Medical School Hotline: Hawai'i Medical Education Program: An Innovative Method to Incorporate American Education Methodologies into the Traditional Japanese System.

Background The current medical educational system in Japan was established more than 60 years ago.1 Reforms introduced by the Japanese were influenced by the Allied Forces and the US educational system in the 50s and 60s. Currently, Japanese medical education is a six-year program that starts immediately after high school. The curriculum consists of general education for first two years; pre-clinical studies which include basic science during the third and fourth years; clinical clerkships during the fifth year; and exams and preparation for the national licensure examination during the sixth year.2 Throughout the six years, the majority of time is spent in lectures, with little or no hands-on clinical experience. Medical education focuses mainly in acquiring didactic medical knowledge necessary to pass the national licensure examination. In comparison, US clinical experiences in medical education are standardized and strictly regulated by accrediting organizations, the Liaison Committee on Medical Education (LCME) during medical school and the Accreditation Council for Graduate Medical Education (ACGME) during residency training after medical school. In 2004, to address the limited clinical experience in Japanese medical education, the Ministry of Health (Ministry of Health, Labor and Welfare) ordered a two-year mandatory postgraduate training program following graduation and acquisition of medical license. Currently, this is required before physicians can practice independently. 2 The Japanese mandatory postgraduate training is similar in its content to that of the clinical clerkship experiences conducted in the third and fourth years of study at US medical schools. Following the two-year postgraduate training, physicians usually continue in residency programs in specific specialty areas. Table 1 is a summary comparison of medical education systems between Japan and the United States. Medical schools in the United States and Canada are accredited by the LCME with strict educational and administrative standards. Accreditation oversight is conducted by the LCME. Accreditation is granted if all the standards are met by the medical school. Students that have graduated from LCME accredited medical schools take the United States Medical License Examination (USMLE) and apply for the National Residency Matching Program (NRMP) for US residency positions. In US residency programs, trainees are assigned greater patient care responsibility under supervision with focused experiences in the specialty areas. For foreign medical school graduates to apply for the NRMP, they must obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG). In July 2010, the ECFMG announced that, effective in 2023, foreign physicians applying for ECFMG certification will be required to graduate from medical schools that have been appropriately accredited.3,4 To satisfy this requirement, foreign medical schools must be accredited through a formal process that uses criteria comparable to those established for US medical schools (LCME), or other globally accepted criteria such as those put forth by the World Federation for Medical Education (WFME). Currently (as of March 2017), most Japanese medical schools do not meet the criteria set by either LCME or WFME. In particular, clinical medical education, such as bedside teaching and patient care responsibility are less extensive in Japanese medical schools than the world standard. The Ministry of Educa-