In this article, I shared my experience as a member of the Professionalism Theme Group at the 2010 Ottawa Conference, and pointed out a new trend in the definition of medical professionalism. Furthermore, I gave my personal opinion on medical professionalism in addition to calling attention to domestic issues regarding the Medical School Accreditation Requirement for ECFMG Certification, pre-and post-graduate training, and attending physicians' workshops.

　There is no clear definition of medical professionalism, although it has long been discussed. However, it is inappropriate to be preoccupied with the details of its definition. It is more important to understand the basic concept of medical professionalism: a spirit of professionalism developed to gain the trust of patients and society, and implement education on professionalism.

　In the implementation of education on professionalism, it is important to: consider situation-dependent professionalism, focus on its relationships with society as well as individuals, and take into account the attributes of both professional and profession. Education on professionalism should encourage learners to reflect and establish their own identity as professionals, rather than placing an emphasis on education based on the norms, which are centered on lists of behaviors and competencies.

　Since the proposal of Best Evidence Medical Education (BEME) by Harden in 1999, there has been an increase in the trend of discussing problems related to medical education using the results of medical education research primarily conducted in English-speaking countries as scientific evidence. However, if medical education, including professionalism and other issues, is discussed without taking into consideration cultures and systems, its essence may be overlooked. The present paper introduces a theory of professionalism regarding Japanese physicians using bushido (samurai spirit) as its model. I hope that the present paper will serve as a foundation for discussions concerning education on professionalism for physicians in Japan.

　Bushido is the so-called identity of the people of Japan, which was "invented" during the "official nationalism" movement in the Meiji era when the state of Japan pursued a policy of increasing wealth and military power. After the defeat of the second world war, nationalistic Bushido almost disappeared, while Nitobe's Bushido has been revived after a long absence. However, Nitobe's Bushido was originally described in English to explain peculiar conduct by samurai worriers, such as hara-kiri (self-immolation by disembowelment) and kataki-uchi (redress) .

　Descriptions of Bushido were written mostly in the Meiji Era as a professional code for the worrier class of samurai. Nitobe's Bushido is one of them, in which he focused heavily on Care/harm, Fairness/cheating, Loyalty/betrayal, and Authority/subversion among the moral intuitions of human beings. On the other hand, Care/harm, Fairness/cheating, and Liberty/oppression are the moral intuitions expected of physicians. This difference is large enough to potentially lead to serious ethical misconduct if physicians act the under Bushido code of professional ethics.

　The Faculty of Medicine of Chiba University implements a curriculum for education on professionalism for students in multiple school years. The curriculum is designed to promote education solely for the Faculty of Medicine and that for interprofessional collaboration. Junior students attend lectures and workshops, which also involve patients, to learn about the definition of professionalism and ethics, and undergo the shadowing method to learn the necessary attitudes and behaviors as professionals from physicians prior to clinical training. In the clinical training, students attend workshops twice to reflect on their attitudes and behaviors from the viewpoint of professionalism. The interprofessional education program encourages students in each school year to learn skills required for interprofessional collaboration along with students of the Faculties of Nursing and Pharmacy. Students establish their identities as professionals - the most important goal for medical education, by comparing themselves with other health care professionals. It is important to implement both programs designed for the Faculty of Medicine and the promotion of education for interprofessional collaboration to help students establish their identities as professionals.

　The 18th term Ethics & Professionalism Committee started to visualize the final outcome of medical professionalism education in FY 2014. Contributions from 7 small groups in the workshop organized by the committee, accumulated knowledge on professionalism , and the outcome in career development education proposed by the Women Physician Career Education Committee were combined to produce the first draft. Public opinions were invited, and a consensus meeting was held to revise it. This draft consists of 7 sub-domains of medical professionalism:

　1. Relationship with patients and ordinary citizens

　2. Commitment to societal mission

　3. Morality expected of physicians

　4. Accepting various values and consideration of fairness

　5. Role as leaders/members of organizations and teams

　6. Pursuit of excellence and continuing professional development

　7. Self-control and career development

Further revision through society-wide discussion will be continued.

　The paper reports a summary of the second session: "Educational strategies: Presentation of cases and SGD + group discussion" of the workshop: "Establishment of a consensus on education on professionalism" . The participants in the session set a goal as a milestone at each of the following stages of professionalism competence, presented educational strategies to accomplish them, and held discussions with each other: (1) Immediately following admission to the university, (2) Junior medical students, (3) Preclinical education, (4) Clinical clerkship, (5) Curriculum for students in multiple school years (for six years) , (6) Clinical training, (7) Life-long education.

Purpose: The learning situation of pharmacy students failing their final exam the previous year (referred to as US) was investigated, and a method of learning support for students with low scholastic abilities was examined.

Method: Questionnaires were completed by students who were unsuccessful in the previous year's final exam a total of three times from April to July 2014, and changes in their academic record were compared with the questionnaire results. Questionnaire contents were: (1)self-learning time, (2)learning support method, (3)weak subject area, (4) progress in the printed material we distributed.

Results: The students with a low academic performance hoped to study by themselves. They felt that physicochemistry and pharmacology were weak subject areas, because high-level understanding was necessary. We realized that the quality of learning was more important than the number of practice problems the students could complete, based on the tests we distributed. In addition, a decline in academic ability was seen in many students at the beginning of the following fiscal year.

Discussion: It is necessary to begin physicochemistry and pharmacology education support when students start their programs for those with a low scholastic ability. Support that incorporates unification-type learning for students unsuccessful in their final exams is also necessary. Furthermore, it is important to design specialized practice problems and individual guidance for students with a low academic performance.

　Based on our experience of visiting the Medical Council of Canada and observing large-scale OSCE (objective structured clinical examination) in Canadian Qualifying Examination Part II , we report differences operation system, implementation status, and examination questions compared to Japan. This very important examination after the post-graduate residency program may provide several invaluable tips when we introduce nation-wide clinical performance examinations.

　This paper reports how Gifu University has been developing an extracurricular course for interprofessional education (IPE) in collaboration with multi-institutions for three years. Since the planning and implementation of such an IPE course have not been described exhaustively, we summarize our experience and the outcomes based on the analysis of a questionnaire survey involving the participants, including students and faculty members.