Perspectives in medical education 9. Revisiting the blueprint for reform of medical education in Japan.

Reform of medical education at Keio University has been underway since 2003. We measure the progress made since then in five specific categories that span fifteen recommendations presented in our "Blueprint for Reform" at the outset of the effort. These are effectiveness of leadership, curriculum reform, recognition of teaching, clinical competence, and comprehensive training in general internal medicine (GIM). First, effective leadership is being sustained through a succession of Deans, although a potentially crippling loss of leadership in the Department of Medical Education must be offset through timely appointment. Second, curriculum reform is awaiting the implementation in 2012 of an integrated, organ system-based curriculum with an emphasis on ward clerkships, but the introduction of PBL has been delayed indefinitely. Third, teaching is being recognized through the use of student feedback to reward good teachers and through funds for six full-time equivalent salaries dedicated to medical education, but promotions still depend exclusively on research, without consideration of teaching ability. Fourth, clinical skills training is still lacking, although enthusiasm for it seems to be building, thanks to the presence on the wards of a (still miniscule) cadre of dedicated teachers. Finally, exposure to GIM remains non-existent; however, visionary leadership in a newly-independent Emergency Department and the wide variety of medical problems seen there provide a remarkable opportunity to craft a uniquely Japanese solution to the problem. The changes implemented to date are impressive, and we remain enthusiastic about the future, even as we recognize the magnitude of the task that lies ahead.