Publisher：BMJ Open Quality  

Purpose This study aimed to examine safety culture among Japanese medical residents through a comparative analysis of university and community hospitals and an investigation of the factors related to safety culture. Method This nationwide cross-sectional study used a survey to assess first and second-year medical residents' perception of safety culture. We adapted nine key items from the Safety Awareness Questionnaire to the Japanese training environment and healthcare system. Additionally, we explored specific factors relevant to safety culture, such as gender, year of graduation, age, number of emergency room duties per month, average number of admissions per day, incident experience, incident reporting experience, barriers to incident reporting and safety culture. We analysed the data using descriptive statistics and multivariate logistic regression analysis. Results We included 5289 residents (88.6%) from community training hospitals and 679 residents (11.4%) from university hospitals. A comparative analysis of safety culture between the two groups on nine representative questions revealed that the percentage of residents who reported a positive atmosphere at their institution was significantly lower at university hospitals (81.7%) than at community hospitals (87.8%) (p<0.001). The other items were also significantly lower for university hospital residents. After adjusting for multivariate logistic analysis, university hospital training remained significantly and negatively associated with all nine safety culture items. Furthermore, we also found that university hospital residents perceived a significantly lower level of safety culture than community hospital residents. Implications Further research and discussion on medical professionals' perception of safety culture in their institutions as well as other healthcare professionals' experiences are necessary to identify possible explanations for our findings and develop strategies for improvement.

DOI： 10.1136/bmjoq-2023-002419

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Scopus

PubMed

Publisher：Postgraduate Medical Journal  

Purpose: In 2024, the Japanese government will enforce a maximum 80-hour weekly duty hours (DHs) regulation for medical residents. Although this reduction in weekly DHs could increase the self-study time (SST) of these residents, the relationship between these two variables remains unclear. The aim of the study was to investigate the relationship between the SST and DHs of residents in Japan. Methods: In this nationwide cross-sectional study, the subjects were candidates of the General Medicine In-Training Examination in the 2020 academic year. We administered questionnaires and categorically asked questions regarding daily SST and weekly DHs during the training period. To account for hospital variability, proportional odds regression models with generalized estimating equations were used to analyse the association between SST and DHs. Results: Of the surveyed 6117 residents, 32.0% were female, 49.1% were postgraduate year-1 residents, 83.8% were affiliated with community hospitals, and 19.9% worked for ≥80 hours/week. Multivariable analysis revealed that residents working ≥80 hours/week spent more time on self-study than those working 60–70 hours/week. Conversely, residents who worked <50 hours/week spent less time on self-study than those who worked 60–70 hours/week. The factors associated with longer SST were sex, postgraduate year, career aspiration for internal medicine, affiliation with community hospitals, academic involvement, and well-being. Conclusion: Residents with long DHs had longer SSTs than residents with short DHs. Future DH restrictions may not increase but rather decrease resident SST. Effective measures to encourage self-study are required, as DH restrictions may shorten SST.

DOI： 10.1093/postmj/qgad044

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PubMed

DOI： 10.1016/j.psyneuen.2023.106180

Web of Science

Publisher：Journal of General and Family Medicine  

Background: The effect of duty hour (DH) restrictions on postgraduate residents' acquisition of clinical competencies is unclear. We evaluated the relationship between DHs and competency-related knowledge acquisition using the General Medicine In-training Examination (GM-ITE). Methods: We conducted a multicenter, cross-sectional study of community hospital residents among 2019 GM-ITE examinees. Self-reported average DHs per week were classified into five DH categories and the competency domains were classified into four areas: symptomatology and clinical reasoning (CR), physical examination and clinical procedure (PP), medical interview and professionalism (MP), and disease knowledge (DK). The association between these scores and DHs was examined using random-intercept linear models with and without adjustment for confounding factors. Results: We included 4753 participants in the analyses. Of these, 31% were women, and 49.1% were in the postgraduate year (PGY) 2. Mean CR and MP scores were lower among residents in Category 1 (<50 h) than in residents in Category 3 (≥60 and <70 h; reference group). Mean DK scores were lower among residents in Categories 1 and 2 (≥50 and <60 h) than in the reference group. PGY-2 residents in Categories 1 and 2 had lower CR scores than those in Category 3; however, PGY-1 residents in Category 5 showed higher scores. Conclusions: The relationship between DHs and each competency area is not strictly linear. The acquisition of knowledge of physical examination and clinical procedures skills in particular may not be related to DHs.

DOI： 10.1002/jgf2.594

Scopus

Publisher：Journal of Patient Safety and Risk Management  

Objectives: Despite existing patient safety measures, both outside and inside hospitals, barriers to patient safety prevail. We aimed to identify the current contributory factors to patient safety in Japan. Methods: This qualitative study included nine expert Japanese health care providers working both inside and outside hospitals. These participants, who included six physicians, one nurse, one pharmacist, and one physical therapist, work across a broad spectrum in government policy and public health, academia, and safety management. Root cause analysis using the online Kawakita Jiro method (KJ method or affinity diagram) was conducted. We labeled and summarized the classification in a fishbone diagram to elucidate barriers to patient safety in Japan. Results: We identified specific factors in six main groups: the hospital system, education, law and policy, culture and society, patient centricity, and multidisciplinary cooperation. Quality of care, patient engagement, and shortage of patient safety specialists were crucial factors for multiple groups. Conclusions: This study clarifies components of patient safety in Japan and provides basic data for promoting comprehensive patient safety in the future. Periodic root cause analysis of comprehensive patient safety issues can help develop strategies to promote patient safety at both the hospital and national levels.

DOI： 10.1177/25160435221144134

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Scopus

Publisher：BMJ Open  

Objective The relationship between the care of patients with COVID-19 and mental health among resident physicians in Japan is imperative for ensuring appropriate care of patients with COVID-19 and should be clarified. We herein assessed the relationship between the care of patients with COVID-19 and mental health among postgraduate year 1 (PGY-1) and PGY-2 resident physicians and factors associated with mental health. Design This nationwide cross-sectional study analysed data obtained using the clinical training environment self-reported questionnaire. Setting An observational study across Japan among resident physicians (PGY-1 and PGY-2) from 583 teaching hospitals. Participants Examinees who took the general medicine in-training examination of academic year 2020. Primary and secondary outcome measures The Patient Health Questionnaire and Mini-Z 2.0 were used to assess mental health, and experience of caring for patients with COVID-19 was divided into three groups (none, 1-10 and ≥11). The prevalence of mental conditions in the three groups was compared using the 'modified' Poisson generalised estimating equations by adjusting for prefecture-level, hospital-level and resident-level variables. Results Of the 5976 participants analysed, 50.9% were PGY-1. The prevalence of burnout was 21.4%. Moreover, 47.0% of all resident physicians had no experience in the care of patients with COVID-19. The well-experienced group accounted for only 7.9% of the total participants. A positive association was found between the number of caring patients with COVID-19 and burnout (prevalence ratio 1.25; 95% CI 1.02 to 1.53). Moreover, the shortage of personal protective equipment was identified as a major contributor to burnout (prevalence ratio 1.60; 95% CI 1.36 to 1.88). Conclusions Resident physicians who experienced more care of patients with COVID-19 had slightly greater burnout prevalence than those who did not. Approximately half of resident physicians did not participate in the care of patients with COVID-19, which posed a challenge from an educational perspective.

DOI： 10.1136/bmjopen-2022-066348

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Scopus

PubMed