Osamu Nomura1,2, Hirotaka Onishi3, Hiroyuki Kato4. 1. Department of Integrated Medical Education, Graduate School of Medicine, Hirosaki University, 1 Zaifu-cho, Hirosaki city, Aomori, Japan. osamunomura@hotmail.com. 2. Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children's Hospital, 2-8-29 Musashidai, Fuchu city, Tokyo, Japan. osamunomura@hotmail.com. 3. International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan. 4. Department of Integrated Medical Education, Graduate School of Medicine, Hirosaki University, 1 Zaifu-cho, Hirosaki city, Aomori, Japan.