Clinicians, educators, and investigators in general internal medicine: bridging the gaps

Distribution of internal medicine rotations among resident physicians in Japan: a nationwide, multicenter, cross-sectional study

BACKGROUND

In Japan, postgraduate clinical training encompasses a 2-year residency program, including at least 24 weeks of internal medicine (IM) rotations. However, the fragmented structure of these rotations can compromise the training's quality and depth. For example, a resident might spend only a few weeks in cardiology before moving to endocrinology, without sufficient time to deepen their understanding or have clinical experience. This study examined current patterns and lengths of IM rotations within the Japanese postgraduate medical system. It scrutinized the piecemeal approach-whereby residents may engage in multiple short-term stints across various subspecialties without an overarching, integrated experience-and explored potential consequences for their clinical education.

METHODS

This nationwide, multicenter, cross-sectional study used data from self-reported questionnaires completed by participants in the 2022 General Medicine In-Training Examination (GM-ITE). Data of 1,393 postgraduate year (PGY) one and two resident physicians who participated in the GM-ITE were included. We examined the IM rotation duration and number of IM subspecialties chosen by resident physicians during a 2-year rotation.

RESULTS

Approximately half of the participants chose IM rotation periods of 32-40 weeks. A significant proportion of participants rotated in 5-7 internal medicine departments throughout the observation period. Notable variations in the distribution of rotations were observed, characterized by a common pattern where resident physicians typically spend 4 weeks in each department before moving to the next. This 4-week rotation is incrementally repeated across different subspecialties without a longer, continuous period in any single area. Notably, 39.7% of participants did not undertake general internal medicine rotations. These results suggest a narrowed exposure to medical conditions and patient care practices.

CONCLUSIONS

Our study highlights the need to address the fragmented structure of IM rotations in Japan. We suggest that short, specialized learning periods may limit the opportunity to gain broad in-depth knowledge and practical experience. To improve the efficacy of postgraduate clinical education, we recommend fostering more sustained and comprehensive learning experiences.

Outcomes of a pilot faculty mentoring program

OBJECTIVE

The purpose of this study was to determine whether a junior faculty mentoring program is beneficial to participants and to identify particular positive and negative aspects of such a program to enable others to institute similar programs.

STUDY DESIGN

In 2001 a pilot program was instituted in our obstetrics and gynecology department for interested faculty members. There were 3 focus groups and a written survey that assessed the project. A combination of qualitative and quantitative methods were used for data analysis; Fisher's exact test was used.

RESULTS

Two recurring themes emerged from the focus group sessions: participants felt better supported by the department and appreciated a greater sense of camaraderie. Most mentees noted the program's success in the following areas of having a role model (83.3%), having increased visibility (82.3%), and having to whom someone to turn (93.8%).

CONCLUSION

The faculty mentoring program had significant benefits for everyone who participated.