The application of the methods of problemoriented system and problem-based learning are essential tools for teaching surgically oriented Japanese physicians-in-training the clinical skills to understand and manage their patients' problems independently. Much time is needed during the first post graduate year in order for these young physicians to become proficient in patient analysis. The use of preprinted worksheets and detailed repetitive medical chart review with immediate corrective feedback, coupled with bedside practical examinations and discussions, facilitate acquisition of needed clinical skills. Surgical trainees need these basic cognitive skills if they are to develop the proper skills for understanding preand post-procedural invasive interventions.Additionally surgical training should includethe use of medical literature for evidence based decision making as well as communicative skills for talking with patients and families. These patient oriented discussions should be in conformity with international ethical standards. Future computerized patient interactions will require surgeons to accept new models of clinical involvement. Life-long continuous medical education will be essential as these new technologies are introduced. Yuong surgeons will lead the changes ; old surgeons will have to adopt the new methods or retire.