This article provides an overview of the current situation regarding domestic fellowships for young cardiovascular surgeons in Japan, based on the author's personal experience and the results of a nationwide survey. The author undertook a one-year domestic fellowship beginning in April 2023 at the Department of Cardiovascular Surgery, Fukuoka Children's Hospital. In addition to gaining extensive experience in pediatric cardiac surgery, the author had opportunities to engage in clinical research and present at academic conferences. Conducting research alongside hands-on clinical training offered valuable insights and deepened the author's understanding of various cardiac conditions. At the same time, practical considerations such as relocating with family and establishing childcare support systems required careful planning. Furthermore, a survey targeting U40 committee members was conducted to investigate the motivations, outcomes, and challenges associated with domestic fellowships. The results revealed that many young surgeons viewed domestic fellowships positively, citing benefits such as diverse clinical experience, acquisition of new knowledge, and the development of professional networks. However, several barriers were also identified, including limited access to information, personnel constraints due to institutional staffing systems, and disruptions to personal and family life. The findings suggest that enhanced cross-institutional support and improved information sharing are essential to facilitate the development of young surgical talent in Japan.

Surgical proficiency significantly impacts cardiovascular surgery outcomes. Regular training for surgical procedures is essential. Since 2018, cardiovascular surgery's specialty system has mandated Off the Job Training (OffJT), defined as non-clinical work training that fulfills certification criteria. A minimum of 30h of OffJT is required for specialty acquisition. Presently, a review is being conducted to examine disparities in OffJT credit acquisition across various facilities and the lack of a standardized OffJT curriculum. This report details a survey of the current OffJT landscape, focusing primarily on executives under 40 years old. We employed a questionnaire-based approach to explore the types of training being conducted and the innovative strategies being implemented, along with an analysis of the findings.

Case Report: The patient was a 70-year-old man with a chief complaint of impaired consciousness. He had visited a hot spring in Yamagata Prefecture. While he was bathing in a hot spring, he lost consciousness and nearly drowned. There was no eye witness. Other guests discovered him floating in the bathtub. He was not breathing and received chest compression by a guest. Subsequently, the patient resumed spontaneous respiration. When the emergency medical team arrived, and Japan Coma Scale (JCS) was 300 and Glasgow Coma Scale (GCS) was E1V1M1. The patient was transported to our hospital, and JCS was 200 at admission. Plain chest x-ray and CT imaging revealed infiltrative opacities in the bilateral lungs, suggesting pneumonia. Head CT imaging was unable to identify the underlying cause of loss of consciousness and showed no hypoxic changes. He continued to have impaired consciousness after arrival at the hospital, and it was determined that he had postresuscitation hypoxic encephalopathy. He was immediately treated with cerebral hypothermia. Midazolam was used for sedation, fentanyl for analgesia, and vecuronium for prevention of shivering. In the emergency room, the patient underwent gastric lavage with cold water and infusion of cold fluid. An Arctic Sun® was placed on the patient after admission to the ICU. A target body temperature of 34°C was reached approximately 4 hours after arrival. His temperature was maintained at 34°C for 24 hours and warmed to 36°C in the next 48 hours. Lung disorder caused by aspiration of hot spring water was treated with antibiotics (tazobactam/piperacillin and azithromycin) and positive-pressure ventilation by a mechanical ventilator. This treatment prevented the lung disorder from increasing in severity. Sedation was discontinued after the body temperature was warmed. Subsequently, the patient’s state of consciousness was improved to the premorbid level, and he eventually was able to return to his normal life. Discussion: When patients nearly drown in a hot spring, their body temperatures are often elevated because they have been in hot water for a long time. Their body temperatures must be lowered quickly to a target level using various cooling methods. Immunity is lowered in a hypothermic state, and pneumonia will inevitably develop due to aspiration of hot spring water. Thus, appropriate management is necessary, including the use of antibiotics. Conclusion: Cerebral hypothermia was effective for postresuscitation hypoxic encephalopathy caused by near drowning in a hot spring.