Education in gastroenterology at a Japanese hospital. Medical and surgical aspects.

Admission to a standard 6-year university course in medicine is very competitive in Japan. Medical practice is dominated economically by a national health service and epidemiologically by diseases of the upper gastrointestinal tract. Gastric cancer is very common, although diseases familiar to Western society are increasing. A detailed examination of the educational program in gastroenterology at the Kitasato University Hospital, one of the newer private teaching hospitals in Japan, reflects the cultural and environmental differences from an American experience. A residency system on the American model has been developed at this hospital. The extensive training in gastroenterological diagnostic techniques, including contrast radiography and endoscopy, is most striking. The ability to describe pathological abnormalities with precision is given great emphasis. Subspecialty training in medical or surgical gastroenterology is not standardized and is oriented primarily toward research and the development of expertise in a limited academic area.