Objectives: The aim of this study was to evaluate the impact of community health worker (CHW) training on recognition and satisfaction regarding the performance of CHWs among members of the community in Amazonas, Brazil, which is a resource-poor area underserved with regard to medical health care accessibility.
Methods: Baseline and endline surveys concerning recognition and satisfaction with respect to CHW performance among members of the community were conducted by interview using a questionnaire before and after implementation of a program to strengthen community health projects in Manicore, Amazonas, Brazil. One of the components of the project was CHW refresher training, which focused on facilitating adequate use of health-care services and providing primary health care, including health guidance. The baseline survey was performed in February 2004 at the beginning of the project, and the endline survey was performed in February 2006 at the end of the project. There were 82 and 120 CHWs working in Manicore at the times of the baseline and endline surveys, respectively. Statistical analysis was performed to determine the significance of changes in experience with CHW activities, expected functions of CHWs, and satisfaction regarding the performance of CHWs between the baseline and endline surveys. In addition, qualitative analysis was conducted to evaluate the acceptability, feasibility, and sustainability of CHW refresher training.
Results: Overall recognition and level of satisfaction regarding CHW performance among members of the community were improved from the baseline to the endline survey, regardless of type of residential area, such as town and/or remote area. Members of the community came to not expect CHWs to “provide strong medicine” (P < 0.001) and “provide injections” (P < 0.001), and came to appreciate “go to hospital with a sick person” (P = 0.031) as a function and role of CHWs.
Conclusions: The results of the present study indicated that steady approaches to motivate and support CHWs in resource-limited settings could improve performance of CHWs and satisfaction of people in the community regarding the activities of CHWs to sustain their health.

Objectives: The aim of this study was to evaluate the impact of community health worker (CHW) training on recognition and satisfaction regarding the performance of CHWs among members of the community in Amazonas, Brazil, which is a resource-poor area underserved with regard to medical health-care accessibility.
Methods: Baseline and endline surveys concerning recognition and satisfaction with respect to CHW performance among members of the community were conducted by interview using a questionnaire before and after implementation of a program to strengthen community health projects in Manicoré, Amazonas, Brazil. One of the components of the project was CHW refresher training, which focused on facilitating adequate use of health-care services and providing primary health care, including health guidance. The baseline survey was performed in February 2004 at the beginning of the project, and the endline survey was performed in February 2006 at the end of the project. There were 82 and 120 CHWs working in Manicoré at the times of the baseline and endline surveys, respectively. Statistical analysis was performed to determine the significance of changes in experience with CHW activities, expected functions of CHWs, and satisfaction regarding the performance of CHWs between the baseline and endline surveys. In addition, qualitative analysis was conducted to evaluate the acceptability, feasibility, and sustainability of CHW refresher training.
Results: Overall recognition and level of satisfaction regarding CHW performance among members of the community were improved from the baseline to the endline survey, regardless of type of residential area, such as town and/or remote area. Members of the community came to not expect CHWs to “provide strong medicine” (P < 0.001) and “provide injections” (P < 0.001), and came to appreciate “go to hospital with a sick person” (P = 0.031) as a function and role of CHWs.
Conclusions: The results of the present study indicated that steady approaches to motivate and support CHWs in resource-limited settings could improve performance of CHWs and satisfaction of people in the community regarding the activities of CHWs to sustain their health.

There are some methods of evaluating teaching: student-, self-, peer- and third person-evaluation etc. Validity, reliability and feasibility are required for assessing the quality of teaching. Therefore, we examined the reliability of teaching evaluation by medical students in Nippon Medical School in comparison with peer evaluation.
1) Twenty-four clinical lectures during the same school year were arbitrarily chosen as objectives. Correlations between student- and peer-evaluations in both generalized ratings and global assessment were analyzed by Pearson's correlation coefficient and Spearman's correlation coefficient by rank.
2) In generalized ratings, a significant correlation between the evaluations was demonstrated (r=0.532, p=0.0056), while a marginal correlation between the evaluations was observed in global assessment (p=0.0492).
3) The results probably provide evidence of the reliability of teaching evaluation by medical students.
4) The criteria for evaluation and the validity of questionnaires should be defined for a more reliable teaching evaluation by medical students.

A survey was conducted to better understand the current status of training of simulated and standardized patients (SP) in medical education and training protocol of SP training at each site, and to determine the future planning of the committee
1) Methods: A series of questions regarding the SP and SP training was sent to all 80 medical schools in Japan.
2) Results: Responses were received from 68 medical school (85%). According to the survey result, 43 medical schools (63%) trained their own SP. The total numbers of SP reported in this survey were 1,036 with ratio of male to female 1:3. The average numbers of SP at each medical school were 24 (range 5 to 87). SP training protocols were included basic training (88%) and to prepare common achievement test OSCE (84%), classes (74%) and advanced OSCE(60%). Only 6 medical school (14%) had the systematic curriculum for SP training.
3) Conclusion: To produce standardized, accurate SP training for medical education, the committee recommends to establish the standard curriculum and portrayal requirements for SP training.

1．The basic training curriculum for simulated and standardized patients （SPs） was provided by the 16th Medical Simulation Committee based upon a nationwide field survey that was conducted by the committee in 2009 and other data.
2．The curriculum consists of 3 essential programs: interpersonal communication, medical education involving SPs, and the medical interview.
3．The medical interview program was composed of basic issues, comprehension of scenarios, acting role and performance, and feedback and assessment.
4．The training facilities or institutions were recommended to properly assess the performance quality of SPs in the educational setting by means of a specific and clearly defined evaluation method.

At Nippon Medical School, a "Basic Clinical Training Course" is provided as an introduction to clinical medicine. Medical students undergo initial clinical skills training with simulators. We describe the technique of effective training to acquire clinical skills and the results of student evaluations and a questionnaire survey.1) The training consisted of 8 practicums, including internal examination, funduscopic examination, otoscopic examination, breast examination, auscultation (heart sounds and lung sounds), and collection of blood samples. Medical students moved in rotation once per time period (45 minutes) and performed practical training in each unit, which comprised 2 practicums.2) The training with the prescribed number of 50 students in 4 time periods was efficiently performed for 2 days and required 9 trainers per day. Student evaluations and a questionnaire survey revealed the interest and enthusiasm of medical students and showed they thought highly of the training.3) The training was efficiently performed and was thought to help reduce the teaching load of instructors. The educational effect of the training can be strengthened by increasing the convenience of the clinical simulation laboratory, by reinforcing the education of clinical skills and attitudes in clinical clerkship, and by evaluating these factors after the completion of the clinical clerkship.

1) We conducted a randomized controlled trial in medical education area and explored practical issues through reflection on the processes.
2) In February 2007, 39 fourth-year medical students in Nippon Medical School listened to the lecture about how to ask key questions for the diagnosis. Shortly after they had medical interview with a standardized patient for measurement purpose. They were randomly allocated to study and control groups. The lecture content for the intervention group corresponded to the interview but the one for the control group did not correspond to the interview.
3) We identified the issues related with ethical review for research, how to mask the information of randomization out of assessors, and equity of educational intervention and assessment offered to both groups.