Differences between the US and Japan - Education system:

I will attempt to do a brief analysis from the top down: “professors” à attendings à residents à medical students. The first day that I started working in the cardiac surgery department, I noticed a big difference from the US: there was no resident! The cardiac surgery department has about 10 staff surgeons, but only 3 of these 10 have the “professor” ranks. The professors usually are much older (at least 50) and have more experiences in operations. The other 7 are just attendings. How this works is that the “professors” are the real first operator in the OR, and the other attendings were merely assisting them during the case. Occasionally, the attendings will get to be the first operator, and the professors will assist, but these are only in straight-forward cases. Therefore, the attending surgeons actually act like the residents in the US in my opinion.

So where are all the residents? Apparently, most residents work in community/county hospitals where the standard of care and complexity of cases are lower than an academic hospital like Nagoya. It is interesting to note that in Japan, medical students graduating from med school will go do a 2-year internship year (very similar to the transitional year in the US, where they do rotations in all disciplines), and then go into specific residency of their choice. To specialize in some disciplines like CT surgery, there’s technically no “fellowship” like in the US; the residents that are finished with their residency will get hired by the specific department and start their training there (it’s more like an apprentice, in my opinion.)

Finally, onto med students. The medical education in Japan is like everywhere else in the world (except for the US). High school graduates enter medical school at the age of 18 years old. It takes 6 years to get an M.D. degree. Therefore, most med students earn their MD at 24 years old, which is A LOT younger than their counterparts in the US (around 28 years old, I think.) When the Japanese med students do their clinical clerkships, they are mainly just observing. In the OR, med students really just stand around and can’t touch anything. They are allowed to scrub in, however. But scrubbing in usually makes things a lot worse for med students, because they cannot really move much to get a better view of the surgical field.

In summary, I feel that the med students in the US are really acting like interns in Japan in terms of what we can do (writing notes, assisting in surgeries, etc). The Japanese system seems to be more fixed and it definitely takes longer to gain autonomy amongst doctors.