The general practitioner (GP) system in Britain was developed about 40 years ago within the National Health Service (NHS) system. Currently 99% of people are registered to GPs from whom they receive primary care and, if necessary, are referred to specialists working in hospitals. Thus, there is a marked difference between the health care systems of Japan and Britain. However, the GP educational system in Britain is very helpful in increasing the number of doctors practicing primary care. The following are proposed in order to reform the pre-and postgraduate medical education system in Japan. 1. An integrated curriculum including the subject of community practice should be introduced early in the undergraduate years. 2. A compulsory, broad clinical training system that includes community practice should be introduced in the early postgraduate period. 3. The international experience of clinical trainees should be increased in order to catch up with changes in the health care in other parts of the world.

Objective.-To survey a broad sample of Japanese internists regarding the effects of postgraduate training on their ability to provide ambulatory care.
Design.-Analysis of internists trained at university or non-university hospitals (as designated by the Ministry of Health and Welfare) by written questionnaire.
Results.-74.0% of respondents (127 in total) had undergone ambulatory care training. 30.7% were trained in outpatient clinic sessions that were held more than once a week on average. 85.8% of respondents said they recognized the differences between ambulatory care and inpatietn care. Furthermore, the percentage of respondents who understood such differences during their postgraduate training periods was higher in the group that had had ambulatory care training than the group that had not. Many respondents also suggested the necessity of training in non-internal medicine specialties (e. g. dermatology, OB-GYN, otolaryngology, orthopedics, urology and ophthalmology) that were not popular postgraduate training programs.
Conclusion.-Postgraduate training had a large effect on the ability of internists to provide ambulatory care. Japanese postgraduate training is still not sufficient in this regard. Residency training programs should put more emphasis on ambulatory care.

Our previous study concerning evaluation methods of postgraduate clinical training showed a usefulness in improving clinical training, especially in the fields of clinical skills and knowledge. However, it also pointed out the unsolved problem of assessment of those behaviors in which no significant differences were shown throughout the residency period. In order to solve this problem, a feedback system has been introduced, consisting of self-evaluation during the residensy, and appropriate counseling regarding hortcomings.
In the present study, the effect of this feedback system on clinical training, particularly on physician behavior, has been analyzed. The study was performed by comparing evaluation scores, based on a five-point scale, from two groups: 35 residents who did not undergo the feedback system, and 84 residents who had. Clinical skills, knowledge, positiveness, behavior with patients and colleagues, and patients' records, were each evaluated after discussions by the teaching staff.
Our results showed that there was a significant improvement not only in clinical skills and knowledge, but also in physician behavior in the group using the feedback system. Thus, it appears that this feedback system is useful in improving postgraduate clinical training.

Causative factors for thrombi formation in left atria of 38 patients with mitral stenosis who underwent mitral valve surgery (open mitral commissurotomy or mitral valve replacement) alone or in combination with other procedures were studied. There were 9 cases of left atrial thrombosis (LAT). Left atrial diameter was increased in LAT(+) group (6.1±1.6cm) compared with LAT(-) group (4.6±0.7cm). There was significant difference in the left atrial diameter between the two groups of patients (p<0.01). Cardiac output was decreased in LAT(+) group (3.04±0.74l/min) compared with LAT(-) group (3.99±1.07l/min). Cardiac output of LAT (-) group was significantly larger than that of LAT(+) group (p<0.05). Mean transition time of blood through left atrium (MTT_LA) was calculated using left atrial volume and cardiac output. In LAT (+) group, MTT_LA was significantly increased (6.2±3.9sec) compared with LAT(-) group (2.9±1.6sec). It is considered that, in mitral stenosis, prolongation of MTT_LA is one of the risk factors for thrombi formation in the left atrium.

Objective: There are few reports of the long-term outcomes of elderlypatients with prostate cancer. We analyzed data from our institution from the past 12years, including the patient history, treatment methods, and prognosis of patients withprostate cancer aged 80 years or more.

Patients and Methods: A total of 179 cases of prostate cancer in patientsaged 80 years or more were retrospectively evaluated. We divided them chronologically intogroups A, B, C, and D: Group A included 40 cases from 2002–2004; Group B, 48 cases from2005–2007; Group C, 46 cases from 2008–2010; and Group D, 45 cases from 2011–2013.

Results: Sixty-one (30%) patients changed treatment course. Interestingly,no cancer deaths occurred in the patients who changed treatment course. Although 14 (7.8%)cancer deaths occurred (A: B: C: D = 4: 4: 6: 0, respectively), all occurred in 2011 orlater.

Conclusion: In our study, over 50 patients who underwent treatment survivedfor 5 years or more. By treating prostate cancer in elderly patients when appropriate, wecan lower the mortality rate due to prostate cancer. Our results support the activetreatment of prostate cancer in elderly patients.