1）We instituted the “CHANGE Nagasaki University Hospital” project to improve both management and medical education and to boost the number of physicians recruited to this hospital.
2）We first identified the physicians’ problems and complaints via a questionnaire. Next, focusing on the most common complaints, we reduced secondary duties and methodically improved the educational environment by employing the a– b–c–d–strategy, which is based on the principles of medical education.
3）As a result, both, the hospital’s economic growth and the recruitment figures for resident physicians have increased continuously over the past 4 years.

A 61-year-old woman who presented with symptoms of dysphagia was hospitalized after right subclavian artery aneurysm was diagnosed. A selective right subclavian arteriogram revealed the presence of two large subclavian arterial aneurysms. The operative procedure consisted of aneurysmectomy through a right supuraclavian incision followed by the reconstruction of the blood vessel by end-to-end anastomosis of the right subclavian artery. The postoperative course was uneventful. Multiple subclavian artery aneurysms are rare among peripheral aneurysms. This case was found by the symptoms of dysphagia caused by compression of the esophagus. The etiology of this case is unclear, but most likely was due to trauma.