Differences in residents’ self-reported confidence and case experience between two post-graduate rotation curricula: results of a nationwide survey in Japan

Abstract

BackgroundIn Japan, all trainee physicians must begin clinical practice in a standardized, mandatory junior residency program, which encompasses the first two years of post-graduate medical training (PGY1 – PGY2). Implemented in 2004 to foster primary care skills, the comprehensive rotation program (CRP) requires junior residents to spend 14 months rotating through a comprehensive array of clinical departments including internal medicine, surgery, anesthesiology, obstetrics-gynecology (OBGYN), pediatrics, psychiatry, and rural medicine. In 2010, Japan’s health ministry relaxed this curricular requirement, allowing training programs to offer a limited rotation program (LRP), in which core departments constitute 10 months of training, with electives geared towards residents’ choice of career specialty comprising the remaining 14 months. The effectiveness of primary care skill acquisition during early training warrants evaluation. This study assesses self-reported confidence with clinical competencies, as well as case experience, between residents in CRP versus LRP curricula.MethodsA nation-wide cross-sectional study of all PGY2 physicians in Japan was conducted in March 2011. Primary outcomes were self-report confidence for 98 clinical competency items, and number of cases experienced for 85 common diseases. We compared confidence scores and case experience between residents in CRP and LRP programs, adjusting for parameters relevant to training.ResultsAmong 7506 PGY2 residents, 5052 replied to the survey (67.3%). Of 98 clinical competency items, CRP residents reported higher confidence in 12 items compared to those in an LRP curriculum, 10 of which remained significantly higher after adjustment. CRP trainees reported lower confidence scores in none of the items. Out of 85 diseases, LRP residents reported less experience with 11 diseases. CRP trainees reported lower case experience with one disease, though this did not remain significant on adjusted analysis. Confidence and case experience with OBGYN- and pediatrics-related items were particularly low among LRP trainees.ConclusionsResidents in the specialty-oriented LRP curriculum showed less confidence and less case experience compared to peers training in the broader CRP residency curriculum. In order to foster competence in independent primary care practice, junior residency programs requiring experience in a breadth of core departments should continue to be mandated to ensure adequate primary care skills.

Differences in clinical knowledge levels between residents in two post‐graduate rotation programmes in Japan

“…In particular, the CRP trainees were more likely to exhibit a better understanding of paediatrics, mental health, and neurology. In a previous study, we reported that trainees in LRPs showed lower confidence and less case experience than those in CRPs [ 7 ]. A limitation of our previous study was that we relied on self-reported measures to investigate clinical knowledge.…”

“…Nomura et al [ 6 ] reported that post-graduate trainees at university hospitals, which mainly provide the LRP, were less satisfied with the training system and clinical skills training than those at non-university hospitals, which provide the CRP. Ohde et al [ 7 ] found that post-graduate trainees in LRPs showed less confidence and less case experience than those in CRPs, especially with respect to paediatrics and obstetrics/gynaecology, which are often excluded from LRPs in many hospitals. Nevertheless, these studies analysed subjective self-evaluation reports by trainees rather than objective measures of knowledge or performance.…”

Fourth‐year dental hygiene students’ educational preparedness: Self‐confidence ratings of the Canadian Dental Hygienists Association baccalaureate competencies (2017‐2019)

“…Such an investigation was deemed important given that self-confidence is associated with professional competence. [9][10][11][12] The concept of self-confidence has provided valuable results in many health studies [13][14][15][16] including ones in oral health. 11,12,17 Holland 9 clarifies the relationship between self-confidence and competence in the following way.…”

“…The concepts are not synonymous, but they are linked 10,[13][14][15][16] with self-confidence being an essential component of professional education. 10,12,16 This study explored graduating students' abilities from the perspective of self-confidence to better understand the learners' educational preparedness with regard to the newly articulated CCBDHP.…”

“…The use of self-confidence ratings could be problematic for regulators with their focus on the assessment of individuals but it appears a reasonable methodology for gaining group data to support program decision-making as evidence by other professional health studies. [10][11][12][13][14][15][16][17]…”