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Mizumoto J, Izumiya M, Horita S, Eto M. The Usage of the Term "Social" in Japanese Primary Care Literature. Cureus 2024; 16:e51972. [PMID: 38333451 PMCID: PMC10853026 DOI: 10.7759/cureus.51972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION There has been a growing recognition of the importance of incorporating a "social" perspective in primary care practice. However, the specific meaning of the term "social" in the context of primary care is often not clearly defined or explained in the literature. This study aims to explore the usage and interpretation of the term "social" in primary care discourse in Japan. METHODS We collected papers containing the term "social" ("shakai-teki" in Japanese) from 810 papers published between 2010 and 2022 in the Official Journal of the Japan Primary Care Association. Through abductive coding, we examined how the term was employed and the different meanings attributed to it. RESULTS The instances of using the term "social" were classified into five distinct categories: (i) non-medical, (ii) emphasizing the importance of topics, (iii) public as an object, (iv) connections with people who support health and well-being, and (v) structural inequities that are detrimental to health. Conclusion: The analysis revealed that the term "social" in the context of primary care discourse was multifaceted and characterized by ambiguity. To ensure effective communication and clarity in discussions, it is crucial for primary care professionals to have a clear understanding of the intended meaning and implications of the term "social."
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Affiliation(s)
- Junki Mizumoto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, University of Tokyo, Tokyo, JPN
| | - Masashi Izumiya
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, University of Tokyo, Tokyo, JPN
| | - Shoko Horita
- Department of Medical Education, School of Medicine, Teikyo University, Tokyo, JPN
| | - Masato Eto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, University of Tokyo, Tokyo, JPN
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Mizumoto J, Mitsuyama T, Eto M, Izumiya M, Horita S. Primary care physicians' perceptions of social determinants of health recommendations: a qualitative study. BJGP Open 2023; 7:BJGPO.2022.0129. [PMID: 36693758 DOI: 10.3399/bjgpo.2022.0129] [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: 08/28/2022] [Revised: 11/27/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Several organisations have called for primary care professionals to address social determinants of health (SDoH) in clinical settings. For primary care physicians to fulfill their community health responsibilities, the implications of the SDoH recommendations need to be clarified. AIM To describe primary care physicians' views about being asked to address SDoH in clinical settings, from both positive and negative perspectives. DESIGN & SETTING A qualitative study in Japan. Twenty-one physicians were purposively recruited. METHOD 'Love and breakup letter' methodology was used to collect qualitative data that contained both positive and negative feelings. Participants wrote love and breakup letters about being asked to address SDoH in a clinical setting, then undertook an in-depth online interview. Data were analysed via thematic analysis using the framework approach. RESULTS The following themes were identified: (i) primary care physicians take pride in being expected to address SDoH; (ii) primary care physicians rely on the recommendations as a partner, even in difficult situations; (iii) primary care physicians consider the recommendations to be bothersome, with unreasonable demands and challenges, especially when supportive surroundings are lacking; and (iv) primary care physicians reconstruct the recommendations on the basis of their experience. CONCLUSION Primary care physicians felt both sympathy and antipathy towards recommendations asking them to address SDoH in their clinical practice. The recommendations were not followed literally, instead contributing to physicians' clinical mindlines. Professional organisations that plan to develop and publish recommendations about SDoH should consider how their recommendations might be perceived by their target audience.
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Affiliation(s)
- Junki Mizumoto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshichika Mitsuyama
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masato Eto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masashi Izumiya
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shoko Horita
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Yamamoto Y, Haruta J, Goto R, Maeno T. What kinds of work do Japanese primary care physicians who derive greater positive meaning from work engage in? A cross-sectional study. J Gen Fam Med 2023; 24:94-101. [PMID: 36909785 PMCID: PMC10000278 DOI: 10.1002/jgf2.595] [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: 08/30/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/22/2022] Open
Abstract
Background Despite the increasing need for primary care physicians (PCPs) around the world, few physicians choose it as a career. PCPs who can find meaning and enjoyment in their work can be role models for medical students and professionals, which may encourage more physicians to specialize in primary care. We aimed to compare the kinds of work that Japanese PCPs who derive greater positive meaning from work engage in versus those who derive less positive meaning from work. Methods This was a cross-sectional study that used self-administered questionnaires to ask Japanese PCPs about their basic characteristics and engagement in and enthusiasm for various types of work. The outcomes of the Japanese version of the work as meaning inventory (J-WAMI) were also assessed. Participants were divided into high- and low-scoring groups according to the median J-WAMI score, and logistic regression analysis was performed to identify factors related to the high J-WAMI-scoring group. Results A total of 268 out of 330 participants were included in the analysis. Males comprised 74.3%, and participants' average experience as a physician was 20.2 years. The median overall J-WAMI score was 38. Factors associated with the high J-WAMI scoring group were enthusiasm for outpatient care (OR: 1.04, 95% CI: 1.02-1.06) and engagement in research (OR: 2.74, 95% CI 1.33-5.66). Conclusions Enthusiasm for outpatient care and engagement in research are associated with greater positive meaning of work among PCPs. Supporting these types of work may enhance PCPs' value of their work.
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Affiliation(s)
- Yu Yamamoto
- General Medicine and Primary Care, Faculty of Medicine University of Tsukuba Ibaraki Japan.,Central General Clinic Ibaraki Japan
| | - Junji Haruta
- General Medicine and Primary Care, Faculty of Medicine University of Tsukuba Ibaraki Japan.,Medical Education Center, School of Medicine Keio University Tokyo Japan
| | - Ryohei Goto
- General Medicine and Primary Care, Faculty of Medicine University of Tsukuba Ibaraki Japan
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Faculty of Medicine University of Tsukuba Ibaraki Japan
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Ishizuka K, Nagano H, Miyagami T, Toyooka T, Ohara S, Ogami E. Real opinions on general medicine residency programs in Japan: Perspectives from medical students, residents, and young academic generalists. J Gen Fam Med 2022; 24:59-60. [PMID: 36605908 PMCID: PMC9808151 DOI: 10.1002/jgf2.584] [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] [Received: 06/17/2022] [Revised: 08/22/2022] [Accepted: 09/15/2022] [Indexed: 01/09/2023] Open
Abstract
Medical students and junior residents have five concerns about general medicine training, and senior residents and young academic generalists respond to these concerns. We hope that this paper will help to dispel some common concerns for those who wish to become specialists in general medicine.
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Affiliation(s)
- Kosuke Ishizuka
- Department of General MedicineChiba University HospitalChibaJapan
| | - Hiroyuki Nagano
- Department of Healthcare Economics and Quality Management, Graduate School of MedicineKyoto UniversityKyotoJapan
| | - Taiju Miyagami
- Department of General Medicine, Faculty of MedicineJuntendo UniversityTokyoJapan
| | | | - Sunsuke Ohara
- Department of General Medicine, Faculty of MedicineJuntendo UniversityTokyoJapan
| | - Erica Ogami
- School of MedicineSaitama Medical UniversitySaitamaJapan
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Lamb E, Burford B, Alberti H. The impact of role modelling on the future general practitioner workforce: a systematic review. EDUCATION FOR PRIMARY CARE 2022; 33:265-279. [PMID: 35904161 PMCID: PMC9519122 DOI: 10.1080/14739879.2022.2079097] [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] [Indexed: 11/02/2022]
Abstract
Role modelling has been identified as an important phenomenon in medical education. Key reports have highlighted the ability of role modelling to support medical students towards careers in family medicine although the literature of specific relevance to role modelling in speciality has not been systematically explored. This systematic review aimed to fill this evidence gap by assimilating the worldwide literature on the impact of role modelling on the future general practitioner (GP) workforce. A systematic search was conducted in Medline, Embase, Scopus, Web of Science, Cochrane, ERIC and CINAHL, and all authors were involved in the article screening process. A review protocol determined those articles selected for inclusion, which were then quality assessed, coded and thematically analysed. Forty-six articles were included which generated four broad themes: the identity of role models in general practice, role modelling and becoming a doctor, the impact of role modelling on attitudes towards the speciality, and the subsequent influence on behaviours/career choice. Our systematic review confirmed that role modelling in both primary and secondary care has a crucial impact on the future GP workforce, with the potential to shape perceptions, to attract and deter individuals from the career, and to support their development as professionals. Role modelling must be consciously employed and supported as an educational strategy to facilitate the training of future GPs.
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Affiliation(s)
- Elizabeth Lamb
- School of Medical Education, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Bryan Burford
- School of Medical Education, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Hugh Alberti
- School of Medical Education, The Medical School, Newcastle University, Newcastle upon Tyne, UK
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Ahmed MM, Fares S, Sayed AA, ElSayed IT, Soliman SSA. House Officers' Choice of Family Medicine Specialty amid the Implementation of the New Universal Health Insurance Law. J Prim Care Community Health 2021; 12:21501327211018940. [PMID: 34032168 PMCID: PMC8155760 DOI: 10.1177/21501327211018940] [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] [Indexed: 12/04/2022] Open
Abstract
Background The new Egyptian Universal Health Insurance Law is introduced through
family-oriented primary health care. Increasing the number of recent
graduates who specialized in family medicine is considered a national need
to overcome family physicians’ shortage. Aim To explore the factors affecting the house officers’ choice of Family
Medicine as a future career amid the implementation of the new Universal
Health Insurance Law in Egypt. Methods This is a cross-sectional study conducted on house officers during their
training in Cairo university hospitals from the first of March 2020 to
February 2021. The researchers offered an anonymous self-administered
questionnaire to all house officers at the beginning of their 2-week family
medicine training (1170 house officers). Results A total of 1052 completed the questionnaire (response rate 90%). Family
medicine as a specialty was considered by 53.6% (n = 564) of participants,
while only 23.4% (n = 246) of participants had an obvious intention to
choose family medicine. Multivariate (adjusted) logistic regression model
revealed that factors significantly associated with intention to choose
family medicine were marital status, knowledge about governmental advantages
for family medicine offered to the specialized recent graduates, and
previously encountered with family practice as customers. Conclusions The choice of family medicine specialty is increasing among house officers.
This could be attributed to the growing interest in family medicine in
Egypt, especially after implementing the new insurance law’s first phase in
several Egyptian governorates.
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Affiliation(s)
- Marwa Mostafa Ahmed
- Department of Family Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samar Fares
- Department of Family Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Asmaa Ahmed Sayed
- Department of Family Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Inas Talat ElSayed
- Department of Family Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Saeed S A Soliman
- Department of Family Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Sripa P, Thepwongsa I, Muthukumar R. Factors associated with the entry to general practice training: A multicentre study. MEDICAL TEACHER 2020; 42:1394-1400. [PMID: 32878524 DOI: 10.1080/0142159x.2020.1811846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite recent studies regarding general practice (GP) career decision-making, the impact of primary care exposure during undergraduate study on career-decision-making remain unclear. PURPOSE To examine the association between primary care exposure with the entry to GP training. METHODS An unmatched case-control study design was employed. A total of 130 trainees in GP training and 260 trainees in other speciality training were randomly selected from speciality training registration. Questionnaires were used to identify primary care exposure and factors associated with career-decision making. Odds ratios (OR) and logistic regression were used to examine the association between the entry to GP training and those factors. RESULTS The response rate was 66.4%. Three variables were found associated with entering GP training, including timetabled primary care sessions in all three clinical years (adjusted OR = 2.91; 95% CI = 1.23 - 6.88), enrolling in rural medical student recruitment schemes (adjusted OR = 3.07; 95% CI = 1.05 - 8.99) and valuing core values of GP (adjusted OR = 8.46; 95% CI = 3.27 - 21.88). CONCLUSION Our findings suggest that timetabled primary care sessions in all three clinical years has a positive influence on entering GP training. This research extends our knowledge of primary care exposure regarding continuity of the exposure.
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Affiliation(s)
- Poompong Sripa
- Family Medicine Unit, Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Isaraporn Thepwongsa
- Family Medicine Unit, Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Thailand
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O’Sullivan B, McGrail M, Gurney T, Martin P. A Realist Evaluation of Theory about Triggers for Doctors Choosing a Generalist or Specialist Medical Career. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228566. [PMID: 33218189 PMCID: PMC7699208 DOI: 10.3390/ijerph17228566] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 01/29/2023]
Abstract
There is a lack of theory about what drives choice to be a generalist or specialist doctor, an important issue in many countries for increasing primary/preventative care. We did a realist evaluation to develop a theory to inform what works for whom, when and in what contexts, to yield doctors’ choice to be a generalist or specialist. We interviewed 32 Australian doctors (graduates of a large university medical school) who had decided on a generalist (GP/public health) or specialist (all other specialties) career. They reflected on their personal responses to experiences at different times to stimulate their choice. Theory was refined and confirmed by testing it with 17 additional doctors of various specialties/career stages and by referring to wider literature. Our final theory showed the decision involved multi-level contextual factors intersecting with eight triggers to produce either a specialist or generalist choice. Both clinical and place-based exposures, as well as attributes, skills, norms and status of different fields affected choice. This occurred relative to the interests and expectations of different doctors, including their values for professional, socio-economic and lifestyle rewards, often intersecting with issues like gender and life stage. Applying this theory, it is possible to tailor selection and ongoing exposures to yield more generalists.
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Affiliation(s)
- Belinda O’Sullivan
- Faculty of Medicine, The University of Queensland, Rural Clinical School, Locked Bag 9009, Toowoomba 4350, DC Queensland, Australia; (T.G.); (P.M.)
- Correspondence: ; Tel.: +61-4-2740-5030
| | - Matthew McGrail
- Faculty of Medicine, The University of Queensland Rural Clinical School, 78 on Canning St, Rockhampton 4700, Queensland, Australia;
| | - Tiana Gurney
- Faculty of Medicine, The University of Queensland, Rural Clinical School, Locked Bag 9009, Toowoomba 4350, DC Queensland, Australia; (T.G.); (P.M.)
| | - Priya Martin
- Faculty of Medicine, The University of Queensland, Rural Clinical School, Locked Bag 9009, Toowoomba 4350, DC Queensland, Australia; (T.G.); (P.M.)
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Liu YA, Cheng S, Hsu YC, Yang PC, Chang HT, Lin MH, Chen TJ, Chou LF, Hwang SJ. In the Name of Family Medicine: A Nationwide Survey of Registered Names of Family Medicine Clinics in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114062. [PMID: 32517287 PMCID: PMC7312184 DOI: 10.3390/ijerph17114062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/16/2022]
Abstract
Family medicine is officially a specialty, but is often not regarded as a specialty by the general public. Past studies have usually investigated the opinions of medical students and resident physicians regarding family medicine, whereas few have focused on practicing family physicians themselves, especially in terms of analyzing how they represent themselves. This study aimed to investigate the patterns of clinic names to better apprehend whether general practitioners see themselves as being on an equal footing with other medical specialists. The registered names, medical specialties, and levels of urbanization of all clinics of Western medicine in Taiwan were collected. For clinics of each specialty, we examined whether their names contained the corresponding specialty designation. For example, a family medicine clinic was checked to determine whether its name contained the term “family medicine” or its abbreviation. The naming of family medicine clinics was then compared with that of clinics with other specialties. Of the 9867 Western medicine clinics included in this study, two-thirds (n = 6592) were single-specialty clinics. In contrast to the high percentages of single-specialty clinics of other specialties with specialty-containing names (97.5% for ophthalmology, 94.8% for dermatology, and 94.7% for otolaryngology), only 13.3% (132/989) of the family medicine clinics had such names. In addition, the urban family medicine clinics had a higher proportion (15.2%, 74/487) of specialty-containing names than the suburban (12.6%, 44/349) and rural family medicine clinics (9.2%, 14/153). Overall, a low percentage of family medicine clinics in Taiwan included “family medicine” in their names. This issue of professional identity deserves further qualitative investigation.
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Affiliation(s)
- Ya-An Liu
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan; (Y.-A.L.); (Y.-C.H.); (P.-C.Y.); (H.-T.C.); (M.-H.L.); (S.-J.H.)
| | - Sally Cheng
- Dr. Jiang’s Clinic, No.264, Wan-Da Road, Taipei 108, Taiwan;
| | - Ya-Chuan Hsu
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan; (Y.-A.L.); (Y.-C.H.); (P.-C.Y.); (H.-T.C.); (M.-H.L.); (S.-J.H.)
| | - Po-Chin Yang
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan; (Y.-A.L.); (Y.-C.H.); (P.-C.Y.); (H.-T.C.); (M.-H.L.); (S.-J.H.)
| | - Hsiao-Ting Chang
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan; (Y.-A.L.); (Y.-C.H.); (P.-C.Y.); (H.-T.C.); (M.-H.L.); (S.-J.H.)
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan
| | - Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan; (Y.-A.L.); (Y.-C.H.); (P.-C.Y.); (H.-T.C.); (M.-H.L.); (S.-J.H.)
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan; (Y.-A.L.); (Y.-C.H.); (P.-C.Y.); (H.-T.C.); (M.-H.L.); (S.-J.H.)
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan
- Big Data Center, Department of Medical Research, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan
- Correspondence: ; Tel.: +886-2-2875-7458; Fax: +886-2-2873-7901
| | - Li-Fang Chou
- Department of Public Finance, National Chengchi University, Taipei 116, Taiwan;
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan; (Y.-A.L.); (Y.-C.H.); (P.-C.Y.); (H.-T.C.); (M.-H.L.); (S.-J.H.)
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan
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Research evidence is essential for the development of family medicine as a discipline in the Japanese healthcare system. BJGP Open 2019; 3:bjgpopen19X101650. [PMID: 31366681 PMCID: PMC6662877 DOI: 10.3399/bjgpopen19x101650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/08/2019] [Indexed: 11/30/2022] Open
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Stiefel F, Stiefel F, Terui T, Machino T, Ishitani K, Bourquin C. Spotlight on Japanese physicians: An exploration of their professional experiences elicited by means of narrative facilitators. Work 2019; 63:269-282. [PMID: 31156208 DOI: 10.3233/wor-192928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND While investigation of physicians' work experience is often limited to issues of satisfaction or burnout, a broader view of their experiences is lacking. OBJECTIVE To explore professional experiences, we asked Japanese physicians (N = 18, 12 men and 6 women) of a general hospital to react to so-called "narrative facilitators". METHODS The narrative facilitators - inspired by clinical psychology, visual sociology and purpose-designed techniques - oriented physicians' narratives towards clinical practise, relationship with peers and context. Transcribed interviews were subject to thematic analysis. RESULTS The thematic analysis of participants' narratives revealed a lonely physician with a tough job, torn between the ideal of patient-centred care and a clinical reality, which limits these aspirations. Patients emerged as anxious and burdensome consumers of medicine. Feeling neither supported by peers nor the institution, physicians also perceived the society as somewhat negligent, delegating its problem to medicine. Communication difficulties, with patients and peers, and the absence of joyful aspects of the profession constituted fundamental elements of their narratives. CONCLUSIONS Comprehensive investigation of physicians' lived professional experience could become a key to conceive ways to support them.
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Affiliation(s)
- F Stiefel
- Psychiatric Liaison Service, University Hospital Lausanne, Switzerland.,Higashi Sapporo Hospital, Sapporo, Japan
| | - Fa Stiefel
- Higashi Sapporo Hospital, Sapporo, Japan
| | - T Terui
- Higashi Sapporo Hospital, Sapporo, Japan
| | - T Machino
- Higashi Sapporo Hospital, Sapporo, Japan
| | - K Ishitani
- Higashi Sapporo Hospital, Sapporo, Japan
| | - C Bourquin
- Psychiatric Liaison Service, University Hospital Lausanne, Switzerland
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Bilal M, Haseeb A, Mari A, Hussham Arshad M, Ali Khan MR, Ahmed A, Jeoffrey R, Saleem Z, Irfan MA, Aamir Khan A, Husain S, Najeeb S, Fuad Garib A, Mustafa Attarwala F, Hasnain Mankani M. Factors Determining Pakistani Medical Students' Career Preference for General Practice Residency Training. Cureus 2018; 10:e3114. [PMID: 30338189 PMCID: PMC6175262 DOI: 10.7759/cureus.3114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Few studies have explored factors affecting preference of medical students towards general practice as a career choice. We conducted a survey in Karachi across various public and private sector medical colleges to examine factors associated with students’ general practice career aspirations in Karachi, Pakistan. Methods From January to March 2018, we distributed a 21-item questionnaire to final year medical students in eight medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item. Results A total of 1400 responses were obtained. The top five specialty fields chosen by students with their numbers were: internal medicine, 898 (64.2%); general practice, 337 (24.1%); pediatrics, 449 (32.1%); surgery, 380 (27.2%); and emergency medicine, 243 (17.4%). The “intent to inherit existing practice” and “other academic or professional experiences prior to medical school” had a positive association with choosing general practice while “having a physician parent’’ had a negative association among the medical students demographics after adjusting for other covariates in the multivariable logistic regression. Medical students who ranked “clinical diagnostic reasoning”, “community-oriented practice”, “involvement in preventive medicine”, and “frequent patient communication” as highly important were more likely to choose general practice, whereas, “access to advanced medical fields”, “mastering advanced procedures”, and “depth rather than breadth of practice” were less likely to be associated with general practice aspiration. Conclusion The study’s results depicted limited interest of family medicine as a career option in graduating students, and pointed out the factors that likely influence the choice of general practice as a career are clinical diagnostic reasoning, community-oriented practice and preventive medicine.
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Affiliation(s)
- Muhammad Bilal
- Medicine, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Abdul Haseeb
- Medicine, The Wright Center for Graduate Medical Education, Scranton, USA
| | - Anum Mari
- Medicine, Ziauddin Medical University, Karachi, PAK
| | | | | | | | | | | | | | | | - Sana Husain
- Medicine, Karachi Grammar School, Karachi, PAK
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Ie K, Murata A, Tahara M, Komiyama M, Ichikawa S, Takemura YC, Onishi H. What determines medical students' career preference for general practice residency training?: a multicenter survey in Japan. ASIA PACIFIC FAMILY MEDICINE 2018; 17:2. [PMID: 29422773 PMCID: PMC5787259 DOI: 10.1186/s12930-018-0039-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 01/22/2018] [Indexed: 06/01/2023]
Abstract
BACKGROUND Few studies have systematically explored factors affecting medical students' general practice career choice. We conducted a nationwide multicenter survey (Japan MEdical Career of Students: JMECS) to examine factors associated with students' general practice career aspirations in Japan, where it has been decided that general practice will be officially acknowledged as a new discipline. METHODS From April to December 2015, we distributed a 21-item questionnaire to final year medical students in 17 medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item. RESULTS A total of 1264 responses were included in the analyses. The top three specialty choice were internal medicine: 833 (65.9%), general practice: 408 (32.3%), and pediatrics: 372 (29.4%). Among demographic factors, "plan to inherit other's practice" positively associated with choosing general practice, whereas "having physician parent" had negative correlation. After controlling for potential confounders, students who ranked the following items as highly important were more likely to choose general practice: "clinical diagnostic reasoning (adjusted odds ratio (aOR): 1.65, 95% CI 1.40-1.94)", "community-oriented practice (aOR: 1.33, 95% CI 1.13-1.57)", and" involvement in preventive medicine (aOR: 1.18, 95% CI 1.01-1.38)". On the contrary, "acute care rather than chronic care", "mastering advanced procedures", and "depth rather than breadth of practice" were less likely to be associated with general practice aspiration. CONCLUSIONS Our nationwide multicenter survey found several features associated with general practice career aspirations: clinical diagnostic reasoning; community-oriented practice; and preventive medicine. These results can be fundamental to future research and the development of recruitment strategies.
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Affiliation(s)
- Kenya Ie
- Department of General Internal Medicine, Kawasaki Municipal Tama Hospital/St. Marianna University School of Medicine, 1-30-37 Shukugawara, Kawasaki, Kanagawa 214-8525 Japan
- Department of Family Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu-shi, Mie 514-8507 Japan
| | - Akiko Murata
- Family Practice Center of Okayama, 292-1 Toyosawa, Katsuta-gun, Nagi-cho, Okayama 708-1323 Japan
| | - Masao Tahara
- Iwakura Station Tahara Clinic, 291-1 Chuzaiji, Iwakura, Sakyo-ku, Kyoto-shi, Kyoto 606-0021 Japan
| | - Manabu Komiyama
- Thank You All, Family Clinic Hiratsuka, 215-3 Okazaki, Hiratsuka-shi, Kanagawa 259-1212 Japan
| | - Shuhei Ichikawa
- Department of Education and Research in Family and Community Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-shi, Mie 514-8507 Japan
| | - Yousuke C. Takemura
- Department of Family Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu-shi, Mie 514-8507 Japan
- Department of Education and Research in Family and Community Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu-shi, Mie 514-8507 Japan
| | - Hirotaka Onishi
- International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
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14
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Sauvaget C, Nishino Y, Konno R, Tase T, Morimoto T, Hisamichi S. Challenges in breast and cervical cancer control in Japan. Lancet Oncol 2016; 17:e305-e312. [PMID: 27396648 DOI: 10.1016/s1470-2045(16)30121-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
Abstract
Since the mid-1990s, there has been an increasing incidence of, and mortality from, cervical and breast cancers in Japan. Such an increase has raised concerns over the efficiency of Japan's screening programmes for these cancers. Although citizens benefit from universal health coverage, the Japanese health insurance system mostly focuses on tertiary prevention and disease treatment, while secondary prevention (screening) is low priority. Citizens have multiple opportunities to be screened for cancer-either through programmes organised by municipalities, or individual or collective, opportunistic and comprehensive health check-ups on a voluntary basis. Despite this, however, participation is as low as 35% of the target population for both cancers. In this Policy Review, we discuss the challenges in the prevention of breast and cervical cancers in Japan, particularly focusing on the structure of the National Health Insurance system and the National Cancer Control Plan, reasons for low participation as a result of social and political attitudes, as well as providing recommendations to overcome these challenges. Japanese women would benefit from new measures to increase participation, a national data surveillance programme to monitor screening activities, and the implementation of a quality assurance system among all providers.
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Affiliation(s)
- Catherine Sauvaget
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer, Lyon, France.
| | - Yoshikazu Nishino
- Department of Epidemiology and Public Health, Kanazawa Medical University, Ishikawa, Japan
| | - Ryo Konno
- Department of Obstetrics and Gynaecology, Jichi Medical University, Saitama Medical Centre, Saitama, Japan
| | - Toru Tase
- Department of Obstetrics and Gynaecology, Miyagi Cancer Centre, Natori City, Japan
| | - Tadaoki Morimoto
- Department of Health Science, School of Medicine, Tokushima University, Tokushima, Japan
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The Contribution of Childhood and Medical School Location to the Career Paths of Graduating Pediatrics Residents. Acad Pediatr 2015; 15:557-64. [PMID: 26344720 DOI: 10.1016/j.acap.2015.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 05/11/2015] [Accepted: 06/07/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare job search experience and postresidency position of pediatric residents on the basis of childhood location (United States or international) and medical school location (American medical graduates [AMG] or international medical graduate [IMG]). METHODS Annual national random samples of 1000 graduating pediatric residents from 2009 to 2013 were surveyed. Multivariable analyses, controlling for resident and program characteristics, compared job search experiences and postresidency positions among 4 groups categorized by childhood and medical school location: US-AMG, US-IMG, international-AMG, and international-IMG. RESULTS A total of 3027 graduating residents (61.1%) responded: 75.2% US-AMG, 15.8% international-IMG, 6.3% US-IMG, and 2.7% international-AMG. The 4 groups varied by demographics (age, race, gender, marital status, children, bi- or multilingual family), educational debt, residency program region and size, and Spanish proficiency (P < .01). The US-AMG were least likely to have a bi- or multilingual family (25.7%) or be proficient in Spanish (15.0%). One-third (34.5%) accepted fellowship positions. International-IMG and US-IMG were more likely than US-AMG to choose fellowship positions (adjusted odds ratio [aOR], 2.04; 95% confidence interval [CI], 1.52-2.74; aOR, 1.77; 95% CI, 1.25-2.52, respectively). Among residents who applied for general pediatric or hospitalist positions, 23.1% reported moderate to considerable difficulty in their job search, and 44.1% accepted positions in underserved areas. International-IMG and US-IMG were more likely than US-AMG to report job search difficulty (aOR, 2.49; 95% CI, 1.55-3.98; aOR, 1.78; 95% CI, 1.04-3.06, respectively), and international-IMG were more likely to accept positions in underserved areas (aOR, 1.68; 95% CI, 1.07-2.63). CONCLUSIONS Multiple factors are involved in pediatrician's career choices. When childhood location is considered with medical school location, there were differences between groups in demographics, job search difficulty, and career intentions.
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