At the hospital where I work, the residency training program consists of 3 years instead of the nationally mandated 2 years of post-medical school training. Although the residents are categorized into a certain “track” (i.e general internal medicine, family medicine, surgery, pediatrics, etc), the first 2 years are spent rotating in different specialties, similar to how a transitional year operates in the US. The 3rd year rotations include more electives so that the PGY3’s (post graduate year 3) can spend time in their area of interest.
After the 3 years, the residents will then undergo further training in their field of interest. These “fields of interest” can include the traditional specialties in the US (i.e. internal medicine-though still a new concept in Japan, family medicine, orthopedics, etc) but can also include subspecialties that would normally be reserved for fellowship training in the US (i.e. cardiology, gastroenterology, etc).
The current residency program “tracks” include about 7 internal medicine, 1-3 surgery, 2 pediatrics, 1-2 family medicine, 2 anesthesiology, 2 ER, etc. per class for a total of about 50 residents.
Because one of the main goals of this residency program is to teach in the US style, the residents can all speak English, albeit at differing levels. Case in point: all the teaching/lectures that I facilitate are in English, hence why the residents must be able to understand and participate.
While not all of the residents plan on undergoing further medical training in the US, there are several per class every year whose goal is to get accepted into a US residency program. The interested residents, therefore, have to take the USMLE exams also, just like US medical graduates. The Step 2 CS (clinical skills) exam poses a special challenge for foreign graduates, but certain activities (i.e. standardized patient OSCE’s, the American faculty, etc) are performed to help the residents achieve a passing score.