In November 2014, a symposium was held by the Japan Society of Medical Education on the theme of the National Medical Licensing Examination. To improve the National Medical Licensing Examination, the post clinical clerkship OSCE was officially implemented from FY2020. Its introduction into the National Medical Licensing Examination will be discussed in the future based on the status of its implementation. The competencies to be assessed are clinical capabilities that can be performed on patients under the “guidance of a supervising physician,” and are suitable for evaluation in the clinical setting where the supervising physician directly observes and evaluates students’ medical practices. In comparison with the OSCE, which evaluates simulated clinical practice, the introduction of the post clinical clerkship OSCE into the National Medical Licensing Examination was discussed.

In the past, pre-graduate medical education and clinical training have not been sufficiently discussed and consistent training of physicians has not been carried out because the entities that implement the studies are different. In order to realize high quality pre-graduate education and post-graduate clinical training, and to promote seamless training of physicians, it is necessary to establish a system of medical education. It is also necessary to consider the outcomes of pre-graduate medical education and clinical training to maintain consistency in the review of clinical training system for physicians in 2020. This paper discusses the Model Core Curriculum for Medical Education and clinical training from the perspective of outcome-based education for consistent physician training.

Educational reforms are required to achieve the "learning outcomes" expected in bachelor degree education programs. In executing reform, three policies of "diploma policy" , "curriculum policy" , and "admission policy" are clearly stated for each institution in order to facilitate integrated operation and practice. For the sake of quality assurance, outcome-based education (OBE), which emphasizes "learning outcomes" , has been introduced to medical education but it has not been adopted by all learning institutions. With the implementation of field-specific evaluations for medical education comes a need for all medical departments and medical colleges to introduce OBE as soon as possible. For this reason, an examination was conducted to find out how to formulate and operate the three policies under OBE.

　As medical safety attracts attention, it has become increasingly important to ensure the quality of medical education, and more emphasis has been placed on educational outcomes. An ideal form of training, in which medical students undergo medical education and then transfer to residency training seamlessly, can be conducted by setting general competencies required for all physicians as educational outcomes, as well as setting milestones in the process. Accomplishing competencies is the pillar of outcome-based education, and the assessment of students' achievements is important.
　The multilateral assessments of their competencies should be conducted, including written examinations, performance tests, observational assessments, and portfolios. In the existing national examination for medical practitioners, no such multilateral assessments are conducted. To promote seamless transition from under- to post-graduate education, it is important for the Faculty of Medicine and medical colleges to appropriately assess students' educational milestones as a condition of awarding them with degrees, in addition to the setting general competencies and such milestones.

　The Japanese Medical Specialty Board has been established with the collaboration of medical and medical care organizations. It ensures the quality of medical specialists and achieves accountability to the people by certifying medical specialists and authorizing training programs. Outcome-based education is characterized by an emphasis on the quality assurance of trained physicians. Therefore, the new medical specialty training system could be constructed through outcome-based education. I give a brief overview of the new medical specialty training system, and it is discussed in the context of the guideline for medical specialty training system published recently.

1)We applied a spiral curriculum devised by Harden to plan a sequential curriculum in outcome–based medical education at the Chiba University School of Medicine.
2)To plan a sequential curriculum, Miller's pyramid was applied to create a model for developing the competencies of physicians.
3)Competence levels based on the developmental model were used to plan learning objectives for each unit, and students and teachers were encouraged to understand the relevance of each lesson to competencies.

Technical skills have traditionally been taught by "learning by doing". This teaching method is mainly associated with potential risks for patients. Teaching technical skills using simulators has emerged in recent years but their effectiveness has not been adequately tested. The objective of this study was to examine the effectiveness of a central venous catheterization (CVC) training program using a simulator.1) Twenty residents were randomized to either receive a training program using a simulator on CVC (simulator group, n=10) or not (non-simulator group, n=10). They were evaluated for their technical competence in performing CVC on patients and their personal concerns about their first experience of CVC.2) There was no difference between the two groups in resident and patient characteristics; however, the simulator group scored significantly higher in the 4-point performance score than the non-simulator group (2.80±0.33 versus 2.30±0.48, P=0.035).3) The completion rate of CVC was higher in the simulator group (90% versus 60%, P=0.12), and they required fewer attempts at needle insertions (1.67±0.71 versus 3.00±1.26, P=0.022).4) Residents in the simulator group noted the effectiveness of this program more frequently than those in the non-simulator group (86% versus 36%, P=0.057) and showed fewer concerns about their first experience of CVC on patients.5) The CVC training program using a simulator improved residents' skills and is likely to be effective to diminish the fears of residents about performing CVC on patients.

The interval between undergraduate medical education and graduate medical education causes residents to become disorganized when they start their first-year residency programs.This disorganized transition may be stressful for residents and preceptors and may cause resident to make medical errors.We performed a pilot study to examine the degree to which program directors agree about the abilities required for the start of the first of year residency.
1) We asked the residency directors at university hospitals and residency hospitals nationwide (343 institutions) to indicate what abilities residents were expected to have at various stages of the residency program.The data received were then analyzed.
2) A total of 134 residency directors (39%) returned the questionnaire.We calculated the percentage (expectation rate) of institutions that reported expected prerequisites at the start of the first year of residency and calculated the accumulated values (cumulative rate) of the percentages.
3) Only 43 (30%) of 141 abilities upon the completion of residency-preparatory programs had a cumulative rate of more than 50%.
4) Domains for which the expectation rate was more than 50% at the start of residency were medicine and related knowledge and practical skills for obtaining physical measurements.
5) Physical examination and practical skills for which the cumulative rate was less than 50% on completion of residency-preparatory programs were those for the reproductive and urinary systems and pediatrics and the insertion and maintenance of intravenous lines and indwelling urinary catheters.
6) Disparities are likely between the abilities of residents and the tasks expected of them upon entry into a residency program.This problem must be urgently addressed through medical education and graduate medical education.

1) The faculty development at each medical school from 2003 through 2005 was analysed.
2) The major themes in faculty development were problem based learning, tutorial, computer based testing, and clinical training.
3) Faculty development is considered an effective way to enhance the contributions of faculty members to medical education.

Clinical training programs play an extremely important role in the new postgraduate clinical training system introduced in 2004 because facilities for clinical training now include various health-related institutions in addition to the university hospitals and special hospitals for clinical training used in the previous system. Although educational goals have been established by the Ministry of Health, Labour and Welfare, trainees may have difficulty achieving these goals, even under the guidance of staff at the various facilities. There are differences in the function and quality of health-related institutions in the community. For the practical and convenient application of educational goals, we have attempted develop a “model program” to supplement the objectives indicated by the learning goals with more specific objectives. These supplementary objectives can be modified by individual institutions. We hope that this “model program” contributes to the development of objectives for each institution and helps improve the quality of the postgraduate training system in Japan.