To improve physical examination skills of medical students, our original system of specialty-based physical examination (SBPE) was introduced into the diagnostic medical practice for 4th-year students. SBPE consisted of clinical practice and tests of every part of the physical examination which were administered and judged by each specialist, thereby greatly reducing the doctors' burden compared with a nonspecialist system. Because of the difficulty of preparing enough simulated or standardized patients, the medical interview was omitted from the system. Instead, the medical interview was directed stepwise according to a separate curriculum. Thus, these characteristics made SBPE much more practical to introduce. Results with this SBPE and those with a previous non-SBPE system were compared; the SBPE succeeded in reducing the number of “poor” grades and increasing the number of “good” grades on the test. These results demonstrate that SBPE is clinically efficacious because specialists could make an accurate evaluation and because the introduction of SBPE strongly motivated students.

Problem-based learning (PBL) tutorials were introduced at our university in April 2001. Because a complete PBLbased curriculum could not be adopted, a transitional curriculum incorporating 3-hour PBL tutorial sessions into the traditional curriculum was introduced. More than 80% of students agreed that PBL is an effective way of learning problem solving at the bedside. Twenty percent to 40% of teachers felt that students who took PBL were more motivated for bedside learning and self-directed learning and had better at presentation than were students who did not take PBL. Because of 80% of the curriculum comprised didactic lectures, most students considered PBL tutorials a type of lecture. For this reason, motivating students to learn additional material originating from PBL tutorials was difficult. Although the combination of a traditional curriculum and PBL tutorials may appear to be a new curriculum, this type of PBL has limited value as a method for studying problem solving.