Introduction: Primary care includes general outpatient clinics and primary/secondary emergency outpatient clinics; however, the differences in treatment settings between these clinics may affect the development of educational programs for postgraduate clinical training. This study aimed to retrospectively investigate the content experienced by residents in community-based outpatient training, which includes general ambulatory training and primary/secondary emergency training, and to compare the differences between items that are more likely to be experienced in general outpatient clinics and those that are more likely to be experienced in the emergency department.Methods: The number of trainees who experienced symptoms and diseases specified in the national residency system was calculated during general ambulatory training and primary emergency training. These numbers were compared by the Fisher's exact test.Results: Items suitable for learning clinical reasoning, such as headache, and items suitable for continuous treatment of chronic diseases, such as dementia, were experienced significantly more frequently in general ambulatory training than emergency training.Conclusion: The symptoms and diseases that are likely to be experienced in general ambulatory training were extracted. These items were considered to be consistent with the purpose of general outpatient training.

We examined ambulatory clinical training for patients with dementia conducted by residents at a university hospital and instructors at a psychiatric hospital who mainly treat patients with dementia in the General Internal Medicine Department of a regional hospital. Residents experienced dementia treatment in the context of primary care, and performed in-depth learning about dementia with the guidance of psychiatrists. It is hoped that dementia treatment will be provided by family doctors. Moreover, it is expected that doctors who have undergone this training will contribute to dementia treatment.

Introduction : We initiated an ambulatory care training program at five community hospitals in Nagasaki, including hospitals on remote islands, for the residents of Nagasaki University Hospital. We examined the educational effect of the ambulatory care training program in meeting the achievement targets for clinical training.
Methods : The study included all residents (n=49) working in Nagasaki University Hospital in 2012. Following completion of the ambulatory care training program, the residents answered a questionnaire on the number of patients and their symptoms, inaddition to a self-assessment, and assessment by their supervisor.
Results : The mean number of patients seen was 3.29 persons / training session. The number of symptoms to be encountered, which are established by Ministry of Health, Labour and Welfare, was positively correlated with the total number of patients seen. Although residents initially had a low rating of self-assessment on diagnosis or treatment, this rating tended to increase with time. The gap in levels on assessment of history taking, diagnosis, or treatment by residents versus those by the supervisors reduced with time in the program.
Conclusion : Our ambulatory care training program is an effective program for meeting the achievement targets in clinical training for residents.

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.

1)With the implementation of mandatory clinical residency in Japan, resident evaluations have become an important part of clinical education. Recently, however, a greater emphasis has been placed on the evaluation of physician instructors. In the West, research examining the teaching skills of clinical physicians has been ongoing since the 1970s and is reviewed in this paper.
2)The Objective Structured Teaching Evaluation (OSTE), which uses standardized students, multiple stations, video recordings, and scoring by observers, was developed in the 1990s.
3)Unlike the Objective Structured Clinical Examination, which is an evaluation tool for medical students and residents, the OSTE is rarely used to evaluate individual performances or used as a part of certification exams. Instead, the OSTE serves as a tool for faculty development or as an outcome measure for the effectiveness of faculty development education initiatives.
4)If available in Japan, the OSTE would be an excellent resource for improving the teaching skills of physicians and would be a useful tool for training sessions for physician instructors. More research is needed to facilitate the introduction of the OSTE to Japan in the future.

1) In Canada, the working conditions of medical residents are negotiated on a province-by-province basis between provincial associations of residents and their respective employers. This paper focuses on the role of the Professional Association of Interns and Residents of Ontario (PAIRO).2) PAIRO negotiates working conditions with the Council of Academic Hospitals of Ontario and has obtained for its members a monthly salary of approximately 390,000 yen for first-year residents (the salary increases with each year of residency), a restriction of on-call duties to 7 of 28 days, and 4 weeks of paid vacation per year.3) In Japan, consideration should be given to the development of guidelines for the working conditions and salaries of residents based on the realities of each specialty and on local needs. To establish and enforce such guidelines, public funding and a third-party agency are necessary.

In Japan, awareness has increased in recent years of the importance of evaluating clinical educators. In Europe and North America, the Objective Structured Teaching Evaluation (OSTE), which employs standardized students, multiple stations, video recording, and scoring by multiple observers, is used to evaluate clinical educators. We report on the implementation of an OSTE in Japan.1) Ten clinician-educator physicians participated in the OSTE, which comprised 5 stations and included standardized residents. The stations were video-recorded, and the educators were assessed by 7 different evaluators.2) The educators were evaluated with a checklist and a 5-point scale. We assessed the reliability and validity of the checklist and analyzed the background characteristics of the clinician educators.3) The factors most closely associated with high ratings on the checklist and the 5-point scale were: having a history of attendance at a seminar for clinician-educators, having greater than 5 years experience as an educator, and not being an internist. There was no interobserver variability among the evaluators.4) The generalizability of the checklist was 0.81, and its reliability index was 0.83. The correlation coefficient between the total scale score and the checklist score was 0.8. 5) Although biases by participants were identified, our project suggests that the OSTE could be used in Japan to objectively evaluate the teaching skills of clinician-educators. Further research on the OSTE in Japan is warranted.

1) We attempted to reform the medical education system for residents at the National Nagasaki Medical Center because the percentage of unmatched applicants in the new national residency training system has been increasing.2) We established a committee for residency training through leadership principles. We then classified problems of the training system and attempted to solve them through the concepts of the learning triangle in education and the educational cycle.3) Finally, we succeeded in improving the educational system for residents by establishing a new committee that individualizes the problems and solves them effectively.