Japan introduced a mandatory residency program in 2004. Teaching hospitals are now responsible for improving patient safety and the overall teaching environment. Questionnaires were sent to teaching hospitals in Kyushu to evaluate residents' work environments and to ask them about improving patient safety. Questionnaires asked about the work environment, experience with medical errors and adverse events, self-reported work conditions, personal anxiety levels about medical errors, and personal suggestions for decreasing medical errors. One hundred eight questionnaires were mailed, and 76 (70.3%) were returned complete and were analyzed. Most residents in Japan work long hours, feel extremely busy, and are anxious about medical errors; many of them reported personal involvement in medical errors or adverse events. Their suggestions to improve patient safety included improvement of the work environment, establishment of a resident support system, and better organization of medical charts and equipment. Considering residents' viewpoints for patient safety is important to help reduce errors in teaching hospitals.

Appropriate clinical communication between patients and physicians requires better cooperation based on patientphysician rapport and consensus development through information sharing.Developing appropriate clinical communication is also important for safer and more reliable clinical care. The aim of the present study was to illustrate an effective politeness strategy for appropriate clinical communication.
1) We conducted focus-group interviews and performed qualitative analysis on the basis of the results of interviews of both patients and physicians.We also performed an Internet survey and organized an Internet-based discussion ofthe politeness strategy and its effectiveness.
2) Patients may consider physicians' overuse of honorifics as feigned politeness, Both patients and physicians recognize that such overuse may work against the development of rapport-based cooperation.
3) Patients may expect physicians to use simpler honorifics, such as “-san.”However, by using honorifics physicians can show respect to patients and establish a more intimate relationship with patients through both positive and negative politeness strategies.
4) When physicians can better understand and use local dialects, the effects of positive politeness may reduce the psychological distance between patients and physicians, have a relaxing effect on patients, and improve clinical information gathering.
5) A positive politeness strategy, such as admiring and talking optimistically, may have different effects depending on the patient's condition or“face.”If successful, this strategy can contribute to the behavioral changes of patients.

OBJECTIVE: To investigate Japanese physicians' use of dialects related to geographic areas and to elucidate how physicians respond to dialect-using patients.
METHODS: We conducted a web-based open survey, to which 170 anonymous physicians reported. We examined the following 1) whether dialects are used during communication with patients; 2) how to communicate with patients using dialects; and, 3) reasons for having difficulty in communicating with patients who regularly use dialects. Geographical areas were divided into the following 8 areas Hokkaido-Tohoku, Kanto, Koshinetsu-Hokuriku, Tokai, Kinki, Chugoku, Shikoku and Kyushu-Okinawa.
RESULTS: Of 170 physicians, 61.2% (95% CI: 53.4-68.5%) reported using dialects. These proportions differed by geographic area (F= 8.141; p<0.001) . Physicians practicing in Shikoku and Chugoku used dialects most frequently, while those practicing in Kanto and Hokkaido-Tohoku used dialects least frequently. Many dialect-using physicians thought that physicians should use the same dialect as dialect-using patients. In addition, dialect-using physicians were more likely to think that a physician-related factor was responsible for having difficulty in garnering clinical information.
CONCLUSIONS: Use of dialects by Japanese physicians during communication with patients seems common and may differ by geographic areas. Physicians' use of dialects could be a useful tool for effective clinical communication.

Background: There is a shortage of general practitioners in Japan. With the revision of educational guidelines, general practice (GP) education has improved. However, the amount of education on GP in medical schools remains inconsistent. This study examined the relationship between medical students’ amount of GP-related education and their subsequent choice of GP majors. Methods: A retrospective cohort study was conducted in a teaching hospital in Japan. Participants were residents in the hospital. The exposure comprised compulsory lectures and training time for community-based medicine in medical schools. The outcome included participants choosing GP majors after their initial 2-year junior residency. Results: Fifty-one participants were included in the final analysis. Of these, 14 majored in GP and 37 in non-GP after their initial 2-year junior residency. Of the participants who took GP lectures for 18 hours or more, 11 chose GP majors, and 18 chose non-GP majors (risk ratio, 2.78; 95% confidence interval [CI], 0.88–8.79). Of the participants who underwent training for 12 days or more, 10 chose GP majors, and 16 chose non-GP majors (risk ratio, 2.40; 95% CI, 0.87–6.68). Conclusion The results do not support the association between the amount of compulsory undergraduate education for community-based medicine and the subsequent increase in the number of residents choosing GP majors in Japan. Educators would do well to explore different approaches, such as improving the quality of education to increase the number of GP residents. Further research is needed to reach more definitive conclusions.

BACKGROUND : Electronic medical records (EMRs) were first introduced in the 1960s, and in Japan they are starting to become popular. Recognizing the need to adapt to a new clinical setting with EMRs, we aimed to explore which interviewing skills were associated with patient satisfaction in this era of EMR use.
METHODS : A prospective observational study was conducted to evaluate interviewing skills among medical residents and to collate data on patients' satisfaction levels at an outpatient general medicine walk-in clinic at a teaching hospital in Japan. Five trained raters reviewed the video recordings of these interviews and assessed them based on a predetermined set of criteria for medical interview skills developed specifically for an outpatient EMR setting. The relationships between these assessment scores and patient satisfaction levels were analyzed.
RESULTS : Significant skills that were associated with higher scores of patient satisfaction included : employed appropriate eye contact (P=0.021) ; and, invited patients directly without using a microphone (P=0.008). In addition, the degree of keyboard typing during interviews was not associated with patient satisfaction.
CONCLUSIONS : In an outpatient setting with EMR, using good non-verbal communication skills to build trustful relationships with patients is more likely to influence patient satisfaction levels. Even when physicians are typing on a keyboard, if they keep appropriate eye contact during medical interviews, patient satisfaction can be improved.