Two years of postgraduate medical education will soon be required. We propose an 8-year integrated curriculum for the organic combination of the undergraduate and postgraduate education. In postgraduate education, clinical professors should responsibly train junior physicians as part of a systematic programs. The curriculum must include not only medical knowledge and skills but also clinical ethics for 8 years, which will contribute to the development of qualified physician desired by society.

To evaluate the present condition and problems of the postgraduate clinical training system for junior doctors at a university hospital, a questionnaire survey concerning the training curriculum, including the rotation system and the timing of teaching about clinical ethics, was given to 176 doctors at Kurume University Hospital who had graduated less than 10 years earlier. The percentage of clinical departments that had a curriculum for postgraduate clinical training was 60.0%. A positive correlation between the existence of a training curriculum and satisfaction with training was observed. Rotation training systems had been established in all clinical departments; however, the rate at which the system was actually used differed among clinical departments. Regarding the timing of teaching about clinical ethics, 64.6% of doctors answered that clinical ethics should be taught during both undergraduate and postgraduate training rather than during only undergraduate training. In conclusion, we found that the postgraduate clinical training system in this university hospital has improved to become a full curriculum with a rotation system. Furthermore, the survey results suggest that a greater emphasis should be placed on clinical ethics during undergraduate and postgraduate medical education.

Workshops for medical education have been held at Kurume University every 1 or 2 years since 1977. In these workshops, teachers and students passionately discuss methods and strategies for improving medical education. The purpose of medical education is to produce good physicians through free and comprehensive ways of thinking. The outcomes of the workshops have been introduced to the curriculum in approximately 65% of the areas discussed. To take part in workshops increases motivation for education in more than 80% of the participants.

A program of clinic visits for humanity education has been conducted for 4th-year medical students who have not experienced clinical practices in wards. The major aim is for students to observe the doctor-patient relationship and to establish a close relationship with the tutor doctor. We evaluated the 5-year follow-up data. The most important part of the program was the orientation, which included the aim of the program for students and teachers and contributed to promoting educational effects. A student cannot become a good physician by staying only in the university hospital. An experienced physician who feels a duty to help educate younger doctors may have beneficial effects. In the program, close contact between the students and the tutor had a great effect upon the student which cannot be obtained in the university hospital.

We examined appropriate group size and related factors in a small-group learning system conducted in a single department with sociomedical themes. The students were randomly divided into 4-and 6-person groups, and results of evaluations of the students and teaching staff were compared. The results suggest that the smaller the group, the more committed the students are to studying. Furthermore, teaching staff should participate in group discussion to deal with inactive students or to improve group dynamics.

One hundred fifty-three activity reports, which were published by departments or divisions of social medicine in Japan from 1991 through 1998 were reviewed to examine how medical ethics and related themes were taught. We examined how many departments and divisions taught medical ethics and related themes each year, and teaching methods were examined in reports from 1998. The number of departments and divisions teaching medical ethics and related themes gradually increased. Instruction in medical ethics was conducted for medical students in the 3rd through 5th years for periods of 3 to 12 months. All instruction employed small-group learning. Most groups learned actively, by conducting such activities as field surveys outside the school.

Many medical students seem to be more interested in clinical medicine topics than in social medicine topics. Through a problem-based, small-group learning course, we examined whether students' degrees of interest differ between topics and change during learning. At the start of the course, students were more interested in clinical/practical medicine topics than in industrial/environmental health topics. However, after the course their degrees of interest in both types of topic had increased and showed no significant difference. In particular, the degree of interest in sociomedical topics increased. In problem-based learning, knowing students' interests in learning about topics helps improve teaching strategies.

To train students to study voluntarily, we introduced “voluntary learning” to both 3rd-and 4th-year medical students. Students were divided into small groups of 7 to 9. Each group independently studied a theme, including its sociomedical aspects. According to a self-administered questionnaire survey, most students approved of the learning program, although the themes and grouping of students affected their satisfaction with voluntary learning. Oral presentation of study results seemed to be useful for clarifying the contents of learning. However, oral presentation and communication skills still need improvement. Teaching skills might also be improved. Voluntary learning in small groups would be an effective method for teaching behaviors necessary for active education.

OBJECTIVESTo evaluate the relationship between subjective symptoms of coldness in fingers and peripheral circulation in patients with hand-arm vibration syndrome (HAVS).

METHODSThirty-five male patients confirmed to have HAVS as an occupational disease took part in this study. Their mean age was 62 years (SD 5) and all were chain-saw operators exposed to vibration for an average of 25 years. Their annual health examination included the history of their daily habits (smoking, drinking, and therapeutic exercise), report of subjective symptoms such as coldness, numbness and tingling in the fingers, and a physical examination; laboratory tests consisted of skin temperature measurement, and pain and vibration perception under conditions of cold provocation. A frequently used method of cold provocation, immersion of the left hand up to the wrist in water of 10°C for 10 min, was used.

RESULTSFinger coldness was classified into 3 groups according to its severity: mild group (n=8), moderate group (n=17) and severe group (n=10). There was no significant difference in age or occupational background between the groups. A significant association was found between finger coldness and prevalence of Raynaud's pheno menon (p<001, χ(2)). The mean skin temperature was significantly lower with the severity of finger coldness (ANOVA, p<0.05). In the cold provocation test, there was no significant difference between skin temperature and coldness at 5 min and 10 min after immersion, though a difference was observed immediately after immersion. No significant difference was observed in the relationship between finger coldness and vibrotactile threshold before, during or after the cold provocation test.

CONCLUSIONSThe severity of coldness in the fingers is significantly related to skin temperature. The severity of finger coldness reflects the extent of peripheral circulatory vasoconstriction. Coldness in the fingers may be a good warning of potential problems in peripheral, circulatory function.