Early clinical exposure has been implemented worldwide as an effective method of medical education. The duration of early clinical exposure is 1 year in some universities in Western countries. In Japan, however, early clinical exposure occurs most often through health and welfare services, and its duration varies. One-year early clinical exposure and reflection upon it were implemented for first-year students at Mie University School of Medicine in 2006 to motivate them and to teach them about professionalism. The effectiveness of this program was evaluated with a questionnaire, a daily log, and a portfolio.1) The questionnaire survey revealed that students considered the program extremely valuable. They had learned much about communication skills, the relationship between medicine and society, patients' families, and professionalism.2) An analysis of the daily logs clearly showed that students were unsure and hesitant at the start of the program. However, they gradually became accustomed to participating in this program and began to learn earnestly.3) Qualitative analysis of the portfolios revealed that students considered 10 items important in the practice of medicine, including communication skills, responsibility, the value of being a physician, professionalism, and the motivation to study medicine.4) In their final reports, the students described the expected behaviors of physicians they should seek to perform, by learning medical ethics or through professionalism.5) In conclusion, 1-year early clinical exposure is a more effective method than short-term or intermittent exposure for medical students because of its uniqueness and the maintenance of motivation.

Medical ethics is taught as a principle of medicine at medical schools in Japan. However, the best way to teach medical students about decision-making in ethical dilemmas in unclear. Therefore, we conducted a survey of 80 medical schools in Japan to identify the current issues in the teaching of medical ethics. We asked how and when students learned about medical ethics at medical school and asked about the objectives, achievement goals, contents, and curricula for the first to sixth years and postgraduate studies.1) A preliminary study of educational affairs at faculties of medicine (response rate, 99%) showed that medical ethics is most likely to be taught in the earliest year (first year, 61%) and is less likely to be taught in later years (fifth or sixth year, 11%). 2) Only 28% of lecturers who teach medical ethics are familiar with the whole curriculum of medical ethics, and only 15 medical schools had cross-faculty teaching.3) Lecturers' satisfaction with the system of teaching medical ethics at medical schools was related with the introduction of the elements of medical ethics at bedside teaching (odds ratio=7.4, p<0.01).4) A logistic regression model adjusted for lecturers' specialties indicated that sufficient content for teaching medical ethics was associated with classroom discussions with clinicians (odds ratio=9.3, p<0.05).5) Despite the recently increased recognition of the importance of teaching medical ethics, the human resources for teaching medical ethics at medical schools are scarce and insufficient. Urgent responses are needed to address current shortcomings in the teaching system and the advanced training of teachers.

A shortage of physicians in rural areas has become a serious problem of the new residency training program in Japan. To address this problem, we propose a model for attracting physicians to rural areas by improving residency training programs and by evaluating a curriculum introduced at Kainan Hospital, a community hospital. In this first paper, we describe the short-term evaluation of the curriculum.1) We introduced clinical teams in which residents were able to actively participate in clinical practice as team members by being supervised by senior physicians. We also introduced teaching rounds and case conferences for residents.2) Focus-group interviews of residents showed that "giving educational opportunities to residents" and "an explicit policy of the hospital to improve the residency training program" are examples of ways to improve residency programs.3) The number of residents working at Kainan Hospital increased. The residency training program was somewhat improved.4) An effective and easily generalized way to provide residents with more learning opportunities is to involve clinicians in teaching residents in hospitals.

A shortage of physicians in rural areas has become a serious problem of the new residency training program in Japan. To address this problem, we propose a model for attracting physicians to rural areas by improving residency training programs and by evaluating a curriculum introduced to Kainan Hospital, a community hospital. In this second paper, we describe the middle-term curriculum evaluation and present our model.1) Interviews of program directors revealed 8 items necessary to improve residency training programs.2) After the residents finish their training, they remain at the same hospital, and the number of the number of physicians at the hospital increases, if the fellowship programs are well-organized.3) Because universities are interested in hospitals at which many residents and fellows work, attracting attending physicians to these hospitals is easier.4) Although attracting enough physicians by improving residency training programs requires 3 to 5 years, achieving this goal by increasing the larger number of medical students would take even longer.

Forty Years AgoAugust,1969 in the prime of the nation-wide university strife, the Japan Society for Medical Education was founded within the Association of Japanese Medical Colleges in order to improve medical education through a long-ranged research-based activity and became an independent organization later.Achievements AfterwardOnly 62 members at the beginning have increased year after year to 2,000 and 230 organization members, including all 80 medical schools, in response to the societal summons. The Society's activities have ranged widely from the undergraduate medical education, begun at the student selection, the graduate education to the continuing education of the health professionals with and through evidence-based research.Some of the real activities during the past forty years have been as follows: (1)Various committees and working groups have worked continuously toward momentarily crucial issues facing medical education, (2)The scientific meetings have been held annually at the medical schools or teaching hospitals for forty years as well as conferences and workshops occasionally, (3)The official journal "Medical Education (Japan)" has been published bimonthly and the educational books as well, (4)Promotion and cooperation of "faculty development" have been one of the most important tasks, (5)Assistance to build the medical education centers in medical schools and hospitals and (6)many others.Future ProspectivesThe Japan Society for Medical Education will continue every activity for the people's health and welfare as an organization of "noblesse oblige".

Medical students in Japan often want to do clinical rotations abroad. Preparation for these important clinical experiences is essential to maximize the learning opportunities. Language ability is only one small part of assuring success.1) It is important to consider the hospital where the rotation will take place, the specific rotation, the living arrangements and commuting to the hospital. Preparation before the rotation should include practice in performing and writing a complete patient history and physical examination.2) It is very helpful to have a cell phone while abroad, as well as a credit card. Students must bring a white coat, and it is recommended that they also bring a Japanese textbook in the field they will study.3) While on a clinical rotation, students must be active participants in patient care and in discussions. They must be aggressive about answering questions during ward rounds. Students must be aware of many cultural differences to have good relationships with patients and colleagues.

In kampo medicine, an illness is considered to affect the entire body, even if the symptoms appear only in the abdomen. Abdominal palpation is considered an important diagnostic physical examination in kampo medicine. Because learning the kampo style of abdominal palpation is difficult, we attempted to simplify the process by developing typical models of 6 important kampo abdominal diagnoses (shinka-hiko, kyokyo-kuman, fukuchokukin-renkyu, shofuku-fujin, shofuku-koman, and shinkabu-shinsuion).1) When we discussed abdominal palpation in lectures on kampo medicine for clinicians we also assessed the opinions and impressions of participants about the abdominal palpation simulators. 2) We administered an anonymous questionnaire survey about interest in kampo medicine, the understanding of abdominal palpation in the kampo style, and an evaluation of the abdominal palpation simulators. We obtained 149 replies from participants of the 11 lectures. 3) Of the participating physicians, 85.2% were interested in kampo medicine. However, 23.5% of physicians were not familiar with abdominal palpation in the kampo style. 4) Furthermore, 58.4% of physicians thought that kampo-style abdominal palpation was explained well or very well in the lecture with the abdominal palpation simulators. The abdominal palpation simulators were judged to be useful or very useful by 72.2% of the physicians. 5) In conclusion, the abdominal palpation simulators were considered to be useful for learning abdominal palpation in the kampo style, even though these simulators have some shortcomings. These models may be useful for simplifying the learning of abdominal palpation by students of kampo medicine.

We conducted a survey of syllabuses of Japanese medical and nursing schools to develop a comprehensive educational program to teach undergraduates of Japanese medical and nursing schools about end-of-life care for the elderly.In addition to the program we developed with the present survey, teaching about ageism and the definition of the end of life of the elderly is necessary.The present survey suggested the importance of teaching about the quality of life of the elderly, including the items of comprehensive geriatric assessment.

Clinical clerkships have been gradually introduced in medical schools in Japan. Because all students do not rotate through the same departments, the satisfaction of medical students differs among the departments, although the underlying reasons for such differences are unclear. To investigate the factors associated with student satisfaction with clinical clerkships, we performed a questionnaire survey.1) Questionnaires were distributed to 99 fifth-year medical students at Kyoto University Medical School. The questionnaire consisted of Likert-type 5-level scales of satisfaction, clinical clerkship assignments, and the attitudes of clerkship supervisors and other attending staff. Eighty-nine students responded.2) The independent factors for students' satisfaction were the attitude of attending staff (beta coefficient, 0.34), the attitude of the clerkship supervisor (0.30), and the frequency of physical examinations (0.09).3) Twenty-two of the 34 students who expressed the lowest level of satisfaction (level 1) reported that "the attending staff rarely had contact with students."4) Factors not associated with satisfaction were: whether the rotation was in internal medicine or surgery; whether the rotation was in a community hospital or a university hospital, and the department.5) These results suggest that medical students are satisfied with a clerkship if they perform frequent physical examinations and if the attending staff have an enthusiastic attitude.

The curricula for Japanese medical schools are being dramatically reformed. Under these conditions, the number of hours allocated to the anatomical dissection course has decreased in the last decade. In the current environment of understaffing, we face a conflict between good educational practice and superior research performance at the University of Yamanashi. To address this problem and to cultivate research-oriented thinking and the teaching ability of medical students, we introduced a novel teaching system in which senior students (3rd to 6th years) serve as teaching assistants (TAs) in the dissection course. In this trial, we undertook the following procedures.1) We performed two surveys of 2nd-year students and TAs to evaluate the performance of the system during the middle and late phases of the laboratory course.2) By referring to the results of the first survey, we simultaneously improved the system.3) Research topics related to anatomy were assigned to the TAs.4) Overall, this system was viewed favorably by both the second-year students and the TAs, although the consistent participation of TAs throughout the term remains to be addressed. By taking these issues and evaluations into account, we will improve the system and propose it as a new elective educational style for Japanese medical schools.