We have an outpatient department and a ward (52 beds) in the department of general internal medicine of the Second Tokyo National Hospital. During the rotation of interns for 8 weeks, interns are taught outpatient management by clinical educators one-on-one basis in the clinic, in addition to inpatient management on the wards, and series of lectures on the general internal medicine, emergency medicine and psychosocial issues. We have a residency program from PGY 3 through PGY 5, which emphasizes outpatient continuous management throughout residency. Our residents present their outpatient cases at the daily outpatient conference that all of us would attend. There are 17 graduates of our residency, many of whom are now clinical educators not only in our hospital but also in the university hospitals and teaching hospitals. Research on the way of training rotation of interns by the national hospitals group suggested superiority of the super-rotate training system of the intern. The residency of general internal medicine would become more important not only for the training of primary care physicians but for the training of clinical educators.

Introduction: To elucidate the issues surrounding adolescents' Internet use in social minority groups, this study investigated the current situation of Internet addiction among Brazilian students who live in A city in Japan.Methods: The participants were 342 local Brazilian students attending international schools. A cross-sectional study using a self-administered questionnaire in Brazilian-Portuguese was conducted. As a primary outcome, we used Young's Internet Addiction Test (IAT) to evaluate the level of self-reported Internet addiction. Social demographics (i.e. age, sex, etc. ), lifestyle (i.e. the time for Internet use, sleeping hours, etc. ), and depressive tendency (Patient Health Questionnaire 2, PHQ2) were also assessed. The χ-square test and logistic regression analysis were used for analysis.Results: The response rate was 65% (222; 111 males and 111 females). Factors related to an IAT score of 50 or higher were sleeping hours (<7.5 hours) (OR: 0.38, 95%CI: 0.21-0.68), the time for Internet use (≥4 hours) (2.6, 1.4-4.8), and PHQ2 score (≥3) (6.2, 3.3-11.5). On logistic regression analysis, an IAT score ≥50 was positively associated with the time for Internet use and PHQ2 score ≥3.Conclusion: The self-report of high Internet addiction among Brazilian students in A city in Japan was significantly related to the time for Internet use and depressive tendency.

We investigated factors related to the perception of achievement and to the degree of satisfaction of junior residents in initial clinical training. Questionnaires were given to second-year postgraduate students at 13 teaching hospitals in Japan. The response rate was 50%(n=89). The perception of achievement and the degree of satisfaction were converted to a 100-point scale. The mean±standard deviation of the two scores were 70±11 and 68±16, respectively. The average number of inpatients and whether the junior resident had taken care of patients were related to both scores. However, gender, the number of departments rotated through, and salary were not associated with either score.

The purpose of the present investigation was to examine the relationship between the open water swimming (OW) performance and the swimming speed at 2, 3, and 4 mmol/l of blood lactate concentration (SSLA2, SSLA3, and SSLA4) or the critical swimming speed (CSS). Six male collegiate swimmers performed the 10 kilometers of OW, as well as the multi-stage graded swimming test, in order to determine the SSLA2, SSLA3, SSLA4. Furthermore, the CSS was calculated based on the personal best records for 50 to 1500 meters of free-style indoor swimming. As a result, the SSLA2, SSLA3, SSLA4, and CSS corresponded to 102±6%, 106±6%, 110±7%, and 106±5% of the average swimming speed of the OW, respectively. Thereafter, the SSLA2 did not differ significantly in comparison to the average swimming speed of the OW, whereas the SSLA3, SSLA4, and CSS differed significantly with the average swimming speed of the OW (p＜0.05). Furthermore, the average swimming speed during the OW significantly correlated with the SSLA2, SSLA3, SSLA4, and CSS, respectively (p＜0.05). These results suggest that the OW performance significantly correlated with the swimming speed at 2 to 3 mmol/l of the blood lactate concentrations and CSS. Furthermore, regarding these parameters, the SSLA2 may accurately reflect the average swimming speed of OW.

In April, 1995, 392 teaching hospitals were surveyed by questionnaire regarding status quo of general medicine in Japan. Independent department of general medicine was established in 11 university and 16 non-university teaching hospitals (11.6% of the respondents). There were another 23 hospitals-3 universtiy and 20 non-university hospitals-in which general medicine was practiced at other department. Therefore, 50 hospitals (21.5% of the respondents) had a group of physicians practicing general medicine in one way or another.
Many problems surrounding general medicine, however, were raised, especially about conceptual gaps between generalist physicians and specialists or patients. It is mandatory for clinicians and educators in general medicine to make the concept of general medicine explicit in understandable words for other specialists and lay people. In addition, high quality practice, education and research products are essential to attract more doctors of younger generation.

The working group on the education of general medicine, Japan Society for Medical Education, has defined general medicine as a discipline which includes following three areas; 1) basic clinical skills which incorporate humane health care, 2) comprehensive community and family medicine and 3) general internal medicine which provides integrated services to solve clinical problems at any level. It has also issued a proposal on undergraduate education of general medicine at university hospitals. The working group now propose a detailed sample curriculum which describes the instruction in three areas mentioned above. Overview, General Instructional Objective (GTO), Specific Behavioral Objectives (SBOs), Learning Strategies (LS) and Evaluation are included in this sequence.

In Europe and America, it is reported that residents develops burnout syndrome or depression by their stress, and these are connected with dropouts from their training program and undesirable outcomes of the patients such as unethical practice. Recently, though resident's poor working conditions and death from overwork, etc. become problems also in Japan.But, Japanese resident's stressor is uncertain.
1) Focus group interview was executed for 25 junior residents in 10 facilities, and their stressor were explored.
2) As a result, three cateogories ; physiological stressor as one human being, stressor as a new member of society, and stressor as a trainee doctor and beginner novice doctor was extracted.
3) Three stressors were named the life gap, the society gap, and the profession gap respectively. The stressor of junior resident was described as the product what was born by the gap of medical student and becoming a doctor.
4) Japanese residents have various stressors. Stressor as a trainee doctor was a stressor peculiar to Japanese junior residents.
5) Stress management should be done considering such a stressor in the light of safety and effective clinical training.