MEDICAL EDUCATION AROUND THE WORLD Rapid change in Japanese medical education HIROTAKA ONISHI 1 & ICHIRO YOSHIDA 2 1 Medical Education & Research Unit, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia; 2 Office of Medical Education, Kurume University School of Medicine, Kurume, Fukuoka, Japan SUMMARY Change in Japanese medical education has been accelerating over the last 10 years. Historically, clinical depart- ments in each medical school played a crucial role, but reports in the mass media tried to refute the feudal ‘ikyoku-koza’ system with a number of malpractice cases, inappropriate patient–doctor communication, etc. At that time policies by the Ministries of Education and Health (rationalized in 2001) independently became more influential in medical education. In particular the network of governmental medical schools has been restructured, merged and privatized since 2001. In the 1990s several private medical schools developed distinctive curricula including problem- based learning (PBL), the objective structured clinical examina- tion (OSCE) and introduction to clinical medicine (ICM). The curriculum for clinical medicine is still a critical issue and will be a major challenge for the management of each medical school. The effectiveness of the National Model Curriculum consisting of more than 1200 objectives might be questionable but the National Common Achievement Test (CAT) will make a strong impact on the preclinical curriculum. In the future each medical school should adopt an outcome-based education system to close the loop of curriculum development. An evaluation system based on the entire medical school or curriculum will be the key to successful education. Introduction Currently in Japan, various media tend to cover areas of medicine. Many TV dramas and magazines describe different aspects of medicine, such as malpractice, rural medicine, the academic struggle between peers in an ivory tower of a medical school, and even the previously hidden area of postgraduate training. Some physicians must feel that these descriptions are too exaggerated, but they may reflect very well the real situations and problems in medicine. Physicians, lawyers, teachers and politicians used to be called ‘Sensei’ in Japanese, but such respect for physicians seemed to have been lost since the 1980s (Watts, 2000). In those days, even academically deficient students were able to gain admission to some of the private medical schools if monetary compensation was accepted (Gillespie et al., 1984). Quality of care and medical education have become critical issues since the rapid growth of the economy. Along with the expansion of such public interest in medicine, several reform plans for Japanese medical educa- tion are in the implementation process. Two-year compul- sory postgraduate rotation training started in April 2004. All the governmental universities and medical schools have been privatized since April 2004. The national CAT to confirm the achievement of the preclinical curriculum is in the final stage of implementation. The academic area of medical education was previously not so common in Japan, the boom in medical education starting in the 1990s. Why are Japanese medical schools changing so rapidly? The objectives of this review are to list related issues and to propose the vision for the next decade. Organizational issues Stakeholders of medical education Three main stakeholders have played roles in undergraduate and postgraduate medical education: the Ministry of Health and Welfare (revised into the Ministry of Health, Labor, and Welfare in 2001: MHLW); the Ministry of Education (also revised into the Ministry of Education, Culture, Sports, Science, and Technology: MEXT); and medical schools. The Japan Medical Association, mainly representing general, practitioners, has worked for continuing medical education but has not much influenced undergraduate or postgradu- ate medical education. MHLW is in charge of the national medical licensure examination and all medical education thereafter. MEXT is responsible for all the issues in under- graduate medical education. No official organization confirms the consistency between undergraduate and post- graduate curricula. There are four other parties closely related to medical education. In 1967 the Association of Japan Medical Colleges was founded to represent all the deans of medical schools and the directors of university hospitals. In 1969 some enthusiastic medical educators founded the Japan Society for Medical Education (JSME). In 1979 the Japan Medical Education Foundation (JMEF) was founded to promote surveys and research into common issues affecting all the medical schools. In 1995 the Foundation for Promotion of Medical Training (PMET) started clinical training in faculty development activities. There is no official Correspondence: Hirotaka Onishi, Medical Education & Research Unit, International Medical University, Sesama Centre, Plaza Komanwel, Bukit Jalil, Kuala Lumpur 57000, Malaysia. Tel: þ60-3-8656-7228; fax: þ60-3- 8656-7229; e-mail: onishi@imu.edu.my Medical Teacher, Vol. 26, No. 5, 2004, pp. 403–408 ISSN 0142–159X print/ISSN 1466–187X online/00/000403-6 ß 2004 Taylor & Francis Ltd 403 DOI: 10.1080/01421590412331270492