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Shikino K, Nishizaki Y, Fukui S, Yokokawa D, Yamamoto Y, Kobayashi H, Shimizu T, Tokuda Y. Development of a Clinical Simulation Video to Evaluate Multiple Domains of Clinical Competence: Cross-Sectional Study. JMIR MEDICAL EDUCATION 2024; 10:e54401. [PMID: 38421691 PMCID: PMC10940988 DOI: 10.2196/54401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/14/2023] [Accepted: 01/28/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Medical students in Japan undergo a 2-year postgraduate residency program to acquire clinical knowledge and general medical skills. The General Medicine In-Training Examination (GM-ITE) assesses postgraduate residents' clinical knowledge. A clinical simulation video (CSV) may assess learners' interpersonal abilities. OBJECTIVE This study aimed to evaluate the relationship between GM-ITE scores and resident physicians' diagnostic skills by having them watch a CSV and to explore resident physicians' perceptions of the CSV's realism, educational value, and impact on their motivation to learn. METHODS The participants included 56 postgraduate medical residents who took the GM-ITE between January 21 and January 28, 2021; watched the CSV; and then provided a diagnosis. The CSV and GM-ITE scores were compared, and the validity of the simulations was examined using discrimination indices, wherein ≥0.20 indicated high discriminatory power and >0.40 indicated a very good measure of the subject's qualifications. Additionally, we administered an anonymous questionnaire to ascertain participants' views on the realism and educational value of the CSV and its impact on their motivation to learn. RESULTS Of the 56 participants, 6 (11%) provided the correct diagnosis, and all were from the second postgraduate year. All domains indicated high discriminatory power. The (anonymous) follow-up responses indicated that the CSV format was more suitable than the conventional GM-ITE for assessing clinical competence. The anonymous survey revealed that 12 (52%) participants found the CSV format more suitable than the GM-ITE for assessing clinical competence, 18 (78%) affirmed the realism of the video simulation, and 17 (74%) indicated that the experience increased their motivation to learn. CONCLUSIONS The findings indicated that CSV modules simulating real-world clinical examinations were successful in assessing examinees' clinical competence across multiple domains. The study demonstrated that the CSV not only augmented the assessment of diagnostic skills but also positively impacted learners' motivation, suggesting a multifaceted role for simulation in medical education.
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Affiliation(s)
- Kiyoshi Shikino
- Department of Community-Oriented Medical Education, Chiba University Graduate School of Medicine, Chiba, Japan
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Yuji Nishizaki
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Sho Fukui
- Department of Emergency and General Medicine, Kyorin University, Tokyo, Japan
| | - Daiki Yokokawa
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Yu Yamamoto
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Hiroyuki Kobayashi
- Department of Internal Medicine, Mito Kyodo General Hospital, Tsukuba, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Yasuharu Tokuda
- Muribushi Okinawa Center for Teaching Hospitals, Okinawa, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
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Nagasaki K, Kobayashi H, Nishizaki Y, Kurihara M, Watari T, Shimizu T, Yamamoto Y, Shikino K, Fukui S, Nishiguchi S, Katayama K, Tokuda Y. Association of sleep quality with duty hours, mental health, and medical errors among Japanese postgraduate residents: a cross-sectional study. Sci Rep 2024; 14:1481. [PMID: 38233476 PMCID: PMC10794685 DOI: 10.1038/s41598-024-51353-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024] Open
Abstract
Long duty hours (DH) impair sleep and negatively affect residents' health and medical safety. This cross-sectional study investigated the association among residents' DH, sleep duration, insomnia, sleep impairment, depressive symptoms, and self-reported medical errors among 5579 residents in Japan who completed the General Medicine In-Training Examination (2021) and participated in the training-environment survey. Weekly DH was classified under seven categories. Sleep duration and insomnia symptoms, from the Athens Insomnia Scale, were analysed to determine sleep impairment; depressive symptoms and medical errors were self-reported. Among 5095 residents, 15.5% slept < 5 h/day, and 26.7% had insomnia. In multivariable analysis, compared with ≥ 60 and < 70, DH ≥ 90 h/week associated with shorter sleep duration and worsen insomnia symptoms. Shorter durations of sleep and more intense symptoms of insomnia were associated with increased depressive symptoms. Medical errors increased only among residents with insomnia, but were not associated with sleep duration. DH > 90 h/week could lead to shorter sleep duration, worsen insomnia symptoms, and negatively impact well-being and medical safety. There was no significant association between sleep duration and medical errors; however, insomnia conferred an increased risk of medical errors. Limiting DH for residents to avoid excessive workload can help improve resident sleep, enhance resident well-being, and potentially reduce insomnia-associated medical errors.
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Affiliation(s)
- Kazuya Nagasaki
- Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, 3-2-7, Miyamachi, Mito, Ibaraki, 310-0015, Japan
| | - Hiroyuki Kobayashi
- Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, 3-2-7, Miyamachi, Mito, Ibaraki, 310-0015, Japan.
| | - Yuji Nishizaki
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Masaru Kurihara
- Department of Patient Safety, Nagoya University Hospital, Aichi, Japan
| | - Takashi Watari
- General Medicine Center, Shimane University Hospital, Shimane, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Yu Yamamoto
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Sho Fukui
- Department of Emergency and General Medicine, Kyorin University, Tokyo, Japan
| | - Sho Nishiguchi
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kohta Katayama
- Department of General Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuharu Tokuda
- Muribushi Okinawa for Teaching Hospitals, Okinawa, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
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Luo S, Zhang Y, Wang P, Yang Z, Zheng J, Wang Z, Zhang J, Zhu J. The moderating role of resilience in the association between workload and depressive symptoms among radiology residents in China: results from a nationwide cross-sectional study. Eur Radiol 2024; 34:695-704. [PMID: 37566268 DOI: 10.1007/s00330-023-10021-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/28/2023] [Accepted: 06/12/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES The current study aimed to explore the moderating role of psychological resilience in the association between workload and depressive symptoms among radiology residents during standardized residency training (SRT) in China. METHODS A nationwide cross-sectional online survey was conducted among radiology residents in China. Workload was measured by working hours per week and the frequency of frontline nightwork in the last month. Resilience was assessed by the 2-item Connor-Davidson Resilience Scale. Depressive symptoms were measured by the Depression Anxiety Stress Scales. The hierarchical regression and simple slope analyses were performed to examine the moderating effect of resilience. RESULTS Among 3666 radiology residents, the mean age was 27.3 years (SD = 2.6) and 58% were female. About 24.4% of the participants reported medium to severe depressive symptoms. The hierarchical regression showed that working hours (ba = 0.11, 95%CI: 0.08, 0.14) and having frontline nightwork more than once (ba = 1.22, 95%CI: 0.67, 1.78) were positively associated with depressive symptoms; the moderating effect of resilience was significant in the association of depressive symptoms with working hours (ba = - 0.02, 95%CI: - 0.03, - 0.01) and having frontline nightwork more than once (ba = - 0.28, 95%CI: - 0.49, - 0.07). The simple slope test showed the association between workload-related variables and depressive symptoms was only significant in those with a relatively lower level of resilience. CONCLUSIONS The study found that resilience was an important modifier buffering the positive association between workload and depressive symptoms among radiology residents in China. Future medical training programs are suggested to include effective intervention components to increase personal resilience. CLINICAL RELEVANCE STATEMENT Heavy workload in clinical setting may pose adverse effect on mental health and job performance of radiology residents. The study investigated whether psychological resilience would mitigate the association between workload and depressive symptoms among Chinese radiology residents. KEY POINTS • Radiology residents with a heavier workload presented a higher level of depressive symptoms in China. • Psychological resilience mitigated the positive association between workload and depressive symptoms. • The association between workload and depressive symptoms was only statistically significant in radiology residents with a relatively lower level of resilience.
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Affiliation(s)
- Sitong Luo
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Yuhang Zhang
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Peicheng Wang
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jianjun Zheng
- Department of Radiology, Ningbo No.2 Hospital, 315000, Ningbo, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jingfeng Zhang
- Department of Radiology, Ningbo No.2 Hospital, 315000, Ningbo, China.
| | - Jiming Zhu
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China.
- Institute for Healthy China, Tsinghua University, Beijing, China.
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Katayama K, Nishizaki Y, Takada T, Kataoka K, Houchens N, Watari T, Tokuda Y, Ohira Y. Association between mentorship and mental health among junior residents: A nationwide cross-sectional study in Japan. J Gen Fam Med 2024; 25:62-70. [PMID: 38240005 PMCID: PMC10792322 DOI: 10.1002/jgf2.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/08/2023] [Accepted: 12/03/2023] [Indexed: 01/22/2024] Open
Abstract
Background Mentorship is a dynamic, reciprocal relationship in which an advanced careerist (mentor) encourages the growth of a novice (mentee). Mentorship may protect the mental health of residents at risk for depression and burnout, yet despite its frequent use and known benefits, limited reports exist regarding the prevalence and mental effects of mentorship on residents in Japan. Methods We conducted a cross-sectional study involving postgraduate year 1 and 2 (PGY-1 and PGY-2) residents in Japan who took the General Medicine In-Training Examination (GM-ITE) at the end of the 2021 academic year. Data on mentorship were collected using surveys administered immediately following GM-ITE completion. The primary outcome was the Patient Health Questionaire-2 (PHQ-2), which consisted depressed mood and loss of interest. A positive response for either item indicated PHQ-2 positive. We examined associations between self-reported mentorship and PHQ-2 by multi-level analysis. Results Of 4929 residents, 3266 (66.3%) residents reported having at least one mentor. Compared to residents without any mentor, those with a mentor were associated with a lower likelihood of a positive PHQ-2 response (adjusted odds ratio [aOR] 0.75; 95% confidence interval [95% CI] 0.65-0.86). Mentor characteristic significantly associated with negative PHQ-2 response was a formal mentor (aOR; 0.68; 95% CI 0.55-0.84). Conclusions A mentor-based support system was positively associated with residents' mental health. Further research is needed to determine the quality of mentorship during clinical residency in Japan.
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Affiliation(s)
- Kohta Katayama
- Department of General Internal MedicineSt. Marianna University School of MedicineKanagawaJapan
- Department of Clinical Epidemiology, Graduate School of MedicineFukushima Medical UniversityFukushimaJapan
| | - Yuji Nishizaki
- Division of Medical Education, School of MedicineJuntendo UniversityTokyoJapan
| | - Toshihiko Takada
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR)Fukushima Medical UniversityShirakawaJapan
| | - Koshi Kataoka
- Division of Medical Education, School of MedicineJuntendo UniversityTokyoJapan
| | - Nathan Houchens
- Medicine ServiceVA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
- Department of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Takashi Watari
- General Medicine CenterShimane University HospitalIzumoJapan
| | - Yasuharu Tokuda
- Muribushi Okinawa Center for Teaching HospitalsOkinawaJapan
- Tokyo Foundation for Policy ResearchTokyoJapan
| | - Yoshiyuki Ohira
- Department of General Internal MedicineSt. Marianna University School of MedicineKanagawaJapan
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Nagasaki K, Kobayashi H. The effects of resident work hours on well-being, performance, and education: A review from a Japanese perspective. J Gen Fam Med 2023; 24:323-331. [PMID: 38025934 PMCID: PMC10646297 DOI: 10.1002/jgf2.649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/20/2023] [Accepted: 08/31/2023] [Indexed: 12/01/2023] Open
Abstract
This article examines the impact of working-hour restrictions on the well-being, performance, and education of medical residents in Japan. Despite Japan's plan to introduce new regulations for resident working hours by 2024, there is still an ongoing debate regarding their appropriateness. This review provides a comprehensive overview of the current regulations of resident working hours worldwide, with a specific focus on weekly hours. The varying regulations are highlighted, including the 80-hour-per-week regulation in the United States and the 48-h-per-week regulation in the European Union influencing other regions. The article also discusses the effectiveness of working-hour restrictions on residents' mental health, with shorter working hours having potentially greater benefits. However, the impacts on medical safety and resident education are mixed, and further reduction in working hours must be carefully considered to avoid adverse effects. The planned changes to working-hour limits for residents in Japan offer a unique opportunity to gain new evidence on the impact of such regulations, which will be of interest to policymakers and researchers worldwide.
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Affiliation(s)
- Kazuya Nagasaki
- Department of Internal Medicine, Mito Kyodo General HospitalUniversity of TsukubaIbarakiJapan
| | - Hiroyuki Kobayashi
- Department of Internal Medicine, Mito Kyodo General HospitalUniversity of TsukubaIbarakiJapan
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Nagasaki K, Nishizaki Y, Shinozaki T, Shimizu T, Yamamoto Y, Shikino K, Fukui S, Nishiguchi S, Kurihara M, Katayama K, Kobayashi H, Tokuda Y. Association between prolonged weekly duty hours and self-study time among residents: a cross-sectional study. Postgrad Med J 2023; 99:1080-1087. [PMID: 37265446 DOI: 10.1093/postmj/qgad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/26/2023] [Accepted: 05/06/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE In 2024, the Japanese government will enforce a maximum 80-hour weekly duty hours (DHs) regulation for medical residents. Although this reduction in weekly DHs could increase the self-study time (SST) of these residents, the relationship between these two variables remains unclear. The aim of the study was to investigate the relationship between the SST and DHs of residents in Japan. METHODS In this nationwide cross-sectional study, the subjects were candidates of the General Medicine In-Training Examination in the 2020 academic year. We administered questionnaires and categorically asked questions regarding daily SST and weekly DHs during the training period. To account for hospital variability, proportional odds regression models with generalized estimating equations were used to analyse the association between SST and DHs. RESULTS Of the surveyed 6117 residents, 32.0% were female, 49.1% were postgraduate year-1 residents, 83.8% were affiliated with community hospitals, and 19.9% worked for ≥80 hours/week. Multivariable analysis revealed that residents working ≥80 hours/week spent more time on self-study than those working 60-70 hours/week. Conversely, residents who worked <50 hours/week spent less time on self-study than those who worked 60-70 hours/week. The factors associated with longer SST were sex, postgraduate year, career aspiration for internal medicine, affiliation with community hospitals, academic involvement, and well-being. CONCLUSION Residents with long DHs had longer SSTs than residents with short DHs. Future DH restrictions may not increase but rather decrease resident SST. Effective measures to encourage self-study are required, as DH restrictions may shorten SST.
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Affiliation(s)
- Kazuya Nagasaki
- Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki 310-0015, Japan
| | - Yuji Nishizaki
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, 113-8421, Japan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Yu Yamamoto
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Sho Fukui
- Department of Emergency and General Medicine, Kyorin University, Tokyo, Japan
| | - Sho Nishiguchi
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Masaru Kurihara
- Department of Patient Safety, Nagoya University Hospital, Nagoya, Japan
| | - Kohta Katayama
- Department of General Internal Medicine, St. Marianna University School of Medicine, Tokyo, Japan
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hiroyuki Kobayashi
- Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki 310-0015, Japan
| | - Yasuharu Tokuda
- Muribushi Okinawa Center for Teaching Hospitals, Okinawa, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
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Morita T, Muroya S, Takahashi O, Ohde S. Factors Associated with Intention to Resign among Medical Residents during the COVID-19 Pandemic in Japan: A Cross-sectional Study. JMA J 2023; 6:292-299. [PMID: 37560358 PMCID: PMC10407254 DOI: 10.31662/jmaj.2023-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/12/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic has significantly affected healthcare workers' mental health worldwide, leading to the intention to resign. Japanese medical residents were no exception to the impact of COVID-19. This study aimed to illustrate how the COVID-19 pandemic affected medical residents' intention to resign. METHODS A cross-sectional study was conducted for Postgraduate Year (PGY)1-5 medical residents in Japan using an internet survey from March 11 to March 18, 2021. During this survey, the Japanese government declared a second-time state of emergency on January 7, 2021, and all restrictions were expanded nationwide until March 21, 2021. Medical residents were categorized into two groups (intention to resign group [IR] or no intention to resign group [NIR]) based on their intention to resign. Multivariate logistic regression analysis was conducted to elucidate the risk factors for the intention to resign. RESULTS 354 medical residents were enrolled in this study (response rate: 40.2%). Ninety-two medical residents (26.0 %) were categorized into IR and 262 (74.0%) into NIR. According to multivariate logistic regression analysis, those who did not have mental support at their hospital had 2.95 times greater chance of intending to resign (Adjusted odds ratio [AOR] = 2.95, 95% confidence interval (CI) [1.42-6.15]). Medical residents who engaged in patients with COVID-19 (AOR = 2.13, 95% Cl [1.08-4.18]) and PGY5 (AOR = 3.38, 95% Cl [1.51-7.56]) had a higher likelihood of intending to resign among residents in all PGY. CONCLUSIONS One in four medical residents intended to resign during the COVID-19 pandemic. Particularly, PGY5 and medical residents who treated patients with COVID-19 were found at risk of having the intention to resign. At times of crisis, such as the COVID-19 epidemic, establishing a mental health support system that targets high-risk residents is critical.
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Affiliation(s)
- Takako Morita
- Graduate School of Public Health and Clinical Epidemiology St. Luke's International University, Tokyo, Japan
| | - Saki Muroya
- Graduate School of Public Health and Clinical Epidemiology St. Luke's International University, Tokyo, Japan
| | - Osamu Takahashi
- Graduate School of Public Health and Clinical Epidemiology St. Luke's International University, Tokyo, Japan
| | - Sachiko Ohde
- Graduate School of Public Health and Clinical Epidemiology St. Luke's International University, Tokyo, Japan
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Watari T, Nishizaki Y, Houchens N, Kataoka K, Sakaguchi K, Shiraishi Y, Shimizu T, Yamamoto Y, Tokuda Y. Medical resident's pursuing specialty and differences in clinical proficiency among medical residents in Japan: a nationwide cross-sectional study. BMC MEDICAL EDUCATION 2023; 23:464. [PMID: 37349724 DOI: 10.1186/s12909-023-04429-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023]
Abstract
IMPORTANCE Standardized examinations assess both learners and training programs within the medical training system in Japan. However, it is unknown if there is an association between clinical proficiency as assessed by the General Medicine In-Training Examination (GM-ITE) and pursuing specialty. OBJECTIVE To determine the relative achievement of fundamental skills as assessed by the standardized GM-ITE based on pursuing career specialty among residents in the Japanese training system. DESIGN Nationwide cross-sectional study. SETTING Medical residents in Japan who attempted the GM-ITE in their first or second year were surveyed. PARTICIPANTS A total of 4,363 postgraduate years 1 and 2 residents who completed the GM-ITE were surveyed between January 18 and March 31, 2021. MAIN MEASURES GM-ITE total scores and individual scores in each of four domains assessing clinical knowledge: 1) medical interview and professionalism, 2) symptomatology and clinical reasoning, 3) physical examination and treatment, and 4) detailed disease knowledge. RESULTS When compared to the most pursued specialty, internal medicine, only those residents who chose general medicine achieved higher GM-ITE scores (coefficient 1.38, 95% CI 0.08 to 2.68, p = 0.038). Conversely, the nine specialties and "Other/Not decided" groups scored significantly lower. Higher scores were noted among residents entering general medicine, emergency medicine, and internal medicine and among those who trained in community hospitals with higher numbers of beds, were more advanced in their training, spent more time working and studying, and cared for a moderate but not an extreme number of patients at a time. CONCLUSIONS Levels of basic skill achievement differed depending on respective chosen future specialties among residents in Japan. Scores were higher among those pursuing careers in general medical fields and lower among those pursuing highly specialized careers. Residents in training programs devoid of specialty-specific competition may not possess the same motivations as those in competitive systems.
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Affiliation(s)
- Takashi Watari
- General Medicine Center, Shimane University Hospital, 89-1, Enya-Cho, Izumo Shi, Shimane, 693-8501, Japan.
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Yuji Nishizaki
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Nathan Houchens
- Medicine Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Koshi Kataoka
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Kota Sakaguchi
- General Medicine Center, Shimane University Hospital, 89-1, Enya-Cho, Izumo Shi, Shimane, 693-8501, Japan
| | - Yoshihiko Shiraishi
- General Medicine Center, Shimane University Hospital, 89-1, Enya-Cho, Izumo Shi, Shimane, 693-8501, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Yu Yamamoto
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Yasuharu Tokuda
- Muribushi Okinawa Project for Teaching Hospitals, Okinawa, Japan
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