BACKGROUND: Japanese medical education has undergone dramatic changes over the last 5 years. Clinical exercises and ambulatory-care training are now stressed to prepare medical students and residents for work in primary and continuing-care settings. For comparative purposes, we conducted a review of the undergraduate and residency training programs for ambulatory care at the University of Toronto in Canada. This report will examine the problems of training programs for ambulatory care in Japan by comparing the Canadian and Japanese models.
METHOD: From December 2004 to March 2005, the first author observed the ambulatory training systems at the University of Toronto.
OUTLINE OF CANADIAN AMBULATORY TRAINING PROGRAMS: There are three typical types of ambulatory training programs in Canada: community-office based programs for undergraduate students in family and community medicine; hospital/clinic based programs for junior residents in internal medicine; and consultation service programs for senior residents in internal medicine. Undergraduate and residency training programs are largely consistent with each other. The current trend in medical education is towards increased consolidation and efficiency in teacher and student training systems, with a reduction in the number of teaching hospitals and integration of teaching staff and curricula. Moreover, team-based training for ambulatory care appears effective.
DISCUSSION: To improve the Japanese ambulatory training system, it is desirable to increase communication and contact between undergraduate-program educators and residency-training program educators in order to achieve integration and consistency between programs.