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.
In April, 1995, 392 teaching hospitals were surveyed by questionnaire regarding status quo of general medicine in Japan. Independent department of general medicine was established in 11 university and 16 non-university teaching hospitals (11.6% of the respondents). There were another 23 hospitals-3 universtiy and 20 non-university hospitals-in which general medicine was practiced at other department. Therefore, 50 hospitals (21.5% of the respondents) had a group of physicians practicing general medicine in one way or another. Many problems surrounding general medicine, however, were raised, especially about conceptual gaps between generalist physicians and specialists or patients. It is mandatory for clinicians and educators in general medicine to make the concept of general medicine explicit in understandable words for other specialists and lay people. In addition, high quality practice, education and research products are essential to attract more doctors of younger generation.
We conducted a follow-up analysis of entrance examinations and premedical and medical academic records of students entering medical school after a general screening from 1979 through 1989 and those of students accepted on the basis of recommendations since 1985. To evaluate their academic records all students of each year were divided into five groups on the basis of entrance examination results, and the mean academic rank of the highest 20% and lowest 20% of students were compared. In premedical subjects (i.e., general education and basic sciences), the mean rank of the highest 20% were as low as the average rank, whereas that of the lowest 20% were nearly as high as the average rank. A similar tendency was observed with respect to medical subjects. The average academic rank of students accepted on the basis of recommendations was higher than that of students accepted on the basis of entrance examination. In a follow-up study, greater insight for the evaluation of academic records was obtained when 100 students were divided into five groups and the highest and lowest 20% were compared than when all students were analyzed as a single group. Finally, all students who graduated in 6 years passed the National Physician's License Examination, whereas the success rate varied among students who took longer than 6 years to graduate.
A follow-up study of the relation between methods of selecting medical students and performance after admission was investigated. The subjects were 318 students who had entered our medical school from 1987 through 1989. Two hundred fiftynine students had passed open entrance examinations and 59 students had passed special examinations for those who had been recommended by their high school principals. We found that students who had earned a degree other than a medical degree had the best performance, as measured by academic records, promotion, and results of the national examination for medical practitioners. They were followed in descending order by students who had been admitted upon recommendations of high school principals, students who had passed open entrance examinations immediately after graduation from high school, students who had prepared for entrance examinations for 1 or 2 years after high school, and students who had prepared for 3 years or more.
To improve the ability of 1st-year medical residents to take histories from patients with chest pain we had residents re-interview patients in a senior cardiologist's outpatient department who had had chest pain of known origin. Three medical residents participated in this training program just after obtaining their licenses to practice medicine. Each resident took histories from approximately 25 consecutive patients during a 1-month period. Causes of chest pain included angina pectoris (38 cases), acute myocardial infarction (16 cases), pulmonary embolism (10 cases), and dissecting aortic aneurysm (4 cases). Each of the three residents stated that they recognized the importance of taking histories from patients with ischemic heart disease and became confident doing so after having interviewed about 15 patients. What they learned in this training program was considered useful when they interviewed new patients in an emergency room who complained of chest pain. One resident wished that this training had started several months after receiving his license because they had little experience taking histories from patients while in medical school. Four months after this training, the senior cardiologist tested the three residents by having them interview new patients with chest pain and found their abilities to be satisfactory. Twenty consecutive cases appears to be a satisfactory number for medical residents to become confident in taking histories from patients with ischemic heart disease. This training program should be started within 3 months after residents receive their medical licenses.
Osaka City University Medical School is now radically reforming its undergraduate curriculum for clinical medical education. Over the next 2 years, lecture will gradually be decreased from 773 to 433 sessions (each session lasting 105 minutes) by introducing organ-based integrated lectures, while practical clinical training will be increased to 15 months and classical bedside teaching will be replaced by clinical clerkships. A new teaching building to be completed by April 1998 will contain many rooms and facilities for students to study alone or in groups. Such innovations became possible only after continuous cooperation and planning by the newly organized curriculum committee and its subcommittees.
In 1994, a basic diagnosis training course was introduced for 2nd-year medical students at Jichi Medical School (JMS) to teach basic interview and physical examination skills with an emphasis on diagnostic processes and principles. In planning and preparing the course, instructors at JMS frequently held discussions to determine learning objectives and activities. We used a comprehensive manual for small-group teaching to standardize lectures as much as possible. In all sessions of the basic physical examination, students were taught in small groups. We also constructed original models to teach palpation and percussion. These models allowed students to participate actively and helped them understand the principles, skills, and findings of palpation and percussion. Instructors at JMS concluded that the models were useful training tools.