山本 祐

INTRODUCTION: The well-being of resident physicians is a globally recognized concern, with high rates of burnout, stress, and attrition. Studies proposed grit-a personality trait defined as perseverance and passion for long-term goals-as a protective factor against poor psychological outcomes. Although studies in Western countries have linked grit with lower burnout and depression among residents, evidence from collectivist cultures, such as Japan, remains limited. METHOD: This nationwide cross-sectional study included data from 2,876 postgraduate year (PGY) 1-2 resident physicians across 553 hospitals in Japan. Participants completed self-administered surveys following the 2024 General Medicine In-Training Examination. Grit was measured using the validated Japanese version of the Short Grit Scale (Grit-S); wellness outcomes-including burnout, job satisfaction, stress, and depressive symptoms-were assessed using the single Mini-Z 2.0 item and the two-item Patient Health Questionnaire. Multilevel logistic regression models with a random intercept for hospital were used to evaluate the associations between grit and wellness outcomes, adjusting for demographic and institutional covariates. RESULTS: Higher Grit-S scores were significantly associated with lower odds of burnout (adjusted odds ratio [AOR], 0.54; 95% CI, 0.45-0.64), high stress (AOR, 0.63; 95% CI, 0.55-0.71), and depressive symptoms (AOR, 0.54; 95% CI, 0.48-0.62). Grit was also associated with greater job satisfaction (AOR, 2.09; 95% CI, 1.80-2.43). DISCUSSION: In this national sample of Japanese resident physicians, higher grit was consistently associated with improved psychological well-being, including lower burnout, reduced stress, fewer depressive symptoms, and increased job satisfaction. These findings suggest that grit is a critical protective trait for residents, even within a collectivist culture. Future research should explore whether the identification of residents with lower grit, especially those with reduced perseverance or inconsistent interests, can help inform customized support programs such as mentoring or structured stress management to enhance well-being.

BACKGROUND: Although community medicine is a required component of postgraduate clinical training, its actual duration and relation to knowledge-based performance remain unclear. This study examined the national distribution of community medicine rotation duration and its association with General Medicine In-Training Examination (GM-ITE) performance. METHODS: We conducted a nationwide multicenter cross-sectional study using GM-ITE 2024 data from second-year resident physicians. Outcomes were compared between those with 1 month and those with 2-3 months of community medicine training. The primary outcome was the GM-ITE total score rate (%), and the prespecified secondary outcome was the correct rate (%) in the general medicine category. Other domain- and specialty-specific correct rates were examined descriptively. Multivariable linear regression was used to estimate the associations between community medicine rotation duration and total score rate. RESULTS: The study included 2,834 second-year residents. Community medicine rotation duration was 1 month for 2,243 residents (79.1%), 2 months for 435 (15.3%), 3 months for 67 (2.4%), 4 months or more for 21 (0.7%), and missing for 68 (2.4%). Total score rate was similar between the one-month and 2-3-month groups (58.36±10.11 vs 58.50±10.23; p=0.785; Cohen's d=0.01). The general medicine correct rate was nominally higher in the 2-3-month group than in the one-month group (54.43±18.31 vs 52.49±17.37; p=0.031; Cohen's d=0.11), but this difference did not remain statistically significant after false discovery rate adjustment (q=0.122). In the multivariable analysis restricted to residents with 1-3 months of community medicine rotation and complete covariate data, a two-month rotation was not significantly associated with total score rate (adjusted β: 0.44; 95% CI: -0.54 to 1.42; p=0.382), whereas a small adjusted association was observed for a three-month rotation (adjusted β: 2.33; 95% CI: 0.29 to 4.37; p=0.025). CONCLUSIONS: One month was the predominant duration of community medicine training in Japan. A small, adjusted association with the total GM-ITE score rate was observed for a three-month rotation but not for a two-month rotation, and it should be interpreted with caution. The general medicine finding was small, exploratory, and not statistically significant after adjustment for false discovery rate.

BACKGROUND: Mentorship is considered essential in residency training, yet its structure and quality in Japan remain unclear. METHODS: We conducted a nationwide, multi-center descriptive study of postgraduate year (PGY) 1-2 residents who completed both the General Medicine In-Training Examination (GM-ITE) and a formal mentorship survey in 2024. Residents who declined participation, provided no response to the survey, had incomplete survey responses, or did not have a formal mentor were excluded. RESULTS: Of 9,179 residents who took the GM-ITE, 3,877 from 570 hospitals were analyzed. Most reported having one mentor (71.6%), and mentors were predominantly male (72.9%). Only 61.0% of programs offered lectures on mentorship. Overall, 46.1% of residents did not perceive feedback as specific or actionable, whereas 69.3% reported trusting their mentors. Mentoring interactions were relatively limited, with 60.4% of residents reporting meeting less than once a month. CONCLUSIONS: Among residents with formally assigned mentors, important gaps remained in mentor diversity, feedback quality, and mentoring engagement. Efforts to strengthen mentor training, improve feedback practices, and promote more structured mentoring interactions may help optimize residents' educational and professional development.

PURPOSE: Marital status has been associated with the well-being and career decisions of physicians; however, its role during residency remains underexplored, particularly in Japan. This study aimed to examine the association among marital status, psychological well-being, and intended specialty choice among postgraduate medical residents in Japan, with a focus on sex differences. METHOD: The authors conducted a nationwide cross-sectional survey in January 2023 of postgraduate second-year residents in Japan immediately after the 2022 General Medicine In-training Examination (GM-ITE). Participants completed the survey and provided complete data on their marital status and outcome measures. The primary outcomes included depressive symptoms (assessed using the Patient Health Questionnaire-2), burnout symptoms, job satisfaction, and work-related stress (assessed using the Mini-Z 2.0) as well as gender role attitudes and intended specialty. The authors estimated adjusted prevalence ratios (PRs) using modified Poisson regression with generalized estimating equations. RESULTS: Among 2,721 residents included in the analysis (mean age, 27.7 years; 879 [32.3%] female), 551 (20.2%) were married, of whom 282 (51.2%) had physician spouses. Depressive symptoms were most common among unmarried residents (613/2,170 [28.2%]) and least common among those married to physicians (50/282 [17.7%]; P < .001). In adjusted analyses, being married to a physician was associated with a reduced depressive symptoms prevalence (PR, 0.62; 95% confidence interval [CI], 0.48-0.81) and increased job satisfaction (PR, 1.09; 95% CI, 1.02-1.18). Marital status showed no statistically significant association with burnout symptoms or work-related stress, and no statistically significant specialty preferences differences were observed according to marital status. Female residents, particularly those married to physicians, were more likely to disagree with traditional gender roles than their male counterparts. CONCLUSIONS: Among Japanese medical residents, marriage-particularly to another physician-was associated with fewer depressive symptoms and greater job satisfaction, whereas marital status was not associated with intended specialty choice.

Clinical training programs in Japan vary in performance, but the features perceived as important in high-performing programs remain insufficiently understood. This qualitative study explored the perspectives of program directors from high-performing hospital-based initial residency training programs in Japan, focusing on performance in the Clinical Simulation Video-Innovative Examination (CSV-IE), a component of the General Medicine In-Training Examination. Semi-structured interviews were conducted with nine program directors from programs ranked in the top 25% by CSV-IE accuracy rate, and the data were analyzed using thematic analysis. Program directors indicated seven interrelated training features as important: resident autonomy and progressive responsibility; broad and diverse clinical exposure; accessible, locally tailored learning resources; collaborative reflection and cascading peer-assisted learning; supervisory safety nets and supportive feedback culture; deliberate clinical reasoning practice; and professionalism development. Rather than identifying isolated factors, the findings suggest that high-performing programs were perceived as coherent educational systems in which these features mutually reinforced one another. These findings reflect program directors' perspectives and do not establish causal effects, but they may offer practical, adaptable insights for improving residency training programs in Japan, particularly in settings with variable local constraints.