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.

A total of 1, 236 cases of gastric cancer operated at Hiraka general hospital during the 14 years from 1975 to 1988, were analyzed and the following results were obtained.
1. There was a distinct tendency to increase in the numbers of early-staged cancer cases and patients over 70 years of age.
Any decrease in the number of operated gastric cancers could not be obeseverd during this period.
2. The ratio of patients aged over 70 years increased to reach 26.4% recently and the ratio of early staged cancer increased to 59.3% in 1988.
3. The over all resection rate was 90.8% and curative resection was performed in 85.2% of resected cases.
4. The cumulative 10-year survival rate in curative resected cases was 74.0%.
5. The rate of the multiple cancer cases was as high as 5.0%.

A total of 417 operated cases of colorectal cancer at Hiraka General Hospital during the 15-year period from 1974 to 1988 were analyzed and the following results were obtained.
1. There was a distinct tendency to increase in the numbers of resectable cases. By region, cases of cancers in sigmoid colon and upper third of rectum (S+Rs) and right side colon (C+A) were on the rise.
2. The ratio of patients aged over 70 years increased to reach 36 % recently. But the ratio of early stage cancer cases was 7.1 % on the average.
3. The over all resection rate was 90.6 %, and curative resection was performed in 78.5 % of colon cancer cases and 82.0 % of rectal cancer cases respectively.
4. The cumulative 10-year survival rate in curative resected cases was 74.7 % for colon cancer and 70.8 % for rectal cancer.
5. The rate of multiple cancer cases was as high as 13.4 %.

As of April 2005, “Shihango-rinsyoushiken” defined in the GPMSP was renamed “Seizouhanbaigo-rinsyoushiken” in the revised regulations (GPSP). The relevant part of the GCP was also modified at the same time. Strictly speaking, therefore, post-approval clinical trials are not the same as postmarketing clinical trials. This report provides an explanation of post-approval clinical trials and the related regulations. It is generally considered that post-approval clinical trials, which help gather more clinical information, should be actively pursued for the further development of approved drugs in the post-marketing setting. However, the results of the questionnaire show that pharmaceutical companies are not willing to conduct them, mainly due to the high cost. To improve the economic efficiency of post-approval clinical trials, it is necessary to streamline monitoring activities that account for 40% of the cost.

SPs have made a dramatic development in medical education over 10 years, due to the influence of medical education curriculum reform and the introduction of the Objective Structured Clinical Examination. However the quality of SPs' activities varies. In order to increase the quality it is necessary to analyze the psychological needs of SPs. The purpose of this survey is to explore SPs' personal characteristics and how they feel during their activities.
1) In a nationwide survey of Japanese SPs, 332 SPs (62%) out of 532 responded.
2) Sixty percent of SPs were between the ages of 50 and 69 years and the ratio of male to female SPs was 1: 4. The ratio of workers and non-workers was 1: 2.
3) A qualitative analysis found that SP motivations were derived mainly from making a contribution to society and self-improvement. Ninety six percent of SPs were satisfied with being an SP, especially when they saw improvements in the students.
4) However, 67% of SPs expressed difficulty with the three core skills of feedback, evaluation and performance.

The role of standardized patients (SPs) has developed rapidly over the last10years because of medical education curriculum reform and the introduction of the objective structured clinical examination (OSCE). As the participation of SPs in medical education has increased, the anxieties and frustrations of SPs have also increased. We believe that an understanding of the attitudes of SPs would improve the quality of their activities. The purpose of this survey was to study the activities and psychological needs of Japanese SPs in the OSCE.
1) The response rate to the nationwide survey was62% (332of532SPs).
2) Role-playing and group discussion were the most common training methods, and the length of training varied from 0 to 40 hours.
3) The factors that SPs felt difficult were judging how much to respond in their performances (73%) and maintaining consistent standards in evaluating examinees (66%).
4) Our results suggest that SPs require more training and that the number of SP educators should be increased.

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.

Introduction: Consultation simulation with simulated patients has rarely been done as a training program.
Method: Fifth-year medical students in 2 neighboring universities attended the same training program at each site. The students’ performance was evaluated.
Result: Most medical students thought that this training program was valuable and that they require more opportunity to practice. Students evaluated their own performance in both medical procedures and differential diagnosis as being poor. However, about 50% of students felt that they paid careful attention to the simulated patient during physical examination. Students thought that the consultation was extremely realistic and that the series of medical procedures they performed at the first attempt was extremely difficult but increased their motivation. They thought that the feedback they received from simulated patients was beneficial.
Discussion: This education program is highly regarded by students and is suggested to be versatile.

Objectives: To investigate future directions of medical interview and physical examination practice (MIPEP) with simulated patients and to clarify its educational meaning for medical students. Design: Qualitative design using 8 focus groups before and after MIPEP with simulated patients (4 pre-MIPEP and 4 post-MIPEP). Methods: Nine simulated patients and 10 medical students participated. Four physicians served as facilitators. Each student practiced consultation, including two medical interviews and physical examinations (of one male and one female simulated patient), for 15 minutes. After every consultation, students had a 15-minute feedback session with a simulated patient and a facilitator. All simulated patients and students participated in both the pre-MIPEP and post-MIPEP focus groups. Results: Through pre-MIPEP and post-MIPEP focus groups, medical students realized that an appropriate disposition and talking with patients during physical examination are helpful. MIPEP with simulated patients helps students to gain confidence before clinical practice. Simulated patients found that the value of MIPEP with simulated patients for medical students was increased by thorough course preparation and by the simulated patient's training and motivation, which was affected by the students' attitudes to MIPEP with simulated patients. Conclusion: MIPEP with simulated patients is valuable for teaching the appropriate disposition towards patients, including making physical contact and talking with patients as fellow human beings. When the students' attitudes satisfy the simulated patients, MIPEP with simulated patients can become a powerful educational method.