Changing societal environments are forcing us to prepare to assume new roles as physicians. The resulting changes coming to the practice of medicine require significant medical education reforms. Specifically, there are nine factors that impact this need for change. Those factors are: 1) expanding medical knowledge, 2) introduction of various new technologies into medicine, 3) easy accessibility to medical knowledge by patients and their family members, 4) an aging population, 5) rapid development of information and communication technology, 6) the imminent arrival of artificial intelligence, 7) specialization of physicians, 8) variety of health professionals, and 9) globalization-.

The OSCE, introduced by Harden et al. in 1975, is an approach to the assessment of clinical competence in which the components of competence are evaluated in a planned and structured way, with particular attention to objectivity of the examination. The student is assessed at a series of stations, with one or two aspects of competence being tested at each station.
Overview of the history of the OSCE, description of administering the examination, and the advantages and disadvantages the method are presented with reference to our own experience.

Department of general medicine (DGM) could play important roles in clinical practice, education and research. Particularly in clinical education, DGM could take a leadership in various areas both in undergraduate and graduate education setting. Among them basic clinical competence education and primary care education are two major areas in which DGM can demonstrate it's leadership. I herewith proposed a curriculum for two areas.

1) Many medical schools in Australia are adopting curricula that encourage medical students to understand the community and the importance of community-based medicine.
2) Flinders University has successfully created and implemented a curriculum in which medical students spend time in small community hospitals and clinics during their third year.
3) Although there are many types of community-oriented medical education, we must consider what kind of medical education would increase the quality of community medicine in Japan.

In 1989 the Medical Council of Canada embarked upon a program to incorporate into its licensing examination a clinical skills component using an OSCE. In February 1991, 240 volunteer first-and second-year residents were tested in a pilot project. The results indicated that a full-scale national administration of an OSCE for licensure was feasible with a reasonable validity and reliability. Since then three large scale administrations have now been run testing 1352, 1672, 1737 candidates. The examination consists of 20 ten minute stations, all standardized patient based using physician examiners as markers. Standard setting is done by a criterion referenced approach. Failure rates have varied from 9% to 17% for all examinees and from 4% to 7% for first time Canadian takers. Reliability estimates determined by Cronbach's alpha range from 0.72 to 0.81. Dependability indices at the cut score were 0.99 for all administrations. Generalizability analyses revealed little or no variance attributable to site. Present efforts are now being focused on sequential testing and validity studies. The Canadian experience has demonstrated the feasibility of testing clinical competence using an OSCE at a licensure level.

This study explored the value of using medical students as standardized patients (SPs) during objective structured clinical examinations for the medical interview. Evaluations by both examiners and examinees revealed that the performance of medical students as SPs provided sufficient reality and reproducibility for the objective evaluation of interview skills. The experience also offered medical students playing SPs the opportunity to learn the importance to patients of eye contact and of a sympathetic and reliable attitude on the part of physicians toward their patients during the medical interview. In conclusion, training medical students to serve as SPs for evaluating interviewing skills in the context of an objective structured clinical examination is beneficial to both the person being evaluated and to the medical student serving as the SP.

Objectives: To investigate how simulated patients perceive physical examinations. Methods: Simulated patients, who were members of the Nagoya University Simulated Patient Society, were divided into two groups according to age, one group in their 40s and one in their 60s, and interviewed about their perceptions of physical examinations. A coding scheme was used to organize the data in thematic categories and extracted concepts. Results: Both groups believed that: 1) training in physical examination is essential for medical students and 2) communication between a patient and a physician during physical examination is important. The 60s group had positive “attitudes” and less “hesitation” in terms of physical examination, whereas the opposite was true for the 40s group. As for “acceptable body parts, ” there was a greater degree of acceptance among the 60s group, whereas the “students' sex” affected the 40s group but not the 60s group. Conclusion: The results suggest that simulated patients can participate in physical examination education, providing each simulated patient's preferences are considered.

1)Leaders of skillslabs at Japanese medical schools are concerned about the future of skillslabs.2)The way skillslabs are presently used in Japan is not in accordance with current evidence on teaching skills.3)We present a stepwise process to bring Japanese skillslabs in line with the standards of 2009.

This study aimed to assess how the gender of medical students affects their communication styles and those of simulated patients (SPs) during objective structured clinical examination medical interviews in Japan.
1) Medical interviews conducted by 82 fourth-year medical students (53 male and 29 female) at Nagoya University School of Medicine were analyzed by means of the Roter Interaction Analysis System.
2) Compared with male medical students, female medical students engaged in significantly more emotionally focused talk, particularly empathy, and asked more open-ended questions.
3) With female medical students, SPs engaged in significantly more social talk (personal remarks), gave more biomedical information, and made more total utterances than they did with male medical students.
4) The gender of medical students significantly affected their communication styles and those of SPs. (127 words)

BACKGROUND: The patient-physician relationship and patient self-management are important in controlling diabetes mellitus. This pilot study assessed the value of patients sharing their stories with physicians.
METHOD: Twelve patients and two physicians participated. Patients told their life stories to a co-medical interviewer, and these were transcribed and summarized in their medical charts. The physicians read the transcripts. The intervention was evaluated by questionnaire and interviews with the patients and physicians. Two coders qualitatively analyzed the interviews. Glycated haemoglobin (HbA1c) and body weight were examined before and six months after the intervention.
RESULTS: 75% of patients felt an improvement in the physician's empathy, advice and ability to share the patient's problems. Physicians reported an improved relationship with 40% of the patients. The patient interview identified: 1) facilitated self-reflection; 2) encouraged self-efficacy; 3) changed perceptions about health-care related behavior; and, 4) difficulties in changing behavior. However, improvement in HbA1c levels and body weight was not significant.
CONCLUSIONS: The patients were satisfied that sharing their stories improved self-reflection and self-efficacy, but found it difficult to adopt healthier options for managing their diabetes. Long-term study of whether improved physician communication skills will enhance outcomes is needed.