Introduction of Problem-Based Preclerkship Clinical Training in Internal Medicine / 医学教育

ABSTRACT

To increase the safety and effectiveness of clinical clerkships, we have developed a 4-week preclinical training program, “Problem-Based Clinical Training, ” based on the concept of problem-based learning with the aim of encouraging life-long self-directed learning. The first week is a preparation period for clinical practice in which students are trained in problem-solving skills, basic-practice skills, and clinical reasoning. The second and third weeks are a practical training period in which students learn how be in charge of a patient's care. The fourth week was a problem-solving period without practical training in which students learned to solve problems. The students were encouraged to record daily “problem notes” describing problems and “problem solving notes” summarizing problems solved. To emphasize lessons learned, the students also presented and discussed problems. Evidence-based medicine was used as a tool for problem solving. Furthermore, medical record training based on the problem-oriented system using evaluations by other students encouraged self-development to improve clinical practice and the medical record. This curriculum should be effective for mastering the skills of self-directed learning and for motivating for advancement due to consideration of contributable proposals for the patients.