POSTGRADUATE MEDICAL EDUCATION PROGRAM AT OKINAWA CHUBU HOSPITAL

A History of the University of Hawaii Postgraduate Medical Education Program at Okinawa Chubu Hospital, 1966-2020

• Geography of Okinawa
  Okinawa is the largest island of a chain called the Ryukyu Islands, south of the main islands of Japan, and located between the Pacific Ocean on the east and the South China Sea on the west. The Ryukyu islands consist of 5 large islands and more than 100 small islands. The total area of Ryukyu islands is about 1/7 of Hawaii, however the population of both are almost same, being over 1,430,000. Flight time from Okinawa to Tokyo is about 2-1/2 hours, and flight from Tokyo to Hawaii is about 71/2 hours. The climate of Okinawa and Hawaii is quite similar.
• Okinawa, Post World War Ⅱ
  In 1945, Okinawa and its surrounding islands were the place where the fierce battles occurred at the end of the World WarⅡ. After the war, the islands remained occupied by the U.S. until its return to Japan in 1972.
  With very few Okinawan physicians remaining after the war, the public health environment faced a perilous future. In 1946 the number of Okinawan physician was 64 in the entire prefecture. In 1950, the number increased to 131 with the population of about 700,000. That was a ratio of approximately 18.7 physicians per 100,000 people.
  For the first two years after the war, there were virtually no hospitals and very few clinics, medical facilities, or healthcare staff to treat the civilian population.
  In 1946, 5 small hospitals were built on Okinawa island and of these the Chubu Hospital became the focal point for medical care. In 1964, the US Pacific Military Command in Hawaii was invited to survey the public health conditions of Okinawa. The survey recommended the establishment of a medical training hospital, a medical library, and also suggested the need to build a medical school. At that time there were no medical education institutions in Okinawa and no formal postgraduate education programs for medical graduates in Japan.
  The majority of medical students from Okinawa who went to universities in mainland Japan did not return for a variety of reasons. The major reason student’s hesitated to come back to Okinawa was that they felt they had greater educational and professional opportunities in mainland Japan. The program was designed to encourage Okinawan medical students to return from Japan after graduation. 1n 1964, Okinawa Chubu hospital was renovated to accommodate physician training.
• The role of US Government and University of Hawaii, John A. Burns School of Medicine (JABSOM)
  In 1967, a formal training program was started at Chubu Hospital and the first director, Dr. Neal L. Gault, was hired to initiate the program. Previously, Dr. Gault achieved great success with the Minnesota Project for the development of medical education in post war Korea.
  Fifteen UH faculty members were employed. The specialties included internal medicine 3, surgery 2, one each in pediatrics, anesthesia, OBGYN, psychiatry, pathology, radiology, laboratory medicine, nursing, and hospital administration.
  The training utilizes a US style of teaching, which is different from the traditional Japanese postgraduate medical education. The training program was funded by the US government and continued from 1967 through 1971. This funding terminated in 1971 when an agreement by the US Senate turned the administrative rights of Ryukyu Island to Japan. Under the Japanese government, the Okinawa prefecture administration and the hospital staff continued the US model of postgraduate training instituted by the UH consultants.
  A great deal of persuasion was needed to recruit the first class of postgraduate physicians for OCH in 1967, as this type of program was uncommon in Okinawa and unique even in Japan. The success of the American system of clinical training was immediate. The physicians were so satisfied with their training that they spread the word to their former classmate in Japan.
  The Japanese medical authorities also recognized that this program offered excellent training and they recommended that Japanese internships and residencies be patterned after this one. The Japanese Medical Association and their advisory committee to the Prime Minister’s Office monitored the program closely, and medical educators from Japan frequently visited this Program.
  Enthusiastic endorsement by the physicians in the program was stated that no program in Japan offers the same opportunities for learning about advanced American medicine. The program became widely known in Japan and many Okinawan medical students returned to visit the hospital during their vacations. Externships were offered to acquaint them firsthand with the program. The various specialty areas in the hospital have all made considerable progress in organizing their staff and operations. In 2 years, all of the services in the hospital began regularly conducting teaching rounds. This type of discussion of the differential diagnoses and treatment led to the development of an academic climate.
  A significant number of physicians trained at Chubu Hospital had further specialty training in the US. After completing their training in the US, most of them returned to Chubu Hospital and became teaching staff there.
• Program by the collaboration of Okinawa prefecture and UH
  In 1973, a new contract was signed between the Okinawa prefecture and UH to continue the partnership at Okinawa Chubu Hospital. This contract was fully funded by the Japanese Government in the first year and by the Okinawa prefecture thereafter.
  The Chubu Hospital’s Education Committee now guides the consultation topics, as well as the selection of consultants. Specialist consultants visit the program for either a period of one week (short term consultant) or three months (long term consultant). Consulting faculty spend time at Okinawa Chubu hospital by lecturing, conducting daily clinical rounds on patients on the wards, and helping teach the trainees in diagnosis, medical decision making, and clinical skills.
• Goals of the Program
  The program quickly became recognized throughout Japan as a center of excellence. Applicants have come from all Japanese medical schools except for the National Defense Medical College. These young medical doctors spend one year rotating through the various specialties (internal medicine 3 months, surgery 3 months, pediatrics 2 months, OBGYN 2 months, anesthesiology 1 month, emergency medicine 1 month) and receive intensive bedside training in patient care. Many remain for additional training for 2 or more years in a specialty.
  The goals of the Program have been accomplished over the years, thanks to a number of important factors:
  
  • adequate funding from the Okinawa prefecture
  • recruiting motivated medical graduates from all over Japan
  • appointing first class Japanese clinicians as staff and faculty in the various specialties
  • strong leadership from the UH program directors
  • continually bringing long term consultant( 1-2 per year) and short term consultants (10-12 per year) from institutions of excellence, mostly from the USA to teach, advice, and criticize
  • providing the opportunity for selected trainees to continue further training in their specialty in the USA.
• Statistical Matters of the Program
  
  • The trend of the number of trainees, 1967-2016
    To date 2019, 1159 physicians have completed the program. Approximately 70% of the trainees have remained in Okinawa prefecture to practice medicine. As a result, the program has enhanced the physician workforce for the islands of Okinawa. Of the 133 staff physicians of Okinawa Chubu Hospital, 98 (74%) are alumni of the program.
    In 2016, the number of physicians in Okinawa prefecture was 3,609, and the physician per 100,000 population ratio was 243, compare to that of 240 for all of Japan. It is amazing that the physician per population ratio of Okinawa had exceeded that of Japanese standard.
  • The program directors, 1967~present

    Program Directors & Advisors

    Name		Year	From	To	Specialty
    Yamauchi, Shoei, M.D.	program advisor	1967			Surgery
    Phillips, Lorne, M.D.	program advisor	1966-1967	1966.08.09	1967.08.11	Surgery
    Gault, N.L. Jr., M.D.	program advisor	1966-1969	1967.07.01	1969.06.15	Internal Medicine
    Sudrann, Robert, M.D.	program advisor	1969-1971	1969.07.28	1971.06.30	Internal Medicine
    Odom, Charles B., M.D.	program advisor	1971-1973	1971.07.01	1973.07.31	Ob-Gyn
    Northup, Robert S., M.D.	program advisor	1973-1974	1973.08.01	1974.07.31	Internal Medicine
    Allen, Samuel M., M.D.	program advisor	1974-1983	1974.08.01	1983.09.30	Surgery
    Talwalkar, Y.B., M.D.	program advisor	1984-1992	1983.10.01	1992.12.31	Pediatrics
    Maeshiro, Masao, M.D.	program advisor	1993-2011	1993.01.01	2011.07.31	Surgery
    Ashimine, Kaoru, M.D.	program advisor	2011-2020	2011.08.01	2020.06.30	Pediatrics
    Hidemitsu, Mototake, M.D.	program advisor	2020-2023	2020.07.01	2023.10.31	Surgery
    Toshiki, Uchihara, M.D.	program advisor	2023- present	2023.11.01	present	Internal Medicine

    Eight physicians have served as the director of UH program in 54 years. Dr. Maeshiro, ex-director of Chubu Hospital was the first Japanese director, and Dr. Ashimine is the first director of alumni of the Hospital.
  • The list of the US consultants, 1976~2016

    The list of the US consultants(1976~2016)

    Since the inception of the program through 2016, 750 consultants were invited, of these 225 were long term consultants ( UH faculties ) and 535 short term consultants. Many consultants were repeatedly invited at the request of Chubu staff.
  • The trend of the number of UH consultants, 1967~2022

    Consultants and Faculties annual transition (1965-2022)

    For the first 7 years all staff were long term consultants, staying 1 year or more, up to 10 years. After 1972, short term consultants increased. However, because of budget constraints from Okinawa prefecture, currently the number of consultants has decreased to 1-2 long term consultants per year and 10-12 short term consultants per year.
  • The number of specialties of consultants , 1967~2022

    Conaultants and Faculties subspeciality Total (1967-2022)

    UH consultants are selected from various specialties. About 38% (319) are specialists of internal medicine and its subspecialties, followed by pediatrics 142, OBGYN 65, radiology 47, pathology 37, surgery 40, anesthesiology 21, orthopedics 10, and so on.
• Future of the Program
  On November 10, 2017, the Program celebrated its 50th anniversary. This was marked by a celebration attended by many of the former trainees from all over Japan. Guests invited to attend the ceremony include Dr. Hedges, Dean of JABSOM, Dr. Izutsu, Vice Dean, the Governor of Okinawa prefecture, and the high rank officer from the Ministry of Health and Welfare of Japan.
  Of course, there are many other factors responsible for the improved medical care in Okinawa, not the least of which has been the establishment of a medical school in 1987. But the impact of the UH training program at Okinawa Chubu Hospital has been one of the main factors in the remarkable change over the past 53 years.
  Growth in the post graduate program is largely due to the establishment of the Office of Global Health at UH JABSOM in 1989.
  Dr. Satoru Izutsu, Professor Emeritus of Public Health and ex-Vice Dean of JABSOM, had been in charge of the program till 2017 , when Dr. Junji Machi, a professor of Surgery of UH and an alumni of this program, succeeded him.
  In 1992, Dr. Neal L. Gault, the first program director, received the Order of Rising Sun, Gold Medal with Neck Ribbon by the Japanese Government, for his contribution to medical education in Japan. Dr. Satoru Izutsu also received the same Medal in 2017.
  These facts clearly indicate that University of Hawaii Postgraduate Medical Education Program at Okinawa Chubu Hospital made a significant impact on improving the postgraduate medical education in Japan.
  The Program can look back on an excellent performance over these past 53 years, because it is a success story of an American education program in a transcultural setting. More importantly now, the Program should be looking at new ways of expanding the role of Japan in the International medical scene.