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Hospital Medicine in the United States has achieved significant progress in the accumulation of evidence. This development has influenced the increasing societal demand for General Medicine in Japan. Generalists in Japan actively engage in a wide range of interdisciplinary clinical practices, education, and management. Furthermore, Generalists have also contributed to advances in research. However, there is limited evidence regarding the benefits of General Medicine in Japan in all these areas, with most of the evidence derived from single-center studies. In Japan, the roles of Generalists are diverse, and the comprehensive definition of General Medicine makes it difficult to clearly delineate its scope. This results in an inadequate accumulation of evidence regarding the benefits of General Medicine, potentially making it less attractive to the public and younger physicians. Therefore, it is necessary to categorize General Medicine and collect clear evidence regarding its benefits. [ABSTRACT FROM AUTHOR]

Background: An increased focus on quality and patient safety has led to the evolution of hospitalists. The number of hospitalists covering ward and outpatient care is on the rise in Japan. However, it is unclear what roles hospital workers themselves consider important in their practice. Therefore, this study investigated what hospitalists and non-hospitalist generalists in Japan consider important for the practice of their specialty. Methods: This was an observational study that included Japanese hospitalists (1) currently working in a general medicine (GM) or general internal medicine department and (2) working at a hospital. Using originally developed questionnaire items, we surveyed the items important to hospitalists and non-hospitalist generalists. Results: There were 971 participants (733 hospitalists, 238 non-hospitalist) in the study. The response rate was 26.1%. Both hospitalists and non-hospitalists ranked evidence-based medicine as the most important for their practice. In addition, hospitalists ranked diagnostic reasoning and inpatient medical management as the second and third most important roles for their practice, while non-hospitalists ranked inpatient medical management and elderly care as second and third. Conclusions: This is the first study investigating the roles Japanese hospitalists consider important and comparing those to that of non-hospitalist generalists. Many of the items that hospitalists considered important were those that hospitalists in Japan are working on within and outside academic societies. We found that diagnostic medicine and quality and safety are areas that are likely to see further evolution as hospitalists specifically emphasized on them. In the future, we expect to see suggestions and research for further enhancing the items that hospital workers value and emphasise upon. [ABSTRACT FROM AUTHOR]

Importance: Standardized examinations assess both learners and training programs within the medical training system in Japan. However, it is unknown if there is an association between clinical proficiency as assessed by the General Medicine In-Training Examination (GM-ITE) and pursuing specialty. Objective: To determine the relative achievement of fundamental skills as assessed by the standardized GM-ITE based on pursuing career specialty among residents in the Japanese training system. Design: Nationwide cross-sectional study. Setting: Medical residents in Japan who attempted the GM-ITE in their first or second year were surveyed. Participants: A total of 4,363 postgraduate years 1 and 2 residents who completed the GM-ITE were surveyed between January 18 and March 31, 2021. Main measures: GM-ITE total scores and individual scores in each of four domains assessing clinical knowledge: 1) medical interview and professionalism, 2) symptomatology and clinical reasoning, 3) physical examination and treatment, and 4) detailed disease knowledge. Results: When compared to the most pursued specialty, internal medicine, only those residents who chose general medicine achieved higher GM-ITE scores (coefficient 1.38, 95% CI 0.08 to 2.68, p = 0.038). Conversely, the nine specialties and "Other/Not decided" groups scored significantly lower. Higher scores were noted among residents entering general medicine, emergency medicine, and internal medicine and among those who trained in community hospitals with higher numbers of beds, were more advanced in their training, spent more time working and studying, and cared for a moderate but not an extreme number of patients at a time. Conclusions: Levels of basic skill achievement differed depending on respective chosen future specialties among residents in Japan. Scores were higher among those pursuing careers in general medical fields and lower among those pursuing highly specialized careers. Residents in training programs devoid of specialty-specific competition may not possess the same motivations as those in competitive systems. [ABSTRACT FROM AUTHOR]

Purpose: Although research in general medicine is important, the contributions and characteristics of general medicine physicians (GMPs) in university hospitals (UH) and community healthcare facilities (CHF) remains unclear. Therefore, this study examines the popularity of research by affiliation, characteristics of journal publication, annual trends, and differences in impact factors (IFs) of journal publications. Methods: This study is a secondary bibliometric analysis of articles in international journals published in PubMed over the past six years (2015– 2020). The analysis compared English articles published by either UH- or CHF-affiliated GMPs in Japan in terms of, among other things, article type, research field, and IF. Results: Of the 2372 articles analyzed, 1688 (71.2%) were published by physicians affiliated with UHs, 62.6% of which were original. Basic research, international collaboration, and ratio of IFs were significantly higher for such papers. In contrast, the number of CHF articles were significantly higher in the areas of clinical research and practice, with a greater proportion of case reports. There was no significant difference in IF between the disciplines within each affiliation, but the IF was the highest in experimental basic research and the lowest in medical and clinical education. In the six-year time series, the number of original papers by UHs and CHFs increased roughly twofold between 2015 and 2020, but the number of articles in the areas of medical education and healthcare quality and safety remained mostly unchanged. Conclusion: The number of international papers published by Japanese GMPs has increased since 2015, particularly in terms of original papers and clinical research from UHs. However, there was no significant difference in the IF between UH and CHF publications. Our findings can guide the development of indicators, research, and education strategies regarding Japanese GMPs' research performance. [ABSTRACT FROM AUTHOR]

Background: Communication skills required for doctors do not consist of simple uses of particular linguistic forms but include uses that are sensitive to the interactional context. In consultations where the doctors have pre‐existing information about their patients, this can complicate the context of problem solicitation. We investigated how doctors tailor opening questions to a context in which they get pre‐existing information from a medical questionnaire (MQ) filled out by the patients. Methods: The data for this study were 87 video recordings of first visits to the department of general medicine at a university hospital in Japan. We qualitatively analyzed doctors' practices in problem solicitation in an opening phase using conversation analysis and triangulated it with quantitative analysis. Results: Open‐ended questions accounted for 26.4% of opening questions. Among the closed‐ended questions, 75.0% were confirming questions about symptoms. In cases with open‐ended questions, doctors minimized the relevance of the MQ to problem solicitation by giving license to repeat the description from the MQ. In cases with closed‐ended questions, doctors highlighted the relevance of the MQ by sharing the MQ. Through these practices, they avoided patients' possible confusion about problem presentation while simultaneously maximizing the possibility of soliciting the patients' narratives. Conclusions: Doctors adjusted the level of relevance of pre‐existing information to problem solicitation through both verbal and nonverbal management of the MQ. It will be useful to instruct such context‐dependent practices to improve communication skills in medical school curriculum. [ABSTRACT FROM AUTHOR]

Geographic maldistribution of physicians is a serious problem in Japan, resulting in a few physicians in remote areas. We distributed questionnaires to 396 medical students at Tokushima University from 2013 to 2016. We examined the intensity of medical students toward medicine in remote areas by using a visual analog scale and investigated what medical specialty they chose after two years of clinical training. The intensity of interest in medicine and the intensity of willingness to contribute to it in remote areas were statistically higher among medical students who intended to choose general medicine. After graduation, only five participants chose to specialize in general medicine. Of the 14 medical students who originally chose general medicine, six chose internal medicine, three chose general medicine, and the others chose surgery, neurosurgery, anesthesiology, orthopedics, or emergency medicine. This study demonstrated that medical students who intend to choose general medicine have a higher intensity of willingness to contribute to medicine in remote areas, indicating that the support program for these students to become general practitioners after graduation increases the number of physicians in remote areas. [ABSTRACT FROM AUTHOR]

Introduction: The educational effects of a hands-on clinical clerkship on medical students at the Department of General medicine of Japanese university hospitals remain to be clarified. This study aimed to determine how such education affects medical students' self-evaluation of their clinical skills. Methods: We enrolled 5th-year-grade students at the Department of General Medicine, Saga University Hospital, Japan in 2017. The students were divided into those who were going to have Japanese traditional-style observation-based training mainly in the outpatient clinic (Group O) and those in the 2018, new-style, hands-on clinical clerkship as one of the group practice members in outpatient and inpatient clinics (Group H). A questionnaire survey using the 4-point Likert scale for self-evaluation of the students' clinical skills at the beginning and the end of their training was conducted in both groups. The pre- and post-training scores of each item in both groups were compared and analyzed using the Mann–Whitney test. Results: All 99 students in Group O and 121 of 123 students in Group H answered the questionnaires. The response rate was 99%. Two items regarding the abilities of "can perform a systemic physical examination quickly and efficiently" and "can clearly explain the current medical condition, therapeutic options, or risks associated with treatment, and discuss the process for obtaining informed consent" showed higher scores in the post-training survey in Group H than in Group O. There were no differences in these scores in the pre-training survey between the two groups. Conclusion: A hands-on clinical clerkship at the Department of General medicine in a university hospital in Japan provided medical students with higher self-confidence in their skills of performing a physical examination and better understanding of patients' treatment options and the process of informed consent than observation-based training. [ABSTRACT FROM AUTHOR]

Background: Japan created a specialty system for general medicine in 2018. However, Japanese academic generalists' contribution to research remains unclear. This study examines the popularity of Japanese general medicine research, the characteristics of journal publications, annual trends, and the characteristics/differences among publications in journals with an impact factor (IF). Methods: This bibliometric analysis extracted international, English-language, journal articles published on PubMed between January 1, 2015, and December 31, 2020. Analysis included articles with either the first, second, or last author in general medicine. We classified articles according to publication or article type and field of research. We obtained standard descriptive statistics for each publication type. Chi-squared test or Fisher's exact test was used to compare nominal variables. For continuous variables, t-tests or Wilcoxon rank-sum tests were used, as appropriate. Results: Of the 2372 articles analyzed, original articles were most common (56.3%), followed by case reports (30.1%), reviews (7.63%), and letters/others (5.9%). Publication volume increased 2.64-fold annually over 5 years. Clinical research (60.5%) was most common among original articles, followed by basic experimental research (17.5%) and public health/epidemiology (12.7%). Medical quality and safety (4.1%), medical and clinical education (3.1%), and health services (1.42%) received comparatively little attention. Eighty percent of articles were published in journals with IF; however, these journals rarely published case reports. Among original articles, the likelihood of publishing in journals with IF was high for basic laboratory medicine articles with higher IF (median IF 3.83, OR 1.71, 95% CI 2.20– 5.95, p=0.044) and lower for clinical education research with the lowest IF (median IF 1.83, OR 0.56, 95% CI 01.8– 0.75, p< 0.001). Discussion: General medicine physicians' international research output is increasing in Japan; however, research achievements have not been generalized, but rather much influenced by clinical subspecialty backgrounds. This will likely continue unless an academic generalist discipline is established. [ABSTRACT FROM AUTHOR]

In Japan, general medicine is still relatively new as a specialty, having been established in 2018 as the 19th primary specialty. The relevant research field has therefore not been fully established yet, and the detailed research areas in this field have not been identified. We conducted a descriptive questionnaire-based web survey of members of the Japanese Society of Hospital General Medicine. Respondents were asked to highlight their research topics from the following categories: diagnostic excellence, design (problem-solving and thinking methodology), symptomatology, physical examination, clinical epidemiology, home and community medicine, general medicine education, organizational management, hospital administration, and "none of the above (add description of your work if desired)". The respondents could choose multiple topics. There were 276 respondents (14% response rate), of whom 240 (86.9%) were male, 103 (37.3%) worked at universities, and 232 (84.1%) had previous research experience. Diagnostic excellence was the most common research topic category among generalists (n=87, 21.3%), followed by clinical epidemiology (n=83, 20.3%), symptomatology (n=41, 10.0%), home and community medicine (n=39, 9.6%), and general medicine education (n=36, 8.8%). Seventy-eight respondents (19.1%) chose "none of the above (add description of your work if desired)". The main research topics were in areas fundamental to diagnostic excellence, ie, diagnostics, diagnostic error, clinical epidemiology, and symptomatology. Home and community medicine and general medicine education were also included as research topics because of their diverse roles. The research interests of generalists are therefore diverse, and new areas and frameworks are likely to be created in the future. [ABSTRACT FROM AUTHOR]

Demand is increasing for general medicine services in Japan, a super-aged society. The new medical specialty system introduced in 2019 obligates physicians to obtain a qualified specialty from among 19 basic specialty fields, including general medicine, before obtaining more advanced qualified subspecialties. The role of the department of general medicine in Japan varies in each hospital. Remuneration for medical services obtained by general medicine departments that mainly provide outpatient care is relatively low, making it difficult to fill positions in this department within a hospital. We conducted a narrative review and discussed ways to increase the status of hospital general medicine departments that mainly provide outpatient care. We consider the following four points to be important: improvement of diagnostic capabilities in the outpatient setting; playing a central role in education for medical students and residents; active involvement with patients who have diagnostic difficulties or social problems; and branding and promotion of the general medicine department. We envision that adopting an active approach to these points will increase the status of general medicine departments that mainly provide outpatient care within the hospital, allowing such newly established departments to start easily in Japanese hospitals in the future. [ABSTRACT FROM AUTHOR]

Purpose: The training of generalist physicians in university hospitals needs to emphasize development of their research role in order to continue improving their research capacity and their standing in academic hospitals in Japan. This cross-sectional descriptive study aimed to survey departments of general medicine (GM) in university hospitals in Japan to identify the research areas and themes pursued by academic generalist physicians. Patients and Methods: The heads of the departments of GM from 71 university hospitals in Japan were enrolled. The main outcomes studied were the identification of the main research areas and themes in academic departments of GM, based on the classification of the National Grants-in-Aid for Scientific Research (KAKENHI): clinical research, public health, preventive medicine, medical education, basic science, health services and safety and quality. Results: We received 47 of 71 replies (66.2% response rate). Clinical research was the most common area of research (62%), followed by public health and preventive medicine (14%), medical education (11%), and basic sciences (9%). Only one department identified health services and safety and quality as a research area (2%). There was marked variability in research areas across the different departments, with 23% of the research targeting the highest specialties, particularly organ-specific research in the fields of gastroenterology, cardiology, immunology, neurology, metabolic endocrinology, and hematology-oncology. Conclusion: The training of generalist physicians in university hospitals needs to emphasize development of their research role in order to continue improving the research capacity and the standing generalist physicians in academic hospitals in Japan. [ABSTRACT FROM AUTHOR]

Background: Although general medicine (GM) faculty in Japanese medical schools have an important role in educating medical students, the importance of residents' rotation training in GM in postgraduate education has not been sufficiently recognized in Japan. To evaluate the relationship between the rotation of resident physicians in the GM department and their In-Training Examination score. Methods: This study is a nationwide multi-center cross-sectional study in Japan. Participants of this study are Japanese junior resident physicians [postgraduate year (PGY)-1 and PGY-2] who took the General Medicine In-Training Examination (GM-ITE) in fiscal years 2016 to 2018 at least once (n = 11,244). The numbers of participating hospitals in the GM-ITE were 381, 459, and 503 in 2016, 2017, and 2018.The GM-ITE score consisted of four categories (medical interview/professionalism, symptomatology/clinical reasoning, physical examination/procedure, and disease knowledge). We evaluated relationship between educational environment (including hospital information) and the GM-ITE score. Results: A total of 4464 (39.7%) residents experienced GM department rotation training. Residents who rotated had higher total scores than residents who did not rotate (38.1 ± 12.1, 36.8 ± 11.7, and 36.5 ± 11.5 for residents who experienced GM rotation training, those who did not experience this training in hospitals with a GM department, and those who did not experience GM rotation training in hospitals without a GM department, p = 0.0038). The association between GM rotation and competency remained after multivariable adjustment in the multilevel model: the score difference between GM rotation training residents and non-GM rotation residents in hospitals without a GM department was estimated as 1.18 (standard error, 0.30, p = 0.0001), which was approximately half of the standard deviation of random effects due to hospital variation (estimated as 2.00). Conclusions: GM rotation training improved the GM-ITE score of residents and should be considered mandatory for junior residents in Japan. [ABSTRACT FROM AUTHOR]

Keywords: family doctor; general medicine; hospital general medicine; residency program EN family doctor general medicine hospital general medicine residency program 59 60 2 01/05/23 20230101 NES 230101 Medical students and junior residents have five concerns about general medicine training, and senior residents and young academic generalists respond to these concerns. Family doctor, general medicine, hospital general medicine, residency program The system of general medicine training is being improved daily, and opinions from general medicine residents are being actively collected, gradually dispelling this concern. [Extracted from the article]

Geographic maldistribution of physicians is a serious problem in Japan, resulting in a few physicians in remote areas. We distributed questionnaires to 396 medical students at Tokushima University from 2013 to 2016. We examined the intensity of medical students toward medicine in remote areas by using a visual analog scale and investigated what medical specialty they chose after two years of clinical training. The intensity of interest in medicine and the intensity of willingness to contribute to it in remote areas were statistically higher among medical students who intended to choose general medicine. After graduation, only five participants chose to specialize in general medicine. Of the 14 medical students who originally chose general medicine, six chose internal medicine, three chose general medicine, and the others chose surgery, neurosurgery, anesthesiology, orthopedics, or emergency medicine. This study demonstrated that medical students who intend to choose general medicine have a higher intensity of willingness to contribute to medicine in remote areas, indicating that the support program for these students to become general practitioners after graduation increases the number of physicians in remote areas. J. Med. Invest. 70 : 129-134, February, 2023.

Background: It is believed that the type of educational environment in teaching hospitals may affect the performance of medical knowledge base among residents, but this has not yet been proven. Objective: We aimed to investigate the association between the hospital educational environment and the performance of the medical knowledge base among resident physicians in Japanese teaching hospitals. Methods: To assess the knowledge base of medicine, we conducted the General Medicine In-Training Examination (GM-ITE) for second-year residents in the last month of their residency. The items of the exam were developed based on the outcomes designated by the Japanese Ministry of Health, Labor, and Welfare. The educational environment was evaluated using the Postgraduate Hospital Educational Environment Measure (PHEEM) score, which was assessed by a mailed survey 2 years prior to the exam. A mixed-effects linear regression model was employed for the analysis of variables associated with a higher score. Results: Twenty-one teaching hospitals participated in the study and a total of 206 residents (67 women) participated and completed the exam. There were no residents who declined to participate in the exam. The mean GM-ITE score was 58 (standard deviation 8.4). The mixed-effects linear regression analysis showed that a higher PHEEM score was associated with a higher GM-ITE score (P = 0.02). Having a department of general medicine, and hospital location in a provincial community (versus an urban setting), were also shown to have a significant relationship with the higher score (P = 0.03, and P = 0.02, respectively). Conclusion: We found that the performance of the medical knowledge base of resident physicians was significantly associated with the educational environment of their hospitals. Improvement of the educational environment in teaching hospitals might be crucial for enhancing the performance of resident physicians in Japan [ABSTRACT FROM AUTHOR]

Although the demand for general physicians has increased in Japan because of its aging population, medical universities primarily provide organ-based education; thus, medical students do not receive sufficient general medical education. The number of residents focusing on general medicine remains low; therefore, to understand the present situation regarding general medicine education, we attempted to clarify the views of medical students and the factors influencing them. In this qualitative study, semi-structured interviews were conducted in 12 medical students at Shimane University, and the results were analyzed through thematic analysis. The results indicated the emergence of three themes and 14 concepts. The three overarching themes were as follows: hopes for the field of general medicine, gaps between ideal and reality of general medicine, and factors affecting students' motivation for specialization in general medicine. Medical students had a positive impression of general medicine and believed that it has potential for further development; however, they felt a gap between their ideals and reality (i.e., unclear expertise). Factors creating this gap included poorly developed education and medical policies. We need to restructure general medicine education based on the participants' perceptions by establishing collaborative curricula between universities and community hospitals and by increasing students' exposure to general medicine. [ABSTRACT FROM AUTHOR]