Koji Nakanishi, MD Dana-Farber Cancer Institute Pediatric Oncology
大阪医科大学第二病理学教室 岡田 仁克
I read discussion on medical education in Japan and the US with particular interest.I essentially agree with Dr. Nagoshi and Dr. Ogimoto. I believe that mistakes inmedicine are much more common in Japan than in the US. In the US, patients frequently sue hospitals and doctors, while lawsuits are just a tip of iceberg in Japan.
I have only one-year experience of postgraduate pathology training in Japan compared to 6 year experience of pathology training in the US (in three different hospitalsfrom a community hospital to academic university hospitals). I would like to share with you my opinion based on my experience.
Rather establishing positions dedicated only to teaching, it is important to incorporate teaching into evaluation. In the US, a single doctor is signing out, teaching and doing research in an academic setting. I do not think anyone is just dedicated to teaching, clinical service or research, in this setting. I have been asked to write evaluation letters on attending doctors when they were considered forpromotion to higher positions. I have been asked to evaluate each attending doctor when I finished each rotation as well. Since attending doctors were well taught by their seniors, they are in general very enthusiastic on teaching as well. As Dr.Nagoshi pointed out, as a resident and fellow, I have been evaluated regarding my teaching ability, too. If you are not good at teaching, it is usually hard to stay in an academic position. In the Univ of Pennsylvania (UPenn), a pathology resident has to do a hour-long lecture every three months or so. These talks are highly attended. Residents almost always prepare for this lecture very well, and even attending doctors learn from residents. I have been amazed by high quality of residency in the UPenn. In my opinion, residency training in pathology is overall far better in the US than in Japan. There are some minor drawbacks in the US. For example, Board Examinations. I experienced Board Exam in Pathology. I have to remember so many things in so many different fields that you cannot use most knowledge in the future. I studied surgical pathology (from head to toe), cytopathology, forensic pathology, pediatric pathology, etc, in anatomic pathology and clinical chemistry, immunology, hematology, microbiology, molecular diagnostics, genetics, laboratory management, etc, in clinical pathology. I wasted hours and days for this exam!!! Everyone is complaining of this situation. But no change has been done, because people do not care once they passed it. There is no re-examination to keep Board-Certified status in the future. It is very good for me. I think similar situations in many other specific fields, like internal medicine. I heard that it is hard to pass the Board Exam in internal medicine.
Shuji Ogino, M.D., Ph.D. Dept. of Pathology and Laboratory Medicine University of Pennsylvania
[Back to HMJ homepage]