山本 祐

Although considerable bodies of literature have elucidated various determinants of burnout and job satisfaction among medical residents, one aspect that remains under-examined is the impact of patient care ownership (PCO). Therefore, we aimed to examine the associations between PCO, burnout, and job satisfaction among residents. This was a nationwide cross-sectional study, using online anonymous surveys from January 17 to March 31, 2024. The participants were residents who participated in the General Medicine In-Training Examination, a nationwide examination in Japan. The primary outcome was burnout, assessed using the Single-item Measure of Burnout Scale. The secondary outcome was job satisfaction, measured by the item included in the Mini-Z 2.0. The explanatory variable was PCO, as assessed by the Japanese version of the PCO Scale. 1816 participants were in the analysis. Multivariable logistic regression analyses revealed that, after adjustment for possible confounders, PCO showed a negative association with burnout, and that there was a positive association between PCO and job satisfaction. The findings suggest the importance of emphasizing PCO in the context of exploring burnout and job satisfaction among medical residents. This knowledge will inform educational interventions to help residents work with less burnout and greater job satisfaction, ultimately leading to better patient outcomes.

BACKGROUND: The optimal hospital size between adequate clinical training and resident well-being remains underexplored, particularly within Japan's unique medical training environment. This study examined the relationship between residents' nationwide General Medicine In-Training Examination (GM-ITE®) scores and their mental health to evaluate the validity of inpatient volume as a criterion for training hospital designation. METHOD: We conducted a nationwide cross-sectional study of 7,498 postgraduate year (PGY)-1 and PGY-2 residents from 608 community-based hospitals in Japan who participated in the GM-ITE® from January 17 to 30, 2024. The GM-ITE® is a highly reliable test for evaluating residents' basic clinical skills. The 2023 GM-ITE® included 80 multiple-choice questions with a maximum score of 80. In the Mini Z 2.0 survey, a score of 3 or more was defined as the presence of burnout symptoms. Training facilities were categorized into four groups by yearly inpatient volume: Very Low (< 3,000), Low (3,000-5,999), Moderate (6,000-9,999), and High (≥ 10,000). We explored the relationships using multivariable analysis between GM-ITE® score, burnout symptoms, and training environment. RESULT: The GM-ITE® scores in the Very Low-Volume group were significantly higher than those of the Low-Volume group (45.8 ± 7.3 vs. 44.3 ± 7.1; adjusted coefficient (AC): 2.007; p = 0.021), but did not differ significantly from those of the Moderate- (45.8 ± 7.3 vs. 44.9 ± 6.7; AC: 1.637; p = 0.060) or High-Volume (45.8 ± 7.3 vs. 46.2 ± 6.9; AC: 1.638; p = 0.082) groups. The prevalence of burnout symptoms among residents in the Very Low-Volume group, did not differ significantly from that of residents in the Low- (13.5% vs. 13.1%; adjusted odds ratio (aOR): 0.974; p = 0.940), Moderate- (13.5% vs. 12.8%; aOR: 0.967; p = 0.923), and High-Volume groups (13.5% vs. 12.1%; aOR: 0.994; p = 0.986). CONCLUSION: Residents at Very Low-Volume hospitals achieve comparable GM-ITE® scores and mental health outcomes to those of residents at larger hospitals. Even Very Low-Volume hospitals are individually assessed, and if recognized as having an educational environment where residents can acquire basic clinical skills, it may be appropriate to certify them as core clinical training hospitals. The educational environment in Very Low-Volume hospitals could be enhanced by supporting residents' mental health and advancing international clinical training programs.

PURPOSE: Patient care ownership (PCO) is a critical component of medical professionalism. Although various determinants of PCO among medical residents have been investigated, the impact of workplace social capital (WSC; a social resource concerning employees' perceptions of trust, reciprocity, and network interactions within the workplace) remains unclear. Here, we aimed to examine the association of WSC and PCO. METHODS: This nationwide cross-sectional study was conducted using an anonymous online survey from January to February 2025. The participants were residents who participated in the General Medicine In-Training Examination. The primary and secondary outcomes were PCO and its four dimensions (i.e. assertiveness, sense of ownership, diligence, and being the "go-to" person), measured using the Japanese version of the PCO Scale, respectively. We adopted WSC and its two dimensions (i.e. horizontal and vertical trust) as the primary and secondary explanatory variables, assessed using the Japanese medical resident version of the WSC Scale, respectively. RESULTS: A total of 2811 residents were analyzed. On multivariable linear regression analysis, WSC total score was positively associated with PCO total score after adjustment for possible confounders. WSC total score was also positively associated with all PCO dimension scores. Additionally, we observed a positive association between each WSC domain score, PCO total score, and each PCO domain score. CONCLUSIONS: Our study revealed a significant and consistent association between WSC and PCO. These findings emphasize the importance of fostering a trusting workplace environment, given that PCO constitutes a pivotal component of professionalism and is likely associated with quality patient care.