Japan’s Postgraduate
medical education
PG-EPOC2-（Postgraduate ） E-Portfolio Of Clinical training

Topics
1. Introduction
2. Basic overview of Japanese medical education
3. Comparison between other countries
4. Post graduate junior residency program
5. PG-EPOC2 - what is possible and what is actually done

Introduction - Japan’s PG medical education
Japan’s medical education has gone through rapid change in the last few years due to external pressure
from WFME (among other things), most importantly the 2023 issue:
Medical programs that does not fulfill the WFME standard are not eligible to even sit for USMLE, andcannot be accepted into US residencies.
Due to the above situation, rapid change has been happening in the field of medical education- be itundergraduate or postgraduate.

Basic overview of Japanese medical education
Medical school
admission

Post CC OSCE

National medical practitioners qualifying examination

Clinical medicine
Basic sciences

Juniorresidency

6 years of undergraduate medical school 2 years of Juniorresidency

Senior residency

Senior residency(Length dependson department)
Minimum 3 years

Board certification examSpecialist training

China, France, India
Japan, UK, Australia*
Colombia, Dominica

Egypt, Nigeria

US, CanadaAustralia*

Post -graduate medical education : junior residency
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Typically, the junior residency lasts 2 years- (In cases of joint programs with cooperative teaching hospitals orfacilities, at least 1 year of training must be conducted at a sponsoring hospital. Up to 12 weeks of training atcommunity facilities can be counted as conducted at a sponsoring hospital)
It is a rotation system that requires junior residents to rotate in various departments, some mandatory and otherselective.
Mandatory rotations are○ Internal Medicine : Cardiology, Neurology, Nephrology, Pulmonology, Endocrinology, Gastrology○ Surgery: General surgery○ Emergency medicine■ Up to 4 weeks of rotation at an anesthesiology department can be counted as a period of training inemergency medicine*○ Pediatrics○ Obstetrics and Gynacology○ Psychiatry○ Community medicine
Elective rotations○ Radiology, Rheumatology, Laboratory medicine, Surgery subspecialities etc

Information from MHW https://www.mhlw.go.jp/stf/newpage_03924.html

It is mandatory to provide opportunities for residents to learn infection control (in -hospital infection,sexually transmitted infections, etc.), preventive medical care (vaccinations, etc.), response to abuse,
support in social rehabilitation, palliative care, advance care planning (ACP), and attend
clinicopathological conferences (CPC), all necessary for fundamental clinical practiceInformation from MHW https://www.mhlw.go.jp/stf/newpage_03924.html

Signs and Symptoms to be Experienced / Diseases and Disorders to be Experienced

Information from MHW https://www.mhlw.go.jp/stf/newpage_03924.html

Signs and Symptoms to be Experienced / Diseases and Disorders to be Experienced

Information from MHW https://www.mhlw.go.jp/stf/newpage_03924.html

Signs and Symptoms to be Experienced / Diseases and Disorders to be Experienced

In order to fulfill theserequirements, the following
system has been developed…

PG-EPOC2●●●

Short for E-POrtfolio of Clinical training, it is an online clinical educationassessment platform
The assessment format follows the instructions given by the Ministry of Healthand Welfare (discussed in the previous few slides)
It is designed to manage the resident’s working assessment logs, andassessments given by the healthcare professionals, patients and senior doctors.

EPOC2 server(the actual serveris in UTokyo)

Hospital manages theClinical internship

PG-EPOC２
patients

Assessor doctors
Residents being assessedList of things that is possible using the PG
EPOC2
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Log of clinical cases experienced by the trainee
360 degree assessment from:
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Detailed assessment with comments from the assessors
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Senior doctors from each department
Patients
Health professionals e.g. Nurses, Radiology technicians, PT, OT, ST…
Mini -CEX, DOPS, CbD

Feedback form for junior residents to raise concerns regarding the training programLog of clinical skills training with assessment from seniors
Academic research using big data from EPOC2

List of things that is done using the PG EPOC2
Really depends on the hospital training program, but most hospital training program requires the log ofclinical cases experienced by the trainee.
Currently, (as of Feb 2022), the data from PG EPOC2 is being used for various studies(information via
https://epoc2.umin.ac.jp/) :●●●●医師の臨床研修評価関連データの分析
EPOC2 データを用いた侵襲的医行為の評価方法の確立のための解析および研修医の評価に影響を与えうる要因の分析
医師臨床研修と連携可能な卒前の臨床教育評価システムの 開発・運用・評価とデータ分析「ICT を基盤とした卒前卒後のシームレスな医師の臨床教育評価シ ステム構築のための研究An example of the userinterface of the experienced
case submission form.
The junior residents are
required to input the patientID, followed by anonymisationof the ID by the resident
entering a unique password.
The case is then given the“EPOC case ID”.

Residents are required to specify thedepartment, and time (or time frame) of
which the cases were experienced.
The “memo” area can be the brief details ofthe case, which serves as a message to thereviewing senior doctors.
A reminder says “please take extra caution as
to not include any details that may lead toidentification of the patient’s identity orpatients’ personal information”.

An example of the PG-EPOC2 user interface. The page below shows the “experienced cases” in red, and“reviewed cases” in blue. At the end of the 2 year junior residency, all of these categories should beexperienced and reviewed.

SummaryJapan has a unique postgraduate medical education system that has gone through rapid change in thelast 2~4 years, due to external pressure.
There is an on-going change in the field of PG medical education as well, a shift that enables usage of big
data and possibly a more outcome-based education.
If implemented wisely, it could help in the quality control of medical graduates and professionalshowever, given the current stage of early implementation, there is a huge discrepancy in the level ofimplementation as well as the amount of work being put in (for the fulfilment of residency training)among hospitals’ training programs.

Thank you for your kindattention.

References●●●●

https://www.ecfmg.org/accreditation/
第４回医道審議会医師分科会 医師臨床研修部会 令和５年12月１日 参考資料４医師臨床研修指導ガ
イドライン －2023 年度版－
Wijnen-Meijer, M., Burdick, W., Alofs, L., Burgers, C., & ten Cate, O. (2013). Stages and transitions inmedical education around the world: clarifying structures and terminology. Medical teacher, 35(4),301-307.
https://epoc2.umin.ac.jp/