Postgraduate Surgical Training: the Japan Model

Continued medical education towards a speciality is a basis of training for medical doctors. In 2004, Japan introduced a mandatory 2-year postgraduate training program for graduating medical students with a super-rotation, using a national matching system. The Japanese Medical Speciality Board was established in 2014 in order to reform the specialist system, and the new surgical residency system was started in 2018. In the new system, the residents should rotate within the hospital group in the registered program to obtain the necessary experiences within the prescribed period (usually 3 years). Surgical training system is organized on three levels, with general surgical speciality on the first level, subspecialities on the second level, and higher-level specialties on the third level. The national clinical database (NCD) was founded in 2010 as the database system linked to the board certification system, and only cases experienced at NCD-accredited facilities are recognized as achievements when applying for surgical specialties. While recognizing that surgical speciality plays an important role in maintaining clinical excellence in gastroenterological surgery, there had been no studies on the relationship between surgical speciality and surgical outcomes. Using NCD of approximately 120,000 cases with eight procedures of gastroenterological surgery, it was revealed that the board-certified surgeons in gastroenterology contribute to favorable surgical outcomes.