山本 祐

Knowledge on case sharing among healthcare professionals, its determinants, and its association with clinical competence and burnout among Japanese resident physicians remains limited. We compared background characteristics between resident physicians who did and who did not share voluntarily their own clinical cases and examined the associations between case sharing with burnout and clinical competence-based on the General Medicine In-Training Examination [GM-ITE®] score. The presence or absence of case sharing was assessed using a questionnaire item, asking, "Do you share your own clinical cases with resident colleagues for learning or educational purposes?" Participants responded YES or NO. Of the 6,063 resident physicians, 4,635 (76.4%) reported sharing their cases. The case-sharing group tended to be women and had more emergency department duties and longer daily study times. The overall burnout prevalence was 17.8% and was significantly lower in the case-sharing group; furthermore, GM-ITE® scores were slightly higher in the case-sharing group. Residents who engaged in case sharing also reported greater clinical and educational engagement. While causal relationships cannot be inferred, these findings highlight the potential relevance of informal peer-to-peer case sharing during residency training.

To address the need to integrate mental health into primary care, Japan introduced a mandatory one-month psychiatry rotation within the two-year postgraduate clinical training program in 2020. However, it remains unclear whether the required rotation improves psychiatric competence, and concerns exist that it might reduce learning opportunities in other fields. This study evaluated the association between the duration of psychiatry rotation and residents' psychiatric and overall clinical competence, measured by a nationwide examination. We conducted a cross-sectional study among 5905 residents taking the General Medicine In-Training Examination (GM-ITE). Using linear mixed-effects models, we examined the association between psychiatry rotation duration (none, 1, 2, ≥3 months) and percentage scores on the psychiatry section (4 questions) and the total examination (80 questions). Models were adjusted for covariates including sex, postgraduate year, hospital settings, and career preference for psychiatry. Compared with residents without psychiatry rotation experience, those with 1, 2, and ≥ 3 months of rotation had significantly higher psychiatry scores, with adjusted mean differences of 5.6% (95% CI: 3.5-7.6), 8.7% (4.4-13.0), and 10.2% (2.8-17.7), respectively. In contrast, no significant difference was observed in total scores regardless of rotation durations. In summary, psychiatry rotations of one month or longer were significantly associated with improved psychiatry scores, without compromising overall clinical learning. These findings support the educational value of required psychiatry rotations and provide an evidence-based perspective for curriculum development and training time allocation in residency programs worldwide.

BACKGROUND: Student involvement in extracurricular activities (ECAs) possesses multiple benefits and has attracted substantial interest in medical education. Most studies on ECAs have been conducted in Western contexts, and findings on the association between ECAs and academic achievement are mixed. We examined the current status of ECA, particularly club activities and study groups, the most representative ECAs in Japan, among medical trainees. METHODS: This was a nationwide cross-sectional study from April to May 2025 in Japan, using an online anonymous self-administered questionnaire. Potential participants were takers of the General Medicine In-Training Examination postgraduate "Year-0" (GM-ITE PGY-0). We asked the participants about their participation in club activities and study groups during their medical school life and evaluated their medical knowledge using their GM-ITE PGY-0 test score. The data were analyzed by descriptive statistics and multivariable linear regression analysis with adjustment for possible confounders. RESULTS: We enrolled 437 of 748 medical trainees. 398 (91.1%) were involved in club activities, predominantly those involving music, while 156 (35.7%) participated in study groups, with clinical reasoning emerging as the most popular. On multivariable linear regression analysis, weekly or more frequent participation in club activities was associated with lower medical knowledge compared with no participation. In contrast, study group participation was positively and dose-dependently associated with medical knowledge test score. CONCLUSIONS: Medical schools should consider strategies to encourage academic ECAs such as study groups while promoting balanced engagement with nonacademic ECAs to optimize both their potential benefits and learning outcomes.

INTRODUCTION: Despite mounting recognition of the importance of student engagement in curriculum development, the current status of student engagement from medical trainees' perspectives has yet to be elucidated. Particularly in Japan, where the educational system places strong emphasis on teacher authority, it is possible that medical student engagement is not promoted as effectively as it could be, and that engagement is not fully perceived by medical students. Thus, we aimed to elucidate the current status of student engagement in curriculum development from the perspective of medical trainees, and to explore factors associated with medical trainees' perceptions of student engagement. METHODS: We performed a nationwide cross-sectional study in Japan from April to May 2025. Participants were newly entered medical residents who took the General Medicine In-Training Examination postgraduate "Year-0." They completed an anonymous online self-administered questionnaire. We analyzed the closed-ended questions using descriptive statistics and linear mixed-effects models, and applied inductive content analysis to the open-ended questions. RESULTS: Of 748 examinees, 428 (57.2%) were included in the analysis. A total of 105 (24.5%) did not perceive that there were student engagement initiatives at their medical school. Only 38 (8.9%) reported participation. The trainees' overall perceptions of how well their opinions were reflected in the medical curriculum were moderate, with a mean score of 5.41 out of 10. This result was supported by the content analysis findings, which identified four themes, including "desire to see more of medical students' opinions reflected" and "disappointment that medical students' opinions are not reflected." Multilevel analysis demonstrated that females had significantly more favorable perceptions than males. CONCLUSIONS: Our findings indicated that awareness, implementation, and perceived value of student engagement remain limited from the perspectives of medical trainees in Japan. Medical educators should implement structural and cultural reforms and develop effective strategies tailored to diverse institutional environments.