Recently, objective structured clinical examinations (OSCEs) have been used to assess the clinical skills of medical trainees. We introduced an OSCE station for heart disease to assess clinical competence at the completion of bedside learning. The station involved students performing a 15-minute focused interview and physical examination of a simulated patient with mitral regurgitation and congestive heart failure. The physical examination included listening to a tape recording of a heart murmur. Each student was evaluated by three examiners. The average scores for the interview and physical examination were 22.3±4.0 points (perfect score, 34 points) and 15.2±2.9 points (perfect score, 22 points), respectively. Kappa statistics, which evaluate variability among examiners, revealed moderate to substantial agreement in the results for both the interview and the physical examination. This study suggests that our OSCE station is useful for assessing clinical competence at the end of bedside learning.

The committee of continuing medical education in Japan Society for Medical Education discussed on PRA of American Medical Association [AMA]. We have first analyzed the brochure of PRA for the members of AMA, and then prepared the questionnaire for AMA. We were able to obtained the answers to the questionnaire which were sent to AMA through courtesy of Japanese Medical Association (JMA). It was realized that AMA emphasizes an importance of PRA for medical practice to the patients; nevertheless acquisition rate of PRA is actually low, and so AMA proceeds with efforts towards completion of PRA.

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.

Continuing medical education for the general practitioners has been activery performed. The former committee for continuing medical education of the Japan Society for Medical Education reported the objectives of continuing medical education for general practitioners. The present committee proposed learning strategies for continuing medical education for general practitioners in accordance with specific behavioral objectives of the curriculum.
It was postulated that appropriate learning strategies are necessary for physicians to provide holistic medical care in their communities, in addition to improving their medical knowledge and skills.
Learning strategies in the curriculum were also coordinated with the continuing medical education system of the Japan Medical Association.

The aim of this study is to clarify the definition and recognition on continuing medical education for administrators (or leaders for residents) of 80 university hospitals and 266 clinical training hospitals as designated by the Ministry of Health and Welfare, using the questionaire consited of 5 main questions, as following:
1) On the curriculum (program) of continuing medical education in their hospitals.
2) On the continuing medical education system of Japan Medical Association.
3) On the continuing medical education activity of the specified academic societies.
4) On guide of continuing medical education for the residents.
5) On definition of continuing medical education.
Answers to a questionaire were returned from 227 institutions (65.6%)
Analyzing the results, present situation of program curricula for continuing medical education in hospitals, participation to continuing medical education system of Japan Medical Association and Academic Societies, and consideration on continuing medical education as a hospital leader were comprehensible.

The aim of this study is to report and analyze the results of a questionnaire concerning the present programs for the junior residents in the postgraduate clinical course in Japan.
A questionnaire was sent to the administrators or the persons in charge of the programs of 347 institutions including 80 university hospitals and 267 clinical training hospitalsas designated by the Ministry of Health and Welfare.
Answers to a questionnaire were returned by 271 institutions (78.1%). The results were analyzed and summarized as follows.
(1) About 95% of both university and clinical training hospitals have their own programs at present.
(2) In the substantial formula of programs, university hospitals have had straight or rotation form while the clinical hospitals have selected rotation or super rotate (comprehensive) form.
(3) The programs of university hospitals have started in majority before 1992 while those of clinical hospitals have began after 1993.
(4) The programs of university hospitals have contained the clinical training at the other departments or institutions in a significantly higher ratio compared to those of clinical hospitals.
(5) The check system for the evaluation of the programs has well functioned in half of both hospitals.
(6) For the assessment of the programs used, about half of the staffs of both university and clinical hospitals feel unsatisfactorily in their active programs.
(7) Concerning the intention to renewal or modification of their programs used, there were rather passive agreements in both university and clinical hospitals.

We evaluated our undergraduate clinical clerkship system in 1992, using the multiplication method advocated by the Working Group on “Evaluation of clinical skills of medical students ” of the Japan Society for Medical Education. We divided the clinical training period into three terms: the first term was held from May through June, the second from September through October, and the third from December through January. We determined scores using checklists and rating scales in ten categories, totalled the scores for each period, and compared them between periods. The total scores for the third period were the highest, followed by those for the second period. Scores for basic knowledge, data gathering, and basic technical procedures increased with increase in the number of training hours. However, scores for manner, attitude, and interviewing skills were already high in the first period. We conclude that the multiplication method is useful for objectively evaluating students' clinical skills.

Discussions on the postgraduate medical school and the speciality training course after graduation had been conducted 2 times in 1994 among the members of the working group on postgraduate medical school and speciality training in Japanese Society for Medical Education. Results of the discussion are reported in this paper as a proposal for the improvement of the present state of education and training in the postgraduate medical schools in our country. In this report, several important proposals which need further discussions such as the shortening the clinical course in postgraduate medical school to 3 years from present 4 years and necessity of establishing the obligatory course for training the basic technology for life science research are presented. It is mandatory to have full time teaching staff as well as exclusive space for postgraduate course in each school to improve the of education of postgraduate medical schools.