[Medical Professionalism as a Pivotal Goal in the Postgraduate Clinical Training].

Postgraduate clinical training for physicians in Japan has been mandatory since 2004, with the provision that the system itself is to be revised every 5 years if necessary. Major revisions were implemented in 2020, involving the objectives, strategies, and evaluations of the clinical training program. Among the revisions was a section on professionalism in the first part of objectives. As one of the committee members involved in the process of this revision, I provide an explanation of the historical background, learning strategies, and assessment of professionalism in physician training.

Distribution of internal medicine rotations among resident physicians in Japan: a nationwide, multicenter, cross-sectional study.

BACKGROUND: In Japan, postgraduate clinical training encompasses a 2-year residency program, including at least 24 weeks of internal medicine (IM) rotations. However, the fragmented structure of these rotations can compromise the training's quality and depth. For example, a resident might spend only a few weeks in cardiology before moving to endocrinology, without sufficient time to deepen their understanding or have clinical experience. This study examined current patterns and lengths of IM rotations within the Japanese postgraduate medical system. It scrutinized the piecemeal approach-whereby residents may engage in multiple short-term stints across various subspecialties without an overarching, integrated experience-and explored potential consequences for their clinical education. METHODS: This nationwide, multicenter, cross-sectional study used data from self-reported questionnaires completed by participants in the 2022 General Medicine In-Training Examination (GM-ITE). Data of 1,393 postgraduate year (PGY) one and two resident physicians who participated in the GM-ITE were included. We examined the IM rotation duration and number of IM subspecialties chosen by resident physicians during a 2-year rotation. RESULTS: Approximately half of the participants chose IM rotation periods of 32-40 weeks. A significant proportion of participants rotated in 5-7 internal medicine departments throughout the observation period. Notable variations in the distribution of rotations were observed, characterized by a common pattern where resident physicians typically spend 4 weeks in each department before moving to the next. This 4-week rotation is incrementally repeated across different subspecialties without a longer, continuous period in any single area. Notably, 39.7% of participants did not undertake general internal medicine rotations. These results suggest a narrowed exposure to medical conditions and patient care practices. CONCLUSIONS: Our study highlights the need to address the fragmented structure of IM rotations in Japan. We suggest that short, specialized learning periods may limit the opportunity to gain broad in-depth knowledge and practical experience. To improve the efficacy of postgraduate clinical education, we recommend fostering more sustained and comprehensive learning experiences.

Factors Driving the Acquisition of University Postgraduate Degrees among Resident Doctors in Nigeria.

The study examined the characteristics and factors driving the acquisition of postgraduate academic degrees among resident doctors in Nigeria. About 10% of the respondents had a form of university postgraduate degree with majority being master's degree. Having more than seven years of professional practice was the only factor predicting the acquisition of postgraduate academic degrees amongst the respondents [AOR: 0.243 (95% CI: 0.069,0.856; p = 0.028)]. The acquisition of postgraduate degree is not common among the surveyed resident doctors; and those that will acquire it do so in the later part of their career.

Educational Problem-solving Conference as Work-based Faculty Development / 医学教育

We conducted a case conference to solve problems in teaching practices and for clinician teachers to discuss various issues occurring in the field. The conference was based on the presentation of individual educational practice cases from faculty development workshops approved by the Ministry of Health, Labor and Welfare. We prepared two months before the event and dealt with four cases on the day of the event. During the discussion, we tried to link educational problems with a theory or a conceptual framework in medical education so that participants, including case presenters, would have a better understanding of clinical training settings. In addition, communication across disciplines was facilitated through discussions. This attempt has the potential to contribute to the development of a community of practice related to cross-disciplinary education. The key to success for this case conference was the "interpreter" role. The person in that role considers the background and context of practice and links practice with theory appropriately. In addition, faculty development for educators who can play the role will also be an issue in the future.

Medical Professionalism and Continuing Professional Development in the Next Amendment of the Postgraduate Clinical Training System / 医学教育

Under the current postgraduate clinical training system for physicians, three principles have been emphasized in its basic tenets; cultivation of character appropriate for physicians, generation of awareness to the societal role of medical science and healthcare, and mastery of basic clinical skills needed to respond appropriately to injuries and illnesses frequently encountered in general practice. In accordance with its quinquennial review rule, the Clinical Training Committee under the Medical Caucus of the Healthcare Professions Council released draft revisions of a notification published by the Director general of the Health Policy Bureau of the Ministry of Health, Labor and Welfare in March, 2018. The document is entitled "On the operation of the ordinance concerning the postgraduate clinical training prescribed in the paragraph (1) of Article 16-2, Medical Practitioners Act" .　A Key distinction of the revised draft is new learning outcomes featuring core values shared by physicians: commitment to physicians' societal mission of public health, altruistic behavior, respect for humanity, and maintaining one's own integrity. Another key distinction is securement of longitudinal consistency in the set of required faculties, from medical school curriculum to continuing professional development programs. Further improvements in systems and environments to enhance devotion to life-long learning are needed.

Postgraduate Clinical Training System～A perspective from the Community-Based Medicine / 医学教育

A community-based medicine program in the postgraduate clinical training system has been offered as a mandatory program since 2004. Training sites range from clinical attachments in rural/remote areas to public health centers in the city. The role of the program director is important for enhancing the community-based medical program and raising resident doctors. Unique training programs have been carried out, such as medical training in the afflicted area of the earthquake/Tsunami disaster area as well as an exchange program between Hokkaido and Kagoshima residents. The Japanese healthcare system is drawing global attention and local demand. Enrichment of the community-based medicine program is vital for the human resource development that makes the Japanese healthcare system innovative and sustainable.

Analysis of Japanese Postgraduate Clinical Training System from the Perspective of Quality of Education / 医学教育

"Quality of education" has various definitions, and the definitions are classified mainly into five categories. Introducing the definition categories of "quality of education" , we analyze what aspects of the postgraduate clinical training system for physicians as an educational program have been reconsidered and redesigned. According to the analysis, we propose to introduce a programmatic assessment, which compose of several assessment methods, for evaluation at each stage of medical education from undergraduate to continuous professional development. Realizing such evaluation, we also propose to introduce a student/trainee assessment from a patient's perspective.

History of Medical education in Japan / 医学教育

At the time of 1945, the number of entrance to medical school in our country exceeded 10,000 people. After the end of the war, Colonel Sams reformed the doctor training course, consolidation of medical schools, national examination, internship system was introduced. After the internship system changed to postgraduate clinical training in 1968 and clinical training based on law in 2004. Before introducing the clinical training based on law, the doctor nurturing pathway was deeply involved by "Ikyoku-Kouza" system in faculty and attached hospital. Medical education standard was established at 1948 and became a nationwide unified curriculum, but the freedom of the curriculum has increased with the advent of Tsukuba University School of Medicine at 1973. Based on these histories, it is necessary to think about the ideal way of making a physician pathway and the future way of the medical education curriculum development.

<b>Survey of Kampo Medicine Awareness in First- and Second-year Resident Physicians at Three General Hospitals in </b><b>Hiroshima</b> / 日本東洋医学雑誌

<p>We conducted a survey of Kampo medicine prescribing rates, and Kampo medicine awareness in first- and second-year resident physicians at three general hospitals in Hiroshima, Japan, to inform future Kampo medicine education strategies.<br>Overall, 85.7% of the resident physicians were interested in Kampo medicine, and 70.8% wanted to practice it. Furthermore, 57.8% of the resident physicians had prescribed Kampo medicine, and of these, about 30% were prescribing it a few times per month, with both the percentage of prescribing physicians and the frequency of prescription being higher than expected. In total, 90.8% of the resident physicians wanted to observe outpatient Kampo medicine clinics and learn about Kampo medicine in their postgraduate clinical training.<br>Overall, 97.4% of the resident physicians thought that seminars and lectures on Kampo medicine are needed, choosing responses that Western medicine is insufficient in some cases (27.0%) and that Kampo medicine is better than Western medicine in some cases (26.4%) among the choices for answers to the need for seminars and lectures. Meanwhile, the reasons for not having an interest in Kampo medicine were : having fewer opportunities to study it ; and feeling that it has a negative image (seeing it as outdated and unscientific). We think that appropriate Kampo medicine education for these physicians would reduce its negative image. The results of this survey suggest that resident physicians need a substantial education in Kampo medicine.</p>

Improving postgraduate clinical training at Social Medical Corporation Kojunkai Daido Hospital / 医学教育

<p>　Social Medical Corporation Kojunkai Daido Hospital is aiming to be the best training hospital. By enhancing seminars in the hospital, we commenced a postdoctoral training program for medical instructors in February 2014 and November 2015. Since we received an accreditation for the clinical training program in 2014, we created an OSCE program on our own for trainees in August 2015 and June 2016. We also collaborated with the University of Nagoya for the OSCE program and held seminars in August 2015 and June 2016. We introduced the EPOC system for the evaluation of trainees in 2014, and Cybouze® for the constructive evaluation of and sharing of information on trainees in April 2016. Our residents obtained high scores for in the examination to evaluate knowledge of trainees held in February 2016, which shows the high quality of our educational program, established by the endless efforts of the educational committee and instructors.</p>

Innovation of Social Medical Corporation Kojunkai Daido Hospital for Postgraduate Clinical Training / 医学教育

<p>　The higher level postgraduate education hospitals are required to have a system with well-developed programs, instruction, and supervision of doctors in clinical training. The Social Medical Corporation Kojunkai Daido Hospital has been maintaining efforts to be a clinical training hospital of excellence.</p><p>　In order to nurture supervisory doctors, the first workshop for supervisory doctors in clinical training was held at Daido Hospital on February 22nd and 23rd, 2014. With consciousness reform in mind, interprofessional relations between the many types of medical professional were established.</p><p>　Daido Hospital was evaluated by the Japan Council for Evaluation of Postgraduate Clinical Training on December 12th, 2014. It was an opportunity to recognize the need for further improvement as a clinical training hospital.</p><p>　On March 7th, 2015 the Objective Structured Clinical Examination for the second year of training doctors in Daido Hospital was held. Clinical training guidance doctors, Nurses, and paramedics learned the skills necessary for the methods and the evaluation in clinical teaching and evaluation.</p><p>　Daido Hospital continues making efforts by conducting a review of the clinical training based on the evaluation of the clinical ability of residents, the ability for education and the clinical skill of teaching doctors, and the training environment.</p>

Experience of holding a workshop for clinical training instructors at Daido hospital / 医学教育

　To improve hospital quality, the development of authorized clinical instructors is urgently needed. Therefore, we held a workshop to develop clinical instructors. At a monthly meeting of the clinical training committee in June 2014, an agenda for holding a workshop was proposed. At the meeting in July 2014, most committee members said they were reluctant to hold a workshop because of heavy clinical duties. However, the hospital president strongly suggested that a workshop might be a foundation for reforming the stagnated hospital and persuaded committee members to hold a workshop to improve the instructors’ skill in teaching residents. At the September meeting, the workshop schedule was discussed. All members of the taskforce, except the chief coordinator and a lecturer, were selected from hospital physicians, and 3 preparatory meetings and 1 rehearsal were held. With the help of administrative staff, our first workshop for clinical instructors was held at Daido Hospital in February 2014. Our workshop helped create new hopes for improving educational tasks at our teaching hospital and improved the educational skills of participants. We also achieved mutual understanding as a team to accomplish a single goal.

Introduction of postgraduate clinical education system for oral surgeons in Japan / 中华医学教育探索杂志

Taking Shinshu University of Japan for example,we attempted to introduce the postgraduate clinical education system for new oral surgeons by analyzing the management of clinical training programs,studies of oral maxillofacial and associated medicine,and practices of scientific research in the department of oral surgery.Their experiences may be useful for us to improve our medical continuing education for young oral surgery residences.

Postgraduate clinical training program at Fujita Health University Hospital / 医学教育

  Since 2003, Clinical training center of Fujita Health University hospital has been cooperated with the Office for medical education of Fujita Health University, school of medicine, in reorganizing the previous training system based mainly on individual departments. After 9 years since then, we established Yanegawara style training system and the trainee–centered curriculums. Outcomes from new system are as follows:<br>1. Self–establishment by problem based learning became common understandings between trainers and trainees.<br>2. Teaching by trainers to trainees and between trainees （R2 to R1） became common in the hospital.<br>3. Trainees can learn the standardized approach in diagnosis and treatment of the patients in ER.<br>4. Unified understanding of the training system was established in the hospital.Although new system brought several good aspects, we found a large heterogeneity in fulfillment of our curriculums not only by the capability of individual residents but also by the effort induced by each department.

Clinical educators unable to accept the clinical medical training system and residents with no sense of belonging: / 医学教育

Through our experiences in faculty development workshops, we realized that we had not sufficiently understood the problems clinical educators had been facing on site. Thus, we planned to perform qualitative research as part of a needs assessment in faculty development workshops.<br>1)We aimed to analyze and structuralize previously unclarified underlying problems by exploring what clinical educators were worried about regarding the initial residency program.<br>2)We performed a questionnaire survey of 214 physicians participating in faculty development workshops and qualitatively analyzed their responses in the form of free comments.<br>3)Once declaring that they would "start with accepting the program," clinical educators are unaware of their ignorance and unacceptably criticize the residency system, such that their "ignorance disguised as criticism" is highlighted.<br>4)With the introduction of the new residency system, a framework for building relationships as a system, which requires residents to be trained in a particular organization, no longer works, causing significant confusion on site.

Factors Required by Japanese Residents in Postgraduate Clinical Training / 医学教育

1)The factors Japanese residents consider most important in postgraduate clinical training are: "relationship with supervising physicians," "well-developed training programs," and "guidance of supervising physicians."2)Items showing a large discrepancy between their importance to residents and residents' satisfaction were: "well-developed training program," "experiencing a large number of cases,""guidance of supervising physicians," and "guidance of senior residents."3)Multiple regression analysis showed that factors significantly influencing residents' satisfaction with training were "quality of the medical service" (r=0.59) and "consideration for accepted residents" (r=0.42).

Continuum of learning objectives from undergraduate clinical clerkship to postgraduate residency / 医学教育

To establish a framework for clinical education as a continuum from undergraduate clinical clerkships to postgraduate residency programs is an enormous challenge for Japanese medical education. The purpose of this article is to compare learning objectives achieved by clinical clerkship students to those achieved by postgraduate residents.1) Eighty-seven clerkship students and 67 residents at our hospital were assessed with the Web-based Evaluation System of Postgraduate Clinical Training with 253 learning objectives established by the Ministry of Health, Labour and Welfare.2) Clerkship students achieved most attitudinal objectives and performed well on the medical interview, basic physical examinations, and physician's order sheet.3) Clerkship students could observe major symptoms and diseases.4) These findings indicate the need to establish a common template for learning objectives used in both clerkships and residency programs.

Re-evaluating the Final Goal in the New Postgraduate Clinical Training System / 医学教育

More than 2 years have passed since the new postgraduate clinical training program was instituted in 2004 to improve the clinical ability of Japanese physicians. However, there have already been discussions about whether the undergraduate curriculum and the postgraduate program should be improved.<BR>After the first physicians finished their training under the new program in the spring of 2006, questions were raised about whether the identical final goals of training could be achieved by transferring some items of postgraduate clinical training to the undergraduate period. Such a change might invigorate the undergraduate curriculum and enhance the effectiveness of the postgraduate program.<BR>1) Are-evaluation of the final goals of postgraduate clinical training might allow some items to be taught during the undergraduate period.<BR>2) Several questionnaires were sent to 211 supervising physicians and 184 first-year residents who had just completed the new internship program at 25 teaching hospitals (university hospitals and postgraduate training hospitals).<BR>3) Both trainees and supervising physicians reacted positively about and expressed a willingness to participate in training items, including noninvasive diagnostic procedures and laboratory studies not harmful to patients, during advanced courses in the undergraduate period.<BR>4) Both trainees and supervising physicians reacted negatively to participating in any invasive procedures that might affect a patient's welfare or sense of shame during the undergraduate period.<BR>5) In the future, training with simulated procedures before actual patients are encountered and enlisting enough supervising physicians are essential for unifying the undergraduate medical school curriculum and postgraduate clinical training programs.

A survey comparing the mental health of residents before and after compulsory postgraduate clinical training / 医学教育

The new postgraduate clinical training system that started in 2004 is expected to have positive effects on the health of residents and the quality of treatment they provide.We performed a survey to examine the effects of this training system on the mental health of residents.<BR>1) The subjects were first-year residents (458 in 2003 and 549 in 2004) who had started postgraduate clinical training at 38 hospitals in Japan.Self-administered questionnaires, which included items about working conditions and mental health, were mailed to each subject.<BR>2) The mean score on the 12-item version of the General Health Questionnaire was 4.8 both before and after the new training system was introduced.The mean Center for Epidemiologic Studies Depression Scale score was 15.3 before and 14.4 after the system's introduction.The results showed no significant difference in mental health of residents before and after the system was changed.<BR>3) The results suggest that the new training system has a positive effect on residents' mental health by increasing sleep time and decreasing occupational stress; however, the new system has also decreased job satisfaction and negatively affected their mental health.<BR>4) Job satisfaction may significantly affect the mental health of residents.