Impact of general medicine rotation training on the in-training examination scores of 11, 244 Japanese resident physicians: a Nationwide multi-center cross-sectional study

Abstract

Background Although general medicine (GM) faculty in Japanese medical schools have an important role in educating medical students, the importance of residents’ rotation training in GM in postgraduate education has not been sufficiently recognized in Japan. To evaluate the relationship between the rotation of resident physicians in the GM department and their In-Training Examination score. Methods This study is a nationwide multi-center cross-sectional study in Japan. Participants of this study are Japanese junior resident physicians [postgraduate year (PGY)-1 and PGY-2] who took the General Medicine In-Training Examination (GM-ITE) in fiscal years 2016 to 2018 at least once (n = 11,244). The numbers of participating hospitals in the GM-ITE were 381, 459, and 503 in 2016, 2017, and 2018.The GM-ITE score consisted of four categories (medical interview/professionalism, symptomatology/clinical reasoning, physical examination/procedure, and disease knowledge). We evaluated relationship between educational environment (including hospital information) and the GM-ITE score. Results A total of 4464 (39.7%) residents experienced GM department rotation training. Residents who rotated had higher total scores than residents who did not rotate (38.1 ± 12.1, 36.8 ± 11.7, and 36.5 ± 11.5 for residents who experienced GM rotation training, those who did not experience this training in hospitals with a GM department, and those who did not experience GM rotation training in hospitals without a GM department, p = 0.0038). The association between GM rotation and competency remained after multivariable adjustment in the multilevel model: the score difference between GM rotation training residents and non-GM rotation residents in hospitals without a GM department was estimated as 1.18 (standard error, 0.30, p = 0.0001), which was approximately half of the standard deviation of random effects due to hospital variation (estimated as 2.00). Conclusions GM rotation training improved the GM-ITE score of residents and should be considered mandatory for junior residents in Japan.

Comprehensive Care through Family Medicine: Improving the Sustainability of Aging Societies

“…Our research was performed in a rural area (close to urban areas) that has one of the lowest physician/patient ratios, which might cause fragmentation of care [ 14 , 15 ]. To prepare for an aged society worldwide, increasing the number of general physicians could be vital to sustaining medical care for older patients with multimorbidity [ 35 , 36 ]. In other countries, family medicine education has been established, and this has dealt with the issues of multimorbidity and fragmentation of care [ 37 ].…”

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

“…The number of resident physicians in university hospitals tends to be greater than in community-based hospitals, so the workload of each resident physician in a university hospital could be shorter than that of a resident physician in a community-based hospital. Moreover, I previously revealed that the amount of study time significantly associated with the GM-ITE score [ 7 ]. Several previous studies have also indicated the relationship between sufficient self-study time and professional development [ 25 , 26 ].…”

“…We have previously demonstrated that the mean GM-ITE scores of junior residents in university hospitals tend to be lower than those of community-based hospitals [ 7 ]. However, the difference in score was centered only on the total GM-ITE scores.…”

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

“…Another study revealed that medical students who chose general practice preferred frequent patient communication, engaging in clinical diagnostic reasoning, and community-oriented practice [9]. Additionally, other studies have revealed that relevant experiences in clinical settings along with having general physician role models were important for increasing students' interest in general medicine [10,11]. Based on the above, the research question of our study was: what prevents medical students from becoming general physicians?…”