Reasons for medical students selecting a rural prefecture in Japan for initial clinical training: a single-center-based cross-sectional study / Journal of Rural Medicine

Objective: Securing a sufficient number of medical residents to work in rural areas is an urgent issue. This study sought to clarify the factors that cause medical students at a rural university in Japan to select a particular place for their initial clinical training.Materials and Methods: A questionnaire was administered to all medical students at Saga University between February and March 2021. Participants were divided into two groups based on their training location choice: those who chose Saga Prefecture (Saga group) and those who selected other prefectures (non-Saga group). Then, logistic regression analysis was performed.Results: The questionnaire was answered by 300 students (46.3% response rate), of whom 291 agreed to participate in the study; 122 (41.9%) and 169 (58.1%) students were allocated to the Saga and non-Saga groups. Within the Saga group, the following factors were statistically significant: being admitted to Saga University’s medical school through the system of special allotment of admission to applicants pledging to work in Saga Prefecture following graduation (or regional quota programs for admission) (odds ratio [OR], 19.18; 95% confidence interval [CI], 6.99–52.60); and being from Saga Prefecture (OR, 6.05; 95% CI, 2.24–16.35). With the non-Saga group, the desire to work in an urban area (OR, 0.03; 95% CI, 0.00–0.37) was statistically significant.Conclusion: To encourage medical residents to choose this prefecture for their initial clinical training, the focus should be on medical students who are from Saga Prefecture or admitted through the regional quota program.

Using a Variable Working Hour System in Compliance with Labor Standards Law in a Japanese Residency Program / 医学教育

Introduction: Work style reform of medical doctors is now an actively discussed matter in Japan. There is also the problem of how to balance the management of legal working hours and the value of medical education in junior residency programs. In particular night and holiday shifts in emergency departments are one of the most important causes of working hour elongation for junior residents. We tried to construct a legally appropriate management method to control their working hours including night and holiday shifts. Method: One-Month Variable Working Hours System and two-shift system were applied to labor management in the medical residency program. Night and holiday working hours were included in regular working hours. Day-time working hours were adjusted to the weekly schedule of each clinical department to cover most of its daily work. Result: Overtime working hours of all residents, including the night and holyday shifts, were managed within the legal limits of 45 hours a month, unless additional overtime work was required. Discussion: Managing worktime through the use of the One-Month Variable Working Hours System is thought to be feasible. In the junior residency program, night and holiday shifts in the emergency department could also be balanced.

A qualitative analysis of characteristics and problems of residency programs in community hospitals in Japan / 医学教育

Introduction: Differences in residency programs between large and small hospitals have not been shown in Japan.<br>Method: We performed a qualitative analysis of focus-group interviews of residents in community hospitals to investigate characteristics and problems of their residency programs.<br>Results: We found that residents in community hospitals treated difficult patients with the help of the medical staff; this cooperation was one of the most important characteristics of residency programs. We also found that residents tended to have less experience in emergency medicine and several other specialties.<br>Discussion: We found that residents in community hospitals learned how to treat difficult patients with the help of medical staff by means of a biopsychosocial model.

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.