Residents at non-university hospitals may have a greater opportunity to see patients with various health problems, since there are many more patients with common diseases and acute illnesses at non-university hospitals.4 This characteristic of non-university hospitals is better consistent with the learning goals set by the Ministry of Health, Labor and Welfare of Japan for being able to care for patients with primary care levels and those who need urgent care. The increased clinical experience with a higher degree of independence is likely to lead to increased satisfaction among residents at non-university hospitals. In addition, despite the smaller number of teaching staff at non-university hospitals than at university hospitals, they may have greater enthusiasm for teaching residents, since some teaching staff at non-university hospitals are likely to have greater clinical competency and teaching skills than those at university hospitals.15,16 A higher quality of educational programs offered by skilled clinical teachers at non-university hospi- tals may be a cause of the increased satisfaction among residents at these hospitals.
The highest mean total score for the PHEEM (149) was achieved by Otowa Hospital, Kyoto. Similarly to several other popular non-university teaching hospitals, such as Okinawa Chubu Hospital, St. Luke’s International Hospital and Teine Keijinkai Hospital, this hospital is well known for having introduced a US-style teaching program through collaboration with invited US teaching faculty and with the Department of Medicine (General Internal Medicine) established as a major teaching department. These trends are seldom observed at university hospitals.15,17 In some university hospitals, Departments of General Medicine or Family Medicine have been established, but the major role of these departments is currently considered to be teaching of medical students, not residents because of the inadequate support to these departments from other subspecialty departments in university hospitals.