Difference in the general medicine in-training examination score between community-based hospitals and university hospitals: a cross-sectional study based on 15,188 Japanese resident physicians

Nishizaki, Yuji; Nozawa, Keigo; Shinozaki, Tomohiro; Shimizu, Taro; Okubo, Tomoya; Yamamoto, Yu; Konishi, Ryota; Tokuda, Yasuharu

doi:10.1186/s12909-021-02649-0

Cited by 14 publications

(12 citation statements)

References 19 publications

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“…It covers four areas of basic clinical knowledge, including ‘medical interview and professionalism,’ ‘symptomatology and clinical reasoning,’ ‘physical examination and clinical procedures,’ and ‘disease knowledge’. 14 , 15 These areas correlate with the PGME objectives as established by the Japanese Ministry of Health, Labor and Welfare. The Japan Institute for Advancement of Medical Education Program (JAMEP), a nonprofit organization, developed the GM‐ITE as an objective evaluation of residents' basic clinical knowledge.…”

Section: Methodsmentioning

confidence: 84%

“…The general medicine in‐training examination (GM‐ITE) is a computer‐based test consisting of 80 multiple‐choice questions. It covers four areas of basic clinical knowledge, including ‘medical interview and professionalism,’ ‘symptomatology and clinical reasoning,’ ‘physical examination and clinical procedures,’ and ‘disease knowledge’ 14,15 . These areas correlate with the PGME objectives as established by the Japanese Ministry of Health, Labor and Welfare.…”

Section: Methodsmentioning

confidence: 99%

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Association between mentorship and mental health among junior residents: A nationwide cross‐sectional study in Japan

Katayama,

Nishizaki,

Takada

et al. 2023

J of Gen and Family Med

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BackgroundMentorship is a dynamic, reciprocal relationship in which an advanced careerist (mentor) encourages the growth of a novice (mentee). Mentorship may protect the mental health of residents at risk for depression and burnout, yet despite its frequent use and known benefits, limited reports exist regarding the prevalence and mental effects of mentorship on residents in Japan.MethodsWe conducted a cross‐sectional study involving postgraduate year 1 and 2 (PGY‐1 and PGY‐2) residents in Japan who took the General Medicine In‐Training Examination (GM‐ITE) at the end of the 2021 academic year. Data on mentorship were collected using surveys administered immediately following GM‐ITE completion. The primary outcome was the Patient Health Questionaire‐2 (PHQ‐2), which consisted depressed mood and loss of interest. A positive response for either item indicated PHQ‐2 positive. We examined associations between self‐reported mentorship and PHQ‐2 by multi‐level analysis.ResultsOf 4929 residents, 3266 (66.3%) residents reported having at least one mentor. Compared to residents without any mentor, those with a mentor were associated with a lower likelihood of a positive PHQ‐2 response (adjusted odds ratio [aOR] 0.75; 95% confidence interval [95% CI] 0.65–0.86). Mentor characteristic significantly associated with negative PHQ‐2 response was a formal mentor (aOR; 0.68; 95% CI 0.55–0.84).ConclusionsA mentor‐based support system was positively associated with residents' mental health. Further research is needed to determine the quality of mentorship during clinical residency in Japan.

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Section: Methodsmentioning

confidence: 84%

Section: Methodsmentioning

confidence: 99%

Association between mentorship and mental health among junior residents: A nationwide cross‐sectional study in Japan

Katayama,

Nishizaki,

Takada

et al. 2023

J of Gen and Family Med

Self Cite

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“…Reportedly, junior residents working for community hospitals score higher than those working for university hospitals on the General Medicine In-Training Examination (GM-ITE), 32 which assesses junior residents’ medical knowledge, 33 indicating that junior residents can learn more from clinical cases in early phases 32 because community hospitals primarily provide care to as many local residents as possible. In addition, factors related to the GM-ITE high score were rotation in the general medicine department, 34 more admitted patients to care for, 35 and receiving clinical training in rural areas.…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies have shown that early practical training in clinical rotation programs for postgraduate trainees may be associated with improved medical knowledge, improved attitudes toward patients, confidence in delivering medical care, and improved clinical performance. [27][28][29][30][31] Reportedly, junior residents working for community hospitals score higher than those working for university hospitals on the General Medicine In-Training Examination (GM-ITE), 32 which assesses junior residents' medical knowledge, 33 indicating that junior residents can learn more from clinical cases in early phases 32 because community hospitals primarily provide care to as many local residents as possible. In addition, factors related to the GM-ITE high score were rotation in the general medicine department, 34 more admitted patients to care for, 35 and receiving clinical training in rural areas.…”

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confidence: 99%

Characteristics of University Hospitals Implementing the Postgraduate Clinical Training “Tasukigake Method” and Their Correlation with Program Popularity: A Cross-Sectional Study

Watanabe¹,

Kataoka²,

Sekine³

et al. 2023

AMEP

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Purpose In 2004, the postgraduate clinical training system in Japan was radically revised by introducing a super-rotation matching system. Although postgraduate clinical training became a mandatory 2 years of training, the program and operation were left to each facility’s discretion, leading to training-program popularity differences. The Japanese Tasukigake method provides clinical training in which “hospitals where junior residents work” and “external hospitals/clinics that provide clinical training” conduct clinical training alternately on a 1-year basis. The study aimed to identify the characteristics of university hospitals that implement the Tasukigake method to help educators and medical institutions create more attractive and effective programs. Methods All 81 university main hospitals were included in this cross-sectional study. The information regarding Tasukigake method implementation was collected from the facilities’ websites. The training program’s matching rate (popularity) was calculated from the Japan Residency Matching Program’s interim report data (academic 2020). We used multiple linear regression analysis to evaluate the association between Tasukigake method implementation, program popularity, and university hospital characteristics. Results The Tasukigake method was implemented by 55 (67.9%) university hospitals, significantly more by public university hospitals (44/55, 80%) than by private (11/55, 20%) ( P < 0.01) and by hospitals without branches (38/55, 69.1%) than with branches (17/55, 30.9%) ( P < 0.001). The maximum hiring capacity of junior residents ( P = 0.015) and number of branches ( P < 0.001) were negatively correlated, and the population of the hospital’s city ( P = 0.003) and salary/month ( P = 0.011) were positively correlated with the Tasukigake method implementation. Multiple linear regression analysis results showed no significant association between the matching rate (popularity) and Tasukigake method implementation. Conclusion The results show no association between Tasukigake method and program popularity; also, highly specialized university hospitals in cities with fewer branch hospitals were more likely to implement the Tasukigake method.

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“…Similar to previous studies regarding the GM-ITE, resident physicians from university hospitals had lower GM-ITE scores in this study. 37 The low PUD index group had a lower proportion of university hospitals, which may be a confounding factor. Third, the resident physicians' baseline clinical skills were not assessed.…”

Section: Limitationsmentioning

confidence: 96%

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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Difference in the general medicine in-training examination score between community-based hospitals and university hospitals: a cross-sectional study based on 15,188 Japanese resident physicians

Cited by 14 publications

References 19 publications

Association between mentorship and mental health among junior residents: A nationwide cross‐sectional study in Japan

Association between mentorship and mental health among junior residents: A nationwide cross‐sectional study in Japan

Characteristics of University Hospitals Implementing the Postgraduate Clinical Training “Tasukigake Method” and Their Correlation with Program Popularity: A Cross-Sectional Study

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

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