Japanese medical graduates are staying away from surgical departments and graduate schools

Abstract

The new graduate medical education system established by the Japanese Ministry of Health, Labour and Welfare has been in place for 4 years, and various merits and demerits have surfaced. Many Japanese medical graduates are pleased that training in many fields and free choice of the place of training are now more possible in comparison with the previous situation. On the other hand, a pronounced uneven distribution of physicians has been identified, with many of today’s Japanese medical graduates wanting to work at well-known hospitals in big cities. This situation is noted in other developed countries, for example, the United States, the United Kingdom, France, and Germany. Furthermore, graduates are choosing not to pursue positions in surgical departments. In the past, Japanese regional and rural medicine was managed by many regional medical universities and staffed by their graduates, but the lack of physicians at such universities has caused the near collapse of rural medicine. In other words, hospitals with well-designed internship systems with many instructors are in big cities, and most Japanese medical graduates flock to these facilities. Before the introduction of the new graduate medical education system, Japanese medical graduates typically chose a department based on their preference or on advice from their seniors without full knowledge of their departments of choice. With the implementation of this new system, interns become familiar with many departments during the 2-year internship and then choose a department. Consequently, most interns do not choose surgical departments because the work there is busy and strenuous. Every year, about 10 graduates wish to become orthopedic surgeons at the time of graduation at our university, but at the end of the 2-year period under this new system, about half decide to become physicians in departments of internal medicine. The reason for this is the new system, which favors internal medicine and puts surgery at a disadvantage. In other words, interns train at internal medicine departments for a long period of time during the first year but do not have many opportunities to learn the most basic skills in surgery. The system does not allow interns to experience the merit and beauty of surgery by, for instance, performing operations and watching their own patients recover and get better. To prevent losing more graduates to other fields outside of surgical departments, first of all it is important to allow interns to experience suturing and to perform simple procedures such as cast immobilization, joint puncture, and endoscopy using animals before the postgraduate years. In Japanese postgraduate education, improving the new system to markedly increase the duration of internships in surgical departments will be important, along with making surgery one of the mandatory subjects from the beginning. According to national health surveys conducted every 3 years by the Ministry of Health, Labour and Welfare of Japan, the number of patients with locomotor organ complaints such as lower back pain, stiff shoulder, and joint pain who visit orthopedic departments is equal to that of patients who visit internal medicine departments. Because all interns will routinely deal with patients with locomotor complaints, orthopedic surgery needs to be made a mandatory subject as soon as possible. Another major issue is that recently many Japanese medical graduates are staying away from graduate schools altogether. A doctoral program of 4 years following medical school has been established as part of the graduate school system in Japan. At a time when graduate schools already are less appealing to students, the newly implemented graduate medical education system further exacerbates the problem. Even with graduates who were thinking about pursuing basic medical research while at their medical school, once they experience the actual practice of medicine during internship, some lose interest in research. What needs to be done to attract graduates to pursue graduate studies in Japan? In regional universities, where interns play an integral role in routine medical care, improving compensation to be commensurate with the workload is essential. All interns are interested in the medical specialist system and in pursuing some specialty. Therefore, even at graduate schools, instead of concentrating only on research, programs need to be designed to incorporate specialist systems. Furthermore, graduate schools that foster highly trained clinicians and specialists are desirable. The Bone and Joint Decade that began at the start of the current century is coming to a close, and throughout the world, educational campaigns promoting locomotor health have advocated the importance of living healthy longer. To markedly advance the treatment of loco motor diseases based on basic studies, we need to attract, guide, and foster as many young researchers as possible.