Follow-up study of the regional quota system of Japanese medical schools and prefecture scholarship programmes: a study protocol

Abstract

IntroductionGiven the shortage of physicians, particularly in rural areas, the Japanese government has rapidly expanded the number of medical school students by adding chiikiwaku (regional quotas) since 2008. Quota entrants now account for 17% of all medical school entrants. Quota entrants are usually local high school graduates who receive a scholarship from the prefecture government. In exchange, they temporarily practise in that prefecture, including its rural areas, after graduation. Many prefectures also have scholarship programmes for non-quota students in exchange for postgraduate in-prefecture practice. The objective of this cohort study, conducted by the Japanese Council for Community-based Medical Education, is to evaluate the outcomes of the quota admission system and prefecture scholarship programmes nationwide.Methods and analysisThere are 3 groups of study participants: quota without scholarship, quota with scholarship and non-quota with scholarship. Under the support of government ministries and the Association of Japan Medical Colleges, and participation of all prefectures and medical schools, passing rate of the National Physician License Examination, scholarship buy-out rate, geographic distribution and specialties distribution of each group are analysed. Participants who voluntarily participated are followed by linking their baseline information to data in the government's biennial Physician Census. Results to date have shown that, despite medical schools' concerns about academic quality, the passing rate of the National Physician License Examination in each group was higher than that of all medical school graduates.Ethics and disseminationThe Ethics Committee for Epidemiological Research of Hiroshima University and the Research Ethics Committee of Nagasaki University Graduate School of Biomedical Sciences permitted this study. No individually identifiable results will be presented in conferences or published in journals. The aggregated results will be reported to concerned government ministries, associations, prefectures and medical schools as data for future policy planning.

Job Stress Factors Affect Workplace Resignation and Burnout among Japanese Rural Physicians

“…However, one study of Japanese rural doctors reported that having a rural origin was not related to intention to continue to their career in a rural area in a multivariate analysis (Matsumoto et al 2005). Though the Japanese government has started expanding the number of medical school entrance exams with a reginal quota since 2008 as previously mentioned (Matsumoto et al 2016), the scholarships are mainly provided by prefectures. Thus, rural medicine has been considered as a unit of the prefecture.…”

“…Japanese rural areas have suffered from a shortage of physicians for several decades (Tanihara et al 2011). Since it has been reported that a large number of physicians who grew up in rural areas subsequently stayed in rural areas (Magnus and Tollan 1993), the Japanese government started expanding the number of medical school entrance places with a regional quota from 2008 (Matsumoto et al 2016). However, since Japanese medical education lasts six years, and several years more is needed to be a full-fledged physician, making sure that those students who enter medical school as part of the rural quote actually continue to work as rural physicians is necessary.…”

Education for Community-based Family Medicine: A Social Need in the Real World

“…21 In addition to that, a regional scholarship system imitating the program of Jichi Medical University has been attempted by medical schools in the whole country, and it reached 17% of the entrance students of medical departments in 2004. 22 Medical experience in remote grounds after graduation…”

“…32 In the efforts in Japan, the above-mentioned Jichi Medical University program boasts a high obligation compliance rate, but it is still long before achieving the goal of the regional quota system started by each prefecture since 2004. 22…”

General practice departments of university hospitals and certified training programs for general practitioners in Japan: A nationwide questionnaire survey

“…Regional quotas, chiikiwaku , were first introduced, on a full scale, into medical schools, in 2009. A medical school's regional quota has three characteristics: (i) special admission different from the usual entrance examination, (ii) scholarships given by the home prefecture, and (iii) obligatory service in the home prefecture after graduation (usually a requirement of some years of rural service) . Jichi Medical University, established in 1972 solely to produce rural doctors, has the similar scholarship system and was used as the model for the regional quotas.…”