Vibration disease is an occupational disease. It is a systemic disease, which impaires not only the peripheral circulatory and nervous functions but also the central nervous functions, and is caused by using vabratory tools such as a chainsaw or a rock drill for a long period.
The present study was performed to elucidate the effects of physical therapy (therapeutic gymnastics) and balneotherapy on the patients with vibration disease.
Sixty inpatients with vibration disease were divided into two groups. One, P group, was just received physical therapy and balneotherapy, and the other, D group, was given a vasodilating drug in addition to physical and balneotherapy throughout the test period. The observed period was 6 weeks. Items used for the evaluation and the judgement in this trial were subjective symptoms and clinical examinations. The subjective symptoms were observed 22 items consisted of palmar hyperhidrosis, insomnia, a heavy feeling in the head, numbness and pain of fingers or arms, etc., evaluating according to the five stage method before the trial, and 3rd and 6th week after the commencement of the trial. The improvement by two or more stages was evaluated as “effective”.
The subjective symptoms in D group became better with significant difference as compared with those in P group (p<0.01). The effective rate in D group was 83.3%, and that in P group was 40.0%. The clinical examinations were performed with respect to peripheral functions and blood chemistry before and after the trial. The peripheral function tests were consisted of cold immersion test, vibration sensation, pain sensation, grasp strength and tapping test. The effective rate in D group was 63.3% and in P group was 33.3%. There was a statistical difference between the two (p<0.05). The collective improvement, which was obtained by evaluating collectively the subjective symptoms and the clinical examinations, was found in 25 cases (83.3%) out of 30 in D group and in 11 cases (36.7%) out of 30 in P group, showing a significant difference (p<0.01).
Thus, the effect of the physical therapy and balneotherapy on the patients with vabration disease was approximately 40per cent in this 6 weeks' trial.

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.

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.