As undergraduate medical education in Japan has been changing, the role of university hospitals is reassessed in this paper. It is essential for medical students to acquire basic knowledge and skills before clinical training. During this term it is necessary for them to learn in university hospitals. However following clinical trainings, especially primary care, lifestyle-related diseases, and clinical clerkship in home medical care, are not performed sufficiently under the present condition in university hospitals. In this training term, we have to introduce community-based medical education under closer cooperation with medical facilities.
Most doctors in community hospitals are clinicians and differ in many ways from physician-scientists in university hospitals. However, conversion from clinician to clinician-educator requires various innovations and endeavors such as the establishment of clinical clerkship, dissemination of EBM, progressive disputation, sufficient accountability, cooperation with co-medical. Undergraduate medical education in community hospitals should be focused on primary care, general internal medicine and emergency medicine. Achievement in our hospital is discussed.
In clinic-based training, medical students take part in various activities, including watching or assisting in clinical procedures and participating in home visits, vaccinations, industrial inspections, health education, and elderly service adjustment meetings. Through these experiences students gain a practical understanding of the importance to primary care of a close patient-physician relationship; consideration of the life and background of patients and families; continuity of care; a suitable relationship between a primary-care clinic and a hospital or specialist; a team approach with other medical staff, such as nurses, community health nurses, helpers, and social workers; and medical and welfare resources of the community. These concepts are difficult to teach effectively in a large university or private hospital. On the basis of my experiences, I would like to comment on the policy of clinic-based training and problems in expanding such training.
In Japan, it is necessary to develop the community medicine (community health care) because of the current of the medical practice. Since 1998, the community-based clinical clerkship (the two weeks' program) has been introduced to the all 5-grade medical students in Jichi Medical School. The aim of this program is to learn not only the knowledge and skill for the community medical practice, but also the attitude included the pleasure, enjoyment and worth to do it. The program contains as many activities of the community medicine as possible other than the out-patient or the in-patient managements. The most of medical students give good evaluation to the program. After the program, many of the medical students became to have the motivation to work in the rural area. In the undergraduate medical education, a community-based clinical clerkship will be more necessary in terms of the development of the community medicine.
We presented here an overview of the international innovation of public health and introduced our community-based educational practice of public health. We also reported it was effective for public health education to let students participate together with teachers in the cooperative movement developing healthy community and let them learn community dynamics, skills of participatory action research and the process of policy making. Today, the under-and post-graduate education of new public health will be effctively performed by participating in the practical healthy community project, which is performed cooperatively by communities, social resources and the university.
The first workshop on medical ethics education was held for 28 members including mainly university tutors and hospital tutors in November 2002 at Gifu. Trail for training of several kinds of medical ethics education technique was evaluated to a certain extent. We submit report of the practice and participants' evaluation of the workshop.
Many medical schools have recently introduced clinical exposure in the early years of training. During this period of early clinical exposure, medical students observe many aspects of a hospital and its staff. Because they do not yet have any special knowledge of medicine, medical students are able to understand problems in medicine from a patient's point of view. We sent questionnaires to students of several medical schools and investigated what students learned, especially about communication. We reported on voluntary research by some medical students at Osaka University. We believe that early clinical exposure gives medical students a chance to recognize and consider many aspects of medicine.
The abundant computer-based materials for medical education developed in Europe and North America have found limited use in Japan. To remedy this situation, the usefulness of such educational materials for Japanese students should be clearly presented, because issues of language and cost are involved. For detailed evaluation of educational material, collaboration with the developing institution is necessary. Kochi Medical School participated in an international collaborative study proposed by the University of British Columbia to evaluate computer-based educational materials. The study evaluated computer-based educational materials for clinical-skills training (CyberPatient) developed at the University of British Columbia. Fourteen medical educational institutions from six countries participated in the study. Kochi Medical School's portion of the study was successfully performed in December 2001. However, we found four problems related to this collaborative study: dealing with foreign languages in educational materials, establishing rapid communication, flexibly coping with sudden changes in study design, and guaranteeing the coherence of the study design among collaborating institutions.