Graduate medical education at Chubu Hospital, Okinawa, Japan.

Japanese medical education differs from U.S. medical education in a number of ways. In particular, Japanese medical students have little hands-on contact with patients in their six years of medical school; in post-graduate training, Japanese residents spend most of their time caring for tertiary care patients with complex diseases, and they generally get little practice in performing such basic patient-care tasks as history taking and physical evaluation. Invited to be a visiting professor at Japan's Chubu Hospital (which is affiliated with the University of Hawaii), the author spent three months working with Japanese pediatrics residents. During this time, he studied the residents' clinical experiences and levels of competency in such basic pediatrics skills as failure-to-thrive workups, estimation of dehydration and fluid replacement, detection of strabismus. He discusses his conclusion that these residents are ill prepared for general clinical work and the possible consequences of this poor preparation. Finally, he briefly reviews similar concerns raised by the American Academy of Pediatrics about how well pediatrics residents in the United States are prepared for general clinical practice.