To develop problem-solving skills and to motivate learning, The Jikei University School of Medicine started a tutorial educational program for fourth-year preclinical students in April 1999. Student doctors' patient-care models focused on discovery learning and acquiring strategies for general medicine through problem-solving skills. After information was first provided by prepractice handouts, one or two tutorial sessions were performed each week. Minimum requirements for each step were established, and instructors provided printed materials, display materials, and detailed oral information to facilitate discovery learning. This program is based on problem-finding and problem-solving through selfdirected learning and feedback systems for tutorial sessions. Examinations used multiple stations to reconfirm program aims and to reinforce problem-solving skills. On a questionnaire survey, 85% of fifth-year students taking part in practical clinical education thought that the tutorial education was needed to acquire problem-solving skills necessary for fifth-year clinical training.

Purpose: To assess problems of a system for evaluating educational methods which cause interevaluator variability at the pulse and blood pressure measurement station of the objective structured clinical examination. Subjects: 186 evaluations for 93 fourth-year medical students. Method: The vital-sign station consists of pulse examination, blood pressure measurement, and a 1-minute oral examination. To assess interevaluator reliability, the differences between two evaluations of each of 15 evaluation steps were calculated and divided into three categories: “greater than 95% agreement, ” “unidirectional disagreement, ” and “bidirectional disagreement.” Results: The steps of “consent to examination, ” “proper verbal instructions, ” “valve release, ” “estimation by palpation”, a question about “normal systolic blood pressure, ” and a question about “the interval and the number of repetitions” showed greater than 95% agreement. The steps of “manner of speaking, ” “palpation of peripheral pulse, ” “stethoscope placement, ” “cuff deflation, ” “presentation of blood pressure, ” and a question about “absolute arrhythmia” showed unidirectional disagreement. The steps of “presentation of pulse measurement, ” “cuff wrapping, ” and “cuff inflation” showed bidirectional disagreement. Discussion: Suggestions to improve intervaluator reliability include:(1) decreasing the evaluation steps to two with a single checkpoint, (2) presenting blood pressure with the palpation method, (3) deleting the oral examination, (4) providing adequate instruction about the differences in the types of cuffs and bladders, and (5) clarifying evaluation criteria and the training of evaluators.

To increase the safety and effectiveness of clinical clerkships, we have developed a 4-week preclinical training program, “Problem-Based Clinical Training, ” based on the concept of problem-based learning with the aim of encouraging life-long self-directed learning. The first week is a preparation period for clinical practice in which students are trained in problem-solving skills, basic-practice skills, and clinical reasoning. The second and third weeks are a practical training period in which students learn how be in charge of a patient's care. The fourth week was a problem-solving period without practical training in which students learned to solve problems. The students were encouraged to record daily “problem notes” describing problems and “problem solving notes” summarizing problems solved. To emphasize lessons learned, the students also presented and discussed problems. Evidence-based medicine was used as a tool for problem solving. Furthermore, medical record training based on the problem-oriented system using evaluations by other students encouraged self-development to improve clinical practice and the medical record. This curriculum should be effective for mastering the skills of self-directed learning and for motivating for advancement due to consideration of contributable proposals for the patients.

Background: A workshop for training clinical clerkship staff has been held since 2009. We examined how the participants felt about the workshop.
Method: The questionnaire was sent to the participants of the workshop.
Result: Of the participants, 82％ thought that the workshop was helpful and that the benefits had continued for more than 2 years. Their motivation for undergraduate medical education was improved. They started to consider how medical students become members of a medical team and to think about the goals of medical practice. To promote further increases in the numbers of clinical clerkships, the participants cited the necessity of increasing the number of faculty advisors, encouraging medical students’ positive attitudes, changing attitudes about patients, extending the training period, and holding such workshops.
Conclusion: The workshop was beneficial for the staff, and the beneficial effects continued long after the workshop was held.