Abstract
BackgroundIn contrast to many western nations where family medicine is a cornerstone of the primary care workforce, in Japan the specialty is still developing. A number of services within the bailiwick of family medicine have yet to be fully incorporated into Japanese family medicine training programs, especially those associated with sexual health. This gap constitutes a lost opportunity for addressing sexual health-related conditions, including cancer prevention, diagnosis, and treatment. In this mixed methods case study we investigated the perceived acceptability and impact of a standardized patient instructor (SPI) program that trained Japanese family medicine residents in female breast, pelvic, male genital, and prostate examinations.Case descriptionBuilding on an existing partnership between the University of Michigan, USA, and the Shizuoka Family Medicine Program, Japan, Japanese family medicine residents received SPI-based training in female breast, pelvic, male genital, and prostate examinations at the University of Michigan. A mixed methods case study targeting residents, trainers, and staff was employed using post-training feedback, semi-structured interviews, and web-based questionnaire.Discussion and evaluationResidents’ and SPIs’ perceptions of the training were universally positive, with SPIs observing a positive effect on residents’ knowledge, confidence, and skill. SPIs found specific instruction-related approaches to be particularly helpful, such as the positioning of the interpreter and the timing of interpreter use. SPIs provided an important opportunity for residents to learn about the patient’s perspective and to practice newly learned skills. Respondents noted a general preference for gender concordance when providing gender-specific health care; also noted were too few opportunities to practice skills after returning to Japan. For cultural reasons, both residents and staff deemed it would be difficult to implement a similar SPI-based program within Japan.ConclusionsWhile the SPI program was perceived favorably, without sufficient practice and supervision the skills acquired by residents during the training may not be fully retained. Deep-rooted taboos surrounding gender-specific health care appear to be a significant barrier preventing experimentation with SPI-based sexual health training in Japan. The feasibility of implementing a similar training program within Japan remains uncertain. More research is needed to understand challenges and how they can be overcome.
Highlights
In contrast to many western nations where family medicine is a cornerstone of the primary care workforce, in Japan the specialty is still developing
While the standardized patient instructor (SPI) program was perceived favorably, without sufficient practice and supervision the skills acquired by residents during the training may not be fully retained
While the use of SPIs to assist with training has many potential benefits, their use within Japan challenges long-standing and strongly-held sociocultural beliefs about gender, identity, and sex
Summary
In contrast to many western nations where family medicine is a cornerstone of the primary care workforce, in Japan the specialty is still developing. This gap constitutes a lost opportunity for addressing sexual health-related conditions, including cancer prevention, diagnosis, and treatment In this mixed methods case study we investigated the perceived acceptability and impact of a standardized patient instructor (SPI) program that trained Japanese family medicine residents in female breast, pelvic, male genital, and prostate examinations. This gap contributes to a lost opportunity for identifying and treating sexual health-related conditions, as well as cancer prevention, early diagnosis, and treatment To address this gap, the Shizuoka Family Medicine Program, Japan, partnered with the University of Michigan Department of Family Medicine, United States of America (USA), to implement a standardized patient instructor (SPI) program to provide Japanese family medicine residents with training in female breast, pelvic, male genital, and prostate examinations at the University of Michigan. Human papillomavirus (HPV) infection, for example, may be common among some segments of the population, women of reproductive age [10, 13, 14]
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