Search

Abstract 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 (

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. [ABSTRACT FROM AUTHOR]

Kazuya Nagasaki,1 Yuji Nishizaki,2,3 Masanori Nojima,4 Taro Shimizu,5 Ryota Konishi,6 Tomoya Okubo,7 Yu Yamamoto,8 Ryo Morishima,9 Hiroyuki Kobayashi,1 Yasuharu Tokuda10 1Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, Ibaraki, Japan; 2Medical Technology Innovation Center, Juntendo University, Tokyo, Japan; 3Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan; 4Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; 5Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Tochigi, Japan; 6Education Adviser Japan Organization of Occupational Health and Safety, Kanagawa, Japan; 7Research Division, The National Center for University Entrance Examinations, Tokyo, Japan; 8Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Tochigi, Japan; 9Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan; 10Muribushi Okinawa for Teaching Hospitals, Okinawa, JapanCorrespondence: Yuji NishizakiMedical Technology Innovation Center, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, JapanTel +81-3-3813-3111Fax +81-3-5689-0627Email ynishiza@juntendo.ac.jpPurpose: In Japan, the General Medicine In-training Examination (GM-ITE) was developed by a non-profit organization in 2012. The GM-ITE aimed to assess the general clinical knowledge among residents and to improve the training programs; however, it has not been sufficiently validated and is not used for high-stake decision-making. This study examined the association between GM-ITE and another test measure, the Professional and Linguistic Assessments Board (PLAB) 1 examination.Methods: Ninety-seven residents who completed the GM-ITE in fiscal year 2019 were recruited and took the PLAB 1 examination in Japanese. The association between two tests was assessed using the Pearson product-moment statistics. The discrimination indexes were also assessed for each question.Results: A total of 91 residents at 17 teaching hospitals were finally included in the analysis, of whom 69 (75.8%) were women and 59 (64.8%) were postgraduate second year residents. All the participants were affiliated with community hospitals. Positive correlations were demonstrated between the GM-ITE and the PLAB scores (r = 0.58, p < 0.001). The correlations between the PLAB score and the scores in GM-ITE categories were as follows: symptomatology/clinical reasoning (r = 0.54, p < 0.001), physical examination/procedure (r = 0.38, p < 0.001), medical interview/professionalism (r = 0.25, p < 0.001), and disease knowledge (r = 0.36, p < 0.001). The mean discrimination index of each question of the GM-ITE (mean ± SD; 0.23 ± 0.15) was higher than that of the PLAB (0.16 ± 0.16; p = 0.004).Conclusion: This study demonstrates incremental validity evidence of the GM-ITE to assess the clinical knowledge acquisition. The results indicate that GM-ITE can be widely used to improve resident education in Japan.Keywords: in-training examination, validity, extrapolation, General Medicine In-Training Examination, Professional and Linguistic Assessments Board, medical knowledge, postgraduate medical education

Background: The relationship between educational outcomes and the use of web-based clinical knowledge support systems in teaching hospitals remains unknown in Japan. A previous study on this topic could have been affected by recall bias because of the use of a self-reported questionnaire., Objective: We aimed to explore the relationship between the use of the Wolters Kluwer UpToDate clinical knowledge support system in teaching hospitals and residents' General Medicine In-Training Examination (GM-ITE) scores. In this study, we objectively evaluated the relationship between the total number of UpToDate hospital use logs and the GM-ITE scores., Methods: This nationwide cross-sectional study included postgraduate year-1 and -2 residents who had taken the examination in the 2020 academic year. Hospital-level information was obtained from published web pages, and UpToDate hospital use logs were provided by Wolters Kluwer. We evaluated the relationship between the total number of UpToDate hospital use logs and residents' GM-ITE scores. We analyzed 215 teaching hospitals with at least 5 GM-ITE examinees and hospital use logs from 2017 to 2019., Results: The study population consisted of 3013 residents from 215 teaching hospitals with at least 5 GM-ITE examinees and web-based resource use log data from 2017 to 2019. High-use hospital residents had significantly higher GM-ITE scores than low-use hospital residents (mean 26.9, SD 2.0 vs mean 26.2, SD 2.3; P=.009; Cohen d=0.35, 95% CI 0.08-0.62). The GM-ITE scores were significantly correlated with the total number of hospital use logs (Pearson r=0.28; P<.001). The multilevel analysis revealed a positive association between the total number of logs divided by the number of hospital physicians and the GM-ITE scores (estimated coefficient=0.36, 95% CI 0.14-0.59; P=.001)., Conclusions: The findings suggest that the development of residents' clinical reasoning abilities through UpToDate is associated with high GM-ITE scores. Thus, higher use of UpToDate may lead physicians and residents in high-use hospitals to increase the implementation of evidence-based medicine, leading to high educational outcomes., (© Koshi Kataoka, Yuji Nishizaki, Taro Shimizu, Yu Yamamoto, Kiyoshi Shikino, Masanori Nojima, Kazuya Nagasaki, Sho Fukui, Sho Nishiguchi, Kohta Katayama, Masaru Kurihara, Rieko Ueda, Hiroyuki Kobayashi, Yasuharu Tokuda. Originally published in JMIR Medical Education (https://mededu.jmir.org).)

Background: Medical students in Japan undergo a 2-year postgraduate residency program to acquire clinical knowledge and general medical skills. The General Medicine In-Training Examination (GM-ITE) assesses postgraduate residents' clinical knowledge. A clinical simulation video (CSV) may assess learners' interpersonal abilities., Objective: This study aimed to evaluate the relationship between GM-ITE scores and resident physicians' diagnostic skills by having them watch a CSV and to explore resident physicians' perceptions of the CSV's realism, educational value, and impact on their motivation to learn., Methods: The participants included 56 postgraduate medical residents who took the GM-ITE between January 21 and January 28, 2021; watched the CSV; and then provided a diagnosis. The CSV and GM-ITE scores were compared, and the validity of the simulations was examined using discrimination indices, wherein ≥0.20 indicated high discriminatory power and >0.40 indicated a very good measure of the subject's qualifications. Additionally, we administered an anonymous questionnaire to ascertain participants' views on the realism and educational value of the CSV and its impact on their motivation to learn., Results: Of the 56 participants, 6 (11%) provided the correct diagnosis, and all were from the second postgraduate year. All domains indicated high discriminatory power. The (anonymous) follow-up responses indicated that the CSV format was more suitable than the conventional GM-ITE for assessing clinical competence. The anonymous survey revealed that 12 (52%) participants found the CSV format more suitable than the GM-ITE for assessing clinical competence, 18 (78%) affirmed the realism of the video simulation, and 17 (74%) indicated that the experience increased their motivation to learn., Conclusions: The findings indicated that CSV modules simulating real-world clinical examinations were successful in assessing examinees' clinical competence across multiple domains. The study demonstrated that the CSV not only augmented the assessment of diagnostic skills but also positively impacted learners' motivation, suggesting a multifaceted role for simulation in medical education., (©Kiyoshi Shikino, Yuji Nishizaki, Sho Fukui, Daiki Yokokawa, Yu Yamamoto, Hiroyuki Kobayashi, Taro Shimizu, Yasuharu Tokuda. Originally published in JMIR Medical Education (https://mededu.jmir.org), 29.02.2024.)

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., Competing Interests: The JAMEP was involved in collecting and managing data as the GM‐ITE administrative organization. It did not participate in designing and conducting the study; data analysis and interpretation; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication. Dr. Nishizaki received an honorarium from the JAMEP as the GM‐ITE project manager. Dr. Tokuda is one the JAMEP directors. Dr. Kobayashi received an honorarium from the JAMEP as a speaker for the JAMEP lecture. Dr. Shimizu and Dr. Yamamoto received an honorarium from the JAMEP as exam preparers of the GM‐ITE. Dr. Nishizaki, Dr. Tokuda, Dr. Kobayashi, Dr. Shimizu, and Dr. Yamamoto were not involved in the analysis., (© 2022 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.)