Family Medicine Education at a Rural Hospital in Japan: Impact on Institution and Trainees

Evolution of the roles of family physicians through collaboration with rehabilitation therapists in rural community hospitals: a grounded theory approach

BACKGROUND

The role of rural family physicians continues to evolve to accommodate the comprehensive care needs of aging societies. For older individuals in rural areas, rehabilitation is vital to ensure that they can continue to perform activities of daily living. In this population, a smooth discharge following periods of hospitalization is essential and requires management of multimorbidity, and rehabilitation therapists may require support from family physicians to achieve optimal outcomes. Therefore, this study aimed to investigate changes in the roles of rural family physicians in patient rehabilitation.

METHODS

An ethnographic analysis was conducted with rural family physicians and rehabilitation therapists at a rural Japanese hospital. A constructivist grounded theory approach was applied as a qualitative research method. Data were collected from the participants via field notes and semi-structured interviews.

RESULTS

Using a grounded theory approach, the following three themes were developed regarding the establishment of effective interprofessional collaboration between family physicians and therapists in the rehabilitation of older patients in rural communities: 1) establishment of mutual understanding and the perception of psychological safety; 2) improvement of relationships between healthcare professionals and their patients; and 3) creation of new roles in rural family medicine to meet evolving needs.

CONCLUSION

Ensuring continual dialogue between family medicine and rehabilitation departments helped to establish understanding, enhance knowledge, and heighten mutual respect among healthcare workers, making the work more enjoyable. Continuous collaboration between departments also improved relationships between professionals and their patients, establishing trust in collaborative treatment paradigms and supporting patient-centered approaches to family medicine. Within this framework, understanding the capabilities of family physicians can lead to the establishment of new roles for them in rural hospitals. Family medicine plays a vital role in geriatric care in community hospitals, especially in rural primary care settings. The role of family medicine in hospitals should be investigated in other settings to improve geriatric care and promote mutual learning and improvement among healthcare professionals.

The Quality of Family Medicine Team Conferences Through the Lens of a Director: An Autoethnography

Introduction In rural medical settings, team conferences are essential for effective patient care, especially given the challenges of limited resources and personnel. These conferences promote collaborative discussions on patient management and serve as vital educational sessions. This study explores the dynamics and efficacy of team conferences in the family medicine department of a rural hospital to optimize patient care and educational outcomes. Methods This qualitative study used autoethnography at Unnan City Hospital, Unnan, Japan. Data collection included semi-structured interviews, direct observation, reflective field notes, and informal conversations with medical students, junior residents, and general medicine trainees. The focus was on conference interactions, educational content, and operational challenges. Data analysis involved coding and theming, with ongoing discussions among researchers and participants to refine findings. Results Three key themes emerged. First, patient outcomes suffered from a lack of professional awareness. Second, mutual understanding and individual autonomy enhanced team quality. Third, team healthcare quality improved through diverse and inclusive learning experiences. Effective facilitation, structured time management, and integrating practical bedside learning with theoretical discussions were crucial for optimizing team conferences. Psychological safety, respect for individual differences, and maintaining motivation were essential for productive team interactions. Conclusion The study highlights the importance of effective facilitation, time management, and integrating practical and theoretical learning in enhancing team conferences in rural medical settings. Psychological safety and mutual respect are vital for fostering a collaborative and motivated team environment. Addressing these factors can improve patient care and educational experiences. Future research should include diverse settings and quantitative measures to validate and refine these insights, enhancing team conferences in rural healthcare environments.

Perceptions of C-reactive Protein Measurement Among General Physicians: A Qualitative Study on Diagnostic Value, Clinical Dilemmas, and Professional Growth

Introduction C-reactive protein (CRP) is a widely used laboratory test for assessing infections, inflammatory diseases, and malignancies, playing a critical role in clinical diagnosis and management. Despite its utility, CRP measurement practices vary among physicians, often influenced by training and clinical experience. This study explores general physicians' perceptions of CRP measurement in clinical practice, focusing on its diagnostic value, associated dilemmas, and impact on clinical growth and decision-making. Methods This qualitative study employed thematic analysis to examine the perceptions of general physicians at Unnan City Hospital, Unnan, Japan regarding CRP measurement. Sixteen general physicians were selected through purposive sampling and participated in one-on-one semi-structured interviews. The interviews were conducted in Japanese, recorded, transcribed verbatim, and analyzed inductively to identify themes. The analysis involved iterative coding and extensive discussion among the research team to ensure the reliability and validity of the findings. Results Three main themes emerged from the analysis: the usefulness of CRP for diagnosis and collaboration, dilemmas associated with CRP usage, and clinical growth through reconsideration of CRP's importance. Physicians highlighted CRP's value in distinguishing inflammatory from non-inflammatory diseases, predicting clinical courses, and facilitating communication with specialists. However, dilemmas arose from discrepancies between CRP levels and clinical symptoms, the influence of various non-specific factors, and habitual testing driven by training, leading to unnecessary tests and diminished clinical skills. Participants recognized the need to view CRP as one of many diagnostic tools, cultivate a habit of questioning its necessity, and reflect on its use to enhance clinical reasoning and professional growth. Conclusions CRP measurement is a valuable diagnostic tool, but effective use requires a balanced and critical approach. Discrepancies between CRP levels and clinical symptoms can lead to over-reliance on laboratory results and unnecessary testing. General physicians should integrate CRP within a broader diagnostic framework, combining it with patient history, physical examination, and other tests. Reflecting on the necessity and implications of CRP measurements can improve clinical reasoning and decision-making, ultimately enhancing patient care and resource management. Future research should explore similar perceptions in diverse healthcare settings and develop strategies to optimize CRP use in clinical practice.

Decision-Making in the Admission of Older Patients: A Thematic Analysis From Multiple-Stakeholder Perspectives

Introduction As rural healthcare systems grapple with an aging population, understanding the factors influencing hospital admission decisions for elderly patients is crucial. This study explores the complex interplay of medical, social, and psychological factors that shape these decisions, as perceived by multiple stakeholders, including physicians, patients, and their families. Method This study was conducted in Unnan City Hospital, a rural community hospital in Unnan, Japan, using a qualitative thematic analysis approach. Participants included general physicians, patients admitted more than once, and their families. One-on-one semi-structured interviews were conducted in Japanese, recorded, transcribed, and analyzed. The analysis focused on identifying themes that influence decision-making processes regarding the admission of elderly patients. The research team, comprising family medicine, public health, and community health care experts, ensured a multi-perspective approach through collaborative coding and discussion. Results Three primary themes emerged from the analysis: "dilemma between medical indications and social admissions," "risks and benefits of hospitalization in response to unpredictable changes in the elderly," and "social factors intertwined with the multilayered nature of hospital admission decisions." Physicians reported a conflict between their medical training and the social needs of patients, often leading to stress and negative emotions. The unpredictable health trajectories of elderly patients necessitated a nuanced risk-benefit analysis for hospitalization. In addition, social factors, such as bed availability, patient's living environment, and psychosocial contexts, significantly influenced admission decisions. Conclusion The study highlights the need for a more holistic approach to medical education and practice, especially in rural healthcare settings. Recognizing the complexity of factors influencing hospitalization decisions, including medical, social, and individual patient circumstances, is vital. The findings underscore the importance of integrating biopsychosocial aspects into the decision-making process for the hospitalization of elderly patients, advocating for patient-centered care that respects the unique challenges in rural healthcare environments.

Enhancing the Comprehensive Integration of General Medicine Education in Rural Japan: A Thematic Analysis

Introduction The dynamism inherent in general medicine, particularly since its recognition as a distinct specialty in 2019, necessitates constant revision and refinement of the curriculum. As general medicine programs proliferate throughout Japan, understanding the revision processes, especially concerning the pivotal concept of lateral integrations, becomes critical. Lateral integrations, which pertain to the interconnectedness between learning contents and contexts, ensure a cohesive learning experience for medical students. In this study, we sought to explore the intricacies and experiences of revising these integrations within the general medicine curriculum. Methods A qualitative thematic analysis rooted in relativist ontology and constructivist epistemology was conducted. The research was carried out at the Unnan City Hospital, Shimane Prefecture, focusing on trainees transitioning between diverse medical settings. Semi-structured interviews were employed to gauge perceptions regarding these transitions, and thematic analysis was used to interpret the data. Reflexivity was ensured by the diverse expertise of the research team, with rigorous discussions to mitigate biases. Results The following four themes emerged from the analysis: (1) confusion due to the transition from acute to chronic clinical settings, with trainees feeling overwhelmed and resistant to focus solely on chronic care; (2) monotony due to the loss of some clinical experiences, indicating challenges in maintaining motivation after transitioning to clinics; (3) disconnection between learning contexts, where participants desired stronger links to their primary training hospitals; and (4) anxiety as community leaders, highlighting the need for instilling leadership skills and a deeper understanding of diverse community healthcare professions. Conclusion This study shed light on the tangible challenges faced by general medicine trainees during transitions between different learning environments. These insights are valuable for educators in refining curriculum structures, ensuring smooth transitions, and enhancing lateral integrations. Addressing these challenges will bolster the quality and relevance of general medicine education in Japan, fostering the creation of adaptable, well-rounded physicians who are attuned to the multifaceted needs of their communities.

Importance of Inclusive Education in General Medicine Through the Perception of Medical Trainees: A Thematic Analysis

Background General medical education plays a pivotal role in ensuring holistic care in the context of rapidly aging populations. Japan's demographic trends underscore the significance of general medicine in elevating community care standards. Understanding and catering to the aspirations, perceptions, and ideals of medical students and residents can significantly augment the effectiveness of general medicine education. This research aimed to explore the perspectives of medical students on the ideal tenets of general medicine education in rural Japan. Method A qualitative approach was employed, focusing on medical students and residents with a keen interest in general medicine, all of whom underwent training at a rural-based Japanese hospital. Through semi-structured interviews, insightful data were garnered and subsequently subjected to a comprehensive thematic analysis. Results The thematic analysis unearthed three core themes: commitment of educators in valuing learner diversity, promotion and understanding of general medicine, and inclusivity and diversity in educational institutions. The first highlighted the centrality of educators' sincerity, emphasizing the importance of genuine, sustained interactions that foster mutual respect and collaborative learning. The second theme underscored the need to elucidate the intrinsic value and modern-day relevance of general medicine, emphasizing its deep roots in community-based practices and its continuity with long-standing medical traditions. The third theme spotlighted the crucial role of comprehensive medical education in fostering enriching dialogues, embracing varied learning experiences, and capitalizing on the distinctive strengths of educational institutions. Conclusion These findings underscore the pivotal shift required in pedagogical approaches to comprehensive medical education. A genuine collaborative educator-learner relationship, the reframing of general medicine's significance rooted in community welfare, and a strong emphasis on inclusivity and dialogue form the cornerstones of these insights. This study provides a touchstone for restructuring educational strategies, aiming for a more integrated, genuine, and encompassing framework that is particularly vital for the effective propagation of general medicine in regions such as Japan.

Shared Reading as a Community of Practice for Overcoming the Generation Gap and Improving Psychological Safety in Rural Family Medicine Education: A Grounded-Theory Approach

Background A community of practice (CoP) is essential for continuous professional development in family medicine. A CoP in medical education comprises a group of individuals who share common interests and learn and share knowledge, skills, and attitudes. The generation gap between teachers and learners can influence their effective collaboration in family medicine education. To address this issue, shared reading, which involves group discussions on medical texts, effectively promotes intergenerational learning within a CoP. Shared reading is particularly beneficial in rural contexts, where medical resources are scarce, and the generation gap between teachers and learners is wide. This study examines how shared reading facilitates learning and practice among family medicine trainees in rural areas. Methods This qualitative study utilized a grounded-theory approach. It involved the participation of eight family medicine residents, five junior residents, and seven medical students from Unnan City Hospital, Japan, in shared reading sessions between August 2022 and March 2023. Semi-structured interviews were conducted with all participants after the sessions. Results Data analysis using the grounded-theory approach yielded three themes: facilitating learning and motivation, respectful collaboration with teachers, and developing a relationship that fosters psychological safety. First, through shared reading, the participants had opportunities to learn about medical issues and engage in continual dialogues with colleagues and teachers. Second, the participants felt motivated to apply their newly acquired knowledge at work and collaborate with teachers. Third, they acquired self-regulated learning skills by adapting their motivations to their interests and experiences. Increased interaction between participants and teachers during the sessions helped mitigate the generation gap and enhanced psychological safety. Conclusions Shared reading effectively promotes continuous learning and motivates medical learners to apply their knowledge and collaborate with teachers. It facilitates the development of self-regulated learning skills, helps mitigate the generation gap, and enhances psychological safety among educators and learners in rural medical education.

The Association Between Vitamin B1 Deficiency and Anemia Among Elderly Patients at a Rural Hospital in Japan: A Cross-Sectional Study

Background and objective Vitamin B1 deficiency can cause a variety of abnormalities in the neuropsychiatric, cardiovascular, and other systems. This condition can be rapidly corrected and prevented from progressing to irreversible sequelae through vitamin B1 supplementation. Therefore, early detection of and intervention in vitamin B1 deficiency are essential. We have previously demonstrated an association between vitamin B1 deficiency and appetite loss in hospitalized older adult patients in rural Japan. This study aimed to examine the additional predictors of vitamin B1 deficiency in patients with appetite loss and other symptoms suggestive of vitamin B1 deficiency. Material and methods This cross-sectional study involved 519 patients admitted to a rural hospital between April 2020 and March 2022. Data on vitamin B1 levels, age, sex, BMI, albumin levels, functional independence measure (FIM), hemoglobin levels, Charlson Comorbidity Index (CCI), and medications were collected from electronic medical records. Vitamin B1 deficiency was defined as serum vitamin B1 level <20 µg/dL. Data were analyzed using the Mann-Whitney U test, Student's t-test, and chi-square test, followed by multivariate logistic regression to examine the predictors of vitamin B1 deficiency. Results A total of 113 patients (21.5%) were found to be vitamin B1-deficient. Multivariate logistic regression showed that anemia was significantly associated with vitamin B1 deficiency [adjusted odds ratio (AOR): 1.71, 95% confidence interval (CI): 1.07-2.73, p<0.05]. Conclusion Based on our findings, anemia is significantly associated with vitamin B1 deficiency in hospitalized Japanese patients living in rural areas. Therefore, physicians should be mindful of the possibility of vitamin B1 deficiency in hospitalized patients with anemia.

Case Report-Driven Medical Education in Rural Family Medicine Education: A Thematic Analysis

Case-based education (CBE) is a teaching method in which learners work on real-life cases to learn and apply concepts and skills they have been taught. Case report-driven medical education using the CBE framework can effectively facilitate student and resident learning, and entice them to become involved in actual clinical practice. Specific case report-driven medical education methods and learning outcomes are not clarified. This study aimed to clarify the specific learning processes and outcomes of case report-driven medical education in rural community-based medical education. Using a qualitative design based on a thematic analysis approach, data were collected through semi-structured interviews. The study participants were medical students and residents in training at a rural Japanese community hospital. Fifty-one case reports were completed and published in Cureus from April 2021 to March 2023. Participants learned about various difficulties related to volatility, uncertainty, complexity, and ambiguity (VUCA) in the medical care of various older patients, which increased their interest in family medicine. They appreciated the importance of case reports in academic careers and how their responsibilities as researchers increase with collaboration. Case report-driven medical education in community hospitals can drive medical students' and junior residents' learning regarding family medicine in the VUCA world.

Heyde Syndrome Complicated by Essential Thrombocythemia: A Case Report

Heyde syndrome is a multisystem disorder characterized by the triad of aortic stenosis (AS), gastrointestinal bleeding, and acquired von Willebrand syndrome. Age-related degeneration is the most common cause of aortic stenosis and is frequently encountered in today's aging society. Approximately 20% of patients with severe aortic stenosis have Heyde syndrome. We encountered an older patient with primary thrombocytosis who was brought to a rural community hospital with bloody stools and was diagnosed with bleeding from an intestinal arteriovenous malformation. A final diagnosis of Heyde syndrome was made based on the presence of severe aortic stenosis and the presence of schistocytes in peripheral blood smears. Valvular diseases can complicate chronic hematological diseases. When the rapid progression of anemia and segmented red blood cells in the peripheral blood are observed in patients with severe aortic stenosis, Heyde syndrome should be considered based on peripheral blood smears and clinical course.

The Effectiveness of Family Medicine-Driven Interprofessional Collaboration on the Readmission Rate of Older Patients

Interprofessional collaboration (IPC) for older patient care among family physicians, dentists, therapists, nutritionists, nurses, and pharmacists in the rural hospital care of older patients could improve the hospital readmission rate. However, there is a lack of interventional studies on IPC for improving the readmission rate among Japanese older patients in rural hospitals. This quasi-experimental study was performed on patients >65 years who were discharged from a rural community hospital. The intervention was IPC implementation with effective information sharing and comprehensive management of older patients’ conditions for effective discharge and readmission prevention; implementation started on 1 April 2021. The study lasted 2 years, from 1 April 2021 to 31 March 2022 for the intervention group and from 1 April 2020 to 31 March 2021 for the comparison group. The average participant age was 79.86 (standard deviation = 15.38) years and the proportion of men was 45.0%. The Cox hazard model revealed that IPC intervention could reduce the readmission rate after adjustment for sex, serum albumin, polypharmacy, dependent condition, and Charlson Comorbidity Index score (hazard ratio = 0.66, 95% confidence interval: 0.54−0.81). Rural IPC intervention can improve inpatient care for older patients and decrease readmission rates. Thus, for effective rural IPC interventions, family physicians in hospitals should proactively collaborate with various medical professionals to improve inpatient health outcomes.

Acute Exacerbation of Hypereosinophilic Syndrome Complicated With Dermatitis, Enteritis, and Myositis: A Case Report

Hypereosinophilic syndrome is a disease that presents with a variety of symptoms caused by an abnormal rise in eosinophils in the blood and infiltration into various organs. Typical symptoms include skin symptoms and diarrhea. Diagnosis may be difficult because of the self-limiting phases of the disease with various symptoms. In addition, diagnosis may be delayed by the presence of rare concomitant symptoms, such as muscle pain and numbness. Here, we report the case of a 67-year-old patient with asymptomatic hypereosinophilia with chronic diarrhea, acute-onset weakness, and myalgia. We diagnosed eosinophilic gastroenteropathy, chronic urticaria, and eosinophilic myositis through multiple biopsies of the skin and colon. This case shows that chronic hypereosinophilic syndrome can be exacerbated transiently with acute symptoms and that prompt examination and treatment of hypereosinophilic syndrome based on the involved organs is recommended in a background of eosinophilia.

Device-Related Thrombotic Microangiopathy in an Elderly Patient With a History of Aortic Surgery

Thrombotic microangiopathy (TMA) is caused by several diseases, including infections, congenital and autoimmune diseases, and malignancies, usually requiring admission to intensive care. The primary pathophysiology of TMA is microvascular thrombosis, and its diagnosis is based on the presence of hemolysis, thrombocytopenia, schistocytes in a blood smear, and organ damage. Among secondary TMAs, device-related TMA could be difficult to diagnose if device implementation was performed years ago. We report the case of an 87-year-old woman with a chief complaint of dyspnea diagnosed with device-related TMA. In device-related TMA, thrombogenesis/thrombocytopenia is triggered by hemolysis/fragmented red blood cells. However, in other TMAs, thrombogenesis or thrombocytopenia is preceded by hemolysis and the presence of fragmented red blood cells. Thus, rapid plasma exchange is necessary to address TMA pathogenesis. TMA can be managed in a community hospital if the facility has access to plasma exchange. It is possible to treat complex TMAs even in community hospitals by carefully considering their pathophysiology. Additionally, improving the quality of general practice in community hospitals will allow for more effective diagnosis and treatment of TMAs.

Rural Easy Japanese as a Method of Mitigating Language Barriers Among Foreigners Seeking Medical Care in Rural Japan

Mitigating difficulties in communication is vital in multicultural societies. Particularly, foreigners face greater communication difficulties because of language barriers, posing a challenge to both themselves and indigenous people. In Japan, the increase in the number of foreigners has driven the use of Easy Japanese, a free online program of Japanese language lessons. Easy Japanese can facilitate communication between medical professionals and foreigners. Easy Japanese is mainly characterized by short sentences, an upfront conclusion, and avoiding polite Japanese words when collaborating with translators. This communication method should prevail not only in urban areas but also in rural areas, and can help individuals in rural contexts prepare for an increase in the number of foreigners.

Bedside Teaching in Rural Family Medicine Education in Japan

Bedside teaching is essential in family medicine education so that residents may learn about various clinical conditions and develop professional skills. In particular, bedside teaching is useful in a rural context because rural family medicine deals with a broad scope of biopsychosocial problems among older patients. Accordingly, based on an inductive thematic analysis, we propose a framework for bedside teaching in rural family medicine education, which consists of four themes: accommodation of different learners, near-peer learning, the change in engagement of medical teachers in bedside teaching, and driving interpersonal collaboration. Bedside teaching can promote interactions between different medical learners. Near-peer learning in bedside teaching compensates for the limited availability of educators and improves learners’ motivation for self-directed learning. Through bedside teaching, medical learners can observe each other and provide constructive feedback, thereby improving their relationships and learning. For effective bedside teaching, medical educators should facilitate learners and collaborate with other medical professionals. Additionally, bedside teaching should accommodate a variety of learners, facilitate near-peer and self-directed learning, educators’ involvement based on cognitive apprenticeship, along with interprofessional collaboration with nurses. Interprofessional collaboration between rural family medicine teachers, learners, and nurses may improve the quality of patient care due to the increased understanding between patients and other medical staff in hospitals.

Reflection in Rural Family Medicine Education

Reflection in medical education is vital for students' development as professionals. The lack of medical educators in rural family medicine can impinge on the effective reflection of residents' learning. Hence, based on qualitative research, we proposed a framework regarding reflection in rural family medicine education, indicating when, where, and how reflection is performed and progresses. The contents of reflection include clinical issues regarding knowledge and skills, professionalism in clinical decisions, and work-life balance. The settings of reflection include conference rooms, clinical wards, residents' desks, and hospital hallways. The timing of educational reflection includes during and after patient examination and discussion with various professionals, before finishing work, and during "doorknob" times (right before going back home). Rural medical teachers need competence as clinicians and medical educators to promote learning in medical residents and sustain rural medical care. Furthermore, medical teachers must communicate and collaborate with medical residents and nurses for educational reflection to take place in rural family medicine education, especially regarding professionalism. In rural family medicine education, reflection can be performed in various clinical situations through collaboration with learners and various medical professionals, aiding the enrichment of residents' learning and sustainability of rural medical care.

Factors Associated with Motivation for General Medicine among Rural Medical Students: A Cross-Sectional Study

General medicine, as the Japanese version of primary care or family medicine, is critical for healthcare in aging societies. Medical students’ perceptions of general medicine and education might be associated with changes in the number of general physicians. This study aimed to clarify the association between these perceptions and students’ preferences for general medicine. A cross-sectional survey was conducted among Japanese medical students using a questionnaire on their perceptions regarding general medicine, background, and preferences for general medicine (knowledge, interest, motivation, and intention). The response rate was 70.3% (490/697). There was a large percentage gap between interest and motivation; therefore, a logistic regression analysis was performed to investigate the cause of this difference. The perceptions that general medicine meets the needs of society and the lack of general medicine educators were positively associated with motivation to become a general physician. In contrast, perceptions of lack of exposure to general medicine beyond the curriculum and inaccessibility were negatively associated with motivation. Medical students’ motivation to pursue general medicine may increase with improvements in flexible general medicine education and accessibility. Future research should investigate the relationship between students’ perceptions of general medicine and their motivation to become general physicians through longitudinal studies.

Nurses’ Contributions in Rural Family Medicine Education: A Mixed-Method Approach

Family medicine residents frequently collaborate with nurses regarding clinical decisions and treatments, which contributes to their education. In rural areas, these residents experience a wider scope of practice by collaborating with nurses. However, nurses’ contributions to rural family medicine education have not been clarified. This study measured the contributions of 88 rural community hospital nurses to family medicine education using a quantitative questionnaire and interviews. The interviews were recorded, transcribed verbatim, and analyzed using the grounded theory approach. Nurses’ average clinical experience was 20.16 years. Nurses’ contributions to the roles of teacher and provider of emotional support were statistically lower among participants working in acute care wards than those working in chronic care wards (p = 0.024 and 0.047, respectively). The qualitative analysis indicated that rural nurses’ contributions to family medicine education focused on professionalism, interprofessional collaboration, and respect for nurses’ working culture and competence. Additionally, nurses struggled to educate medical residents amid their busy routine; this education should be supported by other professionals. Rural family medicine education should incorporate clinical nurses as educators for professionalism and interprofessional collaboration and as facilitators of residents’ transition to new workplaces. Subsequently, other professionals should be more actively involved in improving education quality.

Effect of Residents-as-Teachers in Rural Community-Based Medical Education on the Learning of Medical Students and Residents: A Thematic Analysis

Residents-as-teachers (RaT) is a theoretical framework emphasizing the significance of the similar learning background of teachers and learners. In Japan, community-based medical education (CBME) is a practical approach to teaching family medicine. This study aimed to investigate the impact and challenges of RaT on the learning of medical students and residents in CBME at a rural community hospital in Japan. Over the course of a year, the researchers conducted one-on-one interviews with three residents and ten medical students participating in family medicine training at the hospital. The interviews were recorded and transcribed verbatim. Grounded theory was used in the data analysis to clarify the findings. Three key themes emerged from the research: lack of educational experience with RaT, effectiveness of RaT, and challenges of RaT. Although participants were prejudiced against RaT, they felt its implementation could facilitate the establishment of beneficial relationships between learners and teachers. They were also able to participate in medical teams effectively. The findings suggest that the increased participation of senior doctors in RaT could strengthen its learning effects. RaT in rural CBME should be applied in various contexts, and its effectiveness should be further investigated both qualitatively and quantitatively.

Educating Medical Students for Practice in a Changing Landscape: An Analysis of Public Health Topics within Current Indonesian Medical Programs

Medical curricula need to prepare doctors for emerging health issues and increased public health roles. With medical schools spread over a vast geographical region of Indonesia, ensuring that all schools meet appropriate standards in the quality of subjects, course delivery, and performance is challenging. This paper explores the inclusion of public health subjects in medical education across the country. A search of all subjects (n = 388) who were taught in 28 representative medical schools was undertaken and categorized by geographical region, accreditation grade, and according to the Indonesian National Standard of Medical Competency. Basic biomedicine subjects had the highest representation in the curricula (49.2 ± 8.7%) and public health was generally well represented (14.3 ± 5.0%). All medical schools complied with the minimum of 144 credits required for the bachelor stage. No statistically significant difference was found between school accreditation grades, or when an overall comparison of programs in Eastern and Western regions was undertaken. The Indonesian medical schools included have relatively good curriculum transparency, and public health is an important feature in their curricula. Further research is critical to identify the materials taught, the relevance and the applicability of the specific public health content, and the assessment of public health competency of graduates.

The Perception of Rural Medical Students Regarding the Future of General Medicine: A Thematic Analysis

Although the demand for general physicians has increased in Japan because of its aging population, medical universities primarily provide organ-based education; thus, medical students do not receive sufficient general medical education. The number of residents focusing on general medicine remains low; therefore, to understand the present situation regarding general medicine education, we attempted to clarify the views of medical students and the factors influencing them. In this qualitative study, semi-structured interviews were conducted in 12 medical students at Shimane University, and the results were analyzed through thematic analysis. The results indicated the emergence of three themes and 14 concepts. The three overarching themes were as follows: hopes for the field of general medicine, gaps between ideal and reality of general medicine, and factors affecting students’ motivation for specialization in general medicine. Medical students had a positive impression of general medicine and believed that it has potential for further development; however, they felt a gap between their ideals and reality (i.e., unclear expertise). Factors creating this gap included poorly developed education and medical policies. We need to restructure general medicine education based on the participants’ perceptions by establishing collaborative curricula between universities and community hospitals and by increasing students’ exposure to general medicine.