BackgroundThe medical practice of general practitioners/family physicians in urban areas differs from that in rural areas, accounting for the difference in specific competencies. However, variations in competencies in community healthcare required for general practitioners/family physicians in urban areas compared with those in rural areas have not yet been fully clarified. Thus, this study aimed to elucidate the competencies required for general practitioners/family physicians, especially in those characteristic to urban areas, and compare them with those in non-urban/rural areas.MethodsA qualitative study with individual interviews and qualitative data analysis was conducted. Participants were selected by purposive sampling, and 10 general practitioners/family physicians with clinical experience of ≥7 y after graduation and ≥ 1 y in both urban and non-urban (rural) areas in Japan were recruited. Additionally, semi-structured individual interviews in a private room around the workplace of the interviewee between September 2014 and September 2016 were conducted. For data collection, interview transcripts were analyzed according to the “Steps for Coding and Theorization” method, a sequential and thematic qualitative data analysis technique and data analysis since March 2018.ResultsWe interviewed 10 general practitioners/family physicians of Japan and extracted 10 themes as competencies characteristic to general practitioners/family physicians in urban areas. In addition to the known competencies on urban underserved care, we newly clarified the competencies of the ability to integrate divided care and ability to coordinate and collaborate with various medical care and welfare professionals in urban areas.ConclusionThis study was one of the few studies describing the characteristic competencies of urban general practitioners. In summary, a competency necessary for general practitioners in urban areas is to understand the urban context and provide contextual care suitable for urban areas. In the modern age, where urban population concentration is progressing and the interest in urban health is rising, our study will give certain suggestions for primary care education and practice necessary for urban areas.

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Background Coronavirus disease 2019 (COVID‐19) has substantially affected the health and lives of medical professionals. However, the experiences of nurses engaged in primary care remain unclear. We explored how nurses working in primary care were psychologically and socially affected by the COVID‐19 disaster and how they overcame the difficulties experienced. Methods We conducted a qualitative study of seven Japanese nurses working in primary care. Data collection was performed before, during, and after a workshop based on the Tojisha‐Kenkyu (user‐led research) framework to explore how the COVID‐19 disaster affected the nurses and how they coped. Data were analyzed using inductive thematic analysis. Results Three themes emerged from the analysis: effects of the COVID‐19 disaster on nurses, nurses' newly found strength during the pandemic, and their changes and achievements through the Tojisha‐Kenkyu framework. The first theme comprised four subthemes: fear of the unknown; difficulty in adaptation; dysfunction in patient care; and defilement and oppression. The second theme involved feeling in control and professionalism. The third theme, which was based on participants' discovery of “same and different” fellowships, showed work reconstruction and self‐understanding, which alleviated their difficulties. Conclusions The effect of the pandemic on nurses working in primary care ranges from work‐related frustration to daily life issues. The Tojisha‐Kenkyu method can help nurses to alleviate difficulties. Further research should be conducted to elucidate the constant burden on primary care professionals and establish appropriate occupational and daily life support during pandemics.

Introduction: An understanding of social determinants of health (SDH) and patients' social circumstances is recommended to deliver contextualised care. However, the processes of patient care related to SDH in clinical settings have not been described in detail. Observable practice activities (OPAs) are a collection of learning objectives and activities that must be observed in daily practice and can be used to describe the precise processes for professionals to follow in specific situations (process OPA.) Methods: We used a modified Delphi technique to generate expert consensus about the process OPA for patient care related to SDH in primary care settings. To reflect the opinions of various stakeholders, the expert panel comprised clinical professionals (physicians, nurses, public health nurses, social workers, pharmacists and medical clerks), residents, medical students, researchers (medical education, health care, sociology of marginalised people), support members for marginalised people and patients. The Delphi rounds were conducted online. In Round 1, a list of potentially important steps in the processes of care was distributed to panellists. The list was modified, and one new step was added. In Round 2, all steps were acknowledged with few modifications.Results: Of 63 experts recruited, 61 participated, and all participants completed the Delphi rounds. A total of 14 observable steps were identified, which were divided into four components: communication, practice, maintenance and advocacy. The importance of ongoing patient-physician relationships and collaboration with professionals and stakeholders was emphasised for the whole process of care.Discussion: This study presents the consensus of a variety of experts on the process OPA for patient care related to SDHs. Further research is warranted to investigate how this Communication-Practice-Maintenance-Advocacy framework could affect medical education, quality of patient care, and patient outcomes. | INTRODUCTIONSocial determinants of health (SDHs) are defined as 'the conditions in which people are born, grow, live, work and age … shaped by the distribution of money, power and resources at global, national and local levels'. 1 SDH makes a substantial contribution to population health outcomes. Although health care professionals are expected to train the ability to recognise social structure to influence health outcomes (as is called structural competency) 2 and to deliver individualised care to patients and improve public health, 3 they do not always respond

Objective Vaccination technique is a crucial skill for medical trainees to learn, especially in the current coronavirus disease 2019 pandemic. To this end, validated assessment tools are essential in teaching appropriate techniques. However, valid instruments for assessing vaccine administration skills have not yet been developed. We therefore explored the development and validation of an assessment tool for vaccination techniques based on expert consensus. Methods We implemented a modified Delphi process to develop a vaccination technique assessment tool. We then conducted a validation study to establish the reliability and validity of the tool. Results Two rounds of the modified Delphi process were performed to generate a 19-item, vaccination performance assessment checklist. In the validation study, the linear weighted kappa value for inter-rater reliability of the overall checklist score was 0.725. Spearman's correlation coefficient between the mean checklist score and the global rating was 0.98 (p<0.01). Conclusions This is a pioneering study examining the development and validation of an assessment tool for vaccine administration techniques. The tool will be widely used in vaccination-related education.