A questionnaire was mailed to 236 directors of clinical training hospitals and 164 directors of emergency epartments at university hospitals. A 75.4% response rate for clinical training hospitals and a 78.7% response rate for university hospitals was achieved. About 30% of clinical training hospitals and 80% of university hospitals had established emergency departments and an overall 64% of all institutions surveyed were engaged in public education regarding emergency medicine.
From analysis of patients visiting the emergency room at the Kyoto First Red Cross Hospital in 1993, we concluded that a resident has an on-call clinical emergency medicine experience once every one or two weeks in the initial two-years of postgraduate clinical training. This enabled residents to cover most of the proposed subjects as outlined by the Committee of postgraduate clinical training at the Japanese Ministry of Health and Welfare.
We recommend that the initial two-years of all clinical training programs should include an on-call rotation for emergency medicine.

Although the Ministery of Health and Welfare, Japan, has an intention to revamp the medical care delivery system, the majority of physicians are currently practicing in the context of some sort of public medical insurance system. Therefore, it is madatory that medical students and young physicians understand public medical insurance system and economical issues to practice medicine in a cost-effective way. We propose here neurosurgical cases used for that purpose employing problem-based learning method in tutorial system.