Faculty development （FD） programs have been held all over Japan since the change to the postgraduate clinical training system in 2004. The programs, however, have not been well evaluated in Japan. The objective of our study was to elucidate the effectiveness of 2-day FD workshops at the University of the Ryukyus. We conducted a survey and test about clinical education involving 172 physicians of the University of the Ryukyus from October 2006 to March 2007. Of the total, 42 of them had participated in our FD workshop between 2003 and 2006, and 130 of them had not participated in it. The average follow-up period of the participant group was 24 months after workshops. The participant group （n＝42） had more knowledge of curriculum design and development, giving feedback, and educational techniques than the non-participants （n＝130）. The participant group also had a more enthusiastic attitude than the nonparticipants.
　Our study suggests that the 2-day FD workshops at the University of the Ryukyus could be effective for nurturing knowledge and attitudes toward clinical education, but may have a limited effect on changes in practice and networking among physician instructors.

The ascending aorta and aortic arch were replaced in a 72-year-old woman with Stanford type A aortic dissection. Preoperative three-dimensional computed tomography (3D-CT) revealed that the anatomy of an isolated left vertebral artery was abnormal. After hypothermic circulatory arrest, a 12-mm sealed graft was connected to the island-shaped arch under retrograde cerebral perfusion, followed by antegrade cerebral perfusion via a branch of the graft. The main graft was distally anastomosed, and the graft of the cerebral arteries was subsequently anastomosed on the main graft under continuous cerebral and systemic perfusion. The patient tolerated all procedures well without cerebral or bleeding complications, and was discharged 18 days after surgery. This technique was useful for island reconstruction, even with abnormal cerebral arteries and bleeding control of this anastomosis was simple compared to the conventional island technique.

A 51-year-old woman, who had been undergoing regular treatment and follow-up for hypertension since the age of 17, was diagnosed to have a patent ductus arteriosus (PDA) 6 months previously. On experiencing dyspnea, she visited the emergency room, where she was found to have a complete Atrioventricular (AV) Block and therefore was immediately admitted. The next day, she experienced acute heart failure requiring intubation. A DDD pacemaker was then implanted and the patient recovered thereafter. After recovery, a screening contrast-enhanced CT scan revealed coarctation of the thoracic aorta. The arterial pressure gradient between the arms and legs was about 70mmHg. The division of the PDA and the replacement of the coarcted aortic segment were performed under femoro-femoral cardiopulmonary bypass through a left posterolateral thoracotomy. The patient's postoperative course was good, however, she complained of abdominal pain on the 6th postoperative day. An abdominal CT scan showed hemorrhage in the left rectus abdominus and right iliopsoas muscles. This improved after rest. No arterial pressure gradient was observed between the arms and the legs postoperatively. She was discharged on postoperative day 20.Because the average life expectancy of patients with untreated coarctation of the aorta has been reported to be about 34 years, it is recommended that surgical repair be performed as soon as possible. Patients with childhood-onset hypertension should therefore be evaluated to determine the primary disease whenever possible, such as coarctation of the aorta as in this case.

A 78-year-old man presented at the emergency department with anterior chest pain. Coronary angiography (CAG) revealed three-vessel disease and percutaneous transluminal coronary angioplasty (PTCA) was performed on the right coronary artery. A preoperative plain chest computed tomography (CT) scan revealed hyperostosis of the sternum and clavicle. The patient underwent elective coronary artery bypass surgery 49 days later. During surgery, the thickness of the sternum caused difficulties with implementing median sternotomy. The pleura was also thicker than usual and even pulsation of the left internal thoracic artery (LITA) could not be determined due to severe adhesion. We harvested the right internal thoracic artery (RITA) instead of the LITA. The RITA was in a similar condition, but a 5 cm proximal portion could be prepared. The saphenous vein graft was anastomosed to the left anterior descending coronary artery after proximal anastomosis to the ascending aorta with the heartstring device because of the calcified aorta. The RITA-saphenous vein composite graft was anastomosed sequentially to the distal right coronary and circumflex artery. The patient's postoperative course was uneventful but he complained of numbness and lassitude of both upper extremities for one month. A postoperative contrast-enhanced CT scan revealed a patent LITA surrounded by thick tissue, indicating inflammatory disorders. The CT findings indicated a diagnosis of sternocostoclavicular hyperostosis. The postoperative CAG findings indicated that all bypass grafts were patent and the patient was discharged 32 days after surgery. Sternocostoclavicular hyperostosis is an inflammatory disease that might require surgeons to carefully reconsider graft selection.

The Hawaii-Okinawa Medical Education Fellowship is a longitudinal FD program developed and administered by the John A. Burns School of Medicine at the University of Hawaii and Okinawa Prefecture to train young clinical teachers who will play a central role in residency education. The program also supports the building of networks among clinical teachers. Each year, around six participants learn the skills required of clinical teachers through monthly seminar participation and a year-round curriculum development project. To date, about 60 physicians have completed the fellowship, and many of them are active as clinical teachers at medical institutions in Okinawa. The community of practice consisting of the graduates of this fellowship is gradually expanding. It is expected to contribute more and more to the enhancement of clinical education in Okinawa.