In addition to the conventional Knowledge Skill Scale (K. S scale) evaluated by examinations and reports, the Attitude Scale (AT scale) has been introduced for the final summative eavaluation in the public health course, in order to make medical students learn the importance of social manners as doctors; for example, punctuality in completing the report assignment and participation in obligatory seminars. The authors observed that after introduction of the AT scale, the students' AT scales improved during the next three years. The proper role of the introduction of the two -dimensional criteria (K. S scale and AT scale) in the public health course is discussed.
For the pupose of terminal care education, I am conducting a trial experiment on free discussion in a small group, about six members, of students of a nursing school. After self-introduction, debate is held on two themes, “terminal care of my beloved companion” and “terminal care of mself.” As judged from the results of a questionnaire and the record of debate, the students' attitude toward the question “Am I going to die soon?” asked by a terminally ill patient, changes during the discussion from encouraging, denying, or avoiding to listening to the patient. This style of exercise may be able to be used for terminal care education for medical students, medical and paramedical staff and death educaton for the general public.
In Japan, more than 1, 200 medically-oriented meetings are held each year, with the number of presentations given at those meetings estimated at over 100, 000. A questionnaire was sent to the member societies of the Japanese Association of Medical Sciences in order to obtain information about the character and the role of the meeting abstract. Moreover, Another questionnaire was sent to individual doctors and researchers regarding their views of the abstract selection process. It was found that 65 percent of the meetings held by the member societies, especially large-scale and clinicallyoriented societies, have a referee system. However, submitted abstracts are rarely rejected (average 9 percent), and only the subject matter is supposed to be checked. Moreover, it was clear that most doctors and researchers recognize the necessity of a refereeusystem for national meetings of general interest where they present their research achievements, and think research meetings where a small group of specialists gather to discuss a certain subject have less need for a referee system. Through the use of these two questionnaires, two main concepts were obtained:(1) a referee system is necessary to maintain high-level meetings, and (2) all applicants should be given an opportunity to present thier papers.
In our university, the 5 th and 6 th years medical students receive the MCQ type examination twice a year, in Internal Medicine, Surgery, Pediatrics, Obstetrics and Gynecology and Public Health. The authors determined the validity of each question about public health (total 130 questions, 1984-1988) according to the percentage of correct answers and the phi coefficient. The results were as follows: 1) With most of the questions, the 6 th year students showed a higher percentage of correct answers and phi coefficient, than the 5 th year students. 2) Most of the questions with a low percentage of correct answers showed a low phi coefficient. 3) The authors analyzed the content and answer pattern of questions with both a low percentage of correct answers and a low phi coefficient, and found to typical reasons for these results, that is, students' lack of knowledge and an inappropriate question. Generally speaking, a question with both a low percentage of correct answers and a low phi coefficient is considered an inappropriate question. Our results showed that in some cases the students' lack of knowlege was responsible for both low figures. It is essential for the teaching staff to determine the validity of the MCQ type examination that they make by means of this kind of analysis.
The undergraduate curriculum of Kurume University School of Medicine was analyzed in order to know whether or not this curriculum provides essential knowledge of human genetics and related biological sciences, and whether or not it meets the need for knowledge in the rapidly developing aspects of human genetics. The total number of the lecture hours on human genetics at this medical school was found to be over three times higher than the mean number of lecture hours used in other medical schools in Japan and North America. In terms of lecture hours, molecular genetics was the predominant component, followed by population genetics. Most of the subjects in human genetics which have been generally accepted as “ compulsory” were included in various individual disciplines. However, some of the subjects, including linkage analysis and pharmacogenetics, were not mentioned in any of the lecture. These results revealed that the present curriculum provides at least core knowledge of human genetics, and that teaching of information in rapidly developing domains, such as molecular genetics, was acceptable. It is expected, however, to take some measures to assist students to integrate the components of human genetics, which are taught independently in each discipline at present, into a harmonious whole.
The Nagoya District Court, on May 1989, ruled that doctors could exercise their discretion about whether or not to inform patients that they were suffering from an incurable or grave illness. Taking advantage of this opportunity, the authors carried out a questionnaire survey of medical students as to whether or not they knew this and what opinions they had about telling the truth to patients with cancer. There were 502 respondents among 620 students and these were divided into three groups of almost the same number; those who knew of and understood the judgment correctly, those who knew of it but mistook the meaning, and those who did not know of it. Two thirds of the respondents said that the number of physicians informing the patients of the truth will increase in the future, and that half of them will do so when they become physicians. Those who responded that they would not inform the patients totaled 16 percent. In cases where a famiy member had cancer, 53 percent of the respondents would not inform a relative unless the patient was aware of his own disease, but 57 percent would if the relative wanted to know the real diagnosis. Students in the lower classes gave animated opinions about this problem, and those in the upper classes treatd warily as to whether they would inform the patient of the truth or not.
We, as final year medical students at University of Tsukuba, had an opportunity to take some clinical clerkship courses at McMaster University for three months, from April 3 to June 23, 1989. The curriculum was unique and different from the one we have in Japan, especially in regard to its clerkship. We found it very instructive and stimulating to work with McMaster students and staff members at the hospitals. We learned a lot from this wonderful experience and we want to thank everybody who gave us a warm support.
During my clinical cler ship course as a medical student in Australia from April, 1989, I have learned and experienced with liver and heart transplantations which have not performed in Japan. I have accompanied with liver transplant team of Royal Prince Alfred Hospital and heart transplant team of St. Vincent Hospital, both in Sydney, in order to perform operations and bring organs by airplane or police cars. I have also visited the office and laboratory of the New South Wales Red Cross in Sydney and learned much about social supporting systems for organ transplantation by transplant co-ordinators. Through this significant and precious experiences, I could understand a matured system of Australian organ transplantation.