Lessons learned in developing family medicine residency training programs in Japan

This qualitative project utilized a long interview research design. Questions focused on four topics: 1) circumstances when becoming chair/faculty member; 2) approach to starting the program; 3) how Western ideas of family medicine were incorporated; and 4) future directions. We analyzed the data using immersion/crystallization to identify recurring themes. From the transcribed data, we selected representative quotations to illustrate them. We verified the findings by emailing the participants and obtaining feedback.Participants included: five chairpersons, two program directors, and three faculty members. We identified five lessons: 1) few people understand the basic concepts of family medicine; 2) developing a core curriculum is difficult; 3) start with undergraduates; 4) emphasize clinical skills; and 5) train in the community.While organizational change is difficult, the identified lessons suggest issues that merit consideration when developing a family medicine training program. Lessons from complexity science could inform application of these insights in other countries and settings newly developing residency training.Like many countries in the world, the discipline of family medicine is not well established in Japan. This is surprising, given an effective national health insurance system [1,2], and large number of ambulatory care physicians in Japan. In 2002, about 34.4% of physicians reported working as a solo practitioner or as an employee in a "clinic" (defined as a physician's office without beds or with fewer than 20 beds) [3]. The majority of Japanese physicians receive specialty training in university hospitals or large hospitals for five to ten years, then about one third of them become private practitioners in a clinic [4]. Japanese physicians are not restricted by regulations based on their training or board certification and can label themselves by the kind of practice they wish to have [5]. By default, these sub-specialty-trained doctors become Ja