Consensus Statement; Integrating professionalism education into undergraduate, postgraduate and continuing medical education / 医学教育

1)Professionalism should be explicitly introduced as a fundamental content into curricula/programs of undergraduate medical education, postgraduate clinical training, and of continuing medical education provided by professional societies and the Japan Medical Association.<br>2)We need to enhance our research activities on goals and objectives which should be accomplished through professionalism education, effective learning strategies, appropriate assessment methods, as well as the impact of informal and hidden curricula.<br>3)We propose that the medical profession should collaboratively develop various activities to win the trust of the general society in tandem with the introduction of professionalism education.

Gender differences in job satisfaction, mental health and work environments of hospital internists in Japan / 日本プライマリ・ケア連合学会誌

OBJECTIVE: To describe gender differences in job satisfaction, mental health and work conditions of Japanese hospital internists <br>METHODS: A self-administered, mailed survey was conducted among hospital internists throughout Japan. The survey included questions such as job satisfaction, time allotted for an ambulatory patient, and work environments. <br>RESULTS: Two hundred thirty-four hospital internists were eligible (59 women). Female internists allotted more time for each patient in an ambulatory care setting than their male colleagues (new patient/consultation: P<0.01, routine follow ups: P=0.046). Female internists worked continuously for as long as their male colleagues when they were on night duty (average: 31.1 hours), but their replies indicated that they were not able to maintain continuous high-quality care for as long as the male internists (-4 hours, P=0.02). <br>CONCLUSIONS: Female internists allotted more time for each ambulatory patient, and their replies showed that they were able to maintain quality care continuously for less time than were the males.

Qualitative research for studying stress reactions, stress-relieving factors, and constructing a theoretical model of stress for junior residents in Japan / 医学教育

In Europe and the United States, residents develop“burnout syndrome”or depression because of stress, and these conditions are associated with withdrawal from training programs and undesirable clinical outcomes, such as unethical practices.How stress affects Japanese medical residents and their practice is uncertain, as are factors that relieve stress.Furthermore, a theoretical model of stress in Japanese medical resident is uncertain.<BR>1) Focus group interviews were performed for 25 junior residents at 10 institutions to explore their stress reactions and stress-relieving factors.A theoretical model of stress was then constructed.<BR>2) Adverse effects in patient care and in training, in addition to events in daily life, were found to occur as stress reactions.<BR>3) Improvements in the support system and positive feedback from patients were found to be stress-relieving factors.<BR>4) A theoretical model of stress for trainee physicians was constructed and was similar to a general occupational stress model.<BR>5) Stressors should be reduced and stress-relieving factors should be improved to improve the working conditions of residents and the quality of medical care.

Qualitative research for searching for the stressor of junior resident in Japan / 医学教育

In Europe and America, it is reported that residents develops burnout syndrome or depression by their stress, and these are connected with dropouts from their training program and undesirable outcomes of the patients such as unethical practice. Recently, though resident's poor working conditions and death from overwork, etc. become problems also in Japan.But, Japanese resident's stressor is uncertain.<BR>1) Focus group interview was executed for 25 junior residents in 10 facilities, and their stressor were explored.<BR>2) As a result, three cateogories ; physiological stressor as one human being, stressor as a new member of society, and stressor as a trainee doctor and beginner novice doctor was extracted.<BR>3) Three stressors were named the life gap, the society gap, and the profession gap respectively. The stressor of junior resident was described as the product what was born by the gap of medical student and becoming a doctor.<BR>4) Japanese residents have various stressors. Stressor as a trainee doctor was a stressor peculiar to Japanese junior residents.<BR>5) Stress management should be done considering such a stressor in the light of safety and effective clinical training.

Adapting the Physician Job Satisfaction Scale to Japan / General Medicine

<B>BACKGROUND</B>: Understanding the job satisfaction and dissatisfaction of physicians might help to improve health care in Japan. Nevertheless, no job-satisfaction scale for physicians has been validated in Japanese.<BR><B>OBJECTIVE</B>: To develop a Japanese version of the Physician Job Satisfaction Scale (JSS), a multi-dimensional questionnaire developed by the Society of General Internal Medicine (SGIM) Career Satisfaction Study Group (CSSG), and to evaluate its reliability and validity.<BR><B>METHODS</B>: A Japanese version of the JSS was developed according to the standard protocol of scale translation. A focus group of 7 Japanese physicians was established to identify “Japanese-specific” facets of job satisfaction. After revising the scale based on the discussions of the focus group, a cross-sectional sample of 87 Japanese physicians from hospitals in different regions completed the Japanese version of the Physician Job Satisfaction Scale (JSS-J) to assess its reliability and validity.<BR><B>RESULTS</B>: A focus group identified a Japanese-specific facet, “prestige”. Content validity was also established through the focus group. Internal consistency ranged from 0.53 to 0.83. Test-retest reliability, convergent and discriminant validity were good to excellent.<BR><B>CONCLUSIONS</B>: Although the overall results suggest that the JSS-J can be applied to assess the job satisfaction of Japanese physicians, further qualitative research is required to refine the JSS-J.

An Investigation of the Perception of Achievement and the Degree of Satisfaction of Junior Residents in Initial Clinical Training / 医学教育

We investigated factors related to the perception of achievement and to the degree of satisfaction of junior residents in initial clinical training. Questionnaires were given to second-year postgraduate students at 13 teaching hospitals in Japan. The response rate was 50%(n=89). The perception of achievement and the degree of satisfaction were converted to a 100-point scale. The mean±standard deviation of the two scores were 70±11 and 68±16, respectively. The average number of inpatients and whether the junior resident had taken care of patients were related to both scores. However, gender, the number of departments rotated through, and salary were not associated with either score.

Japanese Attitudes toward Advance Care Planning for End-of-Life Decisions / General Medicine

<B>OBJECTIVE</B>: Advance directives that assume respect for individual autonomy in end-of-life decisions may not be accepted in all cultures. We studied Japanese preferences concerning care planning and written advance directives.<BR><B>DESIGN</B>: A nationally representative Japanese sample answered questions about their preferred mechanism of care planning and preferences for end-of-life care. Factors associated with wishing to participate in care planning were evaluated by logistic regression.<BR><B>RESULTS</B>: Seventy-eight percent of the respondents wanted to be directly involved in care planning. The preferred option for that planning was discussion within the family. The family also emerged as a potential source of knowledge of the patient's values that could inform a physician's decision. Only 23% of respondents desired any type of written advance directive. Greater desire for care planning was related to greater autonomy preference, greater information seeking, greater desire for personal and family decision making, and less willingness to tolerate adverse health states. Women, married subjects, better-educated subjects, and those living alone were more likely to want to participate in care planning.<BR><B>CONCLUSIONS</B>: Most Japanese people want to participate in care planning, but the types of written advance directives most commonly used in the U.S. are not suitable. Japanese physicians should provide adequate information about prognosis and should encourage early conversations about preferences for life-sustaining interventions between patients and their family members.