Objectives: A focus group interview (FGI) was conducted in medical students and training doctors to explore the reasons for their choice of training hospital, the needs of training courses, and other issues, in order to improve the training curriculum and increase the number of training doctors in Yamaguchi prefecture.Methods: We conducted FGI in 11 medical students (two groups) at Yamaguchi University and 10 training doctors (two groups) at one training hospital in Yamaguchi prefecture. The main questions included the reasons for choosing their training hospital and problems with medical education at the university.Results: As important issues for choosing the training hospital, the interviews explored the acquisition of primary care skills, unrestricted courses, attachment to their hometown, liveliness of training doctors, and enthusiasm of teaching doctors. Problems with education at the university included differences in enthusiasm and quality of education between departments, lack of enthusiasm and time of teaching doctors and staff, poor communication and atmosphere, and inequity in education.Conclusions: Our FGI suggested that establishment of a curriculum enhancing primary care, capacity building of teaching doctors, standardization of education programs, decreased work load of university staff doctors, and the attitude of educators and teaching doctors are critical to make hospitals attractive to medical students and training doctors.

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A 90-year-old female was admitted for upper right quadrant pain. Tenderness and muscular guarding of the right hypochondrium were present. The laboratory data demonstrated marked inflammation and slight jaundice. An abdominal ultrasound image revealed wall thickening and swelling of the gallbladder and phyma-shaped constriction in the cervix. No signs of cholecystolithiasis were detected. An abdominal computed tomography (CT) scan showed the entire swelling and wall thickening of the gallbladder. Torsion of the gallbladder was therefore diagnosed and laparoscopic cholecystectomy (LC) was performed. During surgery, it was found that the gallbladder was a Gross type- 1 floating gallbladder and was twisted clockwise 360 degrees around the cervical portion and cystic duct, causing necrosis. Because LC may be useful for treatment of torsion of the gallbladder, it is important to diagnosis torsion of the gallbladder preoperatively.

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We report a rare case of perforation of the sigmoid colon diagnosed seven days after colonoscopy. A 61-year-old female initially underwent a flexible colonoscopy at the department of internal medicine in December 2008. Seven days after the examination, she developed nausea and abdominal pain. There was rebound tenderness and distention of the entire abdomen. An abdominal computed tomography demonstrated free air and ascites. Then an emergency operation was performed with a suspicion of panperitonitis due to perforation of the colon. We performed sigmoidectomy and colostomy (Hartmann's procedure) due to the finding of a perforation in the sigmoid colon and a necrotic change of mesocolon. At postoperative course, patient was treated with polymyxin B by direct hemoperfusion and with neutrophil elastase inhibitor. She overcame her severe condition and was free from the respirator on the eighth postoperative day. She was discharged from our hospital at day 52 after the initial operation. In March 2009 we closed the colostomy. Now she is doing well and healthy.

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