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Description
As participation in overseas elective clinical clerkships increases, many English for Medical Purposes (EMP) programs across Japan provide intensive courses to prepare students, most of whom are non-native English speakers, for clinical practice in diverse healthcare systems worldwide. However, medical education and clinical practice can vary significantly across geographical locations, institutions, medical specialties, and patient populations. This study examines how an intensive EMP pre-departure preparation course at Keio University addresses this challenge. The seven-session course, organized and led by a native-English-speaking physician, focuses on competence in four key areas: history taking, clinical reasoning, oral patient case presentations, and physical examination. While the clinical skills of the 64 students in AY2025 varied considerably, the course-leading physician noticed consistent weakness during the physical examination sessions. In particular, the peripheral limb neurological examination was frequently performed "incorrectly" (as judged by the physician, who was trained in Britain), even by the higher-level students. Notably, almost all reproduced the exact same "error" (from the perspective of the British-trained physician) in one particular component of the examination—reflecting what they had been taught in their clinical skills training in Japan. Given that the practice of medicine is culturally and institutionally embedded, and that students often internalize the styles and habits of small-group supervisors and early-career mentors, observations from this course suggest that intensive pre-departure EMP programs should focus not only on procedural and linguistic formats, but also on how standard medical practice can vary across institutions, cultures and countries and to encourage students to be alert to these differences and adapt where appropriate.