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History of Japanese medical education

Since medical education programs in Korea and Japan seem to mutually influence each other, this review article provides a history of Japanese medical education, focusing on the way in which it influenced and was influenced by Korean medical education. In the late 19th century, the University of Tokyo established the core medical school, disseminating its scholarship and system to other medical schools. In the early 20th century, the balance between the quality and quantity of medical education became a new issue; in response, Japan developed different levels of medical school, ranging from imperial universities to medical colleges and medical vocational schools. After World War II, all of Japan’s medical schools became part of the university system, which was heavily regulated by the Ministry of Education (MOE) Standard for the Establishment of Universities. In 1991, MOE deregulated the Standard; since 2000, several new systems have been established to regulate medical schools. These new approaches have included the Model Core Curriculum, 2-year mandatory postgraduate training, and a medical education accreditation system. Currently, most medical schools are nervous, as a result of tighter regulatory systems that include an accreditation system for undergraduate education and a specialty training system for postgraduate education.


Introduction
In every country, academic medicine is highly dependent on the national culture and changing it can be very difficult [1]. East Asian countries share a similar cultural background, based on Confucianism; Zhang et al. [2] in 2005  This paper provides an overview of the history of Japanese medical education from the prewar period to the present day, both to reflect on curricular transitions and also to analyze major issues that may also affect other countries.

The introduction of Western-style medical education
Japan's national system of medical education began in the early 19th century; it included medical faculties established by provincial schools, independent medical schools established by the feudal government, and a system for studying abroad [3]. During this period, 'Western studies,' based on education in the Netherlands, the United Kingdom, Germany, and France became a trend. The medical sciences, including basic medicine, gradually became educational subjects. In 1872, they developed a new curriculum that included a 3 years of preparatory school and a 5-year medical course taught mainly in German [4]. Daigaku To-ko was renamed 'Tokyo Igakko (medical school)' in 1874; in 1875, it applied to introduce a new course taught in Japanese. Although this was the first government-run medical school, the number of public (prefectural and municipal as well as government-run) medical schools increased to 30 by 1880.
In 1877, the new government founded Japan's first university, the University of Tokyo. It consisted of four faculties: law, science, literature, and medicine [5]. In 1886, its name was changed to the Imperial University in accordance with an Imperial University Decree. In 1893, the Imperial University adopted an academic department system in which faculty members were responsible for offering students instruction and the opportunity to explore various specialized fields [6]. Imperial universities of this period offered compulsory classes assessed using the grade system; there were only a few selective courses.
A Medical Act in 1874 established a qualification system for doctors [7]. The first examination for a medical practice license was conducted in 1875; the nationwide unified examination system was launched in accordance with the regulation of physicians' examinations in 1879. Adding regulations related to higher education, the High School Decree and Vocational School Decree were launched in 1903 and 1894, respectively. Although high schools were positioned as preparatory schools for the Imperial Universities, they were also regarded as institutes of higher education until 1901. Medical faculties were therefore established at five high schools. Later, several private vocational schools appeared, which referred to themselves as universities.
The launch of medical education in Japan was influenced by the German system, since the University of Tokyo had German professors in its medical school.
A hierarchical system was therefore established to disseminate academic knowledge and standards to other medical schools. One major hidden agenda was the need to maintain the consistency of Western medicine, separating medical education from previous practices influenced by complementary and alternative medicine.
Policymakers in this era appear to have been successful, as their objectives were fulfilled, leaving room for traditional practitioners to maintain their practices. One weakness of this system may have been that the historical medical schools had too much influence over the whole medical education system.

Between quality and quantity
In 1918, a general system for universities was estab- In Manchuria and the Kwantung Leased Territory, more than ten medical schools were established, including several medical colleges [9]. However, many medical schools did not have a long history of physician development. In Karafuto (樺太, Sakhalin) Prefecture, a medical lecture center affiliated with Toyohara (豊原, Yuzhno-Sakhalinsk) Hospital was established in 1941, under the direct management of the Japanese Ministry of Education [9]. Japanese medical schools were also established in the Philippines, Indonesia, Malaya (currently Malaysia), and Burma (currently Myanmar) during the short period of time when these were mandated territories [9].
Although all of Japan's medical faculties, colleges, and vocational schools had 4-year curricula, only the imperial universities required applicants to complete preparatory school before enrolling; this was a requirement because fundamental studies were mandatory. Only Seoul and Taipei were given the status of imperial universities. Korea appears to have been very enthusiastic about education during this period, given that an Imperial University was established in Korea before Taiwan, which Japan had ruled at an earlier time.  Enrollment capacity increased from more than 4,000 to more than 8,000 [14]. It also became possible for medical faculties and colleges to freely design their curricula.

Postwar medical education system
The  Studies and Practices for the 21st century continued discussions, issuing four reports. The first report explained the best way to nurture health professionals for 21st century, covering humanistic aspects, patientcenteredness, life-long learning, and global perspectives. [22]. The fourth report specified ways to improve undergraduate medical education, particularly through the careful selection and diversification of educational content [23]. To respond to the reports, the survey collaborators' team for a new vision of medical and dental education issued a report to improve medical and dental education in the 21st century; the report included a 'Model Core Curriculum (MCC)' [24]. The medical

The new accreditation system with international recognition
As for the accreditation system in general, the institu- research on establishing an evaluation system specifically for medical education [28].
In the project, the WFME's global standard for undergraduate medical education was translated into Japanese with partial modifications to match the situation in Japan; it was then disclosed as a standard for evaluation.
In December 2015, all 80 medical schools became members and founded the JACME, with the cooperation of MEXT and AJMC. In addition, the trial evaluation period was repeated until fiscal year 2016; in March 2017, JACME was certified by WFME [29]. The recent situation in Japanese medical education Every medical school that offers undergraduate medical education seems to be nervous about the JACME accreditation system. When they think about making changes to their curricula or systems, most of these changes reflect the JACME evaluation standard. This nervousness increased after the Faculty of Medicine of Osaka City University received a limited-term accreditation [30]. Medical schools renewed their efforts to conform to the Core Curriculum, government policies, and the AJMC.
There were no changes to the 2-year mandatory general postgraduate training system after 2004. However, the specialty training system that covers the following 3 years or longer is currently facing a chaotic situation.
Previously, in Japan, most specialty training and