To determine the effectivenss of “clinical clerkship (CC)” in undergraduate clinical training, a questionaire was sent to 105 students who had received the classical bed side teaching (BST) in 1990 and to 103 who have received CC from 1992 through 1994. The effectiveness of clinical training was pointed out by 53, 7% of group BST and 61.8% of group CC. The numbers of effectively learned items were larger in the order of psychomotor, affective and cognitive domains in the group BST, while there were in the order of affective, psychomotor and cognitive domains the group CC, indicating that CC is more effective in learning in the affective domain than BST (p<0.01). In the affective domain, students learned by observing physicians' attitudes to patients in BST, while they learned through their own personal interactions with their assigned patients in CC. CC is therefore believed to be quite effective for students to learn humanistic attitudes.

Learning of humanistic attitudes in undergraduate medical education is increasingly expected to provide holistic care and comprehensive medical service. However, there has been no report that deals with doctors' attitudes toward patients in relation to the educational subject. Medical students, who had been implemented a clinical clerkship for two months, evaluated doctors' attitudes by questionnairs after clerkship. They scored by checklists and rating scales. In this article, we report the views of medical students on doctors' attitudes, and discuss important points for the success of the learning attitudes during undergraduate educational prosses.

We evaluated our undergraduate clinical clerkship system in 1992, using the multiplication method advocated by the Working Group on “Evaluation of clinical skills of medical students ” of the Japan Society for Medical Education. We divided the clinical training period into three terms: the first term was held from May through June, the second from September through October, and the third from December through January. We determined scores using checklists and rating scales in ten categories, totalled the scores for each period, and compared them between periods. The total scores for the third period were the highest, followed by those for the second period. Scores for basic knowledge, data gathering, and basic technical procedures increased with increase in the number of training hours. However, scores for manner, attitude, and interviewing skills were already high in the first period. We conclude that the multiplication method is useful for objectively evaluating students' clinical skills.

We studied the effect of bath products consisting of sodium bicarbonate and sodium sulfate on living subjects when these products are used with herbal ginseng extract as a trial for a new bath product; changes in dynamic circulation were used as indicators.
Experiments were conducted from December 1990 to February 1991 on 20 subjects consisting of healthy male adults (35.6±8.9 years).
Two types of bath products were used. One consists of sodium bicarbonate and sodium sulfate and the other was the combination of the former with ginseng extracted by alcohol. Twenty five grams of each product was dissolved in 200 liters of water.
As indicators of dynamic circulation, skin surface temperature on thorax, abdomen, dorsal side of hand and dorsum of foot, volume of blood flow in leg skin (on tibia), deep body temperature in frontal region and right calf, electrocardiograph, blood pressure, and the volume of the pulsewave in the right index finger and big toe were measured. After the experiment, each subject's opinion was gathered through a questionnaire.
The experiment was performed in an air conditioned room (26°C and 50% humidity) with bathing at 41°C for 10 minutes. The value of each indicator was measured before bathing and 15, 30, 45, and 60min after bathing.
Although no significant differences in measured values were found between the two kinds of bathing, we observed faster decrease in skin temperature and faster lowering of blood flow rate in the ginseng bath group as compared with the control group. We also noted a decreased difference in pulsewave height between upper and lower extremities after bathing in the ginseng bath group, but not in the control group. This response was observed solely in the ginseng bath group because a significant increase in pulsewave height occurred in the big toe while no increase is observed in the fingers in contrast to the control group.
Faster decrease in blood flow rate in the skin and increase in pulsewave height caused by the exposure to the same temperature imply increased heat conducting distance and interruption of heat transfer from deep areas to the skin. We therefore conclude that ginseng bathing is effective in keeping the body warm. The results of inquiries after bathing indicated that many subjects felt that ginseng bathing tended to warm their bodies.
As a result of using ginseng extracted by alcohol with bath products consisting of sodium bicarbonate and sodium sulfate, differences in peripheral vessel resistance between extremities tended to decrease after bathing. We consider that this is due to the improved general circulation throughout the whole body.

Arteriovenous fistulae are known to be one of the causes of intractable leg skin ulcers. Because they raise peripheral venous pressure, decrease arterial blood flow to peripheral tissue, and cause venous blood congestion, symptoms of skin coldness, edema, pain, dermatitis and skin ulcers may appear in the legs. We observed a 32 year-old woman with multiple intractable bilateral leg skin ulcers due to arteriovenous fistulae successfully treated with Kampo medicines. In 1999, skin ulcers, edema, and pain presented in both her legs. She was diagnosed has having arteriovenous fistulae with various examinations in 2003. She had subsequently been treated with topical preparations on her legs, analgesics and other palliative treatments, but as symptoms had not improved, she first visited our outpatient clinic in August 2006. After an initial oral administration of tokishakuyakusan extract for 6 weeks, her pain improved. Afterwards, ogikenchuto was added for symptoms of qi deficiency. Moreover, bushi powder was added for the treatment of pain exacerbated in cold conditions. After 6 months, the size of her skin ulcers was fairly reduced, and she had no need of analgesic drugs. In past reports, Kampo medicines have not been used for the treatment of intractable skin ulcers due to arteriovenous fistulae. This case suggests that Kampo medicines are a treatment option in this condition.

In 1991, the committee on postgraduate clinical training proposed revised behavioral objectives for basic clinical training in the initial two years. We present here a model for a clinical training program that should enable most residents to attain these objectives within two years.
The program begins with orientation for 1-2 weeks, including a workshop on team care, and nursing practice.
Basic clinical skills for primary care and emergency managements should be learned by experience during rotations through various clinical specialities. All staff members, even senior residents, should participate in teaching beginning residents in hospitals.