There are few training programs in Japan for doctors who wish to practice in rural areas. We propose a postgraduate training program for doctors practicing in rural areas which would include the conditions of training hospitals and requirements for teaching staff. This program clarifies not only the content necessary for doctors practicing in rural areas but also the fundamental competence of all doctors. We sent questionnaires about this program to 24 physicians (20 working at university hospitals and 4 working at community hospitals). Physicians working at university hospitals replied that a program of 3 years is too short and contains too much material. Physicians working in a community hospital replied that this program would be extremely useful for medical students and residents who wish to practice in rural areas. Training programs for doctors who wish to practice in rural areas are needed to improve postgraduate training programs.

A 74-year-old man with pain and swelling of the left thigh was transferred from another hospital for further investigation. On admission, a diagnosis of a left femoral vein thrombosis was made and he continued on anticoagulant therapy. However, three and a half hours after admission he suddenly developed hypotensive shock and became unconscious. Rupture of a peripheral aneurysm was suspected in view of a rapid fall in the hematocrit and the images of vascular echography. Rupture of a left popliteal aneurysm was specifically diagnosed following intraarterial digital subtraction angiography. An emergency aneurysmectomy and vascular reconstruction using the great saphenous vein was performed. Interestingly, Klebsiella pneumoniae was cultured from both the wall of the left popliteal artery and the wound. Antibiotic therapy was therefore changed to flomoxef (FMOX) on the 5th postoperative day (POD 5) and treatment continued for a total of 6 weeks in accordance with the therapy of infectious endocarditis. He returned to the previous hospital on POD 61.

Sources of research funding: We gratefully acknowledge the support of the 17th Congress of the Japanese Society for Emergency Medicine support of this program.
Ethical considerations: The program was conducted after receiving approval from the Institutional Animal Experiment Committee of the Jichi Medical University, and in accordance with the Institutional Regulation for Animal Experiments and Fundamental Guideline for Proper Conduction of Animal Experiment and Related Activities in Academic Research Institutions under the jurisdiction of the Ministry of Education, Culture, Sports, Science and Technology of Japan. It was approved on April 9th, 2014. The approval number is 14-225.
Disclosure of conflicts of interests: We gratefully acknowledge the contributions of personnel from Panasonic Corp. who enabled the interactive communication system.
Abstract
Introduction: Live surgery demonstrations have been widely used in surgical education. However, they cannot be used to demonstrate trauma surgery due to the emergency situation and lack of informed consent. The aim of this study was to conduct a live demonstration of trauma surgery with a porcine model to increase educational opportunities in trauma surgery.
Methods: Live demonstration was conducted at the Center for Development of Advanced Medical Technology (CDAMtec) , Jichi Medical University, Japan. An experienced trauma surgeon instructed three trainees during a live demonstration using pre-planned injuries in a porcine model. A six-point Likert Scale was used on a written survey to determine the value of the program to the viewers. Free-form written comments were also obtained from the participants. Live images of the surgical field were transmitted to a lecture room by a closed wireless LAN with interactive bidirectional audio capability.
Results: Eighty-three participants viewed this live demonstration and completed the questionnaire. Participants were highly satisfied with the live demonstration (mean survey scores: 4.6-5.1/6) , and gave very positive feedback concerning the educational value of this program. Nine free-form comments were submitted, which revealed that the participants felt they could acquire concrete skills for trauma surgery.
Discussion: Live demonstrations for trauma surgery using a porcine model are a feasible and effective educational tool to demonstrate technical procedures and non-technical skills, with possible added advantages regarding the ethical considerations of performing a live surgery demonstration.