For the pupose of terminal care education, I am conducting a trial experiment on free discussion in a small group, about six members, of students of a nursing school. After self-introduction, debate is held on two themes, “terminal care of my beloved companion” and “terminal care of mself.” As judged from the results of a questionnaire and the record of debate, the students' attitude toward the question “Am I going to die soon?” asked by a terminally ill patient, changes during the discussion from encouraging, denying, or avoiding to listening to the patient. This style of exercise may be able to be used for terminal care education for medical students, medical and paramedical staff and death educaton for the general public.

A new diagnostic practical training course was instituted for 4th year students during the first and second terms at Shinshu University School of Medicine. This course includes the following new features: teachers from all clinical departments participated, the general instructional objectives and specific behavioral objectives of each unit of the course were determined, specialists from several departments or sections took charge of one unit of the course, attitude education was given great importance, standardized patients played by teachers are used in interview and POS training and final evaluation units. Evaluation was by students, teachers, and the education planning committee, and teacher training was performed before the start of this course.

To investigate the present state of teaching on terminal care and death in medical school pregraduate curriculums, I conducted a survey of 80 Japanese medical schools using a questionnaire in May and June, 1993. Ninety-one percent of the schools responted. Of the 73 responding schools, 24 stated that they have no formal educational program for medical students concerning the death and terminal care. Forty-nine schools (67%) said that they have terminal care and death education courses in their curriculum at present. This rate is the same as that about 20 years ago in the United States. In Japan, most schools have only lectures on the subject matter, of variable total duration, ranging from 1 to 32 hours (mean 6.4 hours). Only 5 schools have practical training with a chance for medical students to meet terminal patients. Practical training is conducted in hospice or hospice wards in 3 schools, in a pain clinic in 1 school, and in a standard inpatient ward in 1 school. Seven schools have training courses without participation by terminal patients, using role-playing (4 schools), and expression of student's opinions (3) instead. In England, the United States, and Australia, practical training with frequent one-on-one meetings between medical students and terminal patients (as patient-tutors) was reported.

For more effective clinical clerkship of medical students in the internal medicine, a manual was developed, including (1) teaching students how to think and write “the problem oriented medical record”, (2) encouraging students to listen to, talk to and examine their assigned patients daily, (3) having students discuss with a tutor twice daily, (4) encouraging students to obtain clinical training at outpatient clinics also, and (5) advising students to participate in actual medical care of the patients under direct supervision of the assigned resident.