming more common in Japan. With this background in mind, we performed a survey examining the nature of medical students' volunteer activities at the University of Hawaii in the United States and Saga University in Japan. By analyzing the percentages of students participating in volunteer activities and the location and content of the activities, we found that volunteer activities of medical students in Japan and the United States are strongly influenced by differences in the respective premedical education systems. We found that a premedical education that includes volunteer activities plays an important role in the United States. We suggest that further debate on premedical education that includes volunteer work is necessary for Japan to develop its own methods of medical education.