Search

Background: Japanese physician training programs are currently not subject to rigorous national standardization. Despite residency restructuring in 2004, little is known about the current work allocation of residents in Japan. Aims: We quantified the amount of time that Japanese junior residents spend in service versus education in the context of caseload, fatigue, and low-value administrative work. Methods: In this prospective, time-and-motion study, the activity of 1st- and 2nd-year residents at three Japanese community hospitals was observed at 5-min intervals over 1 week, and categorized as patient care, academic, non-patient care, and personal. Self-reported sleep data and caseload information were simultaneously collected. Data were subanalyzed by gender, training level, hospital, and shift. Results: A total of 64 participating residents spent substantially more time in patient care activities than education (59.5% vs. 6.8%), and little time on low-value, non-patient work (5.1%). Residents reported a median 5 h of sleep before shifts and excessive sleepiness (median Epworth score, 12). Large variations in caseload were reported (median 10 patients, range 0-60). Conclusions: New physicians in Japan deliver a large volume of high-value patient care, while receiving little structured education and enduring substantial sleep deprivation. In programs without work-hour restrictions, caseload limits may improve safety and quality. [ABSTRACT FROM AUTHOR]

Objectives: The greater satisfaction of residents in non-university hospitals in Japan found in a previous survey may reflect a better educational environment in these hospitals compared to university hospitals. We aimed to compare the educational environment of university hospitals and non-university hospitals. Methods: A cross-sectional survey was sent to 6725 1st-year resident physicians. The Postgraduate Hospital Educational Environment Measure (PHEEM) was used as a reliable and validated instrument to evaluate the educational environment of teaching hospitals. Results: A total of 2429 PGY-1 physicians-in-training (38% women) completed the questionnaire (response rate, 36%). The mean total scores on the PHEEM ranged from 77 to 125 (mean, 99) for 80 university hospitals, and from 46 to 149 (mean, 102) for 255 non-university hospitals. The PHEEM score was significantly higher for non-university hospitals compared to university hospitals (p=0.001). Among the top ten of hospitals with the greatest scores, there were nine non-university hospitals but only one university hospital. Conclusions: The difference in educational environment may explain the greater satisfaction of non-university residents in Japan and account for the massive shift of residents from university to non-university hospitals after introduction of the new postgraduate medical education program in Japan. [ABSTRACT FROM AUTHOR]

Background: We investigated the views of newly graduating physicians on their preparedness for postgraduate clinical training, and evaluated the relationship of preparedness with the educational environment and the pass rate on the National Medical Licensure Examination (NMLE). Methods: Data were obtained from 2429 PGY-1 physicians-in-training (response rate, 36%) using a mailed crosssectional survey. The Dundee Ready Education Environment Measure (DREEM) inventory was used to assess the learning environment at 80 Japanese medical schools. Preparedness was assessed based on 6 clinical areas related to the Association of American Medical Colleges Graduation Questionnaire. Results: Only 17% of the physicians-in-training felt prepared in the area of general clinical skills, 29% in basic knowledge of diagnosis and management of common conditions, 48% in communication skills, 19% in skills associated with evidence-based medicine, 54% in professionalism, and 37% in basic skills required for a physical examination. There were substantial differences among the medical schools in the perceived preparedness of their graduates. Significant positive correlations were found between preparedness for all clinical areas and a better educational environment (all p < 0.01), but there were no significant associations between the pass rate on the NMLE and perceived preparedness for any clinical area, as well as pass rate and educational environment (all p > 0.05). Conclusion: Different educational environments among universities may be partly responsible for the differences in perceived preparedness of medical students for postgraduate clinical training. This study also highlights the poor correlation between self-assessed preparedness for practice and the NMLE. [ABSTRACT FROM AUTHOR]

Background: The Ministry of Health, Labour and Welfare of Japan has been promoting participation in scholarly activities for physicians during residency training. However, there is debate regarding whether this is worthwhile for residents.Objective: To evaluate residents' opinions of engaging in scholarly activities and identify factors associated with overall satisfaction with their training program.Design: Cross-sectional national survey.Participants: 1,124 second-year residents in teaching hospitals in Japan in 2007Measurements: Collected data included demographics, teaching hospital characteristics and resources, residents' research experiences, including type of activities, barriers to performing scholarly activities, residents' opinions of scholarly requirements, and resident satisfaction with their residency program.Results: 1,124 residents/1,500 responded for a response rate of 74.9%. Our data showed that 60.2% of Japanese residents engaged in some type of scholarly activity. Barriers included: "No resident time"; "No mentor;" and "No resident interest." Sixty-three percent of residents thought that research should be a residency requirement. In multivariate logistic analysis, residents' overall satisfaction with their residency program was significantly associated with participation in research activity (odds ratio (OR), 1.5; 95% confidence interval (CI), 1.1-2.1); male gender (OR, 1.5; 95% CI: 1.1-2.2); satisfaction with residency compensation (OR, 3.8; 95% CI, 2.6-5.0), and satisfaction with the residency curriculum (OR, 19.5; 95% CI, 13.7-27.7).Conclusions: The majority of residents surveyed thought that research activity was worthwhile. Residents' participation in research activity was associated with higher levels of satisfaction with residency training. Implementing measures to overcome existing barriers may have educational benefits for residents. [ABSTRACT FROM AUTHOR]

Background: In Japan, between 2010 and 2020, there were two post-graduate training curricula for post-graduate medical education, as follows: comprehensive rotation programmes (CRPs), which require rotation in at least seven clinical departments; and limited rotation programmes (LRPs), which require rotation in fewer clinical departments. The curriculum that should be used for standardized Japanese post-graduate training has long been debated. Multiple studies show that post-graduate trainees who trained with CRPs were more satisfied and confident and gained more clinical experience than those who trained with LRPs. However, a comparison of objective measurements of the clinical knowledge of Japanese post-graduate trainees has not been reported. The aim of this study is to objectively measure and compare the clinical knowledge of trainees in CRPs and LRPs using a component of the Professional and Linguistic Assessment Board test (PLAB test)., Methods: A nationwide cross-sectional study was conducted in February and March 2020. Post-graduate trainees who graduated from medical school were voluntarily recruited from general hospitals in Japan. To objectively measure the trainees' basic clinical knowledge, the PLAB test was adapted from the UK. The cut-off point was set at 63%, as recommended by the UK General Medical Council. A statistical analysis was conducted to determine whether post-graduate programme differences contributed to the trainees' test scores., Results: Twenty-two facilities volunteered to participate after recruitment, and 97 trainees from 19 facilities participated in the study. Thirty-one participants (32%) were in a CRP, and 66 participants (68%) were in an LRP. According to multiple logistic regression, the adjusted odds ratio of CRP trainees being in the high-scoring group was 5.16 (95% CI: 1.28-20.73, p<0.05). Mean differences in the scores in paediatrics, mental health and neurology were statistically higher among CRP trainees than LRP trainees., Conclusion: Post-graduate trainees who were in a CRP had better basic clinical competence knowledge (PLAB test) scores and performed better when tested in a wider range of subspecialties. Not only exam performance but also clinical performance and the longitudinal trend of trainees' competency in post-graduate medical training should be evaluated in future studies.

Objective: Primary care has potential to play a role for improving the patient care in Japanese health care system; however, little information is available about how patients perceive the roles of primary care physicians (PCPs) within the Japanese health care system. We aimed to assess population-level preferences for PCPs and investigated the extent to which preferences vary in relation to different population groups in Japan., Methods: Data were extracted from a cross-sectional questionnaire survey in October 2003. An 18-item questionnaire was used to measure the preferences for PCPs. Exploratory factor analysis was performed to identify latent factors, while confirmatory factor analysis was used to evaluate the fit of the structure using structural equation modeling (SEM)., Patients: Nationally representative sample of the adult Japanese general population was chosen by controlling for age, sex, and the size of cities., Results: A total of 2,453 adults>or=18-years-old were analyzed. SEM provided a 4-factor structural model of the population-level preference for PCPs, such as clinical competence (path coefficient (pc)=0.72), gate-keeping (pc=0.64), communication with patients or specialists (pc=0.49) and high education (pc=0.25) and demonstrated the best goodness-of-fit. Those who were middle aged, have a high family income, and a high level of education, placed more importance on gate-keeping characteristics, and the rural residents emphasized communication rather than clinical competence., Conclusion: Our results indicate that the preferences for PCPs are divided into four main factors and underscore the variation among preferences according to different population groups, such as age, socioeconomic and educational status, and places of living. These variations should be considered to improve the primary care system in Japan.

Background: Health care workers outside surgical suites in Asia use surgical-type face masks commonly. Prevention of upper respiratory infection is one reason given, although evidence of effectiveness is lacking., Methods: Health care workers in a tertiary care hospital in Japan were randomized into 2 groups: 1 that wore face masks and 1 that did not. They provided information about demographics, health habits, and quality of life. Participants recorded symptoms daily for 77 consecutive days, starting in January 2008. Presence of a cold was determined based on a previously validated measure of self-reported symptoms. The number of colds between groups was compared, as were risk factors for experiencing cold symptoms., Results: Thirty-two health care workers completed the study, resulting in 2464 subject days. There were 2 colds during this time period, 1 in each group. Of the 8 symptoms recorded daily, subjects in the mask group were significantly more likely to experience headache during the study period (P < .05). Subjects living with children were more likely to have high cold severity scores over the course of the study., Conclusion: Face mask use in health care workers has not been demonstrated to provide benefit in terms of cold symptoms or getting colds. A larger study is needed to definitively establish noninferiority of no mask use.

Objectives: The Short Form-8 (SF-8) questionnaire is a commonly used 8-item instrument of health-related quality of life (QOL) and provides a health profile of eight subdimensions. Our aim was to examine the psychometric properties of the Japanese version of the SF-8 instrument using methodology based on nominal categories model., Methods: Using data from an adjusted random sample from a nationally representative panel, the nominal categories modeling was applied to SF-8 items to characterize coverage of the latent trait (theta). Probabilities for response choices were described as functions on the latent trait. Information functions were generated based on the estimated item parameters., Results: A total of 3344 participants (53%, women; median age, 35 years) provided responses. One factor was retained (eigenvalue, 4.65; variance proportion of 0.58) and used as theta. All item response category characteristic curves satisfied the monotonicity assumption in accurate order with corresponding ordinal responses. Four items (general health, bodily pain, vitality, and mental health) cover most of the spectrum of theta, while the other four items (physical function, role physical [role limitations because of physical health], social functioning, and role emotional [role limitations because of emotional problems] ) cover most of the negative range of theta. Information function for all items combined peaked at -0.7 of theta (information = 18.5) and decreased with increasing theta., Conclusion: The SF-8 instrument performs well among those with poor QOL across the continuum of the latent trait and thus can recognize more effectively persons with relatively poorer QOL than those with relatively better QOL.