Geographic Distribution of Regional Quota Program Graduates of Japanese Medical Schools: A Nationwide Cohort Study

Kashima, Saori; Owaki, Tetsuhiro; Iguchi, Seitaro; Inoue, Kazuo; Tazuma, Susumu; Maeda, Takahiro

doi:10.1097/acm.0000000000002688

Cited by 17 publications

(20 citation statements)

References 23 publications

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“…The family medicine education system can recruit physicians from outside rural areas, which is a potential solution to the lack of medical resources in rural settings [ 37 , 38 , 39 ]. In addition, educational systems can offer rural area students with special quota in medical schools with the condition that they return to their rural areas to serve as family physicians [ 40 ]. Furthermore, in family medicine education, interprofessional collaboration is critical for patient care [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Family Medicine Education at a Rural Hospital in Japan: Impact on Institution and Trainees

Ohta¹,

Ryu²,

Sano

2021

IJERPH

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Family medicine is vital in Japan as its society ages, especially in rural areas. However, the implementation of family medicine educational systems has an impact on medical institutions and requires effective communication with stakeholders. This research—based on a mixed-method study—clarifies the changes in a rural hospital and its medical trainees achieved by implementing the family medicine educational curriculum. The quantitative aspect measured the scope of practice and the change in the clinical performance of family medicine trainees through their experience of cases—categorized according to the 10th revision of the International Statistical Classification of Disease and Related Health Problems. During the one-year training program, the trainees’ scope of practice expanded significantly in both outpatient and inpatient departments. The qualitative aspect used the grounded theory approach—observations, a focus group, and one-on-one interviews. Three themes emerged during the analysis—conflicts with the past, driving unlearning, and organizational change. Implementing family medicine education in rural community hospitals can improve trainees’ experiences as family physicians. To ensure the continuity of family medicine education, and to overcome conflicts caused by system and culture changes, methods for the moderation of conflicts and effective unlearning should be promoted in community hospitals.

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Section: Discussionmentioning

confidence: 99%

Family Medicine Education at a Rural Hospital in Japan: Impact on Institution and Trainees

Ohta¹,

Ryu²,

Sano

2021

IJERPH

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“…Several outcomes of Japanese regional quota and prefecture scholarship programmes have been reported. A higher proportion of regional quota graduates and scholarship recipients than of non-quota and non-scholarship physicians worked in rural areas, 15. The regional quota graduates and scholarship recipients had a higher pass rate of the National License Examination for Physicians than the other graduates 12.…”

Section: Introductionmentioning

confidence: 96%

Emigration of regional quota graduates of Japanese medical schools to non-designated prefectures: a prospective nationwide cohort study

et al. 2019

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ObjectivesThis study examined the retention of regional quota graduates of Japanese medical schools and prefecture scholarship recipients within their designated prefectures where they are obliged or expected to work and revealed the personal and regional characteristics associated with their emigration to non-designated prefectures. Regional quota and prefecture scholarship are two of the most ambitious policies ever conducted in Japan for recruiting physicians to practice in rural areas.DesignProspective cohort study.SettingNationwide.ParticipantsRegional quota graduates with prefecture scholarship, quota graduates without scholarship and non-quota graduates with scholarship of Japanese medical schools who obtained their physician license between 2014 and 2016.Primary outcomeThe emigration in 2016 of the participants from the designated prefectures.ResultsTotal participants were 991 physicians, three of whom were excluded due to the missing values of crucial items, leaving 988 participants for analysis (quota with scholarship 387, quota alone 358 and scholarship alone 243). The percentage of those who emigrated was 11.9% (118/988). The mean (±SD) proportion of subjects who emigrated was 11.7% (±10.3) among all prefectures and the proportion varies widely among prefectures (0%–44.4%). Multilevel logistic regression analysis showed those who received prefecture scholarship (OR 0.23; 95% CI 0.08 to 0.67) and whose designated prefecture has an ordinance-designated city (ie, large city) were less likely to emigrate (OR 0.47; 95% CI 0.24 to 0.90). In contrast, graduates from a medical school outside the designated prefecture (OR 4.20; 95% CI 2.20 to 7.67) and who have a right to postpone their obligatory service (OR 3.42; 95% CI 1.52 to 7.67) were more likely to emigrate.ConclusionsA substantial proportion of regional quota graduates and prefecture scholarship recipients emigrated to non-designated prefectures. Emigrations should be reduced by improving the potential facilitators for emigration such as discordance in location between medical school and designated prefecture.

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“…Under pressure from rural prefectures, some medical schools, in cooperation with the prefectural and national governments, established chiikiwaku , or the regional quota program in 2008. The regional quota has rapidly spread to most of the medical schools in Japan [ 12 – 14 ]. The regional quota and Jichi have been reported as a Japanese original policy for recruiting and retaining a rural health workforce [ 3 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…The regional quota is one of the largest policies that Japan has ever adopted to redress the geographic maldistribution of physicians [ 15 ]. Now 16.2% of medical students nationwide are quota entrants [ 14 ]. Typical quota programs have the following characteristics: applicants are limited to those who are legal residents of the prefecture in which the medical school is located; they undergo a special admission process; their undergraduate medical education has an emphasis on rural practice; and upon graduation they agree to work in the prefecture for a specified length of time.…”

Section: Introductionmentioning

confidence: 99%

“…The scholarship amount is usually the same as the one offered to quota students with scholarships, as are the length and obligatory service requirements. A past study reporting short-term outcomes of quota and scholarship programs showed that the proportions of their graduates working in rural areas were higher than that of other physicians [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Education policies to increase rural physicians in Japan: a nationwide cohort study

et al. 2021

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Background Japan has established comprehensive education-scholarship programs to supply physicians in rural areas. Their entrants now comprise 16% of all medical students, and graduates must work in rural areas for a designated number of years. These programs are now being adopted outside Japan, but their medium-term outcomes and inter-program differences are unknown. Methods A nationwide prospective cohort study of newly licensed physicians 2014–2018 (n = 2454) of the four major types of the programs—Jichi Medical University (Jichi); regional quota with scholarship; non-quota with scholarship (scholarship alone); and quota without scholarship (quota alone)—and all Japanese physicians in the same postgraduate year (n = 40,293) was conducted with follow-up workplace information from the Physician Census 2018, Ministry of Health, Labour and Welfare. In addition, annual cross-sectional survey for prefectural governments and medical schools 2014–2019 was conducted to obtain information on the results of National Physician License Examination and retention status for contractual workforce. Results Passing rate of the National Physician License Examination was highest in Jichi, followed in descending order by quota with scholarship, the other two programs, and all medical graduates. The retention rate for contractual rural service of Jichi graduates 5 years after graduation (n = 683; 98%) was higher than that of quota with scholarship (2868; 90%; P < 0.001) and scholarship alone (2220; 81% < 0.001). Relative risks of working in municipalities with the least population density quintile in Jichi, quota with scholarship, scholarship alone, and quota alone in postgraduate year 5 were 4.0 (95% CI 3.7–4.4; P < 0.001), 3.1 (2.6–3.7; < 0.001), 2.5 (2.1–3.0; < 0.001), and 2.5 (1.9–3.3; < 0.001) as compared with all Japanese physicians. There was no significant difference between each program and all physicians in the proportion of those who specialized in internal medicine or general practice in postgraduate years 3 to 5 Conclusions Japan’s education policies to produce rural physicians are effective but the degree of effectiveness varies among the programs. Policymakers and medical educators should plan their future rural workforce policies with reference to the effectiveness and variations of these programs.

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Geographic Distribution of Regional Quota Program Graduates of Japanese Medical Schools: A Nationwide Cohort Study

Cited by 17 publications

References 23 publications

Family Medicine Education at a Rural Hospital in Japan: Impact on Institution and Trainees

Family Medicine Education at a Rural Hospital in Japan: Impact on Institution and Trainees

Emigration of regional quota graduates of Japanese medical schools to non-designated prefectures: a prospective nationwide cohort study

Education policies to increase rural physicians in Japan: a nationwide cohort study

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