LETTERS TO THE EDITOR

Another Challenge of Family Medicine Residency Training in Japan

Masato Niimura, MD | Kazuhisa Motomura, MD | Makoto Kaneko, MD, PhD | Taisuke Tsuji, MD | Toshifumi Yodoshi, MD, PhD

Fam Med. 2021;53(8):730-731.

DOI: 10.22454/FamMed.2021.178064

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To the Editor:

Ryuichi Ohta, MD, MHPE, et al identified the challenges in family medicine training in rural Japan.1 According to the study, family medicine residents struggled to adapt to a broader practice range than those taught in medical school. Additionally, we have found that another issue related to their training in Japan exists. Current family medicine residency programs in Japan provide pediatric training in inpatient settings similar to pediatric residency training. The family medicine residents must rotate in pediatrics for 3 months to obtain their specialty board certification from the Japan Primary Care Association (JPCA), but no specific outpatient training frequency has been set.2

In the United Kingdom, Canada, and the United States, pediatric training within family medicine residencies had been mainly inpatient hospital-based. However, previous reports have recommended either a 6-month inpatient hospital-based training or a 4-week outpatient-based training to experience sufficient outpatient pediatric cases.3 The current training program in Japan may not provide adequate opportunities for the residents due to the short training periods and decreased outpatient visits due to declining birth rates and improved immunization. As a result, they may not experience the required cases during the family medicine residency set forth by the JPCA (Table 1).2

Our facility is one of Japan’s largest and oldest family medicine training facilities for future solo family practitioners on isolated islands.4 The training program graduates need to cover all island inhabitants’ health problems, including children. To determine whether our pediatric training was valuable to actual family practice, we conducted a paper-based questionnaire survey between November 2017 and February 2018, to 15 island physicians, who graduated from our program. We accepted responses received by March 20, 2018. We analyzed these without identifying the person and the clinic. The questionnaire covered their training periods including numbers and kinds of cases they encountered, and the participants selected their answers from multiple lists. This study was approved by our institutional ethics review board.

Twelve of 15 responses were returned (80%). The results showed that the varieties and number of cases they experienced during the 3-month inpatient hospital-based training varied by rotation season (more cases in the winter season and fewer cases in the summer season). Furthermore, they reported minimal experience with the following types of cases: child maltreatment, obesity, autism spectrum disease, health check-ups, adolescent patient care, and immunizations. These cases are expected in outpatient clinics. However, in the context of inpatient-based training, they did not gain enough experience against the requirement by the JPCA.

Ohta et al revealed three main themes (educational background, changing environment, driving the learning cycle) and their concepts were effective for the residency education. We are currently planning a multicenter study in Japan to clarify the current pediatric training programs for family medicine residents. After that, we hope to contribute to the development of an ideal pediatric training program for future family medicine practice by incorporating educational concepts suitable for Japanese family medicine residents, as Ohta et al reported.

References

  1. Ohta R, Ryu Y, Katsube T, Otani J, Moriwaki Y. Strengths and challenges for medical students and residents in rural Japan. Fam Med. 2021;53(1):32-38. doi:10.22454/FamMed.2021.308872
  2. Setting Required Cases During Training. Japan Primary Care Association. Accessed February 18, 2021. https://www.shin-kateiiryo.primary-care.or.jp/aims..
  3. Duke P, Curran V, Hollett A. Training family medicine residents to care for children: what is the best approach? Can Fam Physician. 2011;57(2):e46-e50.
  4. Motomura K. Reflective practice and situated learning in remote medicine. An Off J Japan Prim Care Assoc. 2012;35:165-167.

Lead Author

Masato Niimura, MD

Affiliations: Department of Family Medicine, Okinawa Chubu Hospital, Okinawa, Japan

Co-Authors

Kazuhisa Motomura, MD - Department of Family Medicine, Okinawa Chubu Hospital, Okinawa, Japan

Makoto Kaneko, MD, PhD - Primary Care Research Unit, Graduate School of Health Data Science, Yokohama City University, Yokohama, Japan | Department of Family and Community Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan

Taisuke Tsuji, MD - Department of Pediatrics, Okinawa Chubu Hospital, Okinawa, Japan

Toshifumi Yodoshi, MD, PhD - Department of Pediatrics, Okinawa Chubu Hospital Okinawa, Japan | Department of Clinical Research and Quality Management, University of the Ryukyus Graduate School of Medicine, Okinawa, Japan

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By Kiyoshi Sano,MD,FAAFP  /  Posted 9/6/2021

The required rotation for so-called General Medicine residency in Japan does not include gynecology, obstetrics, mental health, nor orthopedics. It only requires internal medicine, pediatrics, emergency medicine, and primary care mostly in-patient care. Even within the internal medicine rotation, outpatient experience is not sufficient enough. It's almost like Med-Peds hospitalist training. It is true that in these circumstances, it is a major challenge to shift resident's experience to out-patient care in every rotations. Unfortunately, most of the residency training is within the hospital where there's no family medicine clinic or department. It is true that the major challenge in Japan is to create real family medicine clinic to show how the family medicine is applied to the patients.

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  1. Ohta R, Ryu Y, Katsube T, Otani J, Moriwaki Y. Strengths and challenges for medical students and residents in rural Japan. Fam Med. 2021;53(1):32-38. doi:10.22454/FamMed.2021.308872

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