RESUMEN
Medical education programs in North America are often based on the adult education theory of self-directed learning (SDL). Many kinds of SDL have been introduced into preclerkship education, clerkships, residency training, and continuing medical education. The first goal of this paper was to review SDL in North American medical education. The second goal was to describe an example of community-based clerkship in which SDL was applied in the department of family and community medicine of the University of Toronto. A third goal was to give three recommendations for Japanese clinical clerkships. The first recommendation is the effect of the learning contract. The second is that the preceptor should give quick and frequent feedback to students and that a useful Japanese feedback device should be developed with information technology. The third recommendation is that a new curriculum combining community-based education for students with continuing medical education for doctors is necessary to improve Japanese medical education.