The Japanese Association for Thoracic Surgery (JATS) is well known to have contributed significantly to the development of thoracic surgery during the 60 years since its establishment in 1948. Thanks to advances in this field that have saved the lives of many patients suffering from serious disorders, and the proactive application of surgically less invasive procedures, levels of thoracic surgery in Japan and its therapeutic outcomes now rank alongside those of Europe and the United States, and even exceed them for some disorders. If we shift our gaze, however, to the environment facing thoracic surgery and the position in which our field is placed, the situation is grave and fraught with a host of problems. It is vital that these issues be faced now and the situation improved. Having been appointed President of JATS in such a difficult period, I hope to be able to rise to the challenge that this responsibility entails.
My fundamental philosophy concerning JATS is to improve its unique nature as a comprehensive association for thoracic disorders associated with cardiovascular, general thoracic, and esophageal surgery, and my focus is on fulfilling the aspirations of our members. My predecessor, Professor Matsuda, placed the greatest emphasis on this fundamental philosophy, and I also regard its implementation as primary. I would like to set out polices for implementing this basic philosophy from six perspectives: 1) training; 2) the specialist certification system; 3) scientific surveys; 4) improving working conditions for thoracic surgeons; 5) international exchange; and 6) the annual scientific meeting.
- Training: The heart, major blood vessels, lungs, and esophagus, which constitute the main thoracic organs, are anatomically adjacent to each other, and their anatomical features and physiological and pharmacological reactions must be understood when performing surgery. From this perspective, I believe it is highly significant that JATS offers postgraduate courses and hands-on seminars as opportunities for the sharing of knowledge. I also believe that the development by JATS of a future rotation program between its three specialties to provide instruction for surgeons training for specialist certification will be an effective means of improving the content of such training.
- Specialist certification: For surgeons specializing in cardiovascular and general thoracic surgery, the Japanese Board of Cardiovascular Surgery, formed jointly by three societies/associations, and the Japanese Board of General Thoracic Surgery play central roles. Each has produced its own regulations, the content of which is gradually being improved. The conditions for applying for and renewing specialist certification are important, with the question of how training is implemented to acquire specialist certification for the first time being a particular point of concern. From this perspective, the system for registering cases of surgical experience under consideration by the Japanese Board of Cardiovascular Surgery is of great interest, and I am closely watching future developments. Reflection of the results of registration at training institutions is important for improving this registration system, and I believe that parallel development of such a system should also be considered.
Another important matter is to respond to the concerns of surgical residents about whether they can combine the acquisition of specialist certification with entry into a graduate school of medicine, and I believe that in the future we will need to consider the development of alternative programs for them to obtain specialist certification.
- Scientific surveys: Academic societies should take responsibility for assessing and analyzing therapeutic outcomes in Japanese hospitals and disclosing the results, in order to help improve these outcomes. JATS has already gathered and analyzed data in the three areas of cardiovascular, general thoracic, and esophageal surgery. We are making progress in the field of cardiovascular surgery with the development of a database of adult cases, and will be making proposals on subjects such as the necessity of consolidating institutions based on these results. Such scientific surveys require that academic societies exceed a certain size and membership, and I believe that the JATS should continue to play an important role in advancing such investigations. In the near future, we will be producing a database for the field of congenital cardiac disease, and such a system for the areas of general thoracic and esophageal surgery should also be considered. The data obtained will have an important role to play in dispelling prejudice and misunderstandings on the part of the public and the media, as well as in the consolidation of institutions and the improvement of working conditions for hospital doctors.
- Improving working conditions for thoracic surgeons: This is an important matter, and the following factors must be considered in order to achieve improvements: a) numbering system changed to reflect English convention improving the labor productivity of doctors on the basis of advances in “healthcare specialization”; b) consolidating institutions; c) bringing to light “healthcare quality”, in order to resolve public misconceptions and dispel media prejudices about healthcare; d) assessing the legitimacy of health technology; and e) raising the level of interest in medical policies concerning doctors and active involvement in medical policy, by means of educational activities aimed at politicians.
- International exchange: I believe that networking with international associations (such as AATS, STS, ECTS, and ACVTS) with respect to training and research will be important for the further success of JATS activities. In terms of training, the postgraduate courses and the commissioning and dispatch of lecturers to provide hands-on seminars are primary, while in terms of research we intend to press ahead with prospective randomized trials covering multiple institutions, with JATS playing a central role in areas such as drawing up protocols, securing funding, and selecting institutions in which trials will be performed.
- Annual Scientific Meeting: This year the Annual Scientific Meeting will be held for the 63rd time, having undergone many changes during its history. The Annual Scientific Meeting is JATS’s most important event, and its increased success is a vital issue. Conventionally, with the exception of the selection of presentations, scientific meetings have been the sole responsibility of the Chair. However, in recent years this has been supplemented by consultations with the Program Committee, and meetings are now put together by taking a variety of opinions into consideration. This is a very welcome trend, and I believe that in order to develop attractive meetings for our members, a proposed program should be produced at an early stage and used as the basis for exchanging views with the Committee for Scientific Affairs and others. I also regard collaboration with the Japanese Society for Cardiovascular Surgery, the Japanese Association for Chest Surgery, the Japan Esophageal Society, and the Japanese Society of Gastroenterological Surgery as necessary. All of these societies are associated with JATS, to consider how scientific meetings should be held and to put together meetings that take advantage of their individuality.
I believe that as President, my most important task is to obtain the trust and satisfaction of members. I have set out numerous propositions in order to achieve this, and intend to carry these out, focusing on the proposals outlined above, in cooperation with JATS members.