In Kochi Medical School the use of Computer-Assisted Instruction (CAI) has been discussed as a method to improve clinical education. In order to learn from the experiences of American medical schools that are actively using CAI, the activities of five medical schools and two medical education associations the Association of American Medical Colleges (AAMC) and the National Board of Medical Examiners (NBME) were observed in order to investigate new approaches in medical education and the use of computers in medical education. It was found that the teaching of problem-solving has been gradually introduced, with the effective use of computers in doing so. CAI systems are mainly used in the basic medical curriculum and for individual self-learning. There are currently plans to use clinical case simulations as educational materials in Problem-Based Learning and as part of the licensing examination for medical doctors conducted by the NBME. Therefore, computers will also be actively used in clinical education in the near future.

The curriculum of the Duke University School of Medicine is unique and innovative because it starts clinical clerkships in the 2nd year and has introduced research fellowships in the 3rd year. New external pressures require innovations. The innovations of the Duke curriculum are as follows: greater integration of clinical and basic-science education, continuous early clinical exposure in clinics and hospitals, a stronger structure for clinical educational programs, monitoring of each student's performance and of the effectiveness of programs, and extensive program evaluation by surveying directors of graduates.

To understand how often and how well medical and nursing students use information and data on the Internet for selflearning, we conducted a survey of students in the first through fourth years at Kochi Medical School. To allow comparison we also conducted a small survey of medical students at Maastricht University. These surveys indicated several problems in the use of the Internet by students at Kochi Medical School.

The abundant computer-based materials for medical education developed in Europe and North America have found limited use in Japan. To remedy this situation, the usefulness of such educational materials for Japanese students should be clearly presented, because issues of language and cost are involved. For detailed evaluation of educational material, collaboration with the developing institution is necessary. Kochi Medical School participated in an international collaborative study proposed by the University of British Columbia to evaluate computer-based educational materials. The study evaluated computer-based educational materials for clinical-skills training (CyberPatient) developed at the University of British Columbia. Fourteen medical educational institutions from six countries participated in the study. Kochi Medical School's portion of the study was successfully performed in December 2001. However, we found four problems related to this collaborative study: dealing with foreign languages in educational materials, establishing rapid communication, flexibly coping with sudden changes in study design, and guaranteeing the coherence of the study design among collaborating institutions.

Objectives: This study analyzed the effects of computerization of medical information systems and a hospital payment scheme on medical care outcomes. Specifically, we examined the effects of Electronic Medical Records (EMRs) and a diagnosis procedure combination/per-diem payment scheme (DPC/PDPS) on the average length of hospital stay (ALOS). Methods: Post-intervention changes in the monthly ALOS were measured using an interrupted time-series analysis. Results: The level changes observed in the monthly ALOS immediately post-DPC/PDPS were –1.942 (95% confidence interval [CI], –2.856 to –1.028), –1.885 (95% CI, –3.176 to –0.593), –1.581 (95% CI, –3.081 to –0.082) and –2.461 (95% CI, –3.817 to 1.105) days in all ages, <50, 50–64, and ≥65 years, respectively. During the post-DPC/PDPS period, trends of 0.107 (95% CI, 0.069 to 0.144), 0.048 (95% CI, –0.006 to 0.101), 0.183 (95% CI, 0.122 to 0.245) and 0.110 (95% CI, 0.054 to 0.167) days/month, respectively, were observed. During the post-EMR period, trends of –0.053 (95% CI, –0.080 to –0.027), –0.093 (95% CI, –0.135 to –0.052), and –0.049 (95% CI, –0.087 to –0.012) days/month were seen for all ages, 50–64 and ≥65 years, respectively. Conclusions The increasing post-DPC/PDPS trends offset the decline in ALOS observed immediately post-DPC/PDPS, and the observed ALOS was longer than the counterfactual at the end of the DPC/PDPS study periods. Conversely, due to the downward trend seen after EMR introduction, the actual ALOS at the end of the EMR study period was shorter than the counterfactual, suggesting that EMRs might be more effective than the DPC/PDPS in sustainably reducing the LOS.