Open Access Research article

Undergraduate educational environment, perceived preparedness for postgraduate clinical training, and pass rate on the National Medical Licensure Examination in Japan

Yasuharu Tokuda1*, Eiji Goto2, Junji Otaki3, Joshua Jacobs4, Fumio Omata5, Haruo Obara6, Mina Shapiro5, Kumiko Soejima5, Yasushi Ishida5, Sachiko Ohde5, Osamu Takahashi5 and Tsuguya Fukui5

Author Affiliations

1 Mito Medical Center, University of Tsukuba Hospital, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan

2 Department of Medical Education, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan

3 Department of Medical Education, Tokyo Medical University, Shinjuku, Tokyo, Japan

4 University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii, USA

5 Center for Clinical Epidemiology, St. Luke's Life Science Institute, St. Luke's International Hospital, Tokyo, Japan

6 Department of Medicine, Okinawa Chubu Hospital, Okinawa, Japan

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BMC Medical Education 2010, 10:35  doi:10.1186/1472-6920-10-35

Published: 20 May 2010



We investigated the views of newly graduating physicians on their preparedness for postgraduate clinical training, and evaluated the relationship of preparedness with the educational environment and the pass rate on the National Medical Licensure Examination (NMLE).


Data were obtained from 2429 PGY-1 physicians-in-training (response rate, 36%) using a mailed cross-sectional survey. The Dundee Ready Education Environment Measure (DREEM) inventory was used to assess the learning environment at 80 Japanese medical schools. Preparedness was assessed based on 6 clinical areas related to the Association of American Medical Colleges Graduation Questionnaire.


Only 17% of the physicians-in-training felt prepared in the area of general clinical skills, 29% in basic knowledge of diagnosis and management of common conditions, 48% in communication skills, 19% in skills associated with evidence-based medicine, 54% in professionalism, and 37% in basic skills required for a physical examination. There were substantial differences among the medical schools in the perceived preparedness of their graduates. Significant positive correlations were found between preparedness for all clinical areas and a better educational environment (all p < 0.01), but there were no significant associations between the pass rate on the NMLE and perceived preparedness for any clinical area, as well as pass rate and educational environment (all p > 0.05).


Different educational environments among universities may be partly responsible for the differences in perceived preparedness of medical students for postgraduate clinical training. This study also highlights the poor correlation between self-assessed preparedness for practice and the NMLE.