Association between physicians' maldistribution and core clinical competency of resident physicians: a nationwide cross-sectional study.

Autor:	Shikino K; Department of Community-Oriented Medical Education, Chiba University Graduate School of Medicine, Chiba, Japan kshikino@gmail.com ynishiza@juntendo.ac.jp.; Department of General Medicine, Chiba University Hospital, Chiba, Japan., Nishizaki Y; Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan kshikino@gmail.com ynishiza@juntendo.ac.jp., Kataoka K; Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan., Nojima M; Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan., Shimizu T; Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga-gun, Japan., Yamamoto Y; Division of General Medicine, Center for Community Medicine, Jichi Medical University, Tochigi, Japan., Fukui S; Department of Emergency and General Medicine, Kyorin University School of Medicine, Tokyo, Japan., Nagasaki K; Department of Internal Medicine, University of Tsukuba, Mito, Japan., Yokokawa D; Department of General Medicine, Chiba University Hospital, Chiba, Japan., Kobayashi H; Department of Internal Medicine, University of Tsukuba, Mito, Japan., Tokuda Y; The Tokyo Foundation for Policy Research, Tokyo, Japan.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2024 Oct 18; Vol. 14 (10), pp. e083184. Date of Electronic Publication: 2024 Oct 18.
DOI:	10.1136/bmjopen-2023-083184
Abstrakt:	Objectives: With physician maldistribution recognised as a global issue, Japan implemented the physician uneven distribution (PUD) index as a strategic measure. Currently, there is a lack of objective assessment of core clinical competencies in regions influenced by varying levels of physician distribution. In this study, we objectively assess the core clinical competencies in regions affected by physician maldistribution and explore the relationship between the PUD index and the clinical competencies of resident physicians. Design, Setting and Participants: In this cross-sectional study, we gathered data from the January 2023 General Medicine In-Training Examination (GM-ITE) survey. Participants included postgraduate year 1 and 2 resident physicians in Japanese hospitals mandating the GM-ITE or those who voluntarily took it. The GM-ITE scores of the resident physicians were assessed. The PUD index, a Japanese policy indicator, reflects regional physician disparities. A low PUD index signals a medical supply shortage compared with local demand. The trial registration number is 23-7. Results: The high and low PUD index groups included 2143 and 1580 participants, respectively. After adjusting for relevant confounders, multivariate linear regression analyses revealed that the low PUD index group had significantly higher GM-ITE scores than the high PUD index group (adjusted coefficient: 1.14; 95% CI 0.62 to 1.65; p<0.001). Conclusions: The study revealed no clinically differences in GM-ITE scores between residents in regions with disparate physician distributions, suggesting that factors beyond PUD may influence clinical competency. This finding prompts a re-evaluation of whether current assessment methodologies or educational frameworks fully support learning across varied community settings. Competing Interests: Competing interests: JAMEP was involved in collecting and managing data as the GM‐ITE administrative organisation. It did not participate in designing and conducting the study, data analysis and interpretation, preparation, review, or approval of the manuscript, or the decision to submit the manuscript for publication. KS received an honorarium from the JAMEP as a speaker on the JAMEP lecture and exam preparer for the GM-ITE. YN received an honorarium from the JAMEP as a GM-ITE project manager. YT is the JAMEP director and received an honorarium from the JAMEP as a speaker on the JAMEP lecture. HK received an honorarium from the JAMEP as a speaker on the JAMEP lecture. TS and YY received an honorarium from the JAMEP as exam preparers for the GM-ITE. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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