[Training in specialties and subspecialties of surgery: current system in Japan and a proposal for the future]

The maintenance of quality care of surgical patients is the primary concern of surgeons. The Japan Surgical Society has taken the responsibility for establishing standards for the quality care of patients in surgery and surgical subspecialties. The society introduced training systems for surgeons and developed qualifying examinations after 4 years of training in general surgery in 1984, but after 24 years, in response to the demands from surgeons and patients, new training, certification, and recertification programs are under investigation by the Japan Surgical Society and its related societies of subspecialties. Currently, a 3-year training system and subsequent qualifying examination for gastroenterological surgery, pediatric surgery, cardiovascular surgery and pulmonary surgery are being proposed after completing 4-year training and qualifying examination in general surgery. The pros and cons of this system are discussed and a more desirable system for the future is proposed.