Objective: In our postgraduate clinical training program, first-year residents are rotated among six subdivisions of internal medicine (cardiology, respiratory diseases, gastroenterology, and endocrinology plus either hematology, collagen diseases, or neurology) every 2 months. The residents are trained by clinical instructors (attending physicians or senior residents) on a one to-one basis. To evaluate training by instructors, a questionnaire survey of first-year residents was performed. Methods: Questionnaires were sent to all 14 first-year residents who took part in our training program in 1998. A questionnaire assessing the performance of 1st-year residents was also sent to 15 clinical instructors participating in the program. The instructors had an average of 7.5±3.9 years of professional expericence. All participants were confidentially informed of the results. Results: All 14 first-year residents responded. They rated experienced attendants more highly than senior residents. The survey revealed specific problems of certain attending physicians, such as communication difficulties and poor teaching skills. Conclusion: Evaluation by first-year residents of training by clinical instructors provides constructive criticism of the training program and of individual instructors.

1) Clinical education at the Tokyo Medical and Dental University consists of three parts: the preclinical clerkship which prepares students for clerkship, short observatory or partially participatory clinical education, called the combination block, and long participatory clinical education, the clinical clerkship. The clinical clerkship consists of core-and elective-rotations, including ten four-week rotations and two two-week rotations.
2) In implementing clinical clerkship, we sent up to 100 faculty staff to and carefully studied the model used at the Harvard Medical School, and developed our own original one that fits the Japanese setting.
3) To successfully implement the clinical clerkship, we developed a demo movie clip showing students’ expectation and tips for teaching, handed each student a cell phone to carry, allowed students’ charting to the electronic medical record system under supervision, and distributed a handout describing clerkship to all medical and paramedical staff.

To establish a framework for clinical education as a continuum from undergraduate clinical clerkships to postgraduate residency programs is an enormous challenge for Japanese medical education. The purpose of this article is to compare learning objectives achieved by clinical clerkship students to those achieved by postgraduate residents.1) Eighty-seven clerkship students and 67 residents at our hospital were assessed with the Web-based Evaluation System of Postgraduate Clinical Training with 253 learning objectives established by the Ministry of Health, Labour and Welfare.2) Clerkship students achieved most attitudinal objectives and performed well on the medical interview, basic physical examinations, and physician's order sheet.3) Clerkship students could observe major symptoms and diseases.4) These findings indicate the need to establish a common template for learning objectives used in both clerkships and residency programs.

In a clinical introductory program, each group of 9 fifth-year medical students rotated through 9 courses every 2 weeks. In each class, students evaluated the instructional abilities of the faculty. Eighty-two students answered 7 questions on a 5-point scale immediately after each class was completed. Because the questionnaire also served as a record of attendance, responses were obtained from all students who attended. Overall satisfaction was correlated most strongly with teaching skills, followed by contents of the class to achieve goals and the level of difficulty. The evaluation of faculty's instructional abilities by students can provide valuable information on areas to improve so that students can be educated more effbctively and with greater satisfaction.

1)We visited the Duke–NUS Graduate Medical School Singapore to learn the administration and management of, and the theory behind, team–based learning (TBL), a candidate educational method to replace the problem–based learning tutorial.
2)TBL motivates students to prepare for and engage in discussion. The grading of performance in TBL, certain characteristics of assignments, and the use of peer evaluation all promote individual and group accountability for learning.
3)To obtain the maximum overall benefit from TBL and to exploit group dynamics for effective learning, well–designed assignments are the key.

1) The faculty development at each medical school from 2003 through 2005 was analysed.
2) The major themes in faculty development were problem based learning, tutorial, computer based testing, and clinical training.
3) Faculty development is considered an effective way to enhance the contributions of faculty members to medical education.

1)The purpose of this study was to evaluate a role–playing class for informed consent with fifth–year students playing the role of physicians and first–year students playing the role of patients.
2)The first–year students were competent as simulated patients for the informed consent role–playing and were a worthy educational human resource.
3)This role–playing was effective for helping both first–year and fifth–year students understand informed consent and the mentality of patients and to motivate students to study informed consent. This joint class also allowed fifth–year students to review their progress over time and gave first–year students a chance to meet role models.

This study evaluates the pertinent cutoffs of Timed Up and Go (TUG) and Chair Stand (CS) tests for detecting cognitive impairment risk in Japanese elderly. Subjects were community-dwelling adults aged 65 or older (N = 455, 129 men and 326 women). Cognitive function was examined using Urakami’s test for Alzheimer’s disease; physical function was examined by TUG and CS. The maximum score for cognitive function was 15; impairment was defined as 12 or less. Receiver operating characteristic (ROC) analyses were performed to find an appropriate cutoff of TUG and CS for cognitive impairment. Furthermore, the sensitivity and specificity of the combined use of these measures independently distinguishing between subjects with and without a risk for cognitive impairment were determined. Fifty-four subjects (12%) scored as impaired on Urakami’s test. The optimal TUG cutoff for cognitive impairment was 6 seconds and 9 seconds for CS. The combined use of TUG and CS, based on a subject being positive on at least one measure, yielded sensitivity of 78% and specificity of 50%. Area under the ROC curve of TUG and CS were respectively 0.67 and 0.66. When divided into two groups according to the TUG cutoff value, the odds ratio of cognitive impairment in the slower group was 2.1 (95% confidence interval 1.25-3.37). For CS cutoff, the slower-group odds ratio was 3.57 (95% confidence interval 2.20-5.81). For TUG and CS combined, the slower-group odds ratio was 2.11 (95% confidence interval 1.03-4.34). TUG and CS are thus potent predictors for cognitive impairment among elderly adults.