Early clinical exposure has been implemented worldwide as an effective method of medical education. The duration of early clinical exposure is 1 year in some universities in Western countries. In Japan, however, early clinical exposure occurs most often through health and welfare services, and its duration varies. One-year early clinical exposure and reflection upon it were implemented for first-year students at Mie University School of Medicine in 2006 to motivate them and to teach them about professionalism. The effectiveness of this program was evaluated with a questionnaire, a daily log, and a portfolio.1) The questionnaire survey revealed that students considered the program extremely valuable. They had learned much about communication skills, the relationship between medicine and society, patients' families, and professionalism.2) An analysis of the daily logs clearly showed that students were unsure and hesitant at the start of the program. However, they gradually became accustomed to participating in this program and began to learn earnestly.3) Qualitative analysis of the portfolios revealed that students considered 10 items important in the practice of medicine, including communication skills, responsibility, the value of being a physician, professionalism, and the motivation to study medicine.4) In their final reports, the students described the expected behaviors of physicians they should seek to perform, by learning medical ethics or through professionalism.5) In conclusion, 1-year early clinical exposure is a more effective method than short-term or intermittent exposure for medical students because of its uniqueness and the maintenance of motivation.

1) By participating in the white coat ceremony, 60% percent of students felt that they had been accepted as fledgling medical professionals and become members of the medical community, and 86% began to think that they must take care of patients sincerely in the near future.2) The white coat ceremony made students aware that they would become physicians and gave them an opportunity to renew their enthusiasm for starting clinical clerkships. The distance between students and teachers was reduced.3) We will continue to hold the white coat ceremony, because it is an effective way of teaching professionalism to students.

The quality of medical education should be improved so that a physician's entire personality is nurtured. To this end, applying teaching methods from overseas educational institutions at Japanese medical schools would be beneficial. A discussion class taught at the University of Iowa is designed to increase the efficiency and consistency of interactive education. Numerous techniques for teaching discussion introduced at the University of Iowa might help improve the problembased learning methods now commonly used at Japanese medical schools. Moreover, the University of Iowa's method for teaching communication skills, which emphasizes interaction between instructors and students, can provide a model for medical students to acquire essential skills. Therefore, examining the comprehensive teaching system at the University of Iowa will help medical schools fulfill their expected social mission.

OBJECTIVE: This is the first research known to compare residents' attitudes about training in two countries. The objective was to examine and compare Japanese and US family medicine residents' attitudes about their residency training.
METHODS: A cross-sectional survey was conducted at two Japanese sites and one US site in 1991, and repeated in 1995 at these sites, as well as two additional US sites. Family practice residents completed a self administered, Likert scale format questionnaire containing items on demographics, identity as a family physician, resident education, the doctor-patient relationship, personal life, economic and women's issues.
RESULTS: The response rates were Japan, 1991: 92% (12/13) ; US, 1991: 76% (13/17) ; Japan, 1995: 89% (34/38) ; and US, 1995: 91% (60/66) . Fewer Japanese residents reported feeling like an outsider, or discriminated against while on outside rotations. More US residents reported expectations for training were being met, and being satisfied with their education. More Japanese residents reported that outpatient training was inadequate. US residents responded more positively about the rewards of clinical decision making, patient management and the doctor-patient relationship. Japanese residents were less likely to report training as compromising their physical or mental health, or feeling overworked. Financial concerns were similar for both groups. Most female residents reported feeling that being a woman provider was an advantage.
CONCLUSIONS: Some aspects of family medicine training are transculturally similar, while others are influenced by the medical culture of the respective countries. Family medicine residents' perspectives on training may be valuable to educators planning curriculum development.

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 is the report of the 1st Workshop on Basic Clinical Competence Education held on November 22-24, 1996, in Tokyo. Twenty eight medical teachers from 28 medical schools in Japan participated in the workshop. The many aspects of clinical skills education were discussed ; Goals, teaching strategy and evaluation of clinical skills, Teaching methods of medical interviewing and physical examination, Training methods of standardized patients, and Organizing OSCE. Post-workshop questionnaire revealed a great satisfaction among participants. Many participants expressed the need to have this kind of workshop on a regular basis.

We evaluated basic surgical skills in students using the Objective Structured Clinical Examination (OSCE). The study was conducted on 101 sixth-grade medical students (67 males, 34 females) at Kawasaki Medical School in 1993. Theme A (tying of a silk suture) was given to 44 students, and theme B (tying of nylon suture using surgical instruments) was given to 57 students. The following items were evaluated (1) handling of surgical instruments, (2) suturing, (3) knot tying, and (4) suture removal. The average score for theme B was slightly lower than that for theme A. The average score for knot tying was lower than scores for the other items. Thus, it was revealed that all students were not good at tying knots. These scores for minor surgery correlated with the scores for other skills as evaluated by the OSCE. In conclusion, the OSCE appears to be an appropriate method for evaluating basic surgical skills.

We evaluated the interview skills of 46 sixth year medical students (32 men, 14 women) in our outpatient clinic. Six items were evaluated, including the manner in which students responded to patients, the number of times students interrupted patients' statements with closed-ended questions, and the extent to which students maintained eye contact with patients. We found that students interrupted patients every 46.2 seconds on average, and often did not make eye contact with tha patients. It became clear that, although we teach medical interview skills to students, students do not learn these skills very well. We suggest that in order to properly educate medical students, close cooperation between departments is needed.