To clarify physicians' practices and attitudes regarding advance care planning (ACP) in palliative care units (PCUs) in Japan, we conducted a self-completed questionnaire survey of 203 certificated PCUs in 2010. Ninety-nine physicians participated in the survey. Although most Japanese palliative care physicians recognized the importance of ACP, many failed to implement aspects of patient-directed ACP that they acknowledged to be important, such as recommending completion of advance directives (ADs), designation of health care proxies, and implementing existing ADs. The physicians' general preference for family-centered decision making and their feelings of difficulty and low confidence regarding ACP most likely underlie these results. The discrepancy between physicians' practices and their recognition of the importance of ACP suggests an opportunity to improve end-of-life care.

BackgroundTo respond to increasingly complicated healthcare needs in primary care settings, all health and medical welfare professionals are required to collaborate with multiprofessionals, namely via “interprofessional work” (IPW). Interprofessional education (IPE) is essential for effective IPW, especially for medical students. This study aimed to determine whether participation in IPE can increase medical students’ readiness for interprofessional learning.MethodWe examined the difference in readiness of medical students for interprofessional learning before and after an IPE program that used team‐based learning (TBL). Each student was assigned to either a uniprofessional or multiprofessional group. They were evaluated using the Japanese version of the Readiness for Interprofessional Learning Scale (RIPLS). Program participants were 126 second‐year medical students and 18 students of healthcare professions other than medical doctor who participated in a combined IPE program conducted by two universities. Medical students were allocated to 12 uniprofessional and nine multiprofessional groups at random.ResultsOne hundred and twelve medical students who replied to the questionnaire both before and after the program (valid response rate, 88.9%) were eligible for analysis. Of these, 42 were assigned to uniprofessional groups and 70 to multiprofessional groups. After the program, the RIPLS total score increased to a greater extent in the multiprofessional groups than in the uniprofessional groups (difference 3.17, 95% confidence interval 0.47‐5.88, P = .022). Multiple regression analysis showed the same result.ConclusionsLearning in multiprofessional groups increased medical students’ readiness for interprofessional learning in an IPE program using TBL.

BackgroundBurnout in attending physicians is a crucial issue that may negatively impact patient outcomes, as well as affect the quality of training provided to residents. To investigate the association between burnout and stress-coping ability, we conducted a cross-sectional study of attending physicians.MethodsFrom April 2013 to March 2014, we distributed an anonymous, self-administered questionnaire to 1,897 attending physicians who attended teaching-related training sessions and workshops. The questionnaire included the Maslach Burnout Inventory General Survey (MBI-GS, Japanese version) to evaluate burnout; the sense of coherence scale (SOC, Japanese version) to measure stress-coping ability, with higher scores indicating higher stress-coping ability; the Brief Scales for Job Stress (BSJS) to assess stress and buffering factors; demographic factors; mean weekly working hours; and factors related to instructing residents. The MBI-GS was used to determine the presence of physician burnout. Subjects were divided into tertiles based on SOC scores. We conducted logistic regression analysis of burnout using the following independent variables: physician experience, sex, mean weekly working hours, SOC group, mental workload, and reward from work.ResultsOf the 1,543 (81.3%) attending physicians who responded, 376 did not meet the inclusion criteria and 106 had missing data, thus 1,061 (55.9%) were analyzed. The prevalence of burnout was 17.2%. Physicians with burnout had significantly fewer years of experience as a doctor (P < 0.01), were more likely to be female (P < 0.01), worked more hours per week (P < 0.01), and had a lower SOC score (P < 0.01) than physicians without burnout. On the BSJS, the mean score of all stress factors was higher and that of buffering factors was lower in physicians with burnout (P < 0.01). The percentages of physicians with burnout were 35.7%, 12.8%, and 3.2% in the low, middle, and high SOC groups, respectively (P < 0.01). Using the high SOC group as a reference, the adjusted odds ratio for burnout in the low SOC group was 4.7 (95% confidence interval: 2.31 - 9.63) (P < 0.01).ConclusionsIn this study, burnout among attending physicians was significantly associated with SOC scores after adjustment for stress factors and buffering factors.

Background The purpose of this study was to investigate the primary factors associated with inappropriate out‐of‐hours emergency department ( ED ) use by patients with nonurgent conditions. Methods We compared patients with nonurgent conditions who made inappropriate, out‐of‐hours ED visits to patients who visited an acute care hospital during daytime consultation hours between May 30 and October 16, 2014, in terms of patient characteristics and reasons for consultation. Our goal was to identify factors associated with inappropriate ED use, defined as an out‐of‐hours, nonurgent, and unnecessary visits. Results We analyzed data from 84 patients who made inappropriate use of out‐of‐hours emergency care and 147 patients who sought care during regular consultation hours. In the inappropriate use group, “desire to be cured quickly” was the most common reason. Acute upper respiratory infection, acute gastroenteritis, and primary headache comprised 51.1% of diagnoses in the inappropriate use group. One factor associated with inappropriate use was two or more previous out‐of‐hours ED visits (odds ratio ( OR ) 3.19; 95% confidence interval ( CI ) 1.22‐8.31) (reference: 0 visits). Conclusions Patients with two or more previous out‐of‐hours ED visits were more than three times as likely to inappropriately use the ED compared to patients who had not visited the ED at all in the past 3 years.

ObjectivesThe aim of this study was to explore students’ perception of their learning from the interprofessional program implemented in Japan where the implementation and evaluation of interprofessional education is behind that of western countries.MethodsWe conducted a qualitative research of opinions of students who participated in the interprofessional program implemented in the University of Tsukuba. The participants were 105 medical, 65 nursing, and 35 medical science students. At the completion of the program, we asked that the participants write their opinion on what they gained by participating in the program. From their responses, significant descriptions were extracted, coded by content, and then grouped into subcategories. These subcategories were then separated into main categories based on their emergent themes.ResultsThe main categories identified were such as “understanding of medical professionals,” “interprofessional work,” “holistic care,” “communication,” “sharing,” and “empowerment.”ConclusionsThe categories extracted in our study, for the most part, matched previous studies, suggesting that the program helped students enhance their understanding of interprofessional work. Although the Japanese health care system and medical education system are different from those of western countries, this suggests that the benefits of interprofessional education in Japan will be similar to those of western countries.