Although the Ministery of Health and Welfare, Japan, has an intention to revamp the medical care delivery system, the majority of physicians are currently practicing in the context of some sort of public medical insurance system. Therefore, it is madatory that medical students and young physicians understand public medical insurance system and economical issues to practice medicine in a cost-effective way. We propose here neurosurgical cases used for that purpose employing problem-based learning method in tutorial system.

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.

A questionnaire was mailed to 236 directors of clinical training hospitals and 164 directors of emergency epartments at university hospitals. A 75.4% response rate for clinical training hospitals and a 78.7% response rate for university hospitals was achieved. About 30% of clinical training hospitals and 80% of university hospitals had established emergency departments and an overall 64% of all institutions surveyed were engaged in public education regarding emergency medicine.
From analysis of patients visiting the emergency room at the Kyoto First Red Cross Hospital in 1993, we concluded that a resident has an on-call clinical emergency medicine experience once every one or two weeks in the initial two-years of postgraduate clinical training. This enabled residents to cover most of the proposed subjects as outlined by the Committee of postgraduate clinical training at the Japanese Ministry of Health and Welfare.
We recommend that the initial two-years of all clinical training programs should include an on-call rotation for emergency medicine.

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.