Purpose: Observation of operations is believed to be a major part in the clinical clerkship of surgery, but it is very hard to be performed effectively due to the difficulty of providing an appropriate view of surgical field for many students. To overcome this problem, we have started to provide a tele-video system for clinical clerkship of surgery since 2001. The aim of this study was to evaluate the effectiveness of educational program of surgery using tele-video system. Methods: We provided the tele-video system with camera systems in two operating rooms and 2 video projection systems in the teaching room to the third year medical students as a curriculum of clinical clerkship of surgery. Education using tele-video system was performed in the form of the interrogatory teaching between the teacher (operator) and students using microphone. The questionnaires about the program of clinical clerkship of surgery and the education with tele-video system were filled up by 190 students who had completed the 4 weeks clerkship schedule. After then, items in the questionnaires were analyzed in September and in December to evaluate the change of the students response for the education with tele-video system. Results: Eighty-eight percent of students had experienced the education with tele-video system. Most students (96%) recommended this system to their juniors, and 78% of students wanted this system to be also used in other departments clinical clerkship. The advantages of tele-video system were revealed as the better view of surgical field, followed by clear explanation for the surgical procedure, interrogatory teaching between the operator and the students, and so on. The most effective teaching methods were revealed as direct participating in the operation (33%), followed by tele-video system (32%), reading of textbook (19%), and simple observation of the operation (15%). General satisfaction for tele-video system were scored with five (11%), four (48%), three (25%), two (7%), and one (1%) (5=excellent, 1=very poor). General satisfaction rate about tele-video system was markedly improved from September to December. Conclusions: The education with tele-video system in the clinical clerkship of surgery seems to be very effective method for teaching the medical students.