Educational environment of university and non-university hospitals in Japan

Tokuda, Yasuharu; Gotō, Eiji; Otaki, Junji; Jacobs, Joshua L.; Shapiro, Mina; Soejima, Kumiko; Ishida, Yasushi; Ohde, Sachiko; Takahashi, Osamu; Fukui, Tsuguya

doi:10.5116/ijme.4ba1.4034

Cited by 11 publications

(9 citation statements)

References 14 publications

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“…When this national policy of 2-year postgraduate residency training programs was introduced in 2004, the computer-based national matching system was introduced and students could apply to their preferred hospitals throughout the entire country 2. In our previous study, the greater satisfaction of non-university residents was shown compared with university residents in Japan 3. In that study, to compare the educational environments of university and non-university hospitals, we used the Postgraduate Hospital Educational Environment Measure (PHEEM), which is a 40-item inventory, and an evaluation tool consisting of a validated questionnaire with three subscales.…”

Section: Introductionmentioning

confidence: 94%

The hospital educational environment and performance of residents in the General Medicine In-Training Examination: a multicenter study in Japan

Shimizu¹,

Tsugawa²,

Tanoue³

et al. 2013

IJGM

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BackgroundIt is believed that the type of educational environment in teaching hospitals may affect the performance of medical knowledge base among residents, but this has not yet been proven.ObjectiveWe aimed to investigate the association between the hospital educational environment and the performance of the medical knowledge base among resident physicians in Japanese teaching hospitals.MethodsTo assess the knowledge base of medicine, we conducted the General Medicine InTraining Examination (GM-ITE) for second-year residents in the last month of their residency. The items of the exam were developed based on the outcomes designated by the Japanese Ministry of Health, Labor, and Welfare. The educational environment was evaluated using the Postgraduate Hospital Educational Environment Measure (PHEEM) score, which was assessed by a mailed survey 2 years prior to the exam. A mixed-effects linear regression model was employed for the analysis of variables associated with a higher score.ResultsTwenty-one teaching hospitals participated in the study and a total of 206 residents (67 women) participated and completed the exam. There were no residents who declined to participate in the exam. The mean GM-ITE score was 58 (standard deviation 8.4). The mixed-effects linear regression analysis showed that a higher PHEEM score was associated with a higher GM-ITE score (P = 0.02). Having a department of general medicine, and hospital location in a provincial community (versus an urban setting), were also shown to have a significant relationship with the higher score (P = 0.03, and P = 0.02, respectively).ConclusionWe found that the performance of the medical knowledge base of resident physicians was significantly associated with the educational environment of their hospitals. Improvement of the educational environment in teaching hospitals might be crucial for enhancing the performance of resident physicians in Japan.

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Section: Introductionmentioning

confidence: 94%

The hospital educational environment and performance of residents in the General Medicine In-Training Examination: a multicenter study in Japan

Shimizu¹,

Tsugawa²,

Tanoue³

et al. 2013

IJGM

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“…In terms of issues about gifts and honesty, many more residents in community teaching hospitals provided the greater number of acceptable responses than those in university hospitals. After introduction national mandatory residency program by Japanese Ministry of Health, Labour and Welfare, community teaching hospitals improved their educational environments which were proved to be better than those of university hospitals [ 14 ]. The better hospital educational environment included appropriate behaviors related to professionalism.…”

Section: Discussionmentioning

confidence: 99%

“…Many Japanese physicians also report that they are concerned with their inadequate training in this area [ 11 ]. However in the years surrounding our 2005 survey, Japan introduced a national mandatory residency program and we noted that teaching hospitals improved their educational environments, including appropriate behaviors related to professionalism [ 14 ], but little additional information is available on the explicit evaluation of medical professionalism among Japanese physicians.…”

Section: Introductionmentioning

confidence: 99%

Challenging cases of professionalism in Japan: improvement in understanding of professional behaviors among Japanese residents between 2005 and 2013

et al. 2015

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BackgroundProfessionalism is deemed as the basis of physicians’ contract with society in Japan. Our study in 2005, using a questionnaire with scenarios to professionalism, suggested that many physicians at various levels of training in Japan encounter challenges when responding to these common scenarios related to professionalism. It is unclear how medical professionalism has changed among Japanese residents in over time.MethodsWe conducted a follow-up survey about challenges to professionalism for Japanese residents using the same Barry Questionnaire after a seven-year interval from the prior survey. The survey uses six clinical scenarios with multiple choice responses. The six cases include the following challenges: acceptance of gifts; conflict of interest; confidentiality; physician impairment; sexual harassment; and honesty in documentation. Each scenario is followed by 4 or 5 possible responses, including the “best” and the “second best” responses. The survey was conducted as a part of nationwide general medicine in-training examination.ResultsWe collected data from 1,049 participants (290 women, 28%; 431 PGY-1 and 618 PGY-2 residents). Overall, the current residents performed better than their colleagues in the earlier survey for five scenarios (gifts, conflict of interest, confidentiality, impairment, and honesty) but not for the harassment scenario. PGY-2 residents were more likely to select either the best or 2nd best choices to gifts (p = 0.002) and harassment (p = 0.031) scenarios than PGY-1 residents. Residents in the current study chose either the best or 2nd best choices to the gifts (p < 0.001) and honesty (p < 0.001) scenarios than those of the previous study conducted seven years ago, but not for the harassment scenario (p = 0.004).ConclusionsOur study suggests that there is improvement of medical professionalism with respect to some ethical challenges among the Japanese residents in the current study compared to those in our previous study.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-015-0313-6) contains supplementary material, which is available to authorized users.

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“…12 There were few auscultation skill courses provided by cardiology division in most teaching hospitals in Japan. 12,13 Thus, although cardiology fellows and faculty have relatively higher individual skills about cardiac auscultation, their rotating junior doctors are likely to have little chance to improve the skills. Since many faculty physicians of the department of general internal medicine in teaching hospitals in Japan are interested in teaching cardiac auscultation for residents, 14 rotation training in this department may provide precious opportunity to learn cardiac auscultation for junior doctors.…”

Section: Pre-and Post-testmentioning

confidence: 99%

Cardiac auscultation skills among junior doctors: effects of sound simulation lesson

et al. 2020

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Objectives: To evaluate the effect of a sound simulation lesson to improve cardiac auscultation skills among junior doctors. Methods: This study is based on the design of test comparison before and after educational intervention using a convenient sample. For 50 junior doctors in Japan, diagnostic accuracy before and after a sound simulation lesson for cardiac auscultation skills was compared. There were 15 doctors who experienced cardiology rotation. The lesson used seven abnormal cardiac recordings (third heart sound, double gallop, aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, and pericardial friction rub). At tests before and after the lesson, the doctors listened to random sound outputs of the same seven recordings, chose diagnostic findings from multiple-choice items, and obtained individual diagnostic accuracy based on the total number of choosing correct findings. Top 10 doctors obtaining the greatest individual accuracy received a commendation. Results: Pre-lesson diagnostic accuracy was not different between doctors with cardiology rotation training (total diagnostic accuracy of the group, 27/105 [26%]) and those without cardiology rotation (70/245 [29%]). Compared to prelesson, post-lesson total diagnostic accuracy significantly improved with about two-folds (97/350 [28%] vs 170/350 [61%]; McNemar Test, p<0.0001). The improvement was significant for double gallop (5/50 [10%] vs. 15/50 [30%]), mitral stenosis (0/50 [0%] vs. 6/50 [12%]), and pericardial friction rub (1/50 [2%] vs. 35/50 [70%]). Conclusions: The use of a simple sound simulation lesson may help junior doctors to learn cardiac auscultation skills. Clinician educators are encouraged to use this strategy in addition to cardiology rotation training.

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Educational environment of university and non-university hospitals in Japan

Cited by 11 publications

References 14 publications

The hospital educational environment and performance of residents in the General Medicine In-Training Examination: a multicenter study in Japan

The hospital educational environment and performance of residents in the General Medicine In-Training Examination: a multicenter study in Japan

Challenging cases of professionalism in Japan: improvement in understanding of professional behaviors among Japanese residents between 2005 and 2013

Cardiac auscultation skills among junior doctors: effects of sound simulation lesson

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