Family Medicine Education at a Rural Hospital in Japan: Impact on Institution and Trainees

Abstract

Family medicine is vital in Japan as its society ages, especially in rural areas. However, the implementation of family medicine educational systems has an impact on medical institutions and requires effective communication with stakeholders. This research—based on a mixed-method study—clarifies the changes in a rural hospital and its medical trainees achieved by implementing the family medicine educational curriculum. The quantitative aspect measured the scope of practice and the change in the clinical performance of family medicine trainees through their experience of cases—categorized according to the 10th revision of the International Statistical Classification of Disease and Related Health Problems. During the one-year training program, the trainees’ scope of practice expanded significantly in both outpatient and inpatient departments. The qualitative aspect used the grounded theory approach—observations, a focus group, and one-on-one interviews. Three themes emerged during the analysis—conflicts with the past, driving unlearning, and organizational change. Implementing family medicine education in rural community hospitals can improve trainees’ experiences as family physicians. To ensure the continuity of family medicine education, and to overcome conflicts caused by system and culture changes, methods for the moderation of conflicts and effective unlearning should be promoted in community hospitals.

The Perception of Rural Medical Students Regarding the Future of General Medicine: A Thematic Analysis

“…Based on our findings, the relevant clinical experience can be vital for effective general medicine education. This education when delivered across community hospitals can motivate medical students and residents to become general physicians and increase their scope of practice [35,36]. Future studies should investigate the effect of community hospital-based clinical experience in general medicine on the motivation and learning of medical trainees in various contexts.…”

Effect of Residents-as-Teachers in Rural Community-Based Medical Education on the Learning of Medical Students and Residents: A Thematic Analysis

“…Furthermore, since many Asian cultures tend to take a more holistic rather than an individualistic approach to life [ 32 ], RaT will be more effective in Asia when it is implemented in medical teams, as was done in this study. As the present CBME lacks evidence regarding the effects on students’ qualitative and quantitative learning, further studies should be conducted to investigate the effectiveness of rural CBME in different contexts [ 33 ].…”

Nurses’ Contributions in Rural Family Medicine Education: A Mixed-Method Approach

“…The formative and summative assessments of the learners were accomplished using Mini-CEX, multiple-source feedback, and portfolios. After 3 years of training, the residents undergo a national examination in family medicine and obtain a family physician’s certificate [ 20 , 21 ]. In the first year of the training, which began on 1 April medical residents collaborated with various medical professionals at the community hospital.…”

“…Rural family medicine residents experience a wide scope of practice owing to their demand in rural hospitals; therefore, nurses’ support and feedback can be more valuable in rural family medicine education [ 20 ]. Rural family medicine education may involve various conflicts due to systemic and cultural changes for medical residents, as they may have to change their working styles in adjusting to rural clinical situations [ 21 , 22 , 23 ]. In these processes, as the number of senior doctors is low, nurses may play critical roles in supporting residents’ conflicts [ 24 ].…”