Medical education had begun in the 1970s as a pedagogical science and art by the establishment of the Japan Society for Medical Education and its activity thereafter. WHO had played an important role in the backbone of the Society by introducing a new concept of medical teacher training as the shortest way in order to realize "Health for All by the Year of 2000". In 1973 the founder and first president Prof. Ushiba attended the WHO Workshop for Deans held in Sydney and was influenced with a shockingly effective experience.
The WHO's principle of teacher training (faculty development) came from pedagogy professor Bloom's theory of the taxonomy of educational objectives, strategy and evaluation and its practice.
After 40 years since then, the theory and practice of higher education have changed and improved. Of course, medical education is not an exception of higher education. Therefore, we apply its progress in medical education and it does the same each other. They say ten years make an age–old epoch; therefore accordingly, 40 years are four times.
A life expectancy of the theory of medical education will be 40 years. Now we have to reform medical education by change of our mind and by introducing new theory and practice.
Problems facing medical education such as shortage of physicians and medical and health care expenditure, national policy, education of physician scientists and successor medical educators are also discussed.

Forty Years AgoAugust,1969 in the prime of the nation-wide university strife, the Japan Society for Medical Education was founded within the Association of Japanese Medical Colleges in order to improve medical education through a long-ranged research-based activity and became an independent organization later.Achievements AfterwardOnly 62 members at the beginning have increased year after year to 2,000 and 230 organization members, including all 80 medical schools, in response to the societal summons. The Society's activities have ranged widely from the undergraduate medical education, begun at the student selection, the graduate education to the continuing education of the health professionals with and through evidence-based research.Some of the real activities during the past forty years have been as follows: (1)Various committees and working groups have worked continuously toward momentarily crucial issues facing medical education, (2)The scientific meetings have been held annually at the medical schools or teaching hospitals for forty years as well as conferences and workshops occasionally, (3)The official journal "Medical Education (Japan)" has been published bimonthly and the educational books as well, (4)Promotion and cooperation of "faculty development" have been one of the most important tasks, (5)Assistance to build the medical education centers in medical schools and hospitals and (6)many others.Future ProspectivesThe Japan Society for Medical Education will continue every activity for the people's health and welfare as an organization of "noblesse oblige".

1) Common training for the introduction of research and the elective and individual guidance for research should be devised in a manner attractive to graduate students of medicine.
2) To train researchers, a graduate school of clinical medicine should be established as a professional school, separate from an ordinary graduate school.
3) To promote basic medical sciences, the capacity of graduate schools of basic medical sciences should be reduced despite the number of teachers and the bold plan for the financial support of students.

Referencing to one hundred and thirty years history of the modernized medical education in Japan, the author analyzed the stream of its renovation by classified it into four phases according to an old Chinese proverb, “They who want to know what shall be must consider what have been.” The change during sixty years after the World War II (the second phase) had been much more remarkable than that of seventy years before the War (the first phase). The unified medical education at all the new-system universities in the second phase had been diversified multidirectionally at many newlyestablished medical schools in order to meet the nation-wide demand to increase the number of young able physicians who became impulsive power group to innovate the traditional conservative medical society. The third phase had begun in 1991 when the university chartering standards law was liberalized vastly and every medical school could compose its curriculum more freely depending on its and student's demands like as order-made programs. Recent ten years, the fourth phase, are continuing up to today becoming the structure reform of medical education more remarkable and the education curricula core-oriented toward tomorrow's physician training. Now time has changed, “They who want to know what shall be must consider what will be.”

To analyse the present condition and to survey Japanese medical graduate schools (Master's course), questionnaires were sent to all six universities in 1999. All the universities have the aim of, education of medical basic researchers, in common. This aim has high social needs. Four of the six universities also have the aim of, education of high grade specialists in the medical field. The number of applicants has increased for some national and public universities. For other universities, more public relations are necessary to increase the number of applicants. The social situation has altered, and finding employment has became difficult after completion of the course. It is therefore necessary to open new courses to match social needs. Buildings and equipment are not enough at present. As a result, a course for Master of Public Health will be established at Kyoto University.

The clinical competence needed by every beginning resident and the present status of such competencewere examined in August 1998 through questionnaires distributed to clinical educators and the nursing staff of university hospitals and clinical training hospitals designated by the Ministry of Health and Welfare. Completed questionnaires were returned by 576 (65.9%) of clinical educators and nursing staff. With a cluster analysis of the necessity and the present status of clinical competence, 21 items for clinical competence were identified as those most requiring evaluation by the national examination. These 21 items included 11 items for clinical competence in the cognitive domain, 8 items in the psychomotor domain, and 2 in the affective domain. In about half of the direct answers obtained from clinical educators, evaluations were considered necessary for 15 items of clinical competence, of which 13 belonged to the cognitive domain. These results were consistent with the present status. However, practical examinations have also attracted increasing attention, as the results included strong demands that the national examination evaluate some basic clinical skills, such as physical examination and measurement of vital signs. However, about 30 % of authorities governing the national examination thought no changes are needed in the national examination.

This lecture is based on my own experience in medical education at the new University of Tsukuba and Hospitals and also on the activities of the Japan Society for Medical Education. The former(U.T.) has only 25 year history and the latter(J.S.M.E.) has 30 year history both since establishment. Because both are younger than the traditional medical schools and the common medical community of Japan, my idea and opinion will be beyond the average of our country.
Education* ; Education, Medical* ; Japan ; Schools, Medical

The chair system was introduced into the Japanese universities from Germany more than 100 years ago in the Meiji era. Since then, it made very little change and was preserved like antiquities in the medical schools.
During the past 100 years, there had been two opportunities to change it: first in the early 1970s at the time when new medical schools had been established all over Japan and second in 1991 at the time of change of the university chartering standards law which was conducted by the Japanese Ministry of Education toward a liberalization of the past law in order to let the universities match to the change of society and to the progress of art and science.
Although since the latter opportunity some change was observed mainly at graduate schools of the limited high-ranked universities, most of medical schools have neither changed their traditional chair system nor reformed their schools in spite of the ensured liberalization.
In this paper, why reorganization of chair system is necessary, how it can be done and also why and how redistribution of faculty members is crucial and can be performed are explained by citing an example at the University of Tsukuba which has experienced during the past two and half decades from the beginning of its establishment in 1973.

We used questionnaires to study the present status of undergraduate clinical training at medical schools in Japan in February 1996. Completed questionnaires were returned by 81%(65) of 80 medical schools and approximately 54%(1, 328 clinical departments) of the schools. The results were as follows. Courses for early clinical exposure in the 1st or 2nd year were provided at 83% of the 65 schools; clinical clerkships in the 5th and 6th years were provided at 28%. Specific behavioral objectives for clinical training were clearly shown to students and teaching staff at 75% of schools. Clinical procedures that medical students were permitted to perform were listed and announced to students and teaching staffs at 66% of schools. Patients were informed and gave consent for clinical training of students at 77% of schools. Essential knowledge and skills of students were assessed before the start of clinical training at 40% of schools, and summative assessment was made at the end of the training at 72%. Training of clinical teaching staff for faculty development was conducted at 51% of schools. Eightynine percent of schools reported a shortage of clinical teaching staff. Similar results were obtained in the survey of clinical departments of university hospitals: most departments complained of a shortage of teaching staff, of students not being active, and of students not being competent to enter clinical training courses. To improve clinical training, the introduction of clinical clerkships and cooperation with community facilities outside universities were the main issues.