Kinoshita Kensuke, Tsugawa Yusuke, Barnett Peter B, Tokuda Yasuharu
Department of Medicine, Mito Kyodo General Hospital, University of Tsukuba, Mito City, Ibaraki, Japan.
Harvard Interfaculty Initiative in Health Policy, Cambridge, MA, USA.
BMC Med Educ. 2015 Mar 11;15:42. doi: 10.1186/s12909-015-0313-6.
Professionalism is deemed as the basis of physicians' contract with society in Japan. Our study in 2005, using a questionnaire with scenarios to professionalism, suggested that many physicians at various levels of training in Japan encounter challenges when responding to these common scenarios related to professionalism. It is unclear how medical professionalism has changed among Japanese residents in over time.
We conducted a follow-up survey about challenges to professionalism for Japanese residents using the same Barry Questionnaire after a seven-year interval from the prior survey. The survey uses six clinical scenarios with multiple choice responses. The six cases include the following challenges: acceptance of gifts; conflict of interest; confidentiality; physician impairment; sexual harassment; and honesty in documentation. Each scenario is followed by 4 or 5 possible responses, including the "best" and the "second best" responses. The survey was conducted as a part of nationwide general medicine in-training examination.
We collected data from 1,049 participants (290 women, 28%; 431 PGY-1 and 618 PGY-2 residents). Overall, the current residents performed better than their colleagues in the earlier survey for five scenarios (gifts, conflict of interest, confidentiality, impairment, and honesty) but not for the harassment scenario. PGY-2 residents were more likely to select either the best or 2nd best choices to gifts (p = 0.002) and harassment (p = 0.031) scenarios than PGY-1 residents. Residents in the current study chose either the best or 2nd best choices to the gifts (p < 0.001) and honesty (p < 0.001) scenarios than those of the previous study conducted seven years ago, but not for the harassment scenario (p = 0.004).
Our study suggests that there is improvement of medical professionalism with respect to some ethical challenges among the Japanese residents in the current study compared to those in our previous study.
在日本，职业精神被视为医生与社会契约的基础。我们在2005年进行的一项研究，使用了一份关于职业精神情景的问卷，结果表明，日本不同培训水平的许多医生在应对这些与职业精神相关的常见情景时都遇到了挑战。目前尚不清楚日本住院医师的医学职业精神随时间发生了怎样的变化。
在距离上次调查七年后，我们使用相同的巴里问卷对日本住院医师进行了关于职业精神挑战的随访调查。该调查使用六个临床情景并提供多项选择答案。这六个案例包括以下挑战：接受礼物；利益冲突；保密；医生能力受损；性骚扰；以及文件记录中的诚实问题。每个情景后都有4或5个可能的答案，包括“最佳”和“次佳”答案。该调查是作为全国范围内普通医学在职考试的一部分进行的。
我们收集了1049名参与者的数据（290名女性，占28%；431名第一年住院医师和618名第二年住院医师）。总体而言，在五个情景（礼物、利益冲突、保密、能力受损和诚实）方面，当前的住院医师比早期调查中的同事表现更好，但在性骚扰情景方面并非如此。与第一年住院医师相比，第二年住院医师更有可能在礼物（p = 0.002）和性骚扰（p = 0.031）情景中选择最佳或次佳答案。与七年前进行的先前研究相比，本研究中的住院医师在礼物（p < 0.001）和诚实（p < 0.001）情景中选择了最佳或次佳答案，但在性骚扰情景中并非如此（p = 0.004）。
我们的研究表明，与我们之前的研究相比，在本研究中，日本住院医师在一些道德挑战方面的医学职业精神有所改善。
