Methods: The authors conducted an online survey targeting postgraduate trainees in both the US and Japan. The authors recruited two internal medicine residency programs at an urban university program and an affiliated medical center in New York City as well as one university based and four non-university based programs in Japan. The survey questions included demographics, milestones across eight competency areas proposed as universal in the literature, and eleven Iowa Fatigue Scale (IFS) questions. A 4-point scale was used (not important, a little bit important, somewhat important, very important) and responses were dichotomized into 1 (very important) and 0 (others) to compute statistical significance with Chi-Square and Fisher’s exact test. Presence of fatigue and severe fatigue were defined as IFS >30 and IFS > 40, respectively. Chronbach alfa (0.79) confirmed internal consistency for IFS.
Results: 165 out of 393 potential respondents (42%) completed the survey. 58% were US trainees. The proportions of “very important” in systems-based practice milestones were generally lower in both countries (<70%). Significant differences were observed across all competency areas due to lower rating by postgraduate year (PGY) 1 respondents in Japan (Table). Among the PGY 2 and 3 respondents, the statistically significant items (p ≤ .05) included (a) Qualified handoff (US 86% versus Japan 59%), (b) Supervision for team members (80% vs. 41%), (c) Symptom relief (88% vs. 50%), (d) Evidence-based practice (94% vs. 69%), (e) Education for team members (71% vs. 48%), (f) Continuous learning (94% vs. 48%), (g) Communication with health professionals (92% vs. 71%), (h) Difficult conversations (96% vs. 74%), (i) Administrative responsibilities (36% vs. 68%), (j) Compassion and respect (100% vs. 84%), (k) Sensitivity to diversity (91% vs. 58%). The prevalence of fatigue (42% vs. 81%), and severe fatigue (4% vs. 19%) was significantly higher in Japan (p < .01).
Conclusions: There were significant differences in training goals between resident physicians in the US and Japan. US trainees were more likely to see competencies as skills they sought to acquire during residency compared to their Japanese counterparts. GME training should ideally be designed in a way that resident physicians can align their goals with milestones and competencies.
To cite this abstract:Kato, H; Burger, A; Emoto, K; Uehara, Y; Sakama, R; Lin, JJ; Segon, A . DIFFERENCES IN GOALS DURING RESIDENCY TRAINING BETWEEN THE UNITED STATES AND JAPAN. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 27. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/differences-in-goals-during-residency-training-between-the-united-states-and-japan/. Accessed September 16, 2019.