1) Since the 2006 academic year, we have developed a 13-hour course in professionalism for fifth-year medical students at Sapporo Medical University.
2) The course included lectures and small-group discussions on the concept of medical professionalism, the definition of medical professionalism, clinical ethics, legal understanding, and the crisis of community medicine. At the end of the course, the students created their own student physician charter and recited it at the student physician charter ceremony.
3) Seventy-four percent of students evaluated the course positively, 18% pointed out positive and negative aspects of the course, and 8% evaluated the course negatively.

The selection of a primary care career by Japanese medical students is said to be increasing however there are no studies to support this belief.In order to fully understand the alleged increase in the number of medical students choosing primary care we believed that an examination of the factors influencing medical students' decision-making would be helpful.
1) We distributed questionnaires to two hundred ninety eight medical students in 2004 who would graduate in four months from three Japanese medical universities.
2) Questionnaires included demographic factors, career choice, important career choice factors, interest in community medicine, willingness to engage in community medicine, thinking community medicine is useful, and satisfaction with curricula.
3) There were significant associations between a primary care choice and social experience, lifestyle preference, interest in community medicine, willingness to engage in community medicine, and contact with primary care faculty.
4) Using a logistic regression model, lifestyle preference, male gender, social experience before entrance to a medical university and contact with primary care faculty were four significant factors.
5) It might be important to consider those factors in addition to curriculum reform to increase primary care career choice among Japanese medical students.

Although simulated patients (SPs) has become indispensable for the development of medical students' communication skills, few studies have analyzed the effects of SPs on medical students. In particular, no studies have examined the effect of the feedback that medical students receive from SPs during communication training sessions.
1) We invited students to complete a questionnaire and participate in a group interview; the responses and opinions obtained were then analyzed both quantitatively and qualitatively by two independent analysts.
2) Sixty-four percent of students were satisfied with SPs' feedback, whereas 28% of students preferred toreceive negative feedback as a way to improve their skills.
3) Some students criticized SPs' feedback and SPs themselves.
4) The SPs' feedback should focus more on the negative aspects of students' performances, and faculty members should provide a safe and secure educational environment for both students and SPs.

Recent changes in the relationship between physicians and society has affected the values and ethics of physicians, and a“Physician Charter”on medical professionalism has been drafted by the American Board of Internal Medicine Foundation, the American College of Physicians-American Society of Internal Medicine Foundation, and the European Federation of Internal Medicine.We conducted this survey to determine whether the“Physician Charter”can be used to examine the medical professionalism of Japanese physicians.
1) A questionnaire to examine the perceptions of physicians in Japan and the United States of the responsibilities of the “Physician Charter” was distributed.
2) In both countries 30% of physicians understood the contents of the “Physician Charter, ”and 60% believed the charter should be used in every country.
3) The physicians in the United States tended to consider most responsibilities more urgent than did Japanese physicians, and the perceptions of several responsibilities differed between physicians in the two countries.A generation gap among Japanese physicians was observed for some responsibilities.

This study used group interviews and questionnaires with first year medical students to determine: 1) their motivation for entering a medical school; 2) their self-image as future physicians; and, 3) the factors that have influenced these. Our study revealed that medical students' motivation for entering medical school and their self-image as future physicians were influenced by their personal medical experiences, family members who worked in medicine, and medical issues presented in the mass media. We believe that gaining an understanding of changes in students' self-image as future physicians and the factors influencing these changes can be important in the development of effective medical education curriculum, as we face change and upheaval in both medical knowledge and practice.

Objective: To identify the usefulness of critical-incident reports for reflective learning and for classifying the types of experiences that medical students regarded most memorable during clinical clerkship at general medical ward and clinic.
Design: Descriptive qualitative study using the critical-incident technique.
Setting: General medical ward and clinic of a university hospital.
Participants: Fifth-year medical students that took part in the clinical care of patients during the clerkship from October 1, 1996 to September 31, 1997.
Measurements and Main Results: Ninety-five reports were collected over one year and subjected to the analysis. Reports were classified for seven major themes, with a mean of 1.85 themes per narrative. As for the distribution of themes, 68 reports (72%) dealt with biomedical topics, 45 (47%) with communication with patients and families, 26 (27%) with personal feelings, 19 (20%) with the physician's role, 11 (12%) with ethics, 7 (7%) with psychosocial subjects, and 1 (1%) with recognition of alternative medicine. Reports from men and women contained a similar mean number (men 1.82; women 2.09) and distribution of themes.
Conclusions: Medical students have divergent meaningful experiences on non-biomedical themes as well as biomedical issues during their general medicine rotation.

Community medicine clerkships are said to be an important element of current undergraduate medical education. However, little is known about what medical students actually learn from them.Therefore, we performed a study by means of significant event analysis to examine what medical students had learned from 2-week community medicine clerkships.
1) Students in 2006 took part in 2-week community medicine clerkships and then in sessions at the end of their clerkships to review their experiences.
2) The review sessions were recorded, and the students'impressions were extracted and categorized.
3) The depth of their impressions was categorized into 4 depth levels (describing, commenting, generalizing, and planning).
4) Students gave their impressions of the medical system, the role of physicians, patient-centered care, role models, and clinical ethics, and the impressions of most students were at the levels of commenting and generalizing.
5) Medical students learned system-based practice and medical professionalism during their community medicine clerkships, and significant event analysis was a valuable tool for understanding their experiences.

OBJECTIVE: (1) To estimate the prevalence of atrial fibrillation (Af) in the general population of Saitama Prefecture, (2) to identify useful information obtained from subjects' history and laboratory findings for predicting imminent occurrence of Af.
DESIGN: Cross sectional study and retrospective cohort study.
SETTING: Annual health examination of the general population.
PARTICIPANTS: Subjects were 5, 375 men and 8, 419 women with a mean age±standard deviation of 47.2±9.6 and an age range of 18 to 88 years old.
MEASUREMENTS AND MAIN RESULTS: Among the 13, 794 participants who underwent conventional 12-lead electrocardiography (ECG) every year from 1994 to 1997, the prevalence of Af was 0.3%. The cross sectional data showed significant differences between male subjects with and without Af regarding age (P<0.0001), current treatment for hypertension (P<0.0001), arrhythmia (P<0.0001), angina pectoris (P<0.05), history of myocardial infarction (P<0.05), perception of palpitation (P<0.0001), perception of irregular pulse (P<0.0001), shortness of breath (P<0.0001), diastolic blood pressure (P<0.05), total cholesterol (P<0.0001), and casual glucose level (P<0.05) . Significant differences were also found between female subjects with and without Af with respect to creatinine (P<0.0001), current treatment of arrhythmia (P<0.0001), perception of palpitation (P<0.0001), perception of irregular pulse (P<0.0001), and HbAlc level (P<0.05) .
The retrospective cohort data identified 22 subjects who had persistent Af during the study period, and 20 (0.15%) who had newly developed Af during this period on the basis of consecutive ECG recordings of the 13, 772 participants in 1994-1996. Logistic regression analysis revealed that there were significant differences in perception of irregular pulse (P=0.0004), history of myocardial infarction (P=0.0134), fatigability (P=0.0243), aging (P=0.0039) and total cholesterol level (P=0.025) for men, and in history of arrhythmia (P=0.0007) for women between the group with and without Af.
The likelihood ratios and the respective 95% confidence intervals (C.I.) for ECG findings to identify the subjects who would develop Af were as follows: ST depression, 14.6 (C.I., 5.1-42) ; ventricular arrhythmia, 14.9 (3.9-56) ; incomplete RBBB, 9.2 (2.4-34) ; supraventricular arrhythmia, 8.9 (1.3-61) ; second-degree atrioventricular block, 342 (32-3624) ; abnormal Q wave, 16.3 (2.4-112) ; left atrial enlargement, 52.7 (7.2-383) .
CONCLUSIONS: Combining data from subjects' histories for the prediction of imminent Af among subjects in the general population is likely to be useful, especially for the elderly male population. Aging in men, in particular, is an important factor when combined with abnormal findings on conventional 12-lead ECG.

A 31-year-old Japanese female came to our outpatient clinic because of a 15-year history of recurrent episodic chest pain accompanied by fever, each lasting for three days. The patient was diagnosed with familial Mediterranean fever (FMF) because of the following: 1) short attacks of fever recurring at varying intervals; 2) pleuritic chest pain accompanied by fever; 3) the patient's sisters had similar episodes of fever accompanied by abdominal or chest pain; and 4) absence of any other causative factors responsible for her symptoms or pathologic findings. Although FMF has been described primarily in several limited ethnic groups, only a few cases have been reported in Japan. No diagnostic tests are commercially available for FMF so identifying the characteristic clinical picture of FMF is important.

Introduction
This study aims to clarify how patients and local residents regard physicians and medical care in light of the ongoing nationwide tendency of internists to unexpectedly abandon their posts in local community hospitals.
Methods
The subjects of this study were citizens who chose to continue visiting a community hospital in X City after some of its internists recently left their posts in order to return to their previous hospitals. A questionnaire survey was conducted by focus-group interviews of two patient groups.
Results
Three hundred and ninety-nine responses were judged valid. The causative factors cited by the respondents for the internists’ abandonment of their jobs were: the college or university system (81%), the national institutions (79%), and the nation’ s hospital system (72%). Eighty-eight percent of the respondents observed that internists had done the best they could, while 88% pointed out that internists could not avoid changing their workplaces, 96% wanted internists to exert their utmost efforts for their patients, and 85% found internists trustworthy.
Conclusions
Patients affected by internists' job changes were actually inconvenienced by these, and considered it a matter of course that the results should have meant some loss of freedom for themselves. Moreover, it was suggested that that the physicians had lost their trust in the medical organizations, and the patients were left with very mixed emotions about the physicians. Many patients considered that the practice of medicine is a vocation, and, even though they experienced the physicians' withdrawals from their posts, they still expected a humane attitude in the doctors and communication with them, and they trusted them. However, there were some patients who regarded medicine as a service industry, so that it was suggested that there may be a change in the nature of the trust that patients have in doctors.