1) The study tour was organized by Dr. Hinohara to learn about the medical education in North America and its philosophy to support the method.
2) The McMaster University, which started PBL curriculum in 1969, began COMPASS curriculum which focuses on conceptual thinking and e-learning in which tutorial groups still remain as the key to the learning process.
3) The Duke University, which values the researcher promotion, began a new curriculum including at further integration of basic and clinical medicine and structural clinical training (Intersession).
4) The Washington University, which constructed WWAMI Program that cooperated with the medical institutions in four states surrounding Washington, started College System to support the students and to strengthen their clinical competencies.
5) Common aspects of the innovation of medical education in North America are (1) further integration of the basic and clinical medicine, (2) early exposure to the principle of clinical medicine and (3) promotion of professionalism by Clinical Preceptorship.

The interval between undergraduate medical education and graduate medical education causes residents to become disorganized when they start their first-year residency programs.This disorganized transition may be stressful for residents and preceptors and may cause resident to make medical errors.We performed a pilot study to examine the degree to which program directors agree about the abilities required for the start of the first of year residency.
1) We asked the residency directors at university hospitals and residency hospitals nationwide (343 institutions) to indicate what abilities residents were expected to have at various stages of the residency program.The data received were then analyzed.
2) A total of 134 residency directors (39%) returned the questionnaire.We calculated the percentage (expectation rate) of institutions that reported expected prerequisites at the start of the first year of residency and calculated the accumulated values (cumulative rate) of the percentages.
3) Only 43 (30%) of 141 abilities upon the completion of residency-preparatory programs had a cumulative rate of more than 50%.
4) Domains for which the expectation rate was more than 50% at the start of residency were medicine and related knowledge and practical skills for obtaining physical measurements.
5) Physical examination and practical skills for which the cumulative rate was less than 50% on completion of residency-preparatory programs were those for the reproductive and urinary systems and pediatrics and the insertion and maintenance of intravenous lines and indwelling urinary catheters.
6) Disparities are likely between the abilities of residents and the tasks expected of them upon entry into a residency program.This problem must be urgently addressed through medical education and graduate medical education.

OBJECTIVESBisphenol A (BPA), a raw material commonly used in the manufacture of resins such as polycarbonate and epoxy, is a possible xenoestrogen that is hypothesized to disrupt the human endocrine system. Humans are widely exposed to BPA. We investigated the urinary concentration of BPA in infertile Japanese women and its possible association with endometriosis.

MATERIALS AND METHODSWe recruited 166 women (aged 20-45) who had complained of infertility and visited a university hospital in Tokyo. The subjects were interviewed and their urine samples were obtained prior to a laparoscopic diagnosis of endometriosis between January 2000 and December 2001. Urinary total BPA concentration in 140 eligible urine samples was then measured using enzymatic deconjugation of glucuronide and sulfate and high-performance liquid chromatography isotope-dilution tandem mass spectrometry.

RESULTSMedian (25th-75th percentile) unadjusted and creatinine-adjusted urinary BPA concentrations were 1.6 (0.69-2.8) μg/L and 0.80 (0.45-1.3) μg/g creatinine. No significant monotonic association of endometriosis with urinary BPA concentration was observed. Median urinary BPA concentration in women with stage 0-1 endometriosis (0.74 μg/g creatinine) did not significantly differ from that in those with stage II-IV endometriosis (0.93 μg/g creatinine) (p for difference=0.24).

CONCLUSIONSThis study, based on a larger number of samples than those in previous studies in Japan and using the most reliable analytical method currently available, showed that urinary concentrations of BPA in women who consulted a physician for infertility were not higher than those in other populations. Moreover, no association between urinary BPA concentration and endometriosis was found in this cross-sectional study.