Our originally-developed clinical training system, specialty-based physical examination (SBPE), was introduced for 4th-year medical students to improve their clinical skills through instruction by specialists in each body region. We previously reported that SBPE has a beneficial effect on results of performance tests. This time, therefore, we studied the effects of SBPE on written tests by comparing test results before and after the introduction of SBPE. We found that SBPE did not have any beneficial effect on results of a written test, despite having improved results of a performance test. These results were confirmed by analyses of students' questionnaires and a correlation between the two. Thus, our results suggest that written tests and performance tests evaluate different things: written tests evaluate acquisition of diagnostic knowledge, and performance tests evaluate mastery of clinical skills, which seem not to affect each other at the initial stage of clinical education.

To improve physical examination skills of medical students, our original system of specialty-based physical examination (SBPE) was introduced into the diagnostic medical practice for 4th-year students. SBPE consisted of clinical practice and tests of every part of the physical examination which were administered and judged by each specialist, thereby greatly reducing the doctors' burden compared with a nonspecialist system. Because of the difficulty of preparing enough simulated or standardized patients, the medical interview was omitted from the system. Instead, the medical interview was directed stepwise according to a separate curriculum. Thus, these characteristics made SBPE much more practical to introduce. Results with this SBPE and those with a previous non-SBPE system were compared; the SBPE succeeded in reducing the number of “poor” grades and increasing the number of “good” grades on the test. These results demonstrate that SBPE is clinically efficacious because specialists could make an accurate evaluation and because the introduction of SBPE strongly motivated students.

We previously reported that the tutorial system had a beneficial effect on our students' scores on term-end examinations in 1994: the assessments of the tutorials correlated positively with the results of the term-end test. This time we analyzed each student's assessment of the tutorials, results of the term-end examinations, and responses to a follow-up questionnaire to determine what abilities the tutorial system helped students develop. The results suggest that tutorials help medical students develop analytical ability: a prerequisite for the problem-solving process.

The small-group-learning course “Introduction to Medical English” was introduced to the 1st-year students' curriculum in 1994. The effects of this course were examined by analyzing students questionnaires and by comparing results of the term-end examination. The following results were obtained. 1) Results of the term-end examination (multiple-choice method) showed a normal distribution. 2) Results of the questionnaires suggest that although medical English seemed difficult at first, the course produced a good response from students which conventional courses could not. These results suggest that “Introduction to Medical English” has a valuable role at the start of medical education.

We have previously reported that tutorials help medical students develop analytical ability, which is necessary for problem-solving. In this study we analyzed students' assessments of tutorials, results of term-end examinations, and posttutorial questionnaires to determine whether tutorials help students develop interests and proper attitudes for studying. The results suggest that our tutorials are not sufficient for medical students to develop interests and proper attitudes for studying.

There is a need for suitable non-clinical teaching models in undergraduate medical education.This study was undertaken to demonstrate the feasibility of using an animal model to teach surgical skills to medical students.Two gastrotomies were created in each pig, and then closed using stapled and hand-sewn techniques.Animals were sacrificed seven days later and the closures examined grossly and histologically.
1) Medical students, as surgeons with minimal experience, are able to significantly reduce the time needed to perform closure of a gastrotomy in a porcine model using surgical staplers compared to a hand-sewn closure.
2) Medical students can perform advanced abdominal surgery techniques with adequate instruction resulting in excellent surgical outcomes in a porcine model.
3) The porcine model is a valuable tool to teach animal ethics as well as basic surgical techniques in the non-clinical environment and may help to increase interest among students in a surgical career.

Objective: We investigated the relation between fasting insulin (FI) and risk of cerebral infarction in a Japanese general population. Methods: The subjects were 2,610 men and women without past history of stroke or myocardial infarction and under treatment for diabetes, examined between 1992 and 1995 as part of the Jichi Medical School Cohort Study. The FI level was measured once at the baseline. Subjects were divided into quintiles by FI levels, and Cox’s proportional hazard model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for cerebral infarction. Results: During an average of 11.1 years of follow-up, 87 participants developed cerebral infarction. Crude incidence rates of FI quintiles 1-5 were 4.69, 2.35, 1.85, 2.77 and 3.30 per 1,000 person-years, respectively. The multivariate-adjusted HRs for cerebral infarction were 2.33 (95% CI, 1.10 – 4.96) in quintile 1 (Q1), 1.25 (95% CI, 0.55 – 2.84) in Q2, 1.68 (95% CI, 0.76 – 3.70) in Q4 and 2.06 (95% CI, 0.94 – 4.47) in Q5, using Q3 as the reference. Conclusions: The lowest FI level was associated with increased risk of cerebral infarction and the association between FI and risk of cerebral infarction appeared to be a U-shaped relationship.