Clinical educational systems in Jichi Medical University are unique in several aspects.
1）A clinical clerkship is a compulsory 72–week subject.
2）Community–based learning has been adopted for more than ten years.
3）To improve clinical reasoning for medical students, we developed a teaching program using morning conference in Internal Medicine.
4）We introduced a free course–student doctor system.

When introducing the computer-based test (CBT) to the National Medical Licensing Examination, it is desirable to introduce question items with video and audio to take advantage of the characteristics of computers and to fill in the gaps between the audiovisual information presented in the exam and in clinical practice. 　To this end, it is necessary to collect appropriate video and audio materials and to establish the know-how and human resource development for creating items that make use of these materials.　The authors have been engaged in the development of video/audio-assisted CBT for 12 years. In the Kawakita Group of the Health Labour Sciences Research Grant projects, video/audio-assisted question items were given in the CBT trials for the National Medical Licensing Examination. Also, a manual and workshops for video/audio-assisted CBT have been prepared. Based on these experiences, this paper discusses the merits and challenges of CBT for the National Medical Licensing Exam.

In recent years, the Committee for the Improvement of the National Medical Licensing Examination has been discussing the possibility of replacing the National Medical Licensing Examination with CBT. The reasons for this include the diversification of the question format using multimedia and other methods and the need to respond to disasters and pandemics. Against this background, the authors are conducting research on CBT implementation for the National Medical Practitioners Examination. In FY2021, we conducted a CBT trial for the National Medical Licensing Examination using an open-source system. The trial was conducted at ten universities across the country, and most examinees were able to take the exam without any major problems. The future implementation of the CBT format for the national medical examinations will simplify the examination preparation system, develop a multiple examination system in preparation for contingencies, and evaluate examinees' abilities through more diverse question formats.

In the 2022 Model Core Curriculum for Medical Education in Japan, "Chapter 3, Educational strategies and assessment" section II. "Learner Assessment," consists of three parts : II-1. Approaches to learner assessment, II-2. Assessment methods, and II-3. Questions about learner assessment. Based on the idea that "the way assessment is done varies from institution to institution," the answer to the "Question" is deliberately not included. We hope that readers will refer to this chapter when planning learning assessments in curriculum development while considering the curriculum's background and context.

In this revision, we have attempted to align the Model Core Curriculum for Medical Education competency, "problem-solving ability based on specialized knowledge," with the "Standards of National Examination for Medical Practitioners." The major diseases and syndromes in "Essential Fundamentals" correspond to the basic diseases in Table 1 of the Core Curriculum, symptoms, physical and laboratory examinations, and treatment in "General Medicine" correspond to the items in Table 2 of the Core Curriculum, and the diseases in "Medical Theory" correspond to the diseases in PS-02 of the Core Curriculum. The validity of the diseases in the Core Curriculum was verified using the evaluation results of the examination level classification of the "Research for Revision of National Examination Criteria." Approximately 690 diseases were conclusively selected. This revision mentions the number of diseases in the Core Curriculum for the first time. Hopefully, this will lead to a deeper examination of diseases that should be studied in medical schools in the future.