General medicine does not select patient and his problem, and is concerned with the same patient for a long time. We think together with patient and share joys and sarrows with him in order to solve his problems towards the final outcome that he expects, and pursue the quality of solving process and his satisfaction with special regards for dynamics of his family and community.
The characteristics of general medicine in comparison with differentiated medicine, basic requisites, frequently used tools, favorite jobs and the future of general medicine were described. Specific need to develop own tool for “integration”, initiative role of general medicine in medical education and the systems which support general medicine were mentioned.
Several matters which should be seeked in the education and training of general medicine was discussed.

In 1994, a basic diagnosis training course was introduced for 2nd-year medical students at Jichi Medical School (JMS) to teach basic interview and physical examination skills with an emphasis on diagnostic processes and principles. In planning and preparing the course, instructors at JMS frequently held discussions to determine learning objectives and activities. We used a comprehensive manual for small-group teaching to standardize lectures as much as possible. In all sessions of the basic physical examination, students were taught in small groups. We also constructed original models to teach palpation and percussion. These models allowed students to participate actively and helped them understand the principles, skills, and findings of palpation and percussion. Instructors at JMS concluded that the models were useful training tools.

The Jichi Medical School has trained doctors for work in community health care for over 20 years.Students learn medical communication skills by role-play. In this role-play, doctors and patients areplayed by students. Discussions are also held by students. The teaching staff give additional explanations, suggestions and demonstrations. By themselves, students learn about 1) general practice, 2) theprocess of consultation, 3) medical communication and 4) patients' emotions. We plan to develop othereducational resources such as trained simulated patients.

Objective: To investigate whether postgraduate education through evidence-based medicine can affect the knowledge and behavior of residents.
Design: Self-controlled and externally controlled trial.
Setting: University hospital.
Participants: Fifteen residents specializing in family medicine.
Intervention: Four 2-hour seminars and weekly evidence-based medicine-style journal club meetings.
Main outcome measures: Scores from a test of knowledge of evidence-based medicine and the number of MEDLINE searches conducted each month.
Results: All residents improved their knowledge of evidence-based medicine and conducted more MEDLINE searches each month than did other medical residents or residents of our department last year.
Conclusion: Postgraduate education through evidence-based medicine is effective in improving residents' knowledge and behavior.

OBJECTIVE: This is the first research known to compare residents' attitudes about training in two countries. The objective was to examine and compare Japanese and US family medicine residents' attitudes about their residency training.
METHODS: A cross-sectional survey was conducted at two Japanese sites and one US site in 1991, and repeated in 1995 at these sites, as well as two additional US sites. Family practice residents completed a self administered, Likert scale format questionnaire containing items on demographics, identity as a family physician, resident education, the doctor-patient relationship, personal life, economic and women's issues.
RESULTS: The response rates were Japan, 1991: 92% (12/13) ; US, 1991: 76% (13/17) ; Japan, 1995: 89% (34/38) ; and US, 1995: 91% (60/66) . Fewer Japanese residents reported feeling like an outsider, or discriminated against while on outside rotations. More US residents reported expectations for training were being met, and being satisfied with their education. More Japanese residents reported that outpatient training was inadequate. US residents responded more positively about the rewards of clinical decision making, patient management and the doctor-patient relationship. Japanese residents were less likely to report training as compromising their physical or mental health, or feeling overworked. Financial concerns were similar for both groups. Most female residents reported feeling that being a woman provider was an advantage.
CONCLUSIONS: Some aspects of family medicine training are transculturally similar, while others are influenced by the medical culture of the respective countries. Family medicine residents' perspectives on training may be valuable to educators planning curriculum development.

This study aimed to clarify whether a regional palliative care intervention program, the OPTIM project, increased home hospice utilization, and explore the potential association between the home hospice utilization and the hospital staff's perceptions on home care. A questionnaire survey was conducted involving 154 physicians and 469 nurses. The rate of patients who made the transition to home-based care increased 967% in A Hospital, 295% in B Hospital, and 221% in C Hospital in 2010 compared to 2007, which was assumed to be 100. Staff of a hospital where many patients made the transition to home-based care were more likely to agree with the following statements concerning home care perspectives: “I started to consider that even cancer patients can be treated at home until the last moment of their life”, “I usually ask patients whether they wish to receive home-based care”, “We decided on coping strategies for sudden changes in the course of disease and a place to contact in advance”, and “I started to simplify treatment procedures, such as prescriptions during hospitalization for patients and their families to prepare for home-based care“.

Background/Aims: Endoscopic submucosal dissection (ESD) for residual or recurrent colorectal lesions after incomplete resection is challenging because of severe fibrosis. This study aimed to compare the efficacy of the pocket-creation method (PCM) with a traction device (TD) with that of conventional ESD for residual or recurrent colorectal lesions. Methods: We retrospectively studied 72 patients with residual or recurrent colorectal lesions resected using ESD. Overall, 31 and 41 lesions were resected using PCM with TD and conventional ESD methods, respectively. We compared patient background and treatment outcomes between the PCM with TD and conventional ESD groups, respectively. The primary endpoints were en bloc resection and R0 resection rates. The secondary endpoints were the dissection speed and incidence of adverse events. Results: En bloc resection was feasible in all cases with PCM with TD, but failed in 22% of cases of conventional ESD. The R0 resection rates for PCM with TD and conventional ESD were 97% and 66%, respectively. Dissection was significantly faster in the PCM with TD group (13.0 vs. 7.9 mm2/min). Perforation and postoperative bleeding were observed in one patient in each group. Conclusions PCM with TD is an effective method for treating residual or recurrent colorectal lesions after incomplete resection.