It had been 36 years after it first started; a radical reform had been done on the postgraduate clinical training system.The subject point of the change was that in the past, mainly in University hospitals, where postgraduate clinical trainingsystem was managed mainly by the Department of a resident's planned medical staff, to enter in the future; in the newsystem, a resident is incorporated in a training program with contents of internal medicine, surgery and emergency, notjust bounded to particular field, in order to master basic and general clinical abilities. The new postgraduate clinicaltraining system is also expected for the hospital's side to become activated by remaining the clinical training system, andothers. As a matter of course, the System has given a great effect to the curriculums of undergraduate medical education, and so, a revision of medical education to bring up medical staff of excellent quality, is also on its way.

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The postgraduate medical training system will officially start the initial clinical training this year, but the subsequenttraining of medical specialists is left, as a matter of fact, to the independence of medical scientific societies which certifiesmedical specialists. The Ministry of Health, Labour and Welfare has approved in spring 2002 the advertisement ofmedical specialists certified by societies under certain conditions as an alleviating measure of the medical advertisementregulations. The Japanese Board of Medical Specialties comprising from medical scientific societies that participate inthe Japanese Association of Medical Sciences and own a medical specialist certification system, is asking cooperationfrom medical societies in order to foster the respectable medical specialists and establish a medical specialist system.However, many problem awaiting solution have been pointed out in the current medical specialist certification system.For fostering high quality medical specialists, the Japanese Board of Medical Specialties needs to be functioning as athird party.

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Each medical specialist certification system in internal medicine and its subspecialities was founded and controled byeach medical society, but not by the public. Thus, each system had not been harmonized each other, and not recognizedas the public system until the the Ministry of Health, Labour and Welfare (MHLW)'s declaration of permission for publicnotification of each certificated medical speciality when approved according to their criterion. Based on the longstandingdiscussion and negotiation in the special committee on internal medicine of the Japanese Board of MedicalSpecialist, on the other hand, the Japanese Society of Internal Medicine (JSIM) and the societies of subspecialities in theinternal medical fields agreed to build up the so-called 2 stair-system as the framework of medical specialist certificationsystem, where the Certified Member of the JSIM is inevitable for application or renewal of the Fellow of the JSIM andother certifications of medical specialist of the internal medical subspecialities. In face to the new compulsory postgraduateclinical training system with super-rotation for 2 years starting from 2004 fisical year, JSIM decided that 2 yearpostgraduate clinical training is included to the 3 year training period necessary for the application of the Board CertifiedMember of JSIM, because clinical training with super-rotaion system aimed to master the capability of primary medicalcare is recognized to be also an essential part of the training program for internists. For the better medical specialist certificationsystem in the future, the Japanese Board of Medical Specialist should be approved to be the public and independentorganization for quality control of Japanese medical specialist certification system as a whole to improve medicaland welfare quality which fit for the requirement of Japanese people in the 21th century.

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The compulsory postgraduate clinical training of two years influence not only surgical board system but also otherspecialist education. The compulsory postgraduate clinical training has aimed to train the character as the doctor at thetime of a basic formation as the doctor, to deepen understanding to the primary care, and to acquire a basic clinical ability.Therefore, the introduction of the professional education is delayed, and the possibility that the board certified timingget behind more than present is high. After compulsory postgraduate clinical training, it is necessary to give thespecialist education in a thick efficient program. Especially, cooperation between a university hospital and affiliated institutesis important in the surgical specialist promotion.

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JMA's fundamental CME policy is to promote consistent continuing education throughout a physician's career.Although social expections of the physician changes with the times, the immutable expectations are that they possessspecialized knowledge, technical skills, and volition for self-study and self-evaluation, abide by a code of professionalethics, and possess acute intelligence and a rich humanity. The last trait is a foremost asset for physicians in buildingphysician-patient relationships.

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Education in community medicine has become increasingly important. At Jichi Medical School, community-based clinicalclerkships began in 1998. This study examined the effects of a standardized program for medical facilities and clerkshipcontents introduced in 2001. A self-administered visual analogue scale questionnaire was given to 308 fifth-yearmedical students to examine their opinions about this program, community medicine, and the future. Results from beforeand after the introduction of the standardized program were compared. After the program had been introduced, significantlymore students agreed that the clerkship program was “meaningful” and should be continued. Furthermore, significantly more students agreed that “physicians enjoy working in the community, ” “talking with people, patients, and public officials is not difficult, ” and “ I will become a general physician or a specialist in the future.” These resultsshow that the standardized program is effective for education in community medicine.

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Our medical ethics course emphasizes problem-based-learning (PBL) via group discussion of clinical cases. The significanceof instructors' assessments of PBL in ethics education was studied with different assessment tools during thelast 2 years. In the first year, students' behavior and level of functioning in group discussion were assessed on a group basiswith an 8-item instrument. In the second year, students' level of functioning and flexibility in response to differentopinions in group discussion were assessed on an individual basis with a 2-item instrument. Instsments ofstudent's performance in group discussion were positively but weakly correlated with scores of their reports derivedfrom group discussions. Instructors could consistently assess student performance in PBL in terms of behavior and levelof functioning in group discussions. Furthermore, instructors rated flexibility in response to other opinions as an importantfactor in group dynamics, including interaction between students and instructors. These results suggest that instructors'assessments can be used to help evaluate students in a medical ethics course. Instructors' assessments of studentflexibility during PBL can be particularly useful in this regard.

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We performed a questionnaire survey of 199 graduates regarding surgical clerkships to help select future clinical trainingmethods for fifth-year medical students. Many of the graduates understood the significance of clerkships, and 70%were able to benefit from their participation in clinical training. They approved of clerkships, but 22% had critical opinions.Clinical instructors were asked to teach with greater enthusiasm, to be easier to talk with, and to have a deeperknowledge of diseases. Graduates who attended very few lectures in the fourth year were less likely to expect clinical instructorsto teach well. Most graduates believed that clinical instructors should have at least 5 years' clinical experience.These results suggest that all faculties should continue to place a greater emphasis on education and that faculty developmentshould be expanded.

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