Nihon Geka Gakkai zasshi
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Nihon Geka Gakkai zasshi · Jun 2003
[Strategy for surgical treatment of intraductal papillary-mucinous tumors].
The prognosis of malignant intraductal papillary mucinous tumors of the pancreas (IPMTs) should be considered more favorable than that of ordinary pancreatic ductal carcinoma. However, the preoperative diagnosis of malignancy is extremely difficult in IPMT. IPMT with a main pancreatic duct of less than 7 mm, or cystic lesion of less than 30 mm (branched type), or intramural nodule tumor of less than 4 mm, should be observed without performing surgery and followed carefully. ⋯ Which procedure should be selected or performed? A radical operation should be performed with lymph node dissection if a preoperative diagnosis of malignancy is made. If cancer cannot be ruled out in an IPMT, a function-preserving procedure, such as pylorus-preserving pancreaticoduodenectomy, pancreatic head resection with second-portion duodenectomy, segmental resection, partial resection, or spleen-preserving distal pancreatectomy should be selected, and one of these procedures should be carried out with group I lymph node dissection. The greatest challenge in IPMT is making the diagnosis of benign or malignant and selecting the most appropriate treatment.
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Nihon Geka Gakkai zasshi · Apr 2003
[The relationship between surgical and its subspecialty boards in Japan].
This article deals with a 7-year endeavor to reform the board certification system of the surgical specialty and its subspecialties. The most important lesson learned is that the societies running the board must work not for the societies but for trainees and patients. The new postgraduate surgical training program is an overlapping system composed of a general surgery program of 5 years and optional subspecialty program of 7 years. ⋯ Those who pass it and experience 350 general surgery cases within 5 years are eligible for oral examination by the surgery board. Those who pass the written examination for general surgery and experience a certain number of subspecialty surgeries within 7 years after the start of training are eligible for the oral and/or written examinations for the subspecialty board. The surgical societies are responsible for constantly improving the quality of the surgical training programs and qualification systems so that board-certified surgeons are accepted and treated as true surgical specialists in this country.
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Nihon Geka Gakkai zasshi · Apr 2003
[The new national postgraduate residency program and its relation to the general surgery board in Japan].
The new national postgraduate residency program has been proposed to start from 2004 after long-term discussion. This new program consists of 2 years super-rotating program with focusing onto the primary care. It requires basic clinical training in surgery for 3 months in the first year and extra 6 month can be used for optional period. ⋯ Also, a large number of postgraduate residents move from the University hospitals because the regulation sets the number of residents according to the hospital beds. There are various tasks and problems being proposed for these abrupt changes in the training system of doctors and especially for surgeons. This article summarized the interrelationship and problems with discussion.
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Nihon Geka Gakkai zasshi · Mar 2003
[The new Japanese board of surgery for general surgery specialists].
The postgraduate training and board certification system for general surgery has just reached a new era with the upgrading from the previous system for registered surgeons. The new system consists of first-step training of a minimum of 5 years (initially 4 years or more) covering general surgery, emergency medicine, and basic knowledge of subspecialties. ⋯ The new system of a general surgical training consists of a residency training program with registered hospitals and a minimum requirement of surgical experience. At this starting point, the Japan Surgical Society should take responsibility for this new training system, together with the related societies of subspecialties, in this new step for the official and adequate public qualification of surgeons.
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Nihon Geka Gakkai zasshi · Mar 2003
[Compulsory postgraduate clinical training and surgical education].
In April 2004, a new training system for physicians and surgeons will take effect in Japan. All medical graduates, after passing the National Medical Practitioners Examination, are to complete a two-year compulsory clinical training program, which includes rotations to the clinical services of internal medicine, surgery, emergency medicine, pediatrics, obstetrics and gynecology, psychiatry, and regional primary practice. ⋯ The trainees will be provided with reasonable stipends. In accordance with the introduction of new system, the current surgical training system is to be renovated and the terms for surgical trainees to be eligible for surgical specialty boards must be reviewed.