Characteristics of University Hospitals Implementing the Postgraduate Clinical Training "Tasukigake Method" and Their Correlation with Program Popularity: A Cross-Sectional Study

PURPOSE

In 2004, the postgraduate clinical training system in Japan was radically revised by introducing a super-rotation matching system. Although postgraduate clinical training became a mandatory 2 years of training, the program and operation were left to each facility's discretion, leading to training-program popularity differences. The Japanese Tasukigake method provides clinical training in which "hospitals where junior residents work" and "external hospitals/clinics that provide clinical training" conduct clinical training alternately on a 1-year basis. The study aimed to identify the characteristics of university hospitals that implement the Tasukigake method to help educators and medical institutions create more attractive and effective programs.

METHODS

All 81 university main hospitals were included in this cross-sectional study. The information regarding Tasukigake method implementation was collected from the facilities' websites. The training program's matching rate (popularity) was calculated from the Japan Residency Matching Program's interim report data (academic 2020). We used multiple linear regression analysis to evaluate the association between Tasukigake method implementation, program popularity, and university hospital characteristics.

RESULTS

The Tasukigake method was implemented by 55 (67.9%) university hospitals, significantly more by public university hospitals (44/55, 80%) than by private (11/55, 20%) (P < 0.01) and by hospitals without branches (38/55, 69.1%) than with branches (17/55, 30.9%) (P < 0.001). The maximum hiring capacity of junior residents (P = 0.015) and number of branches (P < 0.001) were negatively correlated, and the population of the hospital's city (P = 0.003) and salary/month (P = 0.011) were positively correlated with the Tasukigake method implementation. Multiple linear regression analysis results showed no significant association between the matching rate (popularity) and Tasukigake method implementation.

CONCLUSION

The results show no association between Tasukigake method and program popularity; also, highly specialized university hospitals in cities with fewer branch hospitals were more likely to implement the Tasukigake method.

Resident Perspectives on the Value of Rural General Surgery Rotations: It's Not Just About the Cases

PURPOSE

Understand the scope of cases that residents participate in during rural general surgery rotations and the value residents and program directors find in such rotations. In turn, our goal is to add to the ongoing conversation the value exposure to rural surgery brings to surgery training.

METHODS

Qualitative study analyzed reviews of residents' self-reported case lists and field notes from exit interviews with the site director.

RESULTS

Trainees participated in an average of 105 cases during the rotation, including basic and advanced endoscopy along with exposure to a wide array of surgical cases. Residents had exposure to the rural facility and its staff and participated in a busy outpatient surgical clinic, the hospital, and community activities. We received overwhelmingly positive qualitative feedback from residents regarding how this rural rotation advanced their skills, helped prepare them for life after residency, and for some confirmed their plans to practice in a rural location.

CONCLUSION

With the decline in the number of rural general surgeons and projected continuance of this trend, it is important to understand how trainees view their residency experiences and how those experiences may be shaping their outlook on career choices. Our single-site, qualitative study showed that a rural general surgery rotation during residency has broad importance and value in general surgery resident training. Having a rural rotation also allowed residents to gain understanding of a rural lifestyle, workflow, and the social fabric including the rural surgeons' connections with their communities.