The degree of satisfaction and level of learning in male and female surgical residents: a nationwide questionnaire survey of graduating residents in Japan.

PURPOSE: Since 2002, the Japan Surgical Society has established a board certification system for surgeons to be certified for a specialty. Surgery remains a male-dominated field in Japan. This study aimed to clarify if the Japanese surgical residency training system is equally suitable for female and male residents. METHODS: The Japan Surgical Society conducted the first questionnaire survey regarding the system of surgical training for the residents in 2016. The questionnaire included the degree of satisfaction with 7 aspects of the training system, including the number and variety of cases experienced and duration and quality of instruction, and the learning level for 31 procedures. The degree of satisfaction and level of learning were compared between female and male residents. RESULTS: The degree of satisfaction was similar for all items between female and male residents. Female residents chose breast surgery as their subspecialty more frequently than male residents and were more confident in breast surgery procedures than male residents. Conversely, fewer female residents chose gastrointestinal surgery and were less confident in gastrointestinal surgery procedures than male residents. CONCLUSION: Female residents were as satisfied with the current surgical training system as male residents. However, there may be room for improvement in the surgical system, considering that fewer applications for gastrointestinal surgery come from female residents than from males.

Health Science Students' Perspective on Quality-of-Care-Relating Medical Professionalism.

PURPOSE: Health science students need to be professional to improve quality of care (QOC) in the current Vietnamese healthcare system. Therefore, we aim to evaluate medicine and traditional medicine (TM) students' perception of the professional attributes relating to QOC for improving inter-disciplined professionalism training that promotes QOC in Vietnam. METHODS: The cross-sectional study was carried on 2039 students of 6 years at the University of Medicine and Pharmacy at Ho Chi Minh City (HUMP) from the medical and TM faculty in March, 2021. The Vietnamese American Board of Internal Medicine (ABIM) questionnaire (2011) was used as the survey instrument. The confirmatory factor analysis (CFA) was performed to confirm the validity of the scale in TM students. Mean, Min-Max, standard deviation and sample paired t-test were performed for Likert scale. The one-way ANOVA was used for inferential statistics. RESULTS: The CFA demonstrated the validity of the Vietnamese questionnaire in measuring 4 QOC-relating professional attributes, previously found in medical students for TM students. In both faculties and across academic years, students perceived self-awareness and ensuring QOC as the leading important attribute, while social duty and professional habit as the least important attribute. Contrasting with preclinical phase, students' perception did not differ significantly between the two faculties in their clinical years (p > 0.05). CONCLUSION: TM students share universal QOC-relating professional traits with medical students. Moreover, exposure to clinical environment might increase inter-disciplined agreement on importance of these attributes. However, health sciences students' underestimation of social duty and professional habit persists throughout 6 academic years. Hidden curriculum in clinical training such as specialist-centeredness might hinder the students' improvement in perception of these traits. Therefore, these traits should strongly be emphasized in professionalism training to decrease the effects of hidden curriculum on them.

Does the hospitalization immersion experience improve medical students' understanding of patients' perspectives? A qualitative study.

PURPOSE: Although many studies have assessed the impact of interventions to increase medical students' empathy by improving their understanding of patients' perspectives and feelings, the impact of hospitalization experiences remains unclear. METHODS: Fifth-year medical students at Kyushu University from 2009-2013 participated in a 2-day/1-night course to provide a hospitalization experience. After the course, participants answered an online, anonymous, open-ended questionnaire created by the authors. RESULTS: Of 488 participants, 462 provided responses (95% response rate), which were evaluated by thematic analysis. Students understood inpatients not only through their own hospitalization experience, but also through observations of and conversations with the inpatients they encountered, from a shared perspective of both. Students experienced the realities of hospital life, stress and psychological states of being an inpatient, and psychological pressure from physicians. In addition, students observed the distress of other inpatients and dedication of medical staff. Furthermore, through communication with these inpatients, students understood other inpatients' anxiety about illness and empathy as one of the requirements of health care providers from the patients' perspective. CONCLUSION: This qualitative study investigated the effectiveness of a course on the hospitalization experience. Results showed that medical students understood the perspectives, distress, and anxiety of being an inpatient, not only from their own experiences but also from observation and communication with other inpatients they encountered during their hospitalization. This experience appeared to be an effective teaching strategy for enhancing medical students' empathy by improving their understanding of patients' perspectives and feelings.

Is there disparity between regions and facilities in surgical resident training in Japan? Insights from a national survey.

PURPOSE: This study sought to assess the disparity between regions and facilities in surgical resident training in Japan via a national level needs-assessment. METHODS: A survey was sent to all 909 graduating residents of 2016. Residents trained in the six prefectures with a population of 7 million or more were included in the large prefecture (LP) group. Residents trained in the other 41 prefectures were included in the small prefecture (SP) group. Each group was further divided into a university hospital (UH) group and a non-university hospital (NUH) group. RESULTS: The response rate was 56.3% (n = 512). Excluding nine residents who did not report their prefectures and facilities, surveys from 503 residents were analyzed. The UH group received significantly more years of training. In the SP and UH groups, there were significantly fewer residents who had performed 150 procedures or more under general anesthesia in comparison to the LP and NUH groups, respectively. Self-assessed competencies for several procedures were significantly lower in the SP and UH groups. CONCLUSION: Disparity in surgical resident training was found between regions and facilities in Japan. The surgical residency curriculum in Japan could be improved to address this problem.

Are graduating residents sufficiently competent? Results of a national gap analysis survey of program directors and graduating residents in Japan.

PURPOSE: To evaluate the self-assessed competency of graduating residents (GRs) in Japan upon completion of their residency and to identify the gap between their competency and the competency expected by their program directors (PDs). METHOD: A list of 31 essential surgical procedures was compiled according to the consensus of surgical educators from around the country. A survey with this list was sent to all 909 GRs and their 611 PDs in 2016. The GRs rated their competency to perform these procedures and the PDs were asked to evaluate the expected competency of their GRs using the Zwisch Scale. RESULT: The response rate was 56.3% for the GRs and 76.8% for the PDs. Fewer than half of the GRs who responded felt confident performing ten (32%) of the surgical procedures evaluated. For most procedures, the GRs' self-reported competency was lower than the expectation reported by their PDs. This gap was more than 10% for 13 of the procedures. CONCLUSION: More than half of the GRs in Japan lacked the confidence in their skill to perform one-third of the surgical procedures selected for evaluation in this study. These findings should be used to update the surgical education curriculum in Japan.

Promoting Patient Care Through Communication Training in a Pre-clerkship Pharmacy Education Course in Japan.

Objective. The purpose of this study was to teach communication skills for patient care to pre-clerkship students and observe changes in student perspectives towards communication from pre- to post-training. Methods. Two cohorts of fourth-year pharmacy students completed an eight-week pre-clerkship training course designed to improve their communication skills. The course involved class discussions and in-class research of medications, practicing communication skills, learning to give science-based responses, and developing an awareness of patient education for lifestyle, self-medication, quality of life, and medication adherence. A comparison of students' pre- and post-training responses to a questionnaire were used to assess changes in students' ability and confidence in communicating with patients. An exploratory factor analysis was used to analyze and compare the data results. Results. Students' mean post-training scores for perceived ability to make small talk and confidence to communicate with patients increased compared to pre-training scores. Based on the results of the exploratory factor analysis, the greatest increase in students' scores was in the area of patient education skills. Conclusion. The pre-clerkship communication training improved student understanding of the pharmacy communication skills needed to conduct effective patient education and pharmacist-patient interaction beyond dispensing, affirming the theory that specialized communication training before students' begin a clerkship may be essential.

A snapshot of surgical resident training in Japan: results of a national-level needs assessment survey.

PURPOSE: To evaluate the status of surgical training in Japan through a national-level needs assessment. METHODS: A survey was sent to all 909 graduating residents (GRs) and their 611 program directors (PDs) for the year 2016. A working group of surgical educators from around the country was formed under the education committee of the Japan Surgical Society. The survey items were developed by consensus of this working group. The survey investigated the knowledge and problems of the current curriculum, and the status of the current residency training. RESULTS: The response rates were 56.3% of the GRs and 76.8% of the PDs. Among the participants, 47.6% of the GRs and 29.4% of the PDs believed that the residency curriculum did not match the clinical experience. Over 80% of the GRs and PDs agreed on the importance of training outside of the OR, whereas only 13% of the GRs had received such training regularly. Trainees also reported a lower satisfaction rate about the opportunity to train outside of the OR. CONCLUSION: This national-level needs assessment of surgical training in Japan identified several gaps in the curriculum. These results provide valuable data to assist the ongoing efforts for surgical residency curriculum improvement.

Competencies necessary for becoming a leader in the field of community medicine: a Japanese qualitative interview study.

OBJECTIVES: To clarify competencies for inclusion in our curriculum that focuses on developing leaders in community medicine. DESIGN: Qualitative interview study. SETTING: All six regions of Japan, including urban and rural areas. PARTICIPANTS: Nineteen doctors (male: 18, female: 1) who play an important leadership role in their communities participated in semistructured interviews (mean age 48.3 years, range 34-59; mean years of clinical experience 23.1 years, range 9-31). METHOD: Semistructured interviews were held and transcripts were independently analysed and coded by the first two authors. The third and fourth authors discussed and agreed or disagreed with the results to give a consensus agreement. Doctors were recruited by maximum variation sampling until thematic saturation was achieved. RESULTS: Six themes emerged: (1)'Medical ability': includes psychological issues and difficult cases in addition to basic medical problems. High medical ability gives confidence to other medical professionals. (2)'Long term perspective': the ability to develop a long-term, comprehensive vision and to continuously work to achieve the vision. Cultivation of future generations of doctors is included. (3) 'Team building':the ability to drive forward programmes that include residents and local government workers, to elucidate a vision, to communicate and to accept other medical professionals. (4)'Ability to negotiate': the ability to negotiate with others to ensure that programmes and visions progress smoothly (5) 'Management ability': the ability to run a clinic, medical unit or medical association. (6) 'Enjoying oneself': doctors need to feel an attraction to community medicine, that it be fun and challenging for them. CONCLUSIONS: We found six competencies that are needed by leaders in the field of community medicine. The results of this study will contribute to designing a curriculum that develops such leaders.

Development of culture-sensitive clinical teacher evaluation sheet in the Japanese context.

AIM: Many instruments for evaluating clinical teaching have been developed, albeit most in Western countries. This study aims to develop a validated cultural and local context sensitive instrument for clinical teachers in an East Asian setting (Japan), Japanese Clinical Teacher Evaluation Sheet (JaCTES). METHODS: A multicenter, cross-sectional evaluation study was conducted. We collected a total of 1368 questionnaires on 304 clinical teachers, completed by residents in 16 teaching hospitals. The construct validity was examined by conducting a factor analysis and using structural equation modeling (SEM). We also assessed the reliability using generalizability analysis and decision study. RESULTS: Exploratory factor analysis resulted in three-factor (role model, teaching activities, and accessibility) model including 18 items. Confirmatory factor analysis was performed, using SEM. The comparative fit index was 0.931 and the root mean square error of approximation was 0.087, meaning an acceptable goodness of fit for this model. To obtain a reliable dependability-coefficient of at least 0.70 or higher, 5-8 resident responses are necessary. DISCUSSION AND CONCLUSION: JaCTES is the first reported instrument with validity evidence of content and internal structure and high feasibility in Japan, an East Asian setting. Medical educators should be aware of the local context and cultural aspects in evaluating clinical teachers.

Comparison of students' encountered diseases and available diseases at clerkship sites by exploratory multivariate analysis: Are encountered diseases predictable?

BACKGROUND: Students in clerkship are expected to gain clinical expertise by interacting with real patients in clinical situations. Monitoring and predicting the students' encounter diseases (EDs) is important for providing an optimal experience. EDs should be compared with the available diseases (ADs) at the clerkship site and with the required diseases described in some guidelines for the clinical curriculum. AIMS: To explore the differences in ADs as learning resources among different types of clerkship sites and to investigate discrepancies between EDs and ADs. METHOD: A retrospective observational study used secondary data from government statistics to compare ADs of various types of observable clerkship sites by biplot analyses, which allowed multivariate comparisons. EDs collected from logbooks during clerkships at a university hospital were also compared with ADs across sites. RESULTS: The distributions of ADs differed according to institutional type, and EDs at Kyushu University Hospital were similar to the ADs for the category of hospitals in which it was placed. CONCLUSION: EDs at a clerkship site may be predictable to some extent by analysing the site's distribution of ADs, but further study is needed. Biplot is useful for visualising these types of statistical similarity.