Problem-based learning (PBL) tutorial follows the learning attitude of adult characterized as a self-directed learner. PBL may be applied to facilitate learning of signs, symptoms and pathophysiology that are defined in the Japanese Model Core Curriculum for the undergraduate medical education. When signs, symptoms and pathophysiology are the learning objectives in the PBL, the learners may integrate the related problems to understand the basic mechanisms of the diseases. Whereas didactic lecture-based learning facilitates systematic understanding. Thus, construction of curriculum to accommodate the Model Core Curriculum with learning objectives of signs, symptoms and pathophysiology require through consideration for the characteristics of PBL as one educational modality in the medical education.

1) I observed the educational and faculty development systems at the Case Western Reserve University Schoolof Medicine for three weeks.
2) Emphasis to develop, communication skills was acknowledged. Effective and personalized curriculum with skillful simulated patients, video recording system, and trained preceptor, was practiced.
3) Extensive discussions were practiced toward a major curricular renovation in 2007. Highly motivated basic and clinical teachers, as well as students were contributing the project.
4) Medical students in the US may take an advantage of computer literacy and abundant web-based resources which areprovided in English.

We investigated attitudes in lifestyle planning of female medical students concerning career continuation and family life and examined how medical education should support future career decisions. We based our study on the following 3 hypotheses: 1)female medical students already experience anxiety about future pregnancy, child raising, and family life; 2)female medical students are highly conscious of these issues in deciding their future lifestyle; and 3)female medical students who already anticipate leaving their jobs in the future for family life have a strong desire to balance work and family life.
Anonymous, voluntary questionnaires concerning prospective lifestyles and career continuation were distributed to all female medical students (n=806) registered at Tokyo Women's Medical University in 2006. The response rate was 75.3%. The results were analyzed statistically.
While the majority of subjects had concerns regarding pregnancy, giving birth, and family life, they also intended to marry. In addition, 79.3% (n=363) of the subjects wished to give birth, and most gave priority to postgraduate clinical training over having children, thereby choosing to plan their pregnancy around their training. Subjects expected that they would use a child-care center (n=269, 58.7%) for child raising rather than that their partner would take parental leave (n=121, 26.4%). Subjects were divided into 2 groups: those anticipating leaving their job for family issues, and those who did not. According to the χ-square test and discriminant analysis, the former group perceived the role of wife as more positive and significant than did the latter group and had greater anxiety about balancing their family life and their work as a physician.
Medical education to help develop self-esteem and self-control in female medical students is essential, such as providing mentors and access to reproductive health education from an early stage. In addition, active support for career continuation and education to maintain a work-life balance are needed for both men and women.

1) The study tour was organized by Dr. Hinohara to learn about the medical education in North America and its philosophy to support the method.
2) The McMaster University, which started PBL curriculum in 1969, began COMPASS curriculum which focuses on conceptual thinking and e-learning in which tutorial groups still remain as the key to the learning process.
3) The Duke University, which values the researcher promotion, began a new curriculum including at further integration of basic and clinical medicine and structural clinical training (Intersession).
4) The Washington University, which constructed WWAMI Program that cooperated with the medical institutions in four states surrounding Washington, started College System to support the students and to strengthen their clinical competencies.
5) Common aspects of the innovation of medical education in North America are (1) further integration of the basic and clinical medicine, (2) early exposure to the principle of clinical medicine and (3) promotion of professionalism by Clinical Preceptorship.

We examined the effects of several problem-based learning (PBL) tutorials on the development of clinical abilities among medical students. In 1988, 2 years before our university implemented the PBL tutorial curriculum, one to three trial tutorials were used for a portion of the students in the 1st through 3rd years to identify a suitable tutorial education system for Japanese students. To examine the effects of these trial tutorials, we sent questionnaires to graduates who had participated in the trial tutorials and to those who had not. We found that graduates who had participated in the trial tutorials were more likely than graduates who had not to report logical thinking capabilities during their undergraduate years and clinical problem-solving abilities at the end of their internship. The results suggest that the use of one or more tutorials is effective in helping students develop logical thinking and problem-solving ability.

Positive self-esteem helps students build and maintain self-efficacies to affect later clinical practice. We examined the outcome of problem-based-learning (PBL) curriculum by evaluating self-efficacy in terms of sustained learning and clinical competencies among medical school graduates.
1) We compared practicing doctors who either had PBL tutorial experience or who had not by a questionnaire survey.
2) The subjects self-evaluated whether they had achieved expected abilities (1) at the end of undergraduate years, (2) during 2-year internship, and (3) at present.
3) Among 1, 502 doctors surveyed (response rate=36.0%), doctors with PBL tutorial experience had higher selfefficacy (odds ratio>2.1) in their clinical abilities than doctors without it, especially during the school years.
4) In the later 2 periods, doctors with PBL experience had higher self-efficacy in communication skills.
5) PBL tutorial foster self-efficacy in clinical abilities, especially in communication skills, during earlier clinical career.

1) Japan Society for Medical Education launched a committee for the graduate education of medical educationists in Japan. The committee proposed a direction toward establishing the system, by way of discussion among the members, needs assessment, information gathering of overseas master courses, and discussion at the open meeting.2) To promote medical education in Japan, we should establish 2 systems concurrently: (1) a graduate education for medical educationists who have a broad base of theories and can lead future medical education, and (2) a broader certificate system for medical teachers who have good practical teaching skills.

1) The committee for the graduate education of medical educationists, Japan Society for Medical Education, investigated needs for the education system of medical educationists.2) A questionnaire was sent to 1831 leaders in healthcare education and the society members, and 644 replied (recovery rate 35.2%). Fifty % of the respondents agreed the necessity of medical educationists. Certificate level was most popular, however, master and PhD degrees were also considered to be necessary. 3) These results support the establishment of educational system for medical educationists in Japan.

Skills for breaking bad news (BBN) at the medical interview station were evaluated with the advanced objective structured clinical examination (OSCE). To clarify performances at this station, we compared the scores at this station with those of the Common Achievement Tests OSCE controlled by the Common Achievements Test Organization (CATO). The subjects were a group of students tested at an interval of 1 year 4 months during their clinical clerkships.1) Raters (mostly postdoctorate fellows) played simulated patients after they had been trained to ensure standardization.2) Students who had high scores for BBN skills on the advanced OSCE also had high scores for both the behavior part and the knowledge part of the total evaluation.3) In contrast, students who had high scores for BBN skills on the advanced OSCE did not always have high scores on the Common Achievement Tests OSCE, suggesting the importance of clinical clerkships between these 2 OSCEs.

Computer-based testing (CBT) has been used in Japan since 2002 to assess medical students' basic and clinical medical knowledge, based on the model core-curriculum, before they start clinical clerkships. For effective CBT, multiplechoice questions must accurately assess the knowledge of students. Questions for CBT are submitted by all medical schools in Japan. However, only 40% of questions are chosen for CBT and used at random; the other 60% of questions are rejected because of poor quality. Toimprove the ability of medical staff to devise questions, workshops were held at 30 medical schools. The acceptance rate of questions from schools where workshops were held was significantly increased. The workshops were extremely effbctive for improving the quality of questions.