Muroya Saki, Ohde Sachiko, Takahashi Osamu, Jacobs Joshua, Fukui Tsuguya
Graduate School of Public Health, St. Luke's International University, OMURA Susumu & Mieko Memorial, St. Luke's Center for Clinical, Academia 5th Floor, 3-6 Tsukiji, Chuo-ku, 104-0045, Tokyo, Japan.
Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, 183-0003, Tokyo, Japan.
BMC Med Educ. 2021 Apr 21;21(1):226. doi: 10.1186/s12909-021-02651-6.
In Japan, between 2010 and 2020, there were two post-graduate training curricula for post-graduate medical education, as follows: comprehensive rotation programmes (CRPs), which require rotation in at least seven clinical departments; and limited rotation programmes (LRPs), which require rotation in fewer clinical departments. The curriculum that should be used for standardized Japanese post-graduate training has long been debated. Multiple studies show that post-graduate trainees who trained with CRPs were more satisfied and confident and gained more clinical experience than those who trained with LRPs. However, a comparison of objective measurements of the clinical knowledge of Japanese post-graduate trainees has not been reported. The aim of this study is to objectively measure and compare the clinical knowledge of trainees in CRPs and LRPs using a component of the Professional and Linguistic Assessment Board test (PLAB test).
A nationwide cross-sectional study was conducted in February and March 2020. Post-graduate trainees who graduated from medical school were voluntarily recruited from general hospitals in Japan. To objectively measure the trainees' basic clinical knowledge, the PLAB test was adapted from the UK. The cut-off point was set at 63%, as recommended by the UK General Medical Council. A statistical analysis was conducted to determine whether post-graduate programme differences contributed to the trainees' test scores.
Twenty-two facilities volunteered to participate after recruitment, and 97 trainees from 19 facilities participated in the study. Thirty-one participants (32%) were in a CRP, and 66 participants (68%) were in an LRP. According to multiple logistic regression, the adjusted odds ratio of CRP trainees being in the high-scoring group was 5.16 (95% CI: 1.28-20.73, p<0.05). Mean differences in the scores in paediatrics, mental health and neurology were statistically higher among CRP trainees than LRP trainees.
Post-graduate trainees who were in a CRP had better basic clinical competence knowledge (PLAB test) scores and performed better when tested in a wider range of subspecialties. Not only exam performance but also clinical performance and the longitudinal trend of trainees' competency in post-graduate medical training should be evaluated in future studies.
在日本，2010年至2020年间，有两种研究生医学教育的研究生培训课程，具体如下：综合轮转计划（CRP），要求在至少七个临床科室轮转；有限轮转计划（LRP），要求在较少的临床科室轮转。长期以来，关于应将哪种课程用于标准化的日本研究生培训一直存在争议。多项研究表明，接受CRP培训的研究生学员比接受LRP培训的学员更满意、更自信，并且获得了更多的临床经验。然而，尚未有关于日本研究生学员临床知识客观测量的比较报告。本研究的目的是使用专业和语言评估委员会测试（PLAB测试）的一个组成部分，客观地测量和比较CRP和LRP中学员的临床知识。
2020年2月和3月进行了一项全国性横断面研究。从日本综合医院自愿招募医学院毕业的研究生学员。为了客观地测量学员的基础临床知识，对英国的PLAB测试进行了改编。按照英国医学总会的建议，将及格分数设定为63%。进行统计分析以确定研究生课程差异是否对学员的考试成绩有影响。
招募后有22家机构自愿参与，来自19家机构的97名学员参与了研究。31名参与者（32%）参加了CRP，66名参与者（68%）参加了LRP。根据多因素逻辑回归分析，CRP学员处于高分组的校正比值比为5.16（95%CI：1.28 - 20.73，p<0.05）。CRP学员在儿科、心理健康和神经学方面的平均分数差异在统计学上高于LRP学员。
参加CRP的研究生学员具有更好的基础临床能力知识（PLAB测试）分数，并且在更广泛的亚专业测试中表现更好。未来的研究不仅应评估考试成绩，还应评估临床成绩以及研究生医学培训中学员能力的纵向趋势。
