Association between patient care ownership and personal or environmental factors among medical trainees: a multicenter cross-sectional study

Association between residents' work hours and patient care ownership: a nationwide cross-sectional study in Japan

PURPOSE

In the current era of physician work-hour regulations, patient care ownership (PCO) has received considerable attention. The aim of the study was to investigate the association between working hours and PCO.

METHODS

This was a nationwide cross-sectional study. The study recruited residents who completed the General Medicine In-Training Examination. The primary outcome was PCO, assessed using the Japanese version of the PCO Scale (J-PCOS). The secondary outcomes were the four dimensions of the J-PCOS (i.e., assertiveness, sense of ownership, diligence, and being the "go-to" person). The explanatory variable was weekly working hours. We examined the association using multivariable linear regression analysis.

RESULTS

1836 participants were included in the analysis. After adjustment for possible confounders, residents working ≥ 70 to < 90 h/week had greater PCO than those working ≥ 60 to < 70 h/week. Working ≥ 70 to < 90 h/week was also associated with assertiveness and being the "go-to" person. No clear trend was seen in the relationship between working hours and sense of ownership or diligence.

CONCLUSION

While determining appropriate resident work hours requires comprehensive consideration of a number of factors, in terms of PCO training, the working hours of 80-90 h/week may be an option.

Association of clinical knowledge with patient care ownership among resident physicians: a nationwide cross-sectional study in Japan

PURPOSE

Both clinical knowledge and patient care ownership (PCO) are crucial to the provision of quality patient care and should be acquired during training. However, the association between these two concepts is under-examined. Here, we conducted a nationwide cross-sectional study to investigate the association between clinical knowledge and PCO among resident physicians in Japan.

METHODS

From January 17 to March 31, 2024, we conducted an anonymous, online, self-administered survey for a series of PCO research projects. The survey targeted medical residents who took the General Medicine In-Training Examination (GM-ITE). The mean of the Japanese version of the PCO Scale was used as outcome variable. The primary explanatory variable was total GM-ITE score, while the secondary explanatory variables were GM-ITE category scores in medical knowledge. We conducted multivariable linear regression analysis, controlling for postgraduate years, sex, number of assigned inpatients, weekly working hours, type of hospital, and size of hospital.

RESULTS

We included 1836 participants in our statistical analysis. Multivariable linear regression analysis revealed that after adjustment for possible confounders, GM-ITE total scores showed a significantly negative association with PCO in the highest score quartile (adjusted mean difference - 0.20, 95% confidence interval (CI) -0.33 to -0.07, compared with the lowest score quartile). Additionally, after controlling for possible confounding factors, scores for symptomatology and clinical reasoning showed a dose-dependent negative association with PCO (adjusted mean difference - 0.17, 95% CI -0.30 to -0.03 for the highest score quartile compared with the lowest score quartile). No significant dose-dependent associations were found for the other categories.

CONCLUSIONS

These findings suggest the presence of potential challenges in the simultaneous fostering of clinical knowledge and PCO during residency training. This underscores the need for educators to actively engage in the reconsideration of current postgraduate training strategies, with the aim of effectively cultivating both clinical knowledge and PCO among medical residents.

Postgraduate Year Two Medical Residents' Awareness of Personal Development as a Physician during the Management of Inpatients: A Qualitative Study

Clinical experiences, helping relationships, and reflection are key factors for personal development for physicians. However, few studies have shown which experiences are important for personal growth and how medical residents specifically use their experiences for personal growth. The aim of this study was to identify from the medical residents' perspective which clinical experiences contribute to their personal development. We employed a qualitative design, conducting semi-structured interviews with ten postgraduate year two medical residents at a Japanese teaching hospital. The interviews were transcribed in interview memos, anonymized, and subjected to reflective thematic analysis to generate themes relevant to personal and professional development. Successful clinical experiences with autonomy and responsibility in clinical management were shown to be essential points for personal development as a physician. Autonomy in this study was the attitude of making one's own choices when managing patients. Responsibility was the obligation of the resident to take charge of a patient. Instructing junior trainees, appreciation received from patients, and approval granted by attending physicians reinforced their feelings of personal growth. The realization of what experiences and concepts influence medical residents' personal growth and development will make their professional development more effective.

Translating, adapting, and validating the medical student version of the patient care ownership scale for use in Japan

BACKGROUND

Patient care ownership (PCO) among medical students is a growing area in the field of medical education. While PCO has received increasing attention, there are no instruments to assess PCO in the context of Japanese undergraduate medical education. This study aimed to translate, culturally adapt, and validate the PCO Scale - Medical students (PCOS-S) in the Japanese context.

METHODS

We collected survey data from fifth- and sixth-grade medical students from five different universities varying in location and type. Structural validity, convergent validity, and internal consistency reliability were examined.

RESULTS

Data from 122 respondents were analyzed. Factor analysis of the Japanese PCOS-S revealed three factors with Cronbach's alpha values exceeding the satisfactory criterion (0.70). A positive correlation was observed between the total Japanese PCOS-S scores and the global rating scores for the clinical department as a learning environment (Pearson's correlation coefficient = 0.61).

CONCLUSIONS

We conducted the translation of the PCOS-S into Japanese and assessed its psychometric properties. The Japanese version has good reliability and validity. This instrument has potential value in assessing the development of medical students' PCO.

Development and evaluation of virtual simulation games to increase the confidence and self-efficacy of healthcare learners in vaccine communication, advocacy, and promotion

BACKGROUND

Although healthcare providers (HCPs) are the most trusted source of vaccine information, there is a paucity of easily accessible, multidisciplinary educational tools on vaccine communication for them. Virtual simulation games (VSGs) are innovative yet accessible and effective tools in healthcare education. The objectives of our study were to develop VSGs to increase HCP confidence and self-efficacy in vaccine communication, advocacy, and promotion, and evaluate the VSGs' effectiveness using a pre-post self-assessment pilot study.

METHODS

A multidisciplinary team of experts in medicine, nursing, pharmacy, and simulation development created three VSGs for HCP learners focused on addressing conversations with vaccine hesitant individuals. We evaluated the VSGs with 24 nursing students, 30 pharmacy students, and 18 medical residents who completed surveys and 6-point Likert scale pre-post self-assessments to measure changes in their confidence and self-efficacy.

RESULTS

There were no significant differences in baseline confidence and self-efficacy across the three HCP disciplines, despite varied levels of education. Post-VSG confidence and self-efficacy (median: 5) were significantly higher than pre-VSG (median: 4-5) for all three HCP disciplines (P ≤ 0.0005), highlighting the effectiveness of the VSGs. Medical residents reported significantly lower post-VSG confidence and self-efficacy than nursing and pharmacy learners despite completing the most significant amount of education.

CONCLUSIONS

Following the completion of the VSGs, learners in medicine, nursing, and pharmacy showed significant improvement in their self-assessed confidence and self-efficacy in holding vaccine conversations. The VSGs as an educational tool, in combination with existing clinical immunization training, can be used to increase HCP confidence and engagement in vaccine discussions with patients, which may ultimately lead to increased vaccine confidence among patients.