Happy New Year! I would like to express my gratitude for the approval of my reappointment as president of the Japanese Association for Thoracic Surgery (Takashi Kondo, Chairman) at the General Assembly of our 66th Annual Scientific Meeting; held last October. On the basis of my experiences over these past two years, I feel a renewed sense of determination to devote my full energies to the next two years.

Our principal concern over these next two years will be the establishment of a new system for specialists.

On August 6, 2013, the inaugural meeting of the Organizing Committee for the (tentatively named) Organization of Japanese Specialists (OJS) was held regarding the concept of “impartial third-party organizations,” which has been a catchphrase of the Ministry of Health, Labour and Welfare’s Study Group on the Role of Specialists (SGRS). The individual specialist committees are to be affiliated within the OJS, but in practice, this will mean that some or all of the members of each of the existing association-led specialist committees will participate as representatives or spokespersons (such as for the tri-associational Japanese Board of Cardiovascular Surgery and the Japanese Board of General Thoracic Surgery).

The backbone of the new system will consist of 1) the introduction of a training program system, 2) OJS certification of training programs and specialists, and 3) the formation of training complexes as sites for putting the training programs into action. While these complexes will be made up of flagship hospitals (such as university hospitals) and other cooperating institutions, questions of scale and area have yet to be settled. With regard to area, the SGRS report contains the wording “…as training facilities in collaboration with the prefectural governments,” but in terms of ensuring an adequate number of cases, it is my own belief that a two- or even three-level specialist system will require an even wider scope. Core training facilities will create their own original training programs, which will in turn be certified by the OJS. We must also build a system that will place training managers, establish specialist training management committees, and aggregate training performance records for each individual medical resident. Given the workloads that will be involved in the need for actual guidance, which will fall to attending physicians, it seems likely that a personnel increase at core training facilities will be required – of a single specialist or staff member at the very least. With the requisite presence of attending physicians in associated facilities, committees will be established to guide residents through the training programs and to work with the specialist training management committee in the core training facility, and workloads will increase in proportion to the curricular density of the training programs. Incidentally, I might add that nothing is mentioned on the subject of attending physicians in the text of the “Specialist System Training Program Development Guidelines” (hereafter, “Guidelines”). We will also need to consider the guidance structure for residents.

Regarding the backbone of the new system, one concern is an entry in the Guidelines stating that “subspecialty specialist training shall commence following specialist certification in a basic field.”

Under the current system, courses of training in thoracic and cardiovascular surgery during surgical specialist training can be counted concurrently as course credits towards the respective specialties of trainees, which is to say that subspecialty specialist training is already in progress during surgical specialist training. Following the aforementioned Guidelines would mean that subspecialty specialist training would not begin until after surgical specialist certification. While it would depend on the number of years set for a course of training, it is certain that subspecialty specialist certification will take longer than it does at present. Given that there has been criticism that the time it takes to qualify as a specialist under the current system is already excessive, it has been decided that, as the Japanese Association for Thoracic Surgery, we will come to an agreement with the Japan Surgical Society, and together continue to call for the preservation of the current system of beginning subspecialty training during surgical specialist training.

One point that we will first have to consider as an issue in the new system is that residents will remain in the training complexes for the duration of their training – that is, moving away from the complexes is going to become more difficult. It appears that it will now take five years to undergo surgical specialist training (inclusive of initial training), and unless our thoracic surgery-related facilities participate in one of the surgical specialist training complexes, we will no longer be hosting any surgeons with fewer than five years of post-graduation experience at those facilities. Additionally, if we suppose three to five years for subspecialty training, residents will be confined to the training complexes until between eight and ten years after graduation; therefore, facilities unable to acquire residents will end up as facilities with only aging specialists. To avoid such confusion, it will soon be necessary to design systems that will allow for the transfer of residents between training complexes.

A further issue is how graduate schools will be incorporated into the new system, as the Guidelines contain no information whatsoever on the matter of graduate schools. Nevertheless, whether in basic or in clinical research, a solid education is crucial for clinicians as well; especially now that the sloppiness of clinical articles on antihypertensive agents has become apparent, the importance of a research education cannot be overemphasized. One idea for ensuring and promoting research at the graduate level would be to sanction a number of years for self-assessed training deferral. In so doing, I believe that we would be able to accommodate a variety of graduate education systems.

The Guidelines set out two-way evaluations between physicians and residents as part of the arrangements for a program evaluation system. While there is nothing out of the ordinary about physicians evaluating residents, under the new system a mechanism will be added for residents to evaluate the guidance structure. Ensuring this sort of feedback function is an attempt to enhance the quality of training. In such a system, the emergence of evaluations of the quality of the training complexes themselves is inevitable. Evaluation of quality entails the evaluation of treatment (including surgical outcomes), education, and academic activities – all tasks that will be covered by the individual specialist committees as limbs of the OJS via their training program certification activities. In addition to reports by the training program managers, conceivable evaluation materials would include data from scientific surveys by the Japan Association for Thoracic Surgery, the Japan Adult Cardiovascular Surgery Database (JACVSD), and the National Clinical Database (NCD). This is an extremely important and transformative change, and it is no exaggeration to say that it is a paradigm shift for Japanese medicine. I feel that we must make sure that the steps we are taking towards this new system are well and truly on this path to transformation.

Finally, on the matter of gaining an impact factor (IF) for General Thoracic and Cardiovascular Surgery (GTCS), I would like once again to put out a call for citations to GTCS articles. Our provisional IF has been steadily increasing thanks to the strenuous efforts of our journal’s editorial board. GTCS is the official journal of the Japanese Association for Chest Surgery as well as a designated affiliated journal of the Japanese Society for Cardiovascular Surgery, and it holds the distinction of being Japan’s sole English-language journal in the field of cardiothoracic surgery. We look forward wholeheartedly to our members’ support.