Impact of general practice / family medicine training on Japanese junior residents:a descriptive study

Nakamura, Koki; Kanke, Satoshi; Ishii, Atsushi; Mori, Fuyuto; Hoshi, Goro; Kanto, Kari; Toyoda, Yoshihiro; Kassai, Ryuki

doi:10.5387/fms.2022-35

Cited by 5 publications

(2 citation statements)

References 8 publications

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“…However, the prevalence of the involved inflamed joints was not typical for psoriasis, leading to further investigation of rheumatoid arthritis. In community hospitals, where general physicians often handle diverse medical cases, a systematic approach to diagnosis is crucial, considering common clinical courses of diseases [ 11 , 12 ]. Recognizing the potential coexistence of diseases, particularly in autoimmune disorders, is vital for improving patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Concurrent Presentation of Pustular Psoriasis and Late-Onset Rheumatoid Arthritis: A Diagnostic Challenge in a Community Hospital Setting

Chayama,

Amano,

Ofuji

et al. 2023

Cureus

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The coexistence of autoimmune diseases presents a significant diagnostic challenge in clinical practice, particularly in settings with limited resources. This case report details a rare instance of pustular psoriasis occurring concurrently with rheumatoid arthritis, underscoring the complexities involved in diagnosing overlapping autoimmune disorders. A 70-year-old male with a history of chronic heart failure, atrial fibrillation, and other comorbidities presented to a rural community hospital with a year-long persistent rash and joint and back pain. Physical examination and blood tests revealed high inflammatory markers. A dermatological assessment, including a skin biopsy, diagnosed generalized pustular psoriasis. However, the atypical presentation of acute polyarthritis led to further investigations, revealing elevated rheumatoid factor and anti-citrullinated protein antibody levels, resulting in a diagnosis of late-onset rheumatoid arthritis. The patient underwent a comprehensive treatment regime, including prednisolone, cefazolin, oral terbinafine, methotrexate, and infliximab, leading to gradual symptom improvement to the previous activity of daily life and discharge on the 27th day of hospitalization. This case illustrates the diagnostic intricacies in identifying concurrent autoimmune disorders and highlights the crucial role of general physicians in systematically approaching complex cases in resource-limited settings. It emphasizes the need for heightened clinical vigilance and a multifaceted diagnostic approach when managing patients with overlapping rheumatic symptoms, advocating for consideration of coexisting conditions in autoimmune diseases.

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Section: Discussionmentioning

confidence: 99%

Concurrent Presentation of Pustular Psoriasis and Late-Onset Rheumatoid Arthritis: A Diagnostic Challenge in a Community Hospital Setting

Chayama,

Amano,

Ofuji

et al. 2023

Cureus

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show abstract

“…This is especially crucial in a field as dynamic and multifaceted as general medicine [2]. Recognized as a distinct specialty in 2019, the field of general medicine education has witnessed the establishment of diverse programs across Japan, aiming to cultivate well-rounded physicians capable of handling the complexities of patient care [3,4].…”

Section: Introductionmentioning

confidence: 99%

Enhancing the Comprehensive Integration of General Medicine Education in Rural Japan: A Thematic Analysis

Ohta,

Sano

2023

Cureus

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The dynamism inherent in general medicine, particularly since its recognition as a distinct specialty in 2019, necessitates constant revision and refinement of the curriculum. As general medicine programs proliferate throughout Japan, understanding the revision processes, especially concerning the pivotal concept of lateral integrations, becomes critical. Lateral integrations, which pertain to the interconnectedness between learning contents and contexts, ensure a cohesive learning experience for medical students. In this study, we sought to explore the intricacies and experiences of revising these integrations within the general medicine curriculum. MethodsA qualitative thematic analysis rooted in relativist ontology and constructivist epistemology was conducted. The research was carried out at the Unnan City Hospital, Shimane Prefecture, focusing on trainees transitioning between diverse medical settings. Semi-structured interviews were employed to gauge perceptions regarding these transitions, and thematic analysis was used to interpret the data. Reflexivity was ensured by the diverse expertise of the research team, with rigorous discussions to mitigate biases. ResultsThe following four themes emerged from the analysis: (1) confusion due to the transition from acute to chronic clinical settings, with trainees feeling overwhelmed and resistant to focus solely on chronic care; (2) monotony due to the loss of some clinical experiences, indicating challenges in maintaining motivation after transitioning to clinics; (3) disconnection between learning contexts, where participants desired stronger links to their primary training hospitals; and (4) anxiety as community leaders, highlighting the need for instilling leadership skills and a deeper understanding of diverse community healthcare professions. ConclusionThis study shed light on the tangible challenges faced by general medicine trainees during transitions between different learning environments. These insights are valuable for educators in refining curriculum structures, ensuring smooth transitions, and enhancing lateral integrations. Addressing these challenges will bolster the quality and relevance of general medicine education in Japan, fostering the creation of adaptable, well-rounded physicians who are attuned to the multifaceted needs of their communities.

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Impact of general practice/family medicine training on Japanese junior residents:reflective writing analysis using text mining

Nakamura,

Kanke,

Ishii

et al. 2024

FJMS

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Background : We previously reported the impact of general practice/family medicine training on postgraduate training in Japan using evaluation criteria standardized nationwide. However, there is a possibility that new insights may be gained by analyzing the reflective reports written by these residents. Methods : Junior residents who participated in onemonth general practice/family medicine training at one of five medical institutions with fulltime family medicine specialists between 2019 and 2022 were enrolled in this study. They were assigned to submit a reflective report on their experiences and thoughts every day during the training. We analyzed these reflective writings using text mining and created a cooccurrence network map to see the relationship between the most frequently used words. Results : Ninety junior residents participated in the study. The words that appeared most frequently in the sentences referring to clinical ability included "symptoms," "medical examination," "consultation," "treatment," and "examination." The words of "family" and "(patient) oneself" showed strong association in the cooccurrence network map. Conclusion : It was suggested that general practice/family medicine training greatly contributes to the acquisition of clinical abilities and deepens the learning of junior residents not only about patient care but also about familyoriented care.

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Impact of general practice / family medicine training on Japanese junior residents:a descriptive study

Cited by 5 publications

References 8 publications

Concurrent Presentation of Pustular Psoriasis and Late-Onset Rheumatoid Arthritis: A Diagnostic Challenge in a Community Hospital Setting

Concurrent Presentation of Pustular Psoriasis and Late-Onset Rheumatoid Arthritis: A Diagnostic Challenge in a Community Hospital Setting

Enhancing the Comprehensive Integration of General Medicine Education in Rural Japan: A Thematic Analysis

Impact of general practice/family medicine training on Japanese junior residents:reflective writing analysis using text mining

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