Empathy Among Physicians and Nurses in Japan: A Nationwide Cross-sectional Study.

BACKGROUND: Empathy with patients improves clinical outcomes. Although previous studies have shown no significant differences in empathy levels between physicians and nurses, investigations have not considered differences in cultural backgrounds and related factors of healthcare providers at the individual level. OBJECTIVE: This study compares empathy between physicians and nurses in Japan and identifies relevant factors that contribute to these differences. DESIGN: A cross-sectional survey design was used in the study. The online survey was conducted using the Nikkei Medical Online website. PARTICIPANTS: A total of 5441 physicians and 965 nurses in Japan who were registered as members of Nikkei Medical Online were included. MAIN MEASURES: Empathy was measured by the Jefferson Scale of Empathy (JSE). KEY RESULTS: Cronbach's α was 0.89. The mean JSE score for Japanese physicians was significantly lower at 100.05 (SD = 15.75) than the mean score of 110.63 (SD = 12.25) for nurses (p<0.001). In related factors, higher age (increasing by one year) (+0.29; 95% CI 0.25 to 0.32; p<0.001), self-identified female gender (+5.45; 95% CI 4.40 to 6.49; p<0.001), having children (+1.20; 95% CI 0.30 to 2.10; p=0.009), and working at a hospital with 20-99 beds (+1.73; 95% CI 0.03 to 3.43; p=0.046) were significantly associated with higher scores, whereas those whose mother is a physician (-6.65; 95% CI -8.82 to -4.47; p<0.001) and father is a nurse (-9.53; 95% CI -16.54 to -2.52; p=0.008) or co-medical professional (-3.85; 95% CI -5.49 to -2.21; p<0.001) were significantly associated with lower scores. CONCLUSIONS: Physicians had significantly lower scores on the JSE than nurses in Japan. Higher age, self-identified female gender, having children, working at a small hospital, having a mother who is a physician, and having a father who is a nurse or co-medical professional were factors associated with the level of empathy.

Differences in empathy levels among physicians based on specialty: a nationwide cross-sectional study.

PURPOSE OF STUDY: A physician's ability to empathize is crucial for patient health outcomes, and this differs according to speciality, personal characteristics, and environmental factors. This study aimed to examine the empathy levels among physicians based on their specialities and to identify the influencing factors. STUDY DESIGN: A nationwide, online, cross-sectional survey was conducted using the Nikkei Business Publication online physician member homepage. Participants were 5441 physicians in Japan registered as members of Nikkei Medical Online across 20 specialities. We used the Jefferson Scale of Empathy (JSE) to measure the physicians' empathy levels. Cronbach's alpha was 0.84. RESULTS: The mean JSE score was 100.05, SD = 15.75. Multivariate analyses showed that the highest JSE scores were for general medicine [+5.58, 95% confidence interval (CI) 2.60-8.56], general surgery (+3.63, 95% CI 0.97-6.28), psychiatry (+3.47, 95% CI 1.76-5.17), and paediatrics (+1.92, 95% CI 0.11-3.73). Factors associated with higher JSE scores were being female (+5.86, 95% CI 4.68-7.04), managers (+1.11, 95% CI 0.16-2.07), working in a small hospital (+2.19, 95% CI 0.23-4.15), and with children (+3.32, 95% CI 2.29-4.36). CONCLUSIONS: A significant decrease in the empathy levels was found when the parent of the participant was also a medical provider. Being a general medicine physician or a female physician in a high position who has children was positively and significantly correlated with high empathy levels.

Medical resident's pursuing specialty and differences in clinical proficiency among medical residents in Japan: a nationwide cross-sectional study.

IMPORTANCE: Standardized examinations assess both learners and training programs within the medical training system in Japan. However, it is unknown if there is an association between clinical proficiency as assessed by the General Medicine In-Training Examination (GM-ITE) and pursuing specialty. OBJECTIVE: To determine the relative achievement of fundamental skills as assessed by the standardized GM-ITE based on pursuing career specialty among residents in the Japanese training system. DESIGN: Nationwide cross-sectional study. SETTING: Medical residents in Japan who attempted the GM-ITE in their first or second year were surveyed. PARTICIPANTS: A total of 4,363 postgraduate years 1 and 2 residents who completed the GM-ITE were surveyed between January 18 and March 31, 2021. MAIN MEASURES: GM-ITE total scores and individual scores in each of four domains assessing clinical knowledge: 1) medical interview and professionalism, 2) symptomatology and clinical reasoning, 3) physical examination and treatment, and 4) detailed disease knowledge. RESULTS: When compared to the most pursued specialty, internal medicine, only those residents who chose general medicine achieved higher GM-ITE scores (coefficient 1.38, 95% CI 0.08 to 2.68, p = 0.038). Conversely, the nine specialties and "Other/Not decided" groups scored significantly lower. Higher scores were noted among residents entering general medicine, emergency medicine, and internal medicine and among those who trained in community hospitals with higher numbers of beds, were more advanced in their training, spent more time working and studying, and cared for a moderate but not an extreme number of patients at a time. CONCLUSIONS: Levels of basic skill achievement differed depending on respective chosen future specialties among residents in Japan. Scores were higher among those pursuing careers in general medical fields and lower among those pursuing highly specialized careers. Residents in training programs devoid of specialty-specific competition may not possess the same motivations as those in competitive systems.

Gender Inequality Improvement in Medical School Admissions in Japan.

Purpose: To investigate the effects of gender discrimination in Japan's medical school admission process and to assess whether the situation has improved since the disclosure of such discrimination in 2018. Materials and Methods: A cross-sectional study was conducted using secondary data from the Ministry of Education, Culture, Sports, Science, and Technology. The proportions of male and female applicants vis-à-vis all successful candidates admitted from 2016 to 2021 were analyzed; four medical schools were found to be systematically guilty of discriminatory admission practices. Acceptance rate ratios (ARRs) were estimated, and difference-in-differences (DID) analysis was used to examine the differences in ARRs between the two groups-the 4 and 75 medical schools that were and were not reported, respectively-in the predisclosure (2016-2018) and postdisclosure (2019-2021) periods. Results: Female applicants were subjected to discriminatory admission practices at the four reported medical schools in the predisclosure period. However, postdisclosure, those four medical schools had higher female than male acceptance rates in all 3 years. DID analysis revealed a statistically significant estimated average treatment effect on the treated of 0.25148 (95% confidence interval [0.00455-0.49840]), indicating a 0.25-point increase in ARRs relative to the other 75 medical schools. Conclusions: Discriminatory practices against female applicants have decreased since the disclosure in 2018, with the acceptance rate of female students exceeding that of male students for the first time in 2021. In response to these findings, we propose recommendations to further promote gender equality in medicine.

Performance of GPT-3.5 and GPT-4 on the Japanese Medical Licensing Examination: Comparison Study.

BACKGROUND: The competence of ChatGPT (Chat Generative Pre-Trained Transformer) in non-English languages is not well studied. OBJECTIVE: This study compared the performances of GPT-3.5 (Generative Pre-trained Transformer) and GPT-4 on the Japanese Medical Licensing Examination (JMLE) to evaluate the reliability of these models for clinical reasoning and medical knowledge in non-English languages. METHODS: This study used the default mode of ChatGPT, which is based on GPT-3.5; the GPT-4 model of ChatGPT Plus; and the 117th JMLE in 2023. A total of 254 questions were included in the final analysis, which were categorized into 3 types, namely general, clinical, and clinical sentence questions. RESULTS: The results indicated that GPT-4 outperformed GPT-3.5 in terms of accuracy, particularly for general, clinical, and clinical sentence questions. GPT-4 also performed better on difficult questions and specific disease questions. Furthermore, GPT-4 achieved the passing criteria for the JMLE, indicating its reliability for clinical reasoning and medical knowledge in non-English languages. CONCLUSIONS: GPT-4 could become a valuable tool for medical education and clinical support in non-English-speaking regions, such as Japan.

Performance Comparison of ChatGPT-4 and Japanese Medical Residents in the General Medicine In-Training Examination: Comparison Study.

BACKGROUND: The reliability of GPT-4, a state-of-the-art expansive language model specializing in clinical reasoning and medical knowledge, remains largely unverified across non-English languages. OBJECTIVE: This study aims to compare fundamental clinical competencies between Japanese residents and GPT-4 by using the General Medicine In-Training Examination (GM-ITE). METHODS: We used the GPT-4 model provided by OpenAI and the GM-ITE examination questions for the years 2020, 2021, and 2022 to conduct a comparative analysis. This analysis focused on evaluating the performance of individuals who were concluding their second year of residency in comparison to that of GPT-4. Given the current abilities of GPT-4, our study included only single-choice exam questions, excluding those involving audio, video, or image data. The assessment included 4 categories: general theory (professionalism and medical interviewing), symptomatology and clinical reasoning, physical examinations and clinical procedures, and specific diseases. Additionally, we categorized the questions into 7 specialty fields and 3 levels of difficulty, which were determined based on residents' correct response rates. RESULTS: Upon examination of 137 GM-ITE questions in Japanese, GPT-4 scores were significantly higher than the mean scores of residents (residents: 55.8%, GPT-4: 70.1%; P<.001). In terms of specific disciplines, GPT-4 scored 23.5 points higher in the "specific diseases," 30.9 points higher in "obstetrics and gynecology," and 26.1 points higher in "internal medicine." In contrast, GPT-4 scores in "medical interviewing and professionalism," "general practice," and "psychiatry" were lower than those of the residents, although this discrepancy was not statistically significant. Upon analyzing scores based on question difficulty, GPT-4 scores were 17.2 points lower for easy problems (P=.007) but were 25.4 and 24.4 points higher for normal and difficult problems, respectively (P<.001). In year-on-year comparisons, GPT-4 scores were 21.7 and 21.5 points higher in the 2020 (P=.01) and 2022 (P=.003) examinations, respectively, but only 3.5 points higher in the 2021 examinations (no significant difference). CONCLUSIONS: In the Japanese language, GPT-4 also outperformed the average medical residents in the GM-ITE test, originally designed for them. Specifically, GPT-4 demonstrated a tendency to score higher on difficult questions with low resident correct response rates and those demanding a more comprehensive understanding of diseases. However, GPT-4 scored comparatively lower on questions that residents could readily answer, such as those testing attitudes toward patients and professionalism, as well as those necessitating an understanding of context and communication. These findings highlight the strengths and limitations of artificial intelligence applications in medical education and practice.

Empathy competence and future specialty among medical residents in Japan: a nationwide cross-sectional study.

Empathy is essential for physicians to provide patient-centered care. Nevertheless, the degree to which empathy varies among medical residents based on their desired future specialty remains undetermined. This nationwide cross-sectional study compared empathy levels (Jefferson Scale of Empathy, JSE) of 824 year one and two postgraduate residents in Japan by intended medical specialty, individual characteristics, and training and working environment characteristics. Empathy levels were compared with applicants for general medicine, which emphasizes patient-centeredness. The highest mean JSE and the highest percentage of women residents were observed in general medicine (M = 109.74; SD = 14.04), followed by dermatology (M = 106.64; SD = 16.90), obstetrics and gynecology (M = 106.48; SD = 14.31), and pediatrics (106.02; SD 12.18). Residents interested in procedure-centered departments (e.g. ophthalmology, orthopedics) garnered lower JSE scores. Multivariate regression revealed that future general medicine candidates achieved the highest JSE scores ([Formula: see text] = 6.68, 95% CI 2.39-10.9, p = 0.002). Women achieved significantly higher JSE scores than men ([Formula: see text] = 2.42, 95% CI 0.11-4.73, p = 0.041). The results have implications for empathy training and postgraduate education strategy in different clinical specialties.

Early Diagnosis of Intravascular Large B-Cell Lymphoma by Random Skin Biopsy.

Introduction: Delayed diagnosis of intravascular large B-cell lymphoma (IVLBCL) is associated with a poor prognosis, making early diagnosis and treatment essential. However, early diagnosis remains challenging. Case description: Here we present the case of a 75-year-old man with fever of unknown origin, in whom random skin biopsy (RSB) allowed early diagnosis of IVLBCL. Discussion: The usefulness of RSB, which involves incisional skin biopsies of three or more sites that contain subcutaneous fatty tissue, such as the thighs, abdomen and upper arms, has been debated. In cases of suspected IVLBCL, RSB is less invasive than a biopsy of the internal organs. Conclusion: We suggest that combining RSB with bone marrow examination may facilitate the diagnosis of IVLBCL. LEARNING POINTS: Delayed diagnosis of intravascular large B-cell lymphoma (IVLBCL) is associated with a poor prognosis, but early diagnosis is difficult due to its diverse, non-specific presentation.This case report illustrates the value of random skin biopsy in the early diagnosis of IVLBCL in a man with fever of unknown origin and haematological abnormalities without lymphadenopathy, splenomegaly or bone marrow abnormalities.The diagnostic accuracy of random skin biopsy depends on several factors, including the location and number of sites biopsied, and the depth and width of the biopsy.

Evidence-based prescription of corticosteroids for COVID-19 patients: A comparison between general medicine and other specialty in Japan.

Background: The difference of evidence-based prescription for COVID-19 patients between general medicine and other specialty in Japan is unclear. Methods: A retrospective observational study using a hospital-based administrative database was conducted for the differences between departments for prescriptions of glucocorticoids in COVID-19 patients. Results: Of 65,156 patients, 23,348 met indication for glucocorticoids. General medicine physicians in Japan were more likely to prescribe corticosteroids for COVID-19 patients than other departments after its evidence was published (adjusted odds ratio, 1.32; p < 0.001; 95% confidence interval, 1.11-1.56). Conclusions: General medicine physicians were more likely to practice evidence-based care for COVID-19 patients.

Tetracycline-induced black hairy tongue.

A blackish discolouration on the central part of the dorsal tongue in the front of the circumvallate papillae.

Characteristics of Medical School Deans and University Hospital Directors in Japan.

This cross-sectional study investigates characteristics, including sex, postgraduate experience, and specialty, of medical school deans and university hospital directors in Japan.