The 60th meeting of the Curriculum Study Association was held at Juntendo University Medical School on May 23, 1994, under the joint auspices of the Department of Medical Education, Juntendo University, and the Editorial Committee of the Association. The meeting was honored by the presence of Dr. Clara A. Callahan, who was visiting Japan on the Medical Studies Exchange Program of the American Foundation, Noguchi Medical Research Institute (NMRI).
Dr. Callahan is a well-known pediatrician specializing in the intensive care of immature infants. In our eyes, however, she is above all the vice dean of student affairs at Thomas Jefferson University, where Dr. Gonnella, our friend and an NMRI director, is the vice president and dean of the Medical School. Over the past few years, Dr. Callahan has been in charge of the training program for Japanese students, externs, and residents that the NMRI is sending to Jefferson.
At the meeting, Dr. Callahan gave us a concise and clear explanation of the medical education program at Jefferson using many slides. Their new curriculum, designed to meet both students' and researchers' needs, impressed the audience and prompted an animated discussion.
During the three weeks of her stay, Dr. Callahan visited many universities and hospitals, attending seminars and discussions. She also participated in the general meeting of the Japanese Pediatric Association at Sapporo, Hokkaido. Her energetic activities here will greatly contribute to furthering our mutual understanding and exchanges in the future.

This paper reports on the practical course in health care administration that our fifth-year medical students are required to take in order to facilitate team health care. The course is intended to give students an opportunity to review health care from various viewpoints, including those of patients and ancillary medical personnel. In the present study, we used students' reports and a survey carried out immediately after the course, to measure student reactions and to examine the usefulness and possible improvements for the course.
Approximately 90% of the students acknowledged value in this method of teaching, and believed their experience would help them in the future when they are doctors. Furthermore, the results of an anonymous questionnaire given to doctors with up to five years of postgraduate experience revealed that more than 60% of them supported the continuation of this type of practical course in team health care as a part of medical education.

We used questionnaires to study the present status of undergraduate clinical training at medical schools in Japan in February 1996. Completed questionnaires were returned by 81%(65) of 80 medical schools and approximately 54%(1, 328 clinical departments) of the schools. The results were as follows. Courses for early clinical exposure in the 1st or 2nd year were provided at 83% of the 65 schools; clinical clerkships in the 5th and 6th years were provided at 28%. Specific behavioral objectives for clinical training were clearly shown to students and teaching staff at 75% of schools. Clinical procedures that medical students were permitted to perform were listed and announced to students and teaching staffs at 66% of schools. Patients were informed and gave consent for clinical training of students at 77% of schools. Essential knowledge and skills of students were assessed before the start of clinical training at 40% of schools, and summative assessment was made at the end of the training at 72%. Training of clinical teaching staff for faculty development was conducted at 51% of schools. Eightynine percent of schools reported a shortage of clinical teaching staff. Similar results were obtained in the survey of clinical departments of university hospitals: most departments complained of a shortage of teaching staff, of students not being active, and of students not being competent to enter clinical training courses. To improve clinical training, the introduction of clinical clerkships and cooperation with community facilities outside universities were the main issues.

A questionnaire survey on clinical procedures performed by medical students on patients during undergraduate clinical training was conducted in february 1996. Responses were received from 1328 clinical departments of university cospitals at 80 medical schools. Basic clinical procedures that medical students were permitted to perform on patients were recommended by a committee of the Ministry of Health and Welfare. These procedures are divided into three categories: level 1; procedures that medical students are permitted to perform under the supervision of an instructor; level 2; procedures medical students are permitted to perform with supervision under certain conditions; and level 3; procedures for which medical students are generally limited to assisting instructors or to attending and observing patients. The status of performance of the procedures was investigated. Of level-1 procedures (36 procedures), 8 were performed by medical students at more than 80 % of university hospitals, 19 were performed at from 50% to 70%, 9 were performed at less than 50%. Of level-2 procedures (15 procedures), 8 were performed at from 55% to 79% of hospitals and 7 were performed at less than 50%. For level-3 procedures (15 procedures), medical students were permitted to assist and observe 4 procedures at from 82% to 86% of hospitals, 11 at from 50% to 79%, and 1 at40%. In addition, students were permitted to perform 13 level-3 procedures at from 10% to 44% of hospitals and to perform 3 at from 6% to 9%. In many clinical departments, other kinds of procedures specific to the departments were adopted. Teaching media, such as standardized patients' computer-assisted instruction models, and animal materials, were used, and facilities in the community cooperated in training. Respondents wrote many suggestions and opinions about the difficulties and concerns with the legality of students' performing clinical procedures, patients' consent or agreement, minimal essentials of clinical competence of students, the shortage of instructors, and the training and guidelines for instructors.

We surveyed in every medical university in Japan on how attitudes development is adopted in its medical educational curriculum so far. There are several universities which in some way have already adopted attitudes development into curriculum or teaching items. However, hours of lesson and the contents are so differed among them. Moreover, both evaluation of these lessons by trainees and judgement as far the educational effect by trainers are not programmed satisfactorily. Some universities complain of manpower shortage, difficulties of fixing curriculum, or shortage of total lesson hours, so that they say they cannot dare work on this attempt. But, there are still an increasing number of universities ready to start their programs, where education arranged by non-medical teachers, practical medical experience at the real front, the introduction of simulated patient (SP) into education, and so on are considerd to be carried out.
Thus, we suppose it is time to have and share some guideline for adequate attitudes development education at this moment. And at the same time, a national system to encourage the medical education, including trainning SP, is urgently required to be planned.