We developed a system to evaluate internal medicine residents in terms of general internal medicine and subspecialties and assessed whether the evaluation system was effective and satisfactory for them. Evaluations were performed by the residents and their instructors at 6 months, 12 months, and every year thereafter. A questionnaire was completed by the residents to assess the effectiveness of the evaluation system. In every field, the scores given by the residents themselves after 6 months of residency were an average of 1 grade lower (on a 5-grade scale) than those given by their instructors. The students thought that the evaluation system was effective but contained too many items and had obscure standards. Although evaluation systems for medical residents are uncommon in Japan, we found that the results of the residents' and instructors evaluations were closely correlated. Self-evaluation systems are important in postgraduate education; a standardized system is required for a uniform level of education throughout the country.
The cooperation of health, welfare, and medical staff are essential for terminal care. To clarify the opinions of and experiences with terminal care of students of these professional schools, a questionnaire survey was conducted of 527 students from six schools. All professional school students had little or nc experience with terminal care. Opinions about the importance of terminal care education differed significantly between students of welfare professional schools and students of other medical professional schools. All students of welfare professional schools thought that terminal care education is essential Medical students were significantly more likely than students of other professional schools to agree that patients should be told the truth about their condition by the doctors in charge. Educational programs in which students can gain experience with terminal care are necessary.
For medical students, death education is essential. As a part of death education in medical courses, a lecture was given about telling the truth to patients with cancer. Patients with recurrent cancer took part in this lecture and talked about their operations, informed consent, and telling the truth. From the questions of medical students to both patients and teachers (surgeons), student's opinions about telling the truth were examined. Medical students approve of telling the truth to patients with cancer and support the rights of patients to know the truth about their disease. If they have cancer, they want to be told the truth. However, they are wary of telling the truth to all patients. They think that the truth should not be told without understanding the patient's personality. Students recognized that they are not sensitive enough and want to learn sensitivity by telling the truth.
A questionnaire analysis of early postgraduate clinical training of 6th-year medical students was conducted for 3 consecutive years. After graduation, 32% of the students wished to become family physicians, 58% wished to become specialists, and 9% wished to become other types of doctors. The type of postgraduate clinical training most often considered ideal was superrotation, followed by rotation and straight track. Superrotation should be introduced to junior residents during postgraduate clinical training as should a variety of subspecialty training courses for specialists, including family medicine for senior residents.
Radical changes were made last year in the educational program of liberal arts at Juntendo University School of Medicine. The number of required courses was decreased, and students were given more freedom to choose electives. A survey at the end of the first semester evaluating the reforms showed great satisfaction on both sides: students were highly motivated to study, and the teachers were ready to answer their needs.
A special elective course to prepare for the United States Medical Licensing Examination for 2 hours weekly was introduced for our 3rd-and 4th-year students 3 years ago. The course consists of two parts: one part concerned basic medical knowledge taught by medical faculty with American textbooks and the other part concerned medical English taught by a native English speaker speaking at a natural speed so that students will be able to understand naturally spoken English.
In the past 2 years, all 1st-year medical trainees have been instructed in physical examination of patients with heart disease in the general ward of Tenri Hospital by two or three 2nd-year medical trainees who had received special training in physical examination for heart disease. After 1 year of training, all 1st-year medical trainees became confident in making a proper physical examination and in detecting an S3 gallop but were not confident in detecting other abnormal physical findings. On the other hand, the 2nd-year medical trainees thought that they were able to organize their own medical knowledge by teaching 1st-year medical trainees.