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Shikino K, Sekine M, Nishizaki Y, Yamamoto Y, Shimizu T, Fukui S, Nagasaki K, Yokokawa D, Watari T, Kobayashi H, Tokuda Y. Distribution of internal medicine rotations among resident physicians in Japan: a nationwide, multicenter, cross-sectional study. BMC MEDICAL EDUCATION 2024; 24:316. [PMID: 38509553 PMCID: PMC10956328 DOI: 10.1186/s12909-024-05314-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
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.
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Grants
- 21IA2004 Ministry of Health, Labour, and Welfare
- 21IA2004 Ministry of Health, Labour, and Welfare
- 21IA2004 Ministry of Health, Labour, and Welfare
- 21IA2004 Ministry of Health, Labour, and Welfare
- 21IA2004 Ministry of Health, Labour, and Welfare
- 21IA2004 Ministry of Health, Labour, and Welfare
- 21IA2004 Ministry of Health, Labour, and Welfare
- 21IA2004 Ministry of Health, Labour, and Welfare
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Affiliation(s)
- Kiyoshi Shikino
- Department of Community-oriented Medical Education, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chu-ou-ku, Chiba, Japan.
- Department of General Medicine, Chiba University Hospital, Chiba, Japan.
| | - Miwa Sekine
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Yuji Nishizaki
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Yu Yamamoto
- Division of General Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Sho Fukui
- Emergency and general Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Kazuya Nagasaki
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Internal Medicine, Mito Kyodo General Hospital, Tsukuba, Japan
| | - Daiki Yokokawa
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Takashi Watari
- General Medicine Center, Shimane University Hospital, Izumo, Japan
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Hiroyuki Kobayashi
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Internal Medicine, Mito Kyodo General Hospital, Tsukuba, Japan
| | - Yasuharu Tokuda
- Muribushi Okinawa Center for Teaching Hospitals, Okinawa, Japan
- Tokyo Foundation for Policy Research, Tokyo, Japan
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Kaneko M, Higuchi T, Ohta R. Primary care physicians working in rural areas provide a broader scope of practice: a cross-sectional study. BMC PRIMARY CARE 2024; 25:9. [PMID: 38166745 PMCID: PMC10759475 DOI: 10.1186/s12875-023-02250-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Scope of practice (SoP) is an important factor for primary care physicians (PCPs). One of the strong determinants of SoP is rurality. Although Japan has several rural areas, the SoP in rural areas and the effect of rurality on SoP have not been investigated. This study aimed to describe SoP in Japanese primary care settings and examine the association between rurality and SoP. METHODS This cross-sectional study included PCPs in Japan. The participants were randomly sampled from the mailing list of the Japan Primary Care Association. The Scope of Practice Inventory (SPI) and Scope of Practice for Primary Care (SP4PC) were used as indicators of SoP. The Rurality Index for Japan (RIJ) was used for rurality. This study compared the number of items of SPI (total score, inpatient care, urgent care and ambulatory care) and SP4PC experienced by > 80% of all PCPs in the most urban (RIJ:1-10) and rural areas (RIJ: 91-100). A multivariable linear regression analysis was also performed to examine the relationship between the RIJ and SPI/SP4PC. RESULTS Of 1,000 potential participants, 299 physicians responded to the survey (response rate: 29.9%). PCPs in the most rural areas experienced a greater number of items in the inpatientl/urgent care domains of the SPI and SP4PC than those in the most urban areas. The RIJ was the only common factor for a broader SoP in both the SPI and SP4C models. The coefficients of SoP were 0.09 (95% confidence interval: 0.03-0.16) in the SPI model and 0.017 (0.005-0.03) in the SP4PC model. CONCLUSION Rurality was considerably associated with SoP. The findings of this study will be helpful in understanding the SoP on rural and urban areas.
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Affiliation(s)
- Makoto Kaneko
- Department of Health Data Science, Yokohama City University, 22-2, Seto, Kanazawa-Ku, Yokohama, Kanagawa, 236-0027, Japan.
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan.
| | - Tomoya Higuchi
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
- Shizuoka Family Medicine Program, 1-20-1, Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan
| | - Ryuichi Ohta
- Department of Community Care, Unnan City Hospital, 96-1, Iida, Daito-Cho, Unnan, Shimane, 699-1221, Japan
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Watanabe Y, Kawashima N, Uneno Y, Okamoto S, Muto M, Morita T. Determinants of Attitude Toward End-of-Life Care Among Junior Physicians: Findings from a Nationwide Survey in Japan. Palliat Med Rep 2023; 4:257-263. [PMID: 37732023 PMCID: PMC10507924 DOI: 10.1089/pmr.2023.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 09/22/2023] Open
Abstract
Background Physicians' attitudes can be critical in quality end-of-life care. However, the determinants of the attitudes and whether the attitudes can be modified remain unclear. Objectives To investigate factors correlated with physicians' positive attitudes toward end-of-life care and whether these attitudes are modifiable through acquired factors (e.g., education or mentorship). Design A nationwide survey was conducted in 300 institutions and selected randomly from 1037 clinical training hospitals in Japan. Participants From each selected institution, two resident physicians of postgraduate year (PGY) 1 or 2 and two clinical fellows from PGY 3-5 were requested to answer the survey. Measurements The primary outcome was the Frommelt Attitudes Toward the Care of the Dying (FATCOD) scale score. Factors (e.g., the respondents' age, sex, number of years of clinical experience, training environment, religion, and beliefs around death) were examined for correlation with FATCOD score. Results In all, 198 physicians and 134 clinical fellows responded to the survey (response rate: 33.0% and 22.3%, respectively). Factors with the strongest correlation with FATCOD scores were mostly unmodifiable factors (e.g., being female and one's beliefs around death). Modifiable factors were also identified-number of patient deaths experienced, level of interest in palliative care, availability of support from senior mentors, and frequency of consultation with nonphysician medical staff. Conclusion Physicians' attitudes toward end-of-life care correlate more strongly with nonmodifiable factors, but attitudes can be meaningfully improved via mentoring by senior physicians. Future studies are warranted to determine the effective interventions to foster positive attitudes among physicians involved in end-of-life care.
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Affiliation(s)
- Yukiko Watanabe
- Faculty of Medicine, Okayama University Medical School, Okayama, Japan
| | | | - Yu Uneno
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Soichiro Okamoto
- Medical Corporation Teieikai Chiba Home Care Clinic, Chiba, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuya Morita
- Division of Supportive and Palliative Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Watanabe S, Kataoka K, Sekine M, Aune D, Shikino K, Nishizaki Y. Characteristics of University Hospitals Implementing the Postgraduate Clinical Training "Tasukigake Method" and Their Correlation with Program Popularity: A Cross-Sectional Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:323-332. [PMID: 37026061 PMCID: PMC10072141 DOI: 10.2147/amep.s402259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE In 2004, the postgraduate clinical training system in Japan was radically revised by introducing a super-rotation matching system. Although postgraduate clinical training became a mandatory 2 years of training, the program and operation were left to each facility's discretion, leading to training-program popularity differences. The Japanese Tasukigake method provides clinical training in which "hospitals where junior residents work" and "external hospitals/clinics that provide clinical training" conduct clinical training alternately on a 1-year basis. The study aimed to identify the characteristics of university hospitals that implement the Tasukigake method to help educators and medical institutions create more attractive and effective programs. METHODS All 81 university main hospitals were included in this cross-sectional study. The information regarding Tasukigake method implementation was collected from the facilities' websites. The training program's matching rate (popularity) was calculated from the Japan Residency Matching Program's interim report data (academic 2020). We used multiple linear regression analysis to evaluate the association between Tasukigake method implementation, program popularity, and university hospital characteristics. RESULTS The Tasukigake method was implemented by 55 (67.9%) university hospitals, significantly more by public university hospitals (44/55, 80%) than by private (11/55, 20%) (P < 0.01) and by hospitals without branches (38/55, 69.1%) than with branches (17/55, 30.9%) (P < 0.001). The maximum hiring capacity of junior residents (P = 0.015) and number of branches (P < 0.001) were negatively correlated, and the population of the hospital's city (P = 0.003) and salary/month (P = 0.011) were positively correlated with the Tasukigake method implementation. Multiple linear regression analysis results showed no significant association between the matching rate (popularity) and Tasukigake method implementation. CONCLUSION The results show no association between Tasukigake method and program popularity; also, highly specialized university hospitals in cities with fewer branch hospitals were more likely to implement the Tasukigake method.
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Affiliation(s)
- Sadatoshi Watanabe
- Clinical Translational Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koshi Kataoka
- Division of Medical Education, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Miwa Sekine
- Division of Medical Education, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - David Aune
- Division of Medical Education, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kiyoshi Shikino
- Department of Medical Education, Chiba University School of Medicine, Chiba, Japan
| | - Yuji Nishizaki
- Clinical Translational Science, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Division of Medical Education, Juntendo University Faculty of Medicine, Tokyo, Japan
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Nagasaki K, Nishizaki Y, Nojima M, Shimizu T, Konishi R, Okubo T, Yamamoto Y, Morishima R, Kobayashi H, Tokuda Y. Validation of the General Medicine in-Training Examination Using the Professional and Linguistic Assessments Board Examination Among Postgraduate Residents in Japan. Int J Gen Med 2021; 14:6487-6495. [PMID: 34675616 PMCID: PMC8504475 DOI: 10.2147/ijgm.s331173] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose In Japan, the General Medicine In-training Examination (GM-ITE) was developed by a non-profit organization in 2012. The GM-ITE aimed to assess the general clinical knowledge among residents and to improve the training programs; however, it has not been sufficiently validated and is not used for high-stake decision-making. This study examined the association between GM-ITE and another test measure, the Professional and Linguistic Assessments Board (PLAB) 1 examination. Methods Ninety-seven residents who completed the GM-ITE in fiscal year 2019 were recruited and took the PLAB 1 examination in Japanese. The association between two tests was assessed using the Pearson product-moment statistics. The discrimination indexes were also assessed for each question. Results A total of 91 residents at 17 teaching hospitals were finally included in the analysis, of whom 69 (75.8%) were women and 59 (64.8%) were postgraduate second year residents. All the participants were affiliated with community hospitals. Positive correlations were demonstrated between the GM-ITE and the PLAB scores (r = 0.58, p < 0.001). The correlations between the PLAB score and the scores in GM-ITE categories were as follows: symptomatology/clinical reasoning (r = 0.54, p < 0.001), physical examination/procedure (r = 0.38, p < 0.001), medical interview/professionalism (r = 0.25, p < 0.001), and disease knowledge (r = 0.36, p < 0.001). The mean discrimination index of each question of the GM-ITE (mean ± SD; 0.23 ± 0.15) was higher than that of the PLAB (0.16 ± 0.16; p = 0.004). Conclusion This study demonstrates incremental validity evidence of the GM-ITE to assess the clinical knowledge acquisition. The results indicate that GM-ITE can be widely used to improve resident education in Japan.
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Affiliation(s)
- Kazuya Nagasaki
- Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan
| | - Yuji Nishizaki
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan.,Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Masanori Nojima
- Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Ryota Konishi
- Education Adviser Japan Organization of Occupational Health and Safety, Kanagawa, Japan
| | - Tomoya Okubo
- Research Division, The National Center for University Entrance Examinations, Tokyo, Japan
| | - Yu Yamamoto
- Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Ryo Morishima
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Hiroyuki Kobayashi
- Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan
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