The aim of this study was to compare the educational effects of previously developed case-report scenarios and newly developed narrative scenarios used in problem-based learning (PBL) at the Yamaguchi University School of Medicine.1) Students' reports submitted after they had completed PBL sessions were reevaluated, and the educational effects were compared statistically between the 2 scenario types.2) To reevaluate the students' reports, the learning effects expected of PBL classes, reported by university medical schools in North America, were used.3) The PBL using narrative scenarios was found to be more effective, particularly for the acquisition of clinical reasoning ability and comprehensive patient treatment.4) Our results show that the scenario is an important factor in PBL.

A questionnaire survey of newly enrolled medical students on the sensitivity to human death and dying was conducted at Yamaguchi University in June 1997 and June 1998. The survey was performed during lectures of an elective liberal arts course in medical ethics for first-year students. Responses were received from 415 students, including 63 medical students. Answers from new medical students were compared with those from new students of other faculties. Our results show that our medical school entrance examination does not generally select students with a high motivation for bioethics. We should consider further improvement in the curriculum of the introduction to medicine (igakugairon in Japanese).

We introduced active educational methods in medical ethics education and evaluated their effect on medical students. Three methods were used: 1) small-group discussion to clarify the clinical ethical issues, 2) self-study to analyze examples of doctors' explanations to patients, and 3) self-study with videotapes to recognize informed consent. We asked students to write a report on each subject of the three studies. Before grading their reports, we determined a standard answer for each subject and marked their reports according to an absolute standard. We found the mean value and standard error of the students' scores in study 1 were significantly higher than those in study 2 or 3. These results suggest that small-group discussion is an effective educational method and useful in the analysis of clinical ethical issues.

We sent questionnaires to clinical instructors and trainees within 2 years of the latter passing the national licensure examination for medical practitioners to investigate their opinions about the examination and to improve its style. Most instructors wanted to change the examination into an ideal style; however, the trainees had positive comments about the present examination. Several problems came to light, including whether the present examination is asking the minimum requirements for initial training and what the necessary actions are for assessing clinical skills. We must take measures to improve the examination.

1) A possible reason that medical students do not complete problem-oriented medical records is a problem in putting information received from patient into a problem list.
2) We invented a clinical case and asked students to list problems from the case and to establish an initial plan for admission. The exercise was effective for teaching students to complete medical records.

Recently, as the practical training for clinical skills are extensively introduced in the curriculum of medical schools, the objective structured clinical examinations (OSCEs) is taken to assess the clinical skills of trainees. However, there have been very few papers mentioned about correlation between scores on a written examination of the clinical sciences and those on OSCE in Japan. In this study, to compare these of two kinds of examinations in year five medical students of Yamaguchi University, their scores of the stations of OSCE and those of the written examinations of clinical sciences which seemed to correlate stations of skill's examinations were studied statistically. As a result, there were no statistical significances in each scores between skill's evaluations and written tests. This results that these two examinations estimated the different abilities of students on the taxonomy of medical education. Moreover, OSCE is reconfirmed to be identical as an evaluative method of clinical skills. Now, new medical educational systems should be introducted for the training of skills and attitude for students.

A student's medical interview in an objective structured clinical examination (OSCE) may be assessed slightly differently by simulated patients and by the faculty. In this study, we compared three different scores given by the faculty or simulated patients in the assessment of OSCE medical interviews conducted at our department for 3 years. Scores compared were the total score and the behavior score given by the faculty and the score given by simulated patients. The total score and the behavior score given by the faculty correlated well with the score given by simulated patients. However, for students who received a poor assessment from simulated patients, the three scores were weakly correlated; in particular, the behavior score given by the faculty differed markedly from the score given by simulated patients. These results suggest that simulated patients have a different and important viewpoint on assessment of the medical interview in an OSCE.

Fifth-year medical students at the Yamaguchi University School of Medicine must pass an objective structured clinical examination (OSCE) before beginning bedside learning. Because the OSCE is performed over 3 days, examinees on later days are suspected of having an advantage over those tested on early days. In this study, mean values for each day's scores by one examiner were statistically compared in stations of the medical interview to investigate the difference in scores obtained on each of the OSCE days. In addition, for stations at which one student was evaluated by two examiners, their scores for each student were compared statistically in the same manner. We found no significant day-todaydifferences in mean values of the scores over the 3 examination days. However, significant differences were found between the two examiners' scores in 2 of 3 stations for the medical interview. Although there were no differences in scores among participants during the 3-day communication OSCE, examiner's evaluations and formats should be standardized for OSCE stations.

BACKGROUND: Medical students need interviewing skills to be effective in dealing with patients. However, it is presumed that there are some problems in evaluating the competencies medical students are required to have for practicing medicine.
OBJECTIVE: During Objective Structured Clinical Examinations (OSCE) in Japan, instructors usually evaluate examinee's behavior and attitude toward doing medical interviews. To improve the objectivity of these examinations we examined the assessment of our OSCE medical interview.
METHODS: Medical interviews are usually evaluated using a rating list. The standardized list used in most medical schools is composed of two parts: one scores the student's behavior while conducting the interview and the other evaluates the student's ability to gather information from patients. For 5^thyear student OSCE medical interviews are performed twice, before and after ward rotation. The results of two OSCEs were analyzed in terms of scores on conducting an interview, collecting patient information, and SP, or simulated patient. Data analysis of the students' behavior and attitude were taken over 3 years, from 2000 to 2002.
RESULTS: Total scores and scores on conducting interviews, collecting information, and SP's evaluation all increased when comparisons were made between before and after ward rotation. However, only the differences in the total score and SPs score in 2000 were statistically significant. Moreover, clinical skills for collecting patients' information were found to be unsatisfactory.
CONCLUSIONS: As the standardized OSCE medical interviews are performed at all medical schools in Japan today, further improvements in education and in the evaluation system will be required in the future to ensure students obtain the skills expected of them for practicing medicine.