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1.　NKP Mission

Pioneering standardized residency training (Graduate Medical Education, GME) in Japan by introducing the advantageous US educational system in the 21st century:

Standard training of a resident to be an independent professional physician / practitioner who is competent (6 competencies of ACGME) and to provide safe and standard practice with patient satisfaction.

2.　NKP Goals

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Training of generalists in major fields, including general internal medicine, general surgery, pediatrics, obstetrics-gynecology, family medicine, emergency medicine, and critical care medicine under the ACGME guideline (not necessarily accreditation by ACGME).

Global medicine with establishment of an international hospital (approval by the Joint Commission International) by a support of Thomas Jefferson University (TJU) and University of Hawaii (UH)

24-hour open ER (Emergency Room) by the introduction of the so-called North American EM system.

Open to outside: cooperation with other Japanese and foreign residency programs in terms of respecting diversity and inter-exchange to improve educational process.

Establishment of “Team Care” with nurses, pharmacists, dieticians and other co-medical professionals for both health care and education.

Becoming a Role Model in GME in Japan and in developing countries (like Asian and Pan-Pacific regions).

In future, on the basis of NKP, foundation of Noguchi Medical School.

3.　Background of idea for NKP by NMRI

　In Japan, residency training / GME is not standardized; there is no professional organization (like ACGME of the US) which is responsible for the accreditation of residency programs of all specialties. As a result, the level of residency education varies remarkably depending on the program, and moreover on an individual physician/resident. In addition, the concept of “standard care” is not well educated in GME despite recent recognition of importance of evidence-based medicine (EBM). There is a specialty certification issued by each specialty society; however, specialty-certificate does not require the completion of residency training under the strict guideline and regulation (such as graduation from accredited programs).

　Another problem recently encountered (or recognized) in Japan is the defective (not well organized) emergency care system, particularly in many cities including Tokyo. It is common that patients with acute ill cannot be taken care for more than several hours because the ambulance cannot find an ER which accepts emergency patients. This is partly due to difference in the ER system in Japan but also due to little formal education (residency training) in Emergency Medicine.

　Japanese physicians generally cannot take care of English-speaking patients or foreign people because of problems in communication and frequently lack in standard care. Therefore, many foreigners are facing troubles in health care when staying in Japan. There are only a few international hospitals (St. Lukes International Hospital may be the only one in Tokyo).

　NMRI has been supporting young physicians, residents and students through international exchange (mostly sending them to the US) over the past 26 years, particularly with a strong supporting effort of TJU (JMC) from the beginning under supervision of Dr. Joe Gonnella, and later UH under Dr. Satoru Izutsu. There are approximately 300 registered Noguchi Alumni members, including more than 80 US board-certified physicians. About three-quarter of them are back to Japan, practicing medicine all over Japan. Unfortunately not many of them can continue patient care and education in the same manner as they had learned in the US because of difference between Japan and the US in standard care, residency training method, and mostly difference in the education system.

　For more than several years, NMRI has been considering to establish a new residency training program in Japan in order to improve Japanese GME, and in turn to improve health care for Japanese patients. Since the beginning of this year, the Noguchi Alumni members unified more strongly to provide Japanese young physicians and students with better education through the NMRI seminars. In addition, together with NMRI, the Noguchi Alumni has proposed an idea of a novel residency program, NKP, as summarized above. The key and unique points of NKP are 1) standardized GME for generalists of major fields, 2) international hospital, and 3) 24-hour emergency care.

　With leadership of Mr. Yoshi Asano and other senior members, NMRI looked for a cooperative partner hospital, which can provide NMRI with resources for NKP to get started. Eventually, NMRI contacted one association, JADECOM (Japan Association of Developing Community Medicine) formed by the alumni of Jichii Medical School (JADECOM has more than 20 hospitals in Japan particularly for rural medicine, with a total annual budget of $ 600 million). NMRI are in the final process of collaboration agreement with JADECOM. Once this agreement is approved by both entities (actually it was approved by the Board of Directors of JADECOM on Nov 5, 2009), it is very likely that NKP will begin at one of JADECOM hospitals near Tokyo (“Tokyo Bay Urayasu-Ichikawa Medical Center”) in 2012. This will be a newly re-built medical center, and NMRI/NKP can conduct our own GME with above-mentioned mission and goals by selecting teaching faculty members by ourselves.

4.　Standardization of GME under the ACGME guideline

　This statement is a little overemphasizing the ACGME, but for anyone who is not familiar with ACGME, pls take a look at their website: www.acgme.org

　The bottom-line is to use the advantage of ACGME as much as possible, but also there are many good things in Japan, which we would like to employ too. The goal is not obtain the accreditation of ACGME (at least at the beginning), but to establish the best Role-Model GME program in Japan by using advantages of both Japan and the US. NMRI has some personal relation with ACGME people and therefore we would like to take an advantage of it whenever needed. The following is my note to one person of ACGME; pls read it just for your info.

　“In order to standardize the GME residency training and to become a role model of such residency system in Japan, we would like to use the ACGME Standards/Guidelines. As a faculty member of general surgery residency program of Department of Surgery, UH, I have recognized the strict regulation and understood the difficulties in comply with the ACGME standards. In particular, introducing the ACGME standards to Japan would be not easy at all because of lots of differences in health-care systems and educational systems (many of them controlled by the government by “top-down” methods).

　However, at the same time, we NMRI believe that NKP should follow the ACGME standard guidelines as much as possible in order to provide the best GME to young enthusiastic Japanese physicians. We also believe that NKP is capable of conducting such education with a number of the US board-certified physicians and support of TJU and UH. Moreover, we would like to explore the potential support of the ACGME.

　We understand that one of visions of ACGME is to become a world leader in GME accreditation efforts. Worldwide, there are many countries where GME is not well established or organized; we think Japan is one of them despite the high level of health-care system. At this moment, we do not know any specific activities of ACGME in support of GME in foreign countries. We NMRI would like to discuss about it in future”

5.　Visiting Education System (VES) of NKP

　In order to further unify the Noguchi alumni as educators and heath care providers, we have proposed “Visiting Education System (VES)”. The purpose of VES is to recruit more alumni members and other competent physicians in the process of NKP development. It also serves for the alumni to more actively participate in educational work in Japan. This is for both domestic and international alumni or physicians.

　In this VES, alumni register their profile and desire for teaching and even patient care activities in Japan; for example, one can say “I am a US Board-certified general surgeon, and I would like to visit any institutes in Japan for lectures, conferences with residents / students, teaching round, etc 3 times a year when I come back to Japan from the US. I can do lectures and conferences on abdominal / GI surgery or medical education, particularly about PBL….”. In order to facilitate this VES registration, a VES Form is provided; we would like our members to fill it out whenever possible. There is no obligation for members even after submission of this form, and the contents in the form can be changed any time. Pls see the attached VES Form.

　We, NMRI and Noguchi Alumni, are at an exciting period with likelihood of establishing NKP by ourselves in near future. This requires understanding, cooperation, dedication and commitment of a number of Noguchi alumni. I sincerely hope we can work together for this endeavor to achieve our goals and a future dream.

November 7, 2009

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　Junji Machi, MD, PhD, FACS

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　President of NMRI

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　Professor of Surgery, UH

NKP Update　　02/20/10

　Since the above statement, there have been several progresses in NKP:

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NKP/NMRI and JADECOM have reached an official agreement on December 1, 2009, in order to collaborate each other for establishment of our own residency program / GME, “JADECOM-NKP”.

Since then, Dr Shigeki Fujitani, Dr Yasuharu Tokuda and I have been working together with NMRI and JADECOM in order for NKP to get started. Initially, NKP will support the residency training at one of JADECOM hospitals (Tokyo Kita Shakai-hoken Byoin) from April 2010.

From April 2012, NKP will start our own residency training at Tokyo Bay Medical Center, a newly-built JADECOM hospital. Currently we NKP are in the process of recruiting and selecting physicians / Noguchi alumni who will commit themselves to become NKP faculty members.

The ACGME (of the United States) has opened a new section “ACGME International” just recently, which will support standardization of GME around the world in future. NKP would like to follow the progress of ACGME International.

Many Noguchi Alumni have participated in the VES of NKP, which we would really appreciate. It will take several months more before this VES is actually up running for participants. We will inform them of its activity once it is started.

February 20, 2010

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　Junji Machi