As medical safety attracts attention, it has become increasingly important to ensure the quality of medical education, and more emphasis has been placed on educational outcomes. An ideal form of training, in which medical students undergo medical education and then transfer to residency training seamlessly, can be conducted by setting general competencies required for all physicians as educational outcomes, as well as setting milestones in the process. Accomplishing competencies is the pillar of outcome-based education, and the assessment of students' achievements is important.
　The multilateral assessments of their competencies should be conducted, including written examinations, performance tests, observational assessments, and portfolios. In the existing national examination for medical practitioners, no such multilateral assessments are conducted. To promote seamless transition from under- to post-graduate education, it is important for the Faculty of Medicine and medical colleges to appropriately assess students' educational milestones as a condition of awarding them with degrees, in addition to the setting general competencies and such milestones.

　The Japanese Medical Specialty Board has been established with the collaboration of medical and medical care organizations. It ensures the quality of medical specialists and achieves accountability to the people by certifying medical specialists and authorizing training programs. Outcome-based education is characterized by an emphasis on the quality assurance of trained physicians. Therefore, the new medical specialty training system could be constructed through outcome-based education. I give a brief overview of the new medical specialty training system, and it is discussed in the context of the guideline for medical specialty training system published recently.

In the fourth-year curriculum of the Chiba University School of Medicine, suggesting changes in health behavior and informing patients of bad news were studied through lectures and small-group role-playing with simulated patients as part of an advanced course in medical interviewing. We report on the contents of the curriculum and the results of an evaluation.

A questionnaire analysis of early postgraduate clinical training of 6th-year medical students was conducted for 3 consecutive years. After graduation, 32% of the students wished to become family physicians, 58% wished to become specialists, and 9% wished to become other types of doctors. The type of postgraduate clinical training most often considered ideal was superrotation, followed by rotation and straight track. Superrotation should be introduced to junior residents during postgraduate clinical training as should a variety of subspecialty training courses for specialists, including family medicine for senior residents.

Teamwork is increasingly important for high-quality patient care, and education in multiprofessional or interdisciplinary teamwork has recently been proposed as an essential subject in the core curriculum of Japanese medical schools. We developed a course in teamwork in which medical students devised diagnostic, therapeutic, and support programs from a written patient scenario with the help of a multiprofessional staff, including subspecialty physicians and surgeons, nurses, a counselor, a social worker, and a dietician. The course promoted understanding of mutual roles and the ideal relationship between physicians and comedical staff. Active discussion is necessary for understanding interdisciplinary and transdisciplinary teamwork.

To assess the acceptance of peer physical examination training and the acquisition of professional attitudes as medical doctors, a questionnaire was given to 245 medical students (second, fourth, and sixth year) of Chiba University. All students recognized the value of peer physical examination training, and female students recognized the necessity of training with male examinees. Male students accepted roles of both examiner and examinee, but female students refused to be examined by male students or to be taught by male instructors. The genders of students and instructors must be considered when physical examination curricula are planned.

Educational reforms are required to achieve the "learning outcomes" expected in bachelor degree education programs. In executing reform, three policies of "diploma policy" , "curriculum policy" , and "admission policy" are clearly stated for each institution in order to facilitate integrated operation and practice. For the sake of quality assurance, outcome-based education (OBE), which emphasizes "learning outcomes" , has been introduced to medical education but it has not been adopted by all learning institutions. With the implementation of field-specific evaluations for medical education comes a need for all medical departments and medical colleges to introduce OBE as soon as possible. For this reason, an examination was conducted to find out how to formulate and operate the three policies under OBE.

In November 2014, a symposium was held by the Japan Society of Medical Education on the theme of the National Medical Licensing Examination. To improve the National Medical Licensing Examination, the post clinical clerkship OSCE was officially implemented from FY2020. Its introduction into the National Medical Licensing Examination will be discussed in the future based on the status of its implementation. The competencies to be assessed are clinical capabilities that can be performed on patients under the “guidance of a supervising physician,” and are suitable for evaluation in the clinical setting where the supervising physician directly observes and evaluates students’ medical practices. In comparison with the OSCE, which evaluates simulated clinical practice, the introduction of the post clinical clerkship OSCE into the National Medical Licensing Examination was discussed.

In the past, pre-graduate medical education and clinical training have not been sufficiently discussed and consistent training of physicians has not been carried out because the entities that implement the studies are different. In order to realize high quality pre-graduate education and post-graduate clinical training, and to promote seamless training of physicians, it is necessary to establish a system of medical education. It is also necessary to consider the outcomes of pre-graduate medical education and clinical training to maintain consistency in the review of clinical training system for physicians in 2020. This paper discusses the Model Core Curriculum for Medical Education and clinical training from the perspective of outcome-based education for consistent physician training.

Technical skills have traditionally been taught by "learning by doing". This teaching method is mainly associated with potential risks for patients. Teaching technical skills using simulators has emerged in recent years but their effectiveness has not been adequately tested. The objective of this study was to examine the effectiveness of a central venous catheterization (CVC) training program using a simulator.1) Twenty residents were randomized to either receive a training program using a simulator on CVC (simulator group, n=10) or not (non-simulator group, n=10). They were evaluated for their technical competence in performing CVC on patients and their personal concerns about their first experience of CVC.2) There was no difference between the two groups in resident and patient characteristics; however, the simulator group scored significantly higher in the 4-point performance score than the non-simulator group (2.80±0.33 versus 2.30±0.48, P=0.035).3) The completion rate of CVC was higher in the simulator group (90% versus 60%, P=0.12), and they required fewer attempts at needle insertions (1.67±0.71 versus 3.00±1.26, P=0.022).4) Residents in the simulator group noted the effectiveness of this program more frequently than those in the non-simulator group (86% versus 36%, P=0.057) and showed fewer concerns about their first experience of CVC on patients.5) The CVC training program using a simulator improved residents' skills and is likely to be effective to diminish the fears of residents about performing CVC on patients.