Because of drastic changes in community health care in Japan, increasing emphasis has been placed on medical undergraduate education in community health care.The number of medical school introducing community-based clinical training is increasing.Therefore, effective clinical training in community health care should be developed. This study examined the effects of the location and subjects of training on students' evaluations and impressions of community-based clinical training.
1) Self-administered questionnaires were completed by 499 fifth-year students taking part in community-based clinical training.The main items were the locations and subjects of training and the students' evaluations and impressi ons of training. The associations between these items were analyzed.
2) A total of 96.8% of the questionnaires were analyzed. The students who trained only in clinics were slightly but not significantly more likely to have positive impressions of and to have given higher evaluation scores to training than were other students.
3) Students who participated in health education for healthy persons or patients or both were significantly more likely to answer that“the training program was enjoyable, ”“the preceptors were enthusiastic, ”and“I spent more time with the preceptors.”On the other hand, the students who took part in inpatient care were significantly less likel y to answer that“the training program was enjoyable”or that“the training program is needed.”
4) Students who studied 1 to 4 of the 11 subjects were significantly less likely than were students who studied 8 to 11 subjects to answer that“the preceptors were enthusiastic”and were less likely than were students who studied 5 to 7 subjects to answer that“the training was meaningful.”
5) Students who studied few subjects during training might have negative feelings about community-based clinical training.The experience of health education might have a positive effect on students.On the other hand, the experience of inpatient care probably has a negative effect.

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AIM: gradual shift, from hospitals to long-term care facilities, in where elderly people spend their last years is expected in Japan.Therefore, we performed a questionnaire survey to assess the opinions of directors of long-term care facilities about end-of-life care and director education.
METHODS: In December 2006, data were collected through mailed, anonymous, and self-administered questionnaires. The subjects of this study were managing directors of 214 long-term care facilities in Nagoya City. Our questionnaire survey focused on the directors' attitudes about the following end-of-life issues: 1) requirements for implementing progressive policies for end-of-life care, and 2) educational training for end-of-life care. For data analysis, we divided the facilities into three groups: geriatric hospitals, geriatric health services facilities, and nursing homes.
RESULTS: Directors of 82 facilities returned completed questionnaires (response rate, 38.3%). They regarded staff education concerning end-of-life care, outside medical support, private rooms for end-of-life care, and 24-hour availability of physicians or nurse as requirements for quality end-of-life care at long-term care facilities. Nursing-home directors felt more strongly about the need for 24-hour medical services for end-of-life care than did directors of other types of facilities.Also, most directors wanted to receive additional training about clients' decision-making processes, communi-cation skills, and legal issues related to end-of-life care.
CONCLUSIONS: Our results suggest that staff education concerning end-of-life care and 24-hour medical services are required for quality end-of-life care at long-term care facilities for the elderly.

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Appropriate clinical communication between patients and physicians requires better cooperation based on patientphysician rapport and consensus development through information sharing.Developing appropriate clinical communication is also important for safer and more reliable clinical care. The aim of the present study was to illustrate an effective politeness strategy for appropriate clinical communication.
1) We conducted focus-group interviews and performed qualitative analysis on the basis of the results of interviews of both patients and physicians.We also performed an Internet survey and organized an Internet-based discussion ofthe politeness strategy and its effectiveness.
2) Patients may consider physicians' overuse of honorifics as feigned politeness, Both patients and physicians recognize that such overuse may work against the development of rapport-based cooperation.
3) Patients may expect physicians to use simpler honorifics, such as “-san.”However, by using honorifics physicians can show respect to patients and establish a more intimate relationship with patients through both positive and negative politeness strategies.
4) When physicians can better understand and use local dialects, the effects of positive politeness may reduce the psychological distance between patients and physicians, have a relaxing effect on patients, and improve clinical information gathering.
5) A positive politeness strategy, such as admiring and talking optimistically, may have different effects depending on the patient's condition or“face.”If successful, this strategy can contribute to the behavioral changes of patients.

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The role of standardized patients (SPs) has developed rapidly over the last10years because of medical education curriculum reform and the introduction of the objective structured clinical examination (OSCE). As the participation of SPs in medical education has increased, the anxieties and frustrations of SPs have also increased. We believe that an understanding of the attitudes of SPs would improve the quality of their activities. The purpose of this survey was to study the activities and psychological needs of Japanese SPs in the OSCE.
1) The response rate to the nationwide survey was62% (332of532SPs).
2) Role-playing and group discussion were the most common training methods, and the length of training varied from 0 to 40 hours.
3) The factors that SPs felt difficult were judging how much to respond in their performances (73%) and maintaining consistent standards in evaluating examinees (66%).
4) Our results suggest that SPs require more training and that the number of SP educators should be increased.

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1) In problem-based learning (PBL) tutorials during the2nd year, general symptoms (fatigue, weight change, bleeding, fever, pain, and edema) were chosen as subjects.Changes in the students'way of thinking about how to learn were evaluated before and after PBL tutorials.
2) After tutorials students were significantly more likely to believe that their participation in tutorials was a more effective way of learning. The students'views after tutorials on listening to lectures differed between2006and2007.
3) We conclude that PBL tutorials affect medical students'views about learning.

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[in Japanese]

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