US-style Medical School in Japan: Project proposal by JrSr with UH/JABSOM

<<US-style Medical School in Japan: Project proposal by JrSr with UH/JABSOM>>

Junji Machi, MD, PhD, FACS January 1, 2015 (update)


In the United States, medical school is a 4-year education system after undergraduate (college) education where students learn liberal art (and science) at graduation with BA or BS degrees. The first 2 years of medical school is for basic medicine and the last 2 years is for clinical medicine (including clinical clerkship) although students are exposed to clinical experiences from the first year, and basic medicine is learned through clinical settings frequently (problem-based learning). Particularly during 2 years of clinical medicine education, students spend most of time at teaching hospitals where they function as “student-doctors” as members of clinical team care (medical team, surgical team, and so on). The bedside education (so-called clerkship) is critical for medical student education and mandatory for obtain medical license (USMLE; United States Medical License Examination). 

The medical education in the United States are regulated and accredited by Liaison Committee on Medical Education (LCME). Medical Students of medical schools accredited by LCME can take USMLE and apply for the Matching to enter residency training (graduate medical Education, GME), which is regulated and accredited by ACGME (see below). After all medical training, physicians practice medicine as health care providers; during their practice, medical license needs to be renewed periodically. This requires continuous medical education (CME), which is regulated by ACCME. Specialty board qualification also needs for be renewed periodically for a life-long as medical doctors; this is regulated by specialty board association with requirement of maintenance of certificates (MOC). Therefore, for physicians, medical education never ends. LCME, ACGME and ACCME help to keep these physician’s medical educations in a consistent and persistent manner.

On the other hand, Japan has a 6-year medical school system (after graduation of high school). Medical education is regulated by Ministry of Education and Science. Graduates of medical schools can take a national examination to become MD (medical doctor). After that, there became a 2-year mandatory postgraduate training since 2004 (with a matching system), set by a law of Ministry of Health and Labor; however, this is a level of education similar to that of 2-year clerkship of the medical school of the United States. After this 2-year rule (mandatory residency training), residents can freely choose his or her GME for specialty (such as internal medicine, surgery) and super-specialty (cardiology, cardiac surgery and so on), which does not have any national-level regulation or accreditation (like ACGME of the United States). Physicians can choose their specialty (without matching residency system) freely and therefore there is no control mechanism to set the number of specialties in Japan. Medical license does not need to be renewed, and specialty board certification regulation is not standardized yet.


(Need for global standard medical education in Japan)

Because medical educational system in Japan was established a long time ago, and did not change (improve) much even in the era of rapidly changing health care and education method worldwide. Many developing countries (even European countries) have been trying to improve their medical education by introducing good/advanced educational system of the United States and other places whereas Japan has been conservative without much attempt of revision for further improvement.

However, the wave of globalization is and will be coming to Japan in medical education too. Japan needs to accept global standard while keeping good aspects of health care and education simultaneously.

There are a number of differences in graduate medical education (GME, residency/fellowship training) as described above (and also below) between Japan and the United States. Moreover, the content (curriculum) of medical (student) education differs significantly from that of the United States (and worldwide). Medical education in Japan focuses mainly on medical knowledge (which is necessary to pass national license exam). Particularly, 2-year clinical medicine does not require exposure to clinical work with direct patient care with responsibilities as student-doctors; students participate in clinical situation like as observers rather than actual participants in patient care. Clinical bedside teaching / learning is limited in terms its content and period of time. This is far less than that of the United States (regulated by LCME) or that considered as standard by World Federation of Medical Education (WFME).

 ECFMG (Educational Commission for Foreign Medical Graduates) has announced in July 2010 that, effective in 2023, physicians applying for ECFMG Certification will be required to graduate from a medical school that has been appropriately accredited. To satisfy this requirement, the physician’s medical school must be accredited through a formal process that uses criteria comparable to those established for U.S. medical schools by the Liaison Committee on Medical Education (LCME) or that uses other globally accepted criteria, such as those put forth by the World Federation for Medical Education (WFME).

Currently (as of January 2015), (almost) all Japanese medical schools are not providing sufficient medical education met by criteria of LCME or WFME; particularly, clinical medicine education such as bedside teaching is far less than that of the world standard. Presently, of course, the Ministry of Education and each Japanese medical school are aware of this critical issue of medical education and are trying to change Japanese medical school: the majority of schools are planning to start new curriculum from 2016 or 2017.

(Initial proposal: Previous project by JABSOM; this was actually not conducted)

Japanese medical schools are obviously interested in precisely understanding of the content (curriculum) and actual methodology of the US style medical education under LCME in order to prepare for achievement of accreditation announced by ECFMG by 2023. It is only several years from now but there is not much time; they need to revise their curriculum as soon as possible from now so that graduates from medical school would be educated under criteria met by LCME or WFME.

Therefore a number of Japanese medical schools have been showing interest in contact with and even visit to medical schools in the US, especially University of Hawaii, which has a long history of connection with many Japanese medical schools. If there exists a 4-year US style medical school in Japan, such school can be an excellent model in which all Japanese schools would be interested in and would be able to learn from.

However, currently, it is impossible or very difficult to create a new medical school (even traditional 6-year medical school), particularly the US style 4-year school, in Japan because of various reasons; several organizations have been working on such new school establishment for many years without success. It requires remarkable changes in law of medical education by the government and Ministry of Education, and such changes cannot occur quickly in Japan.

From a legal stand of view, it is possible or feasible to create a new US medical school branch (campus) in Japan. Actually in Japan there are already several undergraduate and graduate schools which are not Japanese schools but branches of schools of foreign countries including the US (like school of economics, law, and so on of Temple University Japan), although there is no US medical school branch in Japan. Worldwide, there are the US medical schools in other countries such as in Singapore.

The initial proposal was to create a branch of University of Hawaii (UH), School of Medicine (JABSOM) in Japan (most likely in Tokyo). It can be very small at the beginning, like 15 or 20 medical students. UH exports all educational curriculum and materials to there; basic medicine can be provided either in Japan or Hawaii but clinical medicine should be provided in Japan. Teaching faculty members are partly current UH faculty who can visit Japan periodically but (because they need to have medical licenses both in the US and Japan) US-trained board-certified Japanese physicians become main faculty members in clinical medicine. 

Graduates of UH branch medical school in Japan is basically exactly same as graduates of UH/JABSOM in Hawaii; they are educated to meet criteria by LCME and pass USMLE, and then apply for the Matching for residency in the US. These students/ graduates have medical education in English and at the same time they should be able to understand and learn in Japanese (because their patients are Japanese in clinical medicine education). They can be from Japan or Hawaii or any other countries as long as they can communicate both in English and Japanese. They complete GME (residency and maybe fellowship) in the US and become certified independent physicians in the US. After that, they can become certified Japanese physicians also by passing Japanese medical license examination and one or two years of clinical training in Japan (this is not sure at this moment because of possible changes of Japanese law).

The UH medical school branch can be a good model for current Japanese medical schools. Moreover, this medical school branch will educate and provide physicians who can become globally competent and active and will play an important role for Japanese medical education as well as that of UH.

Initially, I wanted personally to name this as “Project UHB (University of Hawaii Branch)” I believed this would be critical and probably urgent project which for sure help global-standardization of Japanese medical education, which is one of global missions of UH. 

(New proposal: Current project by JABSOM; this will be actually conducted from 2016)

The initial proposal as described above faced some difficulties due to a regulation of LCME (i.e., medical education conducted by US medical schools outside the United States is not deemed as LCME-approval education, and thereby graduates are not considered as the US medical school graduates) and financial requirement too high to sustain the project for a long period.

Therefore, a new project with modification of the educational system and method is proposed (by JM). This includes collaboration with a Japanese medical school(s) while the main goals/objectives of the above medical school branch and main contents/concept are maintained. It will be called Hawaii Medical Education Program (HMEP).

Briefly, the JABSOM educational contents are exported to Japan and a Japanese medical school will use them for selected medical students who have strong motivation and activities to be educated under globally standardized curriculum. The graduates of HMEP will be graduates of Japanese medical school and thus first acquire MD degree and MD license in Japan whereas they will have a strong candidates for the US Matching to enter the US residency training.

The details of this project will be described in a separate document. This project will be conducted by JABSOM and a Japanese medical school, and JrSr will support this as a liaison organization in Japan.

(Globalization of Japanese medical education as well as GME/residency training)

Japan is still a pretty closed nation in terms of medical education while many other countries, especially developing countries including Asian countries have been active and enthusiastic to import the US or European medical educational systems for educational standardization and globalization. Unless Japan becomes “open” to outside and catches up with globalization, Japan will become an underdeveloped nation in medical education in global environment in 10 years, I believe. Global standard has been ongoing in hospital/ health care organization accreditation (JC-I: Joint Commission International) and residency training / GME accreditation (ACGME-I, as described below).

Similarly, in near future, global accreditation organization like LCME-I or WFME-I may develop. This will be stricter than the regulation set by ECFMG.  Japan must be prepared for such global changes ahead of time. Globalization is not Americanization of Japan. Rather, it should be both-ways. While Japan needs to accept and import good things from international countries, Japan should bring out or export good things of Japan internationally; there are many good advantageous subjects or areas in Japan in health care, art & science of medicine, and even education. The time has come for “open nation” for globalization in medical education as well as TPP (Trans-Pacific Partnership). Japan should not be passive in this regard but be much more active!

JrSr can become the base in Japan to carry out medical education globalization of Japan through HMEP. Such base can be a leader of global-standardization of other Asian countries as well as that of Japan. Once the base is established where American and Japanese professionals can exchange and interact, it can communicate and inter-exchange with other Japanese medical schools and those of foreign countries.

(Benefits of each organization)

1. JrSr: The mission of JrSr is help /support health care providers, especially physicians to be educated so that they can become globally competent and some of them can be leaders in global health care and medical education. From this mission view, this project of HMEP is an ideal opportunity.

2. UH JABSOM: One of missions of UH is to support pan-pacific global health care and education. Therefore, this project can be helpful remarkably to achieve such mission. Current UH educational systems are exported to Japan and then other Asian countries; Staff and faculty members will get meaningful and unique experiences through this project which is the first trial project, which can be expanded if successful. Moreover, JABSOM medical students at Kakaako can interact with medical students in Japan and possibly can rotate and have credits at Japanese medical school teaching hospitals. JABSOM students (and even residents) and faculty members will have more opportunities to work globally. HMEP can be a base for activities in Asian countries as well as in Japan. Global /Japanese educational activities of UH School of Nursing can be performed through this HMEP project. 

3. Japan: Current Japanese medical schools will have a number of experiences by collaboration and communication with such HMEP in Japan (rather than visits to the US or Hawaii). The Ministry of Education and each Japanese medical school can better be prepared for 2023 ECFMG requirement (as mentioned above). The current Japanese government is positive for TPP; however, medical education is one of the lowest priorities in this regard. Either along with TPP or outside TPP, this project will help open Japan nation in global manner.

4. The US: TPP will be going on in many aspects between participating countries including the US and Japan. Currently, health care is one of subjects the US and Japan has been discussing in this TPP, but education / medical education can be an important issue in future. If HMEP is established in Japan, it will provide the US and Japan with excellent model to expand educational partnership between both countries.

5. Supporting / sponsor organization: No mater whatever organization becomes a sponsor for this project HMEP, it deals with education and medicine (health care), which is considered to be a public-interest and deemed as non-profit non-private activity. In addition, its activities are not limited in Japan and eventually will have a strong potential to expand to other countries worldwide. If successful, the reputation of the supporting organization should improve. Companies dealing with health care or educational products can use this project for new technological development or advertisement of products. Tax benefit or exemption can / may be obtained.

(Issues to be addressed)

1. The system: Use of UH JABSOM medical educational system

2. Manpower: Faculty members can be provided by JrSr (mostly JrSr friends/ colleagues) and UH (partly)

3. Financial-Budget

4. Place: UH/HMEP-affiliated teaching hospital, current Japanese medical school’s teaching hospitals and new international teaching hospitals

5. Legal / regulation issues

6. Others

 (Other courses which may be helpful)

- Premedical course (in order to prepare for applying to HMEP)

- English course / class

Original written by Junji Machi, April 22, 2013 

Modified and added: May 4, 2013, January 2014, January 2015)




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