Résumé
<b>Introduction</b> : Selective admission for medically underserved areas (Chiiki-Waku) has been increasing, but qualifications vary. We investigated the current state of these selective admissions to gain a better sense of their nature and to elucidate problems.<br><b>Methods</b> : A web-based cross-sectional survey was conducted among 77 medical schools that accepted applications for selective admission for medically underserved areas in 2013.<br><b>Results</b> : There were a total of 1305 applicants for 148 slots at 62 universities. We observed 86 admissions at national universities, and 90 admissions through recommendation/ admissions office-based entrance exams. Thirty programs placed restrictions on employment after graduation, 84 required accepting scholarships, 8 required joining a specific organization as a condition in the pledge and 83 placed limits on place of origin of the applicant. Only 13 programs had special curricula for education in community medicine.<br><b>Conclusion</b> : In some Chiiki-Waku, problems such as restriction on employment, the obligation to accept scholarships, and other inappropriate conditions were noted. Definition of students from rural backgrounds in Japan differs from the WHO guideline definition. Few programs offer special curricula covering community medicine.
Résumé
<b>Introduction</b> : Municipal government scholarships for the purpose of support of rural health & medically underserved areas has increased, but repayment exemption conditions of the scholarships vary. We conducted a survey of scholarships to clarify their impact on physician careers.<br><b>Methods</b> : A web-based cross-sectional survey was conducted from November 2013 to January 2014 among municipal governments administering scholarships associated with selective medical school admissions for medically underserved areas in 2013.<br><b>Results</b> : There were 59 scholarships administered by 42 municipal governments connected with 53 universities. The mode of the total loan amount was 14.4 million yen. Features of the loan agreements were a high repayment interest rate (over 10%) in 70% of the scholarships and a requirement for lump-sum repayment in 41 scholarships. Three programs allowed free choice of residency training for 3 years or more during the obligatory term, while 48 programs did not allow such choice during the entire obligatory term.<br><b>Conclusion</b> : Eighty-percent of the scholarship programs do not allow for the minimum 3 years of basic post-graduate training required by specialty training program guidelines. In order to prevent the anticipated reduction in future applicants to these scholarship programs, appropriate interest rates, repayment rules, and allowance for specialty training are required.
Résumé
The admission quota for medical students has increased rapidly from 2007 to the present in Japan. Medical students of selective admission for medically underserved areas （Chiiki-Waku） account for most of the increase. Becoming a medical specialist had been reported to be one of the necessary conditions to obtain employment in a medically underserved area. For the last three years, early admissions have occurred in the medically underserved areas in Kagoshima. Consequently, the graduates will start senior doctor training next year. It is very important to provide these individuals with a career plan so that they can become medical specialists. We investigated the information on the medical specialist system and the work system for medical students of selective admission for medically underserved areas in Kagoshima. According to these findings, it is difficult for them to become medical specialists in the current systems. Because medical students of selective admission for medically underserved areas will account for about 20% of the graduates of medical schools a few years later, these problems apply to not only Kagoshima prefecture but also Japan. Because it is difficult to become a medical specialist, the current systems need to be improved. To do so, the cooperation of all interested parties is needed.
Résumé
To respond to the physician shortage, the capacity of medical schools has been increased through selective admission of student to practice in medically underserved areas; however, neither a system nor a curriculum for such students has been established. At Nagoya University, selected students have been admitted, and the division of Education for Community–Oriented Medicine was established in fiscal year 2009. We have introduced special curricula for these students, such as a seminar for community–oriented medicine, training for medical research, local hospital tours, and a special interprofessional education course. In fiscal year 2013, community medicine is expected to be implemented as a compulsory subject in the 4th year curriculum. For the education of students selected to practice in medically underserved areas, we believe that older students serving as role models and cooperation with other organizations and community are important.