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

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 fi elds 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 identifi ed, 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 fl ock 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 fi rst 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 fi elds outside of surgical departments, fi rst of all it is important to allow interns to …