山本 祐

PURPOSE: In the current era of physician work-hour regulations, patient care ownership (PCO) has received considerable attention. The aim of the study was to investigate the association between working hours and PCO. METHODS: This was a nationwide cross-sectional study. The study recruited residents who completed the General Medicine In-Training Examination. The primary outcome was PCO, assessed using the Japanese version of the PCO Scale (J-PCOS). The secondary outcomes were the four dimensions of the J-PCOS (i.e., assertiveness, sense of ownership, diligence, and being the "go-to" person). The explanatory variable was weekly working hours. We examined the association using multivariable linear regression analysis. RESULTS: 1836 participants were included in the analysis. After adjustment for possible confounders, residents working ≥ 70 to < 90 h/week had greater PCO than those working ≥ 60 to < 70 h/week. Working ≥ 70 to < 90 h/week was also associated with assertiveness and being the "go-to" person. No clear trend was seen in the relationship between working hours and sense of ownership or diligence. CONCLUSION: While determining appropriate resident work hours requires comprehensive consideration of a number of factors, in terms of PCO training, the working hours of 80-90 h/week may be an option.

BACKGROUND: The 2022 revised version of the Model Core Curriculum (MCC) for Medical Education in Japan includes "generalism" as a new expertise quality and ability, based on the results of surveys of experts in health professions education. However, the perspectives of medical trainees under the pre-2022 MCC revision were under-examined. Here, we investigated what these trainees felt they had learned about general medicine (GM)-related topics. METHODS: We performed a nationwide cross-sectional study using an anonymous online questionnaire, which was developed with reference to the 2022 revised MCC. The questionnaire consisted of 14 items. For all items, we asked, "Did you learn enough during medical school?" Respondents were asked to respond on a 5-point Likert scale (from 1 = strongly disagree to 5 = strongly agree). RESULTS: Three hundred and eighty-six participants (response rate 55.4%) were included in the analysis. For the item "Behavioral science," the number of participants who chose "3 = neither agree nor disagree" was highest, at 171 (44.3%) and with an average of 3.28, indicating that this item was perceived as insufficiently studied. Approximately half of the participants chose "4 = agree" for all items other than "Behavioral science." CONCLUSIONS: The study suggested that behavioral science may be underlearned among medical trainees of the pre-2022 MCC generation. Medical educators in Japan should formulate curricula in accordance with the 2022 revision MCC and improve curricula regarding behavioral science. Future research should survey the generation of trainees who receive 2022 revision MCC-compliant medical education; comparison of results with those of this study would be valuable in examining the effects of the revised guideline and inform international medical educators.

PURPOSE: Both clinical knowledge and patient care ownership (PCO) are crucial to the provision of quality patient care and should be acquired during training. However, the association between these two concepts is under-examined. Here, we conducted a nationwide cross-sectional study to investigate the association between clinical knowledge and PCO among resident physicians in Japan. METHODS: From January 17 to March 31, 2024, we conducted an anonymous, online, self-administered survey for a series of PCO research projects. The survey targeted medical residents who took the General Medicine In-Training Examination (GM-ITE). The mean of the Japanese version of the PCO Scale was used as outcome variable. The primary explanatory variable was total GM-ITE score, while the secondary explanatory variables were GM-ITE category scores in medical knowledge. We conducted multivariable linear regression analysis, controlling for postgraduate years, sex, number of assigned inpatients, weekly working hours, type of hospital, and size of hospital. RESULTS: We included 1836 participants in our statistical analysis. Multivariable linear regression analysis revealed that after adjustment for possible confounders, GM-ITE total scores showed a significantly negative association with PCO in the highest score quartile (adjusted mean difference - 0.20, 95% confidence interval (CI) -0.33 to -0.07, compared with the lowest score quartile). Additionally, after controlling for possible confounding factors, scores for symptomatology and clinical reasoning showed a dose-dependent negative association with PCO (adjusted mean difference - 0.17, 95% CI -0.30 to -0.03 for the highest score quartile compared with the lowest score quartile). No significant dose-dependent associations were found for the other categories. CONCLUSIONS: These findings suggest the presence of potential challenges in the simultaneous fostering of clinical knowledge and PCO during residency training. This underscores the need for educators to actively engage in the reconsideration of current postgraduate training strategies, with the aim of effectively cultivating both clinical knowledge and PCO among medical residents.

BACKGROUND: Outpatient training for resident physicians has been attracting attention in recent years. However, to our knowledge, there have only been a few surveys on outpatient training, particularly in Japan. This study evaluates outpatient care among Japanese resident physicians by determining how the volume of outpatient encounters and length of outpatient training correlate with residents' clinical competence. METHODS: This study utilised the results of the General Medicine In-Training Examination (GM-ITE; resident clinical competency assessment) for 2,554 post-graduate year 2 (PGY 2) resident physicians in Japan, as well as a self-reported questionnaire regarding their educational training environments conducted after the examination. We investigated whether GM-ITE scores correlated with daily outpatient volume and duration of outpatient training. RESULTS: Regarding outpatient volume, having 1-5 new patient encounters per day was significantly associated with higher GM-ITE scores by multilevel analysis [0 patients: average score 43.7, 1-5 patients: adjusted estimated coefficient (aEC) 1.99, 95% confidence interval (CI) 0.44 to 3.55, P = 0.01]. Regarding the duration of outpatient training, residents trained for one month had the highest GM-ITE scores (one month: average score 46.9; two months: aEC -1.44, 95% CI -2.29 to -0.60, P < 0.001; three months: aEC -1.44, 95% CI -2.22 to -0.65, P < 0.001). CONCLUSION: Minimal daily new outpatient visits and one month of outpatient training effectively correlated with residents' basic clinical competence. TRIAL REGISTRATION: This study was approved by the Ethics Committee of the Japan Institute for Advancement of Medical Education Program (JAMEP; No. 22-30) and retrospectively registered.