1)The Keio University School of Medicine introduced a "white coat ceremony" in 2006 and the taking of an oath written by medical students in 2007 for fourth–year students as part of medical professionalism education just before the start of clinical clerkships.
2)Through activities in 2009, the oath–writing project was highly evaluated by students, and 84% of students felt that Keio University should continue the project.
3)A challenge for the future is finding new ways to encourage more students to participate in the project.

A 36-year-old previously healthy woman with cardiomegaly on a routine chest X-ray was given a diagnosis of primary chylopericardium after pericardial puncture revealed milky effusion. Endoscopy-assisted ligation of the thoracic duct and creation of a pericardial window was performed. The operation was greatly facilitated by the preoperative three-dimensional CT scan with lymphangiography that precisely demonstrated the distribution of the thoracic duct and other lymphatic ducts.