Abstract
BackgroundIn Japan, all trainee physicians must begin clinical practice in a standardized, mandatory junior residency program, which encompasses the first two years of post-graduate medical training (PGY1 – PGY2). Implemented in 2004 to foster primary care skills, the comprehensive rotation program (CRP) requires junior residents to spend 14 months rotating through a comprehensive array of clinical departments including internal medicine, surgery, anesthesiology, obstetrics-gynecology (OBGYN), pediatrics, psychiatry, and rural medicine. In 2010, Japan’s health ministry relaxed this curricular requirement, allowing training programs to offer a limited rotation program (LRP), in which core departments constitute 10 months of training, with electives geared towards residents’ choice of career specialty comprising the remaining 14 months. The effectiveness of primary care skill acquisition during early training warrants evaluation. This study assesses self-reported confidence with clinical competencies, as well as case experience, between residents in CRP versus LRP curricula.MethodsA nation-wide cross-sectional study of all PGY2 physicians in Japan was conducted in March 2011. Primary outcomes were self-report confidence for 98 clinical competency items, and number of cases experienced for 85 common diseases. We compared confidence scores and case experience between residents in CRP and LRP programs, adjusting for parameters relevant to training.ResultsAmong 7506 PGY2 residents, 5052 replied to the survey (67.3%). Of 98 clinical competency items, CRP residents reported higher confidence in 12 items compared to those in an LRP curriculum, 10 of which remained significantly higher after adjustment. CRP trainees reported lower confidence scores in none of the items. Out of 85 diseases, LRP residents reported less experience with 11 diseases. CRP trainees reported lower case experience with one disease, though this did not remain significant on adjusted analysis. Confidence and case experience with OBGYN- and pediatrics-related items were particularly low among LRP trainees.ConclusionsResidents in the specialty-oriented LRP curriculum showed less confidence and less case experience compared to peers training in the broader CRP residency curriculum. In order to foster competence in independent primary care practice, junior residency programs requiring experience in a breadth of core departments should continue to be mandated to ensure adequate primary care skills.
Highlights
In Japan, all trainee physicians must begin clinical practice in a standardized, mandatory junior residency program, which encompasses the first two years of post-graduate medical training (PGY1 – PGY2)
The purpose of this study is to investigate PGY2 physicians’ self-reported confidence with knowledge, skills, and experience of diseases useful to primary care, and to compare these between residents trained in two different rotation curricula
The comprehensive rotation program (CRP) curriculum requires all 1st - and 2nd-year (“junior”) residents to rotate through a standardized set of core departments comprised as follows: internal medicine subspecialties (6 months), surgery (3 months), anesthesiology (1 month), obstetrics-gynecology (OBGYN; 1 month), pediatrics (1 month), psychiatry (1 month), and rural/community medicine (1 month); the additional 10 months are generally spent in a variety of hospital-specific required rotations or career-oriented electives
Summary
In Japan, all trainee physicians must begin clinical practice in a standardized, mandatory junior residency program, which encompasses the first two years of post-graduate medical training (PGY1 – PGY2). In the rapidly specializing health care arena, the training of competent generalists remains a cornerstone of optimal population-level health as measured by a variety of outcomes in many countries [1] Despite this understanding, implementation and prioritization of generalist education programs remains challenging [2]. Curricular structures that best meet this need, balancing core generalist competencies with specialized knowledge and skills, remain the subject of ongoing discussions amongst which curricular redesigns are not uncommon To this end, in 2007, the Alliance for Academic Internal Medicine Education Redesign Task Force, sought to formalize a core set of knowledge, skills, and attitudes, proficiency in which should be maintained throughout a career, regardless of practice in a specialty or general medicine [4]
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