Asia Pacific Family Medicine 2009, 8:9 http://www.apfmj.com/content/8/1/9 We have to take the points of contention below into account in this study. Firstly, further research from other medical schools to assure generalizability will be needed, as our research was conducted in only one medical school. Secondly, researchers' vantage points also have to be considered. Two of the authors (HK and MMa) are bed- side training instructors and supervise all students, which might have influenced interviewees' responses -- they may not have given sufficiently candid opinions regarding this research. Finally, potential linguistic problems remain, namely, we can never convey certain subtle differences in translations from Japanese into English, even though the attempt for back translation was made. As suggestions for further studies, we suggest a longitudinal study for meas- uring medical students changing their points of view, and addition of other medical schools to the study. Based on the research results in this study, we must conduct more comprehensive, data-generating interviews and explore the students' thoughts, experiences and perceptions more deeply. Conclusions In our study, 7 main themes emerged, and at least some effects of the hidden curriculum in medical education likely exist in common between the UK and Japan, despite the differences in their demographic backgrounds, cul- tures and philosophies. The authors are clarifying the whole picture of the effect of the hidden curriculum that is not easily perceived but deeply affects the students' behavior [21] in medical education. We conclude our paper with Hafferty's compelling suggestion, "There is much work left to be done, including the critical step of framing change in terms of restructuring learning environ- ments rather than in terms of modifying curricula [5]". In the case of the learning and training environment for Jap- anese primary care physicians, as we stated, systematically few doctors have been fostered as role models due to the tendency towards specialist, as opposed to generalist, training. This negatively affects the career choice and recruitment of younger general physicians. However, the historical integration of three Japanese pri- mary care societies, the Japanese Medical Society of Pri- mary Care, the Japanese Academy of Family Medicine, and the Japanese Society of General Medicine, into a new organization (the name remains yet undecided), occurred in August 2009. This organization aims to establish a comprehensive certification system and develop the spe- cialty of primary care in Japan. Although still in its infancy, it is certainly beginning to sow the seeds of foster- ing the next generations of Japanese primary care physi- cians. Competing interests The authors declare that they have no competing interests. Authors' contributions MMu designed the study. MMu and HK conducted inter- views and analysed preliminary data. MMa, the senior researcher, advised on the qualitative methodology and modified the initial results. All three authors discussed, revised, and approved the final result. MMu wrote the ini- tial draft of the manuscript and all three authors revised and finally approved the manuscript. MMu is the guaran- tor. Ethical approval Formal ethical approval was obtained from The Univer- sity Ethics Committee at Hokkaido University. Disclaimer Part of this paper was presented at the WONCA 2009 Asia- Pacific Regional Conference, Hong Kong, June 2009. Acknowledgements We thank all medical students who took part in our research. Also we pro- foundly express our gratitude to Rachele Stucker for proof reading, and Ayumi Murakami for back-translating. References 1. 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