The OSCE, introduced by Harden et al. in 1975, is an approach to the assessment of clinical competence in which the components of competence are evaluated in a planned and structured way, with particular attention to objectivity of the examination. The student is assessed at a series of stations, with one or two aspects of competence being tested at each station. Overview of the history of the OSCE, description of administering the examination, and the advantages and disadvantages the method are presented with reference to our own experience.
The Further and Higher Education Act was established by the British Government in 1992. With this act, all former polytechnical schools have become universities accredited by the Funding Council as institutions able to offer university degrees. I studied the background of this Education Act, as well as some of the degree courses and curricula for allied medical sciences, at the University of Portsmouth in its new status.
To investigate the present state of teaching on terminal care and death in medical school pregraduate curriculums, I conducted a survey of 80 Japanese medical schools using a questionnaire in May and June, 1993. Ninety-one percent of the schools responted. Of the 73 responding schools, 24 stated that they have no formal educational program for medical students concerning the death and terminal care. Forty-nine schools (67%) said that they have terminal care and death education courses in their curriculum at present. This rate is the same as that about 20 years ago in the United States. In Japan, most schools have only lectures on the subject matter, of variable total duration, ranging from 1 to 32 hours (mean 6.4 hours). Only 5 schools have practical training with a chance for medical students to meet terminal patients. Practical training is conducted in hospice or hospice wards in 3 schools, in a pain clinic in 1 school, and in a standard inpatient ward in 1 school. Seven schools have training courses without participation by terminal patients, using role-playing (4 schools), and expression of student's opinions (3) instead. In England, the United States, and Australia, practical training with frequent one-on-one meetings between medical students and terminal patients (as patient-tutors) was reported.
This paper reports on the practical course in health care administration that our fifth-year medical students are required to take in order to facilitate team health care. The course is intended to give students an opportunity to review health care from various viewpoints, including those of patients and ancillary medical personnel. In the present study, we used students' reports and a survey carried out immediately after the course, to measure student reactions and to examine the usefulness and possible improvements for the course. Approximately 90% of the students acknowledged value in this method of teaching, and believed their experience would help them in the future when they are doctors. Furthermore, the results of an anonymous questionnaire given to doctors with up to five years of postgraduate experience revealed that more than 60% of them supported the continuation of this type of practical course in team health care as a part of medical education.
In order to appropriately obtain information for the purpose of reforming the school selection process, we analyzed questionaires from 1, 641 students in their first year of medical school. Twenty-five percent of the subjects were women and the 20 participating medical schools consisted of 4 newer national schools, 6 older national schools, 3 provincial or municipal schools, 4 newer private schools, and 3 older private schools. As expected the medical students admitted to a strong desire to enter the specific profession of medicine. Important factors influencing their decision to apply to a particular medical school included (1) geographical location, (2) general public reputation, (3) whether or not the school was part of a university, and (4) the cost of tuition. Students did not appear to pay much attention to specific educational programs, facilities and environment, or the teaching staff of individual schools. The Committee proposes that medical schools make a greater effort to acquaint applicants with the history, purpose, and educational environment of their institution in order to aid the students in their selection process.
In 1991, the committee on postgraduate clinical training proposed revised behavioral objectives for basic clinical training in the initial two years. We present here a model for a clinical training program that should enable most residents to attain these objectives within two years. The program begins with orientation for 1-2 weeks, including a workshop on team care, and nursing practice. Basic clinical skills for primary care and emergency managements should be learned by experience during rotations through various clinical specialities. All staff members, even senior residents, should participate in teaching beginning residents in hospitals.
In Kochi Medical School the use of Computer-Assisted Instruction (CAI) has been discussed as a method to improve clinical education. In order to learn from the experiences of American medical schools that are actively using CAI, the activities of five medical schools and two medical education associations the Association of American Medical Colleges (AAMC) and the National Board of Medical Examiners (NBME) were observed in order to investigate new approaches in medical education and the use of computers in medical education. It was found that the teaching of problem-solving has been gradually introduced, with the effective use of computers in doing so. CAI systems are mainly used in the basic medical curriculum and for individual self-learning. There are currently plans to use clinical case simulations as educational materials in Problem-Based Learning and as part of the licensing examination for medical doctors conducted by the NBME. Therefore, computers will also be actively used in clinical education in the near future.
The importance of medical education and technical cooperation with developing countries is emphasized. As an example, we looked at the residency program of the Department of Surgery, Santa Cruz General Hospital. Provision for postgraduate medical education is quite important in developing countries in order to prevent promising young doctors from leaving the country. Moreover, the curriculum for postgraduate education should be developed in accordance with the health situation of the respective countries. Technical cooperation should be carried out with a long-term perspective, focusing on human resource development, in this case the young doctors. From now on, it will not only be technical experts, but also medical education experts that will be needed in developing countries.