Teaching ambulatory-care medicine is essential for primary-care education. However, few studies of ambulatory-care training have been done in the past decade. We performed a nationwide survey to examine whether and how ambulatory medicine is taught to medical students and residents. We sent questionnaires to all medical schools (n=80) and accredited teaching hospitals (n=389) in February 2001. The response rates were 83.3% and 79.2%, respectively. Fifty-one (78.5%) of the 65 medical schools provided ambulatory-care education, although the programs varied considerably from school to school. Only 104 teaching hospitals (26.7%) had an ambulatory-care training program.

Although postgraduate training in an ambulatory care setting is recognized as beneficial in Japan, such training has not been widely implemented. In April 2001 we surveyed all 389 accredited teaching hospitals in Japan about their ambulatory care training. We asked 1) whether they provide a postgraduate training program in ambulatory care, particularly for problems commonly encountered in primary care settings, 2) if such a program was provided, how it was organized, and 3) if such a program was not provided, what the reasons were. One hundred eighty physicians responsible for the residency programs of 120 hospitals replied (response rate, 87%). Most residents at these hospitals see patients in outpatient clinics regularly during their training. Many faculty members supervise their residents at the outpatient clinic and also see their own patients. Sixty-eight percent of the respondents did not set teaching objectives for ambulatory care training. Frequently mentioned barriers to providing ambulatory care training were limited space and tight outpatient schedules. To promote postgraduate ambulatory care training in accredited teaching hospitals, adequate resource allocation and a national policy are needed.

Because new media have come onstage in the information technology period, also self-learning methods have been diversified. Recently, small group discussion such as clinical conference using the mailing list is lively performed among the primary care physicians, and it is considered to be useful for continuing medical education. To promote the mailing list for continuing medical education, we present as follows; 1) present situation: to show a good example of TFC-ML (total family care-mailing list), 2) usefulness: to know new medical knowledge, new medical information and literatures etc., to discuss clinical cases. 3) issues: a role of moderator, excess of information, correspondence with slander, 4) future: to reevaluate usefulness for continuing medical education. We would like to expect effectiveness of mailing list for continuing medical education.