While many hospitals in Japan are certified to train family physician residents, most have limited experience in this training. The training of a family physician to provide primary care requires a unique set of educational experiences compared to the traditional training of other specialists. Family physicians specialize in the breadth of medical care encountered in a primary care setting rather than the depth of care required in a single organ specialty. In addition to training in the family medicine center to develop ambulatory care skills, family physician residents also need to train with other specialists in hospitals and outpatient settings. Specialists of all disciplines have an essential role in training family physician residents, but there is no clear consensus about what family medicine residents should be taught. To maximize the training with other specialists, residents and teaching physicians need rotation-specific educational goals when training with other specialists to realize the expertise needed for the full spectrum of family medicine.

Family medicine is a linchpin of most successful health systems in the industrialized world, and is increasingly being seen as crucial in the current distressed financial climate. Japan has not had a robust family medicine infrastructure, but recently has begun to develop family medicine in several locations around the country. However, few of these programs are adequately training the type of family physicians Japan needs. This article discusses the background of what family medicine entails, an example of what a successful family medicine university program can do, and the potential benefits to Japan in adopting true family medicine.

Family medicine is a relatively new and rapidly growing discipline in Japan. Nevertheless, for family medicine to achieve recognition as a unique medical discipline in Japan, family medicine must develop its own research agenda and appropriate research methods. However, existing literature in Japanese for guiding the design of family medicine research is scarce. This paper introduces strategies for identifying research questions that emerge from clinical “stories” and connects them with appropriate research designs. This paper provides examples of major categories of research designs including those using a single method and mixed-methods designs that take advantage of the strengths of both qualitative and quantitative methods. A solid research foundation in family medicine needs to be established that preserves the unique attributes of this generalist discipline. Family medicine researchers are needed who can lead research teams to address the complex research questions emanating from primary care clinical practice.

Purpose : The purpose of this study was to review strategies and evidence about effective outpatient precepting in the Western literature.
Methods : The authors searched MEDLINE for studies on family medicine or general medicine outpatient precepting. From 309 papers, the authors applied inclusion and exclusion criteria to identify relevant studies applicable to residency training in family medicine in Japan, and the resulting 18 studies were then analyzed systematically.
Results : Using a dedicated preceptor is the most effective precepting style. In a typical five-minute precepting encounter, most of the time is spent on the diagnosis and management. Insufficient time is spent on the discussion of evidence based medicine (EBM), psychosocial issues, or feedback. To resolve this, precepting techniques such as ‘one-minute precepting’ and SNAPPS can be effectively implemented.
Conclusion : In outpatient precepting, educational discussions incorporating EBM and psychosocial issues as part of standard practice, in addition to providing effective feedback are advocated.

Introduction : In the United States, computerized clinical decision support systems (CDSSs) are being adopted increasingly in primary care. Our purpose is to illustrate the functionality and validity of CDSSs, as well as to discuss the possibility of using them in Japan.
Method : The Department of Family Medicine in the University of Michigan Health System uses a flexible and user-friendly CDSS. In this four-part overview, we examine: 1) integration into work flow in the clinic, 2) response to prompts by the health professionals, 3) content and structure of prompts and reminders, and 4) performance reports.
Results : A CDSS can integrate into a single encounter form preventive and chronic care needs for best quality practice. CDSSs can readily generate clinical care quality and population management reports to support population management and verify best care practices.
Conclusion : As efforts are made to create a viable CDSS in Japan, it would be useful to look at the U.S. example of how a CDSS can both provide clinical decision-making support for evidence-based preventive services and improve the quality of medical practice.

In "osmotic learning" a student passively observes and presumably absorbs clinical knowledge. Unfortunately, clinical teaching based on this style tends to result in low student motivation to study, which leads to low faculty motivation to teach. Here we consider how to improve medical education in Japan based on a case study of a Japanese student's (H.I.) participatory experience with the adult learning model in the United States. 1) A Japanese medical student analyzed the weekly evolution of her responsibilities and contributions to patient care during a 1 month clinical rotation at the University of Michigan. 2) She participated through direct contact with 235 patients during the 1 month rotation. Starting with simple contributions to patient care, over time she became an active member of the treatment team. Due to the ever-increasing relationship of trust built during the rotation, the faculty member could give the student tasks requiring more responsibility. This led to a relative reduction in the faculty member's workload and, in turn, increased teaching efficiency.3) From this case study, we conclude that clinical education based on the adult learning model can be applied in Japan, where "osmotic learning" has been prevalent, and that it can increase the motivation of medical students to learn and faculty to teach.

In the United States, the Family Case Study is a tool used in family medicine to teach students about clinical problems and the effects of illness on the patient and the family. Because the Family Case Study is not well known in Japan, the purpose of this paper was to introduce the Family Case Study on the basis of our experiences and to describe its implementation in the Department of Family Medicine of the University of Michigan Medical School. Although the Family Case Study must be adapted for Japan, we urge its use as a practical means of learning about family medicine and the concept of the biopsychosocial approach through practical learning experiences.

The participation of primary care physicians is essential for the success of ambulatory-care teaching. The “PEP2 Workbook” was developed by the Preceptor Education Project of the Society of Teachers of Family Medicine and provides clinicians with a variety of efficient and effective strategies for ambulatory-care teaching. Strategies include preparation for office visits by students, activities on the first day, one-minute preceptor teaching skills, observation of the student, providing feedback, and dealing with problems. Primary care physicians can apply these strategies readily in clinical practice to improve office-based teaching.

Systematic residency education curricula can provide students and residents opportunities to learn a broad range of clinical skills. One curricular model for Japanese general medicine departments (sogoshinryo-bu) is family-practice residencies in the United States. The values of family practice include first-contact care, continuity, comprehensiveness, coordination, community health, and care of the person. The precepting system is the pillar of resident education and provides the structure for physician-teachers to guide a medical school graduate to become a competent family physician by the end of 3 years of clinical training. Family-practice centers, community-based clinics where university faculty and residents provide care, have a proven record in the United States as clinical classrooms for teaching the values and skills needed for high-quality primary care and could greatly facilitate practice-focused training in Japan.

OBJECTIVE: This is the first research known to compare residents' attitudes about training in two countries. The objective was to examine and compare Japanese and US family medicine residents' attitudes about their residency training.
METHODS: A cross-sectional survey was conducted at two Japanese sites and one US site in 1991, and repeated in 1995 at these sites, as well as two additional US sites. Family practice residents completed a self administered, Likert scale format questionnaire containing items on demographics, identity as a family physician, resident education, the doctor-patient relationship, personal life, economic and women's issues.
RESULTS: The response rates were Japan, 1991: 92% (12/13) ; US, 1991: 76% (13/17) ; Japan, 1995: 89% (34/38) ; and US, 1995: 91% (60/66) . Fewer Japanese residents reported feeling like an outsider, or discriminated against while on outside rotations. More US residents reported expectations for training were being met, and being satisfied with their education. More Japanese residents reported that outpatient training was inadequate. US residents responded more positively about the rewards of clinical decision making, patient management and the doctor-patient relationship. Japanese residents were less likely to report training as compromising their physical or mental health, or feeling overworked. Financial concerns were similar for both groups. Most female residents reported feeling that being a woman provider was an advantage.
CONCLUSIONS: Some aspects of family medicine training are transculturally similar, while others are influenced by the medical culture of the respective countries. Family medicine residents' perspectives on training may be valuable to educators planning curriculum development.