How Japan’s Medical Schools Were Caught Discriminating Against Women

On July 4, 2018, Tokyo prosecutors arrested a senior Ministry of Education official and a company executive in a bribery case. The investigation soon turned to Tokyo Medical University, where the official's son had sat the entrance examination. The university's internal inquiry found that his examination score had been improperly increased and that he was admitted as a result.

The university then examined whether the manipulation went beyond that individual case. Its investigators found that scores had also been adjusted according to applicants' attributes, including sex and the number of years since high-school graduation. A separate system allowed senior officials to order additional points for individual candidates.

By December 2018, MEXT's investigation had expanded from one university to medical-school admissions nationwide. It identified inappropriate or highly likely inappropriate admissions practices at 10 universities, involving sex, age, repeat candidature and other forms of preferential treatment.

How Were The Scores Changed?

Tokyo Medical University's third-party investigation described two systems.

The first, called "attribute adjustment", was introduced in the 2006 admissions year. It allowed the university to alter written-examination scores according to attributes such as sex and the number of years since high-school graduation. The second, "individual adjustment", involved the university's president or chairman instructing admissions staff to change the original scores of particular candidates.

The attribute-based system affected rankings before final admissions decisions were made. The investigators found that some applicants received additional points based on their attributes, while individual candidates could separately receive manual additions.

The difference was reflected in the university's intake. In 2017, women accounted for 54 of 120 entrants, or 45%. In 2018, that fell to 23 of 120, or 19.2%. The third-party investigation also found that the 2018 general and centre-test admissions involved undisclosed score adjustments based on sex and years since graduation.

Why Were Women Being Penalised?

The reasoning recorded by the university's investigators rested on assumptions about women's future careers.

Some admissions officials said women were less likely to remain in positions that would support the university because of pregnancy and childbirth. Others argued that increasing the number of female doctors could affect the distribution of doctors between medical specialties.

The report records that such views were reflected in decisions to favour male applicants. In the 2018 recommendation-based examination, for example, the investigation found that the admissions committee chairman had expressed a desire to admit more men because the previous year's intake had included many women.

The report concluded that using sex to disadvantage applicants was inconsistent with the principles of equality, equal educational opportunity and fair admissions.

How Did Japan Check Other Medical Schools?

MEXT launched an emergency investigation covering all national, public and private universities with medical faculties in Japan. It first examined written responses and six years of data on applicants, candidates and successful admissions by sex and age.

The preliminary figures showed that male pass rates exceeded female pass rates at many medical universities. But MEXT explicitly said that the statistical gap alone did not establish that admissions had been manipulated. The ministry compared the figures with each university's explanation before deciding where to conduct on-site inspections.

Investigators then visited universities, examined admissions documents and heard from staff involved in selection. After identifying several cases that appeared highly likely to involve inappropriate practices, MEXT expanded the exercise into on-site investigations of universities with medical faculties.

What Else Did Investigators Find?

The national investigation identified a broader range of undisclosed admissions practices.

At Juntendo University, MEXT found that women faced a higher pass threshold in parts of the second-stage assessment. It also found criteria under which female applicants with more years of repeat study were treated less favourably than male applicants.

At Kitasato University, applicants on the waiting list were not contacted strictly according to their examination ranking. Male and younger applicants were given priority. At Showa University, current students and one-year repeat candidates received preferential treatment, while another process prioritised children of alumni.

MEXT also identified other cases involving preferential treatment and irregular selection. It classified 10 universities as having inappropriate or highly likely inappropriate practices; that category covered gender and age-based treatment as well as other forms of admissions preference.

What Happened To The Applicants?

Tokyo Medical University then had to revisit admissions decisions made under the altered system.

For the 2017 and 2018 general and centre-test examinations, MEXT recorded that the university contacted 89 applicants to establish their intentions. The university was to use reconstructed rankings based on results before the improper adjustments and admit candidates from the higher positions until capacity was filled.

MEXT's follow-up recorded a maximum of 44 additional admissions under the remedial process. The university also created a compensation process for affected applicants, while earlier examination years were dealt with through separate procedures.

For those earlier candidates, simply offering admission years later could not recreate the opportunity that had originally been lost. The university therefore considered compensation in those cases.

Did The Applicants Go To Court?

Some did. Tokyo Medical University became the centre of a damages case brought by former female applicants.

In September 2022, the Tokyo District Court ruled that the university had unlawfully disadvantaged applicants through its use of sex as an attribute in admissions. MEXT said the court ordered the university to pay about ¥18 million to 27 plaintiffs. Twenty-eight former applicants had brought the case.

The litigation was not confined to Tokyo Medical University. At Juntendo University, the Tokyo District Court in May 2022 recognised the university's liability and ordered compensation to 13 plaintiffs, along with reimbursement of examination-related expenses. According to the plaintiffs' lawyers, the judgment held that treating applicants differently solely because of sex lacked a reasonable basis.

St Marianna University School of Medicine also underwent a third-party investigation after MEXT classified its case as highly likely to have been inappropriate. The university's own investigation found that, although there had been no organisational instruction to discriminate, uniform discriminatory treatment had occurred in evaluating application documents between 2015 and 2018 and could have affected admissions results.

St Marianna subsequently reimbursed eligible applicants for examination fees and related application costs. The university later said the Tokyo District Court had issued its first-instance judgment in December 2023 and that it became final in January 2024.

What Did The Courts Actually Decide?

The Tokyo Medical University litigation then moved to the Tokyo High Court.

According to the plaintiffs' lawyers' account of the ruling, the High Court maintained ¥200,000 in damages for each applicant subjected to the unfair examination process. For four second-stage applicants whom the court found would have been admitted without the score manipulation, it awarded additional compensation: ¥3 million each to three applicants and ¥2 million to another.

The court did not accept every financial claim. Some claims involving differences in university fees, lost income and preparatory-school expenses were rejected where the required causal link was not established. The ruling therefore distinguished between liability for an unlawful admissions process and every financial consequence an applicant might claim from not entering Tokyo Medical University.

The Tokyo High Court judgment was delivered on May 30, 2023.

In October 2024, the Supreme Court rejected the plaintiffs' petition for acceptance of a further appeal. That left the High Court judgment in force; the Supreme Court did not issue a separate merits ruling on whether the underlying score manipulation amounted to sex discrimination.

What Changed After The Scandal?

MEXT's 2018 final report said universities should not, without a reasonable justification, apply undisclosed or uniform differences in treatment based on attributes such as sex, age or whether an applicant was a current or repeat student. It also said admissions methods and criteria had to be clear and consistent with the procedures announced to applicants.

Tokyo Medical University abolished its attribute-based score adjustments and changed its admissions procedures. MEXT's follow-up recorded the removal of sex- and age-based score adjustments and said it later carried out follow-up investigations to confirm improvements in admissions.

The ministry subsequently incorporated the same principle into the common University Admission Selection Guidelines: absent a reasonable justification, universities should not impose uniform differences in treatment based on attributes such as sex.

The Scores Changed. The System Had To Answer.

A bribery investigation in 2018 exposed a hidden admissions system at Tokyo Medical University. What began with the manipulation of one candidate's examination result uncovered a wider practice in which scores could be adjusted according to sex and other attributes.

MEXT then examined medical-school admissions across Japan and identified inappropriate or highly likely inappropriate practices at 10 universities. Some affected applicants received reassessment or compensation; others took their cases to court, where judges considered both the unlawfulness of the admissions process and the limits of compensable loss.

Japan subsequently changed the formal rules governing admissions and required greater transparency around selection. Those changes addressed the system that had been exposed. They did not, by themselves, establish that every assumption behind the old practices had disappeared.