Nomura Kyoko, Yano Eiji, Aoki Makoto, Kawaminami Katsuhiko, Endo Hiroyoshi, Fukui Tsuguya
Teikyo University, Tokyo, Japan.
Med Teach. 2008;30(6):e161-9. doi: 10.1080/01421590802047307.
In 2004, the Japanese government reformed the monospecialty-oriented postgraduate medical education (PGME) program and introduced a new PGME program to develop the primary care skills of physicians by mandatory rotation through different clinical departments.
(1) to evaluate whether residents' clinical competency improved after the introduction of the new PGME program and (2) to compare the change in competency between university and non-university residents.
Surveys were conducted before and after the introduction of the new PGME, i.e. in 2004 (response rate 88%) and 2006 (88%). One in every five residents was sampled, and the study subjects were 2474 second-year residents (1762 university residents and 712 non-university residents) in 2004 who were about to complete the previous PGME program and 1166 second-year residents (487 and 679) in 2006 who were the first generation to complete the new PGME program. The clinical competency ratings were measured by the proportion of respondents reporting 'experience' in 24 clinical specialties and three items regarding the use of medical records and 'confidence' in 35 clinical skills and knowledge items in four areas (i.e basic medicine, allied areas, behavioural science and social medicine, and clinical research).
Compared to the residents in 2004, the clinical experience and confidence level of the residents increased dramatically for almost all of the surveyed items in 2006, regardless of the type of teaching hospital (chi-square or Fisher's exact tests, P < 0.0001). The marked improvement in the clinical competency of university residents was noticeable, resulting in the disappearance of the historical trend for non-university residents to obtain significantly more clinical experience than university residents.
The new PGME program appears to have been successful at improving both the clinical experience and confidence levels of medical residents, especially at university hospitals.
2004年，日本政府对以单一专业为导向的研究生医学教育（PGME）项目进行了改革，并引入了一项新的PGME项目，通过强制轮转不同临床科室来培养医生的初级保健技能。
（1）评估新的PGME项目实施后住院医师的临床能力是否得到提高；（2）比较大学附属医院和非大学附属医院住院医师能力的变化。
在新的PGME项目实施前后进行了调查，即2004年（回复率88%）和2006年（88%）。每五名住院医师中抽取一名作为样本，研究对象为2004年即将完成之前PGME项目的2474名二年级住院医师（1762名大学附属医院住院医师和712名非大学附属医院住院医师），以及2006年完成新PGME项目的第一代二年级住院医师1166名（487名和679名）。临床能力评级通过报告在24个临床专科有“经验”的受访者比例、关于病历使用的三个项目以及在四个领域（即基础医学、相关领域、行为科学与社会医学以及临床研究）的35项临床技能和知识项目中的“信心”来衡量。
与2004年的住院医师相比，2006年几乎所有调查项目中，住院医师的临床经验和信心水平都显著提高（卡方检验或Fisher精确检验，P<0.0001），无论教学医院类型如何。大学附属医院住院医师临床能力的显著提高很明显，导致非大学附属医院住院医师比大学附属医院住院医师获得更多临床经验的历史趋势消失。
新的PGME项目似乎成功提高了住院医师的临床经验和信心水平，尤其是在大学医院。
