Surgical education and postgraduate training in Japan.

Japanese students must pass very competitive entrance examinations to enter medical school after graduating from high school at the relatively young age of 18. There are currently 80 medical schools in Japan, with approximately 7700 students graduating annually. Since 2004, after passing the National Medical Board Examination, all medical graduates are required to complete a 2-year period of clinical training to become medical practitioners. Surgical residency starts only at the third postgraduate year. The Japan Surgical Society initiated a new surgical board certification system in 2002, defining minimum requirements to qualify for the specialty. Four subspecialties are recognized along with general surgery: gastroenterological surgery, cardiovascular surgery, thoracic surgery, and pediatric surgery. General surgery board certification is a prerequisite for subspecialty board certification. Notwithstanding these revisions, the number of surgery candidates is steadily declining because work conditions in the surgical profession are viewed as unfavorable. To regain some level of the previous attractiveness and glory of this specialty, surgeons need to receive significant incentives that counteract some of the downsides of the life of a surgeon.