Board certification in Japan: corruption and near-collapse of reform

Iwata, Kentaro; Mosby, Daniel J; Sakane, Michiko

doi:10.1136/postgradmedj-2017-134994

Cited by 9 publications

(11 citation statements)

References 3 publications

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“… 4 8 Furthermore, additional specialty training for physicians after residency training, scheduled to start in 2018, has caused concern among healthcare professionals and policy makers that young physicians will be even more likely to cluster in large cities. 9–12 …”

Section: Introductionmentioning

confidence: 99%

Results of physician licence examination and scholarship contract compliance by the graduates of regional quotas in Japanese medical schools: a nationwide cross-sectional survey

et al. 2017

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ObjectivesResponding to the serious shortage of physicians in rural areas, the Japanese government has aggressively increased the number of entrants to medical schools since 2008, mostly as a chiikiwaku, entrants filling a regional quota. The quota has spread to most medical schools, and these entrants occupied 16% of all medical school seats in 2016. Most of these entrants were admitted to medical school with a scholarship with the understanding that after graduation they will practise in designated areas of their home prefectures for several years. The quota and scholarship programmes will be revised by the government starting in 2018. This study evaluates the intermediate outcomes of these programmes.DesignCross-sectional survey to all prefectural governments and medical schools every year from 2014 to 2017 to obtain data on medical graduates.SettingsNationwide.ParticipantsAll quota and non-quota graduates with prefecture scholarship in each prefecture, and all the quota graduates without scholarship in each medical school.Primary outcome measuresPassing rate of the National License Examination for Physicians and the percentage of graduates who have not bought out the scholarship contract after graduation.ResultsMost prefectures and medical schools in Japan participated in this study (97.8%–100%). Quota graduates with scholarship were significantly more likely to pass the National License Examination for Physicians than the other medical graduates in Japan at all the years (97.9%, 96.7%, 97.4% and 94.7% vs 93.9%, 94.5%, 94.3% and 91.8%, respectively). The percentage of quota graduates with scholarship who remained in the scholarship contract 3 years after graduation was 92.2% and 89.9% for non-quota graduates with scholarship.ConclusionsQuota entrants showed better academic performance than their peers. Most of the quota graduates remained in the contractual workforce. The imminent revision of the national policy regarding quota and scholarship programmes needs to be based on this evidence.

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Section: Introductionmentioning

confidence: 99%

Results of physician licence examination and scholarship contract compliance by the graduates of regional quotas in Japanese medical schools: a nationwide cross-sectional survey

et al. 2017

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“…16 There is variation in the training experience across programs, and Japan's modest specialty certification criteria have prompted concern about physician competency. 17 These observations suggest Japanese IMGs should view their US residency experience as superior. At the same time, perceptions also are strongly influenced by other factors, including the culture of clinical training and practice and interpersonal relationships.…”

Section: Introductionmentioning

confidence: 99%

Contrasting Residency Training in Japan and the United States From Perspectives of Japanese Physicians Trained in Both Systems

Heist

Torok

2019

Journal of Graduate Medical Education

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Background International medical graduates (IMGs) have significant exposure to clinical training in their home country, which provides opportunity for international comparison of training experiences. One relevant IMG population is Japanese physicians who have completed some training before entering residency programs in the United States and desire to improve medical education in Japan. Objective We examined Japanese IMGs' perceptions of the respective attributes of residency in the United States and Japan. Methods Individual semistructured interviews were conducted with 33 purposively sampled Japanese IMGs who had completed training. We used exploratory thematic analysis, iterative data collection, and thematic analyses with constant comparison. Results Comments were organized into 3 categories: (1) attributes of US residency preferable to Japanese residency; (2) attributes of residency training with no clear preference for the US or Japanese systems; and (3) attributes of Japanese residency preferable to US residency. Within each category, we matched themes to residency program requirements or culture of medical training. Main themes include high regard for Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements, with emphasis on efficient achievement of clinical competency through graded responsibility, contrasted with preference expressed for a Japanese training culture of increased professional commitment facilitated by a lack of work hour limits and development of broad clinician skills, including bedside procedures and radiology interpretation. Conclusions Japanese training culture contrasts with a US model that is increasingly focused on work-life balance and associated compartmentalization of patient care. These findings enhance our understanding of the global medical education landscape and challenges to international standardization of training.

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“…3 All residents of Japan including foreign nationals with a residence card are required by law to be enrolled in a health insurance programme. 4 The free-access system allows patients to visit a hospital directly without referral from a family physician. 3 Although the Japanese healthcare system has achieved better healthcare outcomes, such as long life expectancy and low infant mortality, it is facing two major challenges: financial sustainability of the system and a rapidly ageing population.…”

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confidence: 99%

“…The Japanese Medical Specialty Board was recently established to achieve high standards for physician specialty certifications with formal clinical training accredited by an independent third party. 4 Many societies of specialists felt that their authoritative power was deprived by the Board. 4 The Board changed its direction and guidelines in response to this criticism, and during this process, the application system and programme requirement changed repeatedly.…”

mentioning

confidence: 99%

“…4 Many societies of specialists felt that their authoritative power was deprived by the Board. 4 The Board changed its direction and guidelines in response to this criticism, and during this process, the application system and programme requirement changed repeatedly. Several websites reported that this reduction in Board governance may have negatively affected the number of applicants to family medicine.…”

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confidence: 99%

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Research evidence is essential for the development of family medicine as a discipline in the Japanese healthcare system

et al. 2019

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Board certification in Japan: corruption and near-collapse of reform

Abstract: The board certification system in Japan is undergoing reform, but it is likely to be watered down without significant improvement.

Cited by 9 publications

References 3 publications

Results of physician licence examination and scholarship contract compliance by the graduates of regional quotas in Japanese medical schools: a nationwide cross-sectional survey

Results of physician licence examination and scholarship contract compliance by the graduates of regional quotas in Japanese medical schools: a nationwide cross-sectional survey

Contrasting Residency Training in Japan and the United States From Perspectives of Japanese Physicians Trained in Both Systems

Research evidence is essential for the development of family medicine as a discipline in the Japanese healthcare system

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