Hiroyoshi Endo

The Shift of Residents From University to Non-University Hospitals in Japan: A Survey Study

BackgroundBetween 2003 and 2004, when the new postgraduate medical education program was introduced in Japan, the number of university residents decreased from 5,923 to 3,264 (−31%), whereas the number of non-university residents increased from 2,243 to 4,110 (+45%).ObjectiveTo identify potential reasons for the shift of residents from university to non-university hospitals.DesignCross-sectional mailed survey.ParticipantsThe subjects were 1,794 2nd-year residents at 91 university hospitals and 2,010 2nd-year residents at 659 non-university hospitals.MeasurementsData on hospital demographics, resident demographics, and resident satisfaction with training were collected in 2006 and were compared between university and non-university hospitals.ResultsCompared to non-university hospitals, university hospitals were more likely to have >700 beds (55% vs. 10%, p<0.001) and to have more teaching resources and free access to international medical journals (84% vs. 62%, p<0.001). Nevertheless, one-half (47%) of the university residents reported that they were not satisfied with the residency system and clinical skills training and attributed their dissatisfaction to “daily chores,” “low salary,” and “poor clinical opportunities.” Logistic regression analyses indicated that the proportions of residents who were satisfied with income (OR: 0.32, 95% CI: 0.26–0.40) and the residency system (OR: 0.52, 95% CI: 0.40–0.68) and clinical skills training (OR: 0.77, 95% CI: 0.60–0.99) were significantly lower for university residents than for non-university residents.ConclusionsHospital size and teaching resources do not overcome the other characteristics of university hospitals that lead to residents’ dissatisfaction.

Improvement of residents' clinical competency after the introduction of new postgraduate medical education program in Japan

Background: In 2004, the Japanese government reformed the monospecialty-oriented postgraduate medical education (PGME) program and introduced a new PGME program to develop the primary care skills of physicians by mandatory rotation through different clinical departments. Aims: (1) to evaluate whether residents’ clinical competency improved after the introduction of the new PGME program and (2) to compare the change in competency between university and non-university residents. Method: Surveys were conducted before and after the introduction of the new PGME, i.e. in 2004 (response rate 88%) and 2006 (88%). One in every five residents was sampled, and the study subjects were 2474 second-year residents (1762 university residents and 712 non-university residents) in 2004 who were about to complete the previous PGME program and 1166 second-year residents (487 and 679) in 2006 who were the first generation to complete the new PGME program. The clinical competency ratings were measured by the proportion of respondents reporting ‘experience’ in 24 clinical specialties and three items regarding the use of medical records and ‘confidence’ in 35 clinical skills and knowledge items in four areas (i.e basic medicine, allied areas, behavioural science and social medicine, and clinical research). Results: Compared to the residents in 2004, the clinical experience and confidence level of the residents increased dramatically for almost all of the surveyed items in 2006, regardless of the type of teaching hospital (chi-square or Fishers exact tests, P < 0.0001). The marked improvement in the clinical competency of university residents was noticeable, resulting in the disappearance of the historical trend for non-university residents to obtain significantly more clinical experience than university residents. Conclusions: The new PGME program appears to have been successful at improving both the clinical experience and confidence levels of medical residents, especially at university hospitals.

Higher Internality of Health Locus of Control Is Associated With the Use of Complementary and Alternative Medicine Providers Among Patients Seeking Care for Acute Low-back Pain

ObjectivesGiven that persons with a stronger belief in internal health locus of control (HLC) have been shown to comply well with medical advice, HLC internality may play an important role in low-back pain (LBP) prevention and management because it requires the patients own commitment. Previous studies in conditions other than LBP have shown that the use of complementary and alternative medicine (CAM) is associated with high HLC internality. Here, we examined the relationship between CAM facility visits and internality of HLC in persons with LBP. MethodsWe analyzed the data from the Health Diary Study, which surveyed the health-related behavior of 3477 persons sampled from the general population of Japan. Among 2377 participants aged 18 to 75 years, 673 reported LBP during the study period. We examined CAM facility visits and HLC among 81 previously untreated LBP patients who sought care from western medical doctors or CAM providers during the 1-month study period. ResultsOf the 81 patients, 40 reported at least 1 CAM visit, whereas 41 visited western medical doctors only. Participants who visited CAM facilities had a higher internality score than those who visited western medical doctors after controlling for age, sex, size of residential city, and bodily pain score of the Short Form-8 Health Survey scale. DiscussionVisitors to CAM facilities had a stronger belief in internal HLC. This finding suggests that visitors to CAM facilities are more sensitive to educational intervention for the self-management of LBP than those who visit western medicine. In order not to miss the opportunity of reaching these patients, the education should be more emphasized on CAM facilities.

Association between tuberculosis recurrence and interferon-γ response during treatment

OBJECTIVES We investigated the relationship between tuberculosis recurrence and Mycobacterium tuberculosis antigen-stimulated interferon-gamma (IFN-γ) responses during treatment. METHODS Plasma IFN-γ levels in active pulmonary tuberculosis patients (n = 407) were analyzed using QuantiFERON-TB Gold In-Tube™ (QFT-IT) at 0, 2, and 7 months of the 8-month treatment received from 2007 to 2009 and the patients were followed up for another 16 months after treatment. Risk factors for recurrence were assessed using the log-rank test and Cox proportional hazard models. Random coefficient models were used to compare longitudinal patterns of IFN-γ levels between groups. RESULTS QFT-IT showed positive results in 95.6%, 86.2%, and 83.5% at 0, 2, and 7 months, respectively. The antigen-stimulated IFN-γ responses varied significantly during the treatment course (P < 0.0001). Unexpectedly, positive-to-negative conversion of QFT-IT results between 0 and 2 months was significantly associated with earlier recurrence (adjusted hazard ratio, 5.57; 95% confidence interval, 2.28-13.57). Time-dependent changes in IFN-γ levels were significantly different between the recurrence and nonrecurrence groups (P < 0.0001). CONCLUSIONS Although the IGRA response varies individually, early response during the treatment course may provide an insight into host immune responses underlying tuberculosis recurrence.