Perspectives in medical education 5. Implementing a more integrated, interactive and interesting curriculum to improve Japanese medical education.

Exact parallels can be drawn between the shortcomings in medical education in the US in the 80s and those prevalent in Japan today. Research and clinical practice had primacy over teaching, and primary care medicine, with its focus on humanistic principles, was subordinated to specialization and tertiary care. US medical schools undertook a wide-ranging reform of the traditional curriculum, recognizing its four major shortcomings. These were (i) an institutional failure to accord academic status to teaching, resulting in a disincentive to teach, (ii) a failure by faculty to perceive a shared interest in education, resulting in teaching that was fragmented and even contradictory, (iii) a failure to integrate preclinical and clinical material, resulting in fragmented learning, (iv) a failure to encourage the development of the most important attributes of a physician (independent thinking, problem solving, and self-directed learning). The reform of medical education in the US was achieved through a wholesale restructuring that (i) integrated basic science with clinical medicine across the curriculum; (ii) coordinated teaching across departments by organizing the curriculum into "blocks"; (iii) integrated problem based instruction into the curriculum to encourage active learning; and (iv) elevated the importance of both teaching and primary care. The successful effort to reform medical education in the US can serve as a source of encouragement and a road map for academic institutions in Japan, like Keio University, who recognize the same shortcomings in Japanese medical education and are attempting to develop and implement a curriculum that is more integrated and problem-oriented.