Both specialties of general internal medicine and general medicine have been launched at university hospitals and accredited teaching hospitals in 1970's in Japan. Although both were intended to embody holistic medicine in the era of progressive fragmentation of medicine, the former was the attempt from the very center of excessive fragmentation of internal medicine and the latter, request from the general public seeking for more general approach. The future development of both primary care oriented specialties depend on the realization of quality general practice attracting young physicians of next generation into these fields.
Current curriculums employed in both specialty education are driving the shift of the site of clinical education, i. e., from ward to ambulatory clinic.

This paper has two aims, to summarise recent domestic and international events related to medicoethical-legal decisions in the clinical setting and to discuss the ethical implications of these events. Domestic issues include brain death and organ transplantation, refusal of treatment for religious reasons, disclosure required for legitimate informed consent, surrogate motherhood, prenatal diagnosis and selective abortion, issues pertaining to HIV/AIDS, concealment of medical mistakes, truth telling, public trust in physicians and in health care, and medical research. International issues include voluntary euthanasia and assisted suicide, the imposed separation of conjoined twins, problems pertaining to wrongful life, fetal surgery, the Icelandic database, homosexuality, resource allocation and global justice, and the death of participants in medical research.
It is hoped that this review of recent events related to clinical ethics may serve as a basis for ethical considerations in daily practice.

BACKGROUND: Practice guidelines have been increasingly recognized as an important tool for improving the quality of medical care. However, few studies have evaluated the clinical effectiveness of practice guidelines.
PURPOSE: To gain an insight into the clinical impact of practice guidelines.
METHODS: MEDLINE was searched in order to review experimental or quasi-experimental studies on the clinical impact of therapeutic practice guideline developed by specialist organizations or national/regional agencies.
RESULTS: A total of 17 studies was found, 10 (59%) of which reported positive clinical impacts and seven did not. Among the seven negative studies, two reported poor adherence by providers to guideline recommendations and three did not mention adherence. It was thus not possible to determine whether negative results reflected poor adherence by the providers or ineffectiveness of the practice guidelines themselves. The studies varied so widely that a formal meta-analysis was impossible.
CONCLUSION: The use of practice guidelines tended to have a positive clinical impact. However, sub-optimal study design and/or lack of data on key items such as the extent of adherence to guideline recommendations at the provider's level made the interpretation of study findings difficult.

We reviewed the literature regarding Japan's contribution to research in medicine in 1991-2000. Japan contributed 7.6% of all articles in English listed in the Medline database. The contribution ranged from 0.6 to 11.4% for various clinical science fields and 3.8 to 11.9% for basic science categories of reputable journals. The lowest contributions were in the categories “General and General Internal Medicine” and “Epidemiology”, where Japan contributed only 0.6% and 1.1% of the articles, respectively. The Japanese contribution to high quality clinical research (randomized controlled trials, case-control studies, cohort studies) was meager, while that to the basic sciences was more satisfactory than to the clinical science categories. Appropriate academic and social initiatives should be made to accelerate clinical research in Japan.

Clinical ethics education aims to provide medical students and residents with adequate knowledge and skills to cope with ethical problems encountered in patient care. It is essential for students to study the historical background of biomedical ethics, normative ethical theories, and qualitative and quantitative data relevant to descriptive ethics in Japan. The significance of critical case analysis from an ethical point of view should also be addressed. Informed consent, truth-telling, and medical end-of-life decisions have been gradually gaining recognition as the most important topics in clinical ethics education. Controversial issues, such as medical futility, fair resource allocation, and family involvement in medical decision in our culture, should also be studied.

OBJECTIVE: To examine Japan's overall biomedical research productivity and its trend in the last decade.
METHODS: Articles published during 1991-2000 were accessed through Medline database. The number of articles having affiliation with a Japanese institution was elicited using standard search strategy.
RESULTS: In total 3.8 million articles were published during 1991-2000 while 330, 513 articles (8.7% of total) were originated from Japan. With language limited to English, there were 3.3 million articles in total and 252, 635 (7.6% of total) from Japan. Yearly numbers of articles significantly increased as a whole and also for Japan. The number of English-language articles from Japan increased by 63% during 2000 compared to 1991 while it was 34% on average for all other countries. On the other hand, the number of Japanese-language articles was 77, 878 with a 16.5% decrease in the same time.
CONCLUSION: The number of English-language articles originating from Japan has been increasing at a pace higher than that for all other countries together.

Worldwide societies are aging fast, demanding more and the rising burden of chronic and behavioural related disease increase pressure on healthcare systems.These healthcare challenges are alongside with the fact that formally Japanese doctors occupy a central role in the daily management of Japanese healthcare, as heads of departments, heads of hospitals in large urban settings or in the country side, and as responsible for thousands of clinics countrywide.This paper presents why we feel management education should be provided in medical education programs for Japanese doctors, how it could be structured and why it is relevant in today's Japanese healthcare.It further discusses some of the contents that ought to be taught, including the critical management area of leadership.We conclude that: i) Physician education in management is relevant as change management skills, leadership and motivation are increasingly called upon by new healthcare challenges;ii) The good aspects of Japanese healthcare need to be maintained and doctors'knowledge of management and leadership can prepare them to better defend and develop them with management and politicians; iii) Management education should be“spiral”, maybe starting with Japanese doctors who are heads of healthcare units possibly with a combination of workshops, residential and online courses.