Introduction: The University of Tsukuba has a one-week in-home care course combining a problem-based learning style tutorial and lectures in the comprehensive community-based learning curriculum for 2^nd year students. This study aimed to investigate what medical students are learning concretely from this course.

Methods: We performed a qualitative date analysis of the contents of all 111 student course reports written in the free description using a modified Steps Coding and Theorization method employing the framework of patient-centered clinical method (PCCM).

Results: Medical students learned with keen interest based on their experiences and in the framework of PCCM such as 'Exploring health, disease and the illness experience', 'Understanding the whole person'. These processes led to the awareness of responsibility as a physician.

Conclusion: The in-home care course in the classroom may provide medical students with an opportunity to become aware of their responsibility as a physician.

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.

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.

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/Aims: Chronic constipation and lifestyle factors can affect sleep quality. We evaluated the relationship between chronic constipation and sleep in the Japanese population. Methods: This cross-sectional internet-based survey included 3000 subjects with constipation, classified according to sleep status (good/poor).Primary endpoints were Bristol stool form scale (BSFS) score and correlations between sleep disorder criteria of the Pittsburgh Sleep Quality Index (PSQI) and sleep status (good/poor sleep). Secondary endpoints included correlations between quality of life (QOL) and mood, medical, lifestyle, and sleep factors. Results: The proportion of participants with BSFS category 4 (normal stool) was significantly higher in the good sleep group (P < 0.001). Sleep disturbance (P < 0.05), sleep quality, and duration, use of hypnotic medication, and daytime dysfunction of PSQI (all P < 0.001) significantly correlated with poor sleep. In the poor sleep group, QOL was significantly worse and anxiety and depression levels were significantly higher (allP < 0.001) compared with the good sleep group. Anemia and smoking (both P < 0.05), recent body weight increases, and poor eating habits (all P < 0.001) were significantly higher in the poor sleep group. Male sex, onset associated with change in frequency of stools, sensation of incomplete evacuation for at least 25% of defecations, and manual maneuvers to facilitate at least 25% of defecations correlated with poor sleep. Conclusions Subjects with constipation and poor sleep experienced severe symptoms and had poor QOL. These data support the need for a multifocal treatment approach, including lifestyle advice and pharmacotherapy.

Background/Aims: Chronic constipation and lifestyle factors can affect sleep quality. We evaluated the relationship between chronic constipation and sleep in the Japanese population. Methods: This cross-sectional internet-based survey included 3000 subjects with constipation, classified according to sleep status (good/poor).Primary endpoints were Bristol stool form scale (BSFS) score and correlations between sleep disorder criteria of the Pittsburgh Sleep Quality Index (PSQI) and sleep status (good/poor sleep). Secondary endpoints included correlations between quality of life (QOL) and mood, medical, lifestyle, and sleep factors. Results: The proportion of participants with BSFS category 4 (normal stool) was significantly higher in the good sleep group (P < 0.001). Sleep disturbance (P < 0.05), sleep quality, and duration, use of hypnotic medication, and daytime dysfunction of PSQI (all P < 0.001) significantly correlated with poor sleep. In the poor sleep group, QOL was significantly worse and anxiety and depression levels were significantly higher (allP < 0.001) compared with the good sleep group. Anemia and smoking (both P < 0.05), recent body weight increases, and poor eating habits (all P < 0.001) were significantly higher in the poor sleep group. Male sex, onset associated with change in frequency of stools, sensation of incomplete evacuation for at least 25% of defecations, and manual maneuvers to facilitate at least 25% of defecations correlated with poor sleep. Conclusions Subjects with constipation and poor sleep experienced severe symptoms and had poor QOL. These data support the need for a multifocal treatment approach, including lifestyle advice and pharmacotherapy.