Updated: Oct 23, 2018
I. MEDICAL EDUCATION: THE CURRENT STATE OF AFFAIRS
The Japanese Government Ministry of Health, Labor and Welfare www.mhlw.go.jp/english/registers all physicians and regulates the profession, but does not provide a national continuing medical education (CME) system. However, it encourages physicians to participate in certified CME and allows them to advertise their educational certificates. CME for physicians in Japan is therefore voluntary and is administered and delivered by the Japan Medical Association (JMA), www.med.or.jp/english/index.htmlwith the involvement of regional (prefectural) and local (municipal) medical associations and specialist organizations. The JMA administers over 40 prefectural medical associations, and there are approximately 900 independent, municipal medical associations that are affiliated with the JMA.
The JMA first launched a voluntary CME program in 1987 with an emphasis on hands-on learning through cooperation between hospitals and clinics, and with lectures, seminars and practical training sessions sponsored by local medical associations. An accrediting system was introduced in 1994, and in 1995 the first certificates were issued. In 1997 a consolidated reporting system was introduced, where local medical associations were required to keep records of credits earned by their members at lectures and other learning opportunities, confirm the records with individual members, then submit a list of records annually to the JMA. The JMA’s Council for Academic Affairs oversees the CME programs. Following a review by the CME Promotion Committee, a new program was started in 2010. However, there were concerns about the complexity of the paperwork and also about links to the accreditation system. In addition, specialized physicians, such as optometrists, otolaryngologists, and dermatologists, as well as physicians aspiring to become specialists, faced difficulties obtaining the credential.
Subsequently a CME Program Investigative Commission made up of JMA executive officers was established.The implementation guidelines were revised later in 2010 after being approved by prefectural medical associations. The guidelines do not appear to be accessible in English but Ishii’s article on CME at www.med.or.jp/english/journal/pdf/jmaj/v51no04.pdf#page=3provides a good overview of CME in Japan in general. The JMA and regional medical associations can accredit programs, however it is the program that is accredited, not the provider. Because accreditation is not mandatory the associations are free to determine the criteria for accreditation. Although agencies/companies other than medical associations can offer programs they are generally not accredited and if funded by pharmaceutical companies tend to focus on that company’s products and the appropriate use of medicines. McCann is the largest agency in Japan to provide CME but most of their education is not accredited because it is single sponsored and the medical associations who accredit, prefer multiple sponsors for pharmaceutical-industry-funded CME. All JMA members are eligible to undertake CME programs, but non-members may also participate. Physicians may participate immediately after receiving their medical licenses. To become a member of the JMA, a physician must first join the country or municipal medical association in his/her area, then the prefectural medical association. Membership fees paid to the JMA and to local medical associations may be used in part to fund CME.
Although in theory, there appears to be no barrier to offering high quality pharmaceutical-industry-funded CME (in areas of company expertise), in practice, as previously stated medical associations are unlikely to accredit CME funded by a single company, preferring to accredit CME that has multiple sponsors. The most recent statement of the JMA on CME is as follows: “Continuing Medical Education (CME) Program Physicians are required to follow the progress that has been made in health care and the medical sciences through continuing medical education, to enable them to better deal with the ever-growing demands in both the basic and clinical areas of medicine. The essence of CME is based on voluntary self-study and learning activities…. lectures, seminars, and practical training sessions sponsored by the local medical associations are frequently conducted, and academic evaluations of each physician's study plan are also provided.” (JMA 2017) http://www.med.or.jp/english/activities/kact01.html#ka3 The JMA is also establishing a comprehensive Internet-based information network of medical associations that will link the JMA, local medical associations at the prefectural and municipal levels, and individual members of the associations. One of the aims of the network is to “provide relevant information to physicians (medical association members).” All 47 prefectural medical associations are Internet-connected and have their own websites. Nearly all of the approximately 900 multiple medical associations are also Internet-connected. http://www.med.or.jp/english/activities/kact11.html#12
II. ACCREDITATION SYSTEM
A. METHOD OF EARNING CME CREDITS (MIKAMI 2011)
Credits can be earned in a variety of ways, for example:
· Answering questions posted in JMA’s official monthly journal, Nippon Ishikai Zasshi (Journal of the JMA (www.med.or.jp/english/journal/) CME participants submit answers to the JMA via postcards or the Internet.
· Answering questions posted on an e-learning website. An e-learning system was introduced in 2004, which provides texts and video lectures to participants who then answer related questions online.
· Attending lectures, seminars, workshops, conferences
· Hands-on learning (observations of autopsy and operation, clinical conferences, and other learning through hospital-clinic and clinic-clinic cooperation)
· Serving as a supervisory physician in undergraduate and postgraduate clinical training programs
· Preparing questions for the national medical examinations
· Writing medical papers and books
· UpToDate®a clinical decision support resource, has received approval from the Japan Primary Care Association (JPCA) as an official CME resource. JPCA members can now earn CME credits while using UpToDate to answer clinical questions. http://www.uptodate.com/home/uptodate-recognized-japan-primary-care-association-cme· Most CME provided by pharmaceutical companies tends to be face-to-face, consisting of satellite symposia aligned to medical association meetings. Online learning is becoming more popular with younger doctors but if funded by pharmaceutical companies it tends to focus on the particular medications or devices sold by those companies.
B. CREDITS AND CURRICULUM CODES
One hour of learning is equivalent to one credit (the smallest credit is 0.5 for 30 minutes). A medical practitioner attending a CME lecture or workshop receives a certificate (card, sticker, etc.) from the host organization and submits it with a declaration to acquire credit units. Taking part in hospital clinics or peer review provides 5 credit units and publishing a paper in an academic journal can provide up to 10 credit units. The JMA has developed various curricula for physicians. These include 106 basic healthcare courses, which are broad, non-specialty-specific courses, covering, for example, medical ethics or social security. There is also a curriculum for medical topics, which has two sections, one on important medical practice procedures, and the other on important diseases. The CME Committee of a local medical association may plan a CME workshop, featuring some of the themes in the curricula or the themes may be used in self-directed home learning and group learning. As of 2009, the past CME Certificate was replaced by a Credit Certificate (an annual report of earned credits and curriculum codes). A CME Completion Recognition Certificate is issued to physicians earning 60 or more credits and curriculum codes in total. The CME Completion Recognition Certificate is valid for 3 years. The curriculum committees of individual prefectural medical associations may have specific CME goals for their members. For example, the CME Committee of the Tottori prefecture (one of the regional societies) aspires to assist its membership not only to keep up with the progress in medicine and acquire standard medical knowledge and techniques, but also to cultivate a greater sense of ethical values and human rights. The prefectural medical associations offer quite a lot of CME. For example, in theKumamoto prefecture of Japan, the Kumamoto Medical Association held over 800 medical lectures during 2009, and various specialist societies in this prefecture, including ophthalmologists, obstetricians/gynecologists, pediatricians, and orthopedic surgeons held 105 study sessions during this period (Murgatroyd 2011).
III. CURRENT REQUIREMENTS FOR MEDICAL EDUCATION
CME is not mandatory for physicians in Japan.
The CME program, conducted under the auspices of the JMA as described in Section 1 above, is entirely voluntary, and failure to undertake CME does not affect a healthcare practitioner’s license to practice medicine. Methods of delivery and evaluation are summarized in Section 1b above.Accreditation in Japan is based on self-declaration, and it seems that there is little quality assurance of the CME programs. Physicians receive a report form each year, which comes as a supplement to the JMA Journal. Physicians then fill in the form and can attach certificates of any courses or seminars attended. These forms are then sent to their local medical association who send the forms to the JMA. The data from the forms are then added to a database and certificates are sent to physicians (Murgatroyd 2011).
CE for pharmacists is not mandatory as there is no renewal system of pharmacy license in Japan.
CE for pharmacists in Japan is voluntary. Pharmacists receive a certificate from each provider on completion of CE programs, and some employers recognize or reward them. The Council on Pharmacists Credentials (CPC) www.cpc-j.org/english/is an independent national agency established in 2004 to accredit CE programs in pharmacy. The CPC governing body has representatives from the pharmacy and health professions, and also from academic and educational representatives. The CPC has established standards on all aspects of program evaluation, including standards on credentialing bodies, program planning and content, budgets, and administrative activities. Pharmacy schools, pharmacist societies, pharmaceutical companies, and others provide CE programs, but the content and quality may be variable.Types of CE credentialing program include:· CE credentialing programs to improve pharmacists’ competence by implementing and evaluating training programs (face-to-face lectures, clinical training, distance education, etc.)· Special training programs to improve pharmacists’ competence by certifying them with specific abilities and aptitudes· Pharmacy specialties credentialing programs to recognize and certify pharmacists who have specialized pharmaceutical knowledge and skills in certain disease categories, practice areas, or particular diseases · As of 2017, the CPC has accredited 26 providers to provide CE programs to pharmacists in Japan.These accredited providers include Schools of Pharmacy, Pharmacists Associations, and Academic Societies (Personal communication from CPC). For example, the Japan Pharmacists Education Center (JPEC) http://www.jpec.or.jp/english/mission.htmloffers a range of CE including training courses for medication guidance, training courses for pharmacists working in pharmacies, hospitals and clinics and training courses for pharmacists working for pharmaceutical manufacturers and wholesalersas well as education via TV (CareNet Medical Channel (Sky Perfect TV Channel 772)) and also training courses held in conjunction with the Organization for Pharmaceutical Safety and Research (OPSR),and collaborative training with other organizations such as pharmaceutical colleges, and pharmacist-and healthcare-related organizationsKeio University Faculty of Pharmacy has established a Centre for Continuing Pharmacy Education and provides lectures and online teaching (http://www.pha.keio.ac.jp/en/index.html. Accessed 8 June 2017).The Tokai Regional Alliance Center for Recurrent Education www.pharm.or.jp/eng/130th/data/S03-6.pdf supported by three public universities in the Tokai area also has a CE program for pharmacists, which includes practical training as well as a lecture series delivered by web-conferencing. Toho University School of Pharmacy: http://cptc.phar.toho-u.ac.jp/ and Hoshi Pharmacy University www.hoshi.ac.jp/home/nintei/index.html also provide courses.
Other organisations involved in CE for pharmacists include:
The Pharmaceutical Society of Japan www.pharm.or.jp/eng/curriculum.html
Japan Pharmaceutical Society www.nichiyaku.or.jp/
Graduate School of Pharmaceutical Sciences Faculty of Pharmaceutical Sciences Meiji Pharmaceutical University www.my-pharm.ac.jp/koho/English/
Kanazawa University, Faculty of Pharmaceutical Sciences www.p.kanazawa-u.ac.jp/e/
Faculty of Pharmaceutical Sciences, Nagoya City University www.nagoya-cu.ac.jp/phar/1022.htm
Gifu Pharmaceutical University www.gifu-pu.ac.jp/english/index.htm
Kyoto Pharmaceutical University www.kyoto-phu.ac.jp/english/
Graduate School of Pharmaceutical Sciences, Kyoto University www.pharm.kyoto-u.ac.jp/en/
Kobe Pharmaceutical University www.kobepharma-u.ac.jp/english/index.html. Faculty of Pharmaceutical Sciences, Okayama University www.pharm.okayama-u.ac.jp/en/
Faculty of Pharmaceutical Sciences, The University of Tokushima www.tokushima-u.ac.jp/ph/english/
Faculty of Pharmaceutical Sciences, Kyushu University www.phar.kyushu-u.ac.jp/eng/index.phpSchool of Pharmaceutical Sciences, Nagasaki University www.ph.nagasaki-u.ac.jp/indexe.html
Faculty of Pharmaceutical Sciences, Kumamoto University www.pharm.kumamoto-u.ac.jp/en/Note that the provision of CE to pharmacistsdiffers from that of provision of CME for physician.
For pharmacists, the providers are accredited by CPC, whereas for physicians, the JMA and regional/local societies accredit programs, and not providers.
CME is not mandatory for nurses in Japan.
In Japan, the qualification of public health nurses, midwives, nurses and assistant nurses is stipulated by law, while the certification of specialized nurses is not specified by law (Japanese Nursing Association 2017). Certified nurses and certified nurse specialists, who gain their credentials from the Japanese Nursing Association (JNA), are required by the JNA to renew their licenses every 5 years (JNA 2017). Although continuing education (CE) is not compulsory for nurses or nurse specialists, the JNA encourages nurses to undertake self-education and organizes CE courses in Tokyo and Kobe, designed to improve knowledge and technical skills for nursing practice, administration and education. CE provided includes one-day short courses and courses over several weeks. Courses are also available streamed via the Internet (JNA 2017).At present, nurses have no responsibility for prescribing, however one of the goals of the JNA is to promote theexpansion of the role of nurses (Japanese Nursing Association 2017). The Japanese Association of Nursing Programs in Universities (JANPU) and the JNA hope to introduce nurse practitioners “Tokuteikangoshi,” who could prescribe, but this has not yet been approved (Kondo 2013).A large survey ofoccupational health nurses, conducted in 2010, found that many do not work for companies that support CPD and CE. However survey results showed occupational health nurses in Japan recognized the importance of CE/CPD and wanted to undertake CE/CPD activities (Mizuno-Lewis et al 2014).
IV. FUNDING OF MEDICAL EDUCATION - POLICIES, REQUIREMENTS & REGULATIONS
The JMA has not developed guidelines on pharmaceutical industry gifts and funding, and neither the JMA nor any other physician organization oversees pharmaceutical industry funding. There appears to be no official barrier to pharmaceutical companies funding CME, although the medical associations tend not to accredit CME that is not funded by a number of sponsors. In 1984, the Japan Fair Trade Commission (JFTC www.jftc.go.jp/en/)issued Guidelines on Pharmaceutical Manufacturers and Gift Giving that restricted certain gifts and payments to all physicians. Those guidelines are revised periodically. The Fair Trade Council of the Ethical Pharmaceutical Drugs Marketing Industry (FTCEPDMI) is an industry self-regulatory organization authorized by the JFTC, which promotes compliance through an industry code of conduct. The Japan Pharmaceutical Manufacturers’ Association (JPMA www.jpma.or.jp/english) revises its code of conduct to conform to JFTC and FTCPDMI rules. In 1993, new JPMA rules restricted drug firm assistance to physicians unrelated to their products to a fixed sum per year per institution. However pharmaceutical companies may pay physicians to write articles or deliver lectures. The JPMA also expanded an existing alternative to individual pharmaceutical company grants where pharmaceutical companies contribute to an industry-sponsored foundation budget.
V. MEDICAL EDUCATION RESOURCES
A. NATIONAL AUTHORITIES
The JMA administers and delivers CMEwww.med.or.jp/english/index.html
B. REGULATORY AND ACCREDITATION BODIES RELEVANT
The JMA determines both the method of earning CME credits and what each activity is worth www.med.or.jp/english/index.html
C. COUNTRY-SPECIFIC ARTICLES AND STUDIES
Ishii M. The Continuing Medical Education Program ofthe Japan Medical Association. JMAJ51(4): 219–224, 2008. www.med.or.jp/english/journal/pdf/jmaj/v51no04.pdf#page=3.
Japan Medical Association. Continuing Medical Education (CME) program. www.med.or.jp/english/activities/kact01.html#k
Japan Medical Association (JMA), Physician’s Ethics Code (Tokyo: JMA, 1951); JMA, Principles of Medical Ethics (Tokyo: JMA 2002). English summary available at: www.med.or.jp/english/about_JMA/principles.html
Japan Medical Association. The JMA Guidelines for Physician’s Professional Ethics 2008. Jap Med Assoc J2009;52:75-91.
Japan Pharmaceutical Manufacturers Association (JPMA). JPMA Code of Practice 2013 http://www.jpma.or.jp/english/policies_guidelines/practice.htmlAccessed 08 June 2017.
Japanese Nursing Association. www.nurse.or.jp/jna/english/nursing/education.html· Kondo A. Advanced Practice Nurses in Japan: Education and Related Issues. J Nurs Care 2013. S5:004. doi:10.4172/2167-1168.S5-004 https://www.omicsgroup.org/journals/advanced-practice-nurses-in-japan-education-and-related-issues-2167-1168.S5-004.php?aid=12795
Kurosawa N. Continuing Pharmacy Education in Japan in Dahdal, W.Y. (Ed).American College of Clinical Pharmacy ACCP International Clinical Pharmacist. Spring 2011. 1 (1).www.accp.com/docs/international/0511.pdf. Accessed 8 June 2017
Mikami H. The Continuing Medical Education Program of the Japan Medical Association: Its history and future prospects JMAJ 54(4): 205–209, 2011. http://www.med.or.jp/english/journal/pdf/2011_04/205_209.pdf
Mizuno-Lewis S, Kono K, Lewis DR, Gotoh Y, Hagi N, Sato M, Yoshikawa E, Higashikawa K, Yamazaki M, Naito M, Kondo N. Barriers to continuing education and continuing professional development among occupational health nurses in Japan.Workplace Health Saf. 2014 May; 62(5): 198–20.
Murgatroyd GB. General Medical Council Intelligence Unit Research Continuing professional development: the international perspective July 2011.
Noto Y. American Medical Association (AMA) and its Membership Strategy and Possible Applications for the Japan Medical Association (JMA), 1999. Harvard School of Public Health. -http://e.hsph.harvard.edu/research/takemi/files/rp157.pdf
RodwinMA. Reforming pharmaceutical industry-physician financial relationships: lessons from the United States, France, and Japan. J Law Med Ethics. 2011 Winter; 39(4):662-70.
D. GAME MEMBERS CURRENTLY ACTIVE IN PRODUCING/SPONSORING MEDICAL EDUCATION IN JAPAN
E. KEY MEDICAL SOCIETIES/SPECIALTY BRANDS
Japan Medical Association. (JMA) – Their monthly journal and two special issues a year www.med.or.jp/english/journal/toc/current.html. As well as their activities www.med.or.jp/english/activities/kact01.html#k which allows visitors to search and read papers, to search titles in the video library, to view video-streamed medical TV programs, and to view Internet-based CME courses.
The Japanese Society of Internal Medicine www.naika.or.jp/english.html
The Japanese Society of Psychiatry and Neurology www.jspn.or.jp/english/index.html
The Japan Endocrine Society http://square.umin.ac.jp/endocrine/english/
The Japan Geriatrics Society www.jpn-geriat-soc.or.jp
The Japanese Society of Gastroenterology http://www.jsge.or.jp/index.html
Japan College of Rheumatology http://eng.ryumachi-jp.com/index.html
Japanese Respiratory Society http://www.jrs.or.jp/modules/english/index.php?content_id=1
Japanese Society of Nephrology https://www.jsn.or.jp/en/
The Japanese Dermatological Association https://www.dermatol.or.jp/modules/en/index.php?content_id=2
Japan Diabetes Society www.jds.or.jp/modules/en/index.php?content_id=1
The Japan Society of Hepatology www.jsh.or.jp/English
The Japanese Association for Infectious Disease www.kansensho.or.jp/english
Japan Gastroenterological Endoscopy Society www.jges.net/
The Japanese Society of Hematology www.jsh.or.jp/Englishhttp://www.jshem.or.jp/modules/en/index.php?content_id=1
Japanese Society of Medical Oncologywww.jsmo.or.jp/en
Japan Societyof Clinical Oncologywww.jsco.or.jp/english
JapaneseCollege of Cardiology www.jcc.gr.jp/E-index.html
Japanese Circulation Society http://www.j-circ.or.jp/english/
Japanese Educational Clinical Cardiology Society http://www.jeccs.org/english/
Japanese Gastroenterological Association http://jpn-ga.jp/en/
The Japanese Orthopaedic Association https://www.joa.or.jp/english/english_frame.html
Japan Surgical Society http://www.jssoc.or.jp/english/
The Japan Lung Cancer Society http://www.uicc.org/membership/japan-lung-cancer-society
Japan Society of Pain Clinicians http://www.jspc.gr.jp/en/overview.html
Japan Society of Nutrition and Food Science http://www.jsnfs.or.jp/english/
Japan Society of Metabolism and Clinical Nutrition http://researchmap.jp/?active_center=snsview_view_main_search_summary&summary_id=271982&heading_id=8&search_title=Japan%20Society%20of%20Metabolism%20and%20Clinical%20Nutrition&lang=english
Japan Society of Obstetrics and Gynecology http://www.jsog.or.jp/english/
Japanese Ophthalmological Societyhttp://www.nichigan.or.jp/english/index.jsp
The Oto-rhino-laryngological Society of Japan, Inc. http://www.jibika.or.jp/english/
Japan Pediatric Society http://www.jpeds.or.jp/modules/en/index.php?content_id=
The Japanese Urological Association https://www.urol.or.jp/en/
Japanese Society of Neurology https://www.neurology-jp.org/en/
Japanese Society for Palliative Medicine https://www.jspm.ne.jp/jspm_eng/
Japanese Society of Anesthesiologistshttp://www.anesth.or.jp/english/
The Japanese Association for Thoracic Surgeryhttp://jats-e.umin.jp/
Japanese Society of Clinical Pharmacology and Therapeutics https://www.jscpt.jp/eng/
The Japanese Pharmacological Society http://www.pharmacol.or.jp/en/
The Japan Society for Medical Education http://jsme.umin.ac.jp/eng/index.html
Japan Primary Care Association https://www.primary-care.or.jp/jpca_eng/index.html