Quite a few changes and challenges have arisen in society in general as technology has advanced and the aging population has increased. These can lead to the recognition of the shortcomings of a society’s traditional systems and the various changes that are needed, especially in providing emergency medical care. A super-aged society has been developing in Japan, and the emergency care system needs to change according to these new demographics and society’s needs. The focus has been shifting from critical care and trauma to medical and surgical conditions involving the elderly. Challenges in triage, ambulance diversion, and staffing are discussed in this review. Possible solutions currently underway, such as a public helpline, smartphone app system, coordination by designated hospitals, and universal coverage/government support, are discussed as future directions. Emergency medicine in Japan needs to develop in a more flexible way to meet the upcoming robust challenges of the changing demographics.

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Historic backgrounds, current status (including legislations, statistics, system organizations, involvement of co-medicals, work life balance and female workforce, and hospital managements) and issues facing Emergency Medicine in US are reviewed and made comparison with emerging Emergency Medicine (the US model/style Emergency Medicine also known as "ER style EM" in Japan) in Japan. In US, EM was born in 1960's, then the Residency and the Specialty Board were established. Further organization resulted in roughly 40,000 Emergency Physicians and the nation's Emergency Departments functioning as society's safety net. Reasons for its success are not only because the model they had was based on the society's demand but also because they are able to make their work very sustainable and able to give opportunities for education and research. In Japan, the US model EM was born in 1990s, and emerging. But, the number of Emergency Physicians are still quite few and their work frequently involves inpatient care as well. Interestingly, there is a trend in Europe to adapt the US model EM as well. It appears that it makes sense to have the US model EM to better cope with highly developed urban society's Emergency Care needs. As we review the development of EM in US, it is clear that standardization of Emergency Physicians' quality and sustainable workforce with reasonable work life balance are crucial factors in further development of the US model EM in Japan.

author made a final coding determination. Following the study period, a survey distributed to residents and faculty assessed attitudes towards the synchronous online discussions.Results: The qualitative analysis of the transcripts identified 2352 coded messages. The final coding schema can be seen in Figure 1. Of 1720 identified content codes, the most commonly identified themes were cultural communications (40.8%) and knowledge sharing (39.0%). Within the broader theme of knowledge sharing, participants were most likely to share individual practice experience (366/671 codes). Statements with uncited data/evidence (113 codes) occurred in similar frequency to sharing of academic resources (137 codes).Questions directed towards other members of the audience (48.8% of questions) were only slightly less common than questions directed to the lecturer (51.2% of questions). There were 56 respondents to the survey (30 residents, 25 faculty, 1 fellow). Of the 44 respondents that had presented didactics, 54.5% (24/44) identified that it was challenging to keep up with the synchronous online discussion. From the perspective of the audience, 82.1% (46/56) felt it was easy to keep up with the discussion. Presenters of didactics felt identifying a member of the audience as a surrogate was the easiest means to keep up with the discussion (75%, 33/44 presenters). Audience members agreed that they were much more likely to ask a question in a synchronous online discussion as opposed to speaking out loud (71.4%, 40/56).Conclusions: Weekly academic conferences are a critical component of residency education, enabling not only the acquisition of knowledge but also the social sharing of knowledge/experiences developing of robust communities of practice. Our qualitative analysis found that cultural communication occurred with near equal frequency to knowledge sharing and that sharing of individual practice experiences was more common than sharing of academic resources. These synchronous online discussions may make it more likely for audience members to ask questions of each other or the lecturer but keeping up with the discussion was challenging for lecturers.