Association between regional quota program in medical schools and practical clinical competency based on General Medicine In-Training Examination score: a nationwide cross-sectional study of resident physicians in Japan

Fukui, Sho; Shikino, Kiyoshi; Nishizaki, Yuji; Shimizu, Taro; Yamamoto, Yu; Kobayashi, Hiroyuki; Tokuda, Yasuharu

doi:10.1093/postmj/qgad059

Cited by 4 publications

(1 citation statement)

References 25 publications

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“…Approximately half of all resident physicians took the GM-ITE in Japan. 5,6 The survey was conducted from October 18 to December 15, 2023, and included items like the level planned at their own facility, items that fall under working hours rather than self-improvement, and the residency program directors’ perceptions on the optimal working hours for resident physicians. Overtime duty hours per month was divided into eight categories (C1 to C8) (Supplementary file 1).…”

Section: Methodsmentioning

confidence: 99%

Program Directors’ Perspectives on Duty Hours Following the Physicians’ Work Style Reforms in Japan

Shikino,

Nishizaki,

Nagasaki

et al. 2024

Preprint

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Background: In anticipation of Japan's physician work style reforms scheduled for April 2024, which will restrict physicians' overtime duty hours to under 960 (Level A) or 1920 (Level C-1) hours per year, this study evaluates the potential impact on clinical resident physicians' training environments through the lens of residency program directors. Methods: A cross-sectional survey was administered to program directors from 701 facilities associated with the 2023 General Medicine-In Training Examination (GM-ITE), capturing responses regarding their planned level of overtime, perceptions of optimal working hours for training efficacy, and items considered as duty hours. Results: Out of the 701 facilities, 254 responded (36.2% response rate), with a predominant inclination towards adopting Level A (83.5%). A consensus emerged favoring 40 overtime duty hours per month as optimal, significantly lower than previous suggestions of 60-65 hours per week. The study also delineated the classification of activities as duty hours, with patient procedures and mandatory educational sessions identified as such, while self-improvement was largely not considered duty. Discussion: The findings indicate a substantial shift from previously recommended optimal duty hours towards a more conservative approach. This shift may reflect a proactive adaptation to upcoming regulatory changes and raises questions about the potential impact on the quality of clinical training. The distinction between educational activities and duty hours underscores the need for clarity within the impending work style reforms.

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Section: Methodsmentioning

confidence: 99%

Program Directors’ Perspectives on Duty Hours Following the Physicians’ Work Style Reforms in Japan

Shikino,

Nishizaki,

Nagasaki

et al. 2024

Preprint

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Association between physicians’ maldistribution and core clinical competency in resident physicians

Shikino,

Nishizaki,

Kataoka

et al. 2023

Preprint

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Importance: This study highlights the association between physicians' maldistribution and core clinical competency of resident physicians and emphasizes the global significance of addressing healthcare access disparities. Objective: To investigate the relationship between a prefectural program with and without physician maldistribution and core clinical competency, measured using the General Medicine In-Training Examination (GM-ITE). Design: Cross-sectional study. Setting: Data from the GM-ITE survey were collected in January 2023. Participants: Resident physicians in their first and second postgraduate year (PYG-1 and PGY-2) who were employed at Japanese hospitals that required the GM-ITE or resident physicians who voluntarily participated in the GM-ITE. Exposure: Physician uneven distribution (PUD) index is a policy index developed and adopted in Japan. It serves as an indicator of regional disparities among physicians within the country. A low PUD index indicates that there is an insufficient medical supply relative to the medical demand in that region. Main Outcomes and Measures: The GM-ITE scores of resident physicians. Results: The high PUD index group included 2,143 participants and the low PUD index group included 1,580 participants. After adjusting for relevant confounders, multivariable linear regression analyses revealed that the low PUD index group had a significantly higher GM-ITE score compared to the high PUD index group (adjusted coefficient: 1.14; 95% confidence interval: 0.62-1.65; p<0.001). Conclusions and Relevance: Resident physicians in regions with low PUD indices had significantly higher GM-ITE scores. These findings underscore the significance of addressing physician maldistribution to enhance the clinical competency of resident physicians and emphasize the potential benefits of reducing regional healthcare disparities, particularly in terms of medical education and training. These insights have broader relevance for healthcare policies and medical training programs worldwide, highlighting the need to consider physician distribution as a critical factor in improving healthcare access and quality.

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Association between physicians’ maldistribution and core clinical competency of resident physicians: a nationwide cross-sectional study

Shikino,

Nishizaki,

Kataoka

et al. 2024

BMJ Open

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ObjectivesWith physician maldistribution recognised as a global issue, Japan implemented the physician uneven distribution (PUD) index as a strategic measure. Currently, there is a lack of objective assessment of core clinical competencies in regions influenced by varying levels of physician distribution. In this study, we objectively assess the core clinical competencies in regions affected by physician maldistribution and explore the relationship between the PUD index and the clinical competencies of resident physicians.Design, setting and participantsIn this cross-sectional study, we gathered data from the January 2023 General Medicine In-Training Examination (GM-ITE) survey. Participants included postgraduate year 1 and 2 resident physicians in Japanese hospitals mandating the GM-ITE or those who voluntarily took it. The GM-ITE scores of the resident physicians were assessed. The PUD index, a Japanese policy indicator, reflects regional physician disparities. A low PUD index signals a medical supply shortage compared with local demand. The trial registration number is 23-7.ResultsThe high and low PUD index groups included 2143 and 1580 participants, respectively. After adjusting for relevant confounders, multivariate linear regression analyses revealed that the low PUD index group had significantly higher GM-ITE scores than the high PUD index group (adjusted coefficient: 1.14; 95% CI 0.62 to 1.65; p<0.001).ConclusionsThe study revealed no clinically differences in GM-ITE scores between residents in regions with disparate physician distributions, suggesting that factors beyond PUD may influence clinical competency. This finding prompts a re-evaluation of whether current assessment methodologies or educational frameworks fully support learning across varied community settings.

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Association between regional quota program in medical schools and practical clinical competency based on General Medicine In-Training Examination score: a nationwide cross-sectional study of resident physicians in Japan

Cited by 4 publications

References 25 publications

Program Directors’ Perspectives on Duty Hours Following the Physicians’ Work Style Reforms in Japan

Program Directors’ Perspectives on Duty Hours Following the Physicians’ Work Style Reforms in Japan

Association between physicians’ maldistribution and core clinical competency in resident physicians

Association between physicians’ maldistribution and core clinical competency of resident physicians: a nationwide cross-sectional study

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