Two hundred five inpatients (age, 64.8±21.6 years ; mean±SD) were analyzed with respect to diagnosis, age, and complications to clarify the role of general internal medicine in large hospitals. The patients were divided into two groups: those younger than 40 years and those older than 40 years. In patients younger than 40 years, the most common diseases were viral infections, whereas a wide variety of diseases, including heart diseases, renal diseases, and neoplasms, were seen in patients older than 40 years. Disease in the older group were significantly more complicated than those in the younger group. we conclude that caring for older patients is good training for young residents learning general internal medicine.

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Student self-evaluations in pediatric bedside learning based on a problem-oriented system (POS) were compared with teacher evaluations of the same items. Self-evaluations were also compared with two different methods: unsigned and signed submissions. Students evaluated themselves poorly in the ability to recall pediatric knowledge and highly in the ability to investigate and summarize suggested topics. They evaluated themselves more highly on signed submissions than on unsigned submissions left in a box. Evaluations by teachers were higher than or equal to student self-evaluations. There were few critical evaluations or complaints about POS-bedside learning, but the ratio of criticism was four-fold higher on unsigned submissions. Bedside learning based on POS was accepted willingly by students.

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In addition to the A-and K-type questions, the X₂ type question has been introduced into, and the K'-type question has been eliminated from the Japanese Medical Licensure Examination since 1997. The expected correct answer ratio (ECAR) without any knowledge is 10% for the X₂-type in contrast to 20% for the K2-type. However it still becomes 100% with an 80% knowledge. We designed a formula to study the relation between the knowledge quantity (KQ) and ECAR. The ECAR is 7%, 13%, 25%, 43%, 70%, and 100% for the X_{1, 2}-type in which the number of answer (NA) is indicated as one or two, while it is 5%, 10%, 20%, 40%, 70%, and 100% for the X_{2, 3}-type in which NA is indicated as two or three. The KQ difference between 80% and 100% can be reflected to ECAR in these types and considered to be the better question type.

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We previously reported that the tutorial system had a beneficial effect on our students' scores on term-end examinations in 1994: the assessments of the tutorials correlated positively with the results of the term-end test. This time we analyzed each student's assessment of the tutorials, results of the term-end examinations, and responses to a follow-up questionnaire to determine what abilities the tutorial system helped students develop. The results suggest that tutorials help medical students develop analytical ability: a prerequisite for the problem-solving process.

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Although health education is an important part of health services for the elderly, the contents of municipal health education programs differ from year to year because services are supervised by individual municipalities. In regional health, education programs are rarely developed with apparent general instructional or special behavioral objectives, and the effects of education are rarely adequately evaluated. A workshop on developing programs was held for dieticians working at health centers in Niigata Prefecture. The participants showed a more positive attitude toward program development. The process of curriculum planning in medical education can also be applied to program development for regional health education.

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The need for medical team care is increasing because of advances in medical care and changing national needs. For more than 20 years medical students at the University of Tsukuba have participated in medical team care practice before bedside learning during the third trimester of their 4th year. The objective of this practice is to understand patients from the nurses' point of view and to learn cooperation between doctors and co-medical staff. We analyzed students reports to study what they had learned. A total of 326 items in 11 categories were specified in the free-response part of the reports. The largest category was “nursing/nurses” and the second largest was “communication/human relations.” The results show that the students learned points other than the General Instruction Objectives and that the practice was extremely effective.

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Most medical interns in Japan start working in a specific department at their medical school after graduation and are trained without experiencing medical practices in other departments. At the United States Naval Hospital in Okinawa, Japan, the postgraduate medical training program includes various disciplines in several departments. To emphasize the importance of primary care and to improve the postgraduate medical education system, I propose that practical experience in general medicine be required.

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To investigate the status of ethics education in Japanese medical schools, a self-administered questionnaire was sent to all 80 medical schools in 1995. Sixty-four (80.0%) medical schools responded, of which 60 answered they offer or will offer courses in which medical ethics topics are taught. Most classes are compulsory and are held before bedside teaching begins. Nineteen medical schools have separete medical ethics courses, and the others have medical humanities courses in which medical ethics are taught as part of the course. The respondents rated “the physician's duty, ” “informed consent, ” and “patients' rights” as the three most important topics that should be taught to medical students.

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Epidemiology has played a major role in improving global health in this century. Its importance has increased in the clinical field as well. However, systematic education in epidemiology is conducted only in public health schools in Western countries ; epidemiology is not taught at medical schools. The rapidly growing Internet is being used for distance learning. We took part as teaching assistants in an Internet-based distance learning course in epidemiology offered by the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh. This is the only Internet-based distance learning lecture on epidemiology that is free of charge. Four people in Japan took this course. In this report, we share our experiences with Internet-based distance learning in epidemiology.

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