Tuesday, October 27, 2015

Surgical training is different in Japan

Quite different than what we are used to in the United States as a paper published online in the American Journal of Surgery explains.

In the US, all residency programs are vetted by the Accreditation Council for Graduate Medical Education (ACGME). Japan has no central accrediting organization. Each hospital establishes its own training program without any national standardization.

Medical school graduates in Japan take a national practitioner examination and then complete a two-year rotating internship. Specialization in general surgery residency takes three more years after which the residents may obtain board certification.

The authors surveyed 76 teaching hospitals in Hokkaido, a prefecture in the north of Japan, and 49 (64.5%) responded.

Program directors were in place in 81% of the residency programs. Of that number, 79.3% devoted less than 5 hours per week to education [compared to an ACGME mandate that 30% of a program director’s time must be devoted to education], and 72.4% had dialogues with residents only when necessary.

Of those responding to the question, 31/36 (86%) "had teaching activities outside of clinical settings," but no program had protected time dedicated to teaching.

Fewer than half of the programs had skills or simulation laboratories, with 12.5% having formal simulation training as part of their educational agenda.

Only 55.6% of the programs evaluated the competency of their trainees in knowledge, skills, or scholarly activities.

Not surprisingly, only 8.6% of program directors were satisfied with the way their programs functioned.

To become board-certified in Japan, residency graduates must take a written exam for which the pass rate is 82.1% and an oral examination which has a pass rate of 100%. The pass rate for the oral exam has been an issue. A medical specialty board was established in 2014 and is preparing to oversee the quality of resident education and certification.

Lead author Dr. Yo Kurashima, Director of Surgical Education Research at Hokkaido University Graduate School of Medicine, answered a few questions via email. He said some of the hospitals limit resident work hours and allow residents to go home after call. However, "most do not define work hour limitations, so residents usually work from early in the morning to midnight every day."

No universal surgical residency curriculum exists in Japan, but a national surgical society recently listed criteria that must be achieved prior to board certification.

Dr. Kurashima did some training in Canada where he became familiar with North American residency methods.

For his next project, he said, "We are just starting a national survey which will investigate resident satisfaction regarding their residency.”

I suspect the residents might raise some concerns. I wonder if they will have time to respond.


Anonymous said...

Maybe the lack of protected time and mandates are offset to some degree by the generally stronger group cohesion found in Japanese workplaces. It's possible that trainees receive more of their guidance and instruction more informally, as part of the general management of the group. Just a thought.

Skeptical Scalpel said...

It's a good thought and may be true. I learned a lot from attending rounds when I was training. We didn't have as many didactic conferences back then because it was not mandated. I think didactic conferences are a sham in many programs anyway. I know of some where the residents give lectures to each other. Truly the blind leading the blind. In others, the topics are chosen randomly. The boards/ACGME continue to demand basic science lectures which to me a waste of time. Unless you are a researcher, you don't use much basic science on a daily basis. I blogged about this 3 years ago http://skepticalscalpel.blogspot.com/2012/07/things-that-puzzle-me-about-surgical.html

Anonymous said...

How much do you think these differing standards affect error rates?

Skeptical Scalpel said...

Sorry for the delayed response. Good question. If I had to guess, I would say "not much." Every day you read a new study or article about how bad error rates are here in the US. I don't see how it could be any worse in Japan.

Post a Comment

Note: Only a member of this blog may post a comment.