Yahata Shinsuke, Takeshima Taro, Kenzaka Tsuneaki, Okayama Masanobu
Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe University Graduate School of Medicine, 2-1-5, Arata-cho, Hyogo-ku, Kobe, Hyogo, 652-0032, Japan.
Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1, Toyochikamiyajiro, Shirakawa, Fukushima, 961-0005, Japan.
BMC Med Educ. 2020 Oct 1;20(1):337. doi: 10.1186/s12909-020-02258-3.
Community-based medical education (CBME) has been evolving globally. However, the long-term impacts of CBME programs on career intention are ambiguous. Therefore, this study aimed to reveal the long-term impact of community-based clinical training (CBCT) such as CBME programs in Japan on current community healthcare (CH) practice.
This cross-sectional study targeted physicians who had graduated from Kobe University School of Medicine between 1998 and 2004 and had over 15 years' experience after graduation. Self-administered questionnaires were mailed to participants between September and November 2019. Of the 793 potential subjects, 325 questionnaires were undeliverable. A total of 468 questionnaires substantially sent to the subjects. The exposure was the undergraduate CBCT defined as clinical training about CH in a community. The primary outcome was the provision of current CH practice. The secondary outcome was rural retention. The odds ratios (ORs) and confidence intervals (CIs) were calculated, and the confounders (age, gender, and attitude toward CH at admission; primary outcome, and age, gender, attitude toward rural healthcare at admission, own and spouse's hometown, and emphasis on child education; secondary outcomes) were adjusted using multivariate logistic regression analysis.
A total of 195 (41.7%) questionnaires were analyzed. The mean (standard deviation [SD]) age of study participants was 43.8 (3.5) years and 76.4% were men. A total of 48 physicians (24.6%) experienced CBCT, of which the mean (SD) training period was 26.3 (27.3) days. As many as 148 (76.3%) physicians provided CH at the time of the study, and 12 (6.5%) worked in rural areas. There was no notable impact of undergraduate CBCT on current CH practice (OR, 1.24; 95% CI, 0.53-3.08; adjusted OR [aOR], 1.00; 95% CI, 0.43-2.30) and rural retention (OR, 0.59; 95% CI, 0.06-2.94; aOR, 0.59; 95% CI, 0.11-3.04).
It may be insufficient to use conventional CBCT in Japan to develop CH professionals effectively. Japanese CBME programs should be standardized through a review of their content and quality. They should continue to be evaluated for their medium- to long-term effects.
基于社区的医学教育（CBME）在全球范围内不断发展。然而，CBME项目对职业意向的长期影响尚不明确。因此，本研究旨在揭示日本的CBME项目等基于社区的临床培训（CBCT）对当前社区医疗（CH）实践的长期影响。
本横断面研究的对象是1998年至2004年间毕业于神户大学医学院且毕业后有超过15年工作经验的医生。2019年9月至11月向参与者邮寄了自填式问卷。在793名潜在受试者中，有325份问卷无法送达。总共向受试者寄出了468份问卷。暴露因素是本科阶段的CBCT，定义为在社区进行的关于CH的临床培训。主要结局是当前CH实践的提供情况。次要结局是农村地区的留任情况。计算比值比（OR）和置信区间（CI），并使用多因素逻辑回归分析对混杂因素（年龄、性别、入学时对CH的态度；主要结局，以及年龄、性别、入学时对农村医疗保健的态度、自己和配偶的家乡、对儿童教育的重视程度；次要结局）进行调整。
共分析了195份（41.7%）问卷。研究参与者的平均（标准差[SD]）年龄为43.8（3.5）岁，76.4%为男性。共有48名医生（24.6%）经历过CBCT，其中平均（SD）培训时长为26.3（27.3）天。在研究时，多达148名（76.3%）医生提供CH服务，12名（6.5%）在农村地区工作。本科阶段的CBCT对当前CH实践（OR，1.24；95%CI，0.53 - 3.08；调整后OR[aOR]，1.00；95%CI，0.43 - 2.30）和农村地区留任情况（OR，0.59；95%CI，0.06 - 2.94；aOR，0.59；95%CI，0.11 - 3.04）没有显著影响。
在日本，使用传统的CBCT可能不足以有效地培养CH专业人员。日本的CBME项目应通过审查其内容和质量来实现标准化。应继续对其进行中长期效果评估。
