Although there are no podiatrists in 85% of countries worldwide, how diabetic foot is managed in those countries is still unknown. We sought to identify the health professionals involved in diabetic foot and their tasks in Japan, where no podiatrists exist. This cross-sectional study used the Japanese Nationwide Survey on Foot Ulcer Management dataset, consisting of 249 medical doctors and 680 allied health professionals. The types of health professionals involved in the diabetic foot were identified, and the tasks performed by each professional were compared within subgroups (medical doctors and allied health professionals). We found that the primary medical doctors involved in diabetic foot care in Japan were plastic surgeons (33.5%), dermatologists (21%), cardiovascular/vascular surgeons (15.2%), and cardiologists (12.1%). Nurses were the main allied health professionals (80%), and the rest consisted of prosthetists/orthotists (7.6%), physical/occupational therapists (5.9%), and clinical engineering technologists (3.6%). Medical doctors performed tasks related to their specialties significantly more than others (p < 0.001); however, they also engaged in tasks outside of their specialty, such as plastic surgeons performing preventive foot care (72%). Among allied health professionals, clinical engineering technologists performed more vascular assessments (p < 0.001), and half were engaged in wound management, preventive foot care, and self-foot care education. In conclusion, the type and proportion of health professionals in our study differed from those in countries with podiatrists, and many performed tasks outside their specialties. This is the first nationwide cross-sectional study of diabetic foot care in a country without podiatrists and is unique in examining multiple specialists/professionals in one study.

As a frequent and serious problem in elderly people, malnutrition is a complex health issue. It requires comprehensive care through interprofessional collaborative practice (IPCP) engaging five health professionals in primary care consisting of a physician, dentist, nurse, dietitian and pharmacist. In Indonesia, the usual care involves monthly health screening in community programmes named Posyandu. The current study aimed to explore perceptions of elderly people with malnutrition and their families' experiences with interprofessional teams compared with usual care in primary care. This qualitative study used the phenomenological approach based on Creswell. Interviews were conducted with fourteen elderly people and their families in the intervention group and fourteen elderly people with their families in the control group. Data were analysed using the four steps of descriptive qualitative analysis described by Giorgi, including comparing the experiences of both groups. Elderly people with malnutrition in the intervention group had more valued experiences regarding two-way communication with the IPCP team and felt it involved more comprehensive care for malnutrition management. Participants in the control group experienced communication between the health care providers and elderly people; however, it was not clear enough. There were overlapping roles among health care providers in the usual care. However, both groups shared the experience that family members are partners in nutritional management. Elderly people and their families in the intervention group have more valuable experiences related to two-way communication and comprehensive care. Family as partners was experienced in both the intervention and control groups.

Background:Primary care physicians (PCPs) play a critical role in disaster medicine. However, it is unclear how PCPs who provide chronic support to disaster-affected areas learn from their experiences. Methods:This qualitative study investigates the learnings of young PCPs who provided medical care during the chronic phase of the Great East Japan Earthquake disaster. Results:Thematic analysis of interviews with five physicians revealed the challenges faced by them and their learnings in providing medical support to disaster-affected areas. Conclusions:They not only learned medical skills but also humanistic aspects such as empathizing with the survivors' loss.

This chapter argues for the development of medical education and assessment as a scientific discipline. It describes the important facets of medical education research in general, and research into assessment in particular and offers a set of concrete ideas and recommendations. Yet in medical education, justification research can only establish one link in the chain connecting theoretical scientific findings with practice. Theoretical frameworks help focus research questions and underpin the operational definitions of variables or constructs. Where a theoretical framework tries to organize a set of related theories to explain complicated phenomena, a conceptual framework helps to interpret findings and give directions. The chapter describes four scientific categories in medical education and assessment: ideographic description; developmental, design-based research; justification research; and theoretical or clarification research. Two elements are key to establishing the value of research instruments: validity and reliability. Current views about validity are comparable with modem ideas in philosophy of science.

A preliminary study has found that being competent in their profession is a part of professional culture. This study aimed to evaluate the validity and reliability of collaborative competencies questionnaire and a translated ISS (Intercultural Sensitivity Scale). This study also assessed correlation between collaborative competencies and intercultural sensitivity. Methods This study used a cross-sectional study design and employed a questionnaire derived from a previous qualitative study on components of collaborative competencies. The questionnaire was further modified from literature data. A translated Bahasa Indonesia version of ISS was employed to assess cultural sensitivity when working with different health professionals. Results Of the 464-healthcare professionals in hospital and primary healthcare in Denpasar, invited, 292 responded to the online questionnaire. A response rate of 63.2% from 43 physicians, 103 nurses, 18 dentists, 87 midwives, 41 pharmacy professional was achieved. The ICCQ (Indonesian Collaborative Competencies Questionnaire) was found to be valid and reliable and had three competency themes; role and responsibility, value and ethics; and communication, coordination, and leadership. The translated ISS was also valid and reliable and had three themes defined as interaction engagement, interaction confidence, and interaction attention during collaboration. Healthcare professionals regardless of their workplace and profession had good collaborative competencies. Significant differences were found in the role and responsibility factor. This study also identified significant differences in the engagement theme during collaboration between physicians and nurses, but no significant differences in intercultural sensitivity between healthcare professionals was identified. Conclusion The questionnaires used in the current study were valid and reliable. There was a positive correlation between intercultural sensitivity and collaborative competencies (r = 0.315, p < 0.001) and a strong correlation found in the interaction confidence theme during collaboration with others (r = 0.785, p < 0.001). These findings suggest that healthcare professionals may need to have a structured training on intercultural sensitivity and collaboration early in their education as well as continuously in their practice.

BACKGROUND:Examining the predictors of summative assessment performance is important for improving educational programs and structuring appropriate learning environments for trainees. However, predictors of certification examination performance in pediatric postgraduate education have not been comprehensively investigated in Japan.METHODS:The Pediatric Board Examination database in Japan, which includes 1578 postgraduate trainees from 2015 to 2016, was analyzed. The examinations included multiple-choice questions (MCQs), case summary reports, and an interview, and the predictors for each of these components were investigated by multiple regression analysis.RESULTS:The number of examination attempts and the training duration were significant negative predictors of the scores for the MCQ, case summary, and interview. Employment at a community hospital or private university hospital were negative predictors of the MCQ and case summary score, respectively. Female sex and the number of academic presentations positively predicted the case summary and interview scores. The number of research publications was a positive predictor of the MCQ score, and employment at a community hospital was a positive predictor of the case summary score.CONCLUSION:This study found that delayed and repeated examination taking were negative predictors, while the scholarly activity of trainees was a positive predictor, of pediatric board certification examination performance.

BACKGROUND:The shortage of physicians in several specialties has been brought to public attention in several countries. However, little is known about factors affecting medical students' specialty choice. The objectives of our study were to illustrate medical students' career priority clusters and to assess their association with specialty preference. METHODS:We conducted a nationwide multicenter survey in 2015 at 17 medical schools. The study participants were asked their top three specialty preferences, demographic characteristics, and 14 career priority questions. Multilevel logistic regression models were used to determine the effect of each variable on student career choice. RESULTS:A total of 1264 responses were included in the analyses. The top five specialty choices were internal medicine: 833, general practice: 408, pediatrics: 372, surgery: 344, and emergency medicine: 244. An exploratory factor analysis mapped the 14 career priorities into 3-factor solution: "primary care orientation," "advanced and specific care," and "personal life orientation." Multilevel logistic regression models yielded satisfactory accuracy with the highest ROC curve (AUROC) noted in surgery (0.818), general practice (0.769), and emergency medicine (0.744). The career priorities under "primary care orientation" had positive association with choosing general practice, emergency medicine, internal medicine, and pediatrics. The "advanced and specific care" career priorities facilitated surgery and emergency medicine choice, while reducing the likelihood of choosing less procedure-oriented specialties, such as internal medicine, general practice, and pediatrics. CONCLUSIONS:Our results demonstrated medical students' career priorities and their association with specialty preference. Individualized career support may be beneficial for both medical students and each specialty fields.

Values-based practice is a new practice framework that promotes discussion focusing on the patient’s and healthcare professionals’ values for better clinical decision making. Our workshop was developed along with the framework of values-based practice. This workshop aimed to internalize diversity of values of both patients and health professionals and to rank interprofessional discussion as valuable to reach acceptable decision for both sides. The workshop involved healthcare professionals who worked in a public hospital in Bali. They were 6 medical doctors, 6 nurses, 4 nutritionist, 3 pharmacists, and 3 physiotherapists involved. The participants attended 1.5-hour lectures on comprehensive geriatric management and on interprofessional care for the elderly. In the next 1.5 hours the participants had simulated interprofessional conference for an elderly patient case. In the first half of the conference, participants formed groups of 5-6 people and played the roles of different healthcare members and a patient. The participants discussed the care management decision for the patient. In the latter half the participants started simulated discharge conference. After the conference, participants were asked to complete an evaluation questionnaire for this workshop. Twenty participants completed the questionnaire. Seven participants responded perfectly for the question “the workshop had internalized diversity of values of patients/healthcare professionals’ sides” and the remaining responded fairly. Meanwhile 40% of participants ranked the interprofessional discussion as perfectly valuable to negotiate recognition between patient and healthcare side. Open-ended questions revealed that the discussion enhanced healthcare professionals’ understanding of values of patients in delivering care for elderly patients. Interprofessional discussion allows internalization of values for both of patient and healthcare professionals’ sides.

ObjectivesGlobalisation has increased the opportunities for health professionals working in developed countries to provide clinical and educational support in developing countries. However, how these experiences contribute to the leadership competency of health professionals is unclear; therefore, this study explored this with the objective of analysing the process of developing individual leadership competency.DesignThis is a qualitative descriptive study. Qualitative descriptive study is widely used in healthcare research, particularly to describe the nature of various healthcare phenomena. Qualitative descriptive data were collected in face-to-face, semistructured interviews.SettingThe authors interviewed Japanese health professionals who participated in an international medical cooperation project as part of a multinational medical team between July 2017 and March 2018, and analysed and interpreted the data using a social constructivism paradigm.ParticipantsThe authors interviewed 20 research participants, including 5 nurses, 5 dentists and 10 physicians with an average of 15.3 years of clinical experience.ResultsThe interviews identified 58 emergent themes related to their leadership competency, 23 of which affected the actual medical care in their own institutions. The authors categorised the 58 emergent themes into seven competency areas: leadership concepts, teambuilding, direction setting, communication, business skills, working with others and self-development. The authors identified the relationships among each competency and identified differences between professions: nurses particularly reflected on their empathic attitudes towards patient after global clinical health experience; dentists tended to reflect on their business skills; physicians tended to reflect on their leadership concepts and teambuilding.ConclusionsThis study clarified the leadership competency gained through short-term global clinical health experience and the process of individual leadership competency development. The findings provide expected learning competency for those considering medical practice in developing or other countries in the future.

BACKGROUND:In 2015 in Japan 12.7% of people die at home. Since the government has no policy to increase the number of hospital beds, at-home deaths should inevitably increase in the near future. Previous researches regarding expected place of death have focused on end-of-life patients. The aim of this study is to clarify the percentage and factors of senior people who expect at-home deaths whether they are end-of-life or not.METHODS:Using cross-sectional questionnaire survey data which had been taken by a research group with the support from Tama City Medical Association (Tokyo) in 2014, univariable and multivariable logistic regression analyses were conducted to identify associations among factors. The dependent variable was the expected site of death and other factors were set as independent variables.RESULTS:Of 1781 respondents, 46.5% expected at-home deaths. Data from 1133 people were analyzed and 46.5% of those wanted at-home deaths. Factors significantly associated with expectation of at-home death were men, stand-alone houses for dwelling, expectation to continue life in Tama city, twosome life with the spouse, healthiness, and economic challenge.CONCLUSION:Percentage of those who expected at-home deaths was much higher than the latest percentage of at-home deaths. Some factors associated with expectation of at-home deaths in this study have never been discussed.

Purpose Competence decisions in health professions education require combining scores from multiple sources and identifying pass–fail decisions based on noncompensatory (required to pass all subcomponents) and compensatory scoring decisions. This study investigates consequences of combining scores, reliability, and implications for validity using a national examination with subcomponent assessments. Method National data were used from three years (2015, 2016, and 2017) of the Japan Primary Care Association Board Certification Examination, with four subcomponent assessments: Clinical Skills Assessment–Integrated Clinical Encounter (CSA-ICE), CSA–Communication and Interpersonal Skills (CSA-CIS), Multiple-Choice Questions (MCQ), and Portfolio. Generalizability theory was used to estimate variance components and reliability. Kane’s composite reliability and kappa decision consistency were used to examine the impact of using compensatory and noncompensatory scoring. Results Mean performance (n = 251) on the CSA-ICE, CSA-CIS, MCQ, and Portfolio subcomponent assessments were, respectively, 61% (SD = 11%), 67% (SD = 13%), 74% (SD = 8%), and 65% (SD = 9%); component-specific Φ-coefficient reliability ranged between, respectively, 0.57 and 0.67; 0.50 and 0.60; 0.65 and 0.76; and 0.87 and 0.89. Using a completely noncompensatory scoring approach on all four subcomponents, decision-consistency reliability was 0.33. Fully compensatory scoring yielded reliability of 0.86. Conclusions Assessing a range of abilities in making entrustment decisions requires considering the balance of assessment tools measuring distinct but related competencies. These results indicate that noncompensatory pass–fail decision making, which seems more congruent with competency-based education, may lead to much lower reliability than compensatory decision making when several assessment subcomponents are used.

Since medical education programs in Korea and Japan seem to mutually influence each other, this review article provides a history of Japanese medical education, focusing on the way in which it influenced and was influenced by Korean medical education. In the late 19th century, the University of Tokyo established the core medical school, disseminating its scholarship and system to other medical schools. In the early 20th century, the balance between the quality and quantity of medical education became a new issue; in response, Japan developed different levels of medical school, ranging from imperial universities to medical colleges and medical vocational schools. After World War II, all of Japan’s medical schools became part of the university system, which was heavily regulated by the Ministry of Education (MOE) Standard for the Establishment of Universities. In 1991, MOE deregulated the Standard; since 2000, several new systems have been established to regulate medical schools. These new approaches have included the Model Core Curriculum, 2-year mandatory postgraduate training, and a medical education accreditation system. Currently, most medical schools are nervous, as a result of tighter regulatory systems that include an accreditation system for undergraduate education and a specialty training system for postgraduate education.

Background Few studies have systematically explored factors affecting medical students’ general practice career choice. We conducted a nationwide multicenter survey (Japan MEdical Career of Students: JMECS) to examine factors associated with students’ general practice career aspirations in Japan, where it has been decided that general practice will be officially acknowledged as a new discipline. Methods From April to December 2015, we distributed a 21-item questionnaire to final year medical students in 17 medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item. Results A total of 1264 responses were included in the analyses. The top three specialty choice were internal medicine: 833 (65.9%), general practice: 408 (32.3%), and pediatrics: 372 (29.4%). Among demographic factors, “plan to inherit other’s practice” positively associated with choosing general practice, whereas “having physician parent” had negative correlation. After controlling for potential confounders, students who ranked the following items as highly important were more likely to choose general practice: “clinical diagnostic reasoning (adjusted odds ratio (aOR): 1.65, 95% CI 1.40–1.94)”, “community-oriented practice (aOR: 1.33, 95% CI 1.13–1.57)”, and” involvement in preventive medicine (aOR: 1.18, 95% CI 1.01–1.38)”. On the contrary, “acute care rather than chronic care”, “mastering advanced procedures”, and “depth rather than breadth of practice” were less likely to be associated with general practice aspiration. Conclusions Our nationwide multicenter survey found several features associated with general practice career aspirations: clinical diagnostic reasoning; community-oriented practice; and preventive medicine. These results can be fundamental to future research and the development of recruitment strategies.

Few studies have systematically explored factors affecting medical students’ general practice career choice. We conducted a nationwide multicenter survey (Japan MEdical Career of Students: JMECS) to examine factors associated with students’ general practice career aspirations in Japan, where it has been decided that general practice will be officially acknowledged as a new discipline. From April to December 2015, we distributed a 21-item questionnaire to final year medical students in 17 medical schools. The survey asked students about their top three career preferences from 19 specialty fields, their demographics and their career priorities. Multivariable logistic regression was used to determine the effect of each item. A total of 1264 responses were included in the analyses. The top three specialty choice were internal medicine: 833 (65.9%), general practice: 408 (32.3%), and pediatrics: 372 (29.4%). Among demographic factors, “plan to inherit other’s practice” positively associated with choosing general practice, whereas “having physician parent” had negative correlation. After controlling for potential confounders, students who ranked the following items as highly important were more likely to choose general practice: “clinical diagnostic reasoning (adjusted odds ratio (aOR): 1.65, 95% CI 1.40–1.94)”, “community-oriented practice (aOR: 1.33, 95% CI 1.13–1.57)”, and” involvement in preventive medicine (aOR: 1.18, 95% CI 1.01–1.38)”. On the contrary, “acute care rather than chronic care”, “mastering advanced procedures”, and “depth rather than breadth of practice” were less likely to be associated with general practice aspiration. Our nationwide multicenter survey found several features associated with general practice career aspirations: clinical diagnostic reasoning; community-oriented practice; and preventive medicine. These results can be fundamental to future research and the development of recruitment strategies.

Few studies have systematically explored factors affecting medical students’ general practice career choice. We conducted a nationwide multicenter survey (Japan MEdical Career of Students: JMECS) to examine factors associated with students’ general practice career aspirations in Japan, where it has been decided that general practice will be officially acknowledged as a new discipline.

Objectives: To explore the characteristic features and perceived value of free twice-weekly webinars predominantly focusing on the continuing professional development of primary care physicians in Japan. Methods: In this qualitative study, we conducted a focus group of the webinars' participants (n=6, a purposive sample). The discussion was recorded, with the recording subsequently transcribed, separated into meaningful segments and then open-coded until thematic saturation was reached. Concepts were generated through selective coding. Finally, the extracted concepts were grouped into categories. Results: Extracted concepts were grouped into five categories: technological breakthroughs, the creation of learning opportunities, external interaction, stimulation of internal interaction, and the advantages and disadvantages of nationwide expansion. The webinars were perceived to provide a comfortable learning climate, enabling physicians to teach one another, share their experiences and become virtual colleagues. The chat system stimulated real-time interaction between both a main speaker and participants and the participants. Participants were able to ask questions or give comments in a stress-free atmosphere. The webinars were found to elicit real-time, internal interaction within participating sites without interrupting the sessions. Participants also highly valued the absence of commercial sponsorship. The expansion of the webinars raised two concerns: the possibility of speakers becoming nervous and the increased burden on the organizers. Conclusions: The webinars have successfully allowed sharing of unbiased information and experiences in a comfortable, multifaceted interactive learning environment, enabling participants to feel connected. The chat system permitted interaction not feasible in face-to-face learning opportunities and has shown great promise as a means of online medical education.

Objective　To examine the short-term effects of an inter-professional educational program developed for physicians and other home care specialists to promote home care in the community.Methods　From March 2012 to January 2013, an inter-professional educational program (IEP) was held four times in three suburban areas (Kashiwa city and Matsudo city in the Chiba prefecture, and Omori district in the Ota ward). This program aimed to motivate physicians to increase the number of home visits and to encourage home care professionals to work together in the same community areas by promoting inter-professional work (IPW). The participants were physicians, home-visit nurses, and other home care professionals recommended by community-level professional associations. The participants attended a 1.5-day multi-professional IEP. Pre- and post-program questionnaires were used to collect information on home care knowledge and practical skills (26 indexes, 1-4 scale), attitudes toward home care practice (4 indexes, 1-6 scale), and IPW (13 indexes, 1-4 scale). Data from all of the participants without labels about the type of professionals were excluded, and both pre-test and post-test responses were used in the analysis. A Wilcoxon signed-rank test and a paired t-test were conducted to compare pre- and post-program questionnaire responses stratified for physicians and other professionals, and the effect size was calculated.Results　The total number of participants for the four programs was 256, and data from 162 (63.3%) were analyzed. The physicians numbered 19 (11.7%), while other professionals numbered 143 (88.3%). Attending this program helped participants obtain home care knowledge of IPW and a practical view of home care. Furthermore, indexes about IPW consisted of two factors: cooperation and interaction; non-physician home care professionals increased their interactions with physicians, other professionals increased their cooperation with other professionals, and physicians increased their cooperation with other physicians.Conclusion　Short-term effects to motivate physicians to increase home visits were limited. However, physicians obtained a practical view of home care by attending the IEP. Also, the participation of physicians and other home care professionals in this program triggered the beginning of IPW in suburban areas. This program is feasible when adapted for regional differences.