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Background: As research in family medicine covers varied topics, multiple methodologies such as qualitative research (QR) and mixed methods research (MMR) are crucial. However, we do not know about the difference in the proportion of QR or MMR between Japan, the UK and the US. This knowledge is needed to shape future research within countries with developing primary care such as Japan and other Asian countries. This study aims to describe the use of QR and MMR in Japanese primary care and compare this to the UK and US; then to make informed recommendations for primary care research. Methods: A repeated cross-sectional study (2012–2016) based on the abstracts submitted to the annual conferences of the Japanese Primary Care Association in Japan, the Royal College of General Practitioners in the UK, and the North American Primary Care Research Group in the US and other North American countries. The proportions of QR/MMR among all the posters and paper presentations for each of these three conferences were assessed. Also examined were trends and types of qualitative techniques for all three countries and participants/settings for Japan. Results: There were 1080 abstracts for Japan, 575 for UK and 3614 for US conferences. QR/MMR proportions were 7.5%, 15.1% and 28.1%, respectively. Japan's proportion was lower than that of UK and US (p < 0.001). The proportion was increasing over time for the UK (p = 0.02). Steps for coding and analyses was most popular for Japan, thematic analysis for the UK and grounded theory for the US. Primary care doctors and hospitals were the commonest contexts for Japan. Conclusions: QR and MMR were not as popular in primary care in Japan compared to the UK and the US, whereas their use was increasing in the UK. Approaches, participants and settings may differ among these countries. Education and promotion of QR/MMR and multi-disciplinary collaborations need to be recommended in Japan with developing primary care. [ABSTRACT FROM AUTHOR]

The article discusses the highlights of the "Kyoto Wonca Regional Conference" which was held in Tokyo, Japan from May 27 to 31, 2005. The topics covered by the six keynote lectures during the conference included the global standards for family medicine education and practice as well as the Japanese way of providing primary care. One of the participants in the Global Symposium was associate professor Tai-Pong Lam of the University of Hong Kong who delivered his perspectives on the issue on general practice/family practice as a global standard.

Background: Community-acquired pneumonia (CAP) is a common illness that can lead to mortality. Chest radiography is the standard means of confirmation of pneumonia, but patients may be unnecessarily exposed to radiation. Heckerling's criteria (HC) scoring is a useful substitute for chest radiography and can be used to rule out CAP. HC score ≥ 4 is strongly indicative of pneumonia, while ≤ 1 indicates the patient is pneumonia-free. HC scoring is well validated in Western populations, but has not been validated in an Asian population. Racial differences in symptoms and differences in the method of measuring body temperature may affect the validity of HC scoring in this population. We evaluate the use of HC scoring in a Japanese primary care setting. Methods: We conducted a prospective observational study of febrile patients aged ≥ 16 years that had respiratory symptoms in either of two community hospitals between December 2016 and October 2018. We evaluated the accuracy of HC in discrimination of patients with and without CAP. Pneumonia was defined as respiratory symptoms with new infiltration recognized on chest X-ray or chest computed tomography. Results: Analyzable data from 296 of 341 patients was available (37.2% were female, mean age: 41.1 years). CAP was diagnosed in 58 patients (19.6%). HC discriminated CAP with ROC area of 0.69 (95% CI 0.62-0.76). Sensitivity was 0.66 (95% CI 0.52-0.78) (HC score ≤ 1) and specificity was 0.68 (95% CI 0.61-0.74) (HC score > 1). Conclusions: HC did not detect CAP in approximately 30% of our Japanese cases of acute respiratory illness. HC scoring should be used cautiously in non-Western populations. [ABSTRACT FROM AUTHOR]

Background: Older adults who have health conditions with good prognoses typically fall outside the scope of efforts encouraging advance care planning. We developed group and individual versions of an advance care planning program for use in primary care. Methods: We conducted a quasi-experimental trial in a rural family clinic in Japan. Medically stable patients aged ≥65 years were invited to watch an educational video on advance care planning, followed by an individual (n=46) or group-based (n=63) discussion. Advance directive completion was tracked over four months. Participants completed baseline and follow-up questionnaires and reported occurrence of family discussions about advance care planning and attitudes toward advance care planning. Group discussions were recorded and thematically analyzed to identify barriers and facilitators to engaging in advance care planning. Results: Advance directive completion rates were high for both intervention versions but did not significantly differ between arms (85.7% vs. 80.4%, p=0.45). Only one-fifth of patients in both arms discussed advance care planning with their family after the intervention (20.7% and 21.7%, p=0.89). Patients in the group arm rated their experience slightly higher than those in the individual arm (4.2 and 3.9 out of 5, p=0.023). Qualitative analysis of group discussions revealed that patients were affected by their perceptions of societal norms that prioritize family consensus over patient autonomy; however, these perceptions influenced advance care planning behaviors in inconsistent ways. Conclusions: Group-based advance care planning intervention among medically stable older patients is as effective as an individually-focused discussion in promoting advance directive completion. Future research is needed on ways to enhance patients' ability to discuss advance care planning with their family members. Trial Registration: This study was retrospectively registered on University hospital Medical Information Network Center Clinical Trials Registry (UMIN-CTR) on December 12, 2019 (Trial registry number: UMIN000038916). [ABSTRACT FROM AUTHOR]

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% Cl 1.40-1.94)", "community-oriented practice (aOR: 1.33, 95% Cl 1.13-1.57)", and" involvement in preventive medicine (aOR: 1.18, 95% Cl 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. [ABSTRACT FROM AUTHOR]

Background: Many medical students in Japan were brought up in urban areas, thus rural medical practice is often unfamiliar to them. The University of Tsukuba created a one-day early_exposure program to provide freshman students with experience in rural practices. This study was designed to clarify how this one-day early_exposure program affected medical students' attitudes toward and knowledge of rural practices. Findings: First-year medical students (n = 103) were assigned to one of seven rural clinics in which they experienced rural practice for one day. A pre- and post-program questionnaire, rated on a 5-point Likert scale, was administered to assess students' interest in and knowledge of rural medical practice, with higher scores indicating greater interest and knowledge. Respondents who gave answers of 4 or 5 were defined as having high interest and knowledge. One hundred and one (98.1%) responses were received from students. After the program, the percentage of students interested in rural medical practices was increased (pre- and post-program: 39.0% and 61.0%, respectively; P < .001), as was the number of students who wanted to become physicians in a rural medical practice (pre- and postprogram: 53.0% and 73.0%, respectively; P < .01). Conclusions: Our one-day early_exposure program demonstrated a positive impact on medical students' interest in and knowledge of rural medical practice. Further follow-up surveys are needed to clarify whether these effects are sustained long-term. [ABSTRACT FROM AUTHOR]

The present review defines Japanese family medicine and the current state of the Japanese medical school and residency training in family medicine, and tries to reveal the reasons for the variations in family practice training in Japan. It also explains the status of family physicians’ practices in Japan today and describes the Japanese professional organizations related to family medicine or primary care in Japan. Japanese family practice must undergo further development in order to arrive at an ideal system, as has happened in other nations. Our task is to better educate ourselves about international best practices in family medicine, decide upon the form that family medicine should take within the Japanese medical system, and institute appropriate training in family medicine at both the medical school and residency levels. [ABSTRACT FROM AUTHOR]