Asia Pacific Family Medicine 2009, 8:9 http://www.apfmj.com/content/8/1/9 Results Twenty-five (18 males and seven females, mean age 25 years old, demographic data was shown in Table 1) stu- dents consented to participate. All of them were inter- viewed willingly and seven main themes emerged: "the perception of education as having a low priority," "the prevalence of positive/negative role models," "the persist- ence of hierarchy and exclusivity," "the existence of gen- der issues," "an overburdened medical knowledge," "human relationships with colleagues and medical team members," and "first experience from the practical wards and their patients." 1) The perception of education as having a low priority In total, 14 out of 25 students stated that teachers tended to not infrequently ignore scheduled times for classes or canceled lectures without prior notice, which served to demotivate medical students. While some students accepted and tolerated a certain amount of laziness due to teachers' being busy with other work, they fervently appealed for giving notice in advance and not wasting stu- dents' time. their career choice and development as doctors. Con- versely, others (8/25) reported that negative role models had effectively demotivated the learners, which seemed to affect students more strongly than positive role models. As an example of what behavior demotivated students, one of the interviewees offered the testimony that a class- mate attended only the final lecture, yet was penalized in no way whatsoever. "Some doctors taught us both conscientiously and enthusiasti- cally. They gave us detailed instructions that were most useful to us as learning aids. They served as a good model, and both impressed and motivated us." 3) The persistence of hierarchy and exclusivity 15 of the 25 medical students mentioned that they were treated unfairly for no other reason than their lower posi- tion in the ward. There were also numerous mentions of senior staffs' verbal abuse and vilification of other depart- ments or institutions, causing a serious deterioration in the relations of interdisciplinary or multidisciplinary teams. "When they come, they seem to be running late for some other engagement, and make do with some brief handouts and a 10- minute lecture, after which they promptly leave, saying, 'you are dismissed.' " "They keep telling everyone awful stories about other depart- ments and colleges. They have convinced themselves that theirs is the best way of doing anything. I'm totally sick of hearing about it." 2) The prevalence of positive/negative role models Most (20/25) medical students mentioned the positive or negative effect of mentors, which clearly illustrates a pow- erful influence. Some students (17/25) asserted that teachers' enthusiasm inspired them and even affected Table 1: Characteristics of study participants* year 5 medical students (n = 25) Mean age 25 Sex Male 18 Female 7 Ethnicity All Japanese (except one male student†) Entry to medical school‡ After high school (including gap years) 25 Obtained degrees besides M.D. 0 Marital status Single 24 Married 1 Has children 1 *No characteristics were outside population norms. †There was no difference in ethnicity: Except for one overseas male medical student from Nepal, all subjects were Japanese. (This had no significant effect on the results). ‡Like other tertiary education, medical school in Japan begins immediately after graduation from high school, but lasts 6 years [9]. We did not obtain religious information from the study participants in the interest of protecting their privacy. However, it is reasonable to assume that this had no significant effect on the data due to most Japanese being atheist. 4) The existence of gender issues About half of the medical students (6/18 males, 6/7 females) described problems relating to the peculiarity of the conventional male-dominant position in Japanese medical society. Some female students complained of sen- sitive issues that were specific to women, which had to be rather difficult for men to understand. In addition, another participant gave witness to the fact that one female colleague had been subjected to sexual harass- ment. "Men are in the majority. Well, I have severe menstrual pain ... But I'm too embarrassed to say that's why I can't continue bedside training on a given day. I'm sure that they can never understand how hard it is for me. Creating a supportive atmos- phere for women is very difficult. And I don't think there's really much hope..." 5) An overburdened medical knowledge Most (22/25) medical students mentioned that they must place writing their medical reports above their interac- tions with their patients due to their lack of learning time. Even if they hope to adopt holistic medicine, in which they embrace not only biomedical but also psychosocial approaches and focus on patient-centered care, they could not do that, since it was not as highly rated as the test marks. Page 4 of 7 (page number not for citation purposes)