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.

In 1991, the committee on postgraduate clinical training proposed revised behavioral objectives for basic clinical training in the initial two years. We present here a model for a clinical training program that should enable most residents to attain these objectives within two years.
The program begins with orientation for 1-2 weeks, including a workshop on team care, and nursing practice.
Basic clinical skills for primary care and emergency managements should be learned by experience during rotations through various clinical specialities. All staff members, even senior residents, should participate in teaching beginning residents in hospitals.

It is a great social demand on the medical education system to produce high quality physicians well -prepared for the coming aged society. Besides the inborn emphasis on the technical competence in medical training, the skills to improve the quality of life of patients is currently getting more and more important. In this aspect, human relationship and amenity dimensions need to be more emphasized in the medical education process.
Based upon the observation that lecture-based classes still prevail in the curricula of Japanese medical schools, I dare say that there are eventually no revolutionary strategies initiated for effective learning in the medical education system in Japan. In connection to the strategy development, it is necessary to adopt third-party evaluation of the education system as well as the evaluation by educators themselves.
To sum up, I strongly emphasize the importance of strategic programming of primary care education which includes experience-based training of effective communication skills and of whole-person approach to patients.

Japanese medical graduates are recommended to receive clinical training for more than two years after graduation, because undergraduate clinical training is insuffiicient.
In 1976 the committee of postgraduate clinical training proposed the objectives of basic clinical training after graduation of medical schoool and in 1981 the committee proposed the objectives for the first postgraduate year of training and the methods of clinical skill assessment.
We here present the revised objectives of basic clinical training after graduation of medical school.
It is emphasized that clinical trainees should have basic clinical skills of primary and emergency care during the two year training.
These clinical skills include interviewing techniques, skills in physical examination and interpretation of physical findings, laboratory skills, skills relating to diagnosis and managements, communication skills to other doctors and to other medical co-workers and terminal care.